African-American Women & Breast Cancer

African American women are more likely to die of breast cancer.

Breast cancer is the second highest cause of death by cancer among African American women reports the Sister Network. Although African American women contract breast cancer at a 10 percent lower rate than Caucasian women overall; they're much more likely to die from the disease. In addition, African American women under the age of 40 have a higher rate of breast cancer than whites.

There have been many theories on why African American women have higher breast cancer mortality rates and recent research published in the "Journal of the American College of Surgeons" has found that the differences continue in 2009 regardless of age of diagnosis, stage of the disease, type of treatment or socioeconomic status.

The researchers found that African American women are less likely to have surgery, less likely to survive after surgery and less likely to survive non-surgical treatments.

Tumor Aggressiveness

African American women contract breast cancer earlier than white women do

The American Cancer Society reports that African American women tend to have more aggressive breast tumors but why this is so is still unclear. A 2006 study published in "Cancer Research" reported that the tumors attack African American women at younger ages and was associated with certain gene expression patterns.

Cancer specialist Charles McDonald told MedicineNet reporter Beatrice Motamedi that "the cell types are much more atypical than [those of] the average white woman" and that heredity seems to play a role in breast cancer development in African Americans.

Motamedi also reports that African American women are diagnosed with estrogen-receptor negative tumors twice as often as Caucasian women: these tumors resist estrogen-blocking drugs such as tamoxifen.

Diagnosis and Screening

African American women have less access to specialized cancer drugs

The Sister Network reports that only about half of breast cancers in African American women are diagnosed before the disease has metastasized and spread, an 11 percent difference from white women.

Oncologist Leonidas Koniaris believes screening guidelines need to be changed in reference to black women because over 10 percent of the cases have developed by the time the women have reached the age of 40.

Despite increases in breast cancer screening overall in past decades, African American women are still less likely to have access to low-cost mammograms than white women.

Unequal Treatment

African American women are less likely to have surgery or survive it

Some researchers believe that African American women are less likely to seek treatment for breast cancer and others believe that these treatments are less available to black women.

A 1999 study conducted by the National Cancer Institute (NCI) found that the large discrepancy in mortality rates between black and white women grew as better chemotherapy treatments and screening programs evolved. Dr. Otis Brawley says that poor access to health care and lower standards of care for black women have cheated African American women out of improvements in breast cancer screening and drugs.

At the same time, the difference in tumor aggressiveness and talk of a "black" cancer has led many educated black women, says Brawley, to refuse drugs like tamoxifen because they've heard they've not proven effective in black women.

A 2009 study by Emory University researchers has found that one in four African American women refuse treatment for their late-stage breast cancers. The researchers found that 20.5 percent of the African American women refused chemotherapy and 26.3 percent refused chest radiation.
The scientists believe access to health care, cultural beliefs, demographics, and socioeconomic factors play a role in the refusal.

Socioeconomic Factors

Poverty and breast cancer mortality go hand in hand

The Sister Network says that poverty can influence the development and pathways of disease as can diet and reproductive habits.

Dr. Brawley says that even with early diagnosis, other socioeconomic barriers "prevent many African-American women with breast cancer from receiving the latest, most specific treatments."

The American College of Surgeons study found that women in the lowest income category had the highest rates of metastatic disease, low socioeconomic status was linked with less surgical treatment, and survival rate decreased along with poverty level regardless of treatment received.

Other Risk Factors

Diet and other lifestyle factors can increase breast cancer risk

Other risk factors for breast cancer that may be increased in African American women are the risk factors that the American Cancer Society lists for all women.

Genetic mutations, dense breast tissue, cysts and other benign conditions, early menstruation onset and late menopause, reproductive habits, exposure to environmental toxins, alcohol and tobacco use, obesity, physical activity level, high-fat diets and even night work raise the risk of breast cancer in women.

Further research may provide insight into how these factors may play into the increased mortality rates for African American women with breast cancer.

References

• American Cancer Society: What Are the Risk Factors for Breast Cancer? (Sept. 18, 2009)
• Sisters Network: Breast Cancer Facts; 2010
• "Cancer Research": Breast Cancer in African-American Women: Differences in Tumor Biology from European-American Women; K Amend, D Hicks and CB Ambrosone; (Sept. 1, 2006)
• MedicineNet: Battling Breast Cancer: Beatrice Motamedi; (Jun. 12, 2000)