About 1 in 3 new cancers in women are breast cancer, making it a common type of cancer. But women's experiences -- their treatment, outcomes, and survival rates -- vary greatly depending on their race and ethnicity.
White women are more likely than those in any other racial or ethnic group in the U.S. to get breast cancer. But Black women are most likely to die of breast cancer. White women have the next-highest number of deaths from breast cancer, then Native American/Alaska Native women, Hispanic women, and Asian/Pacific Island women.
The reasons for these major differences are many and complicated. Systemic racism that puts people of color at higher risk for low socioeconomic status and restricts access to care drives many of these health imbalances. Individual women can't control most of these causes. But that doesn't mean you can't take charge of your care. Women of any color or background can take steps to make sure they get the best possible care as soon as possible. What's most important is that you get treatment.
Why Have a Mammogram?
Like many cancers, breast cancer is easier to treat -- and maybe even cure -- the earlier doctors catch it. But many women of color tend to get diagnosed at more advanced stages.
In a study of more than 450,000 women with breast cancer, half the non-Hispanic white women had gotten their diagnosis at stage I. Among white Hispanic women, 40% had a diagnosis at stage I. Only 37% of Black women got a diagnosis that early. As for Asian American women, stage I diagnoses varied. More than half of Japanese- and Chinese-American women caught their cancer at stage I. About 40%-45% of South Asian women and women from other parts of Asia got stage I diagnoses.
Getting routine mammograms – images of the tissue inside your breasts – increases your chances cancer will be found early. Some studies say that routine, on-schedule mammograms slash the risk of death from breast cancer within 20 years of diagnosis by almost half.
The United States Preventive Services Task Force recommends all women get a mammogram every other year from ages 50 to 74. Your gynecologist or primary care doctor may recommend them more often. The American Cancer Society says women should get mammograms every year starting at age 45 and may then cut down to every 2 years at age 55. The ACS also says women 40-44 and 55 and older should have the choice to get mammograms every year if they want to.
Don’t Wait for Diagnosis or Care
Even with routine mammograms, women can still get diagnosed with more advanced cancers. If you do, it’s important to start treatment right away.
Several studies show that there seem to be longer delays between an abnormal mammogram and breast cancer diagnosis for African American and Hispanic women compared to non-Hispanic white women. The same is true of the lag between diagnosis and the start of treatment.
These delays are due, at least in part, to racial and ethnic differences in access to care that are beyond any individual’s control. Getting a diagnosis and starting treatment as soon as possible may affect how well your treatment works. To help you avoid these delays, you might have to speak up and advocate for yourself.
Be on the lookout for test results. Ask the technician at your mammogram when you should expect the results. It should happen within 2 weeks. Keep an eye out for them. If it takes much longer than the tech said it would, call the office and ask about your results.
Follow up with your doctor. If your mammogram results are “abnormal,” that means the image showed something that could be cancer and that you will likely need more tests. If you don’t get a call about next steps along with the test results, call your doctor and ask. If another appointment or test is necessary, schedule it right away.
Ask how soon you can start care. If your tests lead to a breast cancer diagnosis, ask what the next steps are, how soon you can start care, and how to schedule your next appointment.
Many Treatments Available
The type of treatment you will need depends on the stage of your breast cancer. That is, whether the cancer is only in your breast or whether it has spread outside your breast and how far.
Breast cancers that have spread to other parts of the body, such as the lungs, liver, or bones, are called metastatic cancers. While a diagnosis of metastatic breast cancer can be difficult to hear, you have more treatment options than ever before. Women may live for years on some of the breast cancer drugs available today.
Women with metastatic breast cancer usually get systemic treatment. That means medicines that fight cancer throughout your entire body, rather than surgery or radiation that target cancer in a specific area. (Though in some cases, doctors also use radiation and surgery in metastatic breast cancer.)
