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Across the country, breast cancer survival rates have steadily increased over the past three decades, thanks to advances in screening mammography and personalized medicine. However, not every population has benefitted from the advantages of early detection and breakthrough therapies. There is a startling difference between breast cancer outcomes for white women and women who are Black, Hispanic, Native American, or Asian-American. For example:
- Young, Black women under 40 have higher incidences of breast cancer compared to white women.
- Black women are more likely to develop aggressive and advanced breast cancers, including triple-negative breast cancer.
- While white women over 50 are more likely to be diagnosed with breast cancer, Black women are twice as likely to die from breast cancer than white women.
- Hispanic women with breast cancer also have a higher mortality rate than white women.
These differences in outcomes represent inequalities or disparities in healthcare linked to an individual's race, ethnicity, age, socioeconomic background, and/or geographic location. Breast cancer disparities are complicated, involving factors outside of a woman's control (e.g., the biological makeup of their tumor) as well as physical, psychosocial, and organizational barriers to affordable and high-quality healthcare.
Eliminating breast cancer disparities is a national priority, and at MedStar Health, it's a goal that hits close to home. Washington, D.C., has the highest breast cancer mortality rate in the country, which means it's more important than ever that we identify, understand, and address the cause of these disparities for the women in our community.
Did you know Black women are more likely to develop breast cancer under the age of 40 than white women? On the #MedStarBlog, Dr. Lucy De La Cruz explains why inequalities persist in breast cancer treatment and what we can do about it: https://bit.ly/3uXy85p.Click to Tweet
Why do disparities in breast cancer persist?
The use of screening mammography continues to be lower in Black and Hispanics compared with white women across the country. In studies comparing outcomes for white versus Black women who obtained routine screening mammograms, Black women continue to experience disproportionate survival rates. To reduce differences in outcomes, we must understand why they exist—a complex task.
Ongoing research indicates there are a variety of factors that contribute to racial disparities in breast cancer outcomes and treatment, including:
- Biological differences: Black women tend to have more aggressive breast cancers, including triple-negative breast cancer, which is harder to treat. We now understand the importance of identifying tumor biology of these more aggressive subtypes of breast cancer can lead to worse prognoses. This is especially true for women who do not have access to academic institutions that can offer breakthrough therapies.
- Social differences: Advanced cancer care requires health insurance, reliable transportation, and financial resources, as treatment may require time off work, frequent appointments, or high co-pays. Women who don't have insurance or financial security may not be able to afford preventative care or access to new treatment options. In addition, women who speak a different language or have poor health literacy may not be aware of their options. Language and education barriers may also make it harder for certain populations to trust their doctors. If an individual doesn't feel safe or confident in their care, they are less likely to understand and exhibit healthcare-seeking behaviors, like scheduling a breast cancer screening or follow-up care.
- Provider and health system dynamics: Healthcare outcomes are directly related to the types and quality of providers and facilities readily available to patients. Minority women may be more likely to seek breast cancer care from a healthcare facility that doesn't have fellowship-trained physicians, state-of-the-art technology, or the latest research. Health organizations should be responsible for equal distribution of preventative services, timely follow-up after an abnormal screening, and adhering to evidence-based treatment guidelines. But historically, healthcare policy has not enforced these best practices. As a result, Black women may not be diagnosed promptly nor offered a multidisciplinary treatment approach.
What MedStar Health is doing to reduce breast cancer health disparities.
Removing barriers to access, starting with appointments in your preferred language.
Even before you become a patient, we make it easy to make an appointment. Whether you're newly diagnosed with breast cancer or looking for a second opinion, we can see you within 48 hours in our clinic. We understand that a diagnosis can be overwhelming and anxiety-provoking, and we work quickly to better understand your unique cancer case so we can personalize a comprehensive treatment plan.
In addition to experts in radiation, surgical, medical oncology, radiologist and plastic surgery, your care team involves social workers and psychologists who can help to remove any barriers, whether you need a ride to an appointment or financial support. We also work hard to make patients of all races and ethnicities feel welcome, supported, and cared for. If you speak another language, we have staff available to help, including bilingual providers and translators who can serve as a bridge between you and your care team.
A multidisciplinary approach to cancer care expands treatment options.
During our weekly breast cancer tumor boards, our breast cancer specialists work together to identify any limitations that may prevent our patients from accessing the best breast cancer treatments. These meetings also enable us to design customized treatment plans based on the unique characteristics of your breast cancer. Because our breast cancer team includes physicians with specialty-trained across many disciplines, we can consider all of your treatment options. In addition, we can often offer our patients access to state-of-the-art clinical trials and promising therapies that can't be found at other hospitals.
Advancing equitable breast care.
At MedStar Health, we continue to investigate health disparities in breast cancer, and it's something we frequently discuss as a team. Because we partner with the Georgetown Lombardi Comprehensive Cancer Center, we are actively researching how genetics affects treatment options, especially for women with breast cancer. We also conduct outreach and initiatives within the Black and Hispanic communities to ensure that women of all races benefit from cutting-edge cancer care.
One of the ways we're working to empower and equip underserved women to advocate for their breast health is through building our THRivE (The High Risk Evaluation and Education) Program with multiple initiatives. We are currently seeking collaboration with other large academic institutions and with the help of philanthropy, the THRivE program will aim to provide African American and Hispanic women who are considered at high-risk for breast cancer with educational resources in their native languages. By educating at-risk women on their options for risk-management, like genetic counseling and yearly mammograms, and providing easy-to-understand information about their treatment options, we hope to break cultural barriers and equip the next generation of women with knowledge that may be lifesaving.