Black women are more likely than white women to die from all types of breast cancer
Black women are more likely than white women to die even from the most treated types of breast cancer, a study published Tuesday in the Journal of Clinical Oncology found
The findings, experts say, underscore that racial disparities, not biology, drive the biggest differences in death rates between black and white women. While black women and white women are diagnosed with breast cancer at similar rates, black women are 40% more likely to die from the disease.
“In health care there was this notion that an important contributor to the disparities was that black women have higher rates of triple negative,” which is a particularly aggressive type of breast cancer, said lead author Erica Warner. , cancer epidemiologist at Massachusetts General Hospital. .
While that plays a role in the higher death rates, Warner said, “based on these results it’s not a significant or even primary reason.”
Warner and colleagues conducted a meta-analysis that examined 18 studies with nearly 230,000 breast cancer patients in total, 34,000 of whom were Black, comparing the mortality rates of Black women and White women. with the same molecular subtypes of breast cancer.
The subtype of cancer influences how the tumor behaves and responds to treatments, which largely influences mortality rates.
For breast cancer, the subtypes depend on which type of receptors are found on the surface of the tumor cell. Hormone receptor positive (HR-positive) tumors have receptors for estrogen or progesterone, two female hormones. HER2 positive tumors have a type of receptor that allows the tumor to spread more quickly – or respond better to treatment.
In all cases, receptors can serve as clear targets for treatments. Tumors that do not have any of these receptors are called triple negative and are the most difficult to treat.
For the most common subtype, HR-positive, HER2-negative, which contains 60% to 70% of all breast cancer diagnoses, black women were 50% more likely to die from the disease than white women. For those with HR-positive, HER2-positive tumors, black women were 34% more likely to die than white women.
Black women were 17% more likely to die from triple-negative breast cancer than white women, a finding that surprised Warner.
Although black women are three times more likely to be diagnosed with triple-negative breast cancer than white women, given the high mortality rates for this type of cancer in all, the researchers did not expect to see a noticeable difference between the races.
“We thought that hormone receptor positive tumors is where we see the biggest disparities and that we don’t see a difference in triple negative tumors,” Warner said. “We actually saw disparities of similar magnitudes in all the breast cancer subtypes that we looked at.”
“If we can create, we can eliminate”
That the greatest disparities were seen among women diagnosed with positive tumors for the hormone receptor highlights the role of racial disparities in mortality rates, said Dr. Eric Winer, director of the Yale Cancer Center.
“In these cancers, people have to be in extended treatment with hormone therapy for five years or more, which is often associated with the cost of the pocket, so the economy plays a role,” said Winer. “People fall through the cracks, either because they are unable to afford hormone therapy, unable to take it or not, or unable to pick up their medication.”
Doctors may not offer such extended treatments to Black or low-income patients as often, he added. Not all black women are low income or uninsured, though Data from the Centers for Disease Control and Prevention show that Black patients are more likely than White patients to be uninsured.
It’s one of the many structural barriers black women are more likely to face, said Dr. Wendy Wilcox, chief of women’s health at New York City Health + Hospitals.
“There are all these things that we tend not to think about when we think about treating breast cancer, but they absolutely have an effect,” she said.
The so-called social determinants of health – including not only access to good health care, but childcare, transportation to and from appointments, working time, access to healthy food and living in an area with low levels of pollutants—all factors. in which he has better health outcomes across the board.
“There has been a long lack of black women being represented in clinical trials,” Wilcox added. “From the very beginning, the research phase of breast cancer treatment, black women are not represented.”
Black women are also more likely to get breast cancer at a younger age, but are not diagnosed until their cancer is at a more advanced stage.
“Regardless of the subtype, it’s all about early detection,” said Dr. Marissa Howard-McNatt, director of the Breast Care Center at Atrium Health Wake Forest Baptist in North Carolina. “Black women tend to get breast cancer at a younger age. Screening doesn’t start until age 40, but many black women can get breast cancer in their 30s.
Anyone with a history of breast cancer in their family should start screening with mammograms 10 years before a sibling or parent was diagnosed, Howard-McNatt said.
“Women of all racial ethnicities, especially black women, need to know their family history,” she said.
She added that helping black women diagnosed with breast cancer access health facilities that have patient navigators, who help patients with everything from understanding their treatment options to arranging transportation, could help start to reduce the disparities these women face.
There were still no differences in breast cancer death rates between black and white women.
“If you look at breast cancer data from 40 years ago, there was really no difference in breast cancer mortality between black and white women. We weren’t very good at treating and diagnosing. But as we’re getting better, the gap between white and black women has grown,” Warner said. “It is problematic, but that also tells us that we have our foot on the pedal for these differences. If we can create them, we can eliminate them.”