Black Women with Metastatic Breast Cancer Face a Significant Disparity in Their Care

It was a lingering cough, not a lump in her breast, that led to Jamil Rivers’s diagnosis of metastatic breast cancer. After two months of chronic coughing, a chest scan revealed a shadow in her lung. An ultrasound led to finding lesions in her liver. A mammogram revealed the rest: Hormone receptor-positive, HER2-negative metastatic breast cancer. 

“I literally thought, ‘I’m going to die,'” Rivers says when she first heard the news. “I have this wonderful family, my youngest was in kindergarten at the time, I’m married to the love of my life. I’m like, ‘Why would this happen to me?'”

Metastatic breast cancer, also known as stage four breast cancer, occurs when cancer cells have left the primary site (the breast) and are now found in other parts of the body. Rivers was diagnosed de novo, which meant the breast cancer had already spread to other parts of her body at the time of diagnosis. The liver, lungs, bones and brain are the most common places breast cancer metastasizes, says Dorraya El-Ashry, PhD, chief scientific officer for the Breast Cancer Research Foundation (BCRF).

Women diagnosed with breast cancer are living longer, with deaths from the disease declining by 43 percent over the last 30 years, according to BCRF. But not all women are benefitting equally, notes El-Ashry. Black women are diagnosed at almost a similar rate as white women, however Black women are 42 percent more likely to die from breast cancer, El-Ashry says. And there’s a reason for this. Researchers and physicians agree the factors contributing to the disparity gap are complex. Some things are out of human control, including factors like genetic predisposition, how genetics change over time due to behavior and environment, and differences in biological makeup of cancerous tumors, says Evelyn Taiwo, MD, attending physician in medical oncology at New York Presbyterian-Brooklyn Methodist Hospital.

“There are biological differences in breast cancer Black women tend to have. They have a higher incidence of triple-negative breast cancer, which is more aggressive,” said Taiwo.

But there is also a lot within human control that needs to be addressed and can change. Taiwo points to standard of care as one of the places where physicians can combat disparities. Recent research shows Black women are referred for genetic testing at disproportionately lower rates than white women. Taiwo explains this plays into not only prognosis of predisposition to breast cancer but also potential exclusion from life-saving medicine and treatments.

BCRF’s efforts to close the disparity gap are focused on social determinants of health, described by the Centers for Disease Control and Prevention (CDC) as “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes.” These conditions primarily come down to money, power, and resources and include issues like access to quality healthcare, economic stability, racism, and other discrimination. How those social determinants of health intersect with the biology of breast cancer in Black women are key to improving prevention, diagnosis, and treatment outcomes, says El-Ashry.