Triple-Negative Breast Cancer More Deadly for Black Women

Research has repeatedly shown that Black women have lower breast cancer survival rates than white women. Now, a new study has found that a particularly aggressive form, triple-negative breast cancer, can be especially deadly for Black women.

What Is Triple-Negative Breast Cancer?

Triple-negative breast cancer makes up about 10 to 15% of all breast cancers. The name refers to the fact that the cancer cells do not have receptors for the hormones estrogen or progesterone, and do not make much of a protein called HER2. This means that the cells are negative for all three tests.

Triple-negative breast cancer is aggressive and does not respond to hormonal or other targeted therapies. Compared to other forms of invasive breast cancer, triple-negative breast cancer grows and spreads faster, has limited treatment options, and a worse prognosis.

What the Study Showed

The study, which was published in JAMA Oncology, found that Black women with triple-negative breast cancer have a 28% increased risk of death compared with White women. They also had lower rates of surgery and chemotherapy compared to women of European descent. 

Who Was Included in the Study?

The population-based, retrospective cohort study specifically analyzed data from 23,213 patients who were diagnosed with triple-negative breast cancer between January 1, 2010, and December 31, 2015. Of those participants, 25% were Black and nearly 75% were White.

What the Results Showed

During a 3.5 year follow-up, 3,276 patients (or 14.2%) died of breast cancer. When the researchers looked at the data more closely, they made several key findings:

• The five-year survival rate was about 77% for Black women and about 83% for White women.
• Black women had 31% lower odds of receiving surgery after diagnosis and 11% lower odds of receiving chemotherapy. Even when chemotherapy was used, there was evidence that the treatment was less effective in Black women.
• Black patients were diagnosed at younger ages than White patients (56 years vs. 59 years).
• The tumors of Black women were typically larger and were often diagnosed at more advanced stages and had more lymph node involvement—suggesting the cancer was starting to spread.
• Black patients were more likely to have health insurance through Medicaid and were more likely to live in urban areas, as well as in areas that were more socioeconomically disadvantaged.

Senior study author Ying Liu, MD, PhD, an assistant professor of surgery at Washington University School of Medicine in St. Louis and a Siteman Cancer Center research member, tells Verywell that the researchers accounted for other factors—including patients' socioeconomic and demographic information and health insurance coverage, as well as their cancer's features and treatment.

Even after these factors had been accounted for, Liu says that "the risk of death from breast cancer remained significantly higher in African-American women compared with White women."

Addressing the Disparity

Liu’s study looked at the data and not necessarily at the factors that might be behind the figures. Kimberley Lee, MD, a medical oncologist at Moffitt Cancer Center, tells Verywell that the findings indicate that “Black women are receiving inadequate treatment compared to White women" and that she’s “not surprised” that they’ve had worse outcomes as a result.

Equitable Treatment

One factor that likely affected the data is the disparities in cancer treatment. “The differences in treatment along racial lines include Black women being less likely to receive surgery and being less likely to receive chemotherapy compared to their White counterparts,” says Lee. “These treatments are paramount to properly caring for women with breast cancer.”

The actual type of treatment that the women received also matters. Lee says that while the recent study showed that more Black women than White women are dying from breast cancer, "even when both groups received chemotherapy, we do not know what type of chemotherapy these women received."

Lee adds that “other studies have shown that Black women are more likely to get non-standard or inferior chemotherapy regimens for breast cancer." If that was partially what was happening with the latest research, Lee says that it "may also explain some of the racial differences seen in breast cancer survival.”

More Inclusive Research

Liu says that more research is needed to analyze these cancers in Black women and how efficient their treatment is when they have triple-negative breast cancer. He adds that it's also "important to better understand the roles of treatment details, lifestyles, co-morbid health conditions, and social factors in explaining the excess mortality in African American women."

According to Lee, it's crucial to make sure that Black women get the proper care for their cancer—whether it’s triple-negative or another form. To get there, though, Black women need to be included in the research that could lead to better treatments.

“We also need to improve the representation of Black women in our clinical trials,” says Lee. "Further research is needed to understand the biological drivers of breast cancer and further optimize treatments accordingly.”