By: Yalinie Kulandaivelu (Mommy Monitor’s Youth Subcommittee)
October is Breast Cancer Awareness Month, which is an international campaign symbolized by pink ribbons that aims to increase awareness of breast cancer, to raise funds for research, and to educate the public on the importance of early screening, testing, and prevention. In the past 120 years, we have seen leaps and bounds in the diagnosis, treatment, and prevention of breast cancer. Unfortunately, the degree of progress is not the same across all races and ethnicities.
Black women have similar, if not slightly lower, rates of breast cancer compared to white women. Yet, Black women under the age of 50 with breast cancer have a mortality rate double that of white women of the same age. According to data from the United States, overall, Black women of all age groups have a breast cancer mortality rate that is a staggering 40% higher than that of white women. At every stage of the disease, Black women have the lowest survival rates of all racial and ethnic groups, a difference that is most pronounced at stages III and IV of the disease. For each subtype of breast cancer, Black women have survival rates that are 5% to 7% lower than other racial and ethnic groups.
These disparities are due to a combination of factors. For instance, Black women are more likely to experience longer intervals between screening mammograms, abnormal findings, and follow-up. Black women are also more likely to have the more aggressive triple-negative breast cancer that is more difficult to detect on routine mammograms. Triple-negative breast cancer is a subtype of breast cancer that tests negative for estrogen receptors, progesterone receptors, and excess HER2 protein - three characteristics that are used to classify breast cancers. Drug treatments are less likely to be effective for triple-negative breast cancers, which means the significantly expanded armory of breast cancer therapies that are available today are less effective for Black women.
For Black Canadian women, understanding the extent of each of these issues is even more challenging. A scoping review by Dr. Onye Nnorom and her team at the University of Toronto found that there was a lack of data on the prevalence and outcomes of breast cancer among Black women in Canada. They also found differences in screening rates between Black Canadians from different ethnic groups. For example, women from sub-Saharan Africa tended to have lower screening rates compared to women from the Caribbean and Latin America, who had screening rates similar to the general population. Disparities in screening persist among immigrant women in Canada. Dr. Aisha Lofters at St. Michael’s Hospital leads research examining disparities in breast cancer screening among immigrant women. Dr. Lofters and her team found that immigrant women waited longer to receive diagnoses, were diagnosed at later stages in their cancer, and were less likely to have their cancer detected through screening.
A lack of data also hinders our ability to identify significant biomarkers and mutations. Biomarkers are biological signatures that allow doctors and scientists to reach a diagnosis and create targeted treatments. Understanding biomarkers enables drug companies to develop treatments specific to cancer types that occur more frequently among Black women. Identifying biomarkers specific to Black women can also have significant impacts on women of other ethnic groups. For example, the mutations found in the BRCA 1 gene that are associated with higher risks of breast cancer were first identified in Ashkenazi Jewish women. However, research on that biomarker showed that the mutation could be found in all women. Today, the gene is widely used to screen all women for increased risk of breast cancer.
For young women, one of the simplest steps we can take towards combating this illness is understanding how we can lower our risk of developing breast cancer through lifestyle changes and the importance of regular screening for the disease, as well as sharing this information widely within our social circles. You may have a higher risk of breast cancer if:
- You have close relatives who were diagnosed with breast or ovarian cancer, especially before the age of 45;
- You have changes in BRCA1 and BRCA2 genes;
- You have Ashkenazi Jewish heritage;
- You were treated with radiation therapy to the breast or chest in childhood or young adulthood; and
- You have other breast health conditions (e.g. lobular carcinoma in situ, ductal carcinoma in situ, atypical hyperplasias)
Preventing breast cancer starts early. Some of the ways you can reduce your risk of breast cancer are by:
- Maintaining a healthy weight
- Exercising regularly
- Limiting intake of alcoholic drinks
- Avoiding carcinogens (chemicals that can increase your risk of cancer)
- Reducing your exposure to radiation such as mammograms, CT scans, and PET scans
- Talking to your doctor about the risks of hormone replacement therapy or birth control pills and whether they are right for you
- If you can, breastfeeding your children
Closing the gap in breast cancer disparities will require a host of targeted solutions. Sharing culturally appropriate and relevant resources on breast cancer for Black women is one of the first steps towards improving screening and access to health services. For researchers, disaggregating data for race, ethnicity, and immigration status will help with discovering trends in screening, diagnosis, and treatment outcomes, differences in mutations and types of breast cancer, and experiences of racism in breast cancer diagnosis and treatment. Researchers and clinicians will need to work in partnership with Black communities to increase participation and representation of Black women in breast cancer research. For the province and policymakers, changing policies pertaining to collection of race and ethnicity in healthcare will help improve research which in turn can improve breast cancer outcomes among Black women and women of all ethnicities.
For more information about breast cancer prevention and screening in Ontario, check out the following resources:
To learn more about the stories and experiences of Black women with breast cancer in Canada, be sure to check out Uncovered: A Breast Recognition Project.
For women who have been diagnosed with breast cancer in Ontario, the Olive Branch of Hope offers support groups in Toronto and the Peel region, as well as educational seminars.
Other resources for Black women and other racialized women with breast cancer include:
