While African-American women are less likely to develop breast cancer than Caucasian women, black women are less likely to survive if they do develop breast cancer. This appears to be both because black women tend to have more aggressive types of breast cancer and because of disparities in treatment. Genetic differences between ethnic groups have been found with respect to breast cancer. For example, there is increasing frequency of triple negative disease among breast cancer patients according to their degree of African ancestry. However, black women's survival remains worse even when they are carefully matched to similar white breast cancer patients with respect to breast cancer subtype, tumor size, age, access to health insurance, and other prognostic factors. Now a large new study has confirmed that African Americans have worse survival even when controlling for multiple demographic and clinical factors.
How African-American women can improve their breast cancer outcomes
Given the factors outlined above, African-American breast cancer patients can take steps to improve their survival. First, black women can choose the most aggressive appropriate treatments for their breast cancer, on the assumption that they have relatively aggressive disease. In practical terms, this means insisting on clean surgical margins even if it means additional surgery and undergoing radiation treatment and/or chemotherapy if it is offered. Even hormone receptor positive disease without HER2 overexpression ER+/PR+/HER2-, which is normally considered unaggressive, has a worse prognosis in African Americans.
Second, black women can act to avoid treatment delays and receive optimal treatment. Obviously, oncologists and medical centers need to optimize their procedures so that African-American patients receive timely and appropriate treatment and many centers are attempting to do so. However, black women diagnosed with breast cancer cannot afford to assume that such steps have been taken or are effective. Therefore, they can potentially benefit by taking the following steps, possibly with the help of a close family member or friend:
- Have your breast cancer care at the best cancer center in your local area, if possible.
- Make your breast cancer treatment a priority in your life and complete every aspect of your treatment.
- Make sure that your oncologists are aware of your commitment to treatment.
- Get a referral to a medical oncologist from the surgeon who performs your breast surgery as soon as possible and make the appointment immediately. Similarly, if you are going to need radiation, get a referral to a radiation oncologist from your oncologist and make the first appointment as soon as possible. The time between phases of treatment (surgery, chemotherapy, radiation, anti-estrogen treatment) should be measured in weeks, not months.
- Ask each physician that you see what treatment is optimal for your type and stage of disease so that you can compare this to the treatment that is eventually offered.
- If you have an aggressive form of breast cancer (triple negative, HER2 positive, inflammatory breast cancer (IBC), large tumor size, multiple positive lymph nodes, diagnosed under age 45), you need very aggressive treatment. This is likely to include chemotherapy. Even if he or she gives you a choice, your oncologist will have an opinion as to what would be best for you and will tell you if pressed. Make the tough choice.
Latest research finds African-American women have relatively poor survival
The study referenced at the beginning of this news story was designed to examine disparities in breast cancer-specific death rates in a large and diverse cohort containing seven distinct racial groups. To conduct the study, the authors linked data concerning 127,754 breast cancer patients in the Methods Florida Cancer Data System registry (1996-2007) with data from the Agency for Health Care Administration and the U.S. Census. Data was collected with respect to comorbidities (other diseases or medical conditions), patient disease characteristics, and demographic factors, including neighborhood poverty levels.
Native Americans were found to have the worst median breast cancer survival (7.4 years), whereas Asians had the best (12.6 years). When considering race alone, African Americans had the worst survival, followed by Hispanics, Asians, and Asian Indians or Pakistanis. When multiple variables in addition to race were factored into the analysis, African-Americans were found to have even worse survival, whereas it improved for Hispanics. An incremental increase in survival was found for each higher socioeconomic status category in all analyses. The authors conclude that race, ethnicity, and socioeconomic status remain significantly associated with breast cancer survival even when controlling for multiple demographic factors, clinical variables, and comorbidities.
Please see our article on how African-American breast cancer patients can improve their outcomes for more information