Without access to appropriate screening and treatment, breast cancer can be devastating (regardless of your race or ethnicity).
Annually, one out of every ten women across the globe is affected by breast cancer.¹
For some, improved public awareness about mammogram screening, advanced diagnostics, and lifestyle intervention education have helped reduce breast cancer mortality. However, disparities among the various races and ethnicities (even within the same country) are still prevalent.
Over the past four decades in the US, breast cancer rates have generally increased, but overall deaths from breast cancer have also fallen — the exception being among American Indian and Alaskan Native (AI/AN) populations, for whom mortality rates have only recently stabilized.²
However, actual rates of breast cancer are quite varied by population.
According to Surveillance, Epidemiology, and End Results (SEER) data, White women have the highest rates of breast cancer.³
While Black women have comparatively lower breast cancer cases, their mortality rate is 40% higher than White women. Statistically, this population also has the unfortunate distinction of having the lowest 5-year relative survival rate of any race or ethnicity.⁴
Examining and understanding these disparities is crucial to improving treatment outcomes and saving lives. Understanding how breast cancer affects racial and ethnic groups differently can also help you understand the disease better, especially if you are in an at-risk group.
Let’s take a closer look.
We make it easy for you to participate in a clinical trial for Breast cancer, and get access to the latest treatments not yet widely available - and be a part of finding a cure.
Breast cancer affects women of all races and ethnicities. Still, research has shown that specific populations are disproportionately more likely to die from breast cancer.
White women have the highest overall rates of breast cancer (136.3 per 100,000), followed by non-Hispanic Black women (128.3 per 100,000). However, white women have statistically better treatment outcomes, as their mortality rate is 19.7 per 100,000, while black women have a staggering mortality rate of 27.6 per 100,000, 40% higher than White women.
This discrepancy is attributable to various factors, including:
Limited access to quality healthcare
Genetic predispositions to aggressive breast cancer subtypes such as triple-negative breast cancer (TNBC).
AI/AN and Hispanic women have a noticeably lower rate of breast cancer than either White or Black populations (107.4 and 98 cases per 100,000, respectively).⁵ But, their death rate remains disproportionately high (17.6 per 100,000 AI/AN and 13.8 per 100,000 Hispanic). This unfortunate fact is primarily due to the same socioeconomic disparities and gaps in access to care that other women of color face, including late-stage diagnoses (once detected, their breast cancer is more advanced).
Women of Ashkenazi Jewish descent and Black, Hispanic, and Southeast Asian women are also more genetically predisposed to triple-negative breast cancer (TNBC).
A 2021 case study found that Black or African American participants had more than 2x the odds of developing triple-negative breast cancer than White participants. This aggressive cancer subtype tends to occur at a younger age, with a statistically worse prognosis than other forms of breast cancer, as it is more challenging to treat.
According to the Centers for Disease Control and Prevention, 1 in 40 women of Ashkenazi Jewish descent carry a BRCA1 or BRCA2 gene mutation, associated with a much higher risk of developing TNBC.⁶
Asian and Pacific Islander populations have relatively lower breast cancer rates than White and Black women (106 per 100,000). However, among Asian women, some disparities call for better understanding.
For instance, Southeast Asian women have a higher incidence and lower survival rate for breast cancer than East Asian women.⁷ This variation is attributable to differences in access to healthcare, genetics, lifestyle, and environmental factors, and a higher TNBC rate. Knowing that some Asian women have a higher risk for breast cancer than others, researchers are pressing for future data to be disaggregated (ungrouped) into more relevant subgroups rather than treating all Asian women as one entity.
Breast cancer is a complex disease with numerous contributing factors.⁸
Some of these factors include:
Genetic factors: Women who carry a mutation in the BRCA1 and BRCA2 genes have a significantly higher risk of developing breast cancer, particularly at a younger age. These mutations are more common among women of Ashkenazi Jewish descent and some Black and Hispanic populations.
