Preventing Breast Cancer in Black Women

Black and White women get breast cancer at equal rates—some studies have even found that the former develop breast cancer at slightly lower rates. However, studies also show that Black women are 40% more likely to die from breast cancer than women of other races.

Why does this disparity exist and how do we prevent it? Much of the research that has included Black women has focused on non-modifiable risk factors for breast cancer, such as age, genetics, family history of breast cancer, personal breast history, breast density, thorax radiation, and the number of menstrual cycles. However, there are also modifiable risk factors for cancer, and these should be emphasized.

Here is an overview of the risk factors for breast cancer that are unique to Black women, as well as what Black women can do to reduce their risk.

What Black Women Can Do  

Breast cancer health disparities are complex. Some answers remain a mystery because Black women are underrepresented in clinical trials.

The importance of emphasizing preventative health strategies in Black communities cannot be overstated. Policies that increase access to mammography and quality healthcare facilities in Black communities are desperately needed.

There is a need to curb certain lifestyle patterns that contribute to an increased risk of breast cancer. The good news is, unlike genetic risk factors that cannot be altered, lifestyle changes can be made to reduce a person’s risk of getting breast cancer.

Lifestyle Factors 

Breast cancer can affect anyone, not just people with a family history. While you cannot alter your genetics, you can make lifestyle changes that can help reduce your risk. Start by identifying unhealthy behaviors and taking action to remedy them (for example, if you smoke cigarettes, you can work on quitting).

Diet

An inadequate diet can negatively affect the health of the body’s cells as well as contribute to obesity. A nutritious diet is a key component of weight management, and certain eating patterns have been associated with a reduced risk of chronic disease, including cancer.

For example, the Mediterranean diet—which consists of vegetables, fruits, whole grains, fish, and olive oil—has consistently been associated with a decreased risk of breast cancer. Some evidence has also suggested that people who eat a diet that is rich in fruits and vegetables and high in fiber may have a slightly lower lifetime risk of developing breast cancer.

Foods that you might want to add to your diet include:

• High-fiber foods (beans, lentils)
• Soy, tofu
• Cruciferous vegetables (arugula, Brussels sprouts, cauliflower)
• Carotenoid vegetables (carrots, leafy greens)
• Citrus fruits (lemons, grapefruit)
• Berries (cranberries, strawberries, blueberries, raspberries, blackberries)
• Fatty fish (tuna, salmon, sardines, trout)
• Coffee or green tea (three to five cups of coffee may slightly lower breast cancer risk)

There are also some foods and beverages that you may want to avoid or limit, including:

• Soda
• Alcohol
• High-sodium (salt) foods (e.g., processed and fast food)

Other Modifiable Risk Factors

Emphasizing modifiable and lifestyle risk factors is essential to developing a strategy for breast cancer prevention and increased treatment efficacy. Some other preventable risk factors for breast cancer include:

• Smoking: Smoking raises the risk for all cancers, including breast cancer in Black women.
• Heavy alcohol use: Having one drink per day has been found to increase breast cancer risk by 7% to 10% in adult women.
• Obesity: Black women have the highest obesity rates in the United States. High body weight women are 1.5 times more likely to develop breast cancer after menopause. High body weight is known to be associated with increased inflammation and alterations in serum levels of potential growth regulators such as adiponectin, leptin, and estrogen—major players in the development and growth of postmenopausal breast cancer tumors.
• Sedentary lifestyle: Physical activity is protective against breast cancer by as much as 25% to 30%.
• Exposure to radiation: Young women who have had radiation therapy for another condition, like Hodgkin’s lymphoma, are especially at high risk. 
• Hormone replacement therapy: Taking certain forms of hormone replacement therapy for five or more years has been associated with a higher risk of breast cancer.
• History of taking diethylstilbestrol (DES): Women who took DES—which was given to some pregnant women in the United States between 1940 and 1971 to prevent miscarriage—have a higher risk of developing breast cancer later in life.

Estrogen-Disrupting Chemicals in Cosmetics

Some of the personal care and beauty products that are marketed to Black women may contain substances that are known as endocrine disruptors, including hydroquinone, diethyl phthalate (DEP), and mercury. Research has suggested that exposure to these ingredients may increase a person’s risk for cancer.

These chemicals are most often found in:

• Skin lighteners
• Hair relaxers
• Brazilian blowout treatments
• Acrylic nails

You might want to consider limiting or discontinuing the use of these products if you are trying to reduce your risk for breast cancer.

