Black Women and Breast Cancer: Why Disparities Persist and How to End Them
By BCRF | October 5, 2022
By BCRF | October 5, 2022
In the United States, breast cancer continues to be the most common cancer after non-melanoma skin cancer, and it is the second leading cause of cancer death. This year, the American Cancer Society (ACS) estimates that more than 287,850 new cases of invasive breast cancer and 51,400 new cases of ductal carcinoma in situ/stage 0 breast cancer will be diagnosed in women in the United States. While there has been an overall 43 percent decline in breast cancer deaths over the last three decades—thanks to gains in awareness, early diagnosis, and treatment—there is a persistent mortality gap between Black women and white women.
Data compiled by ACS highlight the need to continue working toward closing this devastating gap. While breast cancer incidence rates among Black and white women are close, mortality rates are markedly different, with Black women having a 40 percent higher death rate from breast cancer. Among women under 50, the disparity is even greater: The mortality rate among young Black women, who have a higher incidence of aggressive cancers, is double that of young white women. Advances in early detection and treatment have dramatically reduced breast cancer’s ability to take lives overall, but it’s clear that these breakthroughs haven’t benefitted all groups equally—and this disparity has remained unchanged since 2011.
The gap in breast cancer incidence and outcome among Black women is complex and multifactorial. Social, economic, and behavioral factors may partially account for disparities. Black women are statistically more likely to have diabetes, heart disease, and obesity, and are less likely to breastfeed after childbirth—all of which are risk factors for breast cancer. They are also more likely than white women to have inadequate health insurance or access to health care facilities, which may affect screening, follow-up care, and completion of therapy.
Through continued research, it is becoming increasingly clear that biology also plays a role. Black women are disproportionately affected by more aggressive subtypes, such as triple-negative breast cancer (TNBC) and inflammatory breast cancer, and they are more likely to be diagnosed at younger ages and at more advanced stages of the disease.
According to the National Cancer Institute, disparities in cancer care can be improved in several ways, including by creating statewide cancer screening programs that are accessible to underserved populations and by addressing the biological differences in breast cancer across racial and ethnic groups. A 2019 study that analyzed characteristics of breast cancer patients on a city level showed that women with more resources (such as education and income) may be better equipped to take advantage of healthcare advances. Indeed, cities that have confronted this problem by increasing access to state-of-the art mammography facilities made significant progress in narrowing the breast cancer mortality gap between Black and white women.
The biology of breast cancer is inherently complex, which is why we often hear the phrase, “Every woman’s breast cancer is unique.” While we have made significant progress in understanding the molecular drivers of breast cancer, most studies and clinical trials are conducted in white women. Expanding Black women’s participation in research is critical. We have only recently been able to decipher some of the underlying biology to explain the higher incidence of aggressive tumors in Black women and to identify biomarkers that could ultimately inform personalized therapies and improve outcomes for Black women diagnosed with breast cancer.
BCRF recognizes the continued need for more research to end disparities faced by Black women across the US. Our researchers specifically working in this area include:
Dr. Marjory Charlot’s work aims to address the gaps Black women experience in clinical trial education and communication. Using patient- and community-based participatory research methods, her team will develop and test a mobile health app to help Black breast cancer patients prepare to discuss participating in clinical trials with their providers.
Dr. Fergus Couch has identified inherited mutations in breast cancer susceptibility genes that confer an increased risk of TNBC and may be important for screening in high-risk Black women. Recently, Couch and his collaborators examined gene mutations in a large, racially diverse population of American women. This study showed that mutations in the BARD1, RAD51C, and RAD51D genes, while very uncommon, appear more frequently in Black women with breast cancer and are associated with an increased risk of both TNBC and ER-negative breast cancer. Read more here.
Dr. Laura Esserman is examining the immunological features of breast cancers in Black women to gain a better understanding of the spectrum of disease and the types of interventions that might improve outcomes.
Dr. Kimberley Lee is examining the issues that make it difficult for Black breast cancer patients to start—and stick to—endocrine therapy. Based on her findings, she will then develop culturally tailored interventions.
Drs. Funmi Olopade and Dezheng Huo are identifying genetic factors responsible for TNBC and those that specifically predispose Black women to this aggressive disease. Dr. Olopade and colleagues were the first to discover that Black women have a higher incidence of mutations in the BRCA1 and BRCA2 genes, as well as other inherited susceptibility genes, compared to their white counterparts.
Work led by Dr. Charles Perou and BCRF collaborators has uncovered differences in the genes and gene mutations found in Black women’s breast tumors, compared to those in white women. His team is building on their findings to identify the drivers of metastatic disease determining the adaptive immune system’s role in breast tumor progression and improve therapeutic targeting of TNBC tumors to decrease disparities in outcomes.
Utilizing a comprehensive database of medical records and tumor samples from 600 patients with BRCA1/2 or PALB2 mutations, Dr. Sonya Reid is analyzing how different clinical and genetic features impact recurrence and survival across different racial groups.
Dr. Annette Stanton is conducting research on the unique psychological experiences of Black women diagnosed with breast cancer to help them better cope and decrease depressive symptoms.
Dr. Nikhil Wagle is working to gain a better understanding of Black women with metastatic breast cancer for molecular changes.
Dr. Walter Willett has shown that a plant-based diet—one rich in carotenoids, cruciferous vegetables, berries, fiber, and vitamin D—is associated with a lower risk of breast cancer. He is expanding this project to determine if this result applies to a racially diverse cohort (via the Southern Community Cohort Study) consisting mainly of Black women.
Last year, the World Health Organization announced that breast cancer had become the most frequently diagnosed cancer globally, with 2.3 million diagnoses in 2020—making global breast cancer research even more critical. BCRF investigators are addressing health care inequalities around the world, with a particular focus on Black women in low-resource areas. These studies have the potential to inform strategies to improve outcomes in underserved communities globally.
Drs. Lawrence Shulman and Cyprien Shyirambere have developed effective strategies to integrate early detection services into rural Rwanda’s health care system and reduce time to treatment. They are now working to expand these efforts to reach more women with the goal of reducing preventable breast cancer deaths in Rwanda and other countries.
Dr. Temidayo Fadelu’s study aims to identify barriers keeping Rwandan women from completing adjuvant endocrine therapy—an effective treatment that reduces recurrence and boosts survival—and devise interventions such as text message reminders to improve outcomes.
In another project, Dr. Olopade is investigating differences in tumor biology, genetics, and health care delivery patterns that contribute to the mortality gap between Black and white women. She has expanded her studies to develop infrastructure for clinical trials in low-resource communities in Nigeria and sub-Saharan Africa. Clinical trials to test novel targeted treatments, increase access to quality diagnostic tools, and optimize the standard-of-care treatments will improve outcomes for this population and potentially others in underserved areas.
A deeper understanding of tumor biology, its variations among people of different races, and the intersection of biology and social determinants of health holds the promise to improve prevention strategies, early detection, and treatment of breast cancer to reduce disparities. BCRF continues to work toward this goal.
This article was updated to reflect 2022 data and research projects.
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