Hear the word cancer from your medical practitioner, and thoughts of death are likely to start haunting you.
But despite the ominous-sounding word, the National Cancer Institute’s SEER database notes that the five-year relative survival rate for breast cancer ranges from 100 percent for stage one cancer to 22 percent for those diagnosed with stage four.
Cancers are typically described in stages on a number scale of zero through four—with stage zero describing non-invasive cancers that remain within their original location and stage four describing invasive cancers that have spread outside the breast to other parts of the body.
Aside from skin cancer, breast cancer is the most common form of the disease among women in the United States, according to the Susan G. Komen Facts For Life website, and with October serving as National Breast Cancer Awareness month, there is no better time to review the impact of this disease.
Researchers have found that White women have the highest breast cancer incidents rate of any racial or ethnic group. However, African American women under age 45 have a higher incidence of breast cancer than all other women.
African American and Hispanic/Latina women are also more likely than Whites to be diagnosed with a later stage of the disease and tend to have larger tumors.
Asian American and Pacific Islander women have a lower incidence of breast cancer than other women, and those who are new immigrants to America have lower rates than their counterparts who have lived in the U.S. for many years. For Asian women who were born in America, the rate is similar to that of White women (60 percent higher than women born in Asia.)
Unfortunately, African American women tend to have poorer survival rates than women from other racial and ethnic groups in America, according to the Komen website.
In fact, while White women are more likely to be diagnosed, Black women are more likely to die from the disease.
A large study cited on the American Cancer Society website (of more than 170,000 women diagnosed with breast cancer in the United States) confirmed the results of earlier studies. It found that breast cancer in African American women is typically more aggressive than in White women; tends to be diagnosed at a younger age; is more advanced at diagnosis; and more likely to be fatal at an earlier age.
Research indicates that there are a variety of reasons why this happens.
Black women are more likely to suffer from estrogen receptor-negative breast cancer—a tumor subtype that carries a higher risk of death.
Another analysis of a large nationwide data set found that regardless of their socioeconomic status, Black women were nearly twice as likely as White women to be diagnosed with triple-negative (TN) breast cancer, a subtype that has a poorer prognosis.
Previous studies have indicated that Blacks and Hispanics were more likely to be diagnosed with triple negative breast cancer than non-Hispanic Whites. Some studies have suggested that the higher odds of breast cancer subtypes with unfavorable prognoses in minority racial/ethnic groups could be explained by differences in socioeconomic status. However, these studies were limited by their small and incomplete sampling.
Triple-negative breast cancers tend to grow and spread more quickly than most other types of breast cancer, and a lack of these receptors limits treatment options.
Younger people also suffer more from triple-negative breast cancer, and it is more likely to occur before age 40 or 50, versus age 60 or older, which is more typical for other breast cancer types.
Another study, led by Helmneh Sineshaw, M.D., MPH, analyzed data from 260,174 breast cancer cases recorded in the National Cancer Data Base, a national hospital-based cancer registry database. The analysis showed that patients with low socioeconomic status had higher proportions of triple negative breast cancers than did patients with high or moderate socioeconomic status. However, even after controlling for socioeconomic status, the difference remained: Black women were 1.84 times as likely to be diagnosed with the triple negative subtype.
“The excess odds of triple negative breast cancer in Blacks compared to Whites were remarkably similar, about 80 percent higher, in each socioeconomic group,” said Sineshaw. “That consistent increase suggests factors other than differences in socioeconomic status play a strong role in the excess odds seen in Black women. Further studies are needed to identify those factors.”
Access to healthcare may be another explanation for the disparity in types of cancer (women from some races/ethnicities are more likely than others to have low income and lack health insurance. This often means they have less access to breast cancer screening and treatment) which possibly leads to a later diagnosis.
African American women have a 41 percent higher rate of breast cancer mortality (death) than White women, according to the most recent data available.
In the past, African American women were less likely than White women to get regular mammograms. These lower screening rates may have increased the chances of African Americans being diagnosed with a later stage breast cancer. This may be one reason for the difference in survival rates.
Among younger women (under age 45), the mortality rate of breast cancer is higher in African Americans than in Whites. And the median age of diagnosis is 57 years for African American women, compared to 62 years for White women.
