A Journey of a Thousand Miles:
Addressing Racial Disparities
in Breast Cancer Outcomes
by Pat Battaglia
According to the Centers for Disease Control, “Black women and White women get breast cancer at about the same rate, but Black women die from breast cancer at a higher rate than White women.” Furthermore, Black women are more likely to be diagnosed with triple negative breast cancer, a subtype of the disease that presents challenges to treatment. And breast cancer of any type is more likely to be discovered at a later stage in Black women.1 The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database shows that White females were diagnosed with breast cancer in 2017 at a rate of 131 per 100,000, while the rate for Black women in the same year was about 124 per 100,000. However, approximately 20 White women per 100,000 die annually from the disease, while the death rate for Black women is nearly 27 per 100,000.2 Racial differences in tumor biology appear to be minimal and do not account for this disparity in outcomes among Black and White women diagnosed with breast cancer.3
Of course, incidence and mortality numbers more clearly reveal the human impact of the statistics and percentages cited here. See the accompanying graphic (below) for the numbers in New York State and Monroe County.
Non-Hispanic Black people are the second-largest ethnic minority group in the United States, comprising thirteen percent of the population. It is a diverse group that, taken as a whole, has the highest death rate and shortest survival of any racial or ethnic group in the nation for most cancers.4 The causes of these inequalities are complex and reflect social and economic disparities that involve cancer risk, as well as differences in access to health care.
Having access to health care simply means that a person is able to obtain needed health services in a timely manner. It involves the ease of gaining entry into a health care system, adequate insurance coverage, the location of health care facilities in easily accessible areas, reliable transportation to and from medical appointments, and finding trusted health care providers.5
A Physician’s Perspective
Farhan Imran, M.D., is a physician specializing in hematology and oncology at the Lipson Cancer Center. He serves a diverse patient population and has written eloquently about his experiences as an immigrant and non-black person of color in the medical field.* His patients represent all races and diverse socioeconomic backgrounds.
“Overall I would say that the outcomes [of breast cancer treatment] have been quite similar in my patient population,” he states. Reflective of the national trend, he has noted a slightly higher incidence of triple negative breast cancer in his black patients. “Fortunately the cure or success rate is quite high for majority of breast cancers in both Black and White patients,” he adds.
Noting that his White patients tend to thoroughly research their disease, he acknowledges a number of highly motivated Black patients who do the same and ask pertinent, if sometimes difficult-to-answer questions. “One of my dear Black patients insisted that I quote her studies where certain chemotherapy regimens were tailored to Black women. I told her that, unfortunately, the representation of Black women in clinical trials is lower than White women. As a result, we may not have clinical data that apply purely to Black women.”
Strong social networks, including faith communities, and deep-seated resilience characterize many of Dr. Imran’s Black patients, he says. However, he has observed a hesitancy to place complete trust in health care providers among some of his Black patients. He responds with compassion. “Sometimes I feel that black women find it harder to trust their doctors initially but once they get comfortable with their care teams, they put their blind trust in you and will be ever grateful and thankful for the care they receive.”
A Survivor’s Story
Indicative of the high quality cancer care available in our region, Sheila Searles-Fairey’s breast cancer experience is one of empowerment, although life-altering in its impact.
When she was diagnosed with the disease in the fall of 2015, Sheila had no outward indication that anything was wrong. But an area of concern was detected on her breast during an annual screening mammogram and, from that point, events unfolded quickly. A biopsy confirmed a diagnosis of estrogen-receptor positive breast cancer and, shortly afterward, Sheila underwent a lumpectomy. Unfortunately, a second mass was unexpectedly found by her surgeon during the procedure, resulting in a second surgery to ensure all traces of cancer were removed. After completing radiation treatments and beginning a daily regimen of a hormonal medication directed at her estrogen-based tumor, Sheila is healthy as she approaches the five-year mark since her diagnosis.
Fortunately, Sheila experienced no delays or difficulties in accessing the care she needed. “I think all in all it was a three to four week process from the time of diagnosis, biopsy, surgery, genetic testing, and beginning radiation,” she shared.
Having a good support system helped. “My husband was with me every step of the way. He went to all the doctor visits and all of the radiation therapy. I knew other women who were survivors. They were helpful with information and connected me with the Coalition.” Sheila is still an active member of our survivor community and participates in a number of support programs.
Sheila’s story affirms Dr. Imran’s experience; setting statistics aside, positive outcomes happen across the board.
