Breast cancer is the most common cancer among American women, as well as among Black women. And although breast cancer is the most common cancer, it remains the second leading cause of cancer-related death among women behind cancer of the lungs.
Very disturbing disparities exist between Black women and white women when it comes to breast cancer screening, diagnosis, and survival, and these will be outlined below.
What Is Breast Cancer?
Breast cancer is a malignant growth or tumor that frequently begins to manifest in the milk ducts or lobules of either breast.
Breast cancer can be divided into two groups: invasive and non-invasive cancers. Non-invasive breast cancers are also called “carcinoma in situ” and are generally confined to the duct areas without affecting the surrounding tissue.
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Non-invasive breast cancers can be subcategorized as “ductal carcinoma in situ” (DCIS) and “lobular carcinoma in situ” (LCIS). LCIS is actually not considered cancer, per se. Rather, it is seen as a warning sign that can potentially lead to invasive cancer when undetected.
Invasive breast cancers may develop in the lobules or ducts but then spread into surrounding breast tissue, and can often further metastasize to the lungs, brain, liver, bones, and other major organs. Approximately 80 percent of invasive breast cancers fall into the category of invasive ductal carcinoma.
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Stages of Breast Cancer
- Stage 0. breast cancer is known as carcinoma in situ, the most common being DCIS, as described above.
- Stage 1. Breast cancer signifies early invasive cancer in which the tumor has not spread beyond the breast tissue and is no more than ¾ of an inch in diameter.
- Stage 2. Breast cancer involves a tumor between ¾ of an inch and 2 inches in diameter with some involvement of the local lymph nodes under the arm.
- Stage 3. Breast cancer can involve a combination of various factors, including larger tumor mass, involvement of lymph nodes behind the breast bone, tumor spread into the chest wall or skin of the breast, or under or above the collar bone. Stage 3 also may manifest as inflammatory breast cancer, a rare form of breast cancer wherein the breast becomes red and swollen due to the blockage of lymph vessels in the breast tissue and skin.
- Stage 4. Breast cancer involves the spreading of the disease to other parts of the body and distant organs, a process often referred to as metastasis.
Screening
Breast self-exam (BSE) is an important part of self-screening for women of all ages, although studies show that the percentage of women who practice regular monthly BSE is relatively low.
Mammograms are a very crucial aspect of breast cancer screening and are still considered the best method of early detection. Starting at the age of 40, annual mammograms are recommended for all women, as well as an annual clinical breast exam by a qualified medical professional.
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MRIs of the breast are also utilized for special magnification views, yet mammograms remain the gold standard for early detection.
Treatment
Breast cancer is generally treated with a combination of chemotherapy, hormonal therapy, radiation, and surgery.
Chemotherapy and hormonal treatments are systemic therapies that target cancer cells that have traveled to areas of the body beyond the breast. Surgery and radiation are localized treatments focusing specifically on the breast tissue itself.
Breast cancer surgeries may be “breast-conserving”, wherein “lumpectomies” and other localized surgeries endeavor to conserve as much viable non-cancerous breast tissue as possible. Mastectomies can involve the removal of a portion of the breast tissue and local lymph nodes, as well as radical surgery that encompasses the entire breast and portions of the chest wall, when necessary.
Male Breast Cancer
Only one percent of all breast cancer cases occur in males, and usually between the ages of 60 and 70.
Due to the fact that men have little breast tissue in comparison to women and are often diagnosed with cancer much later in the disease process, male breast cancer frequently involves the chest wall and other surrounding tissue. Men are generally unaware that they are susceptible to breast cancer and thus will ignore the symptoms until the disease has progressed significantly.
Breast Cancer and Black Women: Disturbing Statistics
Although Black women have a lower incidence of breast cancer than their white counterparts, they actually have a higher risk of death from breast cancer, a statistic that scientists are still endeavoring to fully understand.
Some studies have indicated that breast cancers grow more rapidly in Black women and are less responsive to hormone-based therapies. Other studies have also demonstrated that Black women tend to be diagnosed at later stages of the disease than white women, and various factors have been considered to explain this racial difference in diagnosis, including the fact that Black women undergo fewer mammograms.
According to an article on the website of the Black Women’s Health Imperative, both insured Black women and uninsured white women wait twice as long to receive “a definitive breast cancer diagnosis” than white women who are insured, and Black women “waited twice as long as white patients to begin treatment after breast cancer diagnosis”.
Additionally, a study by the American Journal of Public Health found that Black women are less likely to receive appropriate cancer treatment, a conclusion that calls for greater advocacy and racial parity in screening, diagnosis and treatment. This is underscored by the fact that the five-year survival rate from breast cancer among Black women is 69 percent, whereas the five-year survival rate for white women is 84 percent, another disturbing racial differential.
Breast Cancer: Action Is Still Needed
Breast cancer is still a very serious public health issue for American women, and racial disparities regarding screening, diagnosis and treatment of breast cancer have a significant negative impact on Black women and are indeed a cause for alarm, action and advocacy.
Breast self-exam, annual mammograms, and annual clinical breast exams are all important aspects of early detection that all women should undertake and advocate for on their own behalf.
