Black women are more likely than white women to die from even the most treatable types of breast cancer, a study published Tuesday in the Journal of Clinical Oncology found. The findings, experts say, underscore that it’s racial disparities, not biology, driving the biggest differences in death rates between Black and white women. While Black women and white women are diagnosed with breast cancer at similar rates, Black women are 40% more likely to die from the disease.
Lead author Erica Warner, a cancer epidemiologist at Massachusetts General Hospital, noted that within health care, there was a common belief that higher rates of triple-negative breast cancer among Black women contributed significantly to the disparities in mortality rates. However, the study revealed that while this aggressive type of breast cancer does play a role in the higher death rates, it is not a primary reason for the disparities.
Warner and her colleagues conducted a meta-analysis of 18 studies involving nearly 230,000 patients with breast cancer, 34,000 of whom were Black. The study compared the mortality rates of Black women and white women with the same breast cancer molecular subtypes. The researchers found that a cancer’s subtype, which affects how the tumor behaves and responds to treatments, largely influences mortality rates.
Breast cancer subtypes are determined by the receptors found on the surface of tumor cells. Hormone receptor-positive (HR-positive) tumors have receptors for estrogen or progesterone, HER2-positive tumors have receptors that allow the tumor to spread more quickly or respond better to treatment, and triple-negative tumors do not have any of these receptors, making them the most difficult to treat.
The study revealed that for the most common subtype, HR-positive, HER2-negative, which accounts for 60% to 70% of all breast cancer diagnoses, Black women were 50% more likely to die from the disease than white women. For those with HR-positive, HER2-positive tumors, Black women were 34% more likely to die than white women. Even for triple-negative breast cancer, where Black women are three times more likely to be diagnosed compared to white women, the mortality rates were 17% higher for Black women.
Dr. Eric Winer, director of the Yale Cancer Center, emphasized that disparities in mortality rates among women diagnosed with hormone receptor-positive tumors highlight the role of racial disparities in healthcare. Economic factors, such as the cost of extended hormonal therapy and access to treatments, play a significant role in these disparities. Additionally, structural barriers such as lack of representation in clinical trials, access to healthcare facilities, and social determinants of health all contribute to the disparities faced by Black women.
Dr. Wendy Wilcox, chief women’s health officer at New York City Health + Hospitals, highlighted the importance of addressing social determinants of health, including access to healthcare, transportation, healthy food, and living conditions, in improving health outcomes. She also emphasized the need for better representation of Black women in clinical trials and early detection of breast cancer, particularly in younger Black women who may be diagnosed at more advanced stages.
Dr. Marissa Howard-McNatt, director of the Breast Care Center at Atrium Health Wake Forest Baptist in North Carolina, stressed the importance of early detection for all women, especially those with a family history of breast cancer. She recommended starting screening with mammograms 10 years before a sibling or parent was diagnosed to improve early detection rates.
To address the disparities faced by Black women in breast cancer mortality rates, it is essential to provide access to healthcare facilities with patient navigators who can assist patients in understanding their treatment options and arranging necessary support services. By addressing the economic, structural, and social barriers that contribute to these disparities, healthcare providers can work towards eliminating the differences in mortality rates between Black and white women.
Despite the growing gap in breast cancer mortality rates between Black and white women, there is hope for change. Warner emphasized that improvements in diagnosing and treating breast cancer have led to the widening disparities, but also present an opportunity to eliminate them. By addressing the root causes of these disparities and working towards equitable access to healthcare for all women, progress can be made in reducing the mortality rates among Black women with breast cancer.
