Every October, the medical community, our public health agencies, and the media observe Breast Cancer Awareness Month. We consider it an important opportunity to remind everyone that regular mammograms save lives. Regular screening increases breast cancer survival rates when cancers are found at an early stage versus at a later stage of the disease.
Last year’s American Cancer Society updated report on the status of cancer revealed important changes in breast cancer statistics. Results were mixed: the excellent news is that we are taking major leaps forward concerning minority breast cancer mortality overall.
However, in other aspects, there are ethnic disparities in care and cancer care. We seem to be failing our African American, Hispanic, Asian, American Indian, Pacific Islander, and Alaska Native populations, to name a few.
Good news first: Breast cancer mortality is down
Looking at all American women as a homogeneous group, the outlook is optimistic. According to the American Cancer Society, between 1989 and 2020, breast cancer death rates have been declining steadily by an average of 1.6% per year. Overall, this means a person who is diagnosed today is 43% less likely to die of breast cancer than a person diagnosed 30 years ago.
In “real women” numbers, this means that nowadays, 1 out of 39 women diagnosed with breast cancer will die from it—a sharp contrast from the 1970s when breast cancer deaths rose every year.
So, what happened in the late ’80s? This decade saw the birth of the Breast Cancer Awareness movement, with the first Breast Cancer Awareness Month celebrated in 1985. The movement brought a much-needed influx of cash for researchers.
The pink ribbon, the walkathons, and even the public attention on the stories of breast cancer survivors all date back to this decade. In 1989, we finally reversed the trend, and mortality rates began to fall as regular follow-up care rose.
Why is breast cancer research important?
When we say, “clinical research,” most people think about white-coated scientists developing expensive, proprietary compounds. In reality, breast cancer research saves lives by looking at a combination of factors, especially those that determine whether we get cancer in the first place.
That’s not to deny the significant advances in cancer treatment in general. But before we could create more precise “targeted” treatments (which are more likely to work right away), researchers first had to understand what separates each type of cancer and what triggers it.
The past 30 years have also revealed the risk factors behind the disease – and as many are related to lifestyle and environment, we’ve started modifying them. However, perhaps the most significant stride came from a renewed emphasis on interventions for early detection: the earlier we catch it, the lower the death rate.
Breast cancer screening: a game changer
Almost all public health agencies recommend yearly mammography screening for women after a certain age. However, the recommendations for that age have been changing. The recommended age gets tweaked every few years, especially for women deemed at a higher breast cancer risk.
The American College of Obstetricians and Gynecologists, the National Comprehensive Cancer Center Network, the American Cancer Society, and the American Society of Surgical Oncology all recommend yearly screening between the ages of 40 and 45, depending on personal risk factors.
Meanwhile, the US Preventive Task Force (USPTF) traditionally recommends mammograms every two years, starting at age 50. However, they moved to a more “hands-on” approach, and their new draft recommendations now list 40 as the starting age. This is excellent news.
So why do breast cancer disparities remain?
Unfortunately, these advances have not been distributed equally. According to a paper on the National Cancer Institute’s website, Health and Racial Disparity in Breast Cancer, the current five-year survival rate for women with breast cancer is 91%.
However, among minority women, the survival rate is often much lower. And they are more likely to get a breast cancer diagnosis at the more advanced stages of the disease. This must change.
The reasons for the mortality rate differences between black and white women are complex. Some are unavoidable and based on genetics. However, others stem from differences in socioeconomic status and are hard to address without changes to our health care system.
The genetic factor: breast cancer differences by ethnicity
By now, the fact that breast cancer often runs in families is a fact. If you have a first-degree relative who has breast cancer, then your risk of developing it nearly doubles. However, these genetic differences also affect which type of breast cancer you’ll get — and right now, some types of breast cancer are more challenging to treat than others.
This helps explain the racial differences we see in breast cancer outcomes. If we look at the total cases, we will see that, of all ethnic groups, non-Hispanic white women have the highest breast cancer incidence rates, at 136 out of 100,000 women. Incidence rates for black women is 128 out of 100,000, with all other ethnic groups falling in line after that.
The social factor: money, prejudice, and breast cancer mortality
When discussing health inequities, we need to look at socioeconomic status. For systemic reasons that go beyond the scope of this article, African Americans and many racial and ethnic minority women (and men) have a harder time navigating the medical system.
Of all social determinants of health, money is often the most visible. According to the U.S. Census Bureau, black Americans are more likely to live in poverty. And with a low income come a handful of extra barriers to health care access, starting with being uninsured.
Finally, poverty itself also puts one at a higher risk of developing cancer in the first place. It makes it more likely to have comorbidities that increase risk (such as obesity, diabetes, and hypertension).
What can we do to address these health disparities?
First, we need to invest in health equity as a society. This encompasses expanding Medicare and Medicaid, especially their screening or primary care services coverage. We also need to provide more alternatives for people who can’t work full-time, don’t have access to health insurance, or lose their health insurance between jobs.
The United States Preventive Services Task Force has taken a step in the right direction by mandating that insurance companies cover mammograms as part of routine care. No woman should have to wait for treatment when a lump is discovered, be it by self-examination, mammogram, or MRI.
Our country also needs to continue investing in the development of breast cancer treatments, especially on drugs that target fewer common receptors or mutations or that may work with late-stage breast cancer.
And more patients from minority and underserved communities need to participate in cancer clinical trials. For example, according to a 2021 study published in JAMA, 82% of all participants in oncology trials were white.
If you’re between 40 and 45 and have yet to schedule your first mammogram, please take that step and continue to get screened every year!
Dr Aliabadi: smart, sensitive, and sensible gynecological care in Los Angeles
Routinely listed as one of the U.S.’s top specialists in women’s health, Dr. Thais Aliabadi sees her practice as an essential bridge that encompasses every stage of a woman’s life. Her extensive training and warm demeaner can help patients from every walk of life, as they face the challenges and transitions of motherhood, menopause, and their sexual well-being.
Every woman at her clinic, whether she’s a celebrity or a newly diagnosed breast cancer patient, can expect to meet a highly trained team, a superbly equipped facility, and a listening ear.
We invite you to establish care with Dr. Aliabadi. Please make an appointment online or call us at (844) 863-6700.
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Sources
Breast cancer statistics, 2017, racial disparity in mortality by state.
https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21412
Health Disparities and Triple-Negative Breast Cancer in African American Women, A Review. https://jamanetwork.com/journals/jamasurgery/article-abstract/2613703
Surveillance, Epidemiology, and End Results Program.
http://seer.cancer.gov
SEER Cancer Statistics Review (CSR) 1975-2014.
https://seer.cancer.gov/archive/csr/1975_2014/index.html
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