Breast Cancer By Race And Ethnicity

Breast cancer is the second most commonly diagnosed cancer and the second leading cause of cancer-related death in women. However, the rates are affected by race and ethnicity, with certain groups at a greater risk than others. 

Understanding the difference between race and ethnicity

It’s essential to understand the difference between race and ethnicity. The concept of race categorizes people into groups based on certain physical traits, such as skin color and facial structure. Ethnicity is a more specific term for how people culturally identify themselves, and it may be based on physical features as well as language, traditions, and behavior.

SEER and its significance for different ethnic groups 

The Surveillance, Epidemiology, and End Results (SEER) program is a database that provides information on cancer statistics in the United States. The data is collected from every cancer case reported in 19 geographical areas in the US. Overall, it covers about 35% of the population.¹

SEER includes people from diverse populations, including minority ethnic groups such as Hispanics, African Americans, Alaskan natives, and Hawaiian Pacific Islanders. It allows researchers to examine these groups’ cancer prevalence, mortality rates, and care patterns. This is significant because there are racial and ethnic differences in cancer diagnoses and mortality rates.²

SEER has been designed so that the group it studies is equivalent to the overall US population in terms of demographics (such as age, race, and gender). 

What statistics tell us about breast cancer based on race and ethnicity

Research has shown clear racial and ethnic differences in breast cancer incidence and mortality. 

Recent trends in cases and death rates in the US 

For context, some general breast cancer trends in the US, obtained from SEER, include the following:

• Breast cancer case rates are rising in all ethnic groups. This means that, across the racial and ethnic spectrum, more people are being diagnosed with breast cancer each year.

• Breast cancer death rates are slowly decreasing overall, but they have decreased in some ethnic groups more than others. This means that fewer people overall are dying of breast cancer each year, although the decline isn’t uniform across various races and ethnicities.

Research shows that Black women generally have similar or slightly lower rates of breast cancer than White women. Out of every 100,000 women, approximately 133 Black and 140 White women are diagnosed with breast cancer.³

However, Black women are more likely to have certain more aggressive forms, known as triple-negative and inflammatory breast cancer. Black women are also 40% more likely to die from breast cancer than White women.⁴ ⁵ ⁶

How race and ethnicity are linked to early detection, treatment, and access to care 

The disparities in breast cancer for women of different races are complex. Race and ethnicity can influence every aspect of a person’s cancer journey, from how early their cancer is detected to access to treatment options, quality of care, and follow-up checks.

Sociopolitical dynamics of the American health system

Structural barriers within the health system can make access to healthcare challenging for many people. The lack of universal healthcare means that the cost of medical care often falls on the individual.⁷ ⁸

For many people, health insurance is unaffordable, which often prevents them from receiving recommended cancer screenings and the best treatment if cancer is detected. Black women are twice as likely as White women to be uninsured.⁹

Poverty and other socioeconomic factors

Poverty and other socioeconomic factors are associated with certain breast cancer risk factors. Women with low incomes have lower rates of breast cancer screening, are more likely to be diagnosed at later stages, and are more likely to receive inadequate treatment.¹⁰

This is important when considering racial and ethnic disparities in breast cancer because there are differences in average socioeconomic status for different groups. This may put people of certain races or ethnicities at greater risk of both getting breast cancer and dying from the disease.¹¹

Quality of healthcare services received

Healthcare services in underprivileged communities are more likely to have fewer:¹²

• Primary care facilities

• Physicians experienced in the cancer diagnosis, treatment, and follow-up needs of their specific community 

People of some racial and ethnic groups are more likely to live in an underprivileged community than others.

Systemic or individual racism in the healthcare system 

A survey found that physicians are more likely to have negative perceptions of patients who are African American or of lower socioeconomic status compared with their views of those who are White or of higher socioeconomic status. These attitudes could affect the quality of medical care that different types of people receive.¹³

Black people may be more likely to mistrust the healthcare system in general due to historical mistreatment and lack of medical consent (such as in the Tuskegee syphilis study).¹⁴

Mistrust may also get reinforced by present-day experiences of racism and become a barrier to seeing a doctor or pursuing recommended medical or surgical treatments.

