While there have been amazing advances in breast cancer research over the last few decades, a new study suggests that not everyone is benefitting from it. There is a significant racial disparity between black and white women in breast cancer-related deaths in the U.S., according to a new study published in the journal Cancer Epidemiology. And even more shocking is the fact that this gap became even wider in many cities from 1990 to 2009. These startling findings pose the question: Why are more black women dying from breast cancer than white women each year?
The Frightening Findings
This latest research conducted by Sinai Urban Health Institute and the Avon Foundation for Women was prompted by their two earlier studies, which found these racial disparities in several cities across the country. After those findings came out, hospitals all over the U.S. asked them to take a look at the stats in their cities, too. So the researchers looked at breast cancer-related deaths in the 50 largest U.S. cities at four time points (1990-1994, 1995-1999, 2000-2004, and 2005-2009). Of those 50 places, they were only able to get data from 41 of the cities. The goal was to see the black/white disparity in breast cancer mortality (the difference between how many black women died from breast cancer and how many white women died from breast cancer), and how this disparity changed over time. Ideally, we would hope to see that the rates of black women and white women dying from breast cancer have both decreased at the same rate over time. Unfortunately, that wasn't the case.
Here's what they found: Between 1990-1994, the overall racial disparity for the U.S. was 17 percent. That means that at that time, black women were 17 percent more likely to die from breast cancer than white women were. That disparity varied for different cities, but only a few cities had a large disparity at that time. Fast forward to 2005-2009 and the U.S. disparity grew to 40 percent. Again, some cities were faring better than others; for instance, New York only had a 19 percent racial disparity, while Memphis had a 111 percent disparity. During 2005-2009, they saw a racial disparity in 39 of the 41 cities, and this gap grew over time in 35 of those cities. Essentially, the rate of white women dying from breast cancer was declining, while the rate of black women dying from breast cancer was not changing substantially.
The Reason for the Race Gap
The scope of these findings show that this difference cannot be blamed solely on genetics, says study coauthor Marc Hurlbert, executive director of the Avon Breast Cancer Crusade. "Other studies have shown that black women are more likely to get triple-negative breast cancer and more aggressive forms like inflammatory breast cancer," says Hurlbert. "But to go from almost no disparity in 1990 to a significant one in 2009—that change over time and that geographic variability shows that it has to be an issue of accessing care."
While the researchers can't be sure exactly why this disparity exists or why it's continued to grow, they have a few theories: "Certain technological advances related to screening and treatment that became available in the 1990s—such as digital mammography, advances in surgery, and new drugs for treatment—have been less accessible to black women, who are disproportionality poor and un- or under-insured and less able to obtain access to these advances," says lead study author Steve Whitman, Ph.D., director of Sinai Urban Health Institute in a press release.
In their earlier 2012 study, they found that cities with a larger poverty gap and cities that were more segregated had a larger disparity of breast cancer mortality between black women and white women. In areas like this, it wouldn't be uncommon for black women to have a harder time accessing the best, most comprehensive care—including the best hospitals, digital mammography, breast cancer specialists reading mammograms, and patient navigators helping women along the way. These are all things that have been proven to improve your chance of survival, says Hurlbert, but they aren't accessible to all women.
Closing the Gap
Since this data collection ended in 2009, the researchers aren't sure if the disparity continues to grow. "We're optimistic that the addition of Avon funded programs and the Affordable Care Act rolling out will mean more women will have access to insurance," says Hurlbert. "But that might take up to a decade [to affect the data]."
In the meantime, Hurlbert suggests that all women get informed about their breast cancer risk and demand access to high-quality screening and treatment. "Find a center with a dedicated breast imager, ask who is reading your mammogram, demand timeliness," says Hurlbert, as research shows that getting your mammogram read by a breast cancer specialist (rather than a general radiologist) and starting treatment early are crucial steps that can make a huge difference in your outcome.
Hulbert also suggests doing what you can do to lower your personal risk of breast cancer. For instance, we know that exercise can lower your risk, as well as maintaining a healthy weight and lowering your alcohol intake. While these new findings are shocking, Hurlbert hopes they'll help point us in the right direction for future research: "Here's where we are now. Now how can we improve upon that going forward?"