A new perspective by researchers from the American Cancer Society (ACS) and the University of Texas Health Science Center at San Antonio shows the high burden of breast cancer mortality in African American (Black) women versus White women began in the United States in the 1980’s. At that time, breast cancer screening (mammography) and treatments (adjuvant post-surgery hormonal therapy) were disseminated widely in the United States, but unequally among Black and White women. The high rate of breast cancer mortality in Black women than in White women is a reversal from before 1980, when Black women had lower breast cancer mortality. The report was published today in the New England Journal of Medicine.

Black women continue to have a disproportionate high burden of breast cancer mortality largely because of lack of health insurance and other socioeconomic barriers that limit access to high-quality care. To break down disparities in cancer outcomes, it is crucial to increase access to care for underserved populations and develop mechanisms to reverse course, from requirements for increased diversity in clinical trials to health system financial incentives for equitable care.”

Dr. Ahmedin Jemal, senior vice president, surveillance & health equity science at the American Cancer Society and senior author of the study

Study authors calculated breast cancer incidence and death rates according to hormone receptor (HR) status (HR-positive cancers that can be detected early and treated more successfully and HR-negative cancers that are less likely to be detected early and treated successfully). They found that Black women compared to non-Hispanic White women have a 19% higher mortality rate for HR-positive breast cancer types, despite having a 22% lower incidence rate. This finding dispels the notion that Black women have higher breast cancer death rates than White women largely because they are diagnosed with aggressive types of breast cancer, added Jemal.

Further, the authors found that the Black women compared to non-Hispanic White women have a 123% higher mortality rate for HR-negative breast cancer, despite having a 65% higher incidence rate. “Cancer disparities in the Black community result from a myriad of causes rooted in institutional inequities,” said Jemal. “We must address structural racism as a public health issue to close the gaps, advance health equity, and ensure Black women get the screening and treatment they need and deserve.”

Dr. Hyuna Sung is co-author of the study. Dr. Ismail Jatoi, from the University of Texas Health Science Center at San Antonio, is lead author of the research.cer.org.