Why Black Women Are More Likely to Die from Breast Cancer
Updated: Mar 19, 2021
Breast cancer is the second most deadly form of cancer in the United States for women, with the American Cancer Society estimating that upwards of 40,000 women died of breast cancer in 2019 alone. While breast cancer mortality rates have steadily improved in recent years, overall cancer incidence among black and Hispanic people has grown. A major mortality gap has emerged between white and black women.
According to the National Center for Biotechnology Information (NCBI), black women are 42% more likely to die from breast cancer than their white counterparts. This disparity is even more dramatic among women under the age of 40: the American Cancer Society found that black women have both higher incidence rates of breast cancer and double the mortality rate of white women. Although technological advancements in screening and treatment processes have improved breast cancer mortality rates on the whole, a major disparity in mortality rates remains.
A myriad of factors account for this inequality, the primary factor being socio-economic status. Low-income women have a lower chance of receiving breast cancer screenings because of irregular healthcare provisions, lack of accessibility to adequate care, and poor education related to screening. Delayed screening significantly increases the chances of a late-stage diagnosis, which has a higher mortality rate than cancer discovered in its earlier stages. Low-income women also have higher rates of breast cancer risk factors including tobacco use, poor nutrition, lack of exercise, and obesity.
Given that a multitude of research has indicated that there is a large proportion of black people living in poverty, it is evident that the risk factors produced by lower-income status is a direct factor for the mortality disparity, with distressing implications.
Besides the relationship between socio-economic status and a greater risk of death from breast cancer, there are equally relevant biological and psychological factors that likely account for the discrepancy. Aggressive varieties of breast cancer such as triple negative breast cancer have been found to be more prevalent in African American and Hispanic populations, due to the correlation between lower Vitamin D levels (more common in populations with higher melanin content) and more aggressive triple-negative tumors. This form of Breast Cancer has poorer survival rates because it is less responsive to normal treatment methods, limiting treatment options and increasing the risk of death.
African American women also tend to have dense breasts, which is considered a predictor for breast cancer and makes mammograms more difficult to read, hindering early-stage detection and prevention.
Racial bias in the medical field may also play an important role, as surveys show that black women are less likely to be given mammography screening by their physician.
Such a multi-faceted issue may suggest a complicated course of action, but the answer by many cancer experts is glaringly obvious: improve screening and treatment access for black women. The National Cancer Institute suggests statewide cancer screening programs to provide more accessible screening while addressing the biological differences between racial and ethnic groups.
Significant steps must also be taken to mitigate the financial barriers that prevent low-income women from seeking screening services. Programs such as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), created by the Centers for Disease Control and Prevention, provide breast and cervical cancer services to underprivileged women. The expansion of these programs would aid in standardizing and widening screening and preventive measures.
Bridging the gap is not exclusively limited to improving access, though. It also involves ensuring that these services will be taken advantage of, which involves a comprehensive effort in improving education regarding the importance of screening, follow-up, and treatment options. One organization that works to expand this education is Sisters Network Inc., an African-American Breast Cancer Survivorship Organization that provides financial assistance and educational conferences and webinars.
More research about how breast cancer affects black women must also be conducted. Most of the current studies and clinical trials were conducted with white women, prohibiting the understanding of biomarkers that explain the higher frequency of aggressive tumors in black women. New research must target black women so that biological differences are adequately studied and ultimately applied to treatment.