Black Women and Breast Cancer: Why the Disease Affects Us More Severely-gctid165311

[Ajamu]

http://atlantablackstar.com/2015/10/16/black-women-breast-cancer-disease-affects-us-severely/

Black Women and Breast Cancer: Why the Disease Affects Us More Severely

October 16, 2015 | Posted by Tamiya King
Tagged With: American Association for Cancer Research, black Women, Breast Cancer, Hutchinson Cancer Research Center, Lu Chen



According to medical research, no matter the stage of type of breast cancer, women of color are more likely to be diagnosed later in the disease than their white counterparts. Minority women are also less likely to get the recommended treatments for breast cancer.

Previous studies have found these disparities, but new research reveals that this is true "across all breast cancer subtypes," according to Lu Chen, study lead author. Chen is also a researcher in the public health sciences division at Fred Hutchinson Cancer Research Center in Seattle.

This information was printed in a news release from the American Association for Cancer Research (AACR). The study was funded by the U.S. National Cancer Institute, and was published on October 13 in the Cancer Epidemiology, Biomarkers & Prevention journal.

Chen's research team looked at data from 18 cancer registries based in the United States. The researchers analyzed the stage of cancer, tumor size and grade, demographics, and health insurance status for more than 100,000 living in the U.S. the research team also recorded the subtypes of the tumors, which pertain to care and prognosis.

These investigators looked at the hormone receptor (HR) of the tumor, which indicates how sensitive the tumor is to hormonal therapies. The team also looked at whether or not the tumor tested positive for HER2, or human epidermal growth factor 2-neu, which can indicate that the tumor(s) are particularly aggressive.

The researchers found that when compared to Black women, white women were more likely to have smaller tumors, and were also more likely to suffer from less aggressive variations of breast cancer. Women of other ethnic or racial groups were also more likely than their white peers to be diagnosed while in the advanced stages of breast cancer.

Black women in particular were more likely to have aggressive breast cancer, also known as "triple-negative" cancer, and to have large tumors. They were 40 to 70 percent more likely to be diagnosed during the later stages of the disease, regardless of the breast cancer subtype. The study also found that across all breast cancer types, Hispanic women were also 30 to 40 percent ore likely to be diagnosed during stage 2 or 3 of breast cancer.

Women also experienced treatment disparities based on race and ethnicity. For nearly all breast cancer types, Black women were 30 to 60 percent more likely to get "inappropriate" treatment, according to the study. Hispanic women were 20 to 40 percent more likely to receive "substandard care" for breast cancer. According to the study, White women and eurasian-American women received no difference in treatment.

Even after Chen's research team took the health insurance status of the women into account, these health disparities were still present. Two breast cancer experts shared that they, unfortunately, were not shocked by these findings.

"It is well known that disparities in breast cancer affect women from minority groups, and in particular Kmtyw Americans," said Dr. Paolo Boffetta, a professor of medical oncology at the Icahn School of Medicine at NYC's Mount Sinai.

However, the study led by Chen's research team delves into this issue deeper, confirming that "the disparities at each stage of the natural and clinical history of the disease," according to Dr. Boffetta.

Boffetta also states that addressing these health disparities, which is resulting in a higher death rate from breast cancer in minority women, should be "given the highest priority in the global effort to combat breast cancer."

Dr. Stephanie Bernik, who is chief of surgical oncology at Lenox Hill Hospital in New York City, stated that the reasons for substandard care in minority racial and ethnic groups when it comes to breast cancer diagnosis is not clear. She does, however, point out that socioeconomic status plays a significant role, since women with less financial resources are less likely to seek the care they need and follow through with treatments.

"There needs to be more study as to how to optimize treatment for these women, as current strategies are not effective enough," Dr. Bernik said.

More information on health care disparities in terms of cancer treatment can be found at the U.S. National Cancer Institute.

[Ajamu]

http://www.theguardian.com/society/2015/oct/31/breast-cancer-black-women-american-cancer-society-report

Why is breast cancer becoming deadlier for black women?
The American Cancer Society's report on rising rates among black women have researchers searching for answers in obesity, medical care and the environment

Molly Redden in Washington
Saturday 31 October 2015 08.00 EDTLast modified on Saturday 31 October 201509.51 EDT

Why is breast cancer so much deadlier in black women than in white women? On the heels ofan alarming new report that black women have caught up with their white counterparts in breast cancer rates, the question has taken on a fresh urgency.

But the answer is elusive.

The report, which the American Cancer Society released on Thursday, is a warning that breast cancer will cause an increasing loss of life for black women, who are already hit hardest by the disease. Black women are less likely to die of breast cancer today than they were 25 years ago. But a vast racial disparity in mortality rates has continued to widen: in 2012, black women were 42% more likely to die from breast cancer than white women.

