Black women impacted more by breast cancer
Breast cancer month
Merdies Hayes | 10/3/2013, midnight | Updated on 10/7/2013, 4:46 p.m.
Breast Cancer by the numbers
According to a 2010 study conducted by the Centers for Disease Control and Prevention (CDC), breast cancer is the most commonly diagnosed cancer among Black women.
In 2010, the CDC found that breast cancer was the leading cause of cancer death for African American women aged 45-64 years.
The report also found that the breast cancer death rate for women aged 45-64 years was 60 percent higher for Black women than White women or, 56.8 and 36.6 deaths per 100,000 women respectively.
The statistics are alarming. They have been for a generation. The American Cancer Society estimates that one in eight (or 232,000 American women) will be diagnosed with breast cancer over the course of their lifetime. With Breast Cancer Awareness Month beginning this week, it is estimated that more than 40,000 women will die from the disease this year with African American women posting a heavy share of these losses.
The American Cancer Society reported last year that Black women have the highest mortality rate at 36.6 percent per 100,000 American women diagnosed with the disease. This is compared to 22.9 percent (out of every 100,000 women) overall across the nation.
The Cancer Action Network found last month that the five-year relative survival rate is 98 percent when breast cancer is detected at an early stage, but only 24 percent for late-stage cancer. Although breast cancer is the most commonly diagnosed form of cancer among American women, the percentage of people dying from the disease is said to be in decline.
Not so for Black women.
A report last winter by the Centers for Disease Control and Prevention (CDC) in Atlanta, Ga., notes there are persistent large gaps between Black and White women in terms of mortality and stage of cancer at diagnosis. Based on data collected from 2005-2009, African American women, the report found, were 41 percent more likely to die from breast cancer. The report also revealed that Black women have a lower incidence of breast cancer (based on the nation’s population), but are more likely to succumb from the disease than any other racial or ethnic group. An additional study conducted in July by the American Medical Association indicated that when researchers compared the Black breast cancer patients with White patients who had similar demographic characteristics as well as similar tumors, the survival gap dropped considerably among African Americans.
“Most of the difference is explained by poorer health of Black patients at diagnosis, with more advanced disease, worse biological features of the disease, and more ‘comorbid’ (presence of one or more disorders in addition to a primary disease) conditions,” the report found. The study also revealed that African American women died more frequently because they were more likely to have other health conditions. Obesity, high blood pressure, hypertension and heart disease among Black women were found to be fatal contributors when paired with cancer. Research teams at CDC found that 26 percent of the Black patients had diabetes when diagnosed with breast cancer, compared to 15.3 percent of White women.
Researchers also found treatment for Black women was not as good as that of White patients received because the former set of women were less likely to receive combinations of chemotherapy drugs and were directed to undergo surgery with no therapy afterward. WHY
“By the time Blacks [visit the doctor], they’re so sick that treatment isn’t changing the outcomes,” said Dr. Jeffrey H. Silber, director for the Center for Outcomes Research at Children’s Hospital in Philadelphia and leader of a 2011 study conducted by his group. “The outcome is already fated to be poor when patients come in with such advanced disease.” In 2011, 6,040 Black women died from breast cancer.
According to the Atlanta-based medical advocacy group Black Women’s Health Imperative (BWHI), breast cancer tends to appear in Black women at a younger age and in more advanced forms. They announced in 2011 that African American women are twice as likely to develop “triple negative” breast cancer, an aggressive form of the disease which has fewer effective treatment options. This form of cancer grows and spreads more swiftly in Black women possibly because of breast density—one of the strongest predictors of risk for breast cancer and also a known factor limiting the sensitivity of a screening/mammogram. In short, mammograms of breasts with higher density are harder to read and interpret than those of less density. A small tumor can be concealed by dense breast tissue, or by the overlap of normal breast structures.
A diagnosis of “ triple negative” breast cancer means that the three most common types of receptors known to fuel most breast cancer growth (estrogen, progesterone and the HER-2/neu gene) are not present in the cancer tumor. The breast cancer cells have tested negative for hormone epidermal growth factor receptor 2 (HER-2), estrogen receptors (ER) and progesterone receptors (PR). Because the tumor cells lack the necessary receptors, common treatments like hormone therapy and drugs that target estrogen, progesterone and HER-2 are ineffective. Chemotheraphy is still an effective option and triple negative breast cancer may respond better to chemotherapy—provided if it is caught in the early stage. Triple negative breast cancer occurs in 10 to 20 percent of women diagnosed with breast cancer and is more likely to affect younger people, African Americans and Hispanics.
