Breast Cancer in Black Women: Treatment Barriers

Breast cancer is the second most common cancer affecting American women. The rate of new diagnoses of breast cancer in 2019 in the U.S. was 125.4 cases per 100,000 for Black women and 130.3 cases per 100,000 for non-Hispanic White women. Although they have a slightly lower rate of diagnosis, Black women are more likely to die from breast cancer than White women.

Social disparities make it harder for Black women to get early diagnoses and appropriate treatment for breast cancer. According to the research, Black women face the worst poverty rates, limiting their ability to be insured and have access to quality education, health care, and financial resources.

This article covers the barriers to cancer care for Black women that lead to delayed breast cancer diagnoses and inaccessibility to treatment as well as how to seek equitable care.

Mistrust in the Healthcare System

Medical mistrust based on skin color is not new, especially for Black Americans. This mistrust comes from many factors, including frequent misdiagnoses and reduced treatment access. Research shows this mistrust is warranted, as Black Americans receive less-quality care than White Americans. With reduced healthcare quality, their health outcomes will be much worse.

Medical mistrust affects the doctor-patient relationship and can lead to negative patient behavior and health outcomes, according to a 2021 Annals of Family Medicine report. Perceived discrimination from the medical community also affects healthcare options for Black Americans.

It is also possible physicians might offer lower-quality care to Black patients compared to White patients, even in situations where insurance, age, income, and severity of a medical condition might be similar.

Some reports suggest this occurs because Black patients will see different types of physicians. Others suggest this is due to a lack of medical school education about the health issues that affect Black Americans. These physicians might also have less access to clinical resources.

Many of the biases and barriers in health care primarily affect Black females. For example, maternal mortality and injury rates are higher for Black women. Black women are also significantly underrepresented in clinical trials, especially in trials for health conditions that disproportionately impact them, including breast cancer. 

According to a 2019 Food and Drug Administration (FDA) report, Black study participants comprised only 4% of clinical trial subjects for oncology drugs (used to treat cancer). Studies like this one identify difficulties healthcare providers face when trying to answer Black women’s questions on how a drug might help or hurt them, which can further add to mistrust in the healthcare system. 

Access to Care

Black women are more likely to develop triple-negative breast cancer (TNBC). This invasive breast cancer has cells without receptors commonly found in other types of breast cancer. It does not respond well to hormone therapy and medicines targeting HER2 proteins. 

One report from the Tigerlily Foundation found that 53% of TNBC cases were diagnosed in Black women under 50, compared to 16% of White women. People with TNBC will have worse outcomes than other breast cancer types. They also have higher frequencies of relapse and metastases (cancer spread) to the lungs, liver, or brain and a lower survival rate.

A 2020 Frontiers in Public Health review cites poverty, social stress, unsafe neighborhoods, and lack of healthcare access as factors to poorer TNBC outcomes. These factors also negatively affect the ability to get a timely diagnosis and length of survival after diagnosis. 

Lower-quality care also exists in treating cancer for Black women. For example, a study reported in 2020 in the American Journal of Obstetrics and Gynecology found Black and Hispanic women were less likely than White women to receive guideline-consistent treatment for endometrial cancer. Not receiving the guideline-recommended treatment course meant survival was significantly reduced.

Cost of Care

Breast cancer care is expensive, even with insurance. People diagnosed with this type of cancer will need surgery—either a lumpectomy or a mastectomy. They might also need chemotherapy, radiation, or other cancer treatments after the surgery. Those costs and follow-up care can present a financial strain for people with cancer and their families, and this burden affects Black women the hardest. 

One 2018 Journal of Clinical Oncology report finds Black women diagnosed with breast cancer have more financial problems than White women diagnosed with breast cancer. That report also finds that financial hardship plays a role in delayed diagnosis, discontinuation of treatment, and omission of treatment. According to the report’s authors, these racial disparities are connected to higher breast cancer death rates among Black women.

Research has also found Black women with breast cancer often have delays in treatment and extended duration of treatment. One study reported in 2020 in the journal Cancer found Black women were more likely than White women to have the start of treatments delayed by up to 60 days after a breast cancer diagnosis.

The percentage of Black women who had delayed treatment was 13.4%, compared to 7.9% for White women. The study also found cancer care for Black women was more likely to have a longer duration than for all women under 50 receiving breast cancer treatment. 

The study’s authors reported various patient factors that could be blamed for delaying or prolonging treatment. Factors included access to care, tumor status, and socioeconomic status. Interestingly, while socioeconomic stress was a factor for delayed or prolonged treatment, it was not as strong as race. 

Delayed Diagnosis

Early detection and treatment are vital to improving survival, especially for invasive and more aggressive cancer types like TNBC. But Black women are often diagnosed with breast cancer later than White women, leading to treatment delays.  

One study reported in 2021 in the Journal of the American College of Radiology evaluated personal characteristics that could contribute to delays in diagnosis of breast cancers that could generally be detected through preventive screenings and how those delays affected progression and morality. Researchers found racial disparities often led to larger tumors and a higher rate of malignancies resulting from delayed screenings.