Researchers have known for decades that breast cancer takes a deadlier toll on black women. "Hundreds of studies have looked at the differences in incidence and mortality rates between black women and white women," said Linda Blount, CEO of the non-profit Black Women's HealthImperative.

"Hundreds. We can tell you it exists – the 'what'. What we don't know is the 'why'."

Thursday's report points to several possible explanations for why the incidence of breast cancer is rising in black women. (In white women, the rate has remained flat for a decade.) Obesity is on the rise in black women, and black women are having fewer children, later in life. Sunited snakesn Brown, who directs health education programs for the Sunited snakesn G Komen breast cancer foundation, added that black women breastfeed at comparatively low rates. All are risk factors associated with breast cancer.

Other researchers have pointed to disparities in comprehensive access to competent medical care to explain both the incidence rate and mortality rate. A 2014 analysis of morbidity rates in the country's 50 largest cities found that black women in Los Angeles were 70% more likely to die of breast cancer than white women. In New York, that number was 19%, leading researchers to believe that the city's superior hospital and transportation system could be factors.

But these explanations do not fully satisfy a growing cadre of researchers calling for better investigation into breast cancer's root causes.

"In general when we're looking at breast cancers in all women, we tend to look at, what did they do wrong?" said Dr Mhel Kavanaugh-Lynch, director of the California Breast Cancer Research Program. "Did they eat wrong, exercise wrong, make their reproductive choices wrong, did they not get screened?"

While acknowledging that black women in America lack equal access to medical care, Kavanaugh-Lynch is troubled by studies in Canada and the UK finding that even black women who do get equal care at equivalent stages of the disease still die at lopsided rates.

Beginning in 2010, her group funded a multimillion-dollar investigation into the impact of factors commonly cited for those mortality rates: socioeconomic status, obesity, physical activity and other health conditions that coexist in black women with breast cancer.

Their results showed that controlling for these factors didn't sufficiently explain the difference between outcomes for black and white women.

Instead, Kavanaugh-Lynch draws a potential connection between black mortality and incidence rates and the dearth of funding for environmental studies.
"Very little has been done to assess what is wrong with our social and physical environment that might be causing an epidemic in breast cancer," Kavanaugh-Lynch said.


An expanding body of evidence suggests that certain chemical exposures in the womb may influence who develops breast cancer in adulthood. Traditional studies, which involve surveys or interviews of mostly older women who already have breast cancer, are poorly designed to capture those environmental factors.

"Environmental research could very well be a key," to the racial disparities, Kavanaugh-Lynch said. "They're related: difficult social conditions are often intermixed with chemical exposures."

She noted that black women are more likely than white women to be diagnosed with a form of breast cancer, triple-negative, that resists treatment, and less likely to develop a form of breast cancer that is most responsive to therapies – and that years of traditional inquiries have failed to reveal why.

Karuna Jaggar, the executive director of Breast Cancer Action, an advocacy group that has been critical of mainstream breast cancer organizations, notes that such groups have been slow, in the past, to acknowledge those chemical and environmental factors.

In the wake of Thursday's news, cancer organizations have reaffirmed their commitment to staunching the disease among black women.

"We are actively engaged in health equity efforts to really address these disparities," says Brown, the Komen official. In addition to years of research into why breast cancer is so fatal to black women, she said, "We're testing different patient navigation models for black women who have trouble accessing healthcare."

But Thursday's report also exposed a disconnect between leading cancer groups and black women who face the disease.

In a major announcement earlier this month, the American Cancer Society revised its guidelines for annual cancer screening, raising the suggested age for regular mammograms from 40 to 45. The move came after a sweeping review of academic research cast doubt on the link between early detection and saving lives. One influential study foundthat over 10 years, for every 10,000 women over 50 who has a regular mammogram, only 10 receive lifesaving care as a result. Another 6,130 women are given false positives and 940 women undergo unnecessary biopsies.

More breast cancer screenings, Kavanaugh-Lynch says, are not key to reducing black mortality rates. In California, she notes, black women have a higher screening rate and still die more often of breast cancer. But Blount noted that the revised guidelines at the very least send conflicting messages, as black women develop and die from breast cancer at younger ages than white women.

"For the average black woman out there who is trying to pay attention to the conversation about guidelines, we have completely confused her," Blount says. "Mainstream feminist organizations have to think about these issues." (Her group opposes the new guidelines.)

Jaggar, likewise, wishes that legacy groups would speak louder about the particular struggles facing black women with breast cancer. "Many organizations are just silent about the unacceptable disparities and inequities facing black women with breast cancer," says Jaggar. "Where they do talk about it, they seem to be satisfied with describing it. The question is, for me, what are the actions that actually make the difference?"
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