Breast cancer is the second most common type of cancer in women in the United States. A diagnosis of breast cancer can be devastating for anyone. It’s even more alarming to know that the color of someone’s skin can be a factor in their survival.

Overall, the rate of breast cancer diagnosis is similar between white and Black women.

About 82% of Black women live at least 5 years after their initial breast cancer diagnosis, compared to 92% of white women. But Black women are 41% more likely to die from breast cancer even though their incidence rates are similar to or lower than those of white women.

Overall, Black individuals have the lowest survival of any racial/ethnic group for most cancers.

There can be major barriers to getting a diagnosis and treatment, including:

  • Access to mammograms: Black women are more likely to go longer between routine mammograms. They’re also more likely to have a longer gap between an abnormal test and a follow-up mammogram.
  • Cost of healthcare: In the United States, Black people are more likely to be uninsured or underinsured. Data from 2019 show that around 10% of Black people in the United States did not have health insurance. About 6% of white people in the United States were uninsured.
  • Later stage diagnoses: Black women are more likely to be diagnosed with later stages of breast cancer. Research also shows that Black women are less likely to receive chemotherapy and surgery as part of breast cancer treatment.
  • Medical mistrust: There’s also ongoing medical mistrust among Black people. This is associated with fewer visits to doctors and worse health outcomes. About 25% of Black people in the United States report a high level of mistrust of doctors.

This stems from hundreds of years of racism and disparities that continue today for Black people. Many doctors incorrectly perceive that Black people feel pain differently. Black people often are not given the right type or amount of medications for pain management.

It’s not simply a person’s race that increases their risk for breast cancer. It’s racism that creates disparities that increase the risk for Black people. Structural racism creates barriers to accessing adequate housing, income, and healthcare.

It’s a huge part of why so many Black women die from breast cancer.

As with any type of cancer, some factors increase the risk of developing breast cancer. Not everyone with these risk factors will develop breast cancer. Some people who develop breast cancer have no clear risk factors.

Risk factors include:

  • getting older
  • getting your first period before the age of 12
  • going through menopause after the age of 55
  • having a family history of breast cancer
  • having certain gene mutations
  • having dense breast tissue

Black women are more likely to be diagnosed at younger ages than white women. The median age of diagnosis in Black women is younger, at 58 years old. For white women, the median age for breast cancer diagnosis is 62. Black women are also more likely to be diagnosed under the age of 45.

Compared to non-Hispanic white women, Black women are twice as likely to be diagnosed with triple-negative breast cancer (TNBC). This type of cancer is harder to treat and tends to spread faster.

There may be a link between inflammation and insulin resistance and TNBC. This may increase the risk for Black women. There may also be some genetic factors that increase the risk of TNBC.

Black women are more likely to have other chronic health conditions. Again, this is related to higher rates of poverty and less access to healthcare.

Rates of diabetes are higher in Black people. Data from 2017–2018 shows that in the United States, 12% of Black adults had diabetes. This is compared to 8% of white adults. Diabetes is associated with higher levels of several types of cancer, including breast cancer.

It’s unclear exactly why diabetes and breast cancer are connected, but inflammation may be an underlying factor for both conditions. There’s also a connection between diabetes and dense breast tissue. Dense breast tissue is a risk factor for breast cancer. It can also make it harder to find breast cancer at earlier stages.

Black women are less likely to be included in clinical trials. Clinical trials help to advance knowledge about breast cancer and its treatments. Trials explore new treatments that are only available to people who are part of the trial.

Many things prevent clinical trial participation among Black people. For example, clinical trial exclusion criteria can make it harder for Black patients to qualify. Exclusion criteria are characteristics, including certain health conditions, that make a person ineligible to participate in a trial.

The realities of being in a trial — time off work, travel, and other costs — can make it nearly impossible to participate.

There are many things that healthcare professionals need to do to improve care for People of Color.

