Why Do Women of Color Have Worse Breast Cancer Outcomes?

In 2013, Katrece Nolen, a 47-year-old Black woman from Northern Virginia, noticed that one of her breasts was swollen. She called her doctor and was sent for a mammogram. The results did not confirm the presence of cancer, so Nolen was prescribed an antibiotic regimen for what was thought to be happening. mastitis. A few weeks later, his chest was even more swollen.

Nolen contacted a breast surgeon’s office and was told they would not be able to see him for two months. “No proposal was made to consult the manager to see if this question warrants an earlier appointment or to identify another doctor. [have been] available to see me earlier,” he recalled.

When she finally convinced someone to make an appointment with another doctor at the practice, she showed up for her appointment with the required mammogram results and was told she had the CD with the images of her first mammogram, but had to reschedule as she didn’t have the actual mammogram film. , and in the application there was no equipment to read the CD.

“It was 3:00 p.m. and I was the only person in the office,” Nolan said. “The place where I had my mammogram was literally across the street and I ran to offer to get the movie but they told me I had to rebook. My boobs were so big I could barely button my shirt; it was clear there was something desperately wrong, but they showed me no empathy. I just needed to make another appointment. They kept repeating. I felt ignored.”

Nolen believes race plays a role in her difficulty in accessing breast cancer treatment, an experience shared by many women of color. Racial inequality in breast cancer care is unfortunately a very real phenomenon.

A look at the numbers

white and black women Native Americans and Alaska Natives tend to have the lowest rates, while American Indians and Alaska Natives tend to have the highest rates of breast cancer. A White woman has a 13% lifetime risk of developing breast cancer and a Black woman has a 12% risk. death rate is higher It is more common among Black, Hispanic, and Native American women than among white women. This is especially true for the black population. 40% more chance of dying more breast cancer than white women. While the death rate from breast cancer in white women has decreased in recent years thanks to early diagnosis and more effective treatments, at the same time, mortality rates have increased in the black women’s community, especially in the last five years. years. In fact, Black women 31% mortality rate From breast cancer, which is the highest among racial or ethnic groups in the United States.

Why are black women dying from breast cancer at such a high rate?

Rhonda SmithA 10-year breast cancer survivor and executive director of the California Black Health Network says there are many reasons for these shocking statistics. One factor is that African-American women are more prone. triple negative breast cancer, a more aggressive and deadly form of the disease. He said this, coupled with the lack of preventive care and late diagnosis, plays a role, as do general racial disparities in education, prevention, diagnosis and treatment.

Smith has personal experience in this matter. “I was part of a group of breast cancer survivors when I lived in Miami, and there was one here. [in California]and I’ve seen women in both groups with metastatic breast cancer who only lived 10-15 years. “I rarely see Black women who have left two years behind,” she said. He explained that this is because new treatments are sometimes not available for black women. “I have a white friend who has been metastatic for 17 years and her oncologist gave her whatever the newest experimental treatment is,” he said. “I don’t see this happening as often or to the same degree as in women of color.” Therefore, he said, implicit bias plays a role and influences decision-making about care and treatment.

Lack of access is another barrier. “There aren’t that many cancer centers when you look at underserved communities, let alone health centers in underserved communities,” Smith said. Ana Maria LopezThere’s also a lack of diversity in healthcare, said the Sidney Kimmel College of Medicine professor and vice president of medical oncology. “There are less than 10% of students of African descent in medical school,” he said. This is something he would like to see changed. “It would be much more beneficial to have people like you as part of this process than to have people who are so different.”

And when people of color like Nolen come for appointments, they don’t see diagrams or models that look like them. “I don’t think I’ve ever seen a non-white breast model,” Lopez said. “People are like, ‘Oh, that can’t make a difference; it’s just a model.’ But you’re asking the person to identify with it and they won’t.”

Another issue is the underrepresentation of minorities in research. one to work It looked at 230 clinical trials for cancer drugs and found that black participants represented only 3.1% of trial participants and only 6.1% of Hispanics. Black people have been mistreated in past research, Smith says. Tuskegee experiment and Henrietta Shortcomings also played a role. “When it comes to conversations about clinical trial participation, they don’t happen as often as in Black and Hispanic or Latino patients. [they] with white patients,” he added.

How do experts hope to change that?

Smith would like to see bills passed for breast cancer treatment like California’s. SB-65Addressing racial disparities in maternal and infant care by developing research and data collection to educate providers about socioeconomic factors that may contribute to communities of color with higher maternal and infant loss. “If we’re talking about eliminating inequalities in healthcare, educating healthcare providers is an important element,” he explained.

Smith encourages women of all races to talk openly about their family history of breast cancer and empower each other to keep up with mammograms. Lopez urges women who don’t have access to local screening and treatment facilities to take advantage of telehealth and hopes the pressure will continue for more treatment centers in underserved communities. “Many cancer centers are launching satellite clinics to be in more diverse areas,” she said. He said it was a response to something survivors and patients said: “Why don’t you travel to us, instead of we’re going to travel to you?”

While Nolen was still desperately begging to see a doctor, the breast cancer surgeon, a black woman, walked through the lobby and Nolen managed to get his attention. The doctor looked at Nolen’s chart and her swollen breasts and suspected that Nolen had inflammatory breast cancer that could not be detected on a mammogram. The doctor scheduled Nolen for a skin biopsy the next day (Friday), rushed the results, and confirmed the presence of cancer on Monday. Nolen’s experience has taught him that when it comes to racial disparities in healthcare, it’s not always in the form of overt racial slurs.

“In most cases, it is subtle or covert in the way you are spoken to and rejected by medical support personnel when seeking medical care,” he said.

Now, almost a decade later, Nolen looks back at his experiences and is grateful for his persistence. “I might not be here today if I hadn’t defended myself that day and insisted on being seen by the surgeon.”

This resource has been created with the support of Sanofi.

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