Breast Cancer in Black Women: Symptoms, Types, and Prognosis

Finding a lump in your breast can be terrifying. Whether it is discovered during a routine physical, self-exam, or incidentally when you’re putting on deodorant, it’s understandable that you might imagine the worst when you notice something in your body that should not be there.

Fortunately, most breast lumps are noncancerous. There are many more common and benign conditions that cause lumps in the breast, including collections of fluid, deposits of fat, and deposits of calcium.

Greater awareness has eased tensions for some, but for many Black women, simply being more aware of the potential outcomes does little to address their fears.

This article specifically addresses the effect of breast cancer on Black women.

Black Women and Breast Cancer: The Facts

Previously, Black women were found to have a slightly lower incidence rate of breast cancer than White women, but the gap has closed and the medical community is not sure why. What’s most striking is that the mortality rates between the two are markedly different, with Black women having a 40% higher likelihood of dying from breast cancer than women of other races.

For women under 50, the disparity is even greater: The mortality rate among young Black women is double that of young White women. One reason could be the higher likelihood of triple-negative breast cancer, an aggressive and treatment-resistant subtype, in Black women.

The HR+/HER2- subtype makes up more than half of all breast cancer cases in Black women. They also experience an increased risk of breast cancer-related death among those diagnosed with stage 2-3 HR+/HER2-.

Another contributor is delayed diagnosis and treatment, which is the result of persistent socioeconomic gaps and lack of access to quality care for Black women.

Despite advances in treatment that have dramatically reduced breast cancer mortality, the positive effects have not equally benefited all groups.

Types of Breast Cancer

The term used to describe precursor breast cancer is ductal carcinoma in situ (DCIS). DCIS means the cells that line the milk ducts have become cancerous, but those cells have not yet invaded the surrounding tissues. DCIS is often discovered on mammograms.

Two types of invasive breast cancer disproportionately impact Black women: triple-negative breast cancer (a rare, aggressive, treatment-resistant form) and inflammatory breast cancer (IBC). 

Triple-Negative Breast Cancer

Most breast cancers are carcinomas, which means that the cancer cells are derived from the epithelial cells that line the milk ducts or glands of the breast.

Breast cancers are further classified by the presence or absence of hormone receptors (hormone receptor status).

If hormone receptors—such as estrogen and progesterone—are present, then cancer can be treated with hormone-modulating medications. If those receptors are not present, cancer is much more difficult to treat.

Black women are more likely to be diagnosed with triple-negative breast cancer, which can be harder to treat and is more likely to come back than other forms of breast cancers.

Approximately 19% of breast cancers diagnosed in Black women are HR-negative and HER2-negative (triple-negative) compared to 11% in Latinx, 9% in Whites, 6% in Asian/Pacific Islander (API), and 5% in American Indian/Alaska Native (AIAN) groups.

Researchers have been trying to figure out why triple-negative cancer is more common in young Black women. Breast cancer is also more aggressive in Black women younger than 45.

Research shows that Black women may have a higher risk of hormone-receptor-negative breast cancer if they:

Inflammatory Breast Cancer

Inflammatory breast cancer is a rare, highly aggressive invasive breast cancer. IBC only accounts for 1% to 5% of all breast cancers, but Black women are 70% more likely to have IBC.

Dimpling of the skin, which is sometimes called peau d’orange (French for “the skin of an orange”), is a classic sign of inflammatory breast cancer. IBC develops rapidly, blocking lymphatic vessels in the breast, resulting in red, swollen, and tender breasts.

Statistics show that the five-year survival rate for Black women with IBC is lower than it is for White women regardless of the cancer’s hormone receptor status and the patient’s age.

More research is needed to understand the factors behind the racial disparities, but biological and genetic differences, delays in diagnosis and treatment, the standard of care Black patients receive, and environmental factors likely all play a role.

Less Common Types of Breast Cancer

Some breast cancers are not carcinomas. These cancers are less common and often need nonstandard treatment. These other, less common types of breast cancer include:

• Paget disease of the breast: This rare cancer can also affect the areola of the nipple and accounts for 1% to 3% of breast cancers.
• Angiosarcoma: This accounts for less than 1% of breast cancers.
• Phyllodes tumor: These benign masses can become cancerous. Unlike other invasive breast cancers that arise in the epithelial cells, phyllodes tumors begin in the stroma (outer connective tissue of the breast).

Breast Cancer Symptoms in Black Women

Breast cancer usually does not have any symptoms in its early stages when the tumor is small and hard to notice. This stage is also when breast cancer will be easiest to treat, which is why screening mammograms are important.

Black women with breast cancer may first notice a painless lump in their breast. Lumps are usually not cancer (benign) and can be a common occurrence. However, if you notice a lump in your breast that feels unusual, it’s something you will want to discuss with your doctor as soon as possible.

Some changes to your breast tissue can be a sign of cancer and are something that you should not ignore. These include:

• New lump in the breast or underarm (armpit)
• Thickening or swelling of part of the breast
• Irritation or dimpling of breast skin
• Redness or flaky skin in the nipple area or the breast
• Pulling in of the nipple or pain in the nipple area
• Nipple discharge other than breast milk, including blood
• Change in the size or the shape of the breast
• Pain in any area of the breast

If breast cancer runs in your family or you have other risk factors, finding a lump is going to be scary and you might think the worst. However, there are many other causes of breast lumps that are not cancer.

