They are also more likely to be diagnosed at a younger age, and have more aggressive forms of breast cancer — including metastatic cancer, meaning the disease has spread to other organs and the lymph nodes — than white women, according to the Centers for Disease Control and Prevention (CDC). As a result, Black women are also up to 40 percent more likely to die from the disease than women from other racial and ethnic backgrounds and to develop breast cancer before turning 50, the CDC says. This is also likely due to Black women being twice as likely as white women to develop triple-negative breast cancer, the National Institutes of Health (NIH) reports. Thankfully, in recent years, significant strides have been made in identifying risk factors that make Black women more vulnerable to aggressive forms of the disease, which can improve the chances of survival. A triple-negative diagnosis means that the breast cancer tests negative for three receptors: progesterone, estrogen, and HER-2, according to the American Cancer Society (ACS). HER-2, or the human epidermal growth factor receptor 2, is a protein found wrapped around the surface of breast cells that promotes normal growth, the ACS says. When breast cancer is HER-2 negative, there can sometimes be a lack of protein production. According to the ACS, triple-negative breast cancer cells do not have estrogen or progesterone receptors or enough of the HER-2 protein for hormone therapy or other targeted drugs to be effective, limiting treatment options and making it more aggressive than other forms of breast cancer. Unfortunately, this also results in triple-negative breast cancer having a worse prognosis and a higher likelihood that it will return. That said, remission is possible, depending on the stage of cancer at diagnosis, and treatment varies among surgery, chemotherapy, radiation, and targeted medications, such as sacituzumab govitecan-hziy (brand name Trodelvy). This was the case for Michelle Thomas, 46, who was first diagnosed with triple-negative breast cancer at age 39. Although the disease returned less than a year after the end of her first round of treatment, she has been in remission for two years after a second surgery and second round of chemotherapy. “When I first received my diagnosis, I was definitely beside myself. But when I was told it was triple negative, I felt like my life was crashing around me,” she says. “The only good news was that we found it early, at stage 2.” Monique Gary, DO, a breast surgical oncologist and the medical director of the Grand View Health Cancer Program in Sellersville, Pennsylvania, underscores how vital early detection is in treating breast cancer. Still, for some Black women, that’s much harder than it sounds. A study published in the September 2018 issue of the journal Cancer found that Black women with breast cancer often report distrust of the healthcare system and lower access to care, including regular screenings, than white women.
Barriers to Early Breast Cancer Detection in Black Women
Understanding the barriers Black women face in early detection and what makes them vulnerable to more aggressive forms of breast cancer can help provide valuable insight to improve their prognosis. According to Dr. Gary, a few risk factors include:
1. Lack of knowledge about breast cancer and family history
Thomas was intimately acquainted with breast cancer because her mother and grandmother were both diagnosed with the disease before turning 50. As a result, she began getting annual mammograms at age 35 and was diagnosed just four years later. This was critical, because heredity is one of the largest risk factors for developing breast cancer. “I remember feeling a lump about a month before my mammogram and insisting on being seen before my appointment,” Thomas recalls. “The mammogram did not find anything, and I was told not to worry. After several weeks of going back and forth with my primary care doctor, I was finally able to get an ultrasound, which revealed the cancer. Had I not known much about breast cancer or how to self-examine, or not pushed my doctor, the outcome might have looked very different.” Not all Black women are as lucky as Thomas. According to Gary, one of the largest risk factors for Black women is lack of knowledge or access to information about the disease. “Health literacy is sorely needed in our communities, in our homes, and in our places of worship,” she says.
