Although breast cancer is more common in white women, Black women are more likely to develop advanced-stage disease before receiving a diagnosis, according to data from the American Cancer Society (ACS).
They are also more likely to be diagnosed at a younger age and have more aggressive forms of breast cancer than white women, the Centers for Disease Control and Prevention (CDC) says. This includes metastatic cancer, meaning the disease has spread to other organs and the lymph nodes.
As a result, Black women are more than 40 percent more likely to die from the disease, compared with women of other racial and ethnic backgrounds, as well as develop breast cancer before turning 50, the ACS says. This is also likely due to Black women being twice as likely as white women to develop triple-negative breast cancer, the National Institutes of Health (NIH) reports.
What Is Triple-Negative Breast Cancer?
Although triple-negative breast cancer makes up less than 10 percent of breast cancer diagnoses overall, it accounts for more than 20 percent of breast cancer diagnoses in Black women, an analysis published in Frontiers in Public Health found.
Thankfully, in recent years, significant strides have been made in identifying risk factors that make Black women more vulnerable to aggressive forms of the disease. Being aware of these risks can improve the chances of survival, according to the ACS.
A triple-negative diagnosis means that the breast cancer tests negative for three receptors: progesterone, estrogen, and HER-2, the ACS says.
HER-2, or the human epidermal growth factor receptor 2, is a protein found wrapped around the surface of breast cells that promotes normal growth. When breast cancer is HER-2 negative, there can sometimes be a lack of protein production.
According to the ACS, triple-negative breast cancer cells do not have estrogen or progesterone receptors or enough of the HER-2 protein for hormone therapy or other targeted drugs to be effective, limiting treatment options and making it more aggressive than other forms of breast cancer.
Unfortunately, this also results in triple-negative breast cancer having a worse prognosis and a higher likelihood of returning. That said, remission is possible, depending on the stage of cancer at diagnosis. Treatment varies among surgery, chemotherapy, radiation, and targeted medications, such as:
- capecitabine (Xeloda)
- olaparib (Lynparza)
- pembrolizumab (Keytruda)
- sacituzumab govitecan-hziy (Trodelvy)
Triple-Negative Breast Cancer in Black Women
Being diagnosed with breast cancer can be devastating, and receiving a triple-negative diagnosis can be downright earth shattering, especially for Black women, given their risk for more severe disease compared with women of other racial and ethnic backgrounds.
Monique Gary, DO, a breast surgical oncologist and the medical director of the Grand View Health Cancer Program in Sellersville, Pennsylvania, underscores how vital early detection is in treating breast cancer. Still, for some Black women, that’s much harder than it sounds. A small, focus group–based study published in June 2022 in the Journal of Racial and Ethnic Health Disparities found that Black women often report distrust of the healthcare system and lower access to care, including regular screenings, than white women.
Barriers to Early Breast Cancer Detection in Black Women
Understanding the barriers Black women face in early detection and what makes them vulnerable to more aggressive forms of breast cancer can help provide valuable insight to improve their prognosis. According to Dr. Gary, a few risk factors include:
1. Lack of knowledge about breast cancer and family history
According to Gary, one of the largest risk factors for Black women is lack of knowledge or access to information about the disease. “Health literacy is sorely needed in our communities, in our homes, and in our places of worship,” she says.
2. Poverty and access to quality medical care and mammography
According to the United States Census Bureau, the poverty rate for Black Americans in 2021 was nearly 26 percent, compared with just over 9 percent for white Americans. In addition, in 2020 the Henry J. Kaiser Family Foundation reported that Black Americans were 1.5 times more likely to be uninsured than white Americans.
Living at or below the poverty line and not having access to comprehensive medical insurance creates tremendous barriers for Black women. Sadly, this often results in Black women being diagnosed with breast cancer at a later stage or after the cancer has spread, which inevitably increases their mortality rate.
Even among women with insurance coverage, Black women are less likely to be offered the most effective screening modality for dense breasts — 3D mammography — despite having greater breast density on average, according to a study published in August 2021 in the journal Epidemiology.
