Black women are 40% more likely to die from breast cancer than white women. Black women are also more likely to be diagnosed at a later stage or younger age. Death rates for white women with breast cancer are improving more rapidly than for Black women, according to the American Cancer Society.
A new study finds that, in order to reduce racial disparities in breast cancer death rates, Black women should be screened for breast cancer earlier than white women and those of other races. The new research, published in JAMA Network Open, looked at breast cancer deaths in 415,277 U.S. female patients between 2011 and 2020. Based in the risk of dying of breast cancer for each racial group, the researchers concluded that Black women should be screened starting at age 42.
White women should start breast cancer screening at 51, American Indian, Alaska Native and Hispanic women at 57, and Asian and Pacific Islander women at 61.
The current breast cancer screening guidelines from the American Cancer Society advise that women with average risk (no personal or close family history and no genetic mutation that increases breast cancer risk) get a mammogram every year between the ages of 45 and 54, and starting at 55 can decrease to every other year; from ages 40 to 44, women with average risk should have the option for a yearly mammogram.
"We believe that when fairness and optimization of resource allocation to reduce (breast cancer) mortality is the aim of (breast cancer) screening, health policy makers should pursue equity not just equality," the study authors wrote. "Equality in the context of BC screening means that everyone is screened from the same age regardless of risk level. On the other hand, equity or risk-adapted screening means that everyone is provided screening according to their individual risk level."
'A complete shock'
The day before she turned 30 and had planned to leave for a celebratory vacation, Sharonda Vincent felt a lump on her left breast while in the shower. She scheduled a last-minute appointment with a doctor at Planned Parenthood, who told her to enjoy her trip because she doubted it was cancerous.
After Vincent returned home to Philadelphia, the mother of one decided to see her primary care provider, just in case. This led to a series of tests, including a mammogram, ultrasound and biopsy. In the summer of 2005, she was diagnosed with stage 2B breast cancer.
"I was numb, hurt, confused, upset, questioning God," she told TODAY. "It was a complete shock."
Vincent, now 47, has been cancer-free for over 17 years, thanks to the surgery, chemo and radiation she underwent that summer. She's among the millions of Black women who've survived breast cancer, even though the odds are unjustly stacked against them.
Research into the reason for these disparities is ongoing, but it's likely "multifactorial," Dr. Vivian Bea, chief of breast surgical oncology at NewYork-Presbyterian Brooklyn Methodist Hospital and assistant professor of surgery at Weill Cornell Medicine, told TODAY.
What's more, drops in cancer screenings, delays in care and other aspects of the COVID-19 pandemic have worsened the health disparities that Black women with breast cancer face, according to a 2021 report from American Society of Clinical Oncologists.
A doctor who looks like you
As a physician and Black woman, Bea believes that a main inhibitor for the Black community to seeking health care is the absence of doctors who can relate to their life experiences. Only 5% of U.S. doctors are Black, and even fewer are Black women, per 2018 data.
"When I take care of my Black patients ... I can't tell you how often I hear, 'I trust you because you look like me,'" she said. "I hear stories of, 'I talked to this doctor, and I told them I had a mass, and they told me it was nothing,' or, 'I had a pain, and they said it was in my head.' Unfortunately (Black) women are sometimes not taken seriously."
While Vincent doesn't feel her care team approached her differently because of her race, she said she leaned heavily on the only Black medical professional she encountered during her treatment.
In Vincent's initial appointments, she recalled, staff struggled to draw her blood, and she had to be pricked by multiple techs each time, especially uncomfortable given her fear of needles. So the Black medical assistant planned her future visits so the one tech who could draw Vincent's blood on the first try was always available.
"She made it a point to really get close to me," Vincent said. "It was almost like she rode this journey with me. She wanted to make sure I felt comfortable in the office. ... It made a big difference."
Suffering in silence
Shortly after Vincent was diagnosed, she found out her grandmother was going through radiation, the last leg of her own breast cancer treatment, but had never told anyone before.
"As close as we are, my grandmother didn't want to make it too known, so when she learned of my diagnosis, she felt she needed to be that shoulder for me," Vincent recalled. "We shared stories, and I actually used her surgeon."
Vincent suspects that her grandmother's approach is common among Black women. "People in Black families probably feel like, 'We have so much other stuff to worry about, let's not bog the family down with this news,'" she said.
