What Black Women Need to Know About Breast Cancer Risk

Barriers to Healthcare Access Increase Breast Cancer Risk

The first barrier to breast cancer treatment is access. Statistically, Black women are less likely than white women to have adequate access to healthcare facilities and health insurance. Many studies have demonstrated how better access to healthcare can improve treatment outcomes for breast cancer:

• Cureus, 2023: By removing barriers to healthcare access, intervention programs can successfully reduce the disparities in breast cancer screening.
• Journal of Clinical Oncology, 2017: Access to private health insurance led to better outcomes for Black women diagnosed with early-stage breast cancer.
• Journal of the National Cancer Institute, 2023: When healthcare coverage is expanded to low-income Americans, the race-based outcome gap between stage 4 breast cancer patients is eliminated.

In addition, Black women are more likely to have diabetes, obesity, and other conditions that increase breast cancer risk. With increased access to healthcare, Black women can manage these conditions more effectively. This, in turn, can help reduce their breast cancer risk.

Genetic Factors Increase Susceptibility to Aggressive Subtypes

Genetic factors also contribute to breast cancer outcome disparities. Some subtypes of breast cancer are more aggressive or harder to identify than others. Black women are more susceptible to some of the aggressive subtypes.

When compared to women of other racial and ethnic backgrounds, Black women are twice as likely to be diagnosed with triple-negative breast cancer (TNBC). This is a rare subtype of breast cancer that spreads aggressively. It is also more likely to occur before the age of 40, which for most women is the recommended age for starting to receive mammograms. As a result, TNBC is often diagnosed in advanced stages in younger women.

Black women are also more likely than others to develop inflammatory breast cancer. This is another rare and aggressive breast cancer subtype. Its symptoms do not resemble those of more-typical breast cancers. As a result, the disease may be mistaken for other conditions. This makes it more challenging to detect early. As with TNBC, inflammatory breast cancer is more likely to be diagnosed in advanced stages. It is essential to address these genetic disparities between different racial groups, such as through customized screening strategies, to achieve better outcomes for Black women.

Underrepresentation in Clinical Trials

Recent decades have seen significant strides in breast cancer treatment. Systemic therapies like chemotherapy, immunotherapy, and targeted therapy have seen increased use thanks to their validation in clinical trials, leading to a dramatic increase in survivorship.

These advances, however, have not benefited all women equally. Non-white women currently account for only 10% to 15% of clinical trial participants. This means that Black women have less access to advanced treatments. It also means less research into the safety and effectiveness of these treatments in different racial and ethnic groups.

Engaging Black women in clinical trials could play a major role in reducing the healthcare gap. This step would both improve access to innovative treatments and focus research on health differences to ensure that treatments work well for all patients.

Early Detection is Key to Health Equity

Routine screening is a key component of breast cancer detection. The earlier the cancer is detected, the more effective the treatment tends to be. Because Black women are more likely to develop more aggressive subtypes of cancer at earlier ages, screening is particularly crucial for them.

One potential solution, detailed in a study published in JAMA Network Open, is a race-adapted approach to screening. Based on this approach, Black women would begin breast cancer screening earlier than women in other racial and ethnic groups to hopefully identify breast cancer subtypes that are more common in Black people and that also tend to develop at younger ages.

This suggestion is reflected in recent changes to screening recommendations. In 2023, the United States Preventive Services Task Force changed its screening guidelines to lower the age at which routine screenings are recommended. The current recommendations include:

• Women with an average risk should receive annual screenings between the ages of 40 and 74.
• Women with a higher-than-average risk may begin annual screenings between the ages of 25 and 30.
• Women over age 75 should receive annual screenings if their overall health is good, and they have a life expectancy of 10 or more years.

Some experts have recommended that Black women obtain a risk assessment between the ages of 25 and 30. Women who are well-informed about their risk can make educated decisions about starting to screen young, facilitating earlier detection and increasing the likelihood of a good outcome.

Learn More About Black Women and Breast Cancer

Regional Cancer Care Associates provides comprehensive breast cancer care to all patients at its more than 20 locations in New Jersey, Connecticut, Massachusetts, Maryland, and the Washington, D.C., area. The RCCA oncology team is committed to making cutting-edge treatments accessible for women of all races and backgrounds. Contact us with any questions or to request an appointment for breast cancer treatment.

Frequently Asked Questions About Black Women and Breast Cancer

What are the early signs of breast cancer?

Early signs of breast cancer can include:

• A new lump in the breast or armpit
• Thickening or swelling of part of the breast
• Changes in skin texture comparable to an orange peel
• Skin redness, itchiness, or irritation
• Nipple discharge that is not breast milk

Are breast lumps always cancerous?

Most breast lumps are benign, meaning they are non-cancerous. In addition, breasts change appearance over time due to age, weight loss or gain, pregnancy, and hormonal fluctuations. Many of these changes are normal and are not cause for concern. Still, it is important to speak with a healthcare provider about any lumps and other significant changes in breast appearance.

How often should I be screened for breast cancer?

The current screening guidelines recommend that women at average risk for breast cancer start annual screenings at 40 years old. Women with greater-than-average risk may consider starting annual screenings earlier, following the recommendations of their healthcare provider. Black women, and others who may be at elevated risk for various reasons, should talk with their physician about the optimal time for them to begin screening.

What are the primary risk factors for breast cancer?

The main risk factors for breast cancer include:

• Age
• Family history
• Genetic mutations, including BRCA1 and BRCA2
• Racial and ethnic background
• Lifestyle factors, such as alcohol use

What factors affect breast cancer prognosis?

A patient’s prognosis, or likely disease outcome, is dependent on a variety of factors, including how large the tumor is, whether the cancer has spread to lymph nodes, whether it is receptive to certain treatments, and the cancer stage. Late-stage breast cancer generally has a worse prognosis than early-stage cancer.