Breast cancer disparities: why do black women have worse breast cancer outcomes?
Breast cancer disparities: why do black women have worse breast cancer outcomes?
by Breast cancer awareness month of October, tennis star Serena Williams was topless in a music video, singing the song "I Touch Myself" while covering her breasts with her hands. It was all to remind women of the importance of regular breast exams and to be aware of any changes.
"Yes, this took me out of my comfort zone" Williams, 37, wrote on Instagram.. "But I wanted to do it because it's a problem that affects all women of all colors, all over the world."
Actually, breast cancer It disproportionately affects some groups in the United States more than others. Black women are now 42 percent more likely to die for their breast cancer than white women, according to one Report of the Breast Cancer Research Foundation.
Despite similar incidences of breast cancer among black and white women in the US UU., Black women often suffer from the disease at younger ages and are more likely to die from their disease at all ages. This disparity was recognized for the first time thirty years ago in the statistics of the national cancer institute, and it is one that persists today.
In September, the American Association for Cancer Research launched its Cancer progress report highlighting the ongoing challenge of the disparities faced in cancer care. Despite the new advances in early detection and therapy, and with a general decrease in cancer deaths by 39 percent In the 26 years prior to 2015, it is surprising that some American women do not do as well as others in terms of breast cancer outcomes. What exactly explains these differences?
Like many important questions in medicine, the answer is complex. Some of these factors may be genetically driven, and many of them may be related to larger social and structural institutions. Here we break down the main factors.
Possible differences in cancer biology.
As Williams points out and as often happens with all cancers, the sooner breast cancer is detected, the better. This is based on the understanding that contracting a cancer when it is localized (only in the breast), before it has had the opportunity to spread, leads to much better results. For example, the treatment of localized disease has a 99 percent survival rate five years after diagnosis, compared to only 27 percent in metastatic and distant forms of the disease.
This idea in itself may not be surprising, but the surprising thing is that black women have Low incidence of localized disease. than white women, even though black women have Comparable rates of breast cancer Screening by mammography. Although some believe that the data overestimate the rates of mammography in minorities and especially in the elderly, people are looking for other explanations for these differences beyond detection.
A thought about why black women may have worse breast cancer outcomes is rooted in a difference in genes. Although breast cancer is seen as a disease, there are many subtypes. Scientists are improving recognition through genetic screening, what type of cancer a woman has, and each of these subtypes probably has different risks and different outcomes. They also respond differently to therapy.
Scientists are trying to carefully observe the different genetic makeup of cancer cells to understand if biology is at stake to determine the different outcomes in American communities. While the genetic evaluation of cancers is in its infancy, there are some things we already know. It is well documented that Black women are much more likely than white women. Have triple negative breast cancer. This is a type of cancer that does not respond to three of the most common hormones that generally cause mammary cells to grow (estrogen, progesterone, and human epidermal growth factor) and is notoriously more aggressive and difficult to treat.
However, the link between the genes, the environment and the disease is complicated and is often a game of the hen or the egg. It has been shown that a number of risk factors, such as diet, socioeconomic status, body mass index and pregnancy history, also affect the incidence and outcomes of breast cancer, leading some to wonder if these factors play in turn in genetics.
But the fact that racial disparities can be mapped geographically in communities that are known to be poorer and more segregated has meant that differences in cancer outcomes can not be attributed to molecules alone.
Structural systems in play.
Understanding the disparities of breast cancer in the United States requires an appreciation of the great structural inequalities that exist and their far-reaching effects, from the different health care behaviors to the access of health care to the burden of the disease. disease.
Racial inequalities at the social level have shaped systems in huge ways. Access to safe housing, transportation, quality education and jobs, as well as the availability of fresh fruits and vegetables, are elements of daily life that stretch along racial and economic lines in the United States.
Poverty can bring with it a series of poor health outcomes and diseases, including obesity, that can negatively influence a woman's breast cancer outlook. Studies have shown that economic status accounts for much of the disparities in breast cancer outcomes. Black women suffering from breast cancer are More likely to have other medical conditions, which can complicate your illness.
Reduced socioeconomic status has also been associated with a lower rate of receiving recommended chemotherapy and radiation. This may be due to lack of access to care, for example, due to health insurance or lack of transportation. States and cities that have made improvements in insurance coverage have seen a Reduction of breast cancer disparities between white and black women..
In recent decades, fewer studies have been done in breast cancer research in black women. Even now, minority communities are least likely participate in cancer trials that will shape future treatment approaches.
Where to go from here
The first step to address the problem is to recognize that disparate results between breeds are a problem in the US. UU Doctors, scientists and national agencies are now committed to discussing and eliminating disparities in breast cancer outcomes.
The reasons why breast cancer disproportionately affects black women in the US UU They rest in a complicated intersection between genetic and social factors. More research and attention should bring nuanced interventions from multiple angles, including ongoing research on gene therapies and research on how social forces continue to shape health outcomes.
Amisha Ahuja is a resident of internal medicine at the Thomas Jefferson University Hospital and a contributor to the ABC News Medical Unit.
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