Black women, in particular, had a two-fold increase in delayed diagnosis compared to White women. Delayed diagnoses led to delayed biopsies and other diagnostic delays of 45 or more days. Researchers also noted odds of breast cancer mortality increased by 1.6 for the women who experienced diagnostic delays. 

The ability to get a preventive mammogram screening is yet another healthcare barrier for Black women. According to a 2021 Policy, Politics, & Nursing Practice report, there are five negative factors in mammography care Black women face: “accessibility, affordability, availability, accommodation, and acceptability.”

Accessibility relates to lack of transportation or too few care locations. Affordability covers lack of health insurance and cost of care, while availability points to child care issues and not having a primary care provider.

Accommodation covers the failure to provide information and education, negative healthcare experiences and mistrust, and scheduling difficulties. Last, acceptability covers fear of results, embarrassment, racism, and religious or cultural beliefs. 

The report’s authors conclude that access to mammograms is unique to Black women’s experiences, and interventions must be tailored to cultural needs. Those interventions need to exist at local, state, and national levels for cancer screenings and prevention using healthcare practices that include Black women.

How to Seek Equitable Care

To effectively manage breast cancer, every person must receive regular care, including having access to providers and cancer treatments. While barriers might limit your care compared to someone else’s, self-advocacy can increase access to necessary care. 

One of the best ways to advocate for yourself is to do what you can to stop breast cancer early in its tracks. Make sure you are aware of any changes in your breasts, which can include doing a breast self-exam regularly. If you are over 40, you should get a mammogram every one to two years.

If you are younger than 40 and have risk factors for cancer, ask a healthcare provider about the frequency of your screenings. But whatever your age, don’t avoid getting a mammogram because of the cost. 

You have options for getting a low-cost or no-cost mammogram. Options include:

• Your healthcare provider and their staff: If you are 50 or older, the Affordable Care Act requires your insurance company to cover the cost of mammograms every two years without a co-payment. Medicare and Medicaid also cover the cost of mammograms. Your healthcare provider and their staff can help you schedule an appointment and help you contact insurers regarding costs. They might also be aware of affiliated hospital programs offering free mammograms.
• The National Breast Cancer Foundation (NBCF): The NBCF works with medical facilities throughout the United States to provide free mammograms and diagnostic care services to underserved communities. You can use the search option on their website to find a location near you.
• The Susan G. Komen Foundation: This organization can help you find local affiliates offering low-cost breast cancer screening and treatment options. Its website provides a search tool, or you can call its breast care helpline at 1-877-GO-KOMEN (1-877-465-6636), and a representative can help you find options in your area.
• The National Breast and Cervical Cancer Control Program from the Centers for Disease Control and Prevention (CDC): This CDC program offers breast and cervical screenings and diagnostic services to low-income, underinsured, and uninsured women all across the country. Screening options are available to women ages 40 and 64 who do not have appropriate insurance coverage and live at or below 250% of the federal poverty level.

If you do not have health insurance or are struggling financially, the cost of cancer care treatment might seem overwhelming. Before you skip care, know that resources are available to help you.

Your healthcare provider’s office might be able to give a list of organizations that offer financial options for medicine and care. They might also have information for local organizations that assist people with cancer with child care and transportation expenses. Pharmaceutical companies are another option for financial assistance to cover the cost of medication. 

You might also consider looking into community-based agencies that help people diagnosed with breast cancer overcome healthcare barriers, including financial hardship. Ask your healthcare provider, a social worker, or a patient advocate for a list of local support organizations. 

The American Cancer Society has local programs in every state. You can reach out to it via its website or by calling its 24-hour toll-free cancer helpline.  

Several organizations provide support to communities of color, including breast cancer support. These can be valuable resources throughout your cancer care journey. These include:

Summary

Black women are at a higher risk of developing aggressive breast cancer subtypes. They might also have worse health outcomes and higher mortality rates. Black women also face barriers to breast cancer care, including delayed diagnoses and inaccessibility to treatment. 

All women should be aware of changes in their breasts and report any changes to a healthcare provider. Mammograms are recommended for women aged 40 and older and women younger than 40 with risk factors for breast cancer. 

If you are uninsured or underinsured, you have options for getting a mammogram with the help of various cancer care organizations. If you are diagnosed with breast cancer and worried about the cost of care, reach out to your healthcare provider, a social worker, or a patient advocate to help you find local and financial resources that assist with breast cancer care costs. 

A Word From Verywell 

Early detection and aggressive treatment are vital to determining your outlook for breast cancer. Breast cancer that is found in its early stages can be cured. Talk to a healthcare provider about your screening options for breast cancer, especially if you have risk factors like race and family history.

Be aware of the early signs of breast cancer—irritated or itchy breasts, changes in color and shape, a breast lump or thickness, nipple discharge, or nipple inversion. You should tell a healthcare provider immediately if you experience symptoms, even if you recently had a mammogram with no abnormal findings.