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.

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.

“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.”

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.

According to the City of Hope website, among the risk factors are: gender—a woman is 200 times more likely than a man to develop breast cancer; age—risk of developing breast cancer increases as you get older, and half of all breast cancers are diagnosed in women older than 60; genetics—about 5 to 10 percent of breast cancer cases are thought to be hereditary, meaning that they result directly from gene defects inherited from a parent; family history—risk is higher among women whose close blood relatives have this disease. However, less than 15 percent of women with breast cancer have a family member with the disease; weight—being overweight or obese increases breast cancer risk.

Prevention

A number of recent studies have advanced new preventative theories about breast cancer including the part exercise and breastfeeding can play.

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.

The study was published online recently in the journal “Cancer Epidemiology, Biomarkers & Prevention.”

Another study 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.

City of Hope cancer researcher Leslie Bernstein, Ph.D., R.N., professor and director of City of Hope’s Division of Cancer Etiology, says alcohol intake plays another significant, if minor, role in breast cancer risk.

“If you drank one alcoholic drink a day, your risk would only increase minutely, by 10 percent. And that’s small,” Bernstein said, suggesting that women who choose to drink alcohol should limit their consumption to no more than one alcoholic beverage a day. Bernstein and her team are now looking into the role of regular aspirin intake on breast cancer risk, because aspirin acts against inflammation and aromatase — both of which are linked to breast cancer growth and development.

The City of Hope offers a numbe of other health-related prevention suggestions.

  • Breast density—Having dense breasts makes your chance of developing breast cancer four times higher.
  • Know your family history
  • Nutrition—Eat five or more servings of fruit and vegetables daily, limiting processed and red meats. Choose whole grains.
  • Screening—Remember to get annual mammograms and clinical breast exams beginning at 40.

Watch weight—Women who gained 21 to 30 pounds since age 18 were 40 percent more likely to develop breast cancer than those who hadn’t gained more than five pounds.

Potential symptoms:

  • Swelling in all or part of the breast
  • Skin irritation or dimpling
  • Breast or nipple pain
  • Nipple retraction (turning inward)
  • Redness, scaliness or thickening of nipple or breast skin
  • Nipple discharge