Our Promise to Black Women
When 27-year-old Shaneera made the decision to breastfeed her newly born daughter in August 2007, little did she know that decision to breastfeed would change her life. Wanting to give her daughter the gift of a good life start, Shaneera was anxious when she felt a lump while nursing. After months of being brushed off by her primary health care provider, multiple referrals to breast surgeons and misdiagnosis, she was finally diagnosed with stage three breast cancer. In less than three years, on June 23, 2010, Shaneera died of breast cancer. Her husband and now 3-year-old daughter cannot understand what happened.
And neither can we at the Black Women’s Health Imperative understand why Black women have not benefited from the progress being made in research and new technologies. Our mission in launching a new educational campaign is to raise questions, seek understanding, and call attention to what is happening to young Black women.
This is what we know.
We know that although Black women have a lower breast cancer incidence rate than other women, Black women are dying at a significantly higher rate than any other group of women. This fact is more complex than many may think. And most alarmingly, we don’t know why.
Consider these little known facts:
Breast cancer is the most commonly diagnosed cancer among Black women and the second leading cause of cancer death. In 2009, it was estimated that nearly 20,000 new cases of breast cancer occurred among Black women and of those new cases, more than 6,000 would not have a 5-year survival rate.
Among young Black women, under age 40, the breast cancer incidence and mortality rates are higher than in white women. Yet not until 2008 did researchers reveal that the Gail Assessment Model being used to estimate breast cancer risk and to select women for clinical trials was an inappropriate tool to determine Black women’s risk.
Black women are two times more likely to develop triple negative breast cancer, an aggressive form of cancer for which there are few effective treatment options. This particular form of cancer limits treatment options; and certain therapies have been ineffective in treating triple-negative breast cancer.
Black women have a lower 5-year survival rate compared to white women: 77 percent vs. 90 percent, respectively. Yet it is not clear how reduction in mortality for white women can translate to better outcomes for black women.
Although many attribute poor outcomes for Black women to lack of insurance, chronic stress, and inadequate access, researchers and clinicians are just beginning to explore “Unequal Treatment” as a major factor in racial differences in breast cancer mortality. The “Unequal Treatment” research documents that quality of care differences indeed contribute to mortality disparities.
Among these care and treatment differences are inadequate access to quality and appropriate screening mammography and clinical breast exams, delay in testing following abnormal screening results, inadequate communication regarding treatment options and side effects, lower rates of referrals for definitive therapy, reduced monitoring following treatment, and inadequate survivorship care.
Abstract
African-American women face a lower risk of being diagnosed with breast cancer as compared to Caucasian-American women, yet they paradoxically face an increased breast cancer mortality hazard. An increased incidence rate for early-onset disease has also been documented. This manuscript review summarizes the socioeconomic, environmental, genetic, and possible primary tumor biologic factors that may explain these disparities.
Breast cancer incidence is lower in African-American than in Caucasian-American women, yet breast cancer mortality rates are paradoxically higher for African-American women. These poorly understood disparities have been consistently documented in population-based data from the Surveillance, Epidemiology, and End Results (SEER) program since its inception in 1976. Another notable feature regarding ethnicity-related variation in the epidemiology of breast cancer is that African-American women face a greater risk for being diagnosed with early-onset disease. This review summarizes the information available on the epidemiology of breast cancer in African-American women, as well the possible socioeconomic, genetic, and primary tumor biologic factors that account for these variations.
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Lisa A. Newman, M.D., M.P.H., F.A.C.S., Associate Professor of Surgery, Director, Breast Care Center, University of Michigan, 1500 East Medical Center Drive, 3308 CGC, Ann Arbor, Michigan 48109, USA. Telephone: 734-936-8771; Fax: 734-647-9647; e-mail: .(JavaScript must be enabled to view this email address)
And that is why we oppose the 2009 U.S. Preventive Services Task Force (USPSTF) updates to its 2002 breast cancer screening recommendations. The Imperative believes that two of the USPSTF recommendations do a serious disservice to Black women and could prove deadly: 1) that mammograms should be delayed until age 50 and, even then, performed only every other year and 2) that breast self-exams and clinical exams are unnecessary.
We strongly recommend that Black women continue to perform monthly breast self exams, request an annual clinical breast exam performed by a health care provider, and advocate for a mammogram starting as early as possible and no later than age 40. We ask ourselves - what difference does our advocacy make? We are not sure about the long-term impact. But we, at the Imperative, have established breast cancer as a priority issue and ask that you join us in a national movement to advocate for a breast cancer cure for Black women, too.
With many preventive health services beginning September 23 as part of health care reform, we are also tremendously concerned about how health insurance companies will interpret these USPSTF recommendations. Will they use these recommendations to deny coverage of mammograms before age 50, and then only every other year? Will younger Black women be denied the breast cancer screening and the appropriate treatment they need in a timely manner, therefore jeopardizing their chances for overcoming the 5-year survival rate?
As the president and CEO of the Black Women’s Health Imperative (Imperative), a 27-year-old organization dedicated to promoting optimum health for Black women across the life span - physically, mentally and spiritually, I serve as the chief advocate for improving the health status of Black women. We are working tirelessly to ring the alarm on medical and social injustices that result in persistent health disparities and unnecessary lives lost.
In seeking a focus on young Black women, we are calling national attention to these three facts: Black women: 1) tend to be diagnosed with breast cancer at a younger age; 2) are more likely to be diagnosed with a more virulent form of the disease, triple negative breast cancer; and 3) are more likely to die of breast cancer than other women.