Breast Cancer: Black Women and Black Men
Is breast cancer more common in African Americans?
What race has the highest breast cancer rate?
Which racial or ethnic group has the highest mortality rate from breast cancer?
What ethnicity is more likely to get breast cancer?
Breast Cancer Awareness Month is a staunch reminder of the staggering disparities Black and African American women (and sometimes men) face.
Breast Cancer and African Americans
Variations in breast cancer between racial and ethnic groups
- The median age of diagnosis is slightly younger for Black women (60 years old) compared to white women (63 years old).
- Black women are more likely to develop breast cancer before age 40 than white women.
- At every age, Black women are more likely to die from breast cancer than any other race or ethnic group.
- White and Asian/Pacific Islander women are more likely to be diagnosed with localized breast cancer than Black, Hispanic, and American Indian/Alaska Native women.
- Fewer than 1 percent of all breast cancer diagnoses are in men; however Black men have higher rates of all types of breast cancer, and breast cancer incidence rates were 52 percent higher in Black men than in white men in the U.S.
Inflammatory breast cancer (IBC) and triple-negative breast cancer (TNBC) disproportionately affect Black women and contribute to racial disparities in breast cancer mortality.
- Triple-negative breast cancer spreads faster, has fewer treatment options, and tends to have a worse prognosis, accounting for about 15 percent of all breast cancers. Compared with white women, Black women are twice as likely to be diagnosed with triple-negative breast cancer.
- Earlier onset, more advanced stage at diagnosis, and aggressive tumor phenotype are some of the characteristic features of triple-negative breast cancer in women of African ethnicity compared to European American women, denoting one of the most significant examples of racial disparity in oncology.
- Triple-negative breast cancers in Black women were more likely to be Stage 3 (20.3 percent vs. 15.2 percent), more likely to be larger than five centimeters (14.3 percent vs. 9.6 percent), and more likely to have spread to the lymph nodes (39.0 percent vs. 31.6 percent).
- African American women are 28 percent more likely than white women to develop metastatic triple-negative breast cancer (mTNBC) and die.
- Inflammatory breast cancer is a rare, highly aggressive invasive cancer that accounts for one to five percent of all breast cancers, but Black women are 70 percent more likely to have it.
Delays in diagnosis and treatment for breast cancer may contribute to excess deaths among African Americans.
- Compared to white women, African American women experienced a significantly higher risk of ≥2 months delay in diagnosis and surgical treatment.
- Black women had at least a two-fold increase in the odds of delay to diagnostic evaluation, biopsy delays, and total delays ≥45 days compared with white women.
- Black women had a 40 percent to 70 percent higher risk of having stage 4 cancer – which has spread through the body and can no longer be eradicated – than whites.
- Compared to white women, Black women were 31 percent less likely to have surgery and 11 percent less likely to have chemotherapy.
Black women have the highest death rate from breast cancer.
- Breast cancer is the leading cause of cancer death in Black women.
- Black women have a 4 percent lower incidence rate of breast cancer than white women but a 40 percent higher breast cancer death rate.
- Black women who develop breast cancer are less likely than any other race to be alive five years after their diagnosis, regardless of when their cancers were discovered or what type it is.
- The mortality rate among young Black women (under 50) with a higher incidence of aggressive cancers is double that of young white women.
- Before 1980, breast cancer mortality was slightly lower among Black women than among white women. Racial disparities in access to mammography screening and adjuvant endocrine therapy precipitated the divergence in mortality.
Risk Factors for Black Women and Breast Cancer
In addition to being female and having a personal history of breast conditions or a family history of breast cancer, several genetic, biological and lifestyle factors associated with an increased risk of breast cancer are prevalent among African American women and not easily altered.
Genetic Mutations
Two of the most well-known genes that can mutate and raise the risk of breast and ovarian cancer are BRCA1 and BRCA2. Although the rates of genetic mutations among Black and white women were similar, Black women diagnosed with breast cancer were more likely to have mutations in the BRCA2 and PALB2 genes than white women.
Black women with mutations in the gene PALB2 have a 58 percent lifetime risk of developing breast cancer (by age 85 years). White women are almost five times more likely than Black women to be referred for genetic counseling and testing, suggesting racial disparities in how some doctors refer patients for those services.
Dense Breast Tissue
Black women are more likely to have dense breasts, making it harder to detect breast cancer via mammograms and boosting the risk for the disease. Thirty-eight states, including Ohio, require some level of breast density notification after a mammogram. Women with the highest breast density have a four to six times greater risk for breast cancer than those with lower breast density.
Childbearing
Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can raise breast cancer risk. The median age of Black mothers at birth climbed from 24 years in 1990 to 28 years in 2019. Black women have the lowest breastfeeding initiation rate of all racial groups at 69.4 percent, compared with 85.9 percent of white women.
Fertility rates for Black women have declined slightly over the past 10 years, from 70.8 births per 1,000 women in 2008 to 62.0 per 1,000 in 2018. Approximately 15 percent of U.S. Black women aged 40 to 44 have no biological children.