According to the Komen website, a main reason behind differences in mammography screening rates in the U.S. is health insurance. In 2010, only 32 percent of women ages 40 and older with no health insurance had a mammogram within the past two years compared to 71 percent of those with insurance.
Although a lack of health insurance is a main reason for breast cancer screening disparities in the U.S., other factors play a role. Even among women ages 40 and older with insurance, 29 percent did not have a mammogram within the past two years.
However now, African American and White women have the about same rates of mammography diagnostic use.
Even after accounting for differences in access to care, income level and past screening rates, African American women are diagnosed with later stage breast cancer and have worse survival rates than White women. Differences in reproductive factors and the biology of breast cancers of African American and White women also appear to play a role in these disparities.
Another study reported on last July by NBC News poses another reason—African American women tend to be sicker when first diagnosed.
This study, showed not only that the differences are still there years after experts first began to notice them—it also showed that Black women are in poorer shape overall than Whites when they are diagnosed.
“They come in sicker, with more advanced disease and more chronic conditions,” said Dr. Jeffrey Silber of the Children’s Hospital of Philadelphia, who led the study published in the Journal of the American Medical Association. “The disparity looks to be unchanged over the past few decades.”
The findings don’t surprise Karen Jackson, founder and CEO of Texas-based Sisters Network Inc., which tries to educate and motivate African American women about breast cancer. “After 20 years, I have seen this over and over again,” Jackson, who was treated for breast cancer 20 years ago, told NBC News.
Silber’s team, armed with a grant from the Agency for Healthcare Research and Quality, set out to show what the differences really are.
They set up a study looking at women over 65 who are covered by Medicare. They compared 7,375 Black women 65 and older who were diagnosed between 1991 to 2005 to three different groups of 7,375 White patients.
“We matched White patients to Black patients,” Silber said. The first group lived in similar places, were the same age and diagnosed in the same year. The White women lived three years longer than the Black women, on average.
Then the team added the variable of having similar tumors–the same stage, the same aggressiveness and the same type–and who also had other similar conditions, such as diabetes and heart failure. The disparity dropped to one year.
Finally, they added in a third layer which incorporated treatment type. The differences in life expectancy fell to just three months.
“The disparity in treatment, though real, is not accounting for very much,” Silber said. He says this shows the problem is that Black women are showing up sicker in the first place.
“They are not getting the preventive care they need,” he said. “They are not coming in early enough.”
Jackson agreed, but she said that her case shows it’s more than just a matter of seeing a doctor. She knew she had a high risk of breast cancer because two aunts had it. She started having mammograms at 35, and when she felt a mass in her breast a few years later, she asked again and again about it. “The doctors said, ‘Don’t worry; you’re young’,” Jackson said. Her mammograms were clear.
But when she was 50 and still felt the lump, she insisted on an ultrasound after yet another mammogram showed nothing. The ultrasound showed a tumor, and Jackson, now 70, had surgery, chemotherapy and radiation.
“I went from furious to proactive,” said Jackson, a Houston resident who was covered by her husband’s private health insurance plan. “I had insurance. I had mammograms, and I still fell through the cracks. And I thought, what about women who aren’t getting mammograms?”
So, she started Sisters Network Inc.
Many African American women are afraid when they find a lump or other possible symptom of breast cancer, Jackson says. “When you are in a fearful state, you are not accessing things that are available to you,” she said. “That fear of dying immobilizes you. We understand this.”
Sister’s Network (SNI), founded in 1994, is a leading voice and the only national African American breast cancer survivorship organization in the United States. The organization’s purpose is to save lives and provide a broader scope of knowledge that addresses the breast cancer survivorship crisis affecting African American women around the country.
Many women also don’t realize they need regular mammograms–not just one, Jackson says.
Silber’s study also suggested that Black women were not getting other care they need. They were less likely than White women to have had a recent colon cancer screening or a cholesterol test, said the researcher.
Dr. Laura Kruper, who helps direct the breast cancer program at the City of Hope cancer center in Duarte, says other factors matter, too.
“Can a woman take time off work to get this done? Is she close to a facility?” Kruper asks.
“I see lot of patients in my office who have advanced cancers and they ask, ‘Oh, I was supposed to get a mammogram every year?’”
Cultural differences also matter, Kruper says. “I do have women who come in and say ‘God is going to heal me,’” she said.
