Breast cancer is one of the most common kinds of cancer. But it doesn't always impact all women equally. Race and ethnicity can be a key driver in how often it shows up, whether you catch it early or at the metastatic stage, and what kind of treatment you get.
To help you better understand your experience, look at the facts behind breast cancer racial inequality, why women of color have different experiences with breast cancer, and what's being done to make sure everyone gets equal treatment.
Race and Breast Cancer Rates
In the U.S., white women and Black women have the highest rates of breast cancer. Black women have a slightly lower rate than white women. American Indian and Alaska Native women have the next-highest rates of breast cancer, followed by Asian and Pacific Island women. Hispanic women get it the least.
Age plays a role, too. Young women who are Black, Hispanic, or Latina are more likely to get breast cancer than young white women. Older white women have a higher rate of breast cancer than older Black women.
Why Doesn't Breast Cancer Affect Women Equally?
Race and ethnicity matter when it comes to breast cancer testing and care. That's because so many things in life are influenced by it: cultural perspectives on health, breast cancer education, access to quality care. One or a combination of these things can tilt the scales, causing inequalities among different racial groups in finding, treating, and surviving breast cancer.
Income is one of the main reasons for breast cancer inequality because it affects many aspects of diagnosis and treatment. Women with low incomes, who are more likely to be Black or Hispanic, may not have a regular doctor. This can delay both testing and care. That means fewer breast cancer exams and a higher chance of a metastatic breast cancer diagnosis (after it has spread to other areas of the body).
If you live in poverty, you may not have the same level of breast cancer education, either. You might not know as much about best ways to avoid breast cancer or the importance of mammograms. This can also lead to a late-stage diagnosis.
When women with lower incomes do see a doctor, there may be delays and unequal care, resulting in lower survival rates.
Health care access and quality
This can be tied to socioeconomic reasons, too, like employment, income, and education. All of these affect how you make decisions about your health.
- Health insurance. Not all women have equal access to the same levels of health care, including health insurance. Insurance status is a major reason Black and Hispanic women delay treatment. Black women are more likely to be uninsured and to depend on public insurance than white women.
- Health care access. Women who live in poor areas, often including many women of color, may face limited transportation choices, too. This makes it harder to get to clinics and doctors for testing, care, or follow-ups. The farther you have to travel for appointments, the more time off work and child care you may have to arrange. That adds to the hassle and expense. Black women in urban areas and Hispanic women in both urban and non-urban areas are more likely to have less access to mammography than white women.
- Funding. Health care centers that serve vulnerable minority neighborhoods are often underfunded. This means they can't keep up with the latest medical advancements or recommendations. That lowers the quality of care for these communities.
Unequal recommendations and treatment
Women of color can often get different recommendations and delayed care. Cancer test guidelines are often based on studies that don't include many people of color. So they may overlook the differences in cancer rates and risk factors among people of different ethnicities.
Black and Hispanic women are also less likely than white women to get certain standard procedures or guideline-recommended treatments. And Asian women tend to get no follow-up after abnormal breast cancer tests more often than white women.
Representation in health care
The races of cancer doctors (aka oncologists) don't always reflect the communities they're in. That can make it hard to build trust and comfort with patients of diverse backgrounds. Language barriers can also lower the chance of getting breast cancer screenings. If you and your health care professionals don’t speak the same language, it can limit your access to high-quality treatment and affect how well you understand health information. It can also have an effect on how you make medical decisions. More diverse representation among oncologists, on the other hand, may develop more trust and better care in underserved communities of color.
Everything from spirituality to not trusting medical professionals can influence whether you go for treatment and when. Those things, along with misunderstandings about their chance of getting breast cancer and the cultural tendency to stay quiet about health problems, tend to be more common among Black women.
For Hispanic women, cultural barriers may include anxiety, embarrassment, and the influence of media, which often shows women as caregivers who put the well-being of others ahead of their own.
How Are Racial Inequalities in Breast Cancer Being Addressed?
Organizations, doctors, researchers, and communities are working to bring fairness to breast cancer care.
- Better access. Some cities, for example, have improved access to mammography facilities, which reduced the gap in breast cancer deaths between Black and white women.
- The CDC's National Breast and Cervical Cancer Early Detection Program helps uninsured and underinsured women get no-cost tests, education, and outreach services, as well as cancer treatment care guides. The American Cancer Society Cancer Action Network works to increase federal and state funding to help this program reach more people, which could support women of color with limited insurance or resources.
- Data-driven outreach. Other cities are finding out which neighborhoods may be at risk for poor health. Then, they use that data to jumpstart projects to educate young people with higher odds of a metastatic diagnosis about the importance of early tests and prevention. Some organizations are even going door to door in predominantly Black neighborhoods to raise awareness about breast cancer. Doctors are attending community events that encourage women of color to get mammograms.
- More diverse research participants. Breast cancer testing and treatment standards often come from recommendations of research studies and clinical trials. Typically, those have involved mostly white women, so the study results reflect which treatments work well for that group of women. Researchers are trying to sign up more diverse groups for the studies to help all women get better care.
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Cancer Cytopathology: "How structural racism can kill cancer patients."
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Dr. Susan Love Foundation for Breast Cancer Research: "Averting a Crisis: The Need for More Focus on Breast Cancer in Hispanic Women."
Advances in Experimental Medicine and Biology: "Health and Racial Disparity in Breast Cancer.”
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