Black women with breast cancer tend to have worse outcomes compared to white
women because of:
a. Healthcare access
b. Biology of disease
c. Bias in the healthcare system
d. All of the above
Answer: d. It has been very recently – less than 20 years – that the field of breast cancer has begun to give attention to the specific, unique experiences of Black women. We know that, while Black women are slightly less likely than white women to get breast cancer, we are over 40% more likely to die from it. Why? There are many reasons.
Access. Black women are more likely to be under-insured, or uninsured. They have been traditionally less able to get annual screening mammograms, which detect breast cancer at its earliest (and most treatable) stage. That insurance issue also keeps many women out of doctors’ offices, putting off examinations of breast problems until the disease has advanced.
History. There is a long history of unethical treatment of Black people by the medical profession (to name a few: the Tuskegee experiment, the work of Dr. J. Marion Sims, the mistreatments of Henrietta Lacks and Fannie Lou Hamer), and the habit of not trusting doctors runs deep in many Black families. In modern times, this lack of trust in medicine may lead Black women to ignore medical advice. Doctors call this noncompliance, and if they see it in one Black patient, they can be quick to assume that the next Black patient who comes along will be noncompliant, as well. That assumption on the doctor’s part can lead to suboptimal care of the patient.
Ignorance. When a Black woman does have easy access to a doctor and is ready to trust that doctor fully, she still may get suboptimal breast care. There is bias in medicine against Black patients – especially Black women. We are less likely to get a thorough physical examination. We are less likely to be believed when we are in pain or worried (remember Serena Williams’ postpartum health problems?). Black women who feel breast masses may be less likely to be sent for imaging. My personal conversations with other cancer doctors have shown this to be true. Besides inherent bias, there’s the problem of real lack of knowledge. The information we have about breast disease is from studies of mostly white women. We are applying the treatments to every woman, which may not be appropriate.
Biology. We are learning that Black women are more likely to have a more aggressive type of breast cancer, called triple negative disease. While the frequency of that type of cancer is 10-15% in white women, it makes up almost 25% of breast cancer cases among Black women. What we know is that this type of cancer appears to be an inherited trait from our African ancestors: triple negative breast cancer is more common than other types among women in West Africa – the origin of the slave trade. Women in East Africa are less likely to have triple negative breast cancer. But, even when you make all things – socioeconomics, institutional bias, cancer type, etc. – equal, Black women still often have worse outcomes for breast cancer. There are some therapies that create complications more often in Black women, forcing them to stop treatment. There are clearly other facts about breast cancer in general and in Black women in particular that have yet to be discovered. There is more information that we need to know.
October is Breast Health Awareness Month and we at Buy from a Black Woman are excited to have Dr. Q as this month's guest blogger. Throughout the month, she will be offering ideas and facts abo