Race And Breast Cancer: The Survival Gap

The woman on the right is more likely to die of breast cancer than the woman on the left. What's wrong with this picture?

When Zora Brown was diagnosed with breast cancer in 1981 at the age of 32, information about how the disease affected African—American women was hard to come by. "Most of society didn't think educating our community was their job," she says. So, for guidance, Brown looked to the women in her family who'd had the disease—her great—grandmother, grandmother, mother, three of her sisters and her niece—and to those she met in breast cancer support groups. She was stunned by what she saw: "Even back then, I noticed that the people in my mostly African—American support group were young. And the average age in my support group now is 37," says Brown, who lives in Washington, D.C., and is the cofounder of the Breast Cancer Resource Committee, an advocacy group for black women. It also seemed to Brown that blacks were more likely to die from the disease than whites were. And while she knew that poverty and poor access to screening and treatment were a big part of the problem, she sensed something more was at work—something that went beyond long—standing socioeconomic inequities.

Brown began talking to women and canvassing doctors, many of whom agreed that their African—American patients seemed to be younger, with tumors that were more aggressive and less responsive to treatment. "Clearly," she says, "something very different was happening to us."

Now, nearly 22 years after her own diagnosis, startling new studies are bearing out Brown's initial observations: While white women are most often diagnosed with breast cancer after age 50, black women tend to develop the disease in their 30s and 40s—and are 28 percent more likely to die from it. And although white women are slightly more apt to develop breast cancer over a lifetime (113 out of 100,000 versus 99 out of 100,000 African Americans, according to the National Cancer Institute), 25 of those white women go on to die from the cancer, compared with 31 of the black women.

What's behind the shocking mortality gap? Scientists and public—health officials are considering everything from the fact that African—American women are less likely to get into key clinical trials to the possible impact of a high—fat diet, which tends to be more common in poorer populations. They are also pondering an idea that is more controversial:

Black women may be more prone to a particularly aggressive, treatment—resistant form of the disease. In short, some experts speculate that the crucial difference may boil down more to science than society. "There is a biological issue we can't ignore," says Brown. "To do so would be a disservice to African—American women."

Deadly disparities

The National Institutes of Health and research universities such as Columbia and Cornell's Weill Medical College in New York City, Emory in Atlanta and Howard in Washington, D.C., have launched a raft of studies to find out why African Americans are more likely to die from breast cancer. Most of the results aren't due for another year or two, but one thing already seems clear: Poverty and racism are still the chief reasons for the survival gap. Twenty—four percent of African—American women live in poverty, and about 20 percent are uninsured, compared with 10.5 percent and 13 percent of poor and uninsured whites, respectively. And because patients with either basic Medicaid insurance or no insurance at all are likelier to end up being treated at public hospitals, black women are less apt to get top—notch care.

Poverty and racism don't explain why black women are developing breast cancer at such a young age, however. Or why, as some studies suggest, blacks are still more likely to die from the disease even when they receive treatment comparable to that given whites. That's why scientists are increasingly asking whether, in focusing on some of the more obvious problems like equal access to health care, they might have missed the other elephant in the room: biology. Could African Americans be more prone to fast—growing tumors, just as they are more likely than whites to be diagnosed with lupus or sickle—cell anemia? It's already known, for instance, that breast cancer is more common in Ashkenazi Jews than in other Caucasian populations, a difference that eventually led to the discovery of the so—called breast cancer gene. No one knows whether black women carry a genetic mutation such as BRCA1 or BRCA2, but as scientists continue to explore the disease at its most basic level—the cell—possible reasons for the critical cancer divide are starting to come to light.