Race and Breast Cancer: Breaking Down the Disparities
Tackling Racial Disparities in Metastatic Triple-Negative Breast Cancer
Racial disparities in metastatic triple-negative breast cancer
As a breast oncologist with Yale Medicine, Dr. Eric Winer is on a mission to fight racial disparities in breast cancer. But there’s one “entirely unacceptable” statistic that keeps haunting him. “If you’re a Black American woman and you’re 20 years old, you have literally twice the chance of dying of breast cancer before the age of 50, compared to the 20-year-old white American woman who might live in the next town or over on the next street,” says Dr. Winer, who is also the director of the Yale Cancer Center and president of the American Society of Clinical Oncology.
So, what might be causing this alarming discrepancy? Experts believe that higher rates of triple-negative breast cancer (TNBC), an aggressive form of the disease, may play a significant role. TNBC is diagnosed nearly three times more often in Black women and tends to be found later and be deadlier for them.
But Dr. Kimberley Lee, a breast oncologist with Moffitt Cancer Center, wants Black women with metastatic TNBC or at risk for the disease to remember one crucial message: “While disparities exist, people should not despair. Metastatic triple-negative breast cancer is treatable, and Black women respond to the treatments that we have.”
Why Do Black Women Get Triple-Negative Breast Cancer More Often?
Around 15% to 30% of all breast cancers in Black women are triple-negative. This rate is considerably higher than the 5% to 10% seen in non-Hispanic white women. Although the reason for this remains unclear, there are several factors that come into play:
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Age and breast tissue density: TNBC is more frequently found in Black women under 55 years old with dense breasts. This fibrous tissue can pose challenges for mammograms, making it difficult for the machines to detect TNBC tumors early on.
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Reproductive habits: Unlike other types of breast cancer, the odds of developing TNBC appear to increase with the number of pregnancies a woman has had. Breastfeeding seems to lower this risk, but Black women are typically less likely to breastfeed or may not do so for as long as other groups.
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Obesity: There’s some evidence to suggest that higher body fat levels, which are more common in Black women, can fuel the inflammation that leads to TNBC. However, research on the link between body mass index (BMI) and TNBC is inconclusive. It’s important to note that obesity generally leads to poorer health outcomes, regardless of race or ethnicity.
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Genes: Although non-biologic risk factors don’t fully explain the disparity in TNBC rates, there are likely some undiscovered genetic differences at play. However, Black and African ancestry populations have been underrepresented in genetic studies, making it challenging to identify these differences, according to Dr. Anne Marie McCarthy from the University of Pennsylvania.
Why Is Metastatic Triple-Negative Breast Cancer Deadlier for Black Women?
Triple-negative breast cancer lacks the targetable hormones found in other forms of the disease, limiting treatment options and chances of success for everyone. Researchers are investigating whether tumor characteristics in Black women contribute to the aggressiveness of the cancer. However, Dr. Winer believes that genetic differences are likely only a small piece of the puzzle. He attributes the higher death rates to racism, poverty, lack of health education, and limited access to care.
Dr. Rachel Greenup, Chief of Breast Surgery at Yale Medicine, studies the impact of financial hardship on cancer treatment. She reveals that Black women face more barriers to care across all domains, creating a domino effect leading to poorer outcomes. Compared to other groups, Black women tend to have lower household incomes, higher rates of Medicaid or no insurance, transportation issues, and a higher chance of losing their jobs or healthcare after a breast cancer diagnosis. Financial strain raises the risk of death, regardless of the type of cancer, with bankruptcy resulting in a 1.5 to 2 times higher chance of mortality.
Other factors contributing to racial disparities in TNBC include:
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Socioeconomic status: Research indicates that individuals with lower socioeconomic statuses are more likely to be diagnosed with advanced breast cancer. This can lead to additional hurdles that delay or interrupt treatment, such as lack of childcare, transportation, or copay assistance.
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Less use of anti-cancer drugs: Black women receive less standard breast cancer care, including surgery, chemotherapy, and other treatments known to improve survival rates. Dr. Kimberley Lee acknowledges the disparities in the use of drugs necessary to treat early-stage triple-negative breast cancer.
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Lack of Black doctors: Black women often receive cancer care from providers who do not share their race, leading to medical mistrust that may affect treatment outcomes. Dr. Winer recognizes that this mistrust is rooted in underlying racism, which must be addressed.
How to Reduce Racial Disparities in Metastatic Triple-Negative Breast Cancer
Although further research is needed to uncover the driving forces behind these disparities, there are steps Black women can take to improve their cancer care:
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Ask about genetic testing: If you have a strong family history of breast or ovarian cancer, inform your doctor as this increases your chances of having the BRCA1 gene mutation. Genetic counseling or testing can help you understand your risk and explore preventive strategies.
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Discuss breast density: If you are at higher risk for TNBC due to race and other factors, consider talking to your doctor about the benefit of breast MRIs or more frequent breast cancer screenings.
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Consult a patient navigator: These professionals are part of your cancer care team and can help overcome personal barriers to treatment. They can assist with arranging child care, transportation, copay assistance, or financial aid. If you don’t know who to talk to, ask your doctor or reach out to organizations such as the Patient Advocate Foundation.
Where Is Breast Cancer Disparity Research Headed?
While scientists continue to investigate why Black women face higher rates of TNBC, it has become evident that urgent efforts are needed to reduce racial disparities in breast cancer treatment. Future research aims to provide answers to critical questions such as:
- Are doctors offering the appropriate treatment to Black women at the right time?
- Are treatment options adequately explained to Black women, comparable to their white counterparts?
- Do Black women face more difficulties in paying for out-of-pocket expenses?
- Is there sufficient follow-up from doctors emphasizing the importance of early and effective treatment?
- Do Black women have tumors that respond differently to common cancer drugs?
- Can community outreach programs increase breast cancer screenings and improve treatment adherence?
- How can the representation of Black and brown doctors in the healthcare workforce be increased more rapidly?
By addressing these questions and raising awareness, experts believe that we can take a significant step toward improving cancer outcomes for women of all races and ethnicities.