Hormonal Factors 

Any condition that leads to high estrogen levels can increase your breast cancer risk, but the magnitude of that risk is highly debated.

Oral contraceptive pills are among the most prescribed medications in the United States. Much time and many resources have been dedicated to studying the connection between oral contraception use and breast cancer risk.

Birth Control

A Danish study published in 2017 found a weak link between hormone contraceptive use (including birth control pills and intrauterine devices) and breast cancer risk. However, Black women were underrepresented in the study. Still, the use of hormonal birth control methods is widely considered safe.

Hormone Replacement Therapy

Much research has also been dedicated to the potential role of hormone replacement therapy (HRT) and breast cancer risk.

The Women’s Health Initiative study completed in 2002 found that five years of combined HRT (estrogen and progesterone) was associated with a 26% increased risk of invasive breast cancer in postmenopausal women.

Childbearing and Breastfeeding

Studies have suggested that breastfeeding reduces breast cancer risk among women who have had children, and there is mounting evidence that breastfeeding may even be protective of some invasive breast cancer types.

Early research has suggested that breastfeeding might be more or less protective depending on the breast cancer subtype.

Breastfeeding for longer than six months may provide additional protection. Most women who breastfeed experience hormonal changes during lactation that delay their menstrual periods. This reduces a woman’s lifetime exposure to hormones, like estrogen, that can promote breast cancer cell growth.

A study by the Collaborative Group on Hormonal Factors in Breast Cancer found that for every 12 months that a woman breastfed, her risk of breast cancer decreased by 4.3%.

While the magnitude of breastfeeding’s impact on Black women is unknown, it is important to note that Black women in the United States have lower rates of breastfeeding and nearly twice the rates of triple-negative breast cancer compared with White women. Promoting breastfeeding could be a potential preventative measure to limit breast cancer risk.

Medical Intervention 

Chemoprevention drugs—also known as selective estrogen receptor modulators (SERMs)—reduce the effects of estrogen in the body. Examples include tamoxifen or raloxifene. If you are at high risk for breast cancer, taking these medications might be an option for you.

Chemoprevention

Research has shown that chemoprevention drugs are effective at preventing breast cancer in pre- and postmenopausal Black women.

However, like most medications, these drugs do have side effects. If you take chemoprevention medications, you might experience:

• Hot flashes
• Night sweats
• Vaginal dryness or irritation
• Joint and muscle pain
• Weight gain

Aromatase inhibitors like exemestane and anastrozole reduce the amount of estrogen that the body produces. They are a popular chemotherapy medication for hormone-positive breast cancers, but can also be used for chemoprevention.

SERMs and aromatase inhibitors reduce the risk of developing breast cancer by as much as 65% among women who are at high risk. However, some research suggests that these drugs are severely underused in Black communities.

Genetic Testing and BRCA Status

Knowing your BRCA status is an important component of any breast cancer prevention plan and may even influence your decision about which preventative strategies are best for you.

For example, one way of eliminating breast cancer risk in BRCA-positive women is to remove the breasts—a procedure called a mastectomy. Even though Black women are among the highest risk groups of having a BRCA mutation, those who learn that they have a high genetic risk of ovarian and breast cancer are less likely than White or Hispanic women to have their healthy ovaries or breasts removed to lower their risk of developing those cancers.

Genetic testing provides you with valuable knowledge that will inform your medical decisions. The more that you, your family, and your healthcare team know about your BRCA status, the more likely it is that you can begin to consider how to reduce your cancer risk.

Currently, the three most widely considered options to reduce cancer risk in BRCA+ women are:

• Mastectomy (having one or both breasts removed)
• Oophorectomy (having one or both ovaries removed)
• Annual mammograms starting at age 25

While screening tests, like mammograms, do not prevent breast cancer, they do make it more likely that you will find cancer early—when a cure is most likely.

The Importance of Getting a Mammogram

It is not uncommon for Black women to have no symptoms of breast cancer early on. Black women are also more likely to have dense breast tissue, which increases the likelihood that breast cancer is missed on mammograms.

Screening Guidelines

The U.S. Preventive Services Task Force (USPSTF) recommends delaying screening mammograms until the age of 50, but these guidelines put Black women at a disadvantage.

The USPSTF recommendations are based on data that was collected from a sample that consisted of mostly White women. Therefore, the guidelines neglect the factors that contribute to increased breast cancer risk in Black women. 

