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Breast cancer in African American women remains No. 2 killer

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In 2012, the Centers for Disease Control and Prevention (CDC) released an alarming report that showed that, although Black women had fewer new cases of breast cancer than their White sisters since the last study in 1999, the death rates were higher. In fact, according to the Susan G. Komen Foundation, African American women are 41 percent more likely to die of breast cancer than their White counterparts, and in some California cities, the risk is even higher.

Breast cancer is the second highest killer of Black women in the U.S., second only to lung cancer, according to the CDC.

Alarm bells went off around the country because of the higher rate of breast cancer deaths, especially in California where one of the largest populations of Black women lives. Sure there were programs in play that catered to encouraging women of color to get tested, but there needed to be more, much more.

In conjunction with the Susan G. Komen Foundation and a $390,000 grant from Anthem Blue Cross Foundation, the California Circle of Promise was created to address these disparities as well as provide a grass roots system to take down many of the barriers that keep Black women from breast cancer testing and quality care.

The Circle of Promise is the first-of-its kind initiative, designed to enable its seven affiliate offices to coordinate and deliver key services via community events, educational programs, navigation support services and actual screenings. The program went into affect in April 2014 with these three goals:

1) Develop a higher level of breast health literacy among African American women;

2) Change the mindset among African American women from that of fear, avoidance and denial to that of empowerment; and

3) Drive the behavior change needed to enable African American women to become more proactive about their breast health as well as more effective healthcare consumers.

Rhonda M. Smith, managing partner of the California Circle of Promise, is also a breast cancer survivor. She said the development of the Circle of Promise began about five years ago with the release of studies that indicated a disparity in the mortality rates of Black women with breast cancer compared to White women.

“The Komen affiliates in California got together to come up with a plan [since] there were no real programs in place to address the issue. The first priority was to recognize why the disparity existed,” she explained. “We wanted to develop a best-practice model that addresses breast cancer disparities at the system, community and individual levels, specifically targeting African American women who are rarely or never screened, low-income, insured, uninsured or recipients of Medi-Cal.”

She said the problems were many, including cultural differences.

“African American women would show up and there were White doctors, and let’s be real … all healthcare providers are not culturally competent, so it was all about access to healthcare, but quality care as well. If people have to travel to get care, that can be a problem, so that becomes a challenge. A single head of household might have to make choices between paying the rent and taking care of her family or taking off work to go to the doctor. Also, in the Black community, there are a lot of myths that cause fear. And a lot of women are not comfortable talking about breast cancer.”

One of the Circle of Promise’s biggest goals is to build awareness with outreach programs, such as events at local churches, the offering of free educational seminars and events, and most importantly, partnering with the community.

“We also get women screened,” Smith added. “It’s all about leveraging the resources and partnering with various organizations in the communities. We’ll go out into a community [where people lack access] with a mobile unit and conduct exams. We’ll put a whole medical team together.”

One of the Circle’s goals this year is to screen 2,000 women, which in reality could mean saving hundreds of lives. Smith reports that the organization has already successfully screened more than 1,600. The goal of screening 2,000 is based on their resources and facts, she explains. Smith said this number is a percentage based on the number of Black women in California who are age 40 and older.

Surviving

Smith said that being proactive probably saved her life. In 2008, she was a business consultant always on the go. After she was diagnosed and “survived,” she changed her consultancy practice to work in the breast cancer field.

“I was on the road all the time. One morning I just felt something unusual in my right breast. It was a little different than what I usually felt. I got up and made an appointment. I went to get a mammogram. Things happened quickly … in a matter of weeks, I had surgery and then the radiation. I am an example of what I am talking about. I became passionate about aiding other women and helping them grow through this process in the best way possible.”

Sherry Biggham is also a survivor. While Smith’s cancer was at Stage 1 when detected, Biggham was already at Stage 2, making her prognosis a bit more urgent. She woke up with a pain in her left breast, but it took her a few weeks to get in to see her doctor, who referred her to a specialist … a lot of delays were taking place and miscommunication because she was dealing with so many different medical professionals. She went to Cancer Treatment Centers of America, which she says probably saved her life, because everything she needed was in one place.

