Jan 17, 2025 Story by: Editor
Breast cancer remains the most common cancer and the leading cause of cancer-related deaths among women in the United States. Projections for 2025 estimate over 319,750 new cases of invasive breast cancer and 59,080 cases of ductal carcinoma in situ (stage 0 breast cancer) will be diagnosed. Despite a 44% decrease in breast cancer mortality since 1989—attributed to heightened awareness, earlier detection, and advanced treatments—Black women continue to face significantly higher death rates than white women.
Persistent Disparities in Breast Cancer Outcomes
According to the American Cancer Society, while breast cancer incidence rates are comparable between Black and white women, mortality rates for Black women are approximately 40% higher. The disparity is even more pronounced among women under 50, where Black women experience twice the mortality rate of their white counterparts despite higher rates of aggressive cancer subtypes among young women overall.
Advancements in treatment and early detection have significantly lowered overall breast cancer mortality, yet these improvements have not been equally distributed, with this disparity persisting for over a decade.
Contributing Factors to Disparities
The factors contributing to these disparities are multifaceted. Social, economic, geographic, and lifestyle elements, including higher rates of diabetes, obesity, and lower breastfeeding rates among Black women, play a role. Additionally, Black women are more likely to encounter barriers such as inadequate health insurance and limited access to healthcare facilities, which can delay screenings and affect treatment completion.
Biological differences also contribute significantly. Black women are more prone to aggressive subtypes like triple-negative breast cancer (TNBC) and inflammatory breast cancer. These cancers often present at younger ages and more advanced stages.
Two major clinical trials—TAILORx and RxPONDER, partially supported by BCRF—highlight these disparities. Dr. Joseph Sparano, who led the TAILORx trial, noted racial differences in early recurrence rates, despite similarities in late recurrence rates across groups. Similarly, RxPONDER revealed worse outcomes for Black women with hormone receptor–positive/HER2-negative, lymph node–positive breast cancer compared to women of other racial backgrounds, even when recurrence scores were similar.
A 2017 study of women aged 18–64 with early-stage breast cancer found that four factors accounted for 76.3% of excess mortality risk among Black women: lack of private health insurance (37%), tumor characteristics (23.2%), comorbidities (11.3%), and treatment differences (4.8%).
Solutions and Interventions
The National Cancer Institute emphasizes that addressing cancer care disparities involves expanding accessible cancer screening programs and investigating biological differences in breast cancer among racial and ethnic groups. A 2019 study revealed that cities with improved access to advanced mammography facilities achieved progress in narrowing the mortality gap between Black and white women.
Recent findings from BCRF’s Health Equity Initiative, supported by The Estée Lauder Companies Charitable Foundation, underline the importance of regular mammograms and addressing socioeconomic barriers. Black women who missed regular mammograms were three times more likely to be diagnosed at later stages (stages 3 or 4). Similarly, those living below the poverty line had nearly double the risk of late-stage diagnosis.
“This study is a major step forward in helping us unravel the key causes underpinning disparities in breast cancer outcomes,” said Dr. Dorraya El-Ashry, BCRF’s Chief Scientific Officer.
Research and Global Efforts
Ongoing research is critical to closing these gaps. BCRF investigators are studying tumor biology, genetic differences, and social determinants of health to develop targeted interventions. For instance, Dr. Fergus Couch’s research identified rare genetic mutations in Black women associated with increased risks of TNBC and estrogen receptor–negative breast cancer. Meanwhile, Dr. Lisa Newman is creating platforms to engage Black physicians in research to address racial disparities.
Globally, efforts to reduce breast cancer deaths in underserved areas are underway. Drs. Lawrence Shulman and Cyprien Shyirambere are integrating early detection services into Rwanda’s healthcare system. Dr. Olufunmilayo Olopade’s work in Nigeria and sub-Saharan Africa aims to improve diagnostic tools, standard-of-care treatments, and clinical trial infrastructure.
Moving Forward
With initiatives like The Estée Lauder Companies’ $15 million donation to BCRF’s Health Equity Initiative, there is renewed focus on understanding and addressing breast cancer disparities. Expanding research participation among Black women and targeting systemic barriers are vital steps toward ensuring equitable outcomes for all women diagnosed with breast cancer. Source: BCRF