Reproductive History
Starting menstrual periods before age 12 exposes women to hormones longer, raising their risk of getting breast cancer. The average age for periods in the U.S. is 12.16 for Black girls and 12.88 for whites. By age eleven, 28 percent of Black girls and 13.5 percent of whites menstruate.
Little or No Access to Health Insurance
Although significant health insurance gains since the Affordable Care Act (ACA) was implemented, pervasive coverage disparities remain for Black women. Nearly 14 percent of Black women are uninsured, and one in five low-income Black women is uninsured.
Inactive Lifestyle
Not being physically active or being overweight or obese after menopause increases the risk of getting breast cancer. Thirty percent of non-Hispanic Blacks have physical inactivity outside work, and 80.6 percent of non-Hispanic Black women are overweight or obese.
Smoking
Women who are current smokers and have been smoking for more than 10 years appear to have a 10 percent higher risk of breast cancer than women who have never smoked. Between 13 percent and 14 percent of African American women smoke tobacco.
Better Treatments for Triple Negative Breast Cancer
Breast cancer is an out-of-control cell growth that can be found in one or both breasts of women and, in rare occurrences, men. Cancer cells can spread into the blood or lymph system and progress to other body parts. Technology, medication, greater access, and a focus on culturally competent care improve outcomes for Black and African American women and men diagnosed with breast cancer.
Triple-negative breast cancers (TNBC) are the hardest to treat because they lack hormone receptors and HER2 overexpression, so they do not respond to therapies directed at these targets. Chemotherapy is the mainstay for the treatment of TNBC; however, new treatments are starting to become available:
- Sacituzumab govitecan-hziy (Trodelvy) is approved to treat patients with TNBC that has spread to other body parts. Patients must have received at least two prior therapies before receiving the drug.
- Pembrolizumab (Keytruda)is an immunotherapy drug that is approved to be used in combination with chemotherapy for patients with locally advanced or metastatic TNBC with the PD-L1 It may also be used for patients with early-stage TNBC, regardless of their PD-L1 status.
- PARP inhibitors, which include olaparib (Lynparza) and talazoparib (Talzenna), are approved to treat metastatic HER2-negative or triple-negative breast cancers in patients who have inherited a harmful BRCA gene mutation. Olaparib is also approved in certain patients with early-stage HER2-negative or triple-negative breast cancer.
- Drugs that block the androgen receptors or prevent androgen production are being tested in a subset of TNBC that express the androgen receptor.
For a more comprehensive list of the latest advances in all categories and stages of breast cancer treatment, visit the National Cancer Institute.
Better Breast Cancer Prevention Measures
Black and African American women can do more than diet, exercise, tobacco and alcohol cessation, self-breast exams, and annual mammography screening to help prevent breast cancer. Preventative measures for African American breast health are as follows:
- Black women with a higher risk of breast cancer can request MRI (magnetic resonance imaging) and an ultrasound to detect breast cancer. A new technology being deployed in clinical settings is 3-D mammography, also called breast tomosynthesis, which takes images from different angles around the breast and builds them into a 3-D-like image.
- Patients should be mindful of the potential for diagnosing tumors that would not have become life-threatening (overdiagnosis), the possibility of receiving false-positive test results, and the anxiety that comes with follow-up tests or procedures.
- Women with specific patterns of breast, ovarian, tubal, or peritoneal cancer in any family history can order genetic counseling testing to determine the risk of breast cancer.
- Estrogen-blocking pills are a newer preventative therapy. These pills are prescribed to high-risk patients for around five years, reducing development risk by nearly 30 percent.
Support for Black and African American Men and Women Diagnosed with Breast Cancer
Physical, mental, social, and financial support are available to Black and African American men and women diagnosed with breast cancer in Cincinnati and the U.S.
- Cancer Support Community Cincinnati
- Pink Ribbon Girls
- Susan G. Komen – Greater Cincinnati
- Metastatic Stage IV Breast Cancer Community Support Program
- Susan G. Komen Male Breast Cancer Patient Support Group
- My Breast Cancer Team: Support for Women, Men, and Families
- Knowledge is Power: The Black Breast Cancer Experience
- Living Beyond Breast Cancer
- KEYTRUDA Cost Info & Financial Help
- Susan G. Komen Financial Assistance and Insurance
- Young Survival Coalition: Financial Assistance Programs for Young Women with Breast Cancer
- Novartis Oncology Financial Assistance
- ENHERTU Medication affordability options
- Affordable Care Act opened free screenings in some instances.
African American Breast Health Sources
America Cancer Society (ACS)
Black Women Need Genetic Testing for Breast Cancer (ACS)
Lifetime Risk of Developing or Dying from Cancer
Good Morning America: Young women share breast cancer stories
Good Morning America: The latest advancements in the fight against breast cancer
Black Men have higher incidence rates of all types of breast cancer
Black Male Breast Cancer in the U.S Breastcancer.org
Babies After 35: Black Women and Infertility
Dr. Kristi Funk on GMA: New advancements in the fight against breast cancer
GMA: A look at the latest technology for breast cancer treatment
Written by: Crystal Kendrick
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African American Breast Health photo provided by Adobe Stock