Family history: Having one or more people in your family (particularly a first-degree member) diagnosed with breast cancer significantly increases your risk of breast cancer by two to threefold.⁹ Similarly, if you inherit a BRCA1 or BRCA2 mutation, the likelihood of developing breast cancer is 32-52% higher than the average population risk. Inheriting this mutation can also put you at a much higher risk of developing ovarian or colorectal cancer.¹⁰
Age: While breast cancer can occur at any age, the risk increases as you age. Women under 45 account for approximately 10% of all new breast cancer cases, but the risk increases significantly after age 50. However, young Black and Hispanic women are disproportionately more likely to be diagnosed with breast cancer than young White women.
Gender: Women are more likely to develop breast cancer than men, as their breast tissue is more susceptible to hormonal and environmental effects that can promote cancer growth. Still, men do get breast cancer.
Race: White women have the highest incidence of breast cancer. However, being Black or Hispanic increases your risk of developing more aggressive forms of breast cancer.
Breast tissue density: Women with dense breast tissue are more likely to develop breast cancer than those with less dense tissue. In addition, dense breast tissue can make it more challenging to detect cancer during mammography.
Previous history of breast diseases: If you've had certain benign breast conditions, such as atypical hyperplasia, it can increase your risk of developing breast cancer. Women with a history of non-cancerous breast disorders, such as fibrocystic alterations or cysts, may also be more likely to develop breast cancer.
Pregnancy and breastfeeding: Women who have never been pregnant or had their first child after age 30 have a slightly higher risk of breast cancer. On the other hand, breastfeeding, especially for longer than a year, reduces breast cancer risk.
Previous radiation therapy: Exposure to radiation therapy, particularly at a younger age, can increase your risk of developing breast cancer later in life.
Diethylstilbestrol: Women exposed to diethylstilbestrol (DES) in their mother's womb have a slightly increased risk of developing breast cancer. DES is a synthetic estrogen prescribed to pregnant women between 1940 and 1971 to prevent miscarriages.
In addition to these factors, potentially manageable risk factors for breast cancer include:
Oral contraceptives and hormonal replacement therapy: Long-term usage of oral contraceptives or hormone replacement treatment (HRT), particularly those that combine estrogen and progesterone, has been associated with an increased risk of breast cancer.¹¹ ¹²
Physical activity: Regular physical activity can help lower your risk of developing breast cancer. According to some studies, even regular moderate exercise, such as brisk walking, can reduce your risk of breast cancer.
Obesity: Maintaining a healthy weight can help reduce the risk of breast cancer, especially after menopause. Postmenopausal women who are overweight or obese have a higher risk of breast cancer due to increased estrogen levels produced by fat tissue.
Alcohol intake: Drinking alcohol increases your risk of breast cancer.¹³ The more alcohol a woman consumes, the higher her risk. Limiting alcohol intake or avoiding drinking can help reduce this risk.
Vitamin deficiencies: Certain deficiencies could increase the risk of developing breast cancer in some women. For instance, sufficient intake of vitamins C and D has been linked to a reduced risk of breast cancer.¹⁴ It's crucial to ensure you get enough of these vitamins through your diet or supplements approved by your healthcare provider.
Excessive exposure to artificial light: Exposure to artificial light at night, especially blue light from electronic devices, can disrupt your body's production of melatonin.¹⁵ Research shows that melatonin is an antioxidant with anticancerous properties, so avoiding disruption can lower the chance of cancer developing.¹⁶ ¹⁷ ¹⁸
Smoking: Particularly if you are a long-term smoker or began smoking early, smoking increases your risk of developing breast cancer.
Chemical exposure: Certain chemicals, such as those in some pesticides and plastics, may increase your risk of breast cancer. Reducing exposure to these chemicals through lifestyle changes and advocating for better environmental regulation can help lower this risk.
Several factors contribute to disparities in breast cancer outcomes among different racial and ethnic groups.
