What Black Women Need to Know About Breast Cancer
A leading expert shares four tips for Black women about their breast health and discusses a new study that suggests that Black women get screened earlier.
For Black women, breast cancer is the most commonly diagnosed cancer and is now the leading cause of cancer death, according to the American Cancer Society. While Black women are less likely to be diagnosed with breast cancer than white women, Black women are about 40% more likely to die from the disease.
“This is a mind-opening fact that shows disparities exist within breast health,” says Dr. Vivian Bea, director of the breast program at NewYork-Presbyterian Brooklyn Methodist Hospital and an assistant professor of surgery at Weill Cornell Medicine. “Multiple reasons contribute to breast cancer disparities. One factor is inconsistencies in breast cancer screening recommendations.”
Now a new study, published in JAMA Network Open, recommends that Black women begin screening for breast cancer at an earlier age than other racial and ethnic groups. In the study, researchers looked at breast cancer death statistics between 2011 and 2020. They noted that Black women were nearly twice as likely to die from breast cancer before age 50 than white women. Given the stark racial disparity, the study suggests that a “one-sized fits all” screening policy “may be neither fair nor equitable nor optimal” and that Black women should start screening at earlier ages.
“This study is important and highlights the importance of personalized medicine where we move away from the notion that what works for one group will work for another,” Dr. Bea says. “We know that Black women are more likely than other racial/ethnic groups in the United States to be diagnosed with breast cancer at an earlier age yet recommendations do not take this into account. This discrepancy may directly contribute to breast health disparities. To address this, we must move toward more equitable screening recommendations.”
Dr. Bea, who is committed to eliminating disparities through research and health initiatives, says factors contributing to breast cancer disparities range from social determinants to genetics and tumor biology. She spoke to Health Matters about what Black women should know about their breast cancer risk and breast health, and dispels myths about a breast cancer diagnosis.
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 age at which women are recommended to get their first mammogram is not consistent across organizations. However, the new study makes a case that doctors and health policymakers consider a woman’s race and ethnicity when advising them when to start screening so that those who are at high-risk are screened earlier to address deaths caused by early-onset breast cancer. If the guidelines say that screening begin at age 50, then researchers recommend that Black women start eight years earlier at age 42. If the guidelines recommend breast cancer screening at age 40, then Black women should start screening at age 34, the study suggests.
Dr. Bea says it’s essential that Black women get screened early.
“Black women are more likely to be diagnosed at a younger age with the more aggressive tumor subtype, so I recommend that Black women have a risk assessment completed at age 25 — and definitely by age 30 — by a breast expert and, if possible, one who has experience in treating diverse populations,” Dr. Bea says.
She follows guidelines that recommend that average-risk women start screening at age 40. “For patients who are at high risk for breast cancer based on a risk assessment, screening should start before 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,” she 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.
“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,” 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 may be widening the gap of women not getting their mammograms right now. But it’s important to remember early detection saves lives.”
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 director of the breast program 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 @DrBeaMD.
Learn more about breast cancer care at NewYork-Presbyterian Brooklyn Methodist Hospital.