Breast Cancer Risk: Disparities That Affect Black Women

In the United States, about 1 in 8 women will develop breast cancer in their lifetime. Black women have slightly lower rates of breast cancer than White women, but they have a significantly higher risk of developing more aggressive triple-negative breast cancers (TNBC). This and other factors make Black women 41% more likely to die from breast cancer than their White peers.

This article explores why Black women are more at risk for aggressive forms of breast cancer, the factors that increase this risk, and the racial disparities in breast cancer care.

Breast Cancer in Black Women Statistics

Breast cancer is the most commonly diagnosed cancer in Black women in the U.S., with an estimated 36,260 new cases and 6,800 deaths expected in 2022. Compared to other racial/ethnic groups, Black women are more likely to be diagnosed with breast cancer at a young age (under 45) and at later stages of the disease, when it is more difficult to treat.

Research shows that Black women have a 2.7 times higher likelihood of being diagnosed with triple-negative breast cancers—more aggressive forms of the disease that are harder to treat and more likely to recur (come back).

After diagnosis, Black women are more likely to experience delays in treatment of two months or more and are less likely to receive adequate treatment than their White counterparts. Though survival rates have increased in recent years, breast cancer is the leading cause of cancer mortality among Black women, who are 41% more likely to die from the disease than White women.

Factors That Influence Risk of Breast Cancer in Black Women

The risk of breast cancer in Black women can be attributed to a combination of factors, many of which are rooted in systemic racial inequities.

Tumor Biology and Genetics

Black women are nearly three times more likely to be diagnosed with more aggressive triple-negative breast cancers than White women. TNBCs tend to be diagnosed at a later stage and are less likely to respond to traditional treatments (e.g., hormone therapy).

New research has discovered significant molecular differences between Black and White women in how quickly breast cancer cells grow and spread, which may explain the higher mortality rate in Black women.

Genetic mutations more common in Black women are also associated with an elevated risk of breast cancer. In one study, 46% of Black women had the TP53 gene mutation, which causes cancer cells to replicate rapidly. A follow-up study found that Black women have a slightly higher prevalence of three gene mutations associated with breast cancer—BRCA2, CHEK2, and PALB2.

Access to Screenings and Care

Black women have similar breast cancer screening rates as White women but are more likely to be diagnosed in later stages of the disease once breast cancer has spread (metastasized) to other areas of the body. This may be due to a lack of access to more advanced screening methods.

Digital breast tomosynthesis (DBT), or 3D mammogram, is an advanced form of breast imaging that detects 20% to 65% more invasive cancers. Though it is better able to detect aggressive cancers, Black women are given fewer DBT screenings than other racial/ethnic groups.

Delays in care may also contribute to high mortality rates. For example, one study found that Black women waited an average of 29 days for a biopsy following an abnormal breast cancer screening, compared to 20 days for White women. After diagnosis, up to 1 in 7 Black women experience delays of 60 days or longer before treatment begins.

Existence of Comorbidities 

Having one or more health conditions (comorbidities) at the time of breast cancer diagnosis may limit treatment options and have a negative impact on outcomes and prognosis. Research suggests that a higher prevalence of comorbidities in Black women—including diabetes, hypertension, and obesity—may account for nearly half of the disparity in survival rates.

People with comorbidities require comprehensive, coordinated care from a team of healthcare providers to prevent health complications during treatment. However, studies show that only 54% of Black women with comorbidities receive the care they need.

Provider Awareness of Subtypes More Common in Black Women

Researchers exploring the racial disparities in breast cancer care found that Black women are more likely to receive the wrong treatments for breast cancer than White women. The more aggressive breast cancer subtypes prevalent in Black women require a tailored treatment approach (e.g., immunotherapy), but up to 60% of Black women do not receive the necessary treatments. 

Lack of healthcare provider awareness may account for this disparity. Studies show that healthcare providers in underserved communities may not be adequately trained to provide optimal care and treatment. This suggests that gaps in healthcare provider awareness of breast cancer subtypes and appropriate treatments in Black women contribute to high mortality rates. 

Cosmetic Products Targeted to Black Women

Some cosmetic products marketed to and used by Black women are more likely to contain endocrine-disrupting chemicals linked to an increased risk of breast cancer. Parabens, phthalates, and other chemicals in hair, skin, and nail products, mimic the body’s hormones (e.g., estrogen) and may promote the growth and spread of breast cancer cells.

Personal care products that may contain these harmful chemicals include:

• Hair relaxers and oils
• Moisturizers/lotions
• Leave-in conditioners

Screening for Early Detection

Mammogram screening is the most effective way to detect breast cancer in the early stages, when it may be easier to treat. Current guidelines from The American Cancer Society recommend women begin annual screening mammography at the age of 45. But these recommendations were made based on years of data from White women. New research suggests that Black women begin biannual screening for early detection at age 40, which may reduce mortality disparities by 57%.

Summary

Though Black women have slightly lower rates of breast cancer, they are more likely to be diagnosed with more aggressive subtypes of breast cancer and have significantly higher mortality rates than White women. High rates of comorbidities, chemicals in personal care products, disparities in access to screening and care, and genetics contribute to the increased risk of breast cancer mortality in Black women.

Early access to screening mammograms, access to timely and appropriate treatment, and healthcare provider education can help address racial inequities and improve the outcomes for Black women with breast cancer. 

A Word From Verywell 

Black women face a disproportionately high breast cancer burden compared to other racial/ethnic groups, but there is hope for change. Racial inequities in health care have been identified as a top public health priority. Through research, advocacy, and education, researchers and healthcare providers are developing strategies and solutions to improve breast cancer outcomes in Black women.