Who Pays the Highest Price When It Comes to Breast Cancer?
In this, the third in our month-long series on the disparities and inequities of cancer in the U.S. and beyond, we look at the group of American women hardest hit—by far—when it comes to breast cancer.
One in nine women will have breast cancer. The disease is the second-leading cause of death among women in the United States. But no group suffers more from breast cancer than African-American women.
According to the Centers for Disease Control and Prevention (CDC):
• African-American women have the highest death rate from breast cancer of all races/ethnicities. They are 40 percent more likely to die of the disease than white women.
• Forty-five percent of black women are found to have breast cancer that has spread beyond the breast (when it has reached a far deadlier stage) compared with 35 percent of white women.
• After learning that their mammogram is not normal, 20 percent of black women wait or delay seeing a doctor for follow-up more than 60 days. That’s compared to 12 percent of white women. Waiting longer for follow-up care may allow cancer to spread.
• Only 69 percent of black women start treatment within 30 days of their diagnosis of breast cancer, compared with 83 percent of white women.
• Overall, breast cancer death rates among U.S. women fell 27 percent from 1990 to 2005, but not at equal rates. In white women, breast cancer mortality declined by 2.5 percent annually, but it declined just 1.4 percent each year for African-American women.
• Fewer black women receive the surgery, radiation, and hormone treatments they need compared to white women.
Like other types of cancer disparities, the reasons that black women have worse survival rates are numerous. They include poverty, lack of access to care, lack of health insurance, literacy barriers, and unequal treatment by professionals in the healthcare system, according to a March 2002 Institute of Medicine report.
"A lot of the same reasons for disparities that we see in other types of cancers come into play here—less access to care; less access to screening technologies; not receiving the same kinds of treatments and follow-up care," says Dr. David Wetter, a professor in the department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, at the University of Texas MD Anderson Cancer Center, in Houston.
But there are also differences in the types of breast cancer among various racial and ethnic groups. "African-American and Hispanic women seem to get a more aggressive form of cancer and at a younger age—the 'triple negative' breast cancer. It's a more virulent form of cancer with worse outcomes," Wetter says. A "triple negative" breast cancer means the cancer cells do not have receptors for the hormones estrogen or progesterone or high levels of the HER2/neu protein. These levels can tell an oncologist how quickly the breast cancer might grow.
The good news is that black women get mammograms about as often as white women, according to the CDC.
Still, everyone—from government to public health departments to doctors to women themselves—need to take more steps to erase breast-cancer disparities affecting black women, experts say. The Affordable Care Act is a good start. Under the new law, women who have no ability to pay can still get a mammogram.
Even better, the National Breast and Cervical Cancer Early Detection Program provides screenings and diagnostic services to low-income, uninsured, and underinsured women. Click on the "Find a Screening Provider" tab on the program's site to arrange for your mammogram.
Black women should also get regular physical exams and discuss their risk of breast cancer with a health professional. The Agency for Healthcare Research and Quality has a list of questions for women to use to improve communication with a doctor about tests like mammograms.
What more do you think should be done to lower breast cancer rates among African-American women?