You’ve no doubt noticed the influx of pink this month, drawing attention to breast cancer awareness. While October is filled with celebrations for survivors, memorials for those who died of the disease and Public Service Announcements reminding women (and men) to take early detection seriously, this month also serves as a reminder of yet another challenge for Black women. According to the American Cancer Society: Black women die more frequently from breast cancer than White women. In fact, the numbers for breast cancer diagnosis are about the same for African-American and White women; but when it comes to the death rate, Black women are 20-40 percent more likely to die from Breast Cancer than their White counterparts.
The Chicago Defender looked into what’s behind the troubling statistics.
According to the study, “A Perfect Storm: Highlighting Breast Cancer Disparities Among African-American Women,” led by Susan G. Komen Breast Cancer Foundation in partnership with MDS Robert Daly and Funmi Olopade of the University of Chicago, one of the reasons for the disparity is that African-American women often have more aggressive forms of breast cancer, including what’s called triple negative breast cancer. Another reason, the study states, is the misuse and underuse of proven therapies that can contribute to lower survival rates among African-American women.
Another factor that plays a role in the disparity has to do with the differences in the quality of mammograms African-American women receive. There also are issues with appropriate follow-up or delays in diagnosis and treatment.
The Chicago Defender asked representatives at the Susan G. Komen Breast Cancer Foundation Chicago Chapter about the disparities and the best way to address them.
As with most things, cost is a factor.
“Cost can sometimes serve as a significant barrier to care,” said Tiosha Bailey, the executive director of Komen Chicago. “To address this need, it is critical that we advocate for changes to public policy that ensure access to quality care.”
Another factor is the time between the diagnosis and treatment. The average time from diagnosis to treatment was nearly 30 days for African-American women versus about 22 days for White women. Once treatment does start, studies show African-Americans often do not receive the recommended standard of care.
Researchers also found in the studies that African-American women were more likely to stop treatment early or have more treatment delays than White women. This was not due to treatment side effects, but to possible barriers. Barriers to treatment such as not being able to find childcare, not wanting to miss work and not trusting doctors, lack of transportation and other social issues that may come as a surprise to some. However, if these barriers are not addressed, Black women are fighting an uphill battle to survive a breast cancer diagnosis.
“Addressing social determinants of health is a critical piece of the puzzle in order to treat the full patient,” Bailey said. “There must be a concerted effort to better understand the distinction between perceived and actual barriers for each patient. We need to bridge the gap between patient education and physician communication. Patient navigation is a potential solution to help Black women receive the information they need to make an informed decision about their health care. I want to stress the importance of building awareness around existing programs available to women. Komen Chicago can help with making connections to local resources.”
Addressing cultural barriers, building a diverse clinical workforce and educating all clinicians on best practices for providing culturally compotent care are key, Bailey added.
Who is responsible for making the “systematic” changes in terms of treatment for African-American women? Bailey said, “We all have the collective responsibility for addressing the systemic challenges and demanding change. The vision for Komen Chicago 2.0 is to influence systems transformation by collaborating with Federally Qualified Health Centers and every major health system in Cook County. These critical partnerships will enable us all to become more patient-centric, deliver high quality breast cancer education and medical services, ultimately, creating a permanent safety-net infrastructure through community collaboration and patient navigation. The Chicago Health Equity Initiative will address socio-economic barriers to care and system fragmentation across the continuum. We anticipate that data collected by each partner will inform our public policy efforts, while contributing to a culture of continuous quality improvement.”
Reducing the disparity rates for African-American women is one of Komen’s top priorities.
Studies have also revealed other areas of concern including the mistrust of the medical field and concerns about racism.
Patient navigation empowers patients with information and resources necessary to make informed decisions about their care, according to the study. This approach connects women with trained community health workers and/or health care professionals who help them navigate through the health care system, ensuring timely diagnosis and follow-up, while providing access to local resources that support the patients’ individual needs. Research has shown an improvement in 5-year survival rates of women with breast cancer who were supported by patient navigation.