Here’s an overview of the systemic treatments for breast cancer. You might get one or more of them:
- Hormone therapy. The female hormones estrogen and progesterone help some breast cancer cells grow. These cancers are hormone-receptor positive. Some drugs fight these cancers by plugging into special receptors on the breast cancer cells. These drugs block these receptors so that the hormones can’t attach to them. Other drugs help reduce estrogen production in the body. These drugs are only beneficial for people who have hormone receptor-positive cancers.
- Targeted therapy. This is used in many different types of cancer. Targeted therapy is directed at specific proteins on cancer cells that help them grow and spread. By shutting down or weakening these proteins, the drugs can stop the progress of the cancer. Many different proteins can drive breast cancers. The most common target for these drugs is HER2. Whether you get a targeted drug depends on what’s helping your breast cancer cells grow.
- Immunotherapy. This also is used to treat many kinds of cancer. Immunotherapy helps your body’s immune system recognize cancer cells and attack them. The type used in breast cancer blocks a protein on T cells in your immune system that keeps them from attacking cancer cells. You may get this drug along with chemotherapy if you have triple-negative breast cancer. That means the cancer doesn’t have the receptors for either of the hormones (progesterone and estrogen) that play a role in breast cancer or HER2 proteins, which targeted breast cancer drugs fight.
- Chemotherapy. This includes many drugs that can reach and kill cancer cells throughout your entire body. You get the drugs in a pill or through a vein in your arm.
Getting to the Best Treatment for You
Treatment for metastatic breast cancer is not one-size-fits-all. The best treatment for you may depend on the unique makeup of your cancer cells. For example, it matters whether the cells have hormone receptors, HER2 proteins, and proteins that may get in the way of your immune system.
Doctors will need to run tests to learn about your cancer cells. If you aren’t sure whether you’ve had or need these tests, ask. In fact, you may want to go to appointments with a list of questions prepared.
Here’s some questions you might want to ask your doctor:
What type of breast cancer do I have? Your doctor may tell you your cancer stage, hormone receptor status, or HER2 status. Or you can ask each of those questions individually:
- What is my hormone receptor status?
- What is my HER2 status?
- What stage is my cancer?
- How do these factors affect my treatment options and outlook?
You might also ask:
- Do I need more tests before we can decide on treatment?
- Do I need any tests of my own genes or the genes in my tumors?
- What are all the treatment options available to me?
- What are the pros and cons of each treatment?
- Which treatment do you recommend and why?
- Should I consider a clinical trial?
- Should I get a second opinion? Will that delay my care?
- If I’m worried about the cost of care and my insurance coverage. Are there programs that can help me?
When You Need More Options
Not all treatments work for everyone. A treatment may not work at all, or it may work for a while and then stop.
If that happens, your doctor might recommend switching you to something else. You could also be eligible for a clinical trial that might offer a medication your doctor is not able to offer you directly.
This is another topic you’ll want to speak up on.
Some research suggests that doctors may be less likely to offer clinical trials to non-white patients because of personal biases. Some think that people from racial and ethnic minorities are less likely to follow the possibly complicated treatment plans that trials can require. Some assume their minority patients wouldn’t participate because they don’t trust the health care system or they doubt the experimental medications are safe. But research shows that people of racial or ethnic minority groups are just as willing to participate in clinical trials as white people. Still, white people make up the overwhelming majority of trial participants.
If you would like to try a clinical trial, tell your doctor. Ask whether they know about trials that would be right for you and how you can join. Keep in mind, not all doctors and hospitals have connections to clinical trials. You may have to look into them on your own. You can start with clinicatrials.gov. Search using your type of breast cancer and city or state as keywords.
When Treatment Doesn’t Work
If cancer treatments no longer work for you and you decide to stop care, you can still receive treatment to make yourself comfortable. It’s called palliative care. It treats the unpleasant symptoms of cancer and the side effects of cancer treatment. But it doesn’t fight cancer. Its goal is to make you feel more comfortable at any stage of your cancer care.
