Here's what we all know: breast cancer is not unique to one race or type of person. Chances are you know someone who has been affected by it, heard about someone else's survival, or perhaps you are healing from it yourself. Google "breast cancer narratives" and you can find stories on women from every race, ethnicity and culture. This disease does not discriminate based on the color of your skin; that much is clear.
But not everyone understands that it affects racial groups differently.
Take the stats comparing Black women and white women, for example: According to research from the Centers for Disease Control and Prevention (CDC), the incidences of breast cancer for white and Black women are the same. However, Black women are up to 40% more likely to die from the treatable disease. The question is..
Why does breast cancer affect Black women and white women differently?
Genetics
According to the American Cancer Society, Black women are more likely to be diagnosed with an aggressive subtype of breast cancer that doctors are still figuring out how to treat more effectively: triple negative breast cancer (TNBC).
TNBC (which can grow faster than other cancers) accounts for about 10-15% of all breast cancer cases — but it's up to three-times more common among Black women, and experts say these incidences are linked to genes. A 2019 study from the journal Cancer found that the prevalence of TNBC was highest among women of Western-African, Caribbean-born and Eastern-African descent (in that order).
TNBC is unique in that the cancer cells do not have receptors that are responsive to the hormones estrogen and progesterone; nor do they produce the protein human epidermal growth factor receptor 2 (HER2). Because of this, current hormone therapies or HER2 inhibitor treatments are not very useful, says Jennifer Webb, M.D., a radiation oncologist at Bronson Healthcare in Michigan.
For example, "if the estrogen receptors are positive, then you can treat with easy-to-take anti-estrogen pills," she says. "Those help with the cure rate. Though for triple negative patients, those pills don't have as much effect."
The good news is: TNBC tends to respond well to chemotherapy and surgery, especially when it's caught early, says, Nedra Harrison, M.D., a breast surgeon and oncologist at HonorHealth Scottsdale Shea Medical Center.
"The life expectancy when you have the chemotherapy first [then surgery if needed] in a triple negative patient is just about the same as someone who is not triple negative," she says.
Scientists also now know that gene expressions aren't fixed: Research suggests that increasing the expression of tumor suppressor genes through diet and other strategies could reduce the risk of genetically derived breast cancer. Still, more research needs to be conducted.
But even taking TNBC into consideration, the 40% higher mortality rate among Black women can't be explained by genetics alone. There are other systematic issues at play as well.
Lack of access to healthcare and insurance
The key to curing breast cancer is early detection. But according to the CDC, breast cancer is more likely to be found at an earlier stage in white women than in Black women. Part of the reason for that is too many BIPOC women do not have access to quality health care.
"A lot of Black women do not get paid appropriately for the work that they do and can't afford health insurance," says Dr. Harrison. "And health insurance is really important, because that gives you access really to physicians and diagnostics and so on."
Oftentimes, physicians encourage their patients over 40 years old to get a mammogram every year. However, this can be challenging for those who are worried about paying for their next doctor's visit.
These women are not just missing out on diagnostic tests either. Primary care physicians and gynecologists also educate their patients on proper self-breast exams and other preventative strategies such as nutrition, exercise and more, says Dr. Harrison. Financial barriers also extend into the ability to afford expensive surgeries and treatments.
The bottom line: Part of fighting breast cancer in Black women is curing the economic plagues and inequality behind it.
How can Black women lower their risk of breast cancer?
Despite the statistics, there are many actions that Black women (and women of any race) can take to be proactive in when it comes to breast health.
✔️ Find clinics that offer free or low-cost mammograms. According to the Affordable Health Care Act, insurance companies are required by law to pay for mammograms every year or two for women over the age of 40. However, if you're younger or you don't have insurance, there are many clinics and programs that offer free or low-cost mammograms and breast exams. Organizations like the CDC, the Susan G. Komen Foundation, and Planned Parenthood are great resources to find where you can get a screening near you.
✔️ Find out about your family history. "If you know that you have first degree relatives that have breast, ovarian, uterine, colon, prostate cancer, or pancreas cancer, you should be genetically counseled," says Dr. Harrison. A genetic counselor will be able to test you and interpret the results so that you understand your risks and make the next best steps. Some people fear genetic testing because if they are shown to be at a higher risk of disease that they might face discrimination at work or be denied insurance. But Dr. Harrison says that "this is no longer true" and that it should not be a concern.
