How Breast Cancer Is Treated

With insights into the effect on Black women

This article is part of Breast Cancer and Black Women, a destination in our Health Divide series.

Treating breast cancer requires a combination of lifestyle changes, surgery, radiation, and chemotherapy.

For Black women—who have higher rates of treatment-resistant triple-negative cancer and BRCA gene mutations—individualized targeted therapies have become integral in treatment regimens.

As researchers learn more about changes in cells that cause cancer, they’ve been able to develop new types of drugs that specifically target these changes. These therapies can be expensive and require routine follow-up.

This article will discuss the most commonly used breast cancer treatments—with insights into treatments most commonly used for Black women—as well as the financial burdens of healthcare costs and the importance of follow-up care after getting a mammogram.

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Surgery and Specialist-Driven Procedures

The earlier your breast cancer is caught on a mammogram, the more likely it is that it can be cured by surgical removal. Standard treatment calls for surgery to remove the tumor, followed by a combination of targeted therapy such as:

  • Antibody therapy to cut off the ability of the HER2 gene to support the growth of breast cancer cells
  • Immunotherapy for triple-negative cancers
  • Hormone-blocking therapy for estrogen and progesterone (ER+, PR+) positive cancers

Finally, chemotherapy is used to directly kill any lingering cancer cells that escaped surgery.

Lumpectomy

If a tumor is detected early, breast-conserving surgery, called a lumpectomy, is a safe and affordable option. Extra tissue surrounding the cancerous tumor is removed and radiation is performed afterward to reduce the risk of leaving behind cancerous cells. 

Black Women and Lumpectomy

Research has found that Black women who undergo lumpectomy followed by radiation therapy have a higher chance of their cancer coming back in the breast and lymph nodes 10 years after diagnosis compared with White women. Therefore, some Black women consider more aggressive surgery, like a mastectomy. 

Mastectomy

A mastectomy involves surgical removal of the entire breast. A bilateral or double mastectomy is when both breasts are removed. Sometimes other tissues, such as the muscle that lies behind the breast, are removed as well.

Mastectomy is not reserved only for women who have breast cancer; it is a commonly performed procedure for those who are at high risk of developing breast cancer later in life.

Black women who learn that they have a high genetic risk of ovarian or 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, according to researchers at an annual meeting of the American Society of Clinical Oncology.

Breast Reconstruction

Immediate breast reconstruction is being performed more commonly following mastectomy. An implant, tissue from the hips, buttocks, or belly, or both can be used for this procedure. 

Research suggests that Black and Hispanic women are less likely than White women to have breast reconstruction due to the higher likelihood of living in areas with fewer plastic surgeons and having no insurance or insurance that does not cover breast reconstruction.

Other related surgeries include:

  • Sentinel lymph node biopsy
  • Axillary lymph node dissection
  • Re-excision
Black women and breast reconstruction

Julie Bang / Verywell

Access to Care

Delays in Treatment for Black Women

A study found that Black women had more delays in the start of treatment than White women, 13.4% vs. 7.9%, and the disparity remained regardless of socioeconomic status, underscoring the impacts of systemic racism on all Black women.

Societal obstacles like lack of insurance and lower socioeconomic status are significant contributors to both the individual and systemic barriers that create delays in breast cancer treatment for many Black women. The specific factors that contribute to racial disparities, however, are rarely highlighted, such as:

  • Medical mistrust
  • Chronic stress
  • Biased medical recommendations

These impact a Black woman’s ability to comply with breast cancer treatments even when money is not a factor.

Regardless of insurance or income status, Black women should seek the care they need.

Free and cost-saving programs exist via the Centers for Disease Control and Prevention (CDC) National Breast and Cervical Cancer Early Detection Program. Local providers and larger hospital systems also have access to cost-effective treatment services.

Open up a dialogue with your physicians about the difficulties of receiving treatment or getting to and from appointments. Often, the medical staff can assist you with securing free transportation to and from your medical appointment—like with hospital shuttle services—or can contact your health insurance company on your behalf to get lower-priced prescription medications.

Radiation

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

It is different from conventional radiation in that higher doses of radiation are given over a shorter period of time. Conventional radiation therapy consists of lower doses of radiation over the span of six to seven weeks versus three to four weeks with hypofractionated radiation.

