Ninety percent of White women who are diagnosed with breast cancer will live at least five years, but only 76 percent of Black women with the same diagnosis will live five years, according to the American Cancer Society. Is breast cancer more difficult to detect among Black women because they have denser, thicker breast tissue?
"I don't' think that's a truism," said Dr. Denise Johnson Miller, specialist from the Indiana-based St. Francis Medical Group. "Black women have died at a greater rate from the disease, and in the past it was believed that it was because they didn't do self exams and didn't have yearly mammograms. But as we (researchers) drill deeper, we feel there is a genetic component."
Dr. Johnson Miller spoke at "Each One Reach One," an African American breast cancer conference held in downtown Oakland last May. Funding for the conference--California's largest annual cancer education event focused on breast cancer awareness and survivorship--is provided by a coalition lead by the Cancer Prevention Institute of California (CPIC).
In her keynote address, Dr. Johnson Miller highlighted some of the latest clinical updates in breast cancer.
"Young women do have denser breasts, and we recommend a breast MRI for very dense breasts," she said. "But as women age, the collagen that supports the breast is replaced by fat and it's actually easier to find a breast tumor then. Radiation penetrates the fat easily. The fat shows as a dark background and the solid tumor is highlighted white. But then, calcifications can obscure masses. It's tricky."
Treating the disease can also be tricky. One patient can come through treatment, while another doesn't survive, although they were undergoing the same treatment for the same cancer.
"There are many abnormalities in tumor physiology," Johnson Miller said. "There are different genes within the tumors. Although they may look the same under the microscope, they are very heterogeneous. Tumors can be biologically different."
Johnson Miller has made it her business to study the genetics of more aggressive breast cancer tumors and is looking into regional differences, environmental factors and racial issues.
"Scientists are tracing genes back to West Africa," she said. "Something is there, we just haven't had a breakthrough yet, but people are working on it night and day."
Johnson Miller said that she has actually found more Caucasians with aggressive tumors, and acknowledges the mixing of the races over the years.
"It's hard to say 'it's racial,' because what race are you, anyway?" she said. "Black women may present breast masses (lumps) at an earlier age, though, and should really follow up on any masses that are present over one or two menstrual cycles. Have it checked out right away."
CPIC studies strive to develop and implement the latest research methods to understand who gets cancer, why they get it, and the problems of living with the decease.
"There's certainly a lot of interest now to look at the genetics of breast cancer," said Esther John, an epidemiologist with the CPIC. "Maybe it's a genetic profile among African American women that explains what's going on. But we need more research."