There is another equally devastating cancer diagnosis: “inflammatory” breast cancer cannot be detected via self examination nor by mammograms or early diagnosis. It does not appear as a tumor but, rather, as a flowing mass of carcinogens that can travel from the breast, chest wall and lodge within any organ in the body. Although White women are diagnosed frequently with this form of breast cancer, Black women die from it at much higher rates. Doctors are still not familiar with this diagnosis (categorized within the four stages of breast cancer as “3B”), and an accurate count of cases remains elusive. It is the fastest moving cancer and, when found, survival is rare, according to Jocelyn Earls.
“Black women are being misdiagnosed from the start,” said Earls, who has battled inflammatory breast cancer since 2011. Her Rialto-based organization, “Fighting 4 the TaTas: Inflammatory Breast Cancer” is striving to sound the alarm call for women of color about this deadly diagnosis. “We don’t receive the same care as White women, but there is a sad tradition within the Black family about revealing bad news. It’s the ‘I don’t claim’ attitude. We won’t reveal this publicly because too many Black women will simply say to themselves ‘no one needs to know.’ Basically, if you ‘speak it,’ then you ‘claim it.’ We have our heads stuck in the sand on this issue.”
Earls explained that inflammatory breast cancer is a clinical diagnosis, rather than a pathological or indicative finding. Therefore, there is little background available to oncologists to detect it before it metastasizes into a death sentence. “It’s the fear that hurt us,” Earls continued. “Black women get scanned more than White women, but we’re told more often that we have breast cancer. Stages one and two are treatable, but once you get to stages three to four, the prognosis is usually dim.”
Dr. Sheilah Clayton, medical director of the breast clinic at Charles R. Drew University of Medicine and Science in Watts, this week said there are reliable methods to help reduce the chance of contracting breast cancer. “We recommend being active, get more exercise and watch your diet,” she explained, adding that more fruits and vegetables and less red meat can help the body stay healthy. Also, she said, women in menopause should limit hormone replacement because studies have shown that this proceedure could increase the risk of a breast cancer diagnosis. Clayton receives about five to 10 new breast cancer cases each month and said Black woman can be reluctant sometimes to undergo screenings because of a so-called “stigma” of a positive diagnosis. “This arises from a variety of reasons, but often it is because of limited education about breast cancer and, quite often, lack of financial resources,” Clayton said. “We must read more...learn more. Socio-economic factors do play into this reluctance to get screened.”
Clayton explained that inflamatory breast cancer can be caught before it spreads to the skin, but too many women fear the biopsy not knowing that the majority of biopsies do not detect cancer. King Hospital conducts a weeekly breast cancer clinic and also offers a “patient navigator” program that can keep persons informed about what treatment measures are available. “We want people to know that there are support groups available and they should not shy away from discussing their condition with family and friends. They can be your best support group.”
HealthDay, a consumer health news service, this year reported that about 20 percent of Black women with breast cancer have an abnormality on at least one of at 18 recognized genes previously linked to the disease. The study findings stem from an analysis of DNA gathered from nearly 250 Black breast cancer patients within a search for abnormalities among the so-called breast cancer “susceptibility genes.” These abnormalities, the study found, could be a reason why more African American women are diagnosed with the aggressive triple negative cancer.
“For many years, we’ve seen breast cancer take a heavy toll on African American women, and this study begins to resolve unanswered questions about what’s driving these disparities,” said Dr. Jane Churpek of the University of Chicago. She and her colleagues conducted a study last year, examining increased awareness about potentially life-saving genetic screening for African American women with a personal or family history of early onset or aggressive forms of breast cancer, as well as malignancy among their relatives. These clinicians said the results argue for increased screening for mutations in younger African American women (25 to 40 years old) diagnosed with triple negative breast cancer, or women with a family history of the disease. Doctors said such testing may lead to life-saving interventions for family members. The findings were presented in June in Chicago at the annual meeting of the American Society of Clinical Oncology.
The aforementioned CDC report indicated that African American women do not receive the same quality of breast cancer treatment as White women do; White women are also more likely to begin treatment within 30 days of diagnosis. Black women do not. If women of both races received the same treatment, the report found, death rates could fall by almost 20 percent.