Some doctors encourage Black women to follow the American Cancer Society guidelines, which recommend annual or biennial mammogram screening as early as 45 years old for people who do not have a family history of breast cancer. In Black women with a family history or a known BRCA mutation, mammograms are recommended before the age of 40. 

Ultimately, the choice to get a mammogram is up to you. That said, you may want to involve your doctor. Studies show that women are often happiest with their decisions when they are made with the guidance of a trusted health professional through a process called shared decision-making.

A 2014 study found that the three most commonly reported barriers to mammography are fear of cost, fear of mammogram-associated pain, and fear of getting bad news.

There are also systemic issues—such as a lack of insurance, concerns over the ability to pay, no primary care physician, and biased physician care—that add to the barriers Black women face in getting a mammogram.

Other factors that are associated with lower mammogram completion rates include:

• Age younger than 60 
• Health plan membership less than five years
• Family income less than $40,000/year
• Obesity
• Recent immigration
• Rural residency

Testing for Breast Cancer

The Breast Cancer Risk Assessment Tool is an interactive tool that allows health professionals to estimate a woman’s lifetime risk of developing invasive breast cancer over the next five years.

The tool can be useful, but it is not without limitations. While it has been validated for most groups including Black and Latinx women, it still underestimates the risk in some Black women.

The Breast Cancer Risk Assessment Tool cannot provide an accurate risk assessment for:

• Women over the age of 90
• Women carrying a breast-cancer-producing mutation in BRCA1 or BRCA2
• Women with a prior history of breast cancer, whether invasive or in-situ
• Some other subgroups

That said, Black women should still consider using the risk assessment tool. Getting an estimate of risk does not predict who will or will not get breast cancer. Rather, it is a tool to be used with others to help assess risk and create or refine a breast cancer prevention plan.

What You Cannot Change 

Many risk factors increase the chance of having breast cancer, but how some of these risk factors cause cells to become cancerous is not yet fully understood.

Risk factors are divided into non-modifiable factors (those you cannot change) and modifiable factors (those that can be changed).

Non-modifiable risk factors include:

• Gender
• Age
• Height
• Genetic factors
• Family history
• Personal history of breast cancer
• Dense breast tissue
• Earlier onset of menstrual periods
• Late menopause
• Breast radiation early in life
• Treatment with diethylstilbestrol

Modifiable risk factors can be changed. They often relate to your lifestyle. Examples of modifiable risk factors include:  

• Diet
• Overweight or obesity
• Lack of exercise
• Sedentary lifestyle
• Smoking
• Alcohol use (especially chronic alcohol use—more than one drink per day)
• Recent use of birth control pills
• Using hormone therapy after menopause
• Induced abortion

Early Menstruation 

Black girls tend to have their first period at a younger age than White girls, but researchers are not sure why. What is known is that earlier menstruation means that a woman is exposed to estrogen and progesterone levels for longer stretches throughout their lives.

Some research has also found that Black women produce higher levels of estrogen during their menstrual cycle. As a result, researchers believe that early menarche may help to explain the higher likelihood of estrogen-associated conditions, such as breast cancer, in Black women. 

Current theories focus on the alteration of certain hormonal mechanisms, like leptin activation on the gonadotropin-releasing hormone pulse generator, in girls with higher weights. However, definitive paths are not known and more research needs to be done.

The obesity epidemic has disproportionately impacted Black girls, which has led researchers to infer that the earlier age of menarche experienced by Black girls is related to increased weight.

Smaller birth sizes and high levels of weight, height, and skinfold thicknesses in childhood have also been linked to earlier onset of menarche in Black girls, although these associations are weaker and the findings less consistent across studies.

Breast Density 

Black women tend to have dense breast tissue, which makes it difficult to spot breast cancer on mammograms.

Dense tissue shows up white on mammograms, as do cancer cells, increasing the likelihood of a radiologist missing a tumor. A missed diagnosis can lead to larger tumors and delays in treatment.

Family History 

The Black Women’s Health Study, an ongoing study of Black women from all regions of the United States, found a 78% increased risk of breast cancer for Black women who have a first-degree relative with breast cancer.

The association with family history was stronger when both parties were diagnosed at a young age, particularly before age 45. The association between family history of breast cancer and increased breast cancer was observed for both estrogen-positive (ER+) and estrogen-negative (ER-) breast cancer subtypes.

In the Women’s CARE study, having a family history of ovarian cancer was associated with a higher likelihood of having breast cancer risk in White women but not in Black women.

