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Who Gets Breast Cancer and Who Survives?

Breast Cancer Is More Deadly in Minority Women continued...

Regardless of their type of cancer, minority women may not be receiving the full treatment they need. One University of Rochester study found that doctors tend to give black women lower doses of chemotherapy than they give to white women. "We believe that physicians aren't even aware that they're doing this," explains study author Jennifer Griggs, M.D. "Other surveys have found that physicians perceive African-American patients as less likely to adhere to medical advice, so they may unconsciously worry that a too-high dose will cause side effects that will discourage patients from coming back."

Minority women's cancers are also often diagnosed at a later stage, likely because they don't seek out crucial diagnostic tests: Only about 43 percent of all African-American women over age 40 reported having a mammogram in the last year, according to one recent study. "I've had minority women come into my office with huge tumors and I've asked them, 'Why didn't you come in earlier?'" says Christine Pellegrino, M.D., an assistant clinical professor at the Albert Einstein College of Medicine in Bronx, NY. "Sometimes they say it's because they didn't have health insurance, or that they're too busy working or taking care of their kids. But by and large, what's really going on is either a lack of awareness and education about breast cancer or, understandably, denial."

Certain Tumors Are Less Treatable Than Others, and Doctors Know Your Odds of Getting Them

Doctors used to rely on staging — the size of the cancer and how far it had spread — to determine prognosis, but they now know that tumor type is even more important. "Different kinds of tumors have different 'personalities,' and each responds differently to treatment," says Eric P. Winer, M.D., director of breast oncology at the Dana-Farber Cancer Institute in Boston. About two thirds of all breast cancer tumors are hormone sensitive, which means they grow in response to estrogen. The good news: Women who have hormone-sensitive tumors have a higher survival rate because these tumors grow more slowly than other types and can often be prevented from recurring with hormone therapy.

Another 20 percent of all breast cancers have small amounts of a protein called human epidermal growth factor receptor 2 (HER2), which promotes tumor growth, says Winer. These HER2-positive tumors traditionally had a poorer prognosis because they tend to spread more quickly, but newer medications lower chances of recurrence.

The last approximately 15 percent of all breast cancer tumors are triple negative. They're more aggressive and more likely to recur than the others, says Winer, and they're also associated with the poorest survival rates.

Nearly Half of Women Don't Get Enough Chemo

Thirty years ago, if you had breast cancer, you got a mastectomy, period. "Even today, when most of my patients learn they have breast cancer, their first impulse is to say, 'Give me a mastectomy so I don't have to worry about it anymore,'" says oncologist Richard Bleicher, M.D., of Fox Chase Cancer Center in Philadelphia. But experts now agree that a more aggressive approach isn't necessarily better for treating early-stage cancer. In fact, a landmark study found that women with stages I and II breast cancer who had a lumpectomy with radiation were just as likely to survive as those who underwent a mastectomy.

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