“It was a mind and body situation,” Biggham explained. “I had a dietitian, an oncologist; they looked at me from a whole-body perspective.”

Biggham said the experience was still harrowing, especially since at the time, she had two sons. “When I was diagnosed, my youngest was 13 and my oldest was 18. The 13-year-old, he was scared. You have to find out what is going to be best for you while still taking care of your family. Stage 2 meant becoming a survivor because it was caught before it spread to my lymph nodes. Yes, I had to have a mastectomy on my left side. And then the radiation was to keep it from returning. That took eight weeks. Currently, I am in my fifth year of being a survivor.”

“Sometimes you are scared. How are my kids going to get through this? You have to be strong and not show them that you are scared. How am I going to keep my job?”

Biggham said that it’s important to have the right people around you. “It’s very devastating when you get that first word … ‘You have cancer.’ Having the right people around you can take a lot of the stress off of you.”

As with Smith, the biggest thing Biggham wants other women to know is to get checked. “It doesn’t matter how old you are.”

Medical Outlook

Dr. Ashish Sangal, an oncologist at Cancer Treatment Centers of America in Phoenix, said treating breast cancer is quite a challenge. “First I have to get the patient to understand the diagnosis and what it means to her. We have to organize the treatment, which could mean multi disciplines since it depends on what stage the cancer is in and what type it is. It might involve surgery, chemotherapy … an oncologist probably has the most important role in treating a woman with breast cancer.”

There are four stages, and each requires a different set of treatments, Sangal explains. In addition, breast cancer can appear in different areas of the breast, including the lymph nodes (which are around the breast). Stage 1 is small and the earliest point at which the disease can be detected and tends to be limited to one spot in the breast. Stage 2 means that the cancer is invading lymph nodes a little more and the tumor is spreading. Stage 3 means a lot of lymph node activity and could have entered other areas of the body. Once the cancer spreads to the lungs, liver or other areas, that is Stage 4, and it is very difficult to contain, and tends to be fatal, he said.

“Getting the cancer is the initial concern, [after diagnosis]. Even after you remove it, that cancer often comes back. You have to be proactive and work to keep it from coming back, or worse, moving to other parts of the body,” Sangal said. “To prevent that we use radiation therapy.”

Dr. Sangal says that removing cancer is becoming a more sophisticated operation. In the past, doctors would perform a radical mastectomy, where they would remove the entire breast. “Now we can do a lumpectomy, where we just take out the tumor itself and not the entire breast, and then do radiation therapy.”

Diet can also be an important factor, the doctor reports. “Vitamin D is important to keep healthy breasts. And cut back on high fat content, especially as you get older. In fact, a lot of treatment programs today include a nutritionist,” he said.

Supplementing with Vitamin D and cutting out high fat content prior to diagnosis.

However, Sangal points out that prevention is the most important tool in the fight against breast cancer. “We have to work to catch it sooner to cut back on the mortality rate, especially among Black women, where it tends to be higher than others.” Sangal points out, “the treatment per se doesn’t really change with ethnicity.”

Adds Sangal, “It’s been historically seen that Caucasian women have higher incidents of diagnosis. However, African American women die more often from breast cancer, because, one they are being diagnosed at a later stage, so the outcome is going to be more dire. Also, there are certain types of breast cancer that are more likely in Black women.”

Could genes contribute to breast cancer disparity?
While the consensus is that the disparity in mortality rates between White and Black women is largely affiliated with socio-economics, there is new research suggesting that genetic differences in tumors of Blacks may contribute to a higher risk of breast cancer recurrence. According to a study released last month out of Harvard Medical School, Black breast cancer patients have significantly more TP53 mutations and basal tumors, two characteristics that are common in triple negative breast cancers and that indicate more aggressive tumor biology. Black women also have breast tumors with a greater variety of mutations, which could also make the tumors more treatment resistant.

