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News / Health / Breast Cancer

Breast cancer outcomes for women of color fall short

Experts say implicit bias influences quality of care

By Chrissy Booker, Columbian staff writer
Published: October 7, 2023, 5:00am

Breast cancer deaths have fallen in the United States — except among women of color.

According to the American Cancer Society, breast cancer deaths dropped 43 percent or 460,000 from 1989 to 2020. Early detection protocols, genetic testing and social awareness have significantly improved breast cancer survival. Unfortunately, these gains have not extended to women of color.

Dr. Nathalie Johnson, a surgical oncologist at Legacy Health who is Black, has witnessed how breast cancer distinctly affects women of color. Her research assesses how implicit bias influences the level of care women of color receive.

“People go into medicine because they want to take good care of people, but it’s an unrecognized implicit bias that makes it so they don’t offer the same level of care,” Johnson said. “They don’t spend as much time explaining and so then there’s no trust from the patient.”

Breast cancer is the leading cause of cancer-related death in the United States for Black and Hispanic women. Indigenous women are 10 percent more likely to die from it than non-Hispanic white women.

While Black women are less likely to develop breast cancer than white women, they are 40 percent more likely to die from it due to racial, environmental and sociological factors that exist in their communities and the health care industry, according to the Centers for Disease Control and Prevention.

About 1 in 5 Black women is diagnosed with aggressive and deadly triple-negative breast cancer, more than any other racial or ethnic group. (This subtype of breast cancer gets its name from the fact the cancer cells don’t have estrogen or progesterone receptors and don’t make a protein called HER2.)

“Grade 1 tumors are usually the better behaved tumors, whereas higher grade tumors tend to be more aggressive. And Black women do tend to have higher grade tumors. That goes along with having more aggressive cancer and then worse outcomes,” Johnson explained. “If we did a better job of genetic testing and provided screening to people who were carrying that mutation, then we’d find it when it’s small, and then we can cure it more easily.”

While some of the disparities in cancer mortality may be due to genetics, structural and systemic racism also plays a role.

According to an article from Health Care Finance Review in 2000, “the larger literature on societal discrimination suggests that, although racism has changed over time from a blatant ‘Jim Crow racism’ to a more subtle ‘laissez faire racism,’ it persists in contemporary America. As painful as it may be to acknowledge, we must begin with the recognition that discrimination is routine and commonplace in society and likely to be similarly prevalent in medicine.”

Geographical factors also play a role in these outcomes. Redlining, a discriminatory practice that excluded Black communities from receiving bank loans, means that women of color, particularly Black women, were relegated to neighborhoods that did not have accessible health care options.

According to researchers from the Medical College of Wisconsin, “among 27,516 women with breast cancer, those residing in more heavily redlined areas experienced worse survival based on both all-cause and breast cancer specific mortality, after controlling for disease and demographic factors.”

Johnson concurred.

“Because communities of color are very often communities that are not as well funded and supported, many times it’s a long way to get to some of the higher levels of care,” she said. “What’s in your community may not be as specialized, and so you may not have access to some of the higher levels of care. Transportation and geography all contribute to worse outcomes. These situations are blatant effects of systemic racism in the United States.”

Connect with support groups

Pink Lemonade Zest: Targeted at young women with breast cancer. Meets via Zoom 6-8 p.m. on the third Tuesday of each month. Find information at www.pinklemonadeproject.org/others-who-can-help

Pink Lemonade Limoncello: For all breast cancer patients. Meets via Zoom 6-8 p.m. on the first Thursday of each month. Find information at www.pinklemonadeproject.org/others-who-can-help

Legacy Health Breast Cancer Support Group: For all breast cancer patients. Meets via Zoom 5:30−7 p.m. on the first Tuesday of each month. Contact Sara Butler at 503-413-7932 or Margaret Hartsook at 503-413-8404.

Compass Oncology Women’s Cancer Support Group: For all women cancer survivors. Meets via Zoom from 5-6:30 p.m. on the second Monday of each month. Contact Virginia Hill at 503-528-5212 or virginia.hill@compassoncology.com.

Grupo de Apoyo - Cáncer de Mama: For Spanish-speaking breast cancer patients. Meets via Zoom 6-7 p.m. on the second Tuesday of each month. Contact Erika Ramirez at 971-331-1762 or ERamirez@nwfs.org.

Oregon Cancer Foundation Breast Cancer Support Group: All are welcome. Meets via Zoom 6-7:30 p.m. on the second Wednesday of each month. Call 541-632-3654 or email info@oregoncancerfoundation.org.

—Chrissy Booker

Another factor that contributes to this disparity is the fact women of color often lack access to health insurance that would drastically decrease the cost of treatment. The cost of breast cancer treatment runs from $48,000 to $100,000. Researchers suggest that patients carrying the burden of higher treatment costs are more likely to experience bankruptcy and financial stress that decreases quality of life.

Racial bias from health care professionals has been proven detrimental to the level of care women of color receive in general. A study examining racial bias in medicine found that differential treatment stems in part from the historical belief that Black and Hispanic people are more tolerant to pain.

So what is the first step toward eradicating the mistreatment of women of color in health care? Johnson believes it begins with addressing the implicit biases we hold about marginalized communities.

“We are doing a better job now with residents, medical students and nurses, as they’re learning to recognize implicit bias,” she said. “I think it’s a continuum. We’re all learning together. But if we start at the beginning with those who are just coming into the field, then over time we can evolve to be better.”