Socioeconomic level: Many modifiable risk factors for breast cancer, such as obesity, alcohol consumption, high intake of processed foods, and exposure to certain chemicals, are more prevalent among specific racial and ethnic minority groups and underprivileged communities.
This disparity is potentially due to long-term racism and discrimination, which impact these communities' living situations, causing many to live in poverty, with lower education, higher pollution, and lack of access to healthy foods, equal opportunities, or quality healthcare. These inequalities can hinder lifestyle changes that contribute to overall well-being and reduced cancer risk.
African American women, for example, have a higher prevalence of obesity, which contributes to a higher risk of breast cancer, according to many studies.¹⁹ Similarly, alcohol consumption and smoking are higher in some minority groups, increasing their risk.
Access to quality healthcare: Limited access to screening significantly impacts the health outcomes of Black and Hispanic women, who are more likely to be diagnosed with breast cancer at later stages than White women.
Studies show that Black and Hispanic women are frequently diagnosed with cancer growing to 2 cm or larger. Black women have a higher proportion of distant-stage breast cancer than other women, making effective treatment more challenging.²⁰
Disparities in access to healthcare and insurance coverage can lead to delayed or inadequate treatment for minority populations, resulting in worse outcomes.
Medical racial bias also contributes to these disparities. As documented in various studies, some healthcare professionals may have subtle biases or even overtly racist attitudes toward non-white patients, causing them not to provide the same timely and high-quality care they give to White patients.²¹
According to the American Cancer Society, minority populations often face additional barriers to care, such as:²²
Lack of transportation
Inability to take time off work
Insufficient insurance coverage
Inclusion in cancer clinical trials: Even though about 12% of the US population is Black, this community makes up only about 5% of clinical trial participants. On the other hand, Asian populations are often overrepresented in cancer trials (compared to their cancer rates).
There's a real lack of diversity in clinical research, with most studies focusing on non-Hispanic, White participants. This limited understanding of different racial and ethnic backgrounds hinders personalized treatments, impairing health equity and, consequently, cancer outcomes.²³
Cultural and spiritual beliefs: Certain cultural beliefs and practices may impact some people’s willingness to seek medical care or undergo screening for breast cancer, leading to delayed diagnoses and treatment.
For instance, some Black or Hispanic women might avoid breast cancer screening due to cultural beliefs, such as the belief that faith in God can prevent cancer. Additionally, research shows that some women of color may have misconceptions regarding the screening process, or others may tend to believe they have lower risks of developing breast cancer than White women (regardless of their family history).²⁴ ²⁵
Addressing these barriers and providing culturally competent education to all health professionals and researchers can help improve breast cancer outcomes for everyone, regardless of race or ethnicity.
Addressing breast cancer disparities requires a multi-faceted approach focusing on increasing accessibility and awareness of early screening, providing education, and reducing financial barriers.
Some strategies include:²⁶
Low-income subsidies: Providing financial assistance to low-income individuals can help ensure access to healthcare services, including breast cancer screenings and treatment.
Increase early breast cancer screening and timely follow-up: Public awareness campaigns, partnering with local healthcare providers, and offering mobile or pop-up screening clinics in underprivileged areas can promote early detection and treatment of breast cancer. Community outreach and engagement forms like these encourage women to get regular mammograms and clinical breast exams at the recommended ages.
One-on-one patient education: Healthcare providers can offer personalized education to patients during visits, addressing their specific risk factors and concerns. This can help improve patients' understanding of breast cancer and its prevention and encourage them to follow a healthy lifestyle to reduce their risk while also participating in regular screenings and follow-up care.
Client reminders: Implementing reminder systems, such as phone calls, text messages, or mailed reminders, can help patients stay on track with their breast cancer screening and follow-up appointments.
Reduction of out-of-pocket expenses: Reducing the financial burden associated with breast cancer screening and treatment can help ensure that all women have access to necessary care. Policy changes, insurance reform, or partnerships with non-profit organizations can help achieve this.