Better doctor-patient relationships would help, Silber says. “Efforts to increase mammography, efforts to increase and improve communication between primary care physicians and patients would be useful,” he said.
While researchers have identified key risk factors in those who have developed breast cancer, more than 74 percent of breast cancers are diagnosed in women with no identifiable risk factors.
Prevention
A number of recent studies have advanced new preventative theories about breast cancer including the part exercise and breastfeeding can play. In one study, researchers report brisk walking and other forms of exercise reduce a Black woman’s risk of breast cancer.
After following more than 44,000 Black women for 16 years, researchers found that those who exercised vigorously for seven or more hours a week were 25 percent less likely to develop breast cancer than those who worked out less than an hour a week.
The exercises included swimming, running, basketball and aerobics in addition to brisk walking. However, walking at a normal pace was not associated with a lower breast cancer risk.
“Although expert review panels have accepted a link between physical exercise and breast cancer incidence, most study participants have been White women. This is the first large-scale study to support that vigorous exercise may decrease incidence of breast cancer in African American women,” principal investigator Lynn Rosenberg, a professor of epidemiology at Boston University School of Public Health, said in a university news release.
The study was published online recently in the journal “Cancer Epidemiology, Biomarkers & Prevention.”
Another study that analyzed data from nearly 3,700 Black breast cancer patients found that breastfeeding may cut risk for aggressive breast cancer in Black women
Black mothers who don’t breast feed may be at higher risk for an aggressive type of breast cancer, the study suggests.
Researchers noted that about one-third of the women evaluated had estrogen receptor-negative breast cancer.
Women with children were one-third more likely to develop these tumors compared to those who never had children, according to a team led by Julie Palmer, professor of epidemiology at Boston University’s Slone Epidemiology Center.
However, whether or not a mother breast fed her infants seemed to influence her risk for the tumor, the study also found.
For example, the results indicated that women who had four or more children but had never breast fed were 68 percent more likely to develop an estrogen receptor-negative breast cancer, compared to women who had only one child but did breast feed.
When it came to estrogen receptor-positive tumors, the study found that women who had four or more children had a slightly lower risk for these cancers, whether or not they had breast fed their babies.
The findings were published in September in the Journal of the National Cancer Institute.
Prior research has found that the overall risk of breast cancer may be higher during the first five or 10 years after a woman gives birth, with a reduction in risk after that time. However, this study suggests that the risk for estrogen receptor-negative breast cancer, at least, may persist.
Another key prevention strategy is to promote screening, and that is one of the aims of the Komen African American Initiative in Los Angeles. The organization hosts a number of mobile mammogram clinics in partnership with Watts Healthcare Corp. To qualify for a free mammogram, women must be 40 years of age or older, under- or un-insured, and have not had a mammogram in the last year.
To view a list of upcoming events are:
Oct. 6 from 8 a.m.- 2:30 p.m. at Long Beach Rescue Mission, 1335 Pacific Ave., Long Beach.
Oct. 11 from 8 a.m.- 2:30 p.m. at Walton Middle School, 900 W. Greanleaf Dr., Compton.
Oct. 28 from 8 a.m – 2:30 p.m. at Carver Missionary Baptist Church, 5050 S. Hoover St., Los Angeles.
Nov. 3 from 8 a.m.- 2:30 p.m. at Long Beach Rescue Mission, 1335 Pacific Ave., Long Beach.
Nov. 8 from 8 a.m. – 2:30 p.m. at Congregational Church, 2085 S. Hobart Blvd., Los Angles.
Dec. 1 from 8 a.m. – 2:30 p.m. at Long Beach Rescue Mission, 1335 Pacific Ave., Long Beach.
In addition to the mobile clinics, the African American Initiative also features worship pink, which according to Gwen Barker, the organization’s director of mission programs, is one of the biggest efforts. It is a train the trainer campaign that last year helped 66 trainers reach 5,000 others with educational outreach.
For more information on the African American Initiative, contact (310) 575-3011 or (310) 477-7042 during office hours: 9 a.m. to 5 p.m. Monday through Friday.
The initiative also works to educate women. In fact, one bit of information, the organization pushes is the connection between stress and cancer and the high levels of stress that African Americans live under. The initiative also advocates building stress relief into daily life.