System Change Interventions are typically aimed at the patient rather than the system, but demanding changes in health systems is essential to changing these disparities. For example, inner-city health facilities need well-maintained equipment and the mammography technologists at these facilities should have access to continuing education. Interventions that address all stakeholders are needed to close the racial survival disparity in breast cancer. Programs should aim to provide precision medicine. The goal of precision medicine is to give the most effective treatment at the right time for each person’s breast cancer. Understanding the biologic and genomic characteristics of each person’s tumor will help tailor treatments. Precision medicine should focus on initiatives that will help reduce the mortality gap. More data on African-American women is necessary to create useful breast cancer risk assessment tools for early detection and prevention. Initiatives are needed to address the gap in referrals to genetic counseling and testing. In addition, interventions that provide high-quality cancer care coverage are needed, as well as access to and participation in innovative clinical trials.
Knowing Your Risk
Knowing your family history and personal health history are important parts of understanding your risk of breast cancer, according to the American Cancer Society. With this information, women (in partnership with their doctors) can make informed decisions about genetic counseling and whether genetic testing is right for them. But a study showed that African-American women with a family history of breast or ovarian cancer are less likely to get referred for genetic counseling for BRCA and other similar tests than White women. There are options available for women at higher risk of breast cancer to help lower their risk. While more studies in diverse populations are needed, there appears to be a need for more education in the community and for physicians serving the African-American community about the role and value of genomics and genetic counseling.
According to Shannon Lightner, Deputy Director, Office of Women’s Health and Family Services, Illinois Department of Public Health (IDPH), the latest news in terms of risk factors states that “the science around breast cancer is constantly emerging, and sometimes it conflicts with previous studies—just today a new study came out about the role of processed meat as a risk factor in breast cancer. However what we recommend is that women speak with their physicians to better understand their personal risk factors, including the role their family history may or may not play, and how to take steps to reduce those risks and improve their health.”
As for timeline and frequency women should have a mammogram, according to the Illinois Dept. of Health, there has never been a requirement for an annual mammogram. However, recommendations by various medical and cancer advocacy groups vary on the frequency of mammograms (every year or every other year) as well as the age when women should begin to get regular mammograms.
IDPH recommends that a woman speaks with her doctor about the best time to begin getting mammograms, and how frequently to get them, based on her own health history and risk factors.
However, despite that progress, breast cancer remains the second-leading cause of cancer death in women, second only to lung cancer. There is still a large racial gap in mortality, with African-American women having higher death rates compared to Whites, even as incidence rates are similar. There is still much to be done.
The American Cancer Society’s estimates for breast cancer in the United States for
- About 266,120 new cases of invasive breast cancer will be diagnosed in women.
- About 63,960 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer).
- About 40,920 women will die from breast cancer.
- While Black and White women get breast cancer at roughly the same rate, the mortality rate is 42% higher among black women than white women.
At this time, there are more than 3.1 million people with a history of breast cancer in the United States – including women still being treated and those who have completed treatment.
- Numerous studies have confirmed that alcohol consumption increases the risk of breast cancer in women by about 7-10 percent for each one drink of alcohol consumed per day on average. Women who have 2-3 alcoholic drinks per day have a 20 percent higher risk of breast cancer compared to non-drinkers. Obesity increases the risk of postmenopausal breast cancer. Risk is about 1.5 times higher in overweight women and about 2 times higher in obese women than in lean women.
- Growing evidence suggests that women who get regular physical activity have a 10-25 percent lower risk of breast cancer compared to women who are inactive, with stronger evidence for postmenopausal than premenopausal women
- Limited but accumulating research indicates that smoking may slightly increase breast cancer risk, particularly long-term, heavy smoking and among women who start smoking before their first pregnancy.
What the American Cancer Society is doing
The ACS currently funds 155 multi-year grants focused on breast cancer totaling $60.2 million. The organization has played a key role in many of the advances against breast cancer, including funding early work that eventually led to the development of tamoxifen and Herceptin.
To learn more about ACS CAN’s advocacy work and to help make fighting breast cancer a priority in your community, visit acscan.org/makingstrides.