For Black women, breast cancer is the most commonly diagnosed cancer and the second-leading cause of cancer death after lung cancer, according the American Cancer Society. While Black women and White women get breast cancer at about the same rate, Black women are 40 percent more likely to die from the disease, according to a Centers for Disease Control and Prevention study.
“This is a mind-opening fact that shows disparities exist within breast health,” says Dr. Vivian Bea, section chief of breast surgical oncology at NewYork-Presbyterian Brooklyn Methodist Hospital and an assistant professor of surgery at Weill Cornell Medicine. “But we can’t pin it to exactly one thing.”
Dr. Bea, who is committed to eliminating disparities through research and health initiatives, says many factors contribute to breast cancer disparities, ranging from social determinants to genetics and tumor biology. Here she addresses what Black women should know about their breast cancer risks and breast health, and dispels myths about what a breast cancer diagnosis means.
1. Know the facts.
Researchers are working to better understand why there’s such a big disparity in breast cancer outcomes between Black and White women. Access to care is an issue, but other factors include genetics and tumor biology, says Dr. Bea. “We used to believe breast disparities were primarily due to lack of access to healthcare, and then policies were implemented that actually improved mammography screening and insurance availability, and yet the disparity still exists,” she says.
Research indicates that genetics may play a part in this higher risk disparity, and the risk may differ depending on a Black woman’s ancestry, specifically in cases of triple- negative breast cancer. Black women are more likely to have triple-negative breast cancer, a rarer but more aggressive form that does not respond to hormonal treatment.
According to the American Cancer Society, triple-negative breast cancer is about twice as common in Black women than White women in the U.S., and a contributor to the lower breast cancer survival rate among Black patients. “It’s important that Black women know their risk for breast cancer, so that they can educate themselves and be proactive about their health,” says Dr. Bea.
2. Get screened—and bring a friend.
Early detection is the best protection. “Even though Black women are more likely to have triple- negative breast cancer, if we catch these women at the earliest stage of that breast cancer, there is a better chance for survival,” says Dr. Bea.
The American Cancer Society says women should have the choice to start screening with yearly mammograms as early as age 40 if they want to and recommends women should begin having yearly mammograms by age 45, which can change to every other year beginning at age 55. If you have a family history, you should start screenings earlier. “Black women are more likely to be diagnosed at a younger age with the more aggressive tumor subtype, so I recommend going annually starting at the age of 40,” says Dr. Bea.
If you’re nervous about getting a mammogram, Dr. Bea recommends going with a friend so you can hold each other accountable and have moral support.
“I understand that it is not a piece of cake for everyone and can be nerve wracking,” Dr. Bea says. “Maybe do a spa day or a girls’ day after to ease the stress and anxiety around the appointment. Take the focus off the mammogram and make it a whole ritual.”
Through a multi-institutional grant, she received from the American Cancer Society and Pfizer, Dr. Bea is focusing on improving access to screening mammography for Black women in the Brooklyn community by extending hours at NewYork-Presbyterian Brooklyn Methodist Hospital a few times a month and providing access to breast imaging at NewYork Presbyterian Lower Manhattan Hospital.
“We are also working with navigators within faith-based organizations to help get the word out and encourage women in their church to receive their annual mammogram, even in the era of COVID-19,” she says.
3. Don’t believe myths.
There is understandably a lot of fear around a breast cancer diagnosis, but it is important to be aware of the many advances made in care. For example, Dr. Bea says some patients have expressed concern that if they receive a diagnosis of cancer and have surgery, the surgery could cause the cancer to spread. “This is false,” she says.
Women may believe that surgeons will have to remove their breasts, which is also not true. “We can offer modern approaches to breast surgery, such as lumpectomy or breast- conserving surgery, which only removes a portion of the breast,” says Dr. Bea. “Those myths, coupled with a valid fear of COVID, may be widening the gap of women not getting their mammograms right now. But it’s important to remember early detection saves lives.”
She emphasizes that women should not let a fear of COVID stop them from getting their mammograms. “COVID is real, but women should know it is safe to come into the hospital to get their mammogram,” she says. “It is a risk-benefit situation. Wear a mask, practice social distancing, and use hand sanitizer to balance off that risk and get your mammogram.”
4. Know your breasts.
Dr. Bea encourages women to do a breast self-exam every month. “If there is an abnormality, you’d be the first to detect it,” she says. Signs to look for include nipple discharge, a palpable mass (a lump), or any skin changes. “If you’ve never had eczema, a condition that makes your skin red and itchy, in your life, and you see skin changes on your breast, do not assume it’s eczema. Go and see your provider,” she advises.
Clinical breast exams are important at least yearly with a licensed practitioner.
Dr. Bea hopes that by building trust with her patients and prioritizing education, outreach, and early diagnosis, she can address disparities in the community and save lives. “I have a voice and it’s my duty to use it and be at the forefront of this conversation.” She says she is active on social media to try to reach even more patients.
Equally important is a diverse care team. “NewYork-Presbyterian Brooklyn Methodist Hospital has a multidisciplinary team of Black women who treat breast cancer, which is rare,” says Dr. Bea. “If you are diagnosed with breast cancer, it’s important to receive high-quality care, which we offer here with a diverse multidisciplinary department.”
“I love my position because I know that every day I am making a difference, even if it’s touching just one life,” says Dr. Bea. “When someone who looks like me hears me explain breast cancer risks and relate to them, understanding from a cultural standpoint where they are coming from, we’re able to connect and they are more likely to listen to me and trust me. And that trust can make the difference in a life or death situation.” ________________________
Vivian J. Bea, M.D., is section chief of breast surgical oncology at NewYork-Presbyterian Brooklyn Methodist Hospital and an assistant professor of surgery at Weill Cornell Medicine. An expert in breast cancer disparities, Dr. Bea was selected as one of the 40 Under 40 Leaders in Minority Health by the National Minority Quality Forum for her dedication to community outreach and breast cancer disparities research. She is on Twitter at @IamDrVivian.
Knowledge is power!*
•• Black women in the USare more likely than anyother racial group todie from breast cancer.
•• African-Americanwomen are 40 percentmore likely than Whitewomen to die frombreast cancer.
•• Breast cancer is the mostcommon cancer amongBlack women.
•• Breast cancer is also thesecond leading cause ofcancer death amongBlack American women.
•• Black women in the USare more likely thanWhite women to bediagnosed in the under40 and the 40–49 agecategories.
*Statistics taken from the National Institutes of Health and the Susan G. Komen Foundation