2. Poverty and access to quality medical care and mammography
According to the United States Census Bureau, the poverty rate for Black Americans in 2019 was nearly 19 percent, compared with just over 7 percent of white Americans. In addition, in 2020 the Henry J. Kaiser Family Foundation reported that Black Americans were 1.5 times more likely to be uninsured than white Americans. Living at or below the poverty line and not having access to comprehensive medical insurance creates tremendous barriers for Black women. Sadly, this often results in Black women being diagnosed with breast cancer at a later stage or after the cancer has spread, which inevitably increases their mortality rate. Gary stresses the importance of receiving not only timely medical care but also “high-quality medical attention.” This means a doctor who will spend time with their patients, answer questions, and connect them with the diagnostic and treatment services needed. Too often, people living in poverty in the United States or living in disadvantaged areas don’t have access to quality healthcare, according to the American Academy of Family Physicians.
3. Lifestyle
The impact of poverty in the Black community is as broad as it is devastating. Similar to how poverty affects access to health insurance and healthcare, it also creates food insecurity and hinders access to healthy food options. Simply put, eating healthy can be expensive, and more affordable options are typically lower in nutrition. Lack of access to healthy food options is a driving force behind high rates of obesity in the Black community. According to the U.S. Department of Health and Human Services Office of Minority Health, in 2018 Black Americans were 1.3 times more likely to be obese than white Americans, and roughly four out of five Black women were overweight or obese. Because obesity is a known risk factor for cancer, according to the NIH, it’s no surprise that the prevalence in obesity among Black women makes them even more vulnerable to invasive forms of cancer and higher mortality rates.
4. Racism and bias in the medical profession
Some argue that the Black community in general and Black women in particular have cause to be cautious of the medical profession. Historically, researchers have experimented on Black Americans without their consent in the name of medical advancement. Some improvements have been made, but racism and bias remain in the medical establishment. A study published in October 2019 in the journal Science found evidence of racial bias in many layers of the U.S. healthcare system — even in the medical records software many hospitals and practices use. Although Thomas was knowledgeable about breast cancer, was in good health, and had access to quality healthcare and medical treatment, she couldn’t avoid racism and bias. “Not only was I constantly dismissed by my doctor after I first discovered the lump in my breast, I had to switch oncologists after I was diagnosed because my first oncologist constantly challenged me when I would share with him my response to certain treatments,” she recalls. “It was bad enough that I had to fight cancer twice; I didn’t have the energy to also fight my doctor.” “I cannot tell you the number of young Black women turned away by their physicians when they find a palpate lump and are told they have clogged milk ducts or other benign findings without further investigation through diagnostic imaging,” Gary adds. “Rather than focus on the lack of trust in the medical establishment by Black women,” she adds, “I shift the focus to reflect that the medical community has not earned the trust of Black people.”
What Black Women Can Do
Although fighting cancer is not for the faint of heart, there are steps you, as a Black woman, can take to decrease the likelihood of developing an aggressive form of breast cancer or improve your prognosis if you’ve already been diagnosed.
1. Educate yourself about breast cancer and discuss your family history.
A saving grace for Thomas was knowing her family history. Gary encourages Black women to “discuss family history early and often.” “Let’s get informed about our risk factors and discuss them with our families and our physicians,” she says. So, if you’re 40 or older and have an average risk of breast cancer, annual screening mammograms should be part of your healthcare plan. If your risk is higher than average, explore options for more aggressive breast cancer screening with your physician and learn how to perform a breast self-exam.
2. Educate yourself about your options.
It might take a little more research, energy, or time, but there are options for women from all socioeconomic backgrounds. If cost is a concern, consider speaking with a doctor, local hospital social worker, nurse navigator, or staff member at a mammogram center and ask about free programs in your area.
3. Get moving and get healthy.
According to Gary, “Sedentary lifestyle is a known and high-risk factor for many types of cancer, including breast cancer. Even exercising 30 minutes a day can reduce a woman’s risk by greater than 20 percent,” she says. She also suggests eating foods that are high in antioxidants and fiber. If healthy eating is financially challenging for you, ask a social worker for help finding healthy eating programs in your area.
4. Advocate, advocate, advocate!
You must feel empowered to ask your doctors questions and to identify resources.