“That report is not necessarily true,” said Dr. Jay Vadgama, professor of medicine and chief of the division of cancer research and training at Charles R. Drew University of Medicine and Science. “Minorities sometimes don’t follow-up for treatment, but it is up to the private doctor to immediately recommend a follow-up. This involves surgery, radiation, chemotherapy...all the measures to promote the best possible outcome after diagnosis.” Vagdama lamented that women sometimes “get lost” in the situation and many do “fall through the cracks.” He suggested a more proactive attitude involving the patient, family and the doctor. Many times the uninsured person does not follow up,” he explained. “The Affordable Care Act can help remedy that. Now, being without insurance should not prevent you from seeking needed services. Charles R. Drew University of Medicine and Science has seen over 1,400 women since 1998 for breast cancer studies, while 20 to 25 women visit the hospital weekly for treatment. My best advice is to be aware of the local breast cancer centers. Get a clinical examination from your doctor and do your self exam at home. Young women with a family history should follow up vigorously.”
Enrollment began this week for the Affordable Care Act which was signed into law to allow access to healthcare that wasn’t possible for some women before, including mammograms. It is now illegal to deny medical insurance because of a “pre-existing” condition (i.e. “susceptibility genes”). The ACA is particularly relevant to impoverished women, many of whom have no private or employee health plan, nor do they qualify for Medicare. These women tend to wait until the disease has metastasized because they rarely see a physician for a yearly check up, let alone receive a mammogram or even learn about self examination.
Diagnosis of breast cancer at more aggressive stages is more common among African Americans than in their White counterparts; the CDC reported last year that there were nine more deaths among Black women for every 100 breast cancers diagnosed compared to White women.
The American Cancer Society last month reported that the new healthcare law can insure that people with a history of breast cancer receive needed coverage even with a pre-existing condition. The law prohibits the sudden discontinuation of coverage because a patient has been diagnosed with breast cancer or another health condition. It eliminates the use of annual “dollar limits” on coverage and so-called “lifetime limits” that often leave cancer patients without coverage. The law requires that all commercial health insurance plans cover mammograms for women 40 years and older and provides that these screenings and other “proven” preventative services be administered at no cost to patients. ACA also establishes a national prevention and public health fund to sustain and fund a 50-state investment in preventative measures, including regular health screenings. The law will also establish public education campaigns on young women’s breast health.
Uninsured women are less likely to have access to high-quality mammography that may help improve detection of breast lesions concealed in dense breast tissue, which is common among younger Black women. Even when fully insured, according to the Black Women’s Health Imperative, BWHI, African American women are more likely to experience delays in testing following abnormal screening results; receive inadequate communication regarding treatment options and side effects, and have lower rates of referrals for targeted surgery/therapy. Black women can also anticipate reduced monitoring following treatment and have inadequate survivorship care.
The group launched an unusual initiative last year, “Moving Beyond Pink,” which calls for a national commitment to end disparities in diagnosis and treatment. Because many women with early breast cancer often have no symptoms, BWHI emphasizes that it is crucial to get screened before signs of sickness appear.
The most common sign of breast cancer is a new lump or mass. Usually, if one discovers a hard but painless mass with irregular edge bulging from the skin, it is likely to be malignant.
However, breast cancer(s) can sometimes be tender, soft or rounded. It is for this reason that women should immediately notify a physician experienced in diagnosing breast abnormalities. Other signs may include:
- Swelling of all or part of the breast
- Skin irritation or dimpling
- Pain in the breast or nipple
- Thickening of the nipple or breast
- Discharge other than breast milk.
Related to these medical findings is a CDC report issued in 2012 revealing that Black breast cancer patients face a higher risk of heart failure. The study identified an increased risk of coronary disease among African American women that remained even after researchers accounted for other mitigating factors (ex. age, high blood pressure, diabetes) and including the use of chemotherapy drugs or medicines to protect the heart (cardioprotective drugs). Also, about one in four breast cancer patients exhibit symptoms of post-traumatic stress syndrome shortly after they receive their cancer diagnosis. This risk, the CDC found, is highest in Black and Asian patients.
Smoking also increases the risk of breast cancer. The incidence of invasive breast cancer was 24 percent higher in current smokers and 13 percent in former smokers, compared to people who never smoked cigarettes. With an aggressive form of breast cancer, Chemotheraphy is said to work better in younger women provided they undergo early, pre-operative radiation treatment.
BWHI says there are many valuable and empowering steps Black women can take to lessen the chance of death. Foremost, have your doctor show you precisely how to perform a monthly breast examination. Have a clinical breast examination at least once yearly. Insist on a digital mammogram; this method offers the latest in advanced technologies that help detect tumors. Finally, spread the word among family and friends. Understand that cancer disparities do exist and if there is a family history of the disease, early detection and awareness can contribute to your well-being ... and may save your life.