Health & Fit An Expert Explains How Racial Disparities in Breast Cancer Care Contribute to Poor Outcomes for Black Women
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About 281,550 people in the U.S. will be diagnosed withthis year—and 43,600 will die from it, according to the American Cancer Society1. When we dig deeper into the numbers, it turns out there are at play as seen with so many other health conditions, such as diabetes.
White and Black people are diagnosed with breast cancer at roughly the same rate, but Black people are more likely to die from the disease, according to the Centers for Disease Control and Prevention2. Between the years 2014-2018, CDC data shows that 27 out of 100,000 Black women died from breast cancer compared to 19 out of 10,000 white women. (The death rate for other groups of color is lower than Black women or white women.)
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Experts say there are a number of factors at play here, and SELF spoke to Oluchi Oke3, M.D., an oncologist at the University of Texas MD Anderson Cancer Center, to learn more about the harrowing racial disparities in breast cancer. As a Black physician, Dr. Oke understands the importance of closing health care gaps for all patients.
SELF: To start, what are the most common racial disparities we see in breast cancer?
Dr. Oke: The disparities we see are in the onset of diagnosis—meaning at what stage of cancer people are diagnosed—and also in the overall percentage of people of a certain ethnicity that pass away from breast cancer. We see disparities in the type of breast cancer they get. And the average age for a breast cancer diagnosis is younger in Hispanic and Black individuals4.
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Black women are also more likely to be diagnosed with what’s called, which can be , and has a poor prognosis. It is more aggressive, so it grows faster, and we find it at a later stage. When we find it later, the cancer may have spread to lymph nodes or to another organ too. And so we are seeing more African American women dying from their breast cancer, partly just because they're getting diagnosed later, and also because they’re being .
Lack of health insurance is a barrier in receiving timely screening to detect breast cancer early on and is a big reason that we see higher breast cancer death rates in Black women. The most well-known study related to this was published in 2017 by researchers at Emory University5 who reviewed information from over half a million people in the national cancer database. They looked at five factors that may impact the difference in outcome between Black versus Caucasian women with stage 1-3 breast cancer, including demographics, characteristics of cancer, comorbidities, health insurance, and type of treatment. The difference in health insurance was the biggest contributor to the difference in death rate for each group. They showed almost three times as many Black women were uninsured compared to white women, and 35% of the excess risk of death from breast cancer in Black women compared with white women was due to a difference in health insurance. The type of tumor also contributed to the increased risk of death, but not as significantly as the lack of insurance contributed.
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Diagnosed in their 20s and 30s, these three incredible women are determined to make a difference for other people living with stage 4 breast cancer. The experience has empowered Kudirka to tune into her body, use her voice, and "enjoy each second of each day." "I wish I had listened to my body sooner, but I was young and thought I was unstoppable," she recalls. "I have learned that, if my body or my gut is telling me something, I should trust it." Although being diagnosed in her 20s initially felt isolating, Kudirka was met with support from family and friends, and she believes the road ahead is bright.
SELF: Do we know what causes the higher incidence ofIs there a genetic link, or are social determinants of health involved?
Dr. Oke: We really don't know. Some researchers have been looking into the immune system cells surrounding the breast cancer, trying to see if there are any. Another school of thought is that it might be linked to stress, such as stress from the world in general or stress if you’re coming from a lower socioeconomic status. (Editor’s note: Research6 shows that people of color generally have lower household incomes in large part due to systemic barriers to achieving higher socioeconomic status.) There’s a lot of data showing that , so people are wondering if that’s got something to do with this—potentially changing the DNA and changing the genes.
SELF: You mentioned some disparities in diagnosis, and some disparities in prognosis and outcomes. Are there any disparities in treatment access?
Dr. Oke: I have found this to be true mainly in the setting of clinical trials for treatments. Sometimes providers are less likely to offer clinical trials to people of color due to concerns ranging from a lack of insurance or underinsurance that will not cover the costs of the trial to socioeconomic disparities and barriers that may make it hard for patients of color to make all appointments and follow the strict schedules of a clinical trial. Providers are more aware now than before that people of color have a mistrust when it comes to clinical trials due to our country’s history of experimenting on people of color without their consent. Knowing this, providers may not think people of color will participate and therefore don’t offer them clinical trials. However, this is not the approach to take. Providers need to take the time to educate people on what a clinical trial is and all the components it entails.
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And this is more related to diagnosis, but some people don’t know you’re meant to get, or believe myths about mammogram radiation being dangerous. Some people don’t have access to clinics nearby, or the clinics may not even have mammogram machines.
SELF: Some of your research has looked into racial representation among oncology physicians. I'm interested in how the provider side plays into this, and whether you think there's a link between representation and more effective treatment?
Dr. Oke: Definitely. I do have a lot of patients who ask to switch to me or want to be seen by me. They trust that I would have their best interests at heart and say “I want to be able to talk to you.” They feel that I can relate to them. I think people are more likely to seek care if there is an option to see a doctor who looks like them, or enroll in clinical trials with a doctor who looks like them. When you are able to have more doctors who look like their patients, patients tend to be more compliant and more willing to get therapy because of thethat goes on in this country.
SELF: So it sounds like training more diverse providers is a promising path to working on these disparities, but what else can be done?
Dr. Oke: I think going into the actual communities and providing education about breast cancer to people is important. We need education in your church, community centers, and even in local clinics. This is what needs to happen. Especially now, there are Facebook groups spewing out news that’s not evidence or research-based. That's how some patients are getting their education. They have things in their head to suggest that Western doctors only want money and don’t want to help them, or that drugs don’t work, or that chemotherapy is poison. (Editor’s note: Although chemotherapy medications can be a crucial and successful part of cancer treatment, in the medical world many of them are technically classified as “hazardous” since they need to be strong enough to kill cancer cells7.)
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And in general, cultural awareness among physicians is very, very important—that needs to be part of education for all providers. We’ve seen with the significant amount of studies now coming out that Black people are more likely to die after giving birth or after certain surgeries and I think this is linked to things like myths that Black people tolerate more pain compared to non-Black people.
At the medical school level, we need to be teaching cultural awareness and inherent bias that people are not necessarily aware of. Education is very, very needed.
This interview has been edited and condensed for clarity.
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