Why Is Breast Cancer Mortality Higher For African-American Women Than For White Women?


Published:

NAVFAC Washington Walks for Breast Cancer Awareness

© NAVFAC, Flickr CC

White women in the U.S. are slightly more likely to develop breast cancer than black women – but less likely to die of it. There has been a 35 percent decrease in breast cancer mortality rate from 1990-2012. The breakdown by race over this period, however, shows a different story. Death rates for black women decreased by 23 percent, while the death rates for white women declined by 42 percent.

A big, but not the only, reason for this is that white women tend to more frequently get two subtypes of breast cancers, called ER-positive or HER2-positive, for which we now have very effective targeted treatments.

Black women, however, are two to three times more likely than white women to get an aggressive type of breast cancer called triple negative breast cancer, for which there are still no approved targeted treatments. Researchers do not yet know all the reasons why this is so, but are looking for answers.

Research has vastly improved breast cancer treatments and survival rates over the years, with a five-year survival rate for localized breast cancer at 98.9 percent, but the gap in mortality rates between black and white women has stubbornly persisted.

We study breast cancer, with a special emphasis on health disparities. Here are some of the trends we see.

 Chart: The Conversation, CC-BY-ND Source: SEER Cancer Statistics Review

Disturbing Numbers

First, some statistics that lay out the extent of the problem. About 1 in 8 American non-Hispanic white women, and about 1 in 9 African-American women will suffer from breast cancer in their lives.

While breast cancer is slightly less prevalent in African-American women, it is much more likely to be diagnosed at a later stage in them. About 37 percent of white patients and about 47 percent of black patients will have cancers that have spread from their breast to nearby lymph nodes at diagnosis. When the disease has spread, it typically presents a greater treatment challenge. In fact, the five-year survival rate for breast cancer patients with distant metastasis, or disease that has traveled to another organ such as the liver or bone, is 26.9 percent, as compared to 98.9 percent for those with a localized disease.

In addition, the aggressive triple negative type of breast cancer accounts for 12-20 percent of tumors in white women, but about 20-40 percent in black women. Triple negative breast cancer is particularly hard to treat because it does not respond to targeted treatments that have proven to be effective in treating breast cancers that test positive for certain receptors on cancer cell surfaces.

Internal Environment

Beyond triple negative cancer itself, there also seem to be racial differences in what we call the tumor microenvironment of the cancer cells. Tumor microenvironment is the immediate cellular environment of the cancer cells, including surrounding blood vessels, immune cells, signaling molecules and the tissue matrix that surrounds tumor cells (i.e., the extracellular matrix). Since the tumor microenvironment can affect behavior of the tumor cells and their response to treatments, these racial differences could impact tumor biology and disease progression. Studies have also uncovered racial differences in gene expression patterns of cancer cells, in which genes are over-expressed or under-expressed in the tumor cells of black versus white women.

 A triple negative breast cancer cell, showing the heterogeneity of its cells. Heterogeneity of breast cancer also poses challenges for treatment. Kevin Janes/National Cancer Institute, University of Virginia Cancer Center, CC BY-SA One of the common abnormalities found in cancer cells proliferating within tumors is that they often gain or lose stretches of DNA, which could include multiple genes, or even whole chromosomes that carry hundreds of genes. As a result, cancer cells may harbor higher-than-normal or lower-than-normal copies of genes compared to healthy cells. Daughter cells that arise from such cancer cells form a “clone of cells” that could be genetically different from other such clones within the tumor.

When this gain or loss occurs at a fast rate, it results in a tumor with astounding clonal diversity. Such tumors are more likely to harbor clones that can spread very efficiently through the body or resist treatments very staunchly, resulting in a higher risk of death for the patient. Scientists have discovered that breast tumors in black women tend to be more clonally diverse, and therefore harder to treat, than those in white women. The discovery of these biological factors is fairly recent, and research is still ongoing.

Beyond Tumor Biology

Having other diseases, such as diabetes, also could be not only a risk factor for developing breast cancer but also for poorer outcomes, research has shown.

Some statistics point to problems outside of the sphere of medicine, however.

In the U.S., about 23.1 percent of black women live in poverty, compared to 9.6 percent of white women. Studies have shown that a lack of resources makes a huge difference in survival rates, treatment responses, and progression of disease. Poor women are less likely to have good quality health insurance, to get as much information on early detection and screening, and to have access to the best health care and latest treatments.

Another factor, that is both biological and environmental, is obesity. According to the National Cancer Institute, fat tissue actually makes the hormone estrogen. Exposure to high levels of estrogen over a lifetime increases the risk of breast cancer.

Further, in the U.S., obesity is strongly linked to poverty, according to the National Institutes of Health. In other words, since black women are more likely to be poor, they are more likely to be obese – which makes them more likely to develop breast cancer.

The higher incidence of poverty among African-Americans also affects access to high-quality, timely care compared to white women.

