Breast Cancer is the Most Imperative Health Issue Facing African American Women!

Though Black women get breast cancer at a slightly lower incidence rate (3%) than white women, Black women are 42% more like to DIE of breast cancer than white women. That is an astounding number and indicative of a variety of factors, many reflecting racial disparities.

Breast cancer is the most commonly diagnosed cancer among black women, and an estimated 33,840 new cases are expected to be diagnosed in 2019. An estimated 6,540 deaths from breast cancer are expected to occur among black women in 2019.

Women do not need to DIE from breast cancer. It can’t be prevented but early stage breast cancer (meaning it has been localized within the breast) has a 99% 5 year survival rate. Note the inequity here: the overall 5-year relative survival rate for breast cancer diagnosed is 80% for black women versus 91% for white women. And, 52% of breast cancers in black women are diagnosed at a local stage, compared to 63% in white women.

To add more fuel to the fire, Black women under age 40 have higher rates of breast cancer when compared to white women. Black women under age 35 get breast cancer at two times the rate of white women and DIE from breast cancer three times as often as white women.

The overall 5-year relative survival rate for breast cancers diagnosed in 2008-2014 was 81% for black women compared to 91% for white women. This difference can be attributed to both more advanced stage at detection and poorer stage-specific survival among black women. Only 54% of breast cancers in black women are diagnosed at a local stage, compared to 64% in white women.

So what’s the problem? Why are Black women dying unnecessarily?

Higher death rates among Black women reflect the following:

Black women are not taking action. While 92% of black women agree breast health is important, only 25% have recently discussed breast health with their family, friends, or colleagues. And, only 17% have taken steps to understand their risk for breast cancer.
Black Women are often at a more advanced stage upon detection.
Black women may not have access to health care or health insurance so may have lower frequency of longer intervals between mammograms.
Because they may not have insurance, Black women may not follow up on abnormal mammogram results because they can’t afford the diagnostic testing.
Black women don’t get the same prompt high quality treatment compared to white women.
Black women have the highest odds (2 times more likely) of getting Triple Negative Breast Cancer, a kind of breast cancer that often is aggressive and comes back after treatment. It has the highest mortality rate and is the only breast cancer sub-type that does not have a therapy to prevent recurrence. Note that younger women and women diagnosed at later stages are more likely to get Triple Negative Breast Cancer.

*AMERICAN CANCER SOCIETY: CANCER FACTS AND FIGURES 2019

New Cases

Breast cancer is the most commonly diagnosed cancer among black women, and an estimated 33,840 new cases are expected to be diagnosed in 2019. Similar to the pattern among white women, breast cancer incidence rates among black women increased rapidly during much of the 1980s, largely due to increased detection of asymptomatic lesions by mammography screening.

In the most recent period (2006-2015), incidence rates increased slightly more rapidly in NH black women (0.9% per year) than in NH white women (0.4% per year), contributing to a convergence in incidence rates.

During 2011-2015, the overall breast cancer incidence rate in NH black women was 126.5 cases per 100,000 women compared to 130.1 in NH white women. However, rates were higher in NH black women than NH white women in eight US states (Alabama, Indiana, Louisiana, Michigan, Mississippi, Missouri, North Carolina, and Virginia), and were not significantly different in 20 other states. Breast cancer incidence rates are also higher among blacks than whites for women under age 45. The median age of diagnosis is 59 for black women, compared to 63 for white women.

Black women are twice as likely as women of other racial and ethnic groups in the US to be diagnosed with triple negative breast cancers, so called because they lack estrogen receptors, progesterone receptors, and human epidermal growth factor receptor-2. Women with these tumors generally have poorer outcomes because effective treatments have not been developed. A recent analysis comparing molecular features of breast cancers in black and white women estimated that 40% of the racial variation in breast cancer subtype are due to inherited genetic mutations. Inflammatory breast cancer, a rare but aggressive subtype, is also more common in black women than white women. For more information about breast cancer subtypes, see Breast Cancer Facts & Figures at cancer.org/statistics.

*AMERICAN CANCER SOCIETY: CANCER FACTS AND FIGURES 2019

Prevention and Early Detection

Potentially modifiable factors that increase breast cancer risk include weight gain after the age of 18 and/or being overweight or obese (for postmenopausal breast cancer); menopausal hormone therapy (combined estrogen and progestin); alcohol consumption; and physical inactivity. There is growing evidence that high consumption of non-starchy vegetables may be associated with lower risk for hormone receptor-negative breast cancers.

Screening mammography can detect breast cancer at an early stage, when treatment is usually less extensive and more likely to be successful.