✔️ Learn how to perform a self-breast exam. Knowing your breasts — what's normal, and what's not — can be extremely empowering in preventing and treating breast cancer.
How to do a self-breast exam
Both Dr. Webb and Dr. Harrison have had many patients who've detected early signs of the disease themselves. However, it's important to know how to do it properly and know the red flags. Go to your gynecologist or primary care doc and have them teach you how and keep and eye out for these warning signs:
- A new hard lump
- Yellow, brown, or red nipple discharge
- Any changes in the skin of the breast like redness, inflammation, or dimpling.
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Dr. Webb recommends doing a breast exam once a month. "I tell my patients to pick their birth date, and then do it once a month on that day," she says. "It's an easy way to remember."
✔️ Educate yourself on surgery options. For many women, their breasts are an important aspect of their identity. So even if a person finds a lump, they may be afraid of getting looked at all because of potential surgery. However, there are various surgery options out there now that aren't all as extreme as a mastectomy, or the complete removal of the breast.
For example, a lumpectomy, is a breast-conserving surgery where they only remove the tumor (and a small amount of healthy tissue around it). "Patients can then have what we call oncoplastic surgery where they mobilize or move around the breast tissue to fill in the hole," says Dr. Harrison. "These patients look wonderful."
If you are insured, the government has required that insurance companies pay for any reconstruction if you have had a mastectomy or lumpectomy. So in those cases, you may not even have to worry about the costs.
✔️ Eat a balanced diet and find enjoyable exercise. Studies have found that an imbalance of estrogen within the body can increase the susceptibility to certain types of breast cancer. "Most breast cancers that are estrogen and progesterone receptor positive like being in estrogen," says Dr. Harrison. "They're like at a resort and they just thrive."
Before menopause, most estrogen is produced in the ovaries. In postmenopausal women, most estrogen is produced and stored in fat cells. In both cases, diet and regular exercise can have a positive affect in keeping estrogen levels appropriate for your body. Luckily, there are many nutritionists that specialize in cancer prevention and helping cancer patients. And exercise doesn't have to mean hitting the gym intensely 5-6 days a week. Find movement that's fun for you and that you can make a consistent practice.
✔️ Avoid over-exposure to endocrine disruptors. Endocrine disruptors are chemicals (both natural and human-made) that can increase or decrease normal hormone levels within the body. In regards to breast cancer, there are a couple to be aware of:
- Bisphenol A (BPA): This is often used to make water bottles and food containers. Fortunately, there are many companies that make these products BPA-free.
- Triclosan: You can find this antimicrobial compound in liquid body wash, soaps, deodorants and hand sanitizers. These products can also be made triclosan-free.
While some animal studies say that both of these can increase the cancer risk, more studies are needed to be conducted for humans to fully understand their effects. Previously, it was also believed that the phytoestrogens in soy products like tofu could increase the susceptibility of breast cancer in humans, but scientists have found that a moderate intake of soy does not pose a risk.
✔️ Quit smoking. Smoking not only increases your chances of getting cancer, it can make cancer treatments less effective, says Dr. Harrison. "Smoking causes vascular constriction, meaning it contracts the blood vessels in your body," says Dr. Harrison. "So if you have to have surgery, they tell you you must stop smoking two weeks before because it doesn't allow the nutrition in the blood to efficiently get to the areas that need to be healed."
The importance of empowering yourself on your health journey
While knowing statistics about Black women and breast cancer are important, they are not the whole picture. Meaning: each individual — whether Black, white, or of any gender — is not a number, but a human with unique stories, experiences and histories. So to figure out what's best for you in terms of cancer treatment or to reduce your risk of cancer, don't be afraid to ask your doctors questions and get second opinions if you feel like you need to. And if the cost of treatment is a barrier, there are organizations and resources that may be able to assist you.
One of the most important steps in taking ownership in our health is realizing that we are not alone — that there are many Black women who have experienced cancer, or who have had a close relation with the disease. And there are intelligent physicians (women of color, included) working to cure breast cancer in patients from all walks of life. Access to adequate health care for BIPOC women is comparatively limited right now and it's important that this changes. But for now, we can acknowledge and take advantage of the growing support out there for those who need it.
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