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Racial Disparities in Breast Cancer: Why They Persist and How to Narrow the Gap
New data show that more progress needs to be made to close the gap. Here’s how BCRF investigators are addressing the challenge.
In the United States, breast cancer continues to be the most common cancer diagnosed among women after non-melanoma skin cancer and is the second leading cause of cancer death. It is estimated that more than 268,600 new cases of invasive breast cancer and 62,930 new cases of non-invasive breast cancer were diagnosed in women in the United States last year. While there has been an overall 40 percent decline in breast cancer deaths over the last 30 years—thanks to progress in awareness, early diagnosis, and treatment—there is a persistent mortality gap between black women and white women.
New data from the American Cancer Society concerning racial disparities in breast cancer highlight the need to continue working toward closing this gap. Despite the fact that incidence rates have remained relatively stable since the early 2000s, the disparity in breast cancer incidence between black and white women has widened over that time (though it has remained stable in recent years). While black women have a slightly lower incidence of breast cancer, they have the highest breast cancer mortality rate of any race—a rate 40 percent higher than the rate seen in white women. Among women under 50, the disparity is even greater: The mortality rate among black women is double that of white women. It is clear that the advances in treatment that have dramatically reduced breast cancer mortality have not equally benefitted all groups.
What accounts for the disparity?
The gap in breast cancer incidence and outcome among black women is complex and multifactorial. Social, economic, and behavioral factors may partially account for the disparity. Black women are 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 access to screening, follow-up care, and completion of therapy. Finally, black women are also more likely to live in stressful environments and feel the need to be strong, which may influence their decision to seek medical care. Through continued research, it is becoming increasingly clear that biology also plays a role. Black women are about twice as likely as white women to be diagnosed with more aggressive forms of tumors, such as triple negative breast cancer (TNBC), and they are often diagnosed at more advanced stages.
Working toward a solution
According to the National Cancer Institute, the gap in cancer care can be improved in two ways: 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 recent 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 in white women. 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 is committed to eliminating disparities
BCRF recognizes the continued need for disparities research by fostering the innovative and collaborative science needed to resolve this issue. BCRF investigators are working on understanding the differences in breast cancer biology across racial and ethnic groups. For example, Drs. Christine Ambrosone and Chi-Chen Hong are studying the types of immune cells found in and around breast tumors from both black and white women to determine if they affect tumor aggressiveness. Drs. Funmi Olopade and Dezheng Huo are identifying genetic factors responsible for TNBC in diverse groups of women. Work led by Dr. Charles Perou and BCRF collaborators has uncovered differences in biology in breast tumors of black women compared to those in white women that may be targetable to decrease the disparities in breast cancer outcomes. 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.
A deeper understanding of tumor biology and its variations among people holds the promise to improve prevention strategies, early detection, and treatment of breast cancer. BCRF continues to work towards this goal.