Differences in treatment options available

Differences in available treatment options influence breast cancer outcomes.¹⁵ Black women are less likely to receive adequate treatment for breast cancer than White women.¹⁶

For example, research has found that:¹⁷

• Black women are less likely to have mammograms recommended to them by doctors. When mammograms are recommended and performed, Black and Hispanic women are more likely to experience delays in diagnosis and follow-up after their mammogram.¹⁸

• Black and Hispanic women are less likely to receive certain types of recommended treatments, such as early local therapy for potentially curable breast cancer.¹⁹

• Black women are more likely to experience delays in starting treatment after their diagnosis.²⁰

• Black women are more likely to have fewer treatment cycles and stop receiving treatment early.²¹

How are racial/ethnic disparities in breast cancer treatment being addressed? 

Several programs are researching and addressing the racial/ethnic disparities in breast cancer treatment. 

ACCURE

Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) was a clinical trial designed to address and remedy the systemic racial disparities in breast cancer treatment completion. It focused on the principles of transparency and accountability at the institutional level of the healthcare system, using an antiracism and community-based approach to improve cancer care. 

ACCURE successfully eliminated the racial differences in breast cancer treatment completion. In addition, the program improved treatment completion rates among participants of all racial groups. ACCURE is currently not available for enrollment, so you can’t sign up to be a part of it. However, it set a precedent in suggesting that system-level changes can effectively remove racial disparities in cancer care.

The NBCCEDP program 

The Centers for Disease Control and Prevention created the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to help individuals with low incomes without adequate insurance gain access to breast and cervical cancer screening, diagnostic, and treatment services.²²

NBCCEDP funds services for these individuals and provides them with patient navigation services so that they can overcome the barriers to quality care. 

You may be able to participate in the NBCCEDP if:²³

• You have no health insurance, or your insurance doesn’t cover cancer screening.

• Your annual income is at or below the federal poverty level. This amount is updated each year and depends on household size.

• You’re between 40 and 64 years old (although you may still qualify if you aren’t within this age bracket). 

WISDOM

Currently, the same general breast cancer screening (mammogram) recommendations are usually given to all women. However, this one-size-fits-all approach may not be suitable, as we know that people have different levels of risk. 

The Women Informed to Screen Depending on Measures of Risk (WISDOM) study is a US-based program that develops unique breast cancer screening plans for women based on their personal risk factors, along with optional genetic testing.²⁴

The study's goal is to compare how effective this personalized approach is when compared to simply performing annual mammograms for all women over 40 years old. Enrollment in the WISDOM trial is focused on participant diversity to ensure the findings apply to the general population. 

You may be able to participate in the WISDOM program if you:²⁵

• Identify as female

• Are between the ages of 40–74

• Live in the United States

• Have not previously had breast cancer or ductal carcinoma in situ (a type of very early breast cancer)

Developing and approving new treatments for breast cancer subtypes that are more common in non-white ethnic groups

In 2020, the FDA approved the combination of pembrolizumab and chemotherapy to treat advanced triple-negative breast cancer.²⁶

Triple-negative breast cancer cells don’t have the estrogen receptor, progesterone receptor, or a protein called HER2. (The cells test negative for all three of these, and so they’re called triple-negative.) This type of breast cancer tends to be highly aggressive and is currently more difficult to treat because it lacks the targets of many common medications used for breast cancer. 

Developing treatments for the highly aggressive triple-negative and inflammatory breast cancer subtypes is important for reducing disparities because these cancers are more common in Black women. 

What can be done right now to reduce the risks of breast cancer?

Research suggests that lifestyle changes could prevent 25–30% of all breast cancer cases.²⁷ Although there’s no way to absolutely ensure that you won’t get breast cancer, some actions and changes that can reduce your risk include the following:

Don’t miss a screening

A mammogram (an X-ray of the breast) is a screening tool that can detect cancer in the early stages when it’s more treatable.²⁸ All women between 50–74 should consider getting a mammogram every two years. Women aged 40–49 should discuss screening options with their doctor.²⁹

These screening recommendations are generalized and don’t consider that Black women are often diagnosed at a younger age.³⁰

Genetic testing

Changes in certain genes, known as BRCA 1 and BRCA 2, can put women at a higher risk for breast and ovarian cancer. The proteins made by these genes normally protect against cancer, but certain mutations cause the proteins not to work as well, so you’re not as protected and cancer is more likely. 

Not all forms of cancer are hereditary, so genetic testing isn’t always helpful. However, you might wish to consider genetic testing if:³¹

• You have a family history of breast cancer. 

