Why Does Breast Cancer Kill More Black Women?

Scientists have long noted that white women tend to fare better with breast cancer than women of color do, and statistics clearly support this notion. The National Cancer Institute (NCI), for example, says that since 1974 breast cancer deaths among Blacks, who are actually less likely to develop breast cancer, have increased 13%, though they have decreased 11% among Whites. Task forces have even been called in to investigate cities like Chicago and Detroit where there were several accusations of black women being given mammograms of “less than optimal quality”, which would account for the lower number of diagnoses. Though such statistics are alarming, they correlate with other stats and probabilities within the African American demographic such as the increased likelihood of Blacks to be poor and/or uninsured, the low percentage of Blacks that are screened for cancer, and the high percentage that refuse aggressive cancer therapies once diagnosed.

In tackling a large issue, such as breast cancer, one should observe the problem from every angle. The problem that these statistics reference are sometimes termed “access issues”, as economics play a primary role in the accessibility of medications and therapies. As black women are less likely to be able to afford such treatments, they are more likely to succumb to the cancer. As black women are less likely to be screened for cancer, they are more likely to be diagnosed at later ages and later stages, making them less likely to survive. As black women are more likely to refuse aggressive treatment, they are more likely not to get the treatment that they need to survive, and inevitably, not to survive. The solutions to problems such as these extend beyond the reach of science and are being studied by public health professionals who want to find a way to support the uninsured and the financially unstable, as well as human resource and social workers who want to educate the entire black community about awareness and the importance of screenings.

Still, with breast cancer as the leading cause of cancer death for African American women, scientists wonder whether something exists in biology that may be able to explain why more black women die of this disease than any other race. A recent study summarizing new observations, provides such a story, linking types of tumors to this obvious racial disparity. Researchers for the first time used the National Cancer Data Base, a tumor registry maintained by the American College of Surgeons, to explore their theory. They used more than 150,000 cases diagnosed in 1998; 10% of which were in black women. The focus of their study was on the 95,000 women with invasive cancer. Amongst these women they found that about 40% of the tumors in the black women were estrogen-receptor negative (ER neg) compared with 20% in white women. Estrogen is what helps a tumor grow and ER neg tumors are resistant to any drug or therapy that attempt to block the estrogen hormone, though such treatments have been determined to be effective in working against the cancer. The study also found that the ER neg tumors were more common in black women at every stage of the cancer and at all ages.

A similar study was conducted last year using tumor tissue taken from 496 women in the Carolina Breast Cancer Study. The women had been diagnosed between 1993 and 1996. A quick-spreading form of breast cancer called the basal-like subtype appeared in nearly 39% of pre-menopausal black women and 14% of older black women, but only in 16% of non-black women at any age. The basal-like subtype, like the ER neg tumors, is resistant to almost all of the new treatments and therapies. Researchers said it was unclear whether the subtype was occurring because of genetic predisposition or something in the environment that black women may be more likely to be exposed to. In concluding their reports, scientists were quick to note that more observations must be made to determine why these more lethal forms of the cancer have prominence in black women.

Though the aforementioned economic factors obviously contribute to the problem somewhat, this scientific story also seems to have relevance, as well as compelling observations that support the feasibility. It also allows room for new questions and the need for more observations to be made. The idea of genetic predisposition for example, could suggest a biological foundation for racial differences that science has yet to explore or acknowledge. If in fact, genes play a role in determining the type of cancer you develop, is there a trait for such? Are there carriers? Could genetic counseling identify this at an earlier stage than our contemporary methods of diagnosis? Could your risk for breast cancer be determined before you were born?

I, like the scientists, would like to know what it is about black women that make them more prone to the types of cancer that are harder to treat. As a young black woman coming from a long line of breast cancer patients, I already know the importance of screenings and routine health checks, but I can’t help but wonder how much truth is behind the stories of “less than optimal” mammograms; and I am more than eager for researchers to make new observations and come up with more stories that offer a better outlook for women of color.

http://www.usatoday.com/news/health/2007-06-04-breast-cancer_N.htm
Black Women’s Breast Cancer Survival Rates Lag USA Today

http://findarticles.com/p/articles/mi_m1077/is_n5_v50/ai_16536451
Why Breast Cancer Kills More Black Women Ebony

http://www.abcnews.go.com/Health/CancerPreventionAndTreatment/wireStory?id=3564538
Breast Cancer Deadlier in Black Women ABC News

http://www.msnbc.msn.com/id/13167618/
Black Women Prone to Deadlier Cancer MSNBC

http://www.suntimes.com/lifestyles/health/99334,CST-NWS-breast17.article
Breast Cancer Deadlier for Blacks Chicago Sun Times