Hypofractionated radiation therapy is a great choice for women because it:

  • Is less costly
  • Lowers the likelihood of side effects
  • Reduces the number of trips needed to and from the cancer center

Cost burden and lack of access to affordable transportation are major barriers to treatment compliance. Not surprisingly, recent research shows that Black women are less likely to be offered this therapy as an option for breast cancer treatment. 

Drug Therapy

Chemotherapy

Chemotherapy is any systemic treatment that targets rapidly dividing cancer cells that grow. Some chemo drugs are pills that you take by mouth, while others are put directly into the bloodstream through an IV, a process called infusions.

chemotherapy infusion

 Verywell / JR Bee

Black Women and Chemotherapy Side Effects

Black women are often more likely to experience chemotherapy side effects, for unknown reasons. Studies show that neuropathy—nerve damage that can show up as weakness, numbness or throbbing pain, and itching in the hands and feet during chemotherapy treatment—is twice as likely in Black women compared with White women.

Most of the time neuropathy disappears after chemotherapy, but sometimes it can be permanent.

Neoadjuvant Chemotherapy 

Research has shown that initiating chemotherapy before surgery—what healthcare providers call neoadjuvant chemotherapy—can lead to a precipitous decline in cancer cells.

In order to measure the effectiveness of neoadjuvant treatment, healthcare providers look at the tissue removed during surgery to see if any active cancer cells are present. If there are none, then you are deemed to have a “pathologic complete response,” or pCR. A pCR often means you are more likely to live without cancer returning. Overall survival rates, whether cancer recurs or not, increase as well.

PARP Inhibitors

Poly ADP-ribose polymerase (PARP) enzyme fixes DNA damage in both healthy and cancerous cells. By inhibiting them, you make it more likely that cancer cells will die. The use of this therapy is especially important in those with BRCA1 or BRCA2 mutations, which are more common in Black women.

PARP inhibitors, such as Lynparza and Talzenna, have been approved to treat advanced-stage HER2-negative breast cancer in people with a BRCA1 or BRCA2 mutation.

Immunotherapy

Immunotherapy medicines stimulate the immune system to work harder and smarter to detect and destroy cancer cells. Immunotherapy is sometimes combined with chemotherapy to treat triple-negative cancer, especially when it metastasizes (spreads to other areas of the body). 

The immunotherapy medicine Tecentriq inhibits a protein in the immune checkpoint system that helps cancer cells to hide from the immune system. By inhibiting PD-L1, Tecentriq essentially allows immune system cells to “see” the cancer cells and kill them.

Hormonal Therapy

A lot of attention is put on the high prevalence of treatment-resistant triple-negative breast cancer in Black women, but many Black women have hormone-responsive breast cancers.

Hormone therapy is used to treat cancers that are fueled by hormones like progesterone and estrogen. Hormone therapy uses estrogen- and progesterone-blocking drugs—given by injection or in pill form—to stop or block the body’s natural production of hormones. In some cases, surgical removal of the ovaries or testes may be performed to stop the body’s natural production of hormones.

Hormone therapy is particularly helpful at limiting the growth of breast cancer tumors. 

Antibody Therapy

Monoclonal antibodies are man-made versions of antibodies that target and destroy proteins on cancer cells, specifically the HER2 protein on some breast cancer cells.

Trastuzumab, which is sold under the brand name Herceptin, is used to treat both early-stage and advanced breast cancer. Trastuzumab is often combined with standard chemotherapy, and the drug is placed directly into the bloodstream via an IV.

The monoclonal antibodies Pertuzumab (Perjeta) and Margetuximab (Margenza) are sometimes added to the treatment regimen, especially for advanced cases.

Effect on Black Women 

While Black women and White women get breast cancer at about the same rate, Black women are 40% more likely to die from the disease.

There are many factors that contribute to breast cancer disparities, ranging from social determinants to genetics and tumor biology, but one mysterious phenomenon stands out: Black women are twice as likely to have triple-negative breast cancer, a rarer but more aggressive form that does not respond to hormonal treatment. This explains, in part, the lower breast cancer survival rate among Black women.

The U.S. Preventive Services Task Force (USPSTF) recommends initiating screening mammograms at the age of 50, but this puts Black women at a disadvantage because aggressive breast cancers must be diagnosed and treated early.