Dr. Teresa Hagan Thomas is an assistant professor at the University of Pittsburgh School of Nursing. Her research focuses on supporting patients to become strong self-advocates. She is passionate about improving cancer care for all by ensuring that a patient’s needs and priorities are at the center of the care they receive.

“Models of patient navigation help patients coordinate care and often involve connecting patients to community resources who can assist with additional needs.”

— Dr. Teresea Hagan Thomas

“Healthcare professionals have an increasing recognition of the presence of disparities and a collective need for tangible solutions,” says Thomas.

Black women are often diagnosed with later stages of breast cancer and more aggressive subtypes.

“Healthcare professionals are working to increase screening rates among communities at risk for poor outcomes,” Thomas continues. “By increasing screening uptake, individuals can be diagnosed sooner when the cancer is more local and is less likely to have spread to other parts of the body.”

There’s also a move to really recognize how the social determinants of health affect survival. “Increasingly, clinicians and researchers are recognizing the role of access to quality cancer care (both geographically and by insurance), the financial burden in affording treatment, and the extra costs of having cancer,” explains Thomas.

Traditionally, patients may be seen as “nonadherent” when they delay treatment. Through this new lens, patients can be better supported by addressing the reasons why treatment might be delayed.

“Patients may delay diagnosis or treatment because of transportation, financial, or social support issues,” says Thomas. “Clinicians are moving toward addressing these root causes that result in poor treatment outcomes.”

More clinics are using a model of care that includes patient navigators.

“Models of patient navigation help patients coordinate care and often involve connecting patients to community resources who can assist with additional needs,” explains Thomas. “Additional needs [may include] housing, food, financial aid, and other essentials that are needed so that patients can focus on their treatment and well-being.”

Thomas also notes important changes happening to increase diversity in clinical trials. “Clinical trials rarely reflect U.S. demographics, especially among Black populations,” says Thomas. “More effort is being made to reduce the barriers to clinical trials participation and identify ways to support these patients in enrolling.”

Some of the strategies being used include building trust with different communities and working toward a more diverse healthcare workforce.

It’s not the responsibility of Black women to fix a system that often works against People of Color. Major systemic changes are needed to reduce barriers and improve access to healthcare. Low income and lack of health insurance continue to prevent Black women from getting the care they deserve.

But there are things you can do.

Mammography is an important part of breast cancer detection. A mammogram is a type of X-ray. It takes pictures of your breasts to check for any changes.

The early stages of breast cancer often don’t have symptoms. A mammogram is the best way to detect breast cancer early. Ask your healthcare professional about when and where to get a mammogram.

If cost is a barrier for you, talk with your healthcare professional about options. You can also contact the Susan G. Komen Foundation. Their website has resources to find free or low cost mammograms near you.

If you notice any changes in your breasts, talk with your doctor. Breast cancer in the early stages may not have any symptoms, which is why mammograms are so important.

It’s smart to watch for any of the following changes:

  • dimpling in the skin of your breast
  • swelling in your breast
  • pain in your breast or nipple
  • a lump in your breast
  • swollen lymph nodes under your arm
  • discharge from your nipple

You deserve a healthcare professional who listens and understands you. If you don’t feel that your needs are being met, consider finding someone else to work with.

If you’ve been diagnosed with breast cancer, you need a solid support network. Connect with family, friends, and support groups. It may be helpful to have a trusted family member or friend attend medical appointments with you.

If the cost of healthcare is a problem, there are organizations that can help. The American Cancer Society has some resources available.

Ask your healthcare professional or cancer clinic whether there’s a social worker who is part of the team. This person can be a great help in connecting you with local resources.

Black women have higher death rates from breast cancer compared to white women.

There are many reasons for this difference: There are challenges in accessing healthcare. Black women are more likely to be living in poverty and be under- or uninsured. There are high levels of medical mistrust, which worsens health outcomes. Systemic racism is being recognized as a determinant of health.

When healthcare professionals understand the barriers that Black women may face in diagnosis and treatment, change can start to happen to improve outcomes for Black women with breast cancer.