In honor of Breast Cancer Awareness Month, it is important that we also raise awareness about the social determinants of health that are associated with this disease.
According to the Breast Cancer Research Foundation, breast cancer remains the most commonly diagnosed form of cancer among women, and is second only to lung cancer in total cancer-related deaths. While there has been a decline in overall breast cancer mortality, disparities are still present among people with this disease. In fact, black women are 42 percent more likely to die from breast cancer than white women, despite similar incidence rates between the two groups.
Breast Cancer in Minority Women
Research has shown that the higher mortality rates in Black women due to breast cancer can be partially attributed to genetic determinants, as well as access to care and pre-existing health conditions (BreastCancer.Org).
Genetically, Black women are more likely to be diagnosed with triple-negative breast cancer, which means the cancer has no receptors for the hormones estrogen and progesterone, or the HER2 protein, which limits the medicines that can be used to treat the cancer.
However, genetic factors only partially contribute to the overall disparity. Because Black women (and other minority women of color) have higher incidences of obesity, hypertension, and heart disease, these pre-existing health conditions can worsen the overall outcome of their breast cancer compared to otherwise healthy White women.
Additionally, access to care plays a large role in the outcomes of breast cancer. Although it is generally recommended for women aged 45-54 to get mammograms every year (Cancer.Org), it may not be that easy for minority women of lower socioeconomic status to seek these screenings.
According to BreastCancer.Org, researchers conducted a study that looked at information from 177,075 women aged 40 to 64 who were diagnosed with stage I to stage III breast cancer between Jan. 1, 2010, and Dec. 31, 2016.
The information came from the SEER databases, large registries of cancer cases from sources throughout the United States maintained by the National Institutes of Health.
Of the 177,075 women:
148,124 had insurance
28,951 had no insurance or were receiving Medicaid
The researchers also found:
Black women, Native American/Alaskan Native women, and Hispanic women were more likely to be diagnosed with stage III breast cancer than stage I or stage II breast cancer.
White women were more likely to have insurance compared to Black women, Native American/Alaskan Native women, Asian/Pacific Islander women, and Hispanic women.
When the researchers included insurance status and other socioeconomic factors in their analysis, they found that nearly half of the racial difference in the risk of being diagnosed with stage III breast cancer, compared to stage I or stage II disease, was linked to health insurance.
“We’re seeing up to half of the disparity mediated by insurance,” said lead author Naomi Ko, M.D., MPH, assistant professor of medicine at the Boston University School of Medicine. “That may not be surprising, but it’s nice to have the data and the evidence so we can have a thoughtful discussion.
Call to Action
Research has highlighted an urgency in addressing the causes underlying this health disparity. This data should serve as a call to action to policymakers to remove barriers to access to care and screening in areas where these resources are unequally distributed in minority communities.
For scientists, the results indicate the need to identify the biology underlying the incidence of more aggressive tumors in black women. These efforts will require increasing enrollment of minority women in clinical trials to better understand differences in response to treatment and identify race-specific biomarkers that may inform personalized treatment options (Breast Cancer Research Foundation).
Although this is the month that breast cancer is recognized, this is a problem that lasts longer than just the month of October. All women — no matter their age, ethnicity, economic status, or other health conditions — deserve the best breast cancer care and the best prognosis possible.