Breast Cancer Diagnosis in Black Women

Black women tend to get breast cancer at a younger age than White women. In fact:

  • 23% of breast cancers in Black women are diagnosed before the age of 50, compared with 16% in White women.
  • 8% of Black women are diagnosed with metastatic breast cancer, compared with 5% to 6% of women of other races.

This underscores the importance of starting routine breast cancer screening as early as age 40.

Research also shows that Black women are also most likely to be diagnosed with larger (≥5 centimeters) and more clinically advanced tumors. This means that the course of treatment—which often includes a combination of surgery, radiation therapy, and chemotherapy—is longer and more arduous for Black women.

Breast Cancer Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Home Remedies and Lifestyle

Eating healthy foods is integral to maintaining a healthy weight and homeostasis throughout the body. The Mediterranean diet—consisting of vegetables, fruits, whole grains, fish, and olive oil—has consistently been associated with a decreased risk of breast cancer.

There is also some evidence that those who eat a diet rich in fruits and vegetables and high in dietary fiber have a slightly lower lifetime risk of developing breast cancer.

Much of the research that has included Black women has focused on non-modifiable risk factors like:

  • Higher age
  • Genetic risks
  • Family history of breast cancer
  • Personal breast history
  • Breast density
  • Thorax radiation
  • Number of menstrual cycles during her lifetime

Emphasizing Black modifiable and lifestyle risk factors is essential to developing a strategy for breast cancer prevention and increased treatment efficacy.

Some preventable risk factors for breast cancer include:

  • Smoking: Smoking raises the risk for all cancers.
  • Heavy alcohol use: Having one drink per day has been found to increase breast cancer risk by 7% to 10% in adult women.
  • Obesity: Overweight and obesity are particularly problematic after menopause. Women with a high body weight 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%.
  • Not breastfeeding: Studies suggest that breastfeeding reduces breast cancer risk among women who have had children, and may even be protective of some invasive breast cancer types. 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, underscoring the need to promote breastfeeding as a potential preventive measure to limit breast cancer risk.
  • 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 some 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. 

Some research has pointed to targeted marketing of cosmetics as one reason for the significant rise in cancer rates among Black women. While more research needs to be done, some scientists believe that the cosmetic products that are often marketed to Black women contain endocrine disruptors—such as hydroquinone, diethyl phthalate (DEP), and even mercury—that may put people at a higher risk of cancer.

Some of the most worrisome ingredients in cosmetics are in:

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

Your doctor may suggest that you stop using these products while more research is done on their effects on breast health. 

Complementary and Alternative Medicine (CAM)

The use of yoga, meditation, acupuncture, and even medical marijuana has increased in recent years. The Internet is full of add-on therapies to traditional cancer treatment. These alternative therapies should always be discussed with a healthcare provider so that you do not unknowingly hurt yourself.

Frequently Asked Questions

Is there a cure for breast cancer?

No, although some oncologists will use the terms "cured" or "cancer-free" for breast cancer that remains in remission for five years or more. This means there are no longer signs or symptoms of cancer, even though there may be undetectable cancer cells still in the body that could at some point proliferate again.

How is early-stage breast cancer treated?

Early-stage breast cancer is defined as cancer that has not spread beyond the breast or nearby lymph nodes, so treatment focuses on removing the tumor and destroying any cancer cells in the area. This typically involves breast-sparing surgery or a full mastectomy followed by radiation. Chemotherapy rarely is necessary.

How long will I need to have radiation for breast cancer?

The typical course of whole-breast radiation after a lumpectomy is five days a week for six to seven weeks. The same is true for radiation to the chest wall following a mastectomy. An alternative to the standard protocol is hypofractionated radiation therapy, in which larger doses are given for a shorter amount of time—three to four weeks.

What does it feel like to have radiation therapy for breast cancer?

Radiation itself is painless, but you may experience temporary side effects after a few weeks of treatment. The skin of the treated area may look and feel like a bad sunburn—red, rough, swollen, itchy, and sore. It may eventually peel. You also may feel very tired. These side effects will resolve after you finish your course of treatment.

How long will I need chemotherapy for breast cancer?

This will depend on your particular situation and the chemotherapy medications your oncologist prescribes. That said, typically chemotherapy for breast cancer is given for three to six months, with breaks of a few days or weeks between treatment sessions to allow the body to recover.

How will I feel after my first chemotherapy treatment for breast cancer?

