Racial Differences in Advanced Breast Cancer

Cancer development, treatment, and outcomes are tricky topics to understand. The underlying reasons why a person gets cancer or how they might respond to treatment are often unknown and depend on a variety of factors. Just as we can study different risk factors and treatments, we can study different characteristics of people with cancer. Learning more about the individuals getting cancer and their overall outcomes can help us develop new treatments and better identify those at risk.

Many different cancer characteristics have been studied in recent years. However, there has been a growing interest in learning more about race and ethnicity in relation to breast cancer. In honor of Minority Cancer Awareness Month, interesting findings from a few studies on the topic are below.

Who is getting breast cancer?

According to the National Cancer Institute, White people are the most likely to get invasive or advanced breast cancer. The next most likely are Black people and Asian and Pacific Islanders. Latino people are the least likely.¹ The rate of new cases has been relatively stable for White and Latino people. However, the rate of new cases has been increasing for Black people and Asian and Pacific Islanders.²

Interestingly though, Black women are most likely to get mammograms to screen for breast cancer, followed by White women. This is especially true for women from higher financial and education levels. Those with insurance are also more likely to get mammograms. Asian and Pacific Islanders and Latina women are the least likely to get mammograms.³ Even though they are the most likely to get mammograms, Black women still experience longer treatment delays and potentially lower quality of care resulting in poor health outcomes.⁴

One study found that people living in rural areas may also be at a higher risk of getting breast cancer compared to those living in larger cities.⁵

Differences in diagnosis and outcomes

At diagnosis, Black and Latino people are more likely to be diagnosed with larger tumors and more aggressive cancers. Especially younger Black and Latino people living in poorer areas. Minorities are also more likely to be diagnosed with triple-negative breast cancer, a notoriously difficult cancer to treat. They are also more likely to have other health conditions that may impact health outcomes. These include diabetes, obesity, high blood pressure, and cardiovascular disease.

Further, minorities are less likely to be diagnosed at localized stages of cancer. This means, their cancers are often diagnosed after they have spread to other areas of the body. The reasons for this are not well understood. It could be related to genetics, environmental exposures, or lack of access to healthcare. Because of these factors, it is not surprising to learn that the 5-year survival rate is lower in these groups than in White people.²

Variation in treatment

There may also be differences in treatment experiences among different racial and ethnic groups. It has been thought that minority groups may experience treatment delays and poorer quality of care. Black women specifically seem to undergo cancer-directed surgery less often than their White counterparts.^2,4 All of these differences could be due to insurance status, financial barriers, access to healthcare, and mistrust in healthcare providers, among other factors.

What does it all mean?

Overall, these results suggest that there are differences in cancer type, screening, treatment experience, and survival with breast cancer between racial and ethnic groups. The reasons for this are not well understood and may be related to a variety of different factors. Some of these may be related to genetics, environmental or work exposures, social factors, financial issues, lifestyle practices, diet, access to healthcare and helpful resources, and more.

This is such an important topic to talk about, as differences in treatment options, more aggressive cancers, and worse survival rates can take a huge toll on quality of life. However, this information is only from a few studies, and much more research is needed to understand the factors at play. For the time being, studies like these can help call out the differences in general, and may help doctors better diagnose and treat people from all backgrounds.

Resources for minority groups with breast cancer

This information may seem overwhelming and confusing, especially for individuals belonging to minority groups that appear to have worse outcomes. It is okay to ask for help and support as you navigate your journey.

While some large organizations have resources designed for everyone living with breast cancer, there are some minority-specific organizations that can help as well. Several resources to consider if you or a loved one with breast cancer belongs to a minority group include the following:

• Black Women’s Health Imperative: Provides health-related support to black women and girls.
• Latinas Contra Cancer: Provides health education and support group services to Spanish-speaking women.
• African American Breast Cancer Alliance (AABCA): Provides support, survivorship information, education, and connection opportunities to Black women with breast cancer.
• Nueva Vida: Supports Latina women and families affect by cancer by providing education, access to health resources, and mental health support.
• National LGBT Cancer Network: Supports LGBT cancer survivors through training, education, and support groups.
• Malecare: Supports male cancer survivors, including underserved populations, like minority men with cancer.