• Someone in your family has a mutation in one of the BRCA genes.

• You have a personal history of ovarian, fallopian tube, or peritoneal cancer. 

Testing for BRCA mutations will let you know whether you have an increased risk for breast cancer. Although you can’t change your genes, knowing you’re at higher risk could influence your decisions. You might choose to take extra actions to protect yourself against cancer or receive earlier or more frequent screenings. 

If you’re diagnosed with breast cancer, genetic testing can also help assess whether your family members may be at risk.

Consider the risks of medications 

Certain medications might increase the risk of breast cancer. These include:

• Hormone replacement therapy

• Certain antidepressants

• Prolonged use of some antibiotics 

• Oral contraceptives 

Not all studies have consistently shown that all of these medications are linked to an increased risk of cancer, and the increase in risk may be small. 

If you’re worried about a medication you’re taking, consider discussing it with your doctor. They can help you weigh the benefits of medication against the potential increased risk of breast cancer. 

Avoid alcohol

Alcohol increases the risk of breast cancer through hormonal effects and by promoting greater body fat and weight gain. To prevent cancer, The World Cancer Research Fund recommends avoiding alcohol or limiting your intake as much as possible.³²

Manage your weight

Obesity is a risk factor for breast cancer and may increase the risk of having a more aggressive form. It may also be associated with increased mortality and cancer recurrence. Losing 5–10% of body weight after menopause has been found to reduce the risk of breast cancer, while gaining weight after menopause was associated with an increased risk.³³

Exercise daily

Women who are more physically active have lower rates of breast cancer.³⁴ Four hours of physical activity each week could reduce the risk by half. Exercise helps to maintain a healthy body weight, and it may also help to reduce the risk of cancer in other ways, such as by controlling inflammation.

Try to reduce exposure to chemicals

It’s recommended to avoid endocrine-disrupting chemicals, as these affect hormonal pathways associated with breast cancer. Three endocrine-disrupting chemicals to keep an eye on include:³⁵

• Dichlorodiphenyltrichloroethane (DDT) (an agricultural insecticide) 

• Dioxins (pollution in the environment) 

• Bisphenol A (known as BPA, a chemical found in plastics) 

Avoiding these chemicals entirely can be challenging. It may be helpful to choose organic foods, although multiple studies show that while organic food does have lower levels of pesticides, there may still be some pesticides present.³⁶ Reducing your consumption of water and other foods and beverages from clear plastic containers may help decrease your exposure to BPA.

Develop a plan to quit smoking with your doctor

When you smoke, you inhale a variety of carcinogens, which travel to the breast tissue as well as other parts of your body.³⁷ Because of this, it’s strongly recommended to stop smoking to reduce your cancer risk. Quitting smoking can be challenging, but your doctor can help you create a plan to achieve this in a manageable way.

Dietary modifications 

The American Cancer Society recommends a diet based on fruit, vegetables, whole grains, lean protein, and legumes. These foods are high in nutrients that may protect against cancer, such as omega-3s, antioxidants, vitamin D, fiber, folate, and phytoestrogens.³⁸ However, research has not consistently shown that a plant-based diet reduces the risk of breast cancer.³⁹

Research has shown that eating more red meat and processed meats does lead to a small increase in breast cancer risk. Reducing your intake of these foods may help reduce your risk of breast cancer as well as other cancers. 

The lowdown

Breast cancer survival rates are improving overall due to greater availability of screening and treatment. However, inequalities in breast cancer mortality rates persist. Black women are more likely to die from breast cancer than White women.

Governmental organizations, researchers, and advocacy groups are working to develop system-level programs that can reduce or eliminate these ethnic disparities. Programs such as ACCURE have shown that this approach can be highly successful and reduce disparities while also improving outcomes for people of all racial and ethnic groups.

Frequently asked questions

Which race has the highest rates of breast cancer?

In the United States, non-Hispanic White women have the highest breast cancer rates overall, although Black women follow closely behind.⁴⁰

What race has the lowest risk of breast cancer?

In the United States, Hispanic women have the lowest risk of breast cancer.⁴¹

Is cancer less common in Europe?

The rates depend on the specific country in Europe. However, Northern and Western European countries have some of the highest breast cancer rates worldwide.⁴² Six out of the ten countries with the highest breast cancer rates are in Europe.⁴³