Thought to affect one in eight women at some point in their lifetime, the most common cancer to affect women worldwide is breast cancer. Paradoxically, despite black women having the highest mortality rates, they face a much lower chance of being diagnosed compared to their Caucasian counterparts.
Understanding the problem
There are different classes for the genetic defects which lead to breast cancer. These classes include oestrogen receptor positive/negative (ER-positive/ER-negative) or progesterone receptor positive/negative (PR-positive/negative) with ER-positive cancers being the most common. Of these different classes, women diagnosed with hormone receptor negative breast cancers have a lower chance of survival. The rarest types of breast cancer are triple negative breast cancers which lack receptors for oestrogen, progesterone and a protein called HER2. Though it is fortunate triple negative breast cancers are less common, they are also far more aggressive and unresponsive to hormone therapies.
Reports have shown that black women tend to present with breast cancer pre-menopause at much earlier ages than in white women, are more likely to be diagnosed with ER-negative tumours and twice as likely to be diagnosed with triple negative tumours. These tendencies around breast cancer are shown across numerous populations of black women, indicating an irrefutable genetic link. For this reason, despite breast cancer occurring at significantly higher rates in white women, black women globally have a higher chance of it proving fatal.
It is therefore clear that a lack of attention and late stage diagnosis for black women on this issue is problematic and suggests the need for an improvement in the communication of science to quite literally save lives.
One reason for the lack of diagnosis among black women is that within black communities, particularly amongst older women, breast cancer is taboo. There is a stigma pervading the topic that stops black women from discussing it. This increases their risk of mortality as studies have shown that within some black women, discussing cancer is associated with less delays in presentation.
Cancer has for a long time been understandably thought of as an ‘automatic death sentence’, and it is no surprise this sentiment would stretch to the feelings of black women also. It is this fear that inhibits black women from attending screenings to begin with. Further fear of conventional treatment is another worry of many black women as Jones et al in a paper from 2014 showed that a majority believe the treatment and side effects are worse than the breast cancer itself. Another worry concerns the physical ramifications of surgery – many are anxious of being abandoned by their partners and being perceived as less physically appealing.
It is evident that many black women have specific concerns regarding breast cancer which campaigns fail to address.
Lack of easily accessible data
Popular websites responsible for educating the general public often include information on breast cancer incidence, mortality, survival and risk factors. However, this information is often not race-specific or selectively addresses racial differences within breast cancer whilst overlooking others. For example, Cancer Research UK misleadingly highlights that breast cancer occurs at lower incidences within black women but does not further explain they are more likely to die from it. This breadth of knowledge which should be made clear to black women is evidently lacking. The majority of black women in a Chicago study were unaware of differences in breast cancer mortality rates between black and white women. As a result, statistics show black women are less likely to go for consistent screenings. This lack of awareness can have severe consequences, resulting in increased mortality rates.
A way the procedure surrounding breast cancer fails to include black women is the information presented regarding mammograms and the screening process. According to Cancer Research UK, every three years, women aged between 50 and 70 are invited by the NHS for screening.This choice in age range is problematic as, on average, breast cancer is seen within black women in the UK at age 46 – four years before an invitation for routine screening and 21 years earlier than the age breast cancer is seen on average within white women. Regular screening from the age of 50 as a way to increase early detection is therefore unsuitable. This screening age recommendation could help to explain why in 2008 it was reported that, of those with breast cancer, 62% of black women in the UK had grade three tumours as opposed to 42%of white women. Early detection is known to increase the likelihood of successful treatment but a lack of careful consideration can simply result in large disparities across populations, leaving behind those who could use the diagnosis most.
For these reasons among others, breast cancer information needs to be communicated to black women more effectively. The need for cultural sensitivity, changes to the way groups are targeted and better communication of information are some issues of particular concern among many. Not only do black women’s concerns regarding breast cancer need to be addressed, it is necessary to encourage them to partake in screening. If campaigns and screening measures continue to exclude black women – especially as global breast cancer incidence is rising, disparities in mortality will only continue to widen.