Black Women and Breast Cancer: Disparities Continue
“Without a sense of caring, there can be no sense of community.” — Anthony J. D’Angelo
Did you know that the latest statistics from the American Cancer Society reveal that since the 1990s, the breast cancer mortality rate has dramatically fallen by 40 percent? This decline is primarily due to the utilization of screening mammography, in conjunction with newer, more effective, and personalized cancer treatment. Mammography, however, still remains the gold standard in screening for breast cancer. Did you also know that black women are 42 percent more likely to die from breast cancer than white women, even though they tend to be diagnosed less often with the disease? Why is that?
There is much talk about the “harms” of screening for breast cancer such as the anxiety of being “called back” for additional imaging, the stress of an image-guided breast biopsy, or the physical trauma experienced while undergoing the mammogram. However, there is equally significant “harm” in not being screened. Many of the reasons are involuntary and mostly due to unequal access to mammograms because of poverty, a lack of health insurance, inability to get adequate time off from work to get screened, unreliable transportation, a lack of childcare, and a lack of access to effective treatment. These are the “harms” that cause disparities in breast cancer screening rates and they disproportionately affect women of color.
How can we, as individuals, help to eliminate these hurdles? As physicians, particularly radiologists, we must speak directly with the patients in our practices. We must educate and encourage our patients to start and/or continue annual screening. Additionally, by working together with clinics and hospital administrations, we can determine if there are opportunities to provide low or no-cost screening, as well as transportation for patients to and from the clinics. We can go out into our communities during Black History Month and spread the word about the importance of mammogram screening at our workplaces, churches, and local health fairs. It is imperative that we explain the role of and the confusion over breast cancer screening. Lastly, we must impress upon our patients the importance of follow-up imaging and the need to inform their healthcare providers of symptoms.
This does not cover all the various reasons for the higher mortality rate among black women and there are several other factors that also contribute to the increased incidence of triple negative cancers in black women. However, routine screening is a logical place to begin and hopefully, in time, the remaining obstacles can be addressed and overcome as well.
By Cheryl Herman, MD, assistant professor of radiology at Washington University School of Medicine in St. Louis, Mo.