Black women have a much lesser breast cancer survival rates than white women, even from types that are typically thought to be treatable. 

This alarming fact highlights the ongoing disparities in health care and access between different racial groups. The results cast doubt on long-held theories that the racial disparity in breast cancer survival rates is primarily caused by biological variations. Instead, experts contend that structural inequalities in health care access, socioeconomic factors, and other external influences play a much larger role in determining outcomes for Black women with breast cancer.

According to statistics, Black women had a 40% higher chance of dying from breast cancer than White women, despite having almost equal diagnoses. 

This difference has persisted for years, despite despite advancements in breast cancer diagnostic techniques and treatment.

Dr. Erica Warner, a cancer epidemiologist at Massachusetts General Hospital, states that the higher death rate for Black women was formerly belief to be linked to the fact that they are more likely to develop an aggressive form of breast cancer known as triple-negative breast cancer. Warner’s research suggests that although this aggressive cancer subtype does worsen outcomes for Black women, it is not the main cause of the mortality discrepancy.

In a comprehensive meta-analysis, Warner and her associates examined 18 different trials including about 230,000 women with breast cancer, of which 34,000 were Black. They analyzed the mortality rates of White and Black women with the same breast cancer molecular subtypes, which offered insight into how the disease behaves and responds to treatment based on its biological characteristics. 

Breast cancer subtypes are classified based on the kind of receptors found on tumor cells. These receptors controls the cancer behaviour and how it might respond to treatment.

The most prevalent subtypes include hormone receptor-positive (HR-positive) and HER2-positive cancers. HR-positive tumors have receptors for hormones like estrogen or progesterone, which can stimulate cancer growth but also increase the tumors’ sensitivity to hormone-blocking treatments. HER2-positive tumors contain receptors that help the cancer spread more quickly, but targeted therapies are available to control or stop the cancer’s growth. 

Triple-negative breast cancer, which lack all the three main receptors—progesterone, estrogen, and HER2—is the most challenging subtype to treat. Since there are fewer therapeutic options available with the absence of these receptors, this type of cancer is far more aggressive.

According to Warner’s data, Black women had a disproportionately higher risk of dying from all subtypes of breast cancer, not just triple-negative cases. 

For the most common subtype, HR-positive, HER2-negative breast cancer, which accounts for 60% to 70% of all breast cancer diagnoses, Black women were 50% more likely than White women to die from the disease. In cases of HR-positive, HER2-positive cancer, Black women faced a 34% higher risk of death. 

Even for triple-negative breast cancer, Black women had a 17% higher death rate than White women, a finding that surprised Warner and her team. Researchers did not anticipate such a strong racial difference in triple-negative breast cancer mortality, despite the fact that the disease has high mortality rates for all patients.

Warner’s research refutes the notion that Black women’s increased risk of acquiring triple-negative breast cancer is the main cause of their higher death rates from the disease. Indeed, the research showed that racial disparities existed across all breast cancer subtypes. This supports the theory that these variations in results are not caused by biology, but rather by external factors.

Dr. Eric Winer, director of Yale Cancer Center, agrees with this assessment. He notes that hormone receptor-positive tumors, which are among the most curable types of breast cancer, have the biggest breast cancer survival rates gaps. For these cancers, long-term treatment with hormone therapy, lasting five years or more, is often required. 

However, many patients face major barriers due to the high out-of-pocket expenses of these treatments, particularly those from economically disadvantaged backgrounds.

Winer argues that economic inequality plays a central role in the differences in breast cancer survival rates. Many Black women, particularly those with low incomes or without insurance, can find it difficult to get the prescription drugs they require or cannot afford the required therapies.

Another issue, Winer raises, is that medical professionals may not be offering long-term hormone therapy as frequently to Black women or low-income patients. 

This may be because these patients are unable to receive the best therapies possible because of systemic issues or unconscious bias. These differences are made worse by the fact that Black patients are more likely than White patients to be uninsured, according to data from the Centers for Disease Control and Prevention (CDC). 

Many women without insurance were faced with high costs for cancer treatments, including hormone therapy, which can lead to reduced adherence to treatment regimens and worse outcomes.

Dr. Wendy Wilcox, chief women’s health officer at New York City Health + Hospitals, highlights numerous structural barriers that Black women encounter when navigating the health care system. 

For instance, low-income and minority patients are disproportionately impacted by issues including availability of child care, transportation to and from doctor’s visits, and the capacity to take time off work for treatment. 

Health outcomes are also influenced by social determinants of health, such as living in areas with higher pollution levels or restricted access to nutritious food. Wilcox emphasizes that these non-medical factors are often times disregarded but have a significant effect on who receives timely and effective treatment for breast cancer.

Another key problem is the underrepresentation of Black women in clinical trials for breast cancer treatments.

According to Dr. Wilcox, Black women have been underrepresented in research since the very beginning, which implies that when creating new treatments, the unique needs and experiences of this population are not adequately considered. As a result of this exclusion, treatments for Black women may be less effective or may not take into consideration the particular challenges they confront.

Furthermore, compared to White women, Black women have a higher risk of developing breast cancer at a younger age. 

Unfortunately, a lot of people do not receive a diagnosis until their cancer has progressed to a more severe stage, which increases the difficulty of therapy and lowers their chances of breast cancer survival rates.

Dr. Marissa Howard-McNatt, director of the Breast Care Center at Atrium Health Wake Forest Baptist, notes that although breast cancer screening usually starts at age 40, bur many Black women are diagnosed with the disease in their 30s. She suggests that women with a family history of breast cancer should start screening 10 years before their closest relative was diagnosed to improve the likelihood of early detection.

Howard-McNatt also emphasizes the value of patient navigators in assisting Black women access the care they need. 

Patient navigators help with things like making appointments, setting up transportation to medical institutions, and outlining treatment alternatives. Patient navigators can lessen some of the structural obstacles that Black women encounter and increase their chances of receiving timely and appropriate treatment.

Warner concludes by pointing out that the racial gap in breast cancer survival rates has not always existed. 

Forty years ago, there were no appreciable differences in the death rates from the disease between White and Black women because treatments for breast cancer were generally less effective for all patients. However, as advancements in breast cancer treatment have been made, the breast cancer survival rates gap between Black and white women has widened. 

This, Warner says, is evidence that the disparities are not unavoidable. “If we can create them, we can eliminate them,” highlighting how critical it is to address these disparities across the board in the healthcare system. By reducing structural barriers, improving clinical trial representation, and concentrating on equal access to care can narrow the breast cancer survival rates between White and Black women.