The Search For Advances

In future years, we hope we will find specific mechanisms that explain the observed racial differences in breast cancer mortality. Eventually, we believe it will be possible to give each patient customized targeted treatments based on their genetic profile and other factors.

There are many factors that will need to be addressed to create racial equity in breast cancer outcomes. Bridging the gap will require a wide range of experts: clinicians, bioinformaticians, diagnosticians and epidemiologists from the science side, but also social scientists and public health experts. Only by joining together can we make sure that all breast cancer patients get the treatment that is best for them.

Padmashree Rida is a molecular and cell biologist with over 20 years of experience in research related to cell cycle regulation, cell polarity and cancer cell biology.

Ritu Aneja’s lab studies the many cellular differences in different kinds of breast cancer, aiming to find targeted therapies to treat the many different kinds of breast cancer. These differences arise sometimes from race, ethnicity, socioeconomic level as well as one’s personal genetic makeup.

This article was republished from The Conversation.

See also:
Top 12 Foods That Prevent Breast Cancer
What Our Breasts Are Telling Us

The Conversation

Edit Module
Edit ModuleShow Tags
Edit Module Edit ModuleShow Tags

Daily Astrology

October 18, 2019

Early birds may awaken feeling strangely unrested. The Gemini Moon is at odds with Neptune. A dream may linger, unresolved. Use your imagination to revisit the dreamscape and conjure up a happier, more satisfying ending. The day swings into high gear by…
Edit ModuleShow Tags

Alternative Health Directory

Browse all listings »

Edit ModuleShow Tags
Edit ModuleShow Tags

Calendar

October 2019

Come shine with us! Join us in harmony and in our goal to bring the light of Spiritualism forward to all those who are searching.

Where:
VFW Post 2597
775 Boston Rd, Rt 3A
Billerica, MA
View map »


Sponsor: The Spiritualist Fellowship Church Of New England
Website »

More information

Show More...
Show Less...

2nd and 4th Monday of every month This psychic message circle is for anyone wishing to raise their connection using their psychic centers known as the “clairs.” Learn how to use...

Cost: $20

Where:
Messages From Heaven Healing and Learning Center
646 Central Street
Suite 3
Leominster, MA
View map »


Website »

More information

Show More...
Show Less...

Free Evidence-Based Holistic Health Education Program at Wilbraham Senior Center The H.E.A.R.T. Program® (Health Empowerment and Real Transformation), created and instructed by Michelle...

Cost: Free

Where:
Wilbraham Senior Center
45 Post Office Park, #4502
Wilbraham, MA  01095
View map »


Sponsor: Harmony Way
Telephone: 413-636-2475
Contact Name: Michelle Caron
Website »

More information

Show More...
Show Less...

Grades 5-8 Instructor: Kari Pike Wednesdays, 10/16–11/20, 4pm-5pm (6 sessions) Do you ever feel overwhelmed before a test, or when you are working on a difficult homework...

Cost: $125

Where:
Creative Spirit
80 Washington Street
Marblehead, MA  01945
View map »


Telephone: 781-797-0389
Contact Name: Creative Spirit
Website »

More information

Join us at our free boot camp specifically for post-divorce issues! Make new connections while learning essential strategies for building your post-divorce life with confidence and peace of...

Cost: Free

Where:
Skylark Law & Mediation, PC
9 Main Street
Southborough, MA  01772
View map »


Sponsor: Vesta: Redefining Divorce
Telephone: 508-744-6014
Contact Name: Deanna Coyle
Website »

More information

Show More...
Show Less...

Sleep is one of the most under-appreciated ways to heal the body and improve your health. Getting 8 hours of sleep, more or less, is not enough if it is not good quality sleep. This class will...

Cost: $20

Where:
Open Circle Acupuncture & Healing
411 West Main Street, Suite 2R (rear of building)
Northborough, MA  01532
View map »


Sponsor: Open Circle Acupuncture & Healing
Telephone: 508-393-1212
Contact Name: Kim Flaherty
Website »

More information

Are you separated, divorced, considering divorce, or in the process of divorce? Vesta welcomes you to another of our Divorce Resource Nights! These free events are educational, social and...

Cost: Free

Where:
Leading Edge Real Estate
2 Mount Vernon Street
Winchester, MA  01890
View map »


Sponsor: Vesta: Redefining Divorce
Telephone: 508-744-6014
Contact Name: Deanna Coyle
Website »

More information

Show More...
Show Less...

Integrate the pelvic floor into your classes with confidence with Cristin Zaimes. Pelvic floor dysfunction is incredibly common, but not very well understood. People often feel embarrassed or...

Cost: $45

Where:
YogaLife Institute of NH
6 Chestnut Street
Lower Level
Exeter, NH  03833
View map »


Sponsor: YogaLife Institute of NH
Telephone: 603-867-3969
Contact Name: Alice Bentley
Website »

More information

Come and see what this is all about! You will be glad you did. Free to see the demo! Registration required, call 207-221-2363. Here is a podcast for you! What is KCR?...

