Just as all breast cancers are not alike, the impact of breast cancer is not the same for all women. African American women are less likely to get breast cancer than Caucasian women, but they are about 40% more likely to die of it when they do get it. African American women are also more likely to be diagnosed with breast cancer at a younger age than Caucasian women and to have more advanced cancers at diagnosis.
There appear to be multiple reasons for these disparities - including cultural beliefs / misperceptions about screening and cancer; lack of access to screening; inequities in healthcare delivery and treatment; concerns about being exposed to racism by healthcare institutions; and biological differences in the cancers themselves.
Let’s look at some of these more closely.
- Cultural beliefs / misperceptions about screening and cancer: Some African American women may not believe that screening mammograms are a good idea. They may be concerned that getting mammograms actually causes cancer or that a diagnosis of cancer is an automatic death sentence, so why would you want to know. In fact, multiple studies have shown that getting regular mammograms is helpful in having cancers diagnosed earlier. We can’t prevent breast cancer but the earlier it is diagnosed, the better the chance for a good outcome.
- Lack of access to screening, healthcare inequities and racism: Some studies suggest that African American women are less likely to have screening mammograms and more likely to have longer intervals between mammograms than Caucasian woman. There may be fewer screening centers in some communities and women without health insurance may be unaware of programs providing free or low cost screening mammograms and PAP smears. Some healthcare systems may be difficult to navigate and may require that patients be strong self-advocates to get good care. Prior negative experiences with hospitals and clinics may also keep women from wanting to go in for screening or care if an abnormality is identified.
- Biological differences: It may be that some African American women, for unclear reasons, get more aggressive types of breast cancer that can be difficult to diagnosis early. These biological differences are currently under study.
So what can be done to prevent African American women from dying of breast cancer more frequently that White women? I think that at least four interventions can help:
- Education – Through community outreach, work place brown bag health talks, church health fairs, community center workshops and the like, we need to get the word out to all women that breast cancer screening with mammograms and clinical exams is crucial to early diagnosis. While screening does not guarantee an early diagnosis, lack of screening more often results in a late diagnosis. The increased visibility of women who are breast cancer survivors shows others that this does not need to be a death sentence.
- Improved access – One of the things that we do at Swedish is to take screening to work places, community centers, tribal reservations, and community clinics to make it easier for women to get mammograms. The Affordable Care Act will provide more women with insurance that will cover screening.
- Institutional racism and disparities in the provision of health care – Many providers, clinics, and hospital systems are working hard to understand and eliminate unequal treatment based on race, economics, education, disability or other issues. There is a lot more work to be done but things are changing. Learning to advocate for your health care or having friends that can advocate for you is important. No one needs to settle for poor care or to feel uninformed about their findings and options.
- Biology – Ongoing research will provide a better understanding of tumor characteristics which will in turn help to improve screening, interventions, treatment and survival. We, as African American women, need to be willing to participate in research studies to help increase knowledge that will benefit all of us.