June 12, 2000 -- While cancer takes a heavy toll on all Americans, research shows that black women are at greater risk than white women of developing or dying from a handful of cancers, including those of the breast, colon/rectum, lungs, and cervix.
On the other hand, data from the National Cancer Institute (NCI) also show that black women are less likely than white women to be diagnosed with other cancers that can be harder to detect, grow more rapidly and defy treatment, such as ovarian cancer, melanoma, and leukemia.
Black women's health advocates say the single best thing you can do to lower your risk of cancer is to sit down with your elders and get a sense of your family's medical history. Knowing your family tree can help you decide what kinds of screening tests to ask for and lifestyle changes to make.
"I happened to know that my grandmother had breast cancer because she showed me the scar," says Faith Fancher, a breast cancer survivor whose mother was among the first black family practitioners in the state of Tennessee. "But that is something that I think most (black) women don't know."
Here are four of the most common cancers among black women, along with what you can do to protect yourself:
- Breast cancer is a leading cause of cancer death among black women and by far the most common cancer among all women, black or white. The incidence of breast cancer is lower among African-American women, yet this group has a higher rate of breast cancer deaths -- possibly because cancers tend to be detected at a later stage in blacks than whites.
Consequently, black women are less likely to survive when cancer strikes: Their 5-year survival rate is 71%, compared with 87% for white women. The survival rate for black women jumps to 89% if the cancer is diagnosed before it has spread. Yet 44% of newly diagnosed breast cancers found in African-American women have spread to areas beyond the breast compared with 35% for white women.
What to do: Breast self-exam and mammography are vital; early diagnosis is critical. Charles J. McDonald, MD, past president of the American Cancer Society (ACS), says black women should undergo their first mammograms at age 30, a full 10 years before the recommended age for white women. The National Medical Association, a national organization for African-American physicians, also supports early screening. Breast self-exam should begin as soon as a girl menstruates, McDonald says. Black women might also consider a low-fat diet and regular exercise, both of which have been shown in studies to lower a woman's risk of breast cancer, decrease heart disease, and improve overall well-being.
- Colorectal cancer is a case of good news, bad news: The drop in deaths from colorectal cancers since the early 1990s is the second-biggest reason for the overall decline in cancer deaths among women. Yet black women continue to be at greater risk for this disease, with a reported 46.7 cases per 100,000 women for the period from 1987 to 1991, compared with a rate of 39.9 among white women.
As in any other type of cancer, it's important to be tested early, and here, African-Americans have more reason to be vigilant: One reason that colorectal cancer deaths are higher among black Americans is that they are not being screened for the disease as often as other populations, says Deborah Kirkland, manager of the colorectal cancer division for the ACS. A recent study by researchers at Wake Forest University found that the main reason that many low-income, African-American women do not have sigmoidoscopies is that their doctors don't recommend the exam, possibly because they believe that the patient will not be able to pay the cost.
What to do: Talk to your doctor about the three standard screening options for colorectal cancer: a yearly fecal occult blood test plus a flexible sigmoidoscopy every 5 years, a colonoscopy every 10 years, or a barium enema every 5 to 10 years.
Currently, the ACS recommends that testing begin at age 50, but screening can start as early as age 21 for those with a family history of the disease. If you're African-American and you have even one first-generation family member who has been diagnosed with this cancer (a mother, an aunt, and male relatives, too), that's all the reason you need to learn about the tests and ask your doctor when you should begin getting them.
- Lung cancer is the third most common cancer among black females. It is also one of the most preventable; tobacco smoking is the principal culprit. Unfortunately, lung cancer deaths among black women may grow, given that smoking rates among African-American teenagers have increased over the past 10 years, according to McDonald.
What to do: Don't smoke. If you do, quit. And if your partner or your teenagers smoke, consider asking them to stop, for your benefit as well as their own. Unfortunately, there is no screening test for lung cancer before symptoms develop, so proactive steps are the only option.
- Cervical cancer is one cancer that "we're well on the way, in this country, of conquering," says McDonald. Why? Yearly pelvic exams and Pap smears are effective screening techniques, and thanks to a massive public service campaign during the 1990s, more and more women -- black and white -- are beginning to get the message that these simple tests save lives.
Nevertheless, the incidence and mortality rates for cervical cancer are higher among black women than for white women. This is likely because black women tend to have fewer Pap smears and not because of genetics. Two studies presented at the annual meeting of the Society of Gynecologic Oncologists in February 2000 found that there was no difference in survival rates among black and white women after controlling for factors such as sexual history and access to appropriate medical care.
The incidence of invasive cervical cancer among black women also increases rapidly with age. So older women need to be just as vigilant as young women about getting screened.
What to do: Get your Pap smear regularly -- be religious about it. Don't put it off for any reason. And while you're at it, take your mother with you.
Beatrice Motamedi is a health and medical writer based in Oakland, Calif., who has written for Hippocrates, Newsweek, Wired, and many other national publications.