The good news is that fewer women die from breast cancer today because of the increased emphasis on early detection and improved treatment options. The bad news is that those improved treatment options are often not utilized in women of color. In fact, unlike the Caucasian population, “the overall cancer incidence among African American and Hispanic population has continued to grow.”1
Although the numbers of new breast cancer cases are similar for both white and black women, “black women are 42% more likely to die from breast cancer at every age.”2,3 Factors influencing this drastic difference include “poverty, culture, and social injustice.”1
Low income families often struggle to access health care, often do not have a primary care provider, and do not seek out preventative treatments. Likewise, healthcare providers that are employed in “underserved communities are not always equipped and trained to provide the adequate information or treatment to the population that they serve.”1 Therefore, those living in poverty are often diagnosed in later stages of breast cancer, resulting in lower survival rates.
Breast cancer risks include family history, with increasing risk as more family members have been affected by the disease. While these factors cannot be changed, “lifestyle and environmental factors, such as diet, obesity, smoking, alcohol consumption, infectious diseases, and radiation have a profound influence on cancer development.”4 Certain at-risk populations can be treated with specific chemoprevention drugs. However, minorities do not often get these drugs for multiple reasons, including a “lack of insurance, fear of testing, delay in seeking care, barriers to early detection and screening, and more advanced stages of disease at diagnosis.”5
Whatever the reasons, the gap continues to grow between the mortality of black vs. white women with breast cancer. So, whatever we are doing is not working. We need a new strategy to increase preventive medicine for minorities, improve access to care for those at the poverty level, and educate women about their risk factors. Additionally, training for providers who work with underserved communities needs to be improved with a focus on the differences of care needed with respect to socioeconomic status and cultural barriers faced by black women in our society.
At Limbs & Things, we have recently expanded our range of dark-skinned models with the goal to improve teaching through the recognition of ethnic disparities in the care provided to all patients. Our hybrid breast examination trainer allows not only education for providers related to breast exam, it also serves as a wonderful patient teaching guide, allowing women to demonstrate how to complete a self-breast exam. Using this model in the classroom or the clinic can help to start the conversation that is needed to end this social injustice.
In this month of breast cancer awareness, it is our hope that every woman will seek for herself and encourage her friends and family to obtain the appropriate screening as recommended by her doctor. For more information about disparity in breast cancer, please click on R.E.D. Alliance, IU, and Pink-4-Ever, Inc. Initiative
1 Health and Racial Disparity in Breast Cancer
2. Howlader et al. (2015) SEER Cancer statistics review, 1975-2012. National Cancer Institute, Bethesda
3. Coleman MP et al. (2008) Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol 9(8):730-765 (PudMed)
4. Lee OI, Oguma Y (2006) Physical activity In: Schottenfeld D, Fraumeni JF (eds) Cancer Epidemiology and Prevention, 3rd ed Oxford University Press, New York (Google Scholar)
5. Carey LA et el. (2006) Race, breast cancer subtypes, and survival in the Carolina Breast Cancer study. JAMA 295(21):2492-2502 (PubMed) (Google Scholar)