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
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,
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