Closing the Gap: Breast Cancer in African American vs. White Women

It is no mystery that poverty, socioeconomic disparities, and race have enormous impacts on our health and the probability of contracting many illnesses. The intersectionality of race and poverty play a critical role in risk-promoting lifestyles, limited access to healthcare, increased exposure to carcinogens, and ultimately, cancer development (Wells, 2019). Caught in the web of these social forces are poorer women of color in the United States, who have developed higher incidence and lower survival rates of breast cancer compared to all demographic groups. In order to understand how to find solutions to this disparity, we must first understand the factors that create an environment where cancer rates rise dramatically.

Socioeconomic status and race have proven to be a strong predictor of cancer incidence. While genetic predispositions play a significant role in the development of cancer, research shows that out of 39 cancer types, 32 are associated with poverty (Wells, 2019). In general, poorer populations report more chronic illnesses and more disease complications, making the treatment of cancer, specifically, more difficult and the implications of developing cancer more severe. Intersectionality of different marginalized groups in the United States, adds nuances and puts up more barriers between people and cancer care and prevention.  In particular, the intersection of race and poverty in the United States have increased difficulty accessing quality healthcare. In January of 2019, several faculty at WashU publishes a book called Poverty and Place: Cancer Prevention in Low-income Women of Color. According to this book, African Americans, in general, are twice as more likely to fall below poverty than white people (Wells, 2019), making it difficult to both access and finance the healthcare they need. Living as a member of a marginalized, or lower-income group increases stress and stress related illnesses, as well as cancer mortality rates. Understanding how social factors affect the prevalence of disease is critical in order to break the barriers that stand between marginalized groups  and quality and accessible healthcare.

Once we understand that disadvantaged populations are at a higher risk for developing disease due to many different intersecting factors, it allows us to look at the issue from a more informed perspective.  Breast cancer is the second most common cause of death for African American women, preceded only by lung cancer (Wells, 2019). Shockingly, while breast cancer rates in white women have declined over the last decade, the rate of breast cancer in African American women has continually increased[1]. Evidently, there is a strong need to understand how this disparity manifests itself in our society, and how barriers prevent African American women from achieving good health. African American women are more likely to be diagnosed with breast cancer at later stages of the disease and experience delays in treatment. Often, there are long intervals between screenings, lack of timely follow up and delays in treatment after diagnosis has occurred[2]. These problems arise specifically and as a direct result of the race and socioeconomic status of the patient, and alarmingly lead to increased mortality among African American women compared to white women. African American women are 42% more likely to die from breast cancer than white women[3]. The graph below shows the number of deaths from female breast cancer from the years 2009 to 2013.

Number of New Deaths From Female Breast Cancer (2009-2013) [4]

Additionally, African American women may have a more challenging time accessing healthcare, and because of  barriers such as access to higher education, higher paying jobs, and job security, they may not have the ability or resources to prioritize their health. In addition, African American women are not treated equally in medical settings and medical interventions can be neglectful or insufficiently administered due to marginalization and bias.

Recently, studies have shown that young African American women suffer from a higher incidence of basal-like breast cancer, an aggressive subtype of breast cancer that has no targeted therapies. Basal-breast cancers are usually estrogen, progesterone receptor, and HER2 negative (triple negative breast cancer). This type of breast cancer is immensely difficult to treat and has poor survival rates [5]. While the exact reason for the disproportionate incidence of basal-like breast cancer in African American women is unknown, studies show that there are concrete ways to lower the incidence rate of all types of breast cancer in African American women, which would significantly help decrease this disparity. In order to target disparities, we must look at the circumstances which allow cancer rates to flourish in certain groups. People of lower socioeconomic status often live in areas of the country where access to healthcare is sparse and the shortcomings in health education are abundant. Because of this, African American women may not be aware of preventative measures for breast cancer, specifically early diagnostic techniques like mammograms. According to Marlyn Allicock’s article, on African American Women’s perspective on breast cancer, 68% of basal-like breast cancer could be prevented by decreasing obesity rates and increasing breast feeding [6]. Educating populations that are particularly at risk for obesity and low rates of breastfeeding about the relation to breast cancer may help reduce the prevalence of basal-like breast cancer in African American women. By filling in “knowledge gaps,” and understanding current cultural “attitudes and beliefs” about cancer prevention, we can more easily target barriers to healthcare and ultimately lower rates of basal-like breast cancer in this subgroup of the population [7]. Causes of breast cancer in African American women are difficult to target because of their intricate nature, but it is critical to lowering the prevalence and disproportionate incidence of this disease.

By comprehending the gravity of the disparities in breast cancer incidence between white and African American women in breast cancer incidence, mortality, and treatment, it is clear that these problems are deeply rooted in social issues. Nevertheless, there are concrete solutions to raise awareness of prevention strategies and to change medical settings so that screenings and treatments are timelier. The Center for Disease Control and Prevention’s (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) offer uninsured women access to no-cost screening, diagnostic and other pathways to cancer treatment and care [8]. More than 180,000 have received free screenings from this outreach program. In addition, the American Cancer Society Cancer Action Network (ACSCAN) as well as other groups are working to support cancer patients who have experienced discriminatory experiences in medical settings, and is also working to create a patient navigation system especially for underserved populations [9]. Finally, prevention outreach programs are starting to become more prevalent across the country [10]. Closing this gap will require comprehensive solutions that target the multidimensional issue, and tackle the intersectionality aspect of cancer care; these programs take steps in the right direction.

Edited by: Casey Connelly

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