Bea pointed out that she often hears Black women say, "I never had cancer in my family, so I'll never get breast cancer," but that's "totally not true," she stressed.
Karla Baptiste, 49, who was diagnosed with breast cancer 15 years ago, didn't have a family history of breast cancer, but when she noticed a rash on her left breast, she decided to do some investigating.
"I thought (it) was weird because I've never had a rash on my breast before," she told TODAY. "So I went to the restroom and applied some cortisone cream and I felt a large mass."
After a mammogram and ultrasound, doctors told her she had an invasive ductal carcinoma — the most common type of breast cancer, which starts in the milk duct — that they thought was stage 2. But it was actually stage 3A.
"The tumor was larger than they thought, and it was in 14 out of 24 of my lymph nodes," Baptiste recalled.
With treatment, including radiation and 16 weeks of chemotherapy, she was able to be cancer-free for seven years — until she started having back spasms, low blood pressure and shortness of breath, all signs her cancer had moved to her spine and was stage 4.
"I cried because I was so frustrated because I kept saying something's not right. And I was just given this, 'No, you're fine, you're just working out too hard,'" she said. "Always trust your instincts, always."
Her cancer later came back a third and fourth time, but today, she's still cancer-free.
Tracy Tomer, diagnosed with stage 3A breast cancer in January 2020, told TODAY that hearing from other Black women in her Brooklyn neighborhood that they had breast cancer was a revelation of sorts.
"We never know what other people are going through until we sometimes are going through things ourselves," Tomer, 55, said. "In my community, I don't know if women talk to one another ... but when you start confiding in people, you find out what's going on with others. ... I never knew so many Black women were dealing with breast cancer. You start to think, well, what's going on in the community?"
Accessing quality care
Asked what aspects of the health care system she'd want to improve to better support Black breast cancer patients, Bea called out the lower quality of care that Black women often receive.
"The first step is making sure all providers who see any woman understand the standard of care that they deserve," she said. "What's the age that they should get a mammogram? Who should they be sent to? The answer is a specialist where they're treated in a multidisciplinary fashion, not your buddy down the street."
As Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Center in New York City and advisor to the cancer information platform SurvivorNet, explained it, "It's not just how quickly you get to a doctor, but are you getting to a doctor that knows how to treat your disease correctly?"
Comen also pointed out that Black people aren’t adequately represented in breast cancer research, which limits the quality of their care. In 2019, Black participants comprised only 4% of clinical trial subjects for oncology drugs that were later approved. She added that "physicians need to be sensitive to historical racism" in the medical profession, in particular experimentation on Black bodies, and "how that plays into fears about clinical trials."
"A Black woman might come to me and say ... 'If you want to give me the new drugs, in a clinical trial how many Black women were treated by it?'" Comen explained. "In some instances, different ethnicities can have different side effects."
Baptiste is committed to fighting these care disparities through her memoir, "Dig in Your Heels," and her work as vice president of the Dallas chapter of the Sisters Network, a national organization of Black breast cancer survivors. The group helps un- and under-insured individuals pay for mammograms and other screenings.
In Baptiste's opinion, one of the reasons Black women are diagnosed at younger ages and later stages than other races is a fear of what will come after a breast cancer diagnosis. To combat this mindset, Baptiste has also shared her story of trusting her instincts when her cancer returned as part of Pfizer's Get It Done initiative, which promotes cancer screenings and follow-ups.
"I just wanted to present like cancer doesn't have to be a period, I always say it can be a comma," Baptiste said. "You think your life is over. So I just wanted to show life does go on."
Black breasts matter
Vincent, Bea and Tomer all said that Black women tend to put other people's problems above their own — and that's why Vincent and Tomer hope talking about their diagnoses will encourage fellow Black women to prioritize their own health.
"We have a tendency (to think), 'Oh, it went away so I'm not going to worry about it,'" Tomer said, recalling the stinging sensation she felt in her breast two months before seeing a doctor. "I was like, 'I'll take care of everybody else. I'll be all right.'"
Bea added: "Black women's lives matter. They need to know that, and oftentimes they don't feel that way. ... Black breasts matter."
She went on to stress the importance of Black women seeing a health care provider if they notice any changes in their breasts, such as masses, nipple discharge, skin changes or swelling.
"Don't take no for an answer if you feel within your soul that something is wrong," Bea said.