Addressing Disparities in Breast Cancer Care Among African American Women

Racial disparities in breast cancer survival rates among African-American women has been well-documented over the past 40 years. Early studies largely connected poor survival rates in this group to having a lower economic and social status. We now know, based on evidence, that there are multiple factors causing this issue, ranging from breast cancer prevention efforts to what happens to this group after breast cancer treatment. This topic was featured on CNN's "Black in America" TV series over a decade ago, highlighting the tendency of African-American women to develop aggressive diseases linked to worse outcomes. Before the series aired, screening mammography became widespread, with breast cancer survival rates in white women increasing in all 50 states, while survival rates in African-American women only increased in 11 states. The series helped to highlight these disparities as a public health issue, while also disproving the belief held by some in the African-American community that breast cancer was a "white woman's" disease. 

Since the TV show aired in 2008, the number of African American and white women getting breast cancer has become more similar. Five-year relative breast cancer survival rates in the U.S. remain lower in African-American women compared to white women. Overall, African-American women continue to be 42% more likely to die from breast cancer than white women in the U.S. 

Breast Cancer Diagnoses in African-American Women

African-American women are more likely to be diagnosed with advanced stage of disease compared to other racial groups in the U.S., which plays a significant role in ethnic disparities in survival rates. Certain tumor characteristics, such as a higher likelihood of developing aggressive basal-like and triple-negative breast cancer, show that biological differences linked to ancestral migration from western sub-Saharan Africa may play a role in breast cancer rates in African-American women. Biological differences may also explain why African-American women, on average, receive a breast cancer diagnosis at a younger age – twice as likely to be diagnosed with breast cancer under the age of 35 compared to white women. These factors led the American College of Radiology/Society of Breast Imaging to update its screening guidelines for African-American women, recommending doctors look at risk factors at age 30 for women from this group to determine if high risk screening prior to age 40 would provide additional benefit. 

In addition to biological factors, economic and social factors continue to play a central role in differences in breast cancer survival. According to the U.S. Census Bureau, poverty rates are more than twice as high in African-American communities compared to white-American communities. Those patients with less means are less likely to have a primary care physician and to receive preventive health care services including mammography screening. This is also reflected in cancer care, leading to decreased rates of chemotherapy and radiotherapy following a breast cancer diagnosis, which impacts African-American women at increased rates. In addition, complex medical conditions, seen at higher rates among this group – including obesity, diabetes and hypertension – can also lead to worse outcomes after a breast cancer diagnosis.

Breast Cancer Prevention Efforts

There are some encouraging signs that breast cancer prevention efforts are moving in the right direction, as gaps in mammography screening rates between African-American and white women continue to close over time. Still, more work needs to be done to improve overall screening rates, especially among women from low socioeconomic backgrounds who often experience barriers to accessing health care. To assist in these efforts, the Institute of Medicine has recommended three culturally-appropriate strategies to improve breast cancer awareness for breast imaging care providers, which we have made great strides in here at Denver Health: 

1. Personal outreach in surrounding communities, especially underserved regions, with the goal of improving breast cancer screening engagement. See more.
2. Same-day care programs that consolidate breast imaging services, which can reduce access-related barriers associated with return visits.
3. Multidisciplinary health navigation systems that help guide patients through their breast care experience, which can improve patient retention and reduce delays in care. Read about one example.

Many targeted efforts, from disease prevention to treatment, will be required to increase breast cancer survival rates among all demographic groups.

Learn more in my 2020 research article.