How Chronic Myeloid Leukemia Affects Black Women Differently

Chronic Myeloid Leukemia (CML) is a form of cancer that originates in the bone marrow, leading to an overproduction of white blood cells. While this disease can affect individuals of all racial and ethnic backgrounds, Black women face unique challenges when it comes to diagnosis, treatment, and overall disease progression.

Emerging research suggests that these differences contribute to hormonal influences, genetic factors, healthcare access disparities, and systemic medical biases. Understanding these factors is crucial for developing targeted interventions to improve outcomes for Black women with CML.

The Role of Hormones and Treatment Responses

Hormonal differences may influence how CML manifests and progresses in Black women. Research suggests that estrogen and other sex hormones play a role in the growth and survival of leukemia cells. Yet, there is limited research examining how these hormonal fluctuations impact treatment response, specifically in Black women.

Hematologic Differences in Women with CML

One study found that women with CML often present with more severe cases of:

Anemia (low red blood cell count) (p = 0.019)
Thrombocytosis (excess platelets in the blood) (p = 0.041)

These differences may alter treatment efficacy, as anemia can impact how well the body tolerates certain medications. Additionally, anemia and thrombocytosis may be influenced by hormonal fluctuations, but more research is needed to understand these mechanisms fully.

Genetic Variations & Drug Metabolism in Black Women

Another critical factor is genetic polymorphisms, which affect drug metabolism. Studies have shown that certain genetic variations influence how well patients respond to tyrosine kinase inhibitors (TKIs)—the primary treatment for CML.

Because drug metabolism can vary based on genetic ancestry, some Black women may experience:

Slower or faster drug processing, affecting medication effectiveness
Increased resistance to standard treatments, requiring alternative therapies

Without adequate research on these genetic differences, Black women may not receive the most effective treatment plans, leading to poorer disease outcomes.

Why Early Symptoms Are Often Ignored in Black Women

The early symptoms of CML—such as fatigue, weight loss, and night sweats—are often nonspecific and can easily be attributed to stress, lifestyle changes, or less severe conditions. Several factors contribute to delayed diagnoses in Black women:

1. Healthcare Access & Socioeconomic Barriers

Black women are more likely to face limited access to healthcare facilities, particularly in underserved communities.

Financial constraints and lack of insurance can delay doctor visits and screenings.
Implicit bias in healthcare settings often leads to the dismissal of Black women’s symptoms.

A study published in Cancer Epidemiology, Biomarkers & Prevention found that Black patients with leukemia had longer wait times before diagnosis, which directly impacts survival rates.

2. Cultural Perceptions & Medical Mistrust

Historical mistreatment of Black communities in medical research—such as the Tuskegee Syphilis Study—has contributed to distrust in the healthcare system. Some Black women may feel reluctant to:

Report symptoms early
Seek second opinions after medical dismissal
Participate in clinical trials, limiting available data on how CML affects them

3. Normalization of Symptoms Due to Chronic Stress

Black women often experience higher levels of chronic stress due to systemic racism, socioeconomic challenges, and caregiving responsibilities. These factors can normalize fatigue and discomfort, making it less likely that symptoms will be recognized as potential signs of leukemia.

Real-World Example: Walela Nehanda

Walela Nehanda was diagnosed with advanced-stage CML at 23 after experiencing symptoms for years. They initially dismissed their symptoms as the result of:

The stress of homelessness and poverty
Constant fatigue from overworking to survive

By the time Nehanda sought medical care, their CML had progressed significantly, making treatment more difficult. Their story highlights the urgent need for awareness and early detection of Black women.

The Latest Research on CML in Melanin-Rich Populations

Although research on CML in Black women is still limited, some studies have provided insight into how leukemia presents in melanin-rich populations.

1. Racial Differences in Leukemia Subtypes

A study published in Leukemia & Lymphoma found that Black patients with leukemia often have:

Lower median hemoglobin levels (indicating more severe anemia)
Higher beta2-microglobulin levels (a marker associated with poorer prognosis)

While this study primarily focused on Chronic Lymphocytic Leukemia (CLL) rather than CML, it underscores how racial differences impact leukemia progression and treatment outcomes.

2. Gender & Ethnic Differences in CML Patients

Another study found that:

Women presented with more severe pre-treatment prognostic factors than men
Hispanic patients had better treatment responses than non-Hispanic patients, though these differences were not significant when only first-line imatinib therapy was considered.

This suggests that racial and ethnic differences in leukemia progression and treatment response warrant further investigation—particularly for Black women.

Addressing Disparities in CML Treatment & Care

To improve CML outcomes for Black women, systemic changes are needed in medical research, healthcare access, and patient education.

1. Increasing Black Women’s Participation in Clinical Trials

Clinical trials help researchers determine how genetics, metabolism, and treatment responses vary among different populations. Encouraging more Black women to participate in CML trials can lead to:

More personalized treatment options
Greater understanding of hormonal and genetic factors in CML progression

2. Training Healthcare Providers in Cultural Competency

Many Black patients report feeling dismissed by medical professionals. Implicit bias training for healthcare providers can help improve:

Patient-provider communication
Early detection of symptoms
Trust and medical adherence

3. Improving Healthcare Access in Black Communities

Solutions to reduce disparities include:

Expanding affordable health insurance coverage
Increasing medical facility availability in underserved areas
Providing transportation and telemedicine services for accessibility

4. Raising Awareness About CML Symptoms in Black Women

Public health initiatives should focus on:

Community-based education programs on early symptoms
Social media campaigns tailored to Black women’s health concerns
Encouraging Black women to advocate for themselves in medical settings

Chronic Myeloid Leukemia presents unique challenges for Black women due to:

Hormonal and genetic differences
Barriers to early diagnosis
Healthcare access disparities
Medical mistrust and implicit bias

Addressing these challenges requires a multifaceted approach, including more research, equitable healthcare access, and culturally competent medical care. By tackling these disparities, the medical community can improve outcomes for Black women with CML and ensure they receive the care they need.