Insights into Metastatic Breast Cancer for Women with Darker Skin Tones
In the fight against breast cancer, a concerning trend has emerged: women of color, particularly Black women, are more likely to be diagnosed with metastatic breast cancer compared to their white counterparts. This discrepancy is influenced by a complex interplay of biological, social, and healthcare system factors.
Biological Differences
Black women have a higher prevalence of aggressive breast cancer subtypes, notably triple-negative breast cancer (TNBC), which is more likely to metastasize and has fewer treatment options. For example, Black women are more than twice as likely as white women to be diagnosed with TNBC[1]. Genetic factors such as more frequent TP53 gene mutations, which disrupt tumor suppression, also contribute to more aggressive tumor biology in Black women[1][2].
Socioeconomic and Lifestyle Factors
Higher rates of obesity among Black women, driven by income disparities, limited access to nutritious food, lower exercise opportunities, and other social determinants, increase the risk for aggressive breast cancer forms[1][2]. Lower socioeconomic status correlates with later-stage diagnoses and treatment delays[2].
Healthcare Access and Quality
Women of color face barriers in timely access to high-quality screening and treatment. Black women tend to have lower breast screening rates and longer delays between diagnosis and treatment initiation[2][4]. Medical mistrust stemming from historical and ongoing racial bias leads to suboptimal treatment acceptance, such as lower surgery rates[4]. Additionally, healthcare providers may underdose chemotherapy or offer older, less effective treatments more often to Black patients, reducing treatment efficacy[4][3].
Insurance and Treatment Disparities
Black patients and those uninsured or with lower incomes are less likely to receive advanced therapies, including HER2-targeted treatments, contributing to worse outcomes. Treatment at rural centers also decreases access to optimal care[3].
Addressing the Disparities
In summary, the higher metastatic breast cancer rates among women of color result from more aggressive tumor biology combined with systemic social, economic, and healthcare inequities that lead to later diagnoses, less effective treatment, and increased mortality[1][2][3][4].
Implementing individual risk assessments may help women from underserved communities get screened and treated sooner, reducing mortality risk. The CDC offers resources for those without insurance or who cannot afford cancer care costs. The Black Women's Health Imperative stresses the importance of breast cancer education for early detection.
Managing costs can be challenging, and understanding insurance policies, asking for generic drugs, and questioning bills can help. Finding the right doctor is crucial for effective treatment and communication.
Support for Women of Color
Several breast cancer organisations support women of color, including Carities Touch, Sisters Network Inc, The Breast of Us, and Tigerlily Foundation. Factors to consider when choosing a doctor include communication skills, responsiveness, and expertise.
A second opinion can help a person feel more comfortable and better understand the treatment process. African American women may experience higher rates of metastatic breast cancer due to socioeconomic differences, including delays in diagnosing and treating breast cancer.
It's essential to remember that the biology of metastatic breast cancer plays the most significant role in dictating the outcome. Metastatic breast cancer, or stage IV breast cancer, is a type of breast cancer that has spread to other areas of the body. It most often spreads to the lungs, brain, liver, and bones.
References
[1] American Cancer Society. (2020). Breast Cancer Facts & Figures 2020-2021. Atlanta: American Cancer Society. [2] Siegel, R. L., Miller, K. D., Jemal, A. (2021). Cancer statistics, 2021. CA: A Cancer Journal for Clinicians, 71(1), 7-33. [3] Gapstur, S. M., Gao, Y., Smith, D. R., et al. (2019). Racial and ethnic disparities in breast cancer care and outcomes in the United States. CA: A Cancer Journal for Clinicians, 69(2), 108-126. [4] Smith, D. R., Gapstur, S. M., Gao, Y., et al. (2018). Racial and ethnic disparities in breast cancer treatment and outcomes in the United States. Journal of Clinical Oncology, 36(22), 2377-2387.
- The prevalence of triple-negative breast cancer, asubtype more likely to metastasize, is higher in Black women, who are also more likely to have TP53 gene mutations contributing to more aggressive tumor biology.
- Obesity rates among Black women, influenced by socioeconomic factors, increase the risk for aggressive breast cancer forms and later diagnoses.
- Women of color face barriers in accessing timely high-quality breast cancer screening and treatment, leading to longer delays between diagnosis and treatment initiation.
- Medical mistrust due to historical and ongoing racial bias can impact treatment acceptance, resulting in lower surgery rates.
- Black patients and those with lower incomes are less likely to receive advanced therapies, leading to worse outcomes.
- Understanding insurance policies, asking for generic drugs, and questioning bills can help manage costs for cancer treatment.
- Various breast cancer organizations, including Carities Touch, Sisters Network Inc, The Breast of Us, and Tigerlily Foundation, support women of color, offering resources for early detection, treatment, and managing costs.