In fact, at any point in your cancer care, you have the right to palliative care. You can get palliative care along with cancer-fighting treatment. You can also continue to get it if you decide to stop your other treatment.
If you make the decision to stop cancer treatment and you are not already receiving palliative care, ask your care team about getting it. The goal is to make your quality of life better and lower your stress as long as you are living with cancer.
Be Your Own Advocate
Being your own advocate could help make sure you get the best possible treatment for your specific breast cancer. That means you’ll need to speak up, ask questions, and not be afraid to push back when you disagree.
You can use these tips to advocate for your health care:
Bring someone with you. A cancer diagnosis can give you a lot to process. When you have a friend or relative at appointments with you, they can help remember new information and ask questions you might not think of.
In a study, some African American women said they got better treatment from staff and providers at health care facilities after the workers saw that someone else was advocating for them.
Communicate your needs and goals. If any personal problems, challenges, or beliefs will keep you from taking your doctor’s advice, say so. Whether you need transportation, financial help, or a treatment that won’t cause you to lose your hair or miss work, tell your doctor.
Make your goals of care clear, too. Maybe your doctor thinks your goal is the most aggressive, fastest treatment. But if that treatment will cause you to miss your child’s high school graduation, maybe you want to know your other options.
If you don’t explain why you are reluctant to follow your doctor’s recommendations, they may assume you don’t want care.
Know your rights. You are not obligated to accept the first recommendation your doctor makes. You can:
- Ask questions
- Express doubts
- Ask about other options and how they compare to each other
- Get a second opinion
- Change health care providers
It’s a fact that experiences with breast cancer treatment vary depending on a patient’s race and ethnicity. Women of color may get diagnosed later and start care later than others. But no matter the color or your skin, you can take action to help make sure you get the best possible care as soon as possible.
Photo Credit: peterschreiber.media / Getty Images
American Cancer Society: “Breast Cancer Statistics,” “American Cancer Society Guidelines for the Early Detection of Cancer,” “Treatment of Stage IV (Metastatic) Breast Cancer,” “Questions to Ask Your Doctor about Breast Cancer,” “Breast Cancer Gene Expression Tests,” “Hormone Therapy for Breast Cancer,” “Targeted Therapy for Breast Cancer,” “Immunotherapy for Breast Cancer,” “Chemotherapy for Breast Cancer.”
Susan G. Komen: “Breast Cancer Risk: Race and Ethnicity.”
Epidemiology: “Recent Changes in the Patterns of Breast Cancer as a Proportion of All Deaths According to Race and Ethnicity.”
JAMA: “Differences in Breast Cancer Stage at Diagnosis and Cancer-Specific Survival by Race and Ethnicity in the United States.”
American College of Radiology: “New Study Cements Fact that Mammography is a Primary Factor in Reduced Breast Cancer Deaths.”
U.S. Preventive Services Task Force: “Recommendation: Breast Cancer: Screening.”
Breast Cancer Research and Treatment: “Time to diagnosis and breast cancer stage by race/ethnicity.”
BMC Medicine: “The impact of race and ethnicity in breast cancer—disparities and implications for precision oncology.”
Know Your Girls: “Mammogram FAQs: Here’s What to Expect,” “Everything you should know if you need a follow-up test.”
American Journal of Public Health: “Challenging assumptions about minority participation in US clinical research.”
ASCO Educational Book: “Enrollment of Racial Minorities in Clinical Trials: Old Problem Assumes New Urgency in the Age of Immunotherapy.”
Get Palliative Care: “What is Palliative Care?”
Support Care Cancer: “Medical Advocacy Among African American Women Diagnosed with Breast Cancer: From Recipient to Resource.”
CancerCare: “How Health Care Disparities Affect Your Care.”
National Cancer Institute, Surveillance, Epidemiology, and End Results Program: “Cancer Stat Facts: Female Breast Cancer.”