October 17, 2016 - 10:00 am
Cancer isn’t fair. It strikes the best of people, the ones who deserve it the least and the ones with so much life to live. But it’s not completely random.
Studies show that there are racial trends when it comes to breast cancer.
Black women are less likely than white women to be diagnosed with breast cancer, but are more likely to die from it.
“Black women as a group get less than optimal care compared to white women,” said Dr. Otis Brawley, the chief medical officer of the American Cancer Society.
The Susan G Komen Foundation cites that in the past, black women were screened for breast cancer less than white women, which could account for the fatality rates. Today, about the same percentage of black and white women over the age of 40 get mammograms: 66 percent.
“Some, but not all, findings have shown that African-American women may have more delays in follow-up after an abnormal mammogram than white women,” according to Komen.
Black women typically get diagnosed younger and at a later stage than white women.
Hispanic women have better news. Despite lower screening rates, the diagnosis and fatality rates are lower than those of white women.
Brawley said that Hispanic women are typically in much better overall health in their 60s than white and black women, which reduces many of the typical risk factors of cancer.
And, almost all of those risk factors boil down to a main issue: being overweight.
And, he said, half of black women are obese, compared with 35 percent of white women.
Obese women are less likely to get drugs dosed correctly. The dosage is based on height-weight ratio, so obese women need higher doses. But, higher doses cause worse side effects.
A lot of doctors won’t increase dosage even if a woman’s weight calls for it because of those effects, Brawley said.
Obesity is linked to high-carbohydrate, high-calorie diets. And, Brawley said, you see poor girls who eat these type of diets have a higher incidence of breast cancer.
In addition, the earlier a girl surpasses 100 pounds, the earlier her onset of menstruation. Early onset of menstruation is also a risk factor for breast cancer.
Income and education
Continuing treatment can be an issue for all patients.
But, poorer women tend to quit treatment earlier. Brawley said poor women stop radiation before the full six-to-eight-week course because of access. And he said the black-white disparities in fatality rates could be due to the socioeconomic issues.
“It’s easier for middle class women to get to the doctor for treatment,” he said.
Brawley said that 7.5 percent of black women and 2 percent of white women who were diagnosed with a type of breast cancer that could have been cured by surgery chose not to have it.
“Some of it being scared of being treated, and some of it is transportation issues,” he said. “We had one woman who said if she took the time off to get treated for breast cancer, she’d lose her job.”
The Affordable Care Act has leveled out the opportunities some for poor women. Mammograms are covered by federal mandate every six months if the provider lists it as a screening.
But, Brawley said, there is still a disparity. If you’re looking for the best of the best in medical care, it helps to have money.
“If you are poor and uninsured, finding just an average doctor is going to be tough,” he said.
The average age of a woman diagnosed with breast cancer is 64. And while the American Cancer Society advocates for consistent mammograms for women aged 45 and older, and for any woman who wants one aged 40-44, there’s a significant drop-off of screening in the 50-70 age range.
While 60 percent of women aged 40 or older regularly get mammograms, only 40 percent of women aged 50-70 do. And there’s the rub: As the risk of cancer increases, the rate of screenings declines.
“If we can get everyone to screen in their 50s and 60s, we could save more lives of women in their 50s and 60s than all women who die of breast cancer in their 40s,” Brawley said.
Having a full-term pregnancy before the age of 30 reduces the risk of breast cancer. But, if a woman waits until 30 to have a child, the breast cancer she is more likely to have is estrogen-receptor positive, which has a higher survival rate.