You may feel very tired and nauseous after your first chemotherapy session or you may feel just fine. Chemotherapy side effects can vary depending on the medications used, and they're cumulative: You're likely to experience more side effects as your treatment progresses, which may include fatigue, nausea and vomiting, hair loss, soreness inside your mouth, anemia, and bruising.

Is breast cancer treatment covered by insurance? 

All preventive services, like mammograms and genetic counseling, are covered by health insurance, but unfortunately, many cancer treatments are not. The average cost of treatment is between $20,000 and $100,000. This may seem like an expensive cost, and for many Americans it is, but keep in mind that most cancer regimens require a combination of surgery, chemotherapy, radiation, and sometimes immunotherapy.

Why do Black women have larger breast tumors?

Some research has pointed to race-specific differences in tumor biology as one reason why Black women tend to have larger breast cancer tumors. Triple-negative cancers disproportionately impact Black women and tend to be more aggressive and harder to treat. There is also evidence that when chemotherapy is given it is less effective in Black women, underscoring possible genetic differences that can be ameliorated with personalized medicine.

A Word From Verywell

Black women are disproportionately impacted by aggressive breast cancer, so follow-up care after getting a mammogram or learning you’re in remission is essential to timely treatment. High healthcare costs may be an issue whether you have insurance or not.

Talk to your healthcare providers about cost-saving measures, but be firm in conveying the standard of care you expect—never accept lower-quality care at a lower cost. Also remember to maintain a healthy lifestyle—like eating a healthy diet, exercising, and quitting smoking—throughout your treatment course. This has been shown to help treatment efficacy and improve overall outcomes.

Figuring out the most effective treatment regimen for you may be a challenge because some chemotherapy treatments do not work as effectively in Black women. More inclusive research is needed to discover the types of targeted therapies that work best.

If you think you might be interested in taking part in a clinical trial, talk to your healthcare provider. Discuss the opportunity to participate in clinical trials using targeted therapies, as gene-targeted and immunotherapies have been proven to be safe and effective in improving outcomes of treatment-resistant breast cancers like the triple-negative subtype. Targeted therapies are the future of breast cancer research, especially in treating the subtypes that disproportionately impact Black women, because they work even when chemotherapy does not.

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Article Sources
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  1. American Cancer Society. Surgery for Breast Cancer. Revised September 18, 2019.

  2. American Cancer Society. Should I Get Breast Reconstruction Surgery? Revised September 18, 2019.

  3. American Cancer Society. Radiation for Breast Cancer. Revised September 18, 2019.

  4. American Cancer Society. Chemotherapy for Breast Cancer. Revised September 18, 2019.

  5. American Cancer Society. Targeted Therapy for Breast Cancer. Revised December 23, 2019.

  6. American Cancer Society. Hormone Therapy for Breast Cancer.  Revised September 18, 2019.

  7. American Cancer Society. Managing Nausea and Vomiting at Home. Revised July 29, 2019.

  8. American Cancer Society. Be Healthy After Treatment.

  9. New York Presbyterian. Health matter: What Black women need to know about breast cancer

  10. National Center for Complementary and Integrative Health. Complementary and Integrative Approaches for Cancer Symptoms and Treatment Side Effects: What the Science Says. October 2018.

  11. National Cancer Institute. Understanding cancer prognosis. Updated June 17, 2019.

  12. Albuquerque RC, Baltar VT, Marchioni DM. Breast cancer and dietary patterns: a systematic review. Nutr Rev. 2014;72:1–17. doi:10.1111/nure.12083

  13. Aune D, Chan DS, Greenwood DC, Vieira AR, Rosenblatt DA, Vieira R, Norat T. Dietary fiber and breast cancer risk: a systematic review and meta-analysis of prospective studiesAnn Oncol. 2012;23:1394–1402. doi:10.1093/annonc/mdr589

  14. American Cancer Society. Radiation for breast cancer. Updated September 18, 2019.

  15. Susan G. Komen Foundation. Chemotherapy. Updated May 25, 2021.

  16. American Cancer Society. Chemotherapy side effects. Updated May 1, 2020.

  17. National Cancer Institute. Breast cancer treatment (adult) (PDQ)—patient version. Updated April 8, 2021.

  18. American Cancer Society. DES exposure: Questions and answers. Updated June 10, 2015.

  19. Susan G. Komen Foundation. Side effects of radiation therapy. Updated May 19, 2021.

Additional Reading