Understanding Breast Cancer Racial Disparities

BCRF takes a look at how breast cancer affects people of color—and what our investigators are doing to close gaps in outcomes

All races and ethnicities are affected by breast cancer, but people of color have long encountered significant disparities in screening, care, treatment, and outcomes compared to their white peers. While progress has been made to identify the root causes of breast cancer disparities, much more work must be done to eliminate them.

Here, we highlight how breast cancer affects certain racial groups, and how BCRF researchers are tackling this problem.

Breast cancer disparities statistics

The consequences of breast cancer disparities in non-white breast cancer patients are dramatic. While white women of European descent are slightly more likely to be diagnosed with breast cancer, women of African descent are more likely to die from their disease.

Black women have a 41 percent higher death rate from breast cancer compared to white women. For Black women under 50, the incidence of aggressive cancers such as triple-negative breast cancer (TNBC) is double that of young white women.

Despite significantly lower incidence rates of the disease, American Indians and Native Alaskans are eight percent more likely to die from breast cancer than white women.

Native American women and women of African, Hispanic, and Latin American descent are also more likely to be diagnosed at an earlier age and with more aggressive breast cancers.

Why racial disparities in breast cancer persist

There are many complex and interrelated factors driving breast cancer disparities, making it difficult but not impossible to identify strategies for overcoming them. BCRF is proud to fund the work of researchers who are getting us closer to achieving breast cancer health equity for all. Factors under investigation include:

Underrepresentation in clinical trials

Research breakthroughs can only reach patients through rigorous testing in clinical trials, but most participants in breast cancer clinical trials are white. Currently, minorities represent less than 10 to 15 percent of the participants in breast cancer clinical trials.

In the last three decades, we have seen a dramatic 40-plus percent decline in breast cancer deaths overall—a trend attributed most notably to increased use of systemic therapies. But not all women benefit equally from these therapies, and without multiracial and multiethnic participation in research and clinical trials, we lose the opportunity to understand why.

BCRF’s commitment: BCRF researchers are investigating strategies for improving participation of people of color in clinical trials, such as using mobile health resources, finding ways to engage Black healthcare professionals in research and patient recruitment in clinical trials, and uncovering differences in healthcare delivery patterns that contribute to the mortality gap between Black and white women. In addition, a large clinical trial effort is ongoing to develop the infrastructure necessary to run clinical trials in low-resource areas of Nigeria and the U.S.

BCRF also supports large clinical trial networks that have the capacity to share and integrate information across many institutions. This is an important part of reducing disparities because the low number of people of color in clinical trials limits how much pertinent data can be collected from one trial. For example, investigators are taking advantage of the large amounts of data generated to better understand the relationship between race and treatment response biomarkers in TNBC. They’re also seeking to identify other biomarkers that indicate which patients are at a higher risk for chemotherapy-induced neuropathy, a treatment side effect disproportionately impacting Black women. 

To learn more about clinical trial participation or to find a clinical trial visit BreastCancerTrials.org.

Social determinants of health: Limited access to affordable, high-quality healthcare & more

Difficulty accessing care is one of the major barriers faced by Black women and other people of color face. According to data analysis from the Kaiser Family Foundation, people of color are more likely than their white counterparts to be uninsured. This is due in part to where they live and availability of affordable health insurance. 

Healthcare system disparities negatively impact early breast cancer screening, preventative strategies, treatment, and follow-up care. For example, when compared to white women, Black women are 31 percent more likely to require longer time to complete therapy and nearly three times more likely to forgo risk-reducing anticancer medicines as prescribed.

Other social determinants of health can negatively impact prevention and risk-reduction strategies and are major contributors to poor breast cancer outcomes. Limited access to affordable, high-quality healthcare amplifies chronic illnesses that increase risk and promote worse prognoses. Diabetes, heart disease, and obesity are some of the comorbidities that complicate breast cancer care.

BCRF’s commitment: BCRF supports several studies that are examining how social determinants of health influence breast cancer risk and outcomes in order to identify ways to close the gap in mortality between people of color and white women. BCRF investigators are looking at the barriers to quality breast cancer care and devising innovative strategies to address them, particularly in under-resourced areas. This includes:

• Leveraging digital technology to reach communities with limited access to healthcare
• Working with community leaders who can facilitate communication with their members
• Developing the infrastructure needed for integrating early detection services in rural communities in Rwanda and the U.S.
• Addressing treatment toxicities that affect people of color and hinder patient adherence to therapies

BCRF investigators are also delving into how comorbidities influence breast cancer and taking a deeper dive into the socioeconomic factors that contribute to it. These studies will shed light on the role of structural and social determinants including structural racism, experiences with discrimination, and levels of stress on breast cancer risk, treatment outcomes, and survivorship in people of color. 

In addition, BCRF—in partnership with The Estée Lauder Companies—has launched a novel project devoted to defining the intersection of social determinants of health, genetics, and breast cancer in Black women. Through this project, investigators hope to gain a comprehensive picture of Black women’s breast cancer and understand the heterogeneity of this population. The goal: Enable the development of strategic interventions that will close the disparity gap.  

Genetic and biological factors

Genetics and biology are at the root of how our bodies function and can predispose people to certain health conditions such as obesity, diabetes, and heart disease—comorbidities that increase breast cancer risk and/or adversely affect breast cancer outcomes. Compared to white women, Black women are 50 percent more likely to be obese and have a two-fold increased risk of being overweight than white women. They also have a two-fold increased risk of diabetes and are 60 percent more likely to develop or be diagnosed with diabetes following breast cancer treatment than white women.

BCRF supported studies in breast tumor biology have increased our understanding of the underlying genetic predisposition to breast cancer, including aggressive forms of the disease like triple-negative breast cancers, which are more frequently diagnosed in Black women.

BCRF’s commitment: Genetics and tumor biology play a significant role in the development of breast cancer and BCRF researchers are focused on defining key elements that contribute to the disparity in outcomes for people of color. Studies have identified inherited mutations in breast cancer susceptibility genes that confer an increased risk of TNBC and may be important for screening in high-risk Black women. BCRF supported the first studies to describe the recurrent mutations in inherited susceptibility genes, such as BRCA 1 and 2, expressed in Black women compared to their white counterparts. Ongoing studies have showed that mutations in the BARD1, RAD51C, and RAD51D genes, while very uncommon, appear more frequently in Black women with breast cancer and are associated with an increased risk of aggressive breast cancers.

Investigators are also looking at the larger environment that surrounds the tumor as well as the immune cells therein that may affect the aggressiveness of Black women’s breast cancer or influence the immune system to promote breast tumor progression. Still other studies are comparing tumor features, both clinical and genetic, across diverse racial groups to assess if they are associated with or affect breast cancer recurrence and survival.