Cost: Free

Where:
Leapin' Lizards
449 Forest Ave
Portland, ME  04101
View map »


Telephone: 207-221-2363
Website »

More information

The modern science of epigenetics is providing evidence that the patterns of self-sabotage, isolation, chronic illness, depression, addiction, challenges in relationship or an inability to prosper...

Cost: $27

Where:
Circles of Wisdom
386 Merrimack Street, #1A
Methuen, MA  01844
View map »


Sponsor: Circles of Wisdom
Telephone: 978-474-8010
Contact Name: Cathy Kneeland
Website »

More information

Facilitator: Peyton Pugmire Fridays, 9/20, 10/18, 11/15, 12/20, 9:30am–10:30am Everyone leaves with a powerful message to inspire their weekend!  Join Peyton Pugmire,...

Cost: Pay What You Wish

Where:
Creative Spirit
80 Washington Street
Marblehead, MA  01945
View map »


Telephone: 781-797-0389
Contact Name: Creative Spirit
Website »

More information

Show More...
Show Less...

In just one day you will come away with valuable knowledge about the issues associated with separation and divorce, increasingly aware of your next steps in the process, bolstered by the new...

Where:
Burns & Levinson
1 Citizens Plaza
Suite 1100
Providence, RI  02903
View map »


Sponsor: Vesta: Redefining Divorce
Telephone: (508) 333-3191
Website »

More information

Explore your psychic awareness in this fun and informative workshop Designed specifically for people who are awakening to their own psychic senses, this class will provide you with personalized,...

Cost: $125

Where:
The Mills at Salmon Falls
3 Front Street
Lower Mill
Rollinsford, NH  03869
View map »


Sponsor: Raylene Sousa Medium LLC
Telephone: 207-956-0220
Contact Name: Raylene Sousa
Website »

More information

Join us at Vesta’s One-Day Divorce Retreat in Providence, RI! In just one day you will come away with valuable knowledge about the issues associated with separation and divorce,...

Cost: $149

Where:
Burns & Levinson
1 Citizens Plaza
Suite 1100
Providence, RI  02903
View map »


Sponsor: Vesta: Redefining Divorce
Telephone: 508-744-6014
Contact Name: Deanna Coyle
Website »

More information

Facilitator: Jamie Berg Adult Level Do you have too much stuff? Would you like to manage all of your stuff with ease? In this workshop you will learn how to KonMari and you will...

Cost: $50

Where:
Creative Spirit
80 Washington Street
Marblehead, MA  01945
View map »


Telephone: 781-797-0389
Contact Name: Creative Spirit
Website »

More information

Every time we see a giggling baby or an innocent child full of laughter, we're reminded that we are all born with this natural and innate sense of happiness, that it is actually our birthright....

Cost: $108 early-bird price ($120 after October 12)

Where:
Unity Farm Sanctuary
30 Lyman Street, Suite 108B
Westborough shopping center
Sherborn, MA  01581
View map »


Sponsor: www.SOHUM.org
Telephone: 508-329-3338
Contact Name: Ritu Kapur
Website »

More information

Led by Chuck Raffoni ( E-RYT200) named a “person making postiive change in the world for the LGBTQ Community” by Pride Connections and featured on NBC's TODAY SHOW for teaching...

Cost: $50

Where:
KJ Fitness
Tewksbury , MA


Sponsor: YogaWithChuck.Com
Contact Name: Chuck
Website »

More information

Steven Farmer, PhD Here’s a great opportunity to not only clear out the psychic debris that has attached to your soul body as you journeyed through life but also retrieve and reintegrate...

Cost: $77

Where:
Circles of Wisdom
386 Merrimack Street, #1A
Methuen, MA  01844
View map »


Sponsor: Circles of Wisdom
Telephone: 978-474-8010
Contact Name: Cathy Kneeland
Website »

More information

October 19–25 Join Seth Monk and Candita Carracci Mamet for a week of yoga, meditation, personal growth and relaxation.

Where:
Sivananda Ashram Yoga Center
Paradise Island, Bahamas, MA


Website »

More information

Reiki Master Teacher Libby Barnett, M.S.W., integrates her healing skills with past experience as a medical social worker at Massachusetts General Hospital. 38 years experience. Reiki...

Where:
Concord, MA


Telephone: 603-654-2787
Website »

More information

Here’s a great opportunity to not only clear out the psychic debris that has attached to your soul body as you journeyed through life but also retrieve and reintegrate those soul fragments...

Where:
Methuen, MA


Telephone: (978) 474-8010
Website »

More information

Learn to overcome spinal tensions through therapeutic postures, designed to decompress your spine and relieve pain. Taught by a certified yoga therapist, classes bring you through poses...

Cost: 5/$50

Where:
Bliss Through Yoga
484 Bedford St
East Bridgewater, MA  02333
View map »


Telephone: 508-331-3564
Contact Name: Janice O'Brien
Website »

More information

Show More...
Show Less...
Edit ModuleShow Tags
Edit Module Edit ModuleShow Tags