How does breast cancer affect Black women?

Share on Pinterest

Breast cancer is a type of cancer in which the cells in a person’s breast grow uncontrollably. The type of breast cancer will depend on which cells become cancerous.

The breast consists of three main parts:

• the lobules, which are glands that produce milk
• the ducts, which are the tubes that carry the milk to the nipple
• the connective tissue, which is the surrounding fatty and fibrous tissue

Most breast cancers begin in the lobules or ducts.

A 2020 article notes that breast cancer is the most common type of cancer that develops in females. Approximately 12.4% of females in the United States will experience breast cancer in their lifetime.

Breast cancer occurs due to genetic mutations and DNA damage in the breast. Exposure to estrogen can influence the development of this type of cancer.

Moreover, this form of cancer is often silent. Many people do not realize that they have symptoms until a routine breast cancer screening.

Some people may notice a lump on their breasts during self-examination.

According to the American Cancer Society (ACS), the incidence and mortality rates of breast cancer in females are as follows:

Although non-Hispanic Black females have lower incidence rates of developing breast cancer than non-Hispanic white females, they have a higher mortality rate.

Breast cancer mortality rates are approximately 40% higher for Black females than for white females.

Moreover, the ACS note that non-Hispanic Black females have higher incidence rates compared with white females before the age of 40. In addition, they are more likely to die from breast cancer at every age.

Breast cancer can affect Black females differently compared with white females.

According to a 2016 article, Black females are:

• more likely to receive a diagnosis at a later stage
• less likely to receive the appropriate treatment
• more likely to have lower survival rates based on the stage of the breast cancer

Historically, Black females in the U.S. have had lower overall incidence rates compared with white females. However, over the years, these rates have increased, while the incidence rates for white females have been consistent.

Additionally, Black females have higher mortality rates and are more likely to die from breast cancer than females of other races or ethnicities.

The ACS note that the differences in mortality rates can occur due to:

• an advanced stage of breast cancer at diagnosis
• a higher prevalence of obesity
• a lack of access to high quality cancer treatment
• a lack of health insurance

Black females are more likely to receive a diagnosis for more aggressive subtypes of breast cancer that are resistant to treatment, such as triple-negative breast cancer (TNBC).

TNBC disproportionately affects those who have the BRCA1 gene, as well as young Black females.

Black females are also more likely to have worse clinical outcomes after a diagnosis of TNBC than other females. This is the result of health inequities, such as:

• a lack of access to breast cancer screening
• a lack of access to oncology care and treatment
• delays in treatment

Healthcare policies, access, and utilization can contribute toward health inequity.

Medical mistrust

Research shows that biases, prejudices, and mental stereotypes that healthcare professionals have about the Black community lead to health inequities.

There is also some evidence that historically marginalized groups are more likely to refuse treatment due to mistrust in the medical community.

For example, Black females are less likely to opt for surgery due to medical mistrust. This then limits the treatment options, which can contribute to the increase in mortality rates.

Additionally, healthcare staff are more likely to underdose Black females when performing chemotherapy treatment. They are also more likely to commence older treatments and recommend nonstandard chemotherapy.

Lack of access to high quality healthcare

A 2020 research paper states that Black females are less likely to have breast cancer screenings at breast imaging centers of excellence. The ones they do visit are less likely to have dedicated breast radiologists.

Black females are also more likely to have longer times between screenings than non-Hispanic white females.

Furthermore, there is a delay between the time of receiving a diagnosis and getting treatment. Only 69% of Black females start treatment within 30 days of receiving a breast cancer diagnosis in comparison with 82% of non-Hispanic White females.

Also, approximately 25% of Black females experience 3 or more months of delay in starting treatment.

The hospitals to which Black females have access are less likely to have a National Cancer Institute comprehensive cancer center designation, which can lead to slower adoption of cancer therapies.

Finances and health insurance

A 2016 research paper reports that Black people and other historically marginalized groups are less likely to have health insurance than white people.

In states that have not undergone Medicaid expansion under the Patient Protection and Affordable Care Act, 40% of Black people would otherwise be eligible for Medicaid, and they are two times more likely to be uninsured.

Black people in states that are not expanding Medicare are also more likely to live in rural areas that may not have as much access to healthcare services than those living in urban areas. They are also less likely to have access to preventive services, such as routine checkups.

There are multiple risk factors that contribute to developing breast cancer.

A 2016 study identifies several risk factors that may affect Black females more than other females, such as a lack of access to healthcare, and increased stress due to discrimination and racism.

