The global pandemic has brought to light a troubling issue in the US health care system: significant disparities in health outcomes among minorities, including African Americans, Latin Americans, and Native Americans. The Centers for Disease Control and Prevention reports that racial and ethnic minorities are far more likely to test positive for the virus and to be hospitalized.[1] For instance, cases have been “skyrocketing” among Latinos, with rates up to four times higher than their share of the population in some states.[2] Another report found hospitalization rates nearly four times higher for older African Americans than whites.[3] Overall, reports show that death rates are six times higher for African Americans and Latinos than for whites.[4]
Such disparities are not limited to COVID-19. There are also significant disparities in breast cancer diagnoses and deaths, particularly between white and African American women. While African American women have had lower rates of breast cancer than white women since 1975, the incidence has increased in recent years even as rates have fallen in white women.[5]
We also know that African American women are more likely to be diagnosed with breast cancer than white women before age 60 but less likely after age 60. However, they are more likely to die from breast cancer, regardless of age. In fact, breast cancer deaths are 40 percent higher in black women compared to white women. And even though death rates from breast cancer are dropping, they are falling twice as fast among white women aged 60 to 69 than African American women.2
The good news is that the rate of breast cancer deaths in women under 50 is declining at the same rate for white and African American women.
What’s going on?
Researchers have identified several possible reasons for the disparities.
- African American women have lower rates of screening mammography.[6]
- African American women are more likely to be diagnosed with triple-negative breast cancer, which is far harder to treat and has a higher death rate. Yet they also seem to do worse overall than white women diagnosed with this subtype.3,[7]
- African American women have higher rates of obesity than white women, which has been linked to hormone-negative breast cancers.3
One of the most important things shown to help close the disparity gap is screening mammograms. When white and African American women are screened at the same rate, those disparities disappear.[8]
Today, screening mammograms are free for all women with health insurance, so cost is less of an issue for many women. We think a big issue is knowledge – more women need to understand the importance of screening mammograms. Thankfully, several organizations are working to get the word out to women, including Sisters Network Inc., the African American Breast Cancer Alliance, Black Women’s Health Imperative, and Sisters by Choice.
Understanding Your Risk
African American women have the same risk factors for breast cancer as women of any other race and ethnicity. And while a family history of breast cancer is certainly a risk, it is not the most important one. Simply being a woman and getting older are the greatest risk factors (neither of which you can do anything about, of course). Other risk factors you can’t control include:[9]
- Reproductive history. Early menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising the risk of getting breast cancer, as does a first pregnancy after age 30.
- Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram.
- Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ may also increase the risk.
- Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts (such as for treating Hodgkin’s lymphoma) before age 30 have a higher risk.
- Previous use of diethylstilbestrol (DES). This drug was given to some pregnant women between 1940 and 1971 to prevent miscarriage. Women who took it, and those whose mothers took it, have a higher risk.
However, there are things you can do to lower your risk of breast cancer.6
- Get plenty of exercise.
- Maintain a healthy weight.
- Reduce your use of hormone replacement therapy and even certain birth control pills (talk to your doctor about alternatives).
- Breastfeed.
- Drink less alcohol (or not drinking at all). Current guidelines call for no more than one drink a day for women.
And, of course, get recommended screening mammograms. While they can’t reduce your risk of breast cancer, they can reduce your risk of dying from breast cancer.
[1] Centers for Disease Control and Prevention. COVID-19 in Racial and Ethnic Minority Groups. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html
[2] Cano RG, Snow A, Aderson B. COVID-19 is ravaging America’s vulnerable Latino communities. Associated Press. June 19, 2020. https://apnews.com/d3c55be27a2549afa2906c190fe5adc9
[3] Medicare COVID-19 Data Release Blog. Centers for Medicare and Medicaid Services. Available at: https://www.cms.gov/blog/medicare-covid-19-data-release-blog
[4] What Does and Does Not Correlate With COVID-19 Death Rates. http://ceepr.mit.edu/files/papers/2020-009.pdf
[5] Richardson LC, Henley J, Miller J, Massetti G, Thomas CC. Patterns and trends in black-white differences in breast cancer incidence and mortality—United States, 1999–2013. MMWR 2016;65(40):1093–1098.
[6] Chlebowski R, Chen Z, Anderson GL, et al. Ethnicity and Breast Cancer: Factors Influencing Differences in Incidence and Outcome. J Natl Cancer Inst. 2005;;97(6):439-48.
[7] Dietz EC, Sistrunk C, Miranda-Carboni G, et al. Triple-negative breast cancer in African-American women: disparities versus biology. Nature. 2015;15:-254.
[8] Grabler P, Dupuy D, Rai J, Bernstein S, Ansell D. Regular screening mammography before the diagnosis of breast cancer reduces black:white breast cancer differences and modifies negative biological prognostic factors. Breast Cancer Res Treat 2012;135:549–53.
[9] Centers for Disease Control and Prevention. What Are the Risk Factors for Breast Cancer? Available at: https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm. 2018.
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