Dr. Tanya Keenan, a co-author of the study, added that the higher risk of tumor recurrence in Black women was reduced when these genetic differences were adjusted for in statistical analyses. This suggests that genetic differences may, at least partly, contribute to the higher risk of breast cancer recurrence among Black breast cancer patients.

“Our study adds important pieces to the puzzle of why African American women with breast cancer are less likely to survive,” said the study’s senior author, Aditya Bardia, an assistant professor of medicine at Harvard Medical School and attending physician at the Massachusetts General Hospital Cancer Center. “If our findings are confirmed by additional studies, they may open doors to the development of targeted therapies against the tumor subtypes more likely to affect African Americans, and potentially help reduce racial disparities in breast cancer.”

Dr. Keenan added that these study results underscore the critical need to involve higher numbers of Black patients in research about the genetics of breast cancer and the effort to  develop better treatments for the types of cancers that disproportionally affect Black women, particularly triple negative breast cancer.

Early detection of utmost importance

Everyone agrees that early detection is of the utmost importance, because it can dramatically affect the outcome to the point of being a matter of life and death. Quite simply, the more advanced the cancer is, the more difficult it is to treat.

A relatively new form of detection is emerging as a result of using a machine called the DBT, or digital breast tomosynthesis, also known as 3D breast imaging. Available at 15 Veteran Affairs hospitals across the country, this machine provides a much more detailed look at the breast. Instead of taking just one picture of the breast during the imaging process, it takes multiple pictures. The radiologist can scroll through and can see more of the breast. The process is similar to a CAT scan, says Dr. Katherine Martin, director of Breast Imaging at the VA hospital in Phoenix.

Circle of Promise has created a new effort to foster more awarness of their breast cancer status. The current campaign is called “Speak Up! Talk About It” and can be accessed at www.SpeakUpTalkAboutIt.org.

For more information about Komen screening dates, which happen throughout the year, contact Kelly McMillan toll free at (844) -KOMEN-CA. For information about the Circle of Promise Initiative, visit the website at www.californiacircleofpromise.org.

For more on Rhonda M. Smith, CEO of Breast Cancer Partner Circle of Promise, call: (888) 808-4446 and the website: www.breastcancerpartner.com, email: rmsmith@breastcancerpartner.com; LinkedIn: www.linkedin.com/in/rhondamsmith.Media Room: http://breastcancerpartner.com/media.shtml.

Breast Cancer Symptoms

These signs or symptoms do not automatically mean you have breast cancer. However, at the first sign, it is best to seek a qualified physician for further exploration.

  • A change in how the breast/nipple feel
  • nipple tenderness
  • lump or thickening near breast or under arm
  • change in skin texture
  • lump in the breast
  • A change in how breast/nipple looks
  • change in size or shape
  • dimpling (creases, denting or puckering of the skin on the breast, which could be signs of cancer pulling the skin inwards)
  • unexplained swelling
  • unexplained shrinkage
  • recent change in one’s size compared to other
  • nipple turning inward
  • skin becomes scaly, red or swollen
  • Any nipple discharge, especially clear discharge or blood
  • Pain in one spot that does not go away
  • No symptoms does not mean no cancer, so have regular checkups.
  • Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health
  • Clinical breast exam (CBE) about every three years for women in their 20s and 30s and every year for women 40 and over

*Women should know how their breasts normally look and feel and report any breast changes to a healthcare provider right away.

  • Breast self-exam (BSE) is an option for women starting in their 20s.
  • Some women–because of their family history, a genetic tendency, or certain other factors–should be screened with MRIs along with mammograms. (The number of women who fall into this category is small: less than 2 percent of all women in the United States.) Talk with a doctor about your history and whether you should have other tests or start testing at an earlier age.

Source: Circle of Promise, Komen, WebM.D., CDC, National Cancer Institute, Cancer.org, National Cancer Center of America.

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