Minority Women More Likely to Develop Aggressive Disease Than Whites

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Historically, black women have been more likely to be diagnosed with breast cancer when they were younger than 40 and more likely to die from breast cancer than white women. For many years, black women were less likely overall to be diagnosed with breast cancer than white women. But an October 2015 report from the American Cancer Society found that for the first time, rates of breast cancer among black and white women were about equal.

Now another study has found that minority women, especially black and American Indian/Alaska Native women, are more likely to be diagnosed with more advanced stage breast cancer as well as receive treatment below the standard of care than white women.

The study was published online on Oct. 13, 2015 by the journal Cancer Epidemiology, Biomarkers & Prevention. Read the abstract of “Racial Disparities in Breast Cancer Diagnosis and Treatment by Hormone Receptor and HER2 Status.”

To do the study, the researchers looked at information in the SEER database, a large registry of cancer cases from sources throughout the United States maintained by the National Institutes of Health.

The researchers looked at information from about 102,064 women diagnosed with invasive breast cancer between 2010 and 2011, including:

  • age
  • ethnicity
  • income level
  • insurance status

The researchers also looked at the characteristics of the cancer the women were diagnosed with, as well as treatments, including:

  • cancer stage
  • tumor grade
  • tumor size
  • first treatment
  • cancer subtype
  • hormone-receptor status
  • HER2-receptor status

There are four main subtypes of breast cancer:

  • luminal A, which is hormone-receptor-positive (either estrogen- and/or progesterone-positive) and HER2-negative; this is the most common type of breast cancer
  • luminal B, which is hormone-receptor-positive (either estrogen- and/or progesterone-positive) and HER2-positive
  • basal-like, which is hormone-receptor-negative and HER2-negative (also called triple-negative breast cancer); this is considered an aggressive subtype because the cancer has no hormone or HER2 receptors, so medicines that target those receptors aren’t effective
  • HER2-enriched, which is hormone-receptor-negative and HER2-positive

Overall, women of other ethnicities were more likely to be diagnosed with more advanced stages of breast cancer compared to non-Hispanic white women.

Compared to black women, the researchers found that non-Hispanic white women were more likely to be diagnosed with tumors that were:

  • smaller
  • hormone-receptor-positive and HER2-negative, which is considered a less aggressive subtype

Compared to non-Hispanic white women, black women were more likely to be diagnosed with tumors that were:

  • larger
  • hormone-receptor-negative and HER2-negative -- the aggressive triple-negative subtype

Black women also were 40% to 70% more likely to be diagnosed with stage IV breast cancer across all four subtypes compared to women of other ethnicities.

Hispanic women were 30% to 40% more likely to be diagnosed with stage II and/or stage III disease across all four subtypes compared to women of other ethnicities.

American Indian/Alaska Native women were 4 times more likely to be diagnosed with stage IV triple-negative breast cancer than women of other ethnicities.

When the researchers looked at the treatment the women received, they found that compared to non-Hispanic white women, black women were 30% to 60% more likely to receive treatment that didn’t meet national guidelines -- meaning they received substandard care. Hispanic women were 20% to 40% more likely to receive substandard care than non-Hispanic white women.

"We found that there is a consistent pattern of late diagnosis and not receiving recommended treatment for some racial and ethnic groups across all breast cancer subtypes," said Lu Chen of the Fred Hutchinson Cancer Research Center and the study’s lead author. "The treatment for breast cancer is currently dependent on the type of breast cancer, defined by the estrogen receptor, progesterone receptor, and HER2 status. This is the reason why we think it's important to look at the disparities by subtype."

She added, "Given the racial and ethnic disparities, targeted, culturally appropriate interventions in breast cancer screening and care have the potential to reduce the disparities and close the existing survival gaps."

No matter your ethnicity, there are steps you can take to keep your risk of breast cancer as low as it can be. You may want to ask your doctor about your risk of breast cancer, as well as about lifestyle choices you can make to lower that risk, including:

  • maintaining a healthy weight
  • exercising every day
  • limiting or avoiding alcohol
  • not smoking
  • eating a healthy diet that’s low in processed foods, sugar, and trans fats

To learn more about breast cancer risk and other options to keep your risk as low as it can be, visit the Breastcancer.org Lower Your Risk section.

If you’ve been diagnosed with breast cancer, you and your doctors will put together a treatment plan that meets the needs of your unique situation and takes into account your overall medical condition and your personal style of making decisions.

If you’re not comfortable with the treatment plan your doctor recommends or want to see if another doctor recommends the same options, you may want to consider getting a second opinion from another doctor.

Many women diagnosed with breast cancer feel a sense of urgency about jumping right in and starting treatment immediately. In most cases, though, there’s time to do some research to make sure your diagnosis is correct and your treatment plan makes sense -- and this may include getting a second opinion.

Getting a second opinion means asking another breast cancer specialist, or a team of specialists, to review all of your medical reports and test results, give an opinion about your diagnosis, and suggest treatment options. A second opinion may confirm your original doctor’s diagnosis and treatment plan, provide more details about the type and stage of breast cancer, raise additional treatment options you hadn’t considered, or recommend a different course of action. Even if you’ve already had treatment, it’s not too late to get a second opinion. A second doctor can weigh in on your diagnosis and treatment plan to date, offering any additional thoughts or recommendations.

There is only one of you and you deserve the best care possible. Don’t be afraid to ask questions and advocate for your care.

For more information on planning your treatment and getting a second opinion, visit the Breastcancer.org Treatment & Side Effects section.



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