A new study published in the Journal of Clinical Oncology sheds light on the troubling racial disparities in breast cancer mortality. While Black and white women are diagnosed with breast cancer at similar rates, Black women are 40% more likely to die from the disease—even for the most treatable types.
“Within health care, there was this notion that an important contributor to disparities was that Black women have higher rates of triple-negative,” Erica Warner, the lead author of the study and a cancer epidemiologist at Massachusetts General Hospital, told NBC News. Triple-negative breast cancer is particularly aggressive and difficult to treat. However, Warner emphasized, “based on these results, it isn’t a significant or even a primary reason” for the differences in death rates.
The study analyzed data from 18 studies that included nearly 230,000 breast cancer patients, 34,000 of whom were Black.Researchers compared the mortality rates of Black women and white women with the same breast cancer molecular subtypes. Subtypes, determined by the type of receptors found on tumor cells, affect how the tumor behaves and how it responds to treatment.
For the most common breast cancer subtype—hormone receptor-positive (HR-positive), HER2-negative, which accounts for 60% to 70% of all breast cancer diagnoses—Black women were found to be 50% more likely to die from the disease than white women. In cases of HR-positive, HER2-positive tumors, Black women were 34% more likely to die.
Even with triple-negative breast cancer, which is challenging for anyone to survive, Black women were still 17% more likely to die than white women—a finding that surprised Warner. “We thought that the hormone receptor-positive tumors is where we would see the biggest disparities and that we would not see a difference in the triple-negative tumors,” she said. “In reality, we saw disparities of similar magnitudes across all breast cancer subtypes that we looked at.”
Economic and Structural Barriers to Care
Dr. Eric Winer, director of the Yale Cancer Center, highlighted the socioeconomic barriers that impact breast cancer survival rates for Black women. “In these cancers, people need to be on extended treatment with hormonal therapy for five years or more, which is often associated with out-