What Black women need to know about breast cancer
By Jessica Saenz
Thanks to improved therapies and early detection, breast cancer is increasingly treatable. Despite these improvements, breast cancer is now the leading cause of cancer death among Black women, according to a new report by the American Cancer Society.
Black women are now 41% more likely to die from breast cancer than white women, despite a lower risk of being diagnosed with the disease. This is partly because Black women are more likely to be diagnosed with breast cancer at a later stage when it is harder to treat.
But Black women have lower survival rates for every stage of breast cancer diagnosis. Many complex factors contribute to this gap in care outcomes ― all of which are fueled by systemic racism that limits access to high-quality cancer treatment.
As health care professionals work to address the disparities in cancer care for Black women and other minorities, increasing awareness of these disparities is imperative. If you are a Black woman, this is what you need to know about breast cancer:
Breast cancer screening is the best defense against breast cancer.
When life gets busy, it's easy to delay or even skip important health screenings. But the longer cancer goes undetected, the more opportunity it has to grow and spread. Regular screenings are the best way to detect cancer early, when it is easier to treat.
"We know that African American women are less frequently undergoing screening mammography. If that were fixed, it would go a long way toward overcoming this disparity," says Donald Northfelt, M.D., a Mayo Clinic hematologist and oncologist, and breast cancer researcher. "To have a diagnosis of breast cancer made earlier through screening, when the tumors are smaller and can be more easily removed, would be a big advance."
"I'm the first to admit that sometimes the information out there is confusing because there are different guidelines. Mayo Clinic and the American Cancer Society recommend that you start your screening mammograms at the age of 40 and continue to do them annually," says Michele Halyard, M.D., a Mayo Clinic radiation oncologist and co-founder of the Coalition of Blacks Against Breast Cancer.
The best approach for wading through competing information is to talk to your health care professional. Together, you can identify risk factors and preferences that might change how often you should be screened.
"Talk to your health care provider about what is best for you," says Dr. Halyard. "Don't be afraid of mammograms. There might be a bit of discomfort, but it is well worth it to save your life, and early detection is the key."
Genetic testing can expose your inherited risk factors.
When you discuss screening recommendations with your health care professional, it helps to give them a full picture of your risk factors, including lifestyle choices and medical history. But knowledge of the risk factors in your genes is just as important, and the best way to reveal these mutations is through genetic testing.
"A woman who has an identified genetic predisposition to cancer needs to be screened more frequently. That's how we can detect the cancer early and help her more effectively," says Dr. Northfelt. "Get your genetic testing done. If you have a genetic predisposition, then we want you to be screened every six months."
Talk to your health care professional about genetic testing, how you can obtain it and if it's right for you. If you decide you prefer an over-the-counter genetic test, know that the data these tests provide can be insightful. But it's important to review results with a genetic counselor or your health care professional to understand how they affect your risk of breast cancer or other diseases.
While a family history of breast cancer is concerning and should be discussed with your health care professional, most breast cancers are not linked to family genetics, says Dr. Halyard. "Only about 5% to 10% of breast cancers have a genetic link. That includes BRCA1, BRCA2 and some other genes that are associated with breast cancer. That may change as we get more information in the future, but that's what we know today."
Black women are more likely to have an aggressive form of breast cancer.
"Black women are at higher risk for triple-negative breast cancer, which is the most aggressive type of breast cancer. And it tends to occur at younger ages," says Dr. Halyard.
Triple-negative breast cancer, also called basal-like breast cancer, is not sensitive to the hormones estrogen or progesterone and does not produce too much of the growth-promoting protein called HER2. This makes it difficult to treat.
Triple-negative breast cancer accounts for 35% of breast cancer diagnoses in African Americans, and it is associated with a high rate of recurrence and poor five-year survival rates, according to a study led by Fergus Couch, Ph.D., a geneticist at Mayo Clinic.
Triple-negative breast cancer is traditionally treated with chemotherapy and, though more research is needed, immunotherapy has shown some promise.
If you have dense breasts, you might need additional screening tests.
About half of women undergoing mammograms have dense breast tissue. Though it's common and normal, many women with dense breast tissue are unaware of it. A radiologist who analyzes your mammogram can determine the level of density on your breast.
"Breast density is a problem because on a mammogram, dense breast tissue looks white or gray, and cancers also look white or gray. It's possible for breast density to hide cancer in the breast," says Dr. Northfelt. "There are various techniques that we can use to overcome that. We have contrast-enhanced mammography, MRIs and ultrasound exams that can help overcome the problem that breast density creates and allow us to see the breast tissue more clearly."
Women who are younger, have less body fat or take hormone therapy for menopause are more likely to have dense breast tissue, but the only way to know with certainty is to talk to your health care professional and determine the best screening test for you.
"It's important for women to understand their breast density and seek better answers if they're told they have dense breasts without further explanation. That's not satisfactory," says Dr. Northfelt.
Second opinions are important and should be encouraged.
Understand that you have the right to ask questions and get further clarification. If you are unsatisfied or your instincts tell you otherwise, ask for a second opinion.
"If we were shopping online for shoes, we would check a number of sites," says Pamela McCall, a radiology systems analyst at Mayo Clinic and an 18-year breast cancer survivor. "If they don't have the right color, we're not buying. We would look until we found the shoes to match the dress or the purse. It's worth taking that time for yourself. As women, we tend to be caregivers, but it's worth taking this time for your health."
Still, some people might not feel comfortable asking for a second opinion or raising concerns about their care to their health care professional. If this is the case for you, preparing ahead of time or bringing a family member can help.
"Sometimes people are overwhelmed when they're diagnosed, and they don't get their questions answered, or they're too timid to ask questions. Keep persisting and understand the information about your breast cancer," says Dr. Halyard. "If you're a family member, be that voice of support. Go with them to appointments and ask questions for them if they are not comfortable."
You can also seek a second opinion without a referral from your current health care professional. This will require some work on your end, but the peace of mind can make it worth the effort.
"There's been a tragic lag in the improvement in breast cancer outcomes for African American women. Currently, 90% of women in the U.S. survive five years after a breast cancer diagnosis, which means we don't typically expect the cancer to come back," says Dr. Northfelt. "In African American women, that number is only about 83% to 84%."
With more research uncovering inequities and their solutions, cancer experts at Mayo Clinic and around the world are working toward improved outcomes for Black women and other minorities.
"There are many things we need to work on and correct to overcome this disparity and bring African American patients to the same level of success that everyone else is achieving, and we're working on that diligently at Mayo Clinic," says Dr. Northfelt. "We need to make sure that African American women have access to better care to overcome this disparity and have just as good an outcome as everybody else in our country."
Watch Drs. Halyard and Northfelt discuss breast cancer and the care disparities experienced by Black women in this Mayo Clinic Town Hall video:
Learn more about breast cancer and find a Mayo Clinic breast cancer clinical trial.
Also read this article: "3 ways anyone with a cervix can fight cervical cancer disparities."
Learn about the Coalition of Blacks Against Breast Cancer, co-founded by Dr. Halyard.
The U.S. Preventive Services Task Force is proposing changing its guidelines to recommend all women begin screening mammography at age 40.
Patients could receive breast-conserving therapy, a lumpectomy followed by whole-breast radiation therapy, rather than mastectomy.
Dr. Caroline Clune discusses some of the common types of noncancerous breast symptoms known as benign breast disease.