More Needed on Black Women and Breast Cancer

Pamela Merritt

Recent studies have discovered a dramatic decline in breast cancer incidence resulting from a reduction in the use of hormone replacement therapy. It's good news -- except that it's not true for African-American women.

Last year I watched an excited medical reporter announce during the evening newscast that researchers had found a dramatic decline in breast cancer incidence resulting from a reduction in the use of hormone replacement therapy. By the time the report was over I was as excited as the reporter. Positive news about a proven way to reduce the risk of breast cancer is always welcome.

I immediately thought about the women in my family, so I sent out an e-mail blast with the information and my advice that my aunts have a chat with their doctor. I just assumed that all women were subject to the risks of hormone replacement therapy and that all women would be candidates for a reduction in risk by not taking that treatment option.

I was wrong. A recent study reports that stopping hormone replacement therapy does not reduce the risk of breast cancer for African American women. Researchers from the University of Chicago Medical Center found that the decline in breast cancer rates in American women over the age of 50 during 2002 and 2003 was limited to Caucasian women. Figuring out what that means and what to do with that information isn't easy. Breast cancer is complex and a person's background factors in to their individual risk. Understanding how breast cancer affects different populations is key to lowering risk, increasing early detection and survival. So we should welcome new research that highlights the different ways breast cancer affects African American women.

Last year Science Daily reported on a Kimmel Cancer Center at Jefferson in Philadelphia study that found that African American women are diagnosed with breast cancer later than Caucasian women and, when diagnosed, often have a more aggressive type of breast cancer and a poorer prognosis. African American women have a lower incidence of breast cancer than Caucasian women, but are more likely to die as a result of the disease and that gap is widening. Research points to a lack of access to healthcare being a strong factor contributing to disparities in both rates and outcomes, but biology also plays a key role.

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Earlier this year, Science Daily reported that researchers are looking into whether breast cancer rates in African American women are connected to the conditions in our neighborhoods. Researchers at the University of Chicago are exploring the possible connection between disadvantaged communities and early onset breast cancer. Beyond the lack of access to affordable and dependable healthcare there is also the stress of struggling to survive in disadvantaged neighborhoods and dealing with crime, depression and lack of nutritional options. Researchers hope to be able to assist policy makers in developing plans that will address these factors and thus reduce risk.

And now there is the recent news that stopping hormone replacement therapy did not reduce the risk of breast cancer for African American women. A deeper look finds that the lack of decline may be related to the fact that African American women are less likely to use hormone replacement therapy so they didn't suffer the increased risk associated with HRT nor did they benefit from the stopping the treatment. Biology also plays a key role as close to 80 percent of breast cancers in Caucasian women are estrogen receptor positive and depend on estrogen to grow while only 60 percent were found to be estrogen receptor positive in African American women. This study is not a green light for African American women to resume hormone replacement therapy and all women should discuss treatment options and risks with their doctor.

All of these studies point to the need for increased breast cancer awareness in the African American community. We need to share information about early detection and screening options. We need to protect and defend clinics that are often the only source of well-woman health screenings for low-income women of color even as we support increased access to affordable healthcare for all. We need to educate ourselves and our communities and friends about the specific and unique risk factors associated with breast cancer and African American women.

The medical community should also use the results of these studies to examine how they are conducting research. Biology plays a role and researchers need to be mindful of the race and ethnicity of their subjects and avoid making conclusions about all women when there may be radically different result for certain populations. Funding for population specific research is needed so that researchers can accurately tackle complex medical mysteries rather than resort to a one size fits all strategy that may leave women of color out in the cold.

This news should inspire us to renew our commitment to promote early detection, access to treatment and to eventually find a cure for breast cancer. Because I want to see my fellow women of color join in the survivor procession at the next Race for the Cure.

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