Black Women Face Multiple Barriers to Risk-Reducing Care
Black women with a higher-than-average risk of developing breast cancer encounter a number of hurdles when making decisions about preventive care that could help reduce that risk, according to an Ohio State University study.
The research was published in the March 1, 2023, issue of the journal PLoS ONE. Read “Racial differences in prevention decision making among U.S. women at high risk of breast cancer: A qualitative study.”
Factors that increase breast cancer risk
The average woman has about a 13% risk of developing breast cancer in her lifetime. Although doctors don’t know what causes breast cancer, they do know there are factors that can make a woman’s risk higher-than-average, including:
a strong family history of breast cancer
a genetic mutation linked to a higher risk of the disease, such as BRCA1 or BRCA2
being diagnosed with certain benign breast conditions
These factors can mean a woman has a 20% to 80% risk of developing breast cancer in her lifetime.
Steps to reduce higher-than-average breast cancer risk
If you know you have a higher-than-average risk of breast cancer because of a genetic mutation or other reason, there are a number of steps you can take to lower that risk, including lifestyle factors such as:
maintaining a healthy weight
exercising regularly
limiting alcohol
never smoking (or quitting if you do smoke)
Other, more aggressive ways women at high risk can reduce their risk are:
taking medicine, such as tamoxifen, to reduce the risk of developing hormone receptor-positive breast cancer
starting breast cancer screening earlier and having screening tests more often
having prophylactic (protective) surgery to remove the breasts, ovaries, and fallopian tubes before any cancer develops
About the study
Little research has been done on the way women at high risk of breast cancer make decisions about reducing that risk, as well as how that decision-making process might be different for women of different races, ethnicities, and cultural backgrounds. In this study, the researchers wanted to uncover differences in how high-risk white and Black women make decisions about risk-reducing steps.
The study included 50 women:
30 non-Hispanic white women
20 Black women
Overall:
six white women had a BRCA mutation and were considered to have severe breast cancer risk
22 white women and 19 Black women were considered to have high breast cancer risk
two white women and one Black woman were considered to have moderate breast cancer risk
Of all the women:
30% of white women and 8% of Black women had a household income of $90,000 or higher
8% of Black women and 2% of white women had a household income of less than $20,000
28% of white women and 16% of Black women were ages 46 to 70
The researchers interviewed all the women, and asked them:
when and how they learned about their breast cancer risk
how they thought about their personal breast cancer risk in the context of their lives
what their decision-making process was for any steps they had taken to reduce that risk
how they felt about their risk and any steps they had taken
The interviews suggested that Black and white women with a high risk of breast cancer think about that risk differently:
Black women were more likely to have a family member or friend who had been diagnosed with cancer other than breast or ovarian cancer.
Black women were more likely to think of all cancers as somewhat the same and to believe they were at equally high risk of developing all types of cancer. Women with this more general perception of cancer risk didn’t believe much could be done to reduce risk and thought that screening and following healthy lifestyle recommendations were the only steps they could take.
White women were more likely to perceive themselves to be at a specific risk for breast or ovarian cancer and were more likely to consider more aggressive risk-reducing steps, such as taking medicine or having preventive surgery.
White women were more likely to report moderate or high levels of worry about their cancer risk.
Black women were more likely to mention faith when talking about cancer risk and to say that faith in God would help protect them from cancer. This stronger spiritual connection seemed to offer mental health benefits, but also was linked to a lower likelihood of using other steps to lower breast cancer risk.
Black women were more likely to be coping with a current major health issue, such as HIV, which competed with taking steps to prevent a future cancer.
Black women had less access to a specialist healthcare provider, such as a genetic counselor, when learning about their breast cancer risk, and were more likely to say their primary care doctor was their main source of information about their breast cancer risk.
Black women were less likely to know about surgery and medicine options to reduce the risk of breast cancer.
Although most women in the study had heard of genetic testing, Black women were less likely to have actually had testing done.
Black women were more likely to report that financial concerns affected their decisions about whether to take steps to reduce their breast cancer risk. Black women also were more likely to say that they did not have health insurance for an extended period of time.
“The contexts within which white and Black women make prevention decisions differ in important ways,” the researchers wrote. “These contexts are complex, involving past experiences, current health challenges, emotional states, access to and interactions with healthcare providers, and resource availability and constraints. But the broad patterns revealed by this study suggest that Black women may be less equipped to focus on breast cancer risk as an issue to be addressed proactively, may less frequently possess the information that would facilitate risk-management decision making, and may be more constrained in their ability to make and carry out those health-protective decisions. These patterns likely originate from a range of causes, which may include differential access to financial and other resources (i.e., comprehensive health insurance, household income and wealth, adequate time away from work and family responsibilities to seek out healthcare), cultural differences in orientation toward healthcare providers and options, differences in personal exposure to cancer and cancer treatment in loved ones, differential access to specialists or risk-informed [primary care physicians], and distinct experiences of respect or discrimination in healthcare settings.”
What this means for you
The results of this study are very troubling, but do highlight some areas to consider if you’re a Black woman with a higher-than average risk of breast cancer or don’t know your breast cancer risk:
You may want to start the conversation with your doctor about your personal breast cancer risk, especially if you have a strong family history of the disease.
If your doctor doesn’t discuss all the options available to you to reduce your risk — including genetic testing and preventive medicine and surgery — ask for a referral to a doctor who specializes in breast cancer risk or a genetic counselor.
If specialist or genetic testing costs are a concern, ask to speak to a patient navigator at the facility. It’s important to know that health insurance generally covers genetic counseling and testing for women with a strong family history of breast or ovarian cancer. The navigator can help you understand your insurance coverage and offer options for financial help if you need it.
All people — no matter their race, ethnicity, gender identity, sexual orientation, age, economic status, or other health conditions — deserve the best healthcare possible, including care that can reduce breast cancer risk. Differences that affect outcomes, including access to specialist care, should be eliminated.
— Last updated on May 25, 2023 at 2:02 PM