Reproductive risk factors include:

• having begun menstruating at an earlier age
• experiencing a late onset of menopause
• using birth control pills
• having dense breasts
• aging
• having a history of breast cancer or noncancerous breast diseases
• having a family history of breast or ovarian cancer
• having undergone treatment of radiation therapy to the breasts
• having taken the drug diethylstilbestrol or having a biological parent who took this drug
• having genetic mutations, such as BRCA1 and BRCA2

Learn more about genetic mutations and breast cancer risk for women of color here.

Other risk factors include:

• a lack of physical activity
• alcohol consumption
• smoking

Reaching or maintaining a moderate weight can also help reduce the chance of breast cancer. However, health inequity can make it challenging to change the diet and get more exercise.

The above 2016 study states that there is an association between a lower income and reduced levels of nutrition and fitness. This stems from socioeconomic inequality, which disproportionately affects Black people in the U.S.

Most people with early breast cancer do not present with any symptoms.

However, when breast cancer advances, people may notice the following:

• a lump in the breast or armpit
• dimpling of the skin
• thickening or swelling of the breast
• flaky skin around the nipple
• nipple discharge
• changes in the size or shape of the breast
• breast pain

Black people may also notice a darkening of the skin tissue overlying the breast compared with the surrounding area, which may appear violet in color.

Learn more about the signs of breast cancer here.

A regular breast self-examination can be an important way to detect breast cancer early and increase a person’s chances of successful treatment.

Breastcancer.org recommend five steps to conduct a breast self-examination:

Step 1

People should look at their breasts in the mirror with their shoulders straight and their arms on their hips.

It is important to check that breasts are their usual size, shape, and color. Also, there should not be any visible swelling or changes.

It is important to contact a healthcare professional immediately if people notice any dimpling of the skin, a change in the position or shape of a nipple, or any discoloration.

Step 2

People should raise the arms above the head and look in the mirror for any of the changes mentioned above.

Step 3

With arms up, people should look for any discharge from their nipples. Discharge can be watery, milky, yellow, or bloody.

Step 4

After looking in the mirror, people should lie on their back on a comfortable surface. They should then lift the left arm behind the head and use the right hand to feel the left breast.

Using firm pressure with the finger pads, it is best to feel all around the breast tissue to check for any lumps or changes. It is important to feel all the breast tissue, from the armpit to the cleavage and from the collarbone to the top of the abdomen.

Once a person has checked one breast, they should switch arms and hands and check the other breast.

Step 5

While standing or sitting, a person should lift the left arm above the head and repeat the same checks with the right hand and left breast. They then need to switch arms and hands and check the other breast.

Some people may find that it is better to perform this step in the shower, as it may be easier to notice any changes on wet skin.

One of the most important ways to reduce the risk of breast cancer is to try to detect it early. Black females should have regular breast screenings and see a healthcare professional immediately if they notice any changes in their breasts.

People can examine their own breasts in addition to regular breast screenings. This may help detect breast cancer earlier.

The U.S. Preventive Services Task Force currently recommend that females aged 50–74 years have breast cancer screening every 2 years.

Those who are between 40 and 49 years of age should contact a healthcare professional to discuss whether regular breast cancer screening is the right choice for them.

If a person has a family history of breast or ovarian cancer, a doctor may recommend regular screening.

People should contact a healthcare professional immediately if they notice any changes in their breasts. The earlier people catch breast cancer, the higher their chances of survival.

Access to culturally competent healthcare is vital. Some people may be more comfortable seeing a Black physician.

BlackDoctor.org is a website where Black people can find doctors in their insurance network.

Receiving a breast cancer diagnosis and undergoing treatment can be difficult.

People may notice an adverse effect on their emotional, psychological, and mental health.

Learn more about mental health resources for people of color here.

There are several breast cancer organizations that provide support to communities of color. They include:

• African American Breast Cancer Alliance
• Sisters Network Inc.
• Sisters by Choice
• Black Women’s Health Imperative
• Smith Center for Healing and the Arts

Black females are more at risk of developing aggressive strains of breast cancer and have higher mortality rates. This gap between the rates of incidence and mortality may be due to health inequities.

It is important to check breasts regularly for any changes and notify a healthcare professional immediately if any changes do appear.

Black females can access support from several organizations. They can also find a Black physician in their insurance network if they feel more comfortable speaking with a Black healthcare professional rather than a white one.