Black Women Continue To Die From Breast Cancer At A Higher Rate Than White Women

The gap continues to grow, but it ultimately depends on where you live.

A new study found that black women in the US continue to die from breast cancer at a higher rate than white women.

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The breast cancer mortality rate for black women in the US is 30.7 deaths per 100,000 women, while the mortality rate for white women is 21.4 deaths per 100,000, according to new research from the Sinai Urban Health Institute, funded by the Avon Foundation for Women. That means the rate of breast cancer deaths is 43.1% higher in black women than white women.

The study, published Monday in the journal Cancer Epidemiology, looked at race-specific breast cancer deaths between 2010 and 2014 in the 50 largest cities in the US. This is a follow-up to their 2014 study, which found that black women in the US were 39.7% more likely to die from breast cancer than white women were between the years 2005 to 2009. (One limitation worth noting is that these studies only compared deaths in non-Hispanic black women and non-Hispanic white women.)

The study found that racial disparities in breast cancer deaths vary greatly depending on where you live.

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At the city level, the gap in mortality rates grew in 24 of 43 US cities (they couldn't get complete data from all 50 of the largest cities).

Atlanta had the highest disparity, where black women were 117% more likely to die from breast cancer than white women were. This jumped from just 4.1% in 2005–2009, making it the city with the largest increase in disparity. Significant racial disparities were also seen in Austin, Texas (94%); Wichita, Kansas (80%); San Antonio, Texas (79%); and Kansas City, Missouri (77%).

Fortunately, three cities saw a significant decrease in racial disparities when compared to the 2005–2009 data: Memphis, Boston, and Philadelphia.

So why is the gap growing? The research shows that in most of these cities, fewer white women are dying from breast cancer, while black women are dying at the same rate as before — or higher.

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Back in the early 1990s (the earliest period of time the researchers examined), breast cancer mortality rates for black women and white women were about the same. But in the years after that, as innovations in screening and treatment became available, the disparity began to grow.

"Around that time, we started to see white women make improvements in breast cancer mortality rates because they were able to access screening and treatment, while black women were maybe not able to access it as well as white women," study co-author Bijou Hunt, of the Sinai Urban Health Institute at Sinai Health System, told BuzzFeed Health.

"And not just [access to resources], but access to quality resources, quality mammography, and quality treatment."

While the study didn't look at why the disparity exists, an obvious factor seems to be access to the same innovations that brought breast cancer deaths down in white women.

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"The fact that the disparity grew dramatically over the period of time, and the fact that it varies by geography, that suggests that probably access to quality health care is the key issue," study co-author Marc Hurlbert, PhD, of the Breast Cancer Research Foundation, told BuzzFeed Health.

"The biology [and] the genetics of a black woman in New York can't be that different from someone in Chicago or Los Angeles."

And even when the care is accessible, the quality and timeliness may be lacking for those in lower-income areas.

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While a mammogram at any center is better than no mammogram at all, you should ideally get screened at an imaging center that's accredited by the American College of Radiology (you can find one here) and have your results read by a breast imaging specialist.

But for many people, particularly those getting care from a federally qualified health center, that's typically not their experience, as epidemiologist Richard Warnecke, PhD, of the University of Illinois at Chicago, told BuzzFeed Health.

"The facilities doing the mammograms are not necessarily able to do the diagnostic work," he said. "Or they may not have someone [who can] read the mammogram." This can lead to delays in diagnosis, treatment, and surgery. Research shows that black women continue to experience significant clinical delays in relation to other racial and ethnic groups.

"Patients need to know that there are places where you can get a complete spectrum of diagnoses," said Warnecke. "If you have an abnormal mammogram, you should go to one of those places."

Biology and genetics may play a role, but it's not the only factor at play.

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Breast cancer is actually less common in black women than white women. However, black women are more likely to be diagnosed with triple-negative breast cancer (a more aggressive type) and are more likely to be diagnosed at a younger age.

So it's likely the interaction of biological and societal factors that creates this disparity. "If you had this biological propensity that we see in women with West African ancestry for an earlier, more aggressive form of breast cancer type, and if you're then living in areas where the quality of the mammography is poor, that's like a perfect storm," Sarah Gehlert, PhD, a professor of racial and ethnic diversity at Washington University in St. Louis who was not involved in the study, told BuzzFeed Health.

There's also evidence that your environment can affect your health in ways unrelated to care.

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Researchers have been studying the role of environment on stress response and cancer rates. In one animal study, researchers found that rats that were prone to developing breast tumors were 3.3 times more likely to develop cancer after experiencing social isolation and stress.

Gehlert, who studies how social environments relate to health disparities, recalled speaking with patients in lower-income areas who told her they "had to keep one eye open or one ear open when they slept just to make sure they were safe," noting that a lack of sleep can increase inflammation and suppress immune function. According to 2013 data from the US Census Bureau, 28.6% of black women live below the poverty level, compared to 10.8% of white women.

Environmental factors can range from a stressful living situation to access to healthy, affordable foods. It can also manifest in feelings of fear or distrust when you have to travel far from your neighborhood for treatment, said Gehlert, not to mention the cost and inconvenience of transportation and child care.

"Because African American women are more likely to have this early-onset form, it means that all of these things are happening during your reproductive years where you're more likely to have small children and still be working," said Gehlert. "That's much different from an older Caucasian woman who develops it at 70."

Since black women are at a higher risk of triple negative breast cancer, knowledge of family history and screening recommendations are particularly crucial.

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That can be hard when the screening guidelines aren't exactly clear (here is a side-by-side comparison of the conflicting recommendations from different groups), which is why it's so important to talk to a primary care doctor about your risk factors, your family history, and any changes in your breasts.

Having equal access to a strong support system — including a patient navigator — may help close the gap.

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Patient navigators, employees who guide patients through the process from screening to diagnosis to treatment, are one tool to address health disparities by ensuring that everyone has equal access to support and education after a cancer diagnosis.

Because chances are, after you hear "cancer," you tend not to retain a lot of the information that comes directly after that, says Hurlbert. "You need to have a note taker or friend [in the room]."

One study that Gehlert was involved in looked at patient navigation experiences for black women diagnosed with breast cancer in St. Louis. They found that when patient navigation was disjointed or discontinued, breast cancer patients were more likely to view radiation as optional, rather than a vital treatment method. "The problem is that in many places there isn't one navigator that treats you throughout," she said. Ensuring that everyone has a patient navigator — and has consistent, reliable communication with them — may help improve outcomes for those without a strong support system.

The good news is that the disparity is closing in several cities, and the researchers will be paying close attention to any factors that may play a role in that.

Courtesy of the Avon Foundation for Women

The racial disparity in breast cancer deaths went from 111% to 69% in Memphis, from 43% to 23.5% in Philadelphia, and from 49% to 0.7% in Boston. And in 19 cities, there was an improvement in health disparities as the mortality rates for black women decreased more than the mortality rates for white women. The study authors said that it's too soon to speculate as to why these cities saw an improvement.

"One of the real values this research gives us is that it's a huge call of action to these communities to say, 'OK, what can we do about this?" Cheryl Heinonen, president of the Avon Foundation, told BuzzFeed Health. "You only find disparities if you look for them."

"The commonly asked question right now is 'why?' The problem is that we don't exactly know the answer to why. I don't think there is one simple or single answer," said Hunt. "We need more research to understand that — especially if were gong to be able to address these disparities, we need to first know what's driving them."