Breast Cancer in Hispanic/Latina Women

The disease can strike earlier and be more aggressive

In the United States, the rate of breast cancer in Hispanic/Latina women is lower than in non-Hispanic white women. (The incidence is even less in Hispanic/Latina women who were not born in the country.) But those statistics can be deceiving. Not only is breast cancer the leading cause of cancer deaths in Hispanic/Latina women living in the U.S., as it is for all women in America, but the disease tends to affect these women at a younger age (premenopausal breast cancer) and is more aggressive in them than in many other populations.

Unfortunately, the low rate often means that Hispanic/Latina women and their healthcare providers are less likely to worry about the disease.

If you are a Hispanic/Latina woman, understanding the signs of breast cancer and how breast cancer affects those with your background could help save your life. There are limited studies about breast cancer in Hispanic/Latina women, but that is beginning to change, and more information about breast cancer in this population is becoming available.

Causes and Risk Factors

A 2018 study identified breast cancer genes that are more common among women of Hispanic/Latino descent. While this doesn't completely explain the increase in breast cancer rates when women of this ethnic background move to the United States, different genetic tendencies could provide some information about why the disease is different in women of Hispanic/Latino background.

Beyond that, though, the differences between Latinas in and outside the United States suggests that there could be lifestyle and environmental factors that contribute to the development of the disease in these women as well.

For instance, women who use high-dose estrogen oral contraceptives for family planning may have an increase in their risk of breast cancer. Studies suggest that women living in Latin America may not have the same exposure to oral birth control as women of Hispanic/Latina background in the United States.

In terms of environmental exposures, one study found that agricultural exposure to chemicals was higher among Hispanic/Latina women who had breast cancer in the U.S. than among women who did not have breast cancer.

Screening and Diagnosis

Screening mammograms are the leading method of identifying early breast cancer. According to a National Cancer Society Survey, only 61 percent of Hispanic/Latina women over age 40 reported having a screening mammogram in the two years prior to the survey, compared to 69 percent of black women and 65 percent of white women.

There are several explanations for this, including a lack of health insurance, limited access to health care, and unfamiliarity with the health care system in the United States. Language barriers also play a role.

Furthermore, experts have suggested that the lower incidence of the disease in peers outside the U.S. means that Hispanic-American women with ties in Latin countries may be less likely to know someone who had the disease, which naturally makes these women less concerned that it could happen to them.

Breast cancer self-examination, which can detect lumps and breast changes, is obviously something everyone can do. But Hispanic/Latina women do not frequently seek medical attention for breast lumps.

Hispanic/Latina women are more likely to seek care for breast cancer in an emergency situation, once advanced-stage breast cancer begins to cause pain. At this stage, the disease is usually less treatable and usually has a worse prognosis.

Disease Stage and Prognosis

Not only do Hispanic/Latina women have lower utilization of screening mammography, but many also delay following up on abnormal screening tests. The resulting delay in the treatment of breast cancer in Hispanic/Latina women affects the prognosis. With time, tumors become larger and are more likely to spread to other areas of the body, requiring more extensive treatment and making them more difficult to eradicate.

But there are other factors besides delayed attention that affect breast cancer prognosis in Hispanic/Latino women.

Differences in the Disease

Hispanic/Latina women are more likely to develop breast cancer before menopause. Breast cancer has more aggressive features in Hispanic/Latino women, whether premenopausal or postmenopausal, than in others.

Features of breast cancer in Hispanic/Latino women include:

  • Advanced stage: Cancer stage describes how substantial the breast cancer is and how far it has spread. Advanced stage cancer is large and may have metastasized (spread to other tissues).
  • Higher grade: Breast cancer grade describes the microscopic features of cancer, including how fast the cells multiply and how different they are from normal breast cells. High-grade breast cancer is more likely to grow, spread rapidly, and recur after treatment than low-grade cancer.
  • Hormone receptor negative (HR-): Breast cancers that have estrogen or progesterone hormone receptors may shrink with medication. Hispanic/Latina women tend to have HR- breast cancer, which does not improve with hormone-modifying medication.
  • Human epidermal growth factor receptor 2 positive (HER2+): A protein that can be detected in breast cancer cells, HER2 is associated with a worse breast cancer prognosis. Hispanic/Latina women are more likely to be diagnosed with HER2+ breast cancer than others.

These differences have a major impact on a woman's treatment options, side effects of treatment, and prognosis. It isn't quite clear why breast cancer in Hispanic/Latino women is more aggressive, and hopefully, further studies will clarify the best treatments for these types of cancers.

Treatment

Another issue for Hispanic/Latina women is that they are less likely to receive appropriate and timely breast cancer treatment when compared to non-Hispanic white women. This issue may have a number of contributing factors.

Delays in treatment or inadequate treatment could be due to language barriers, healthcare access, and cost, or to a bias on the part of the healthcare team. It is also possible that some Hispanic/Latina women might not seek care after being diagnosed with breast cancer.

Many women, regardless of race or ethnicity, are concerned about the side effects of treatment (e.g., nausea, hair loss, vomiting, and decreased energy), which may keep them from seeking it. It is possible that side effects related to appearance may be of particular concern for Latina women, as 75 percent say that looking their best is an important part of their culture, according to a Univision study on Latina attitudes and behaviors related to beauty.

When it comes to a population of individuals, the group may have some common characteristics, but each individual woman, her family, and her health care team can have a unique set of issues that affect the medical and surgical treatment of her breast cancer.

Solutions

Hispanic/Latina women respond well to community-based breast cancer awareness programs, which leads to better outcomes. This is especially true when programs are led by Hispanic/Latina women, particularly survivors who can speak to the need for early detection and treatment.

Having hospital patient navigators that follow patients from diagnosis through treatment, making sure they keep appointments and helping them navigate a complicated healthcare system, can help women adhere to their treatment regimen. Bilingual navigators can improve communication between the surgeon and the oncologist and the woman (as well as her family), which helps reduce a woman's level of anxiety.

A Word From Verywell

If health care and support for Hispanic/Latina women with breast cancer is to improve, breast cancer awareness outreach needs to happen in communities where Hispanic/Latina women gather for meetings or social events, such as schools, houses of worship, and community centers. Materials need to be in Spanish and community educators, preferably survivors, ideally need to be an ethnic and cultural match to the women living in those communities.

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