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.”
Founded 1974 in response to President Richard M. Nixon’s avowed “war on cancer,” CPIC is an independent research center supporting clinical trials in Northern California. Its scientists conduct a wide range of studies to describe and explain the cancer burden in human populations, with a focus on racial/ethnic, socioeconomic, and cultural differences in the Greater Bay Area and California populations.
An ongoing CPIC health study of more than 133,000 California teachers is leading cancer researchers to some interesting theories that may contribute to discovering the causes and prevention of breast and other cancers.
CPIC and collaborators at university medical schools and institutions throughout the state have been conducting research for the aptly named California Teachers Study since it began in 1995. The continuing health study has focused on lifestyle, medical history and women’s health, as it follows and surveys the large group of teachers through the years.
“These teachers have given us great data,” CPIC researcher Christina Clarke, Ph.D. said. “Since the study began, the teachers in this study have cumulatively filled out about 4.5 million pages of questions, provided around 10,000 biospecimens, and participated in approximately 3,000 interviews.”
Early results from the study found that teachers have a much lower rate than the general population of cervical cancer, as well as heart disease and lung cancer because they are generally a non-smoking group. Findings also confirmed a concern initially expressed by California teachers themselves that they experienced a higher rate of breast cancer than comparable women in California.
Later findings from the study have revealed lifestyle factors that may affect breast cancer risk. The researchers have found that breast cancer risk was higher among women who combined hormone therapy use with more than one alcoholic drink per day. They also found that strenuous, long-term exercise reduced the risk of invasive and in-situ breast cancers.
Researchers are looking at other factors that may have an impact on cancer, including obesity, diet, second-hand smoke, and air pollution.
“Look around you: One in two people risk developing cancer,” CPIC Director Dr. Sally Glazer said during a recent fundraising dinner for the institute. “Instead of focusing on cancer treatment, our goal is cancer prevention.”
Another important health group, Black Women for Wellness, is committed to healing, educating, and supporting Black women. It started as “Sisterfriends,” with the 1994 “Birthing Project” in Los Angeles-a group of women concerned about the health and well-being of babies. Today, they take on the plethora of health issues Black women encounter.
The group has posted an African American Women Breast Cancer Fact Sheet on its website, www.bwwla.com. Included are “symptoms to look for,” like a lump or thickening in the breast or armpit; a change in the size or shape of the breast; a discharge from the nipple or a change in the color or texture of the skin of the breast or areola, such as dimpling and puckering.
The site suggests each woman commit to a breast health program of monthly self examinations, clinical examinations by a physician each year and mammograms.
“Between the ages of 30 and 35, African American women should have at least one mammogram and then one every one to two years until age of 50,” it says. “After 50, a woman should get a mammogram each year.”
The site also suggests this tip on redesigning diet and exercise: Limit daily fat intake and increase daily vegetable consumption to curtail breast cancer risk.