Other uncommon breast cancer symptoms to look for include:

• Dimpling: Skin that begins to resemble an orange peel can be a sign that a tumor is developing underneath.
• Breast puckering: If you develop an indentation of the breasts when your arm is up that retracts when you put your arm down, you may have breast puckering, a sometimes subtle sign of breast cancer.
• Swelling, redness, or darkening of the breast: Inflammatory breast cancer is an aggressive form of breast cancer that can present with symptoms that mimic an infection. Black women are 70% more likely to develop IBC than White women. If you experience painful swelling or redness in the breast, contact a doctor immediately to avoid life-threatening complications.
• Change in size or shape: Uneven breasts and changes in breast size are natural, but rapid changes in shape and size may be an early warning sign of breast cancer.
• An itchy, scaly rash on the nipple: An itchy nipple can resemble eczema, but if you have never had eczema in the past, do not assume that it has developed all of a sudden.
• Breast pain after menopause: Breast pain after menopause is rare, but it may be an early sign of breast cancer. 

Causes

People with breast cancer have certain changes in their DNA, but that’s not the only factor that causes breast cancer. No one knows exactly why breast cancer happens, but there are known risk factors, including:

• Genetic mutations (most notably BRCA 1 and BRCA 2 mutations)
• Family history of breast cancer
• Reproductive history that includes early periods (before 12 years old) or late menopause (after 55)
• Breasts with higher amounts of connective tissue compared to fat (dense breasts) which can mask cancers
• Personal history of breast cancer
• Exposure to radiation (including radiation therapy for another condition, like Hodgkin’s lymphoma)
• Taking some forms of hormone replacement therapy for five or more years
• Taking the drug diethylstilbestrol (which was given to some pregnant women in the United States between 1940 and 1971 to prevent miscarriage)
• Smoking
• Heavy alcohol use
• Overweight or obesity (especially after menopause)
• Sedentary lifestyle
• Older age

Certain risk factors like smoking, being overweight or obese, and alcohol use are preventable, while others like older age, reproductive history, and genetics are out of your control.

The reasons for the rise are complex, but the significant disparities between mortality rates for White and Black women are striking. The mortality rate for Black women diagnosed with breast cancer is 42% higher than that for White women.

While higher triple-negative rates provide some explanation, new research has shown that hazardous work environments, chronic stress, and biological differences contribute to these disparities in meaningful ways.

One area of interest is stricter regulation of the ingredients used in cosmetic products. Some preliminary research has shown that there might be a link between these often unregulated products and rising cancer rates in Black women. The marketing campaigns behind many of these harmful products often target Black women.

Effect on Black Women

Some studies have found that the number of new breast cancer cases per year is lower in Black populations than in White populations, while others have shown that the numbers are about equal. No matter the case, the mortality rates for Black women far exceed those for White women.

According to the CDC, from 2005-2009 Black women had a 41% higher breast cancer death rate and were more likely to be diagnosed at regional or distant cancer stages compared to White women (45% vs. 35%, respectively).

The burden of breast cancer in Black communities exists at each phase in the complex breast cancer care trajectory—from screening and follow-up of abnormal findings, to treatment initiation and completion. These disparities are fueled and compounded by the racial wealth gap, which leads to frustrating delays in receipt of diagnosis and treatment.

The few studies that have assessed the racial disparities in breast cancer diagnosis only looked at system delays—which means that delays in the diagnosis and treatment of breast cancer in Black communities are underreported.

Gaps in the U.S. healthcare system, like lack of health insurance and bias in health care, mean that timely access to health care is elusive for Black women. Black women are more likely to detect breast cancer through self-examination, at which point it has progressed to a noticeable lump (a sign of more advanced disease).

Delay of more than two months in treatment initiation has been associated with worse breast cancer survival. Lack of access to care and biological differences in breast tissue—Black women tend to have dense breasts which can make it harder to see abnormalities on mammograms—are two of the many reasons why.

The reasons why breast cancer affects Black women differently from women of other races are still under debate. Inclusive research that can provide the medical community with accurate answers remains a challenge, and current research conclusions are difficult to come by. However, advances in screening and treatment have improved survival for Black women with breast cancer in the United States.

Diagnosis

Breast cancer is the most diagnosed cancer in Black women. They are also diagnosed at a younger age, with a median age of 59 compared to 63 for White women.

Breast cancer is typically detected in one of three scenarios:

• During screening (including a mammogram)
• Incidentally on a physical exam before symptoms have developed
• After you notice a lump

A healthcare provider will take a detailed health history and do a clinical breast exam. They might also order additional tests—like a mammogram, ultrasound, or MRI—to figure out what the breast lump is.

Your doctor may ask you to indicate the size and location of the lump, as well as how it feels. Hard, painless lumps are more serious.

Most lumps that are identified during a self-exam and assessed on a mammogram turn out to be noncancerous. If cancer is suspected, a biopsy will need to be done.

