The black-white disparity in breast cancer mortality has remained stable since 2011 after widening over the past 3 decades.
With the start of Breast Cancer Awareness Month, new evidence from the American Cancer Society regarding racial disparities in access to health care highlights the work that still needs to be done to close the black-white gap in women with breast cancer.
Breast cancer is the most common cancer diagnosed among women in the United States after skin cancer and is the second leading cause of cancer death among women after lung cancer. In 2019, an estimated 268,600 new cases of invasive breast cancer are expected to be diagnosed in women in the United States, along with 62,930 new cases of non-invasive (in situ) breast cancer, according to BreastCancer.org.
Although it is not new information, the black-white disparity in breast cancer mortality has remained stable since 2011 after widening over the past 3 decades, according to the recent report. The mortality rate remains 40% in black women despite a slightly lower incidence of breast cancer within this population. This disparity is even higher among women aged less than 50 years, who have a mortality rate that is double that of white women, according to the report.
A scientific review conducted in 2017 addressing black-white disparity and mortality in patients with breast cancer found that the risk of disease can be mitigated if chemoprevention is applied in appropriate at-risk populations and that major modifiable risk factors, such as achieving and maintaining a healthy weight, regular physical activity, and minimal alcohol intake, are critical in prevention.
However, scientific evidence revealed that racial/ethnic disparities in breast cancer are attributed to risk factors such as lack of medical coverage, barriers to early detection and screening, more advanced stage of disease at diagnosis among minorities, and unequal access to improvements in cancer treatment.
Furthermore, black women are more often diagnosed with more aggressive forms of tumors, such as triple-negative breast cancer, which cannot be treated by hormone therapies. Clinical evaluations as well as drug testing and other treatments often predominantly include white participants than those of other races, who often do not respond in precisely the same way to these treatments.
“Black women are being diagnosed with more aggressive disease like hormone receptor negative diseases, such as triple-negative breast cancer, at more advanced stages, at younger ages, and experience a longer time to treatment,” said Timiya Nolan, PhD, postdoctoral researcher at Ohio State University’s College of Nursing focusing on health disparities in cancer survivorship in an interview with Forbes.
According to Nolan, this only accounts for a portion of the disparity.
“About 40% of health is driven by social and economic factors, and health behaviors account for about 30%. We know that Black women are less likely to follow recommendations for diet and physical activity and have higher BMIs than White women. We also know that these women face more stress inducing environments with the experience of racism and discrimination, low healthcare access and/or knowledge of resources, and even challenging encounters with healthcare providers,” Nolan said in the interview with Forbes.
The National Cancer Institute notes that although addressing cancer disparities is not simple or straightforward, creating statewide cancer screening programs that are accessible to underserved populations as well as addressing biological differences in cancers across racial and ethnic groups could begin to close the black-white gap in cancer care.
“Initiating survivorship care planning early, establishing a baseline for sociocultural insights, building trust, and providing evidence-based care are prime examples of where the healthcare system can be more targeted to black women,” Nolan concluded in the interview with Forbes.