The opposite was found with cervical cancer: A family history of cervical cancer was associated with breast cancer in Black, but not White women.

Genes

Genetic damage to your DNA always happens in breast cancer, but the cause of that link is not well understood. Some genetic mutations are passed down in families: About 5% to 10% of breast cancers are caused by abnormal genes passed from parent to child. Others are spontaneous.

Everyone has BRCA1 and BRCA2 genes, which are responsible for helping to repair cell damage and keep breast cells growing normally. When these cells do not function properly, they allow mutated DNA to create abnormal proteins in cells. If these mutations are passed from generation to generation, the breast cells remain damaged and increase breast cancer risk.

An additional 2% to 3% of cases are related to a mutation in one of the following rare, less penetrating genes: CHEK2, BRIP1, ATM, and PALB2. Each gene mutation is associated with a twofold increase in the risk of developing breast cancer.

A 2015 study found that young Black women have a higher rate of abnormal BRCA1 or BRCA2 genes than previously believed, which may help explain why Black women have a worse prognosis than White women.

About 5% of women diagnosed with breast cancer in the United States have an abnormal BRCA1 or BRCA2 gene, but this is likely a serious underestimation since the data comes from mostly non-Hispanic White women.

Identifying genes that cause breast cancer has led to a rise in personalized medicine, a new age method of personalizing a treatment plan by targeting problem genes.

Gene expression tests can be used to learn more about your cancer and help tailor your treatment plan. The test uses a sample taken from a biopsy to look for patterns of a number of different genes—a process called gene expression profiling.

The patterns that are found can provide clues to help oncologists predict if certain early-stage breast cancers are likely to come back after initial treatment. They can also help doctors identify which chemotherapy treatments will be the most effective after breast surgery. 

Aging

The Centers for Disease Control and Prevention (CDC) has found that while breast cancer rates are similar between Black and White women in the United States, there are significant differences in the ages at which the two groups are diagnosed.

In a study looking at breast cancer diagnosis from 2009-2013, among the 221,000 breast cancer diagnoses that were evaluated each year, Black women were more likely to be diagnosed before the age of 60, but less likely to be diagnosed after the age of 60 compared to White women.

Black women were also less likely to be diagnosed at a localized stage than White women were (54% vs. 64%, respectively).

Getting a mammogram is a matter of life and death for many Black women. Research has shown that 8% of Black women with breast cancer are diagnosed with metastatic breast cancer compared to 5% to 6% of women of other races. Black women are also most likely to be diagnosed with larger and more clinically advanced tumors.

Effect on Black Women 

Triple-negative cancers tend to be more aggressive and harder to treat. Black women are more likely to get this type of breast cancer than women in other racial groups.

There is also evidence that when chemotherapy is given, it is less effective in Black women. If there are genetic differences that explain the effect, personalized medicine might be able to address them eventually.

There are also non-biological factors—such as lack of access to quality care, higher uninsurance rates, systemic racism, and the wealth gap—that delay diagnosis.

What this looks like in real life is that many Black women are seeking care when their cancer is in its later stage. Even when Black women seek care in a timely fashion, they may not get the same timely or high quality of care as White women. One study showed that Black women were 31% less likely to have surgery and 11% less likely to receive chemotherapy than White women.

More research is needed on the race-specific differences in tumor biology, treatment options, and environmental factors that impact the breast cancer course in Black women.

Fortunately, increasing inclusivity in research studies is a primary focus of scientific research, and we are beginning to see the fruits of that labor, as screening guidelines have been updated and the number of personalized treatments that Black women have access to has increased. 

The following conclusions from the American Cancer Society provide some insights as to why:

• Even though 92% of Black women report that they believe breast health is important, only 25% say that they have recently discussed breast health with their family, friends, or colleagues. Only 17% said that they have taken steps to understand their risk for breast cancer.
• Black women are more likely to present with advanced-stage cancer upon detection.
• Black women are less likely to have health insurance. As a result, they are more likely to skip or neglect mammograms. 
• Getting a mammogram without insurance is expensive. Providers need to provide low-cost options to address, and ultimately eliminate, the racial wealth gap. Black women are struggling to pay or stressing over the cost of healthcare services like mammograms and lab work. As a result, some Black women may not follow-up on abnormal mammogram results because they cannot afford the diagnostic testing.
• Black women often go to lower-quality healthcare facilities and receive lower-quality care, which means that they do not get the same prompt high-quality treatment as White women. 
• Black women are nearly three times more likely than White women to get triple-negative breast cancer—a rare and aggressive subtype that is often fatal because of its treatment-resistant nature. It is the only breast cancer subtype that does not yet have a therapy to prevent it from recurring.
• Younger Black women may get diagnosed at later stages. They are also more likely to get a diagnosis of triple-negative breast cancer when they do get diagnosed.

