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Breast Cancer Doesn’t Play Fair

Women of color are more likely to die from breast cancer, but addressing these disparities can begin to level the playing field.


Kathleen Goss, PhD

Vice President, Regional Cancer Control, American Cancer Society

Breast cancer affects women from all communities and populations, but it in no way affects them equally. Mortality rates for breast cancer are 41 percent higher for Black women, for example, compared to White women, despite similar incidence rates. Black women are also twice as likely to be diagnosed with triple-negative breast cancer — an aggressive type of breast cancer associated with poor outcomes — compared to women from other racial and ethnic groups.

The underlying causes of the unequal burden of breast cancer in Black women are complex and multi-faceted — from more advanced stage at diagnosis to prevalence of risk factors and access to high-quality healthcare. For example, according to American Cancer Society researchers, lack of private or Medicare insurance and unfavorable tumor characteristics (e.g., triple-negative breast cancer) explained at least one-third to one-fifth of the Black/White disparity in breast cancer deaths, respectively. These and other obstacles to health equity must be addressed to decrease the devastating impact of breast cancer on communities of color.

Social determinants of health

Recognizing that the conditions in which women live, learn, work, and play affect their health risks and outcomes — also called social determinants of health — is a necessary step to tackle breast cancer health inequities. Addressing these factors — such as socioeconomic status, education, neighborhood and physical environment, food, social support networks, and access to high-quality health care — requires coordinated effort and commitment from stakeholders across all sectors.

Long-term solutions involve increasing culturally tailored training for healthcare providers, supporting state and national policies to improve access to care, increasing partnerships to serve the needs of patients and their families, and expanding implementation and policy research.

Unfortunately, the COVID-19 pandemic has unveiled and exacerbated health disparities and heightened the sense of urgency to address them. Delays in breast cancer screening and hesitancy to seek treatment during the pandemic have only led to concerns about more later-stage diagnoses and poorer outcomes, especially for women of color. Public awareness campaigns like “Get Screened” from the American Cancer Society are encouraging people to help them to schedule their regular cancer screenings and providing tools to help. Because here’s the bottom line: cancer doesn’t wait on anything or anyone, not even a global pandemic.

Lowering risk factors

At the individual level, it is also critical to know and lower one’s risk factors for developing breast cancer whenever possible. Lifestyle behaviors including smoking, obesity, lack of physical activity, and alcohol consumption are all associated with increased cancer risk. Knowing one’s family history of breast cancer also allows women to understand their risk, including risk for rare hereditary breast cancer. Often caused by mutations in the BRCA1 or BRCA2 genes passed to a child from a parent, these breast cancers are typically the aggressive triple-negative type and are frequently diagnosed at a younger age than other breast cancers.

Women with a strong family history may choose to undergo genetic counseling to estimate their risk of carrying a BRCA mutation, to be tested for a mutation if they are at elevated risk, and to lower her risk or find cancer early if she carries a mutation. It is estimated that 40 percent of the racial variation in breast cancer subtype is due to inherited mutations, underscoring the importance of empowering women of color with these decision-making tools and comprehensive access to care.

The challenges are extraordinary, but action is necessary. Eliminating breast cancer disparities and moving toward greater health equity for all women is achievable with steadfast commitment, development of evidence-based solutions, and sustainable structural and social change.

The more than 281,000 women who will be diagnosed with breast cancer in the United States this year are depending on us, and for them, we can’t afford to wait.

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