Breast cancer among minorities: Access to care is critical to saving lives

October 13, 2014 | by Nicole White

All women are at some risk of developing the disease in their lifetimes, but breast cancer, like other cancers, has a disproportionate effect on minorities.

multi-ethnic women talk breast cancer While breast cancer is most common among white women, minority women, especially African-American women, are more likely to die from the disease. Access to screening, quality care and follow-up care are crucial to bridging the gap.

Although white women have the highest incidence of breast cancer, African-American women have the highest breast cancer death rates of all racial and ethnic groups. They are 40 percent more likely to die of breast cancer than white women. The five-year survival rate for African-American breast cancer patients is 78 percent, compared to 90 percent for white women, according to the American Cancer Society. Many factors contribute to this disparity, including that black women tend to have cancers that are more aggressive and harder to treat.

But access to screening, prompt follow-up when a mammogram indicates something is not normal, and access to high quality medical care also play a significant role. In fact, City of Hope experts on breast cancer among minorities found that 15 percent of black women who have had breast cancer do not receive yearly follow-up mammograms – despite their increased risk of developing the disease.

Other minority groups also have disparities in access to care and differences in the types of cancers they tend to develop. Identifying these differences isn’t enough. Early detection, appropriate treatment and access to follow-up care are crucial factors in eliminating the disparities in outcomes for minority women, City of Hope experts say.

“We did a preliminary study that informed our current survivorship study – and so many African-American breast cancer survivors were not getting basic minimal follow-up surveillance,” said Kimlin Tam Ashing, Ph.D., founding director of the Center of Community Alliance for Research & Education. “Also, patients were not being educated about their treatments, possible side effects and how to improve their symptom management and self-care to enhance their survivorship.”

Both black and Latina women face a greater-than-average risk for more serious disease and death from breast cancer, as well as disparities in follow-up care. City of Hope provides peer navigators to minority women, helping them transition from active treatment to follow-up and survivorship care.

Latinas and family history

Latina women are also more likely to develop hereditary forms of breast cancer. While BRCA mutations occur in only about 1 percent of the general population, a City of Hope study indicates it’s more common among Latinas. The study found a “high prevalence” of BRCA mutations – 25 percent of the study’s 746 Latina women with a personal or family history of breast or ovarian cancer tested positive for a BRCA mutation.

This makes access to genetic cancer assessments especially important for this population of women – but these tests aren’t always available to underserved Latino communities regionally and globally. At the same time, breast cancer is a significant health threat for Latinas: It’s both the most commonly diagnosed cancer in Latinas and the leading cause of cancer death.

Jeffrey Weitzel, M.D., director of the Division of Clinical Cancer Genetics, has led City of Hope’s efforts in research on genetic cancer risk among Latinas and is bringing much needed cancer-risk counseling and expertise to Mexico, Latin America and South American countries. Weitzel and his team also found that many Latinas have BRCA mutations that involve large rearrangement mutations and may be overlooked by basic screenings. This led to the development of a cost-effective genetic testing panel to screen for the most common BRCA mutations among Latinas, and these tests have been a critically important tool for underserved populations.

Asian-American women have the lowest death rate from breast cancer compared to other groups of women – but the disease is nonetheless a health threat to them. It is the most commonly diagnosed cancer for this ethnic group – and the leading cause of death for Filipino women, according to the U.S. Department of Health and Human Services.

Survival is often linked to catching cancers early, when they are most treatable – which is why mammograms remain an important screening tool. However, minority women report fewer mammograms. For example, among women over 40, only 49 percent of American Indian or Alaska Native women and 56 percent of Asian women report having received a mammogram within a two-year period, according to the Centers for Disease Control and Prevention.

Developing a survivorship plan

For minority women – and all women – fighting breast cancer must start with early detection and persist past chemotherapy, radiation therapy, surgery and reconstructive surgery. Solid survivorship care plans can make a difference in continued health and quality of life. The Center of Community Alliance for Research & Education recommends these topics be covered in all survivorship plans.

•    Breast cancer treatment's effects on other parts of the body. These effects can involve the heart, bones, eyes, teeth, gums and hormonal function. It can also lead to menopause, cause hot flashes or interfere with fertility. Women need to make all of their health care providers – even optometrists and dentists – aware of the care they're receiving.

•    Short- and long-term treatment side effects. All are possible, including lymphedema, hot flashes and fatigue.

•    Symptom management. Although hot flashes and fatigue can seriously affect quality of life, they can be managed. Unfortunately, many women never mention these issues or receive help from their doctors to take care of these conditions.

•    Quality of life. Many survivors find they need spiritual guidance, help sleeping, stress management strategies and counseling. Resources for managing these important issues should be part of a survivorship care plan – and health care providers should be able to assist in identifying these resources.

•    Steps you can take on your own. Learning how to eat healthy and easily increase physical activity can lead to big differences in quality of life after cancer care. So can keeping up with vaccinations and drinking enough water.

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Learn more about breast cancer treatment and research at City of Hope.

Learn more about becoming a patient or getting a second opinion by visiting our website or by calling 800-826-HOPE (4673). City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.

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