Black Women Face Barriers to Breast Cancer Treatment, Study Finds

Breast cancer treatment has come a long way, but it appears that some populations may be getting left behind. According to a September study published by the Red Journal, Black women are 16% less likely to be offered hypofractionated radiation therapy, an increasingly popular breast cancer treatment, than White women.

According to the Centers for Disease Control and Prevention (CDC), although Black women and White women get breast cancer at about the same rate, the breast cancer mortality rate is 40% higher for Black women. Additionally, Black women are more likely to have more aggressive breast cancers with a higher chance of recurrence.

“Beyond the fact that breast cancer tends to be a more biologically aggressive disease in African American [women] than in White women, this disparity in breast cancer mortality also reflects social barriers that disproportionately affect African American women," Ogori Kalu, MD, a general surgeon at Saint Michael's Medical Center in New Jersey, tells Verywell.

What Is Hypofractionated Radiation Therapy?

“Radiation therapy is an important part of breast cancer treatment for most patients,” Kalu says. 

In breast cancer treatment, radiation therapy often follows breast surgery—such as a lumpectomy or mastectomy—to kill any cancer cells that remain, reducing cancer recurrence risk. 

However, it's important to note that not all radiation therapy is the same. For example, Kalu says, “Conventional radiation therapy delivers small amounts of radiation to a patient over five to seven weeks.” In contrast, she says that hypofractionated radiation therapy, also called hypofractionation, delivers larger doses of radiation in as little as three to four weeks. 

With these fewer sessions, patients experience fewer side effects, such as fatigue and loss of appetite. Hypofractionation also reduces the need to travel to a cancer center often, making this option more convenient for many patients. 

The study found that hypofractionation was just as effective and less costly compared to conventional radiation therapy. For these reasons, the study found that hypofractionation use increased over the four-year study period, from about a quarter of eligible patients in 2012 to more than two-thirds in 2016. However, the treatment appears to lag behind for certain populations, especially for Black women.

Barriers for Black Women With Breast Cancer

When speaking about their findings, lead researcher Alliric Willis, MD a surgical oncologist and associate professor of surgery at Sidney Kimmel Medical College, said in a press release, “This demonstrates that even though treatment guidelines do not take race into account, race is a factor in breast cancer treatment.”

Despite these advances in breast cancer treatment, Black women continue to face multiple barriers in cancer treatment, starting with delays in breast cancer diagnosis to financial costs for treatment.

Delays in Diagnosis

"I found a lump when I was 31 years old," Maimah Karmo, founder and CEO of the Tigerlily Foundation, a national breast cancer foundation that provides resources to young women, tells Verywell. "They told me for six months that it wasn’t cancer and that I was too young to have breast cancer. They told me to come back in six months to a year or when I was 40. If did that I would be dead today."

Karmo, who is Black, returned to her doctor six months later and pushed for a biopsy. Her doctor agreed. The biopsy revealed that Karmo had stage 2 breast cancer. She was only 32 years old. "The lump had doubled in size between the first time I saw her and the next appointment—just within six months," she says.

In general, the earlier breast cancer is detected, the sooner it can be treated, increasing a woman's chances for survival. Even after a diagnosis, recent research finds more Black women delay initiating treatment compared to White women.

Implicit Bias from Medical Providers

Research shows that Black individuals are often less likely to trust in physicians and hospitals compared to White populations. “For black people, there’s a natural defense mechanism when you’re in front of a person in uniform, like a doctor or police officer," Karmo says. "It can be a hostile environment, in which you’re talked down to or dismissed." 

Some reasons behind this mistrust may include the U.S. history of exploitative clinical research, such as the case of Henrietta Lacks, a Black woman whose cells were used without Lacks's knowledge or consent and continue to underpin much of modern medicine. Studies also show many medical providers hold implicit biases toward Black patients. Research shows that providers are less likely to deliver effective treatments to Black people when compared to their White counterparts—even after controlling for factors like class, health behaviors, comorbidities, and access to insurance.

Karmo says doctors tend to avoid mentioning clinical trial participation to Black women diagnosed with breast cancer. A 2016 study even found that Black women were less likely to be offered BRCA1/2 genetic testing than White women.

"If you don’t know what to ask for, you don’t know how to advocate for yourself,” Karmo says. 

Financial Considerations

For Black women who are the head of their household, uninsured, or underinsured, a breast cancer diagnosis can provoke concerns that they can't afford treatment. 

Patients with private insurance were more likely to receive hypofractionation than uninsured patients or those on Medicaid, according to the study. In addition, patients who lived in zip codes with the highest income levels were 25% more likely to undergo the therapy than patients from zip codes in the lowest income category.

“It’s really sad that women are making decisions about their health and their life because of financial reasons, ” Karmo says. 

"Imagine you’re working an hourly wage job, and you’re living in a place far from the cancer center," she says. "Also, if you’re going for a second or third opinion, that’s lost wages. If you’re losing money, who's going to feed your children?"

Mending the Inequality Gap 

To help close the healthcare gap, Karmo says the Tigerlily Foundation launched the #InclusionPledge initiative through the organization. With this pledge, key players in the healthcare system, including pharmaceutical companies, healthcare organizations, and policymakers, are held accountable for removing barriers to care for Black women.

Karmo says the #InclusionPledge provides a tangible framework that assesses different ways to remove treatment obstacles for Black women living with breast cancer, including:

• Ensuring doctors provide Black women with adequate information, including genetic testing, imaging, and clinical trials
• Offering stipends or free transportation if there are financial and geographical barriers
• Providing patient education material that is easier to understand

"As long as I'm alive, I want to give back and ensure that all women, especially young women and women of color, have education, access, and resources," Karmo says.

It will take a multifaceted approach to fix a complex problem such as healthcare disparities in breast cancer. However, measures such as the #InclusionPledge, which has already amassed 11,000 pledges and 60 partners, are aiming to change the future of healthcare experience for Black women.