Access to Care 

Black women are at high risk for getting and dying from breast cancer, and early detection is not happening sufficiently to stop this from happening.

According to the American Cancer Society, non-Hispanic Black, Hispanic, and American Indian/Alaska Native (AIAN) patients are less likely to be diagnosed with local-stage disease (56%–60%) compared to non-Hispanic White patients (64%–66%). About 5% of White women are diagnosed at an advanced stage vs. 8% of non-Hispanic Black women.

In the most recent period (2013–2017) reported by the American Cancer Society, the breast cancer death rate was 40% higher in Black women than in White women.

Black women also experience more delays in the start of treatment than White women (13.4% vs. 7.9%). Researchers found that the disparity remained regardless of socioeconomic status, which highlights the impact of systemic racism on all Black women.

The reasons for the delay are complex and multifaceted, with both economic and logistical issues appearing to compound over the course of treatment.

A lack of insurance and lower socioeconomic status are also significant contributors to both the individual and systemic barriers that create delays in breast cancer treatment for many Black women. However, the specific factors that contribute to racial disparities are rarely highlighted.

Free and cost-saving programs like the CDC’s National Breast and Cervical Cancer Early Detection Program are helping to make early screening mammograms more accessible to Black women. Many local providers and larger hospital systems are also starting to provide cost-effective treatment services.

If you are struggling to access care, it’s important to discuss the barriers with your doctor. Their office or the healthcare system that they are part of might be able to help you by providing free transportation to appointments. Also, talk to your insurance company about ways to lower the cost of your prescriptions.

Frequently Asked Questions 

What should I eat to prevent breast cancer?

No foods have been shown to prevent breast cancer, but some foods may help lower your risk. For example, the Mediterranean diet has consistently been associated with a decreased risk of breast cancer.

Other anti-cancer foods you might want to add to your diet include:

• High-fiber foods like beans and lentils
• Soy and tofu
• Cruciferous vegetables like arugula, Brussels sprouts, and cauliflower
• Carotenoid vegetables like carrots and leafy greens
• Citrus fruits like lemons and grapefruit
• Berries like cranberries, strawberries, blueberries, raspberries, and blackberries
• Fatty fish like tuna, salmon, sardines, and trout
• Coffee or green tea

Why are Black women at a higher risk for breast cancer?

Black and White women get breast cancer at a similar rate, and some studies have shown that Black women actually get breast cancer at a slightly lower rate than White women and women of other races.

The health disparity is seen in how many women die from breast cancer. Black women are 40% more likely to die from breast cancer than White women.

The reasons for this are many. Systemic barriers to care, chronic stress, differences in tumor biology, missed diagnoses because of dense breast tissue, and the higher likelihood of having triple-negative breast cancer (an aggressive, treatment-resistant subtype) all contribute to the higher rates of death for Black women. 

Can Black women do anything to prevent breast cancer?  

The best ways to prevent breast cancer are: eating a nutritious diet, maintaining a weight that works well for your height, staying physically active, getting a routine mammogram, and seeking genetic counseling if you have a personal or family history of breast cancer.

If you are at risk for breast cancer—for example, you have a BRCA mutation—discuss the pros and cons of taking chemoprevention medication and the possibility of early breast removal with your doctor.

Does having a family history guarantee that I’ll develop breast cancer? 

No, but having a family history of breast cancer does increase your risk. Many women with a family history of breast cancer do not develop breast cancer, but your higher-risk profile makes it even more important to explore preventative strategies early.

A Word From Verywell

You don’t need to overhaul your life to decrease your breast cancer risk. Whether starting a home exercise regimen or using wearable technology to encourage more physical activity, every little bit counts. The most important thing is that you stick with the health-positive changes that you make and incorporate these new behaviors into a sustainable lifestyle that works for you.

Getting a mammogram can be lifesaving for any woman, but especially for Black women. While the recommendations vary depending on who you ask, it’s never too soon to talk to your doctor about your risk and when you should start having mammograms.

If you are facing barriers to getting a mammogram—be it your own fear, a lack of transportation, or cost—discuss them with your loved ones and your healthcare team. Allow the people in your life to help you take this crucial preventive healthcare step.