Deaths

Breast cancer is the second most common cause of cancer death among black women, surpassed only by lung cancer. An estimated 6,540 deaths from breast cancer are expected to occur among black women in 2019. Breast cancer death rates among black women increased from 1975 to 1991 but declined thereafter as a result of improvements in both early detection and treatment. Prior to the mid-1980s, breast cancer death rates for white and black women were similar. However, a larger increase in black women from the mid-1970s to the early 1990s, followed by a slower decline, led to a widening racial disparity that peaked around 2010. Since 1990, breast cancer death rates dropped by 26% in NH black women compared to 40% in NH white women. Breast cancer death rates in the most recent time period (2012-2016) are about 40% higher in black women compared to white women. The racial disparity is largely due to more advanced stage at diagnosis, higher prevalence of obesity, comorbidities, and unfavorable tumor characteristics (e.g., triple negative breast cancers), as well as access and adherence to high-quality cancer treatment. A recent study by American Cancer Society researchers found that lack of private/Medicare insurance and unfavorable tumor characteristics were the most important factors contributing to the higher risk of death among black breast cancer patients under age 65 with early-stage disease, explaining one-third and one-fifth of the disparity, respectively.

Survival and Stage Distribution

The overall 5-year relative survival rate for breast cancers diagnosed in 2008-2014 was 81% for black women compared to 91% for white women. This difference can be attributed to both more advanced stage at detection and poorer stage-specific survival among black women. Only about half (54%) of breast cancers in black women are diagnosed at a local stage, compared to 64% in white women.

More advanced stage at diagnosis among black women has been largely attributed to issues related to access to high-quality health care, including fewer screening mammograms, lack of timely follow-up of abnormal results, and receipt of health care at lower resourced or non accredited facilities. Lower stage-specific survival has been explained in part by unequal access to and receipt of prompt, high-quality treatment among black women compared to white women. The greater burden of triple negative breast cancers in black women also contributes to disparate outcomes. However, one study found the greatest survival disparities were for patients with hormone receptor-positive tumors. Racial disparities are typically larger when effective treatment is available, highlighting the influence of access to care.

Breast Cancer is the Most Imperative Health Issue Facing African American Women!

Black women in the U.S. are 40% more likely to die from breast cancer than white women, and a recent study found that while 92% of black women agree breast health is important, only 25% of women have recently discussed breast health with their family, friends, or colleagues and only 17% have taken steps to understand their risk for breast cancer.

Black women are more likely to be diagnosed with breast cancer younger, at later stages and with more aggressive forms of the disease, limiting treatment options.

Study Confirms Disparities in Triple Negative Breast Cancer Diagnoses

8-Jul-2019

A new study published early online in CANCER, a peer-reviewed journal of the American Cancer Society, shows that women of color and young women may face elevated risks of developing triple-negative breast cancers, which are often aggressive and do not respond to hormone therapy or targeted therapy.

Previous U.S. studies have found racial disparities in triple-negative breast cancer diagnoses, but few have looked beyond the scope of one state. To conduct a larger study, Lia Scott, PhD, MPH, of the Georgia State University School of Public Health, and her colleagues analyzed all breast cancer cases diagnosed during 2010-2014 from the United States Cancer Statistics database, a population-based surveillance system of cancer registries with data representing 99% of the U.S. population.

The team identified 1,151,724 cases of breast cancer from 2010-2014, with triple-negative cases accounting for approximately 8.4% of all cases. The researchers uncovered a significant burden of triple-negative breast cancer for women of color, specifically non-Hispanic black women, and for younger women.

Compared with non-Hispanic white women, non-Hispanic black women and Hispanic women had 2.3-times and 1.2-times higher odds of being diagnosed with triple-negative breast cancer, respectively. More than 21% of non-Hispanic black women were diagnosed with triple-negative breast cancer, compared with less than 11% for all other types of breast cancer. Women younger than 40 years of age had twice the odds of being diagnosed with triple-negative breast cancer than women aged 50-64 years. Also, among women who were diagnosed with breast cancer, those diagnosed at late stages were 69% more likely to have triple-negative cancer than other types.

The authors noted that due to the aggressive nature of triple-negative breast cancer and the lack of therapeutic options, it is important to know which individuals face a higher risk and what factors may influence this risk.

"With the advent and availability of more comprehensive cancer data, such as the United States Cancer Statistics database, it is important that we continue to explore disparities in order to better inform practice and policy around screenable cancers like breast cancer," said Dr. Scott. "We hope that this update on the epidemiology of triple-negative breast cancer can provide a basis to further explore contributing factors in future research."

This study was funded by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award 1F31MD012752.