Bias training for healthcare providers: Local healthcare facilities can incorporate bias training programs for their staff. Understanding and addressing biases can lead to more accurate and early detection of breast cancer in underrepresented groups. It can also lead to them receiving the timely and appropriate treatment needed to improve their outcomes.
Improve diversity in clinical trials: Clinical trials often have historically had limited diversity in their participant pool. Increasing efforts to widen the range of participants (mainly from racial and ethnic minorities) to ensure that breakthroughs apply to everyone.
There is no guaranteed way to prevent breast cancer, but adopting specific lifestyle changes and being proactive about screenings can help reduce the risk.²⁷
Here are some of the most crucial changes to consider:
Controlling your weight: Maintaining a healthy weight can help reduce the risk of breast cancer, particularly after menopause.
Exercising regularly: Regular physical activity can help lower the risk of breast cancer.
Reducing or eliminating alcohol consumption: Limiting alcohol intake to one drink per day or less can help reduce the risk of breast cancer.
Avoid smoking or being a second-hand smoker: Smoking or using tobacco products is linked to an increased risk of breast cancer, so developing a quit plan with your doctor or avoiding secondhand smoke can help lower this risk.
Getting adequate nutrients and vitamins: Sufficient vitamin intake, particularly vitamins D and C (through a balanced diet or supplementation), can help reduce the risk of breast cancer.
Avoiding highly processed foods, high in saturated and trans fats or sugar: The best diet to maintain is one rich in fruits, vegetables, and whole grains. Research shows a healthy diet goes a long way in helping you reduce your risk of developing breast cancer.²⁸
Monitoring medication use, particularly hormonal contraceptives: Being aware of the potential risks associated with the long-term use of oral contraceptives can help you make informed decisions about your health. Consider speaking to your doctor about your other risk factors and how they relate to your chosen method of birth control.
While White women may have the highest incidence of breast cancer in the US, women who belong to racial and ethnic minority groups, notably Black and Hispanic women, often face worse outcomes. Often, this is due to having lower socioeconomic levels resulting from historical and current discrimination, which increases their risk factors, while in other cases, this could be due to being diagnosed with more aggressive forms of breast cancer. In addition, facing systemic barriers such as limited access to quality healthcare can lead to late diagnoses and a lack of timely and effective treatment.
It’s essential to recognize that these inequities aren’t just medical issues but also changeable social issues. Improving outcomes for women of color who face higher breast cancer disparities can be achieved by addressing modifiable risk factors, improving access to high-quality healthcare for cancer screening, early detection and treatment, and strengthening patient education.
Additionally, it’s crucial to address underlying biases and lack of diversity in today’s healthcare systems, including breast cancer surveillance and treatment clinical trials. By addressing these disparities, we can work towards equity in breast cancer diagnosis, treatment, and outcomes for women of all races and ethnicities.
The percentage of Black women with breast cancer varies depending on age, genetics, and lifestyle. However, overall, the rate of breast cancer in Black women is around 128 per 100,000.
Black women have the highest mortality rate from breast cancer, primarily due to late-stage diagnoses, limited access to quality healthcare, and genetic predispositions to more aggressive subtypes or the presence of other diseases.
In some cases, yes. Numerous factors contribute to developing breast cancer. You can reduce your risk by managing modifiable factors such as weight, exercise, alcohol consumption, smoking, diet, and using certain medications. However, adopting preventative measures for breast cancer through healthy lifestyle habits alone does not guarantee that you won’t develop breast cancer (particularly if you have a family history of breast cancer or a strong genetic mutation). Still, even if you belong to a high-risk group, managing any risk factors within your control is beneficial, as this can reduce your overall risk and improve your prognosis if you are ever diagnosed with the condition.
Alcohol, tobacco and breast cancer – collaborative reanalysis of individual data from 53 epidemiological studies, including 58 515 women with breast cancer and 95 067 women without the disease | British Journal of Cancer