Identifying Ways to Do Better
Yet the facts cannot be ignored. Nationally, the Black Lives Matter movement has drawn attention to deep-seated racism in our society. The racial disparity in breast cancer outcomes is a symptom of this pervasive disorder. Dr. Imran shares his thoughts on the actions he feels will make a meaningful difference.
“More Black women should be encouraged to participate in clinical trials. Not only that, researchers should design studies that are focused primarily on Black women and their health issues. This will lead to better understanding of their disease biology and other characteristics, and treatments would be better geared towards them.”
He also emphasized the role of access to mammography in Black communities. While early detection isn’t a cure for breast cancer, the disease can’t be treated until it’s found. And outcomes are best when it’s detected at the earliest stage possible. Mammography, while imperfect, remains the most reliable way to detect breast cancer for the majority of individuals. “There should be more mobile mammography events in Black communities and churches,” Dr. Imran maintains.
Access to Care in a Local Community
Ensuring equitable access to screening and other health care services requires funding. The New York State Department of Health provides funds for its Cancer Services Program**, which offers free screenings for breast, cervical, and colorectal cancers to uninsured and underinsured residents of the state. It also covers follow-up care in cases where suspicion of cancer has been raised or the disease has been diagnosed. These services are administered on a county-by-county basis. In the Rochester area, the Monroe County Cancer Services Program offers free mammograms at a number of locations, including the Anthony Jordan Health Center, which is located in a city neighborhood and serves a significant number of people of color. When this Center needed a mammography unit, the Coalition provided funding for this important community resource.
But when an Anthony Jordan patient needs follow-up imaging after a mammogram, they are referred to a comprehensive imaging center. Several of these centers operate in the area; all are located outside city limits. State funds do not cover transportation costs.
A recently discontinued grant provided Anthony Jordan patients with transportation to Highland Breast Imaging (HBI) in Henrietta for diagnostic work-ups. These funds were also used to assist those with high-deductible insurance, as well as the uninsured. Unfortunately, when the funds on hand run out, these services will be discontinued. This will negatively impact access to needed care for a significant number of city people.
Those with limited means of transportation who need diagnostic services will continue to have access to the HBI facility at Strong Memorial Hospital, which is located on a bus line. And the HBI staff is working diligently to find a way to continue to cover the services that no longer receive grant funding.
We at the Coalition are following this recent, unfortunate development in our community with concern.
Close to Home: Disparities Statewide and in Our Community
A clear picture of the human impact of disparities in breast cancer outcomes in our region, or any locality, is best revealed by the actual breast cancer incidence and mortality figures.
THE LATEST NUMBERS FOR NEW YORK STATE AND MONROE COUNTY
These are more than just numbers. Each one represents a person diagnosed with breast cancer or a life lost to the disease. We at the Coalition are deeply concerned by the disparities in mortality between Black and White individuals reflected in these numbers.
New York State breast cancer incidence/mortality data averaged, annually
Breast cancer incidence
Breast Cancer mortality
Monroe County breast cancer incidence/mortality data averaged, annually:
Breast cancer incidence
Breast cancer mortality
The latest numbers for breast cancer in Monroe County, with source, by RACE averaged annually:
Breast Cancer actual incidence WHITES
Breast Cancer actual mortality, WHITES
Breast Cancer actual incidence, BLACKS
Breast Cancer actual mortality, BLACKS
The First Steps on a Long Road
Ensuring access to breast cancer screening, follow-up imaging, and timely and effective treatment is vital to addressing racial disparities in breast cancer outcomes. Including Black populations in the design of clinical trials is another key element that will add to our understanding of why these disparities exist and how to address them. These are just two of the initial steps that, over time, will lead to the larger changes needed to close the racial gap in breast cancer treatment outcomes. Our Advocacy and Research committees are open to those who wish to explore these questions in a group of empowered individuals. In this journey of a thousand miles, the time for those first small steps is now.
* Read Dr. Imran’s personal experience here.
** For information on the New York State Cancer Services, click here.
This story appeared in the Fall 2020 edition of Voices of the Ribbon newsletter.
In response to national unrest surrounding the Black Lives Matter movement in the Summer 2020, our Director issued a statement, explaining why racial disparity issues matter to us at the Coalition. Declaring that “Racism has long been a factor we see in the disparities in cancer diagnosis and treatment,” the statement has the full support of our staff and Board of Directors because it is based on sound evidence.