Gary stresses the importance of receiving not only timely medical care but also “high-quality medical attention.” This means a doctor who will spend time with their patients, answer questions, and connect them with the diagnostic and treatment services needed.
In addition, the Epidemiology study found that Black women are less likely to undergo a magnetic resonance imaging (MRI) scan after receiving a breast cancer diagnosis.
Too often, people living in poverty in the United States or living in disadvantaged areas don’t have access to quality healthcare, according to the American Academy of Family Physicians.
The impact of poverty in the Black community is as broad as it is devastating. Similar to how poverty affects access to health insurance and healthcare, it also creates food insecurity and hinders access to healthy food options.
Simply put, eating healthy can be expensive, and more affordable options are typically lower in nutrition. Lack of access to healthy food options is a driving force behind high rates of obesity in the Black community.
According to the U.S. Department of Health and Human Services Office of Minority Health, in 2018 Black Americans were 1.3 times more likely to be obese than white Americans, and roughly four out of five Black women were overweight or obese. Because obesity is a known risk factor for cancer, according to the NIH, it’s no surprise that the prevalence of obesity among Black women makes them even more vulnerable to invasive forms of cancer and higher mortality rates.
4. Racism and bias in the medical profession
Some argue that the Black community in general and Black women in particular have reason to be wary of medical professionals. Historically, researchers have experimented on Black Americans without their consent, in the name of medical advancement.
“What people may fail to realize is that bias has important implications for treatment and survival,” Gary notes.
Genetic testing is an example of this: Despite similar rates of mutation, women of color are not tested as frequently as white women, a review found.
Furthermore, Black women are represented in less than 3 percent of breast cancer clinical trials, according to a study published in 2020.
“This is indefensible, and the medical community must do better in trial design recruitment and retention for those who are dying at a disproportionate rate,” Gary adds.
Some improvements have been made, but racism and bias remain in the medical establishment. A study published in October 2019 in the journal Science found evidence of racial bias in many layers of the U.S. healthcare system — even in the medical records software many hospitals and practices use.
“I cannot tell you the number of young Black women turned away by their physicians when they find a palpable lump and are told they have clogged milk ducts or other benign findings, without further investigation through diagnostic imaging,” Gary says. “Rather than focus on the lack of trust in the medical establishment by Black women,” she adds, “I shift the focus to reflect that the medical community has not earned the trust of Black people.”
What Black Women Can Do
Although fighting cancer is not for the faint of heart, there are steps you, as a Black woman, can take to decrease the likelihood of developing an aggressive form of breast cancer or improve your prognosis if you’ve already been diagnosed.
1. Educate yourself about breast cancer and discuss your family history.
Knowing your family history can be a saving grace. Gary encourages Black women to “discuss family history early and often.”
“Let’s get informed about our risk factors and discuss them with our families and our physicians,” she says.
In 2018, the American College of Radiology put out a statement that African-American women should start the conversation with their physician regarding their breast cancer risk at the age of 30, and strong consideration should be given to starting breast cancer screening before the age of 40.
So, if you’re 40 or older or at high risk of breast cancer due to family history, annual mammograms should be part of your healthcare plan. If your risk is higher than average, explore options for more aggressive breast cancer screening with your physician and learn how to perform a breast self-exam.
2. Educate yourself about your options.
It might take a little more research, energy, or time, but there are options for women from all socioeconomic backgrounds. If cost is a concern, consider speaking with a doctor, local hospital social worker, nurse navigator, or staff member at a mammogram center and ask about free programs in your area.
3. Get moving and get healthy.
According to Gary, “A sedentary lifestyle is a known and high-risk factor for many types of cancer, including breast cancer. Even exercising 30 minutes a day can reduce a woman’s risk by greater than 20 percent,” she says. She also suggests eating foods that are high in antioxidants and fiber.
If healthy eating is financially challenging for you, ask a social worker for help finding healthy eating programs in your area.
4. Advocate, advocate, advocate!
You must feel empowered to ask your doctors questions and to identify resources.