CAROLA NEUMANN, MD
Many of us may be familiar with statistics about breast cancer: One out of eight women are diagnosed with the disease, according to the National Cancer Institute. The Centers for Disease Control and Prevention report that, after skin cancer, breast cancer is the most common cancer in women, regardless of race or ethnicity. A breast cancer diagnosis is too common for all women in the United States.
What may not be as familiar is that, even though the incidence rates are similar, the outcomes of women with breast cancer vary differently by race and ethnicity. Research from the American Cancer Society tells us that African American women are 42 percent more likely to die from their breast cancer than white women. In Allegheny County, the National Cancer Institute reports that the breast cancer mortality rate (deaths per 100,000 people) is 22 for white women and 35.1 for African American and Latinx women.
Why is there such a large disparity? Researchers do not know the exact cause for this difference. They do have some ideas, though more research needs to be done. Part of the disparity could be the kind of breast cancer African American women have more typically than white women.
“African American women are affected at an earlier age and more often by an aggressive kind of breast cancer called triple negative,” says Carola Neumann, MD, associate professor of pharmacology and chemical biology at the University of Pittsburgh School of Medicine. According to the Breast Cancer Research Foundation, African American women have twice the rate of triple negative breast cancers than any other racial group in the United States.
One way to categorize breast cancers is by their receptors. The three most common receptors are estrogen, progesterone and human epidermal growth factor (HER2). These three kinds of breast cancer receptors can be targeted specifically with hormone therapy or other drugs. Triple-negative breast cancers do not have any of those three receptors and are, therefore, harder to treat (though they can be treated with surgery, chemotherapy and radiation therapy).
Researchers think some African American women are more likely to inherit triple-negative breast cancers, though more research needs to be done. Another factor possibly contributing to the disparity is access to health care. This includes being underinsured or uninsured and difficulty in getting to and from care.
So, what is being done to get rid of this disparity? Dr. Neumann cites the need for more research on identifying the biology of aggressive breast cancers in African American women. “Without research and clinical trials, very little will change,” she says. “African Americans in general are underrepresented in research. But we need to study this population to know why they are dying from breast cancer more often and what treatment will better treat their cancers.”
Early detection is important. Breast self-exams and mammograms are first steps to early diagnosis. Dr. Neumann says that equally important, however, is knowing about your disease and your treatment options. Education is key to empower and become an advocate for yourself. Thanks to research, treatment options for breast cancer have clearly improved over the years. However, Dr. Neumann reminds us that patients, scientists and physicians have to work together to develop better treatments for metastatic disease.
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