The Racial Disparities In Breast Cancer Diagnosis & Treatment
From inadequate maternal health for Black women to higher COVID-19 infection and mortality rates, it's clear that the racial disparities in health care are widespread. October is Breast Cancer Research Month, which means many people and organizations are honoring breast cancer survivors and advocating for medical advances. But while the spotlight is on breast cancer, we can't ignore the gaping differences between the diagnosis and treatment of Black and white individuals.
The racial disparities in breast cancer treatment.
A study published in the journal Advances in Experimental Medicine and Biology says the number of new breast cancer cases are similar between Black and white women; however, Black women are more likely to be diagnosed at younger ages. Catching cancer early is often regarded as promising since it means earlier and less aggressive treatment. "Yet, Black women are more likely to die from breast cancer at every age," the study writes.
The reason being, while breast cancer is affecting many Black people earlier in life, that does not mean doctors are catching it in its earliest stage. In fact, Dorraya El-Ashry, Ph.D., chief scientific officer at the Breast Cancer Research Foundation (BCRF), says these diagnoses usually come at later stages of the disease.
Additionally, Black women are at a higher risk of developing a more aggressive subtype of breast cancer, called triple-negative breast cancer. "We see these aggressive types more often in young Black women, and we also do not have targeted effective therapies for these types of cancers," says Melissa Boneta Davis, Ph.D., scientific director at the International Center for the Study of Breast Cancer Subtypes.
These are just a few of the reasons breast cancer death rates are 40% higher in Black women than white women. Systemic racism and the lack of adequate health care for people of color also play a role.
How racism plays a role in the disparities.
Systemic racism plays a role in a couple of ways, Davis tells mbg. "One, that access to screening—which we know does have an impact on survival—somehow is cost-prohibitive to many African Americans." Particularly, those who have late-stage (interval) tumors, which develop in between screening visits, she explains.
Secondly, racism leads to the marginalization of minority women, which affects their access to quality and equitable treatment within the health care systems they're a part of, Davis adds. Many Black people are also hesitant to visit the doctor because the system is often perceived as being imbued with systemic racism and unaware of its own implicit bias, integrative medicine physician Eudene Harry, M.D., previously told mbg.
Finally, while researching the genetic risk factors for breast cancer, Davis noticed a lack of representation of non-white patients. "So the genetic analyses that currently dictate, for instance, breast cancer mutation testing, largely fall within populations that are of European descent," she says. Without equal representation, it's difficult (and nearly impossible) to develop effective, targeted treatments.
What needs to be done to bridge the gap?
Because the issue is multifaceted, it needs to be tackled from several angles. "We can't solve the problem until we adequately fully understand the issues at play," El-Ashry says. "Research is the only way to truly understand cancer such that we can improve diagnosis, prognostication, treatment, cure, and even prevention for Black women and men."
That said, increasing diversity in research pools is also necessary. "We have been working on looking for risk genetic alleles that are more relevant to African Americans and women who are of African descent," Davis says, "and we have found that there are variants that are specific to certain ancestry groups." Those ancestry groups need to be incorporated into risk models in order to make prevention options more effective across the population, she says.
One way to encourage greater representation is through public health initiatives at both state and national levels, Davis suggests. She also encourages anyone of African descent who is a cancer patient or survivor to volunteer to participate in breast cancer genetic studies.
Finding local or national organizations to support breast cancer research, especially in communities of color, can also be beneficial. The SHARE organization in New York, the Sisters Network, the TOUCH Black Breast Cancer Alliance, and BCRF are just a few.