05 Feb African Americans and Breast Cancer
Breast Cancer is the most common cancer found among every racial and ethnic group.
Race is not a risk factor for breast cancer, but the rates of being diagnosed and dying from breast cancer differ among ethnic groups. African American women tend to have lower survival rates than women from other racial and ethnic groups in the United States. White women are more likely to get breast cancer, but African American women are more likely to die from breast cancer (see graphs below). Studies have also found that African Americans often have aggressive tumors with a poorer prognosis.
As mentioned above, the causes of higher mortality rates, more frequent late-stage diagnosis, and poorer survival rates are complex and not completely understood. Aggressive tumor characteristics linked to poorer prognosis appear to be more common in African American women and may contribute to lower survival rates. However, even when controlling for these factors, African American women have poorer survival rates. This can be explained in part by unequal receipt of prompt, high quality treatment for African American women compared to white women. Below are more explanations for this disparity:
- Access to health care and poverty: A higher proportion of African Americans live in poverty than do whites. Barriers related to poverty include the lack of a primary care physician, inadequate health insurance and limited knowledge about breast cancer. Further, through lifelong dietary and reproductive habits, poverty may influence disease pathology and genetic markers of disease, such as lack of a local (or easy to get to) mammography center or lack of transportation to a mammography center.
- Health Insurance: Prior to the Affordable Care Act, a main reason behind the differences in mammography screening rates in the U.S. was health insurance. Women who did not have health insurance were much less likely to get mammograms than women with health insurance. In 2010, only 32 percent of women ages 40 and older with no health insurance had a mammogram within the past two years compared to 71 percent of those with insurance .To learn about getting health insurance in California if you are uninsured please visit Covered California.However, even though a lack of health insurance was a main reason for breast cancer screening disparities in the U.S., other factors play a role. Even among women ages 40 and older with insurance, 29 percent did not have a mammogram within the past two years .
- Breast cancer screening practices: Mammograms and clinical breast exams help find breast cancer at early stages, when the chances of survival are highest. Studies have shown that racial prejudice may result in African American women being referred for mammography less frequently. More research is needed in this area.
- Culture: Studies show that cultural factors affect an African American woman’s decision to be screened and treated for breast cancer. Barriers related to culture include low perception of risk for breast cancer, myths handed down within families and communities, and mistrust of the health care system.
- Lack of a usual health care provider
- Lack of awareness of breast cancer risks and screening methods
- Biology of some breast cancers. Even after accounting for differences in access to care, income level and past screening rates, African American women are diagnosed with later stage breast cancer and have worse survival than white women [99-101]. Differences in reproductive factors and the biology of breast cancers of African American women and white women also appear to play a role in these disparities [102-107].
Although white women have higher rates of postmenopausal breast cancer compared to African American women, African American women have higher rates of premenopausal breast cancer . This may be due, in part, to differences in prevalence rates of some reproductive factors related to breast cancer risk. For example, compared to white women, African American women tend to be an earlier age at their first period, more lifetime periods and higher blood estrogen levels [218-220].
African American ethnicity and triple negative breast cancer
The biology of breast tumors also varies by race and ethnicity. Triple negative breast cancers are more common among African American women than among women of other ethnicities [221-226]. Triple negative breast cancers are:
- Estrogen receptor-negative (ER-)
- Progesterone receptor-negative (PR-)
- HER2/neu-negative (HER2-)
Triple negative tumors have a poorer prognosis compared to other subtypes of breast cancer. They tend to be higher grade and have a greater number of mutations in the p53 gene—factors also linked to a worse prognosis [216,227-229].
Although data are limited at this time, some lifestyle factors may play a role in the higher rate of triple negative breast cancer among African American women. Some studies have found that compared to white women, African American women tend to have lower rates of breastfeeding and tend to carry excess weight in the abdomen area, both of which may increase the chances of having triple negative tumors [217,223,230-231].
It may also be that certain reproductive and lifestyle factors protect more against estrogen receptor-positive (ER+) breast cancers than ER- breast cancers, including triple negative breast cancers. So, although African American may be more likely than white women to have these protective factors, they may not lower the risk of triple negative breast cancers as much as they lower the risk of ER+ cancers. For example, African American women are more likely than white women to [217,223,230-231].
- Have more children
- Have a younger age at first childbirth
- Be overweight or obese (before menopause)
Although these factors lower the risk of breast cancer, this benefit may be limited to ER+ breast cancers [164,217,230-231]. There is even some evidence that these factors may increase the risk of triple negative breast cancers [164,217,230-231]. However, data are limited. These topics are under active study.
Learn more about triple negative breast cancer
Learn more about the molecular subtypes of breast cancer
Learn more about rates of breast cancer by race and ethnicity
Learn about differences in breast cancer rates in the U.S. and around the world
Review the San Diego’s community profile to learn more about these issues locally.
African American Support in San Diego
Susan G. Komen San Diego Funds the following breast health programs:
Circle of Faith
African American breast cancer support group in Southeast San Diego. This group meets the second Saturday of each month at 1601 Kelton Road, San Diego, 92114 from 10:30 am – 12:00 pm.
Contact: Cassandra at (619) 482-2037 or via email at firstname.lastname@example.org
Vista Community Clinic
Provides health education and clinical referrals to all uninsured women focusing those in most need including African American, Hispanic, and Asian/Pacific Islander Women.
phone: (760) 631-5000
La Maestra Community Health Centers
Providing quality healthcare to ethnically diverse communities.
phone: (619) 779-7900
Stay tuned for more resources and community programs coming in 2014-2015
For more free breast cancer services in San Diego click here.
How can you help?
Circle of Promise
Susan G. Komen launched the Circle of Promise campaign to engage African-Americans in its mission to end breast cancer forever by fostering increased awareness, support, empowerment and action. African-American women have the highest death rate and poorest survival rate of any other racial or ethnic group for breast cancer. In an effort to rewrite the story of African American women and breast cancer, Komen has pledged to decrease the mortality of African-Americans from breast cancer by increasing awareness of the risk of breast cancer, reducing pervasive myths in the community, encouraging breast self-awareness leading to early detection and treatment and mobilizing the community to collectively fight for access to quality care for all.