The two most common biopsy types are a fine-needle biopsy and a larger core-needle biopsy, although some conditions require a surgical biopsy. The type of biopsy used will depend on the size and location of the mass, as well as patient factors, patient preferences, and resources.

Treatment

The treatment option that is best for you depends on what stage your cancer is at. It may require chemotherapy, radiation, and/or surgery. 

Local treatment options include surgical removal of breast tissue and radiation therapy. These are the most commonly performed procedures in breast cancer patients and are often used together.

Depending on the type of breast cancer and how advanced it is, you may need additional treatments that kill cancer throughout the body (systemic treatment).

Examples of systemic treatments for breast cancer include:

These treatments can reach cancer cells by being ingested by mouth (orally) or put directly in the bloodstream (intravenously).

A team of healthcare professionals is needed to manage your cancer treatment. An oncologist (a doctor who specializes in cancer treatment) will lead the care team and manage your care. They will share pertinent information with your primary care doctor.

A plastic surgeon might also be brought into your care team if you are interested in breast reconstruction surgery after having a partial or full mastectomy. 

Access to Care

Black women are at high risk for getting and dying from breast cancer, and early detection is not happening often enough to stop these poor outcomes.

According to the American Cancer Society, 65% of White women are diagnosed with breast cancer when it is at an early stage compared to only 55% of Black women. Nearly twice as many Black women are diagnosed with late-stage breast cancer compared to White women.

Recommendations vary. The U.S. Preventive Services Task Force recommends biennial screening from ages 50 to 74.

Getting a mammogram before the age of 50 is an individual choice that should be based on your risk profile. No matter the case, lack of insurance, misinformation, and physician bias should never stand in the way of you getting the preventative services that you need. 

According to a recent study, the three most commonly reported barriers to mammography were fear of cost, fear of mammogram-associated pain, and fear of getting bad news.

Systemic problems such as the lack of health insurance, concerns about the ability to pay, not having a primary care physician, and biased physician care add another level of difficulty to an already challenging situation.

Other factors that are associated with lower mammogram completion rates include:

• Age younger than 60 
• Health plan membership less than five years
• Family income less than $40,000/year
• Obesity: Obese women were more likely than non-obese women to report that mammograms caused them too much pain.
• Recent immigration
• Rural residency

Over 30% of Black women do not get their recommended mammograms. Patient reminders by mail and social media, as well as telephone reminders using live callers or automated calls, are an excellent way to raise screening rates. If your doctor does not provide these services, ask about them at your next appointment.

Prognosis

Black women are disproportionately affected by breast cancer. While Black women and White women get breast cancer at about the same rate, Black women are 40% more likely to die from the disease.

Factors like social determinants to genetics and tumor biology influence the disparities, but do not explain them completely. They also do not explain one of the grimmest statistics: Black women are twice as likely to have triple-negative breast cancer, a more rare but more aggressive form of breast cancer that does not respond to hormonal treatment.

The fact that Black women are more likely to have a more aggressive form of cancer partly explains why there is a lower breast cancer survival rate among Black women. However, the reasons why triple-negative breast cancer is found more often in Black women is unknown. 

There are also substantial racial and ethnic differences in the types of breast cancer tumors that most commonly impact Black women. Research shows that 8% of Black women with breast cancer are diagnosed with metastatic breast cancer compared to 5% to 6% of women of other races.

Black women are also most likely to be diagnosed with larger and more clinically advanced tumors.

Coping 

Finding out that you have breast cancer can shake you to your core. You may have feelings of anger, confusion, resentment, numbness, and guilt. Talking to family and friends can help you to build or strengthen a support network.

Making a list of questions to ask your doctor can help you to form a plan to face your diagnosis head-on. Knowing what to expect will empower you to take charge of the situation. 

Knowledge and awareness of breast cancer disparities have improved in recent years, and there are many breast cancer support networks that serve Black women. These local networks not only help you deal with your feelings and the lifestyle changes ahead, but can also help prepare you for many of the practical things that you and your family might need to do—like finding childcare and securing financial support such as benefits and sick pay. 

What’s right for you on your cancer journey might not be what’s right for someone else. The bleak statistics that Black women often see do not tell the whole story. Many Black women do survive breast cancer.

A Word From Verywell

Many Black breast cancer survivors say that the experience has given them a renewed appreciation for life and their social networks. Others have made new friendships, found inner strength that they did not know that they had, and found ways to help others cope with the diagnosis. 

The more that you know and understand about your diagnosis, the better prepared you will be to take it on. Being aware of the role that health disparities will play in your care will be essential to navigating potential barriers that you will face.

The persistence of racial disparities in breast cancer is primarily caused by a lack of access to health care, but even when policies are implemented that improve mammography screening, insurance availability disparities still exist—which is why more studies highlighting the role of genetics and tumor biology in the propagation of the disease need to be done.

Biased healthcare delivery, medical mistrust, and targeted marketing of potentially dangerous cosmetic problems are also barriers that Black women face. More inclusive research is needed to bridge the gaps in understanding the race-associated differences that exist.