Breast Cancer

Recently, the mother of a good friend of mine lost her five-year battle with breast cancer. The battle had had its many ups and downs, and at one point it seemed as though she might actually be winning when the cancer went into remission for several months. But, unfortunately, it reemerged, and the last of the fight was more one against the pain and the ravages of the disease than against the disease itself, which, by that time, had spread through her body. In those last days, she suffered much before mercifully slipping into a semi-coma. When my friend called to let me know that her mother had finally died, the pain in her voice brought into clarity the fact that we as Black women are waging yet another war, in addition to all the other medical wars we are already fighting.

Before my friend’s mother’s passing, I had assumed that enough had been written and reported about breast cancer and that another article would be superfluous. I was only slightly disturbed when my own aunt was diagnosed with a cancerous breast tumor several years ago (luckily, it was discovered early and all she had to undergo was a lumpectomy), thinking that a diagnosis of breast cancer was no longer an automatic death sentence. In my blasé attitude, I was definitely naïve. The first strategem in any fight is knowing what you are fighting against. And in doing basic research, I found that we as Black women are uniquely vulnerable to this disease.

The statistics for Black women are particularly disturbing. Even though we are less likely than our White counterparts to contract breast cancer, we are more likely to die from it when do get it. According to the American Cancer Society, the five-year survival rate for Black women with breast cancer is 70%, while for White women, it is 85%. The whys of this disparity had doctors scratching their heads in puzzlement for years. Initially, the medical community attributed our lower survival rates to socioeconomic factors, believing that Black women had less access to quality medical care. And then the blame-the-victim explanations were touted, with doctors believing that many of us were not taking care of ourselves and were not diligently seeking preventive care.

Not to say that there aren’t many of us guilty of not taking the basic precautions, such as annual mammogram exams or, at the least, constant self-exams. For lower-income women who do not have medical coverage, getting screened may be cost-prohibitive, and clinics offering free exams may not be accessible to them. Then some women lack the requisite education about breast cancer, so when prioritizing their personal health concerns, these women may consider breast cancer a remote danger when compared to the more pervasive diseases suffered by the African-American community, such as hypertension and diabetes. Lastly, there is the everpresent issue of medical racism, where medical practitioners are less concerned with the care and treatment of Black women, and do not give them the same quality of care they might give their White counterparts. All of the above put Black women at risk of late diagnosis and treatment.

But even taking the afore-mentioned factors into account, the disparity between the survival rates was still not fully explained until a few years ago. Researchers at George Washington University Hospital, in an attempt to discover why Black women had lower survival rates of breast cancer, came across a disquieting find: the cancer found in Black women is much more aggressive than that found in White women and, therefore, harder to combat. Dr. Robert Siegel, director of the university’s cancer center at the time of the study, reported that the cancer found in Black women grew faster, contained more malignant cells and did not respond as well to hormone treatments than that found in White women. Thus, Black women are less likely to respond to treatment and are more likely to succumb to the disease.

Right now, there is no agreed upon explanation for this biological variance. Siegel suspects that it may have something to do with the basic African-American diet, with its high concentrations of salt, fat and sugar. But whatever the reason, the inherent danger in this variance is that Black women may be at a disadvantage when it comes to recommended preventive strategies, screening schedules and treatment options. Currently, the recommended screening schedule is for women over the age of 49 to start getting annual mammograms (both my friend’s mother and my aunt were over 50 when they were first diagnosed). Whereas, this may be a satisfactory dictum for other racial groups, it may not be enough to prevent the disease in Black women. One possible option is that the screening guidelines for Black women be changed to recommend mammographies at earlier ages, even as young as 30.

Because of the growing death rate of Black women from breast cancer, a symposium of physicians, public health officials and consumer advocacy groups met together for the first time in September of last year to discuss the importance of increased Black participation in clinical trials for breast cancer. The symposium was sponsored by the Magic Johnson Foundation, the National Medical Association, Merrill Lynch/the August Group, the Breast Cancer Resource Committee, and Astra Zeneca Pharmaceuticals and was the largest to date of groups coming together to discuss the need for improved education, screening and prevention treatment and research in the Black community.

The Magic Johnson Foundation (MJF) particularly stressed the need to include more Black women in clinical trial research. In conjunction with the National Breast Cancer Awareness Initiative, MJF is setting a three-year goal to help women in urban communities obtain breast cancer education, screening and treatment services. Hopefully, this will get the word and help out to those who are at risk.

The main emphasis to combatting breast cancer rates in Black women is education and early diagnosis. Preventive care goes a long way in increasing the survival rate. Unfortunately, for whatever reasons, Black women are more likely to have later diagnoses where the disease has already spread throughout the body. This late-stage cancer is always harder to combat. Add to it the complication of an overly aggressive tumor and the prognosis becomes drearier.

Knowledge is the key strategem in this fight. Debbie Allen recently hosted a television special called To My Sisters…A Gift for Life that examined the problem of breast cancer in the African-American community. The show presented interviews with medical professionals, profiles of breast cancer survivors, and words of encouragement and advice from several African-American celebrities. The video-tape is available and can be ordered on-site at biotechnical.com.

For more information on Black women and breast cancer, contact the National Black Women’s Health Project at (202) 835-0117, or visit the website of the National Alliance of Breast Cancer Organizations www.nabco.org or call them at (212) 889-0606. For a quick question-answer session, go to the Breast Cancer in Women of Color website.

Hopefully, one day we will win the fight against breast cancer. But until then, we need to be well armed with knowledge and diligence.