Breast cancer should be on every woman's radar, since it affects an estimated 1 in 8 women. But it's an even bigger concern for Native American women, who are 7 percent more likely to get breast cancer and 10 percent more likely to die from it than non-Hispanic white women.
As cancer deaths drop in every other ethnic group, they're rising in Native American women. Cases of this cancer have jumped by nearly 2 percent each year among American Indian and Alaskan Native women in their 40s, according to the CDC. It's the fastest increase in any racial or ethnic group.
The rising rates of breast cancer deaths make it even more important for Native American women to know their risks and get screened. Regular mammograms can find breast cancer early, when it's most treatable.
What Are the Risks?
A few things increase your chances of getting breast cancer. It's important to talk to your doctor about risks like these:
Your genes. Changes called mutations in genes can increase your risk of getting breast cancer. If your mother, sister, daughter, or another close relative had breast cancer, it might run in your family.
Your age. Most breast cancers are diagnosed in women over age 50. Native American women are more likely than white women to be diagnosed earlier, before age 50.
Your breast density. Breasts are made from fat and connective tissue. Having dense breasts means your breasts contain more tissue than fat. This not only increases your risk for breast cancer, but it also makes the cancer harder to see on a mammogram.
Your weight. Over half of Native American women are overweight and nearly one-third are obese. When you have extra fat tissue, your body makes more of the hormones insulin and estrogen, which have been linked to an increased risk for breast cancer. Not exercising enough can also lead to weight gain and a higher breast cancer risk.
How much you drink. Alcohol is linked to breast cancer risk. The more alcohol you drink, the more that risk rises.
Whether you breastfed. When you breastfeed, your body makes less estrogen, a hormone that can increase breast cancer risk. For every 12 months of breastfeeding, the breast cancer risk drops by more than 4 percent. Native American mothers are less likely to exclusively breastfeed in their baby's first 6 months compared to women of other ethnic groups.
Why Are Native American Women's Risks Different?
It often takes longer for Native American women to get diagnosed and treated for breast cancer than non-Hispanic white women. They're also less likely to get the recommended treatments.
Decades of government policies that pushed Native Americans off their lands and reduced their chances of finding good jobs have contributed to these disparities. Today, many Native Americans must travel long distances to get to a cancer center. Nearly 30 percent of Native Americans don't have health insurance, which is almost double the national rate.
Cultural factors may also play a role in breast cancer disparities. Some Native Americans don't trust Western medicine because it's so different from traditional medicine. They worry that cancer treatments like chemotherapy and surgery might hurt them instead of help them.
What Are the Differences in Diagnosis?
Screening guidelines recommend that women get regular mammograms to detect breast cancer. Not knowing about these recommendations prevents some Native American women from getting screened until their cancer has already spread.
Native American women have one of the lowest breast cancer screening rates in the country. And those who do have a positive mammogram result are less likely to get a biopsy to confirm the diagnosis.
Most breast cancers in Alaska Native women are hormone receptor-positive. This means the hormones estrogen or progesterone help these cancers grow. Knowing your cancer's hormone status can help your doctor match you to a treatment that's more likely to work for you. Yet Native American women are less likely than white women to get tests of their cancer's hormone receptor status.
How Does Treatment Differ?
Getting the recommended treatment can improve your odds of surviving breast cancer. Native American women are less likely to receive the optimal breast cancer treatment. Surgery is part of the treatment for most women with breast cancer. Many women get a lumpectomy, which removes just part of the breast. Native American women are more likely to have a mastectomy, which removes the whole breast. Both surgeries are effective treatments, but mastectomy causes more complications and reduces quality of life.
One reason why so many Native American women have a mastectomy instead of lumpectomy is that they live too far away from a treatment center to get radiation therapy. Radiation is recommended after lumpectomy because it reduces the risk that the cancer will come back.
Native American women are also less likely to have chemotherapy with surgery, or to get hormone therapy, which is a treatment for hormone receptor-positive cancers. These differences could affect their outcome.
What Can You Do?
You do have some control over your breast cancer risk. First, it's important to find a doctor you trust. You can search for health centers near you through the government's Indian Health Service or the Department of Health & Human Services.
Talk to your doctor about your breast cancer risk. Though you can't change things like your age or genes, there are a few things you can do to lower your chance of getting breast cancer:
- Keep your weight in a healthy range
- Walk or do other exercises at least 3 days a week
- Limit alcohol to one drink a day or less
- If you have a baby, breastfeed for at least one year if you can
Screening is also important. Many women with breast cancer don't have symptoms. Ask your doctor when you should start getting mammograms. Guidelines recommend starting between ages 40 and 50. But because breast cancer affects Native American women at a younger age, you might want to start screening sooner, depending on your risks.
Between mammograms, check your breasts. Call your doctor right away if you notice:
- A lump
- Any changes in size or shape
- Flaking, peeling, scaling, or crusting of the nipple
- Redness or warmth
- Fluid leaking from the nipple
To learn more about breast cancer, visit the American Cancer Society or the American Indian Cancer Foundation. These organizations offer resources, including ways to find help paying for cancer screenings and treatments.