Black Women and Breast Cancer Risk
New research from Mass General Brigham confirms racial disparities in breast cancer survival: Black women are 17% to 50% more likely to die from the disease than white women, depending on the breast cancer subtype.
But one of the researchers wants women to know that they can make a difference in their own outcomes.
“There are a lot of reasons to be hopeful. These disparities are not inevitable,” says Erica Warner, ScD, MPH, a Mass General Cancer Center epidemiologist and investigator at Massachusetts General Hospital.
“Forty to 50 years ago, there was no difference in mortality between Black and white women. These disparities emerged over time. So that tells us that there’s something about how we’re living and how we’re treating people with breast cancer that has contributed to that. And if we could create it, we can undo it,” Dr. Warner shares.
The Warner Lab works to ensure that all women benefit from advances in breast cancer detection and treatment. Dr. Warner encourages women to advocate for themselves by understanding the risk factors and getting screening tests and follow-up care. She also offers advice to those facing a diagnosis.
Racial disparities in breast cancer
Dr. Warner acknowledges that racial disparities in health care are complex. According to her research, reasons include socioeconomic inequality, delays in diagnosis, and inadequate access to high-quality treatment.
“There is a legacy of systemic racism in health care. It is historic, but it’s also still happening right now. Black Americans have less income, less wealth, live in more socioeconomically deprived areas, and have less access to high-quality care,” she explains.
“Disparities arise because some people get advantaged and other people don’t. As we have improved our ability to detect breast cancer through new technology, and as we have gotten better at treating breast cancer, there has been a growing gap in which people get those things and which people don’t. Black women are less likely to receive the benefits of all these advances that we’ve made.”
Dr. Warner believes that identifying and acknowledging the problem is the first step to addressing it. There are national efforts to reduce disparities, such as Equal Hope. Mass General Brigham is mindfully creating approaches to improve the timeliness, quality, and completeness of care received by Black women, through its United Against Racism initiatives and the Lifestyle Medicine Program at Mass General Cancer Center.
Breast cancer risk factors in Black women
Women can make a difference in their own care by understanding certain risk factors. Some are especially relevant for Black women.
Breast density
Breast density is a measurement of the amount of fatty tissue compared to the amount of fibrous tissue in a breast. It can be difficult to detect breast cancer in women with more fibrous tissue using traditional mammograms.
“There is some evidence that Black women, on average, have denser breasts,” Dr. Warner explains. “This does not necessarily mean they are more likely to get breast cancer, but the disease may be more difficult to see. Early detection and treatment are essential for the best chances at survival, so women with dense breasts may benefit from special types of screening.”
Mass General Brigham uses 3D mammography, which provides clearer images of breast tissue. Dr. Warner encourages all women to ask their doctors about their own breast density and what screening tools are right for them.
Reproductive history
Hormones and reproductive history play large roles in the development of breast cancer. These factors can increase a woman’s risk:
Starting your menstrual cycle (periods) before age 12
Going through menopause after age 55
Not having any children, or starting to have children after age 30
Not breastfeeding
Many of these factors may not be in a woman’s control, but Dr. Warner says it’s important to understand how they may affect your personal risk. She highlighted the significance of breastfeeding, which can reduce a woman’s risk. Specifically, breastfeeding is protective against triple-negative breast cancer in Black women who have had multiple births.
“You can actually reduce your risk just by breastfeeding,” she says. “Unfortunately, breastfeeding is less common in Black women than in white and Asian women. Black women face many barriers to breastfeeding, such as not having paid maternity leave and a lack of spaces for pumping.”
Body weight
Although body weight is a risk factor that people can change, it’s associated with breast cancer in complex ways, Dr. Warner says. Being heavier at younger ages is associated with a lower risk of breast cancer. But after menopause, being heavier is associated with an increased risk.
Most breast cancers are diagnosed after menopause. So managing body weight and being physically active after menopause are important steps women can take to try and manage or reduce their risk of breast cancer.
The concepts of lifestyle medicine can help, Dr. Warner says. Lifestyle medicine helps people adopt behaviors that have been proven to improve health and prevent disease, such as:
Adequate sleep
Avoidance of risky substances (for example, quit smoking and limit alcohol)
Healthy eating habits
Healthy relationships with other people
Regular exercise
Advocate for yourself
When you are an active participant in your health care, you can help reduce disparities. This includes being screened for breast cancer and talking with your doctor about your personal risk for the disease.
The United States Preventive Services Task Force (USPSTF) recommends that women have a screening test for breast cancer every other year starting at age 40. However, some women with increased risk should be screened earlier or more often.
Dr. Warner recommends that every woman ask their doctor the following questions:
Can we review my personal risk factors for breast cancer?
With my personal risk factors, when should I get screened for breast cancer?
Do I have dense breasts?
Should I get a more advanced type of screening?
Should I get genetic testing or genetic counseling?
If you have been diagnosed with breast cancer, Dr. Warner recommends the following:
Get a second opinion.
It’s important that you feel comfortable and feel like you have a trusted representative when you’re going through breast cancer care. “Where you’re diagnosed might not be the best place for you to get your care. Make sure you feel comfortable with the institution or at least someone on the team,” she says. Getting a second opinion might not only reveal more treatment options, it also can find you a better clinical home.
Understand your diagnosis.
Treatment options and chances of survival often depend on the cancer subtype. Black women have a higher risk of hormone receptor–negative tumors, sometimes called triple-negative breast cancer. These subtypes traditionally have been more difficult to detect with mammography and have had fewer treatment options because they don’t respond well to hormonal therapy.
But new medications have come out that are specifically for women with triple-negative breast cancer. “I hope that over time, that will make that type of breast cancer less deadly,” Dr. Warner says. “So it’s important for women with breast cancer to understand what subtype of breast cancer they have.”
Ask detailed questions about treatment options.
What does the doctor recommend? Why do they think that’s the best approach? Are there other options? What are the risks and benefits of each option?
Ask about clinical trials. “Sometimes people think of clinical trials as just experiments, or as a last resort. But they are where you can get cutting-edge care,” Dr. Warner says. “And we’re always trying to get better representation of Black people so that we can understand whether new therapies work well in those populations.”
Get a survivorship care plan. A survivorship care plan is a document that summarizes the details of your diagnosis and treatment. It offers guidance for your ongoing health care, including monitoring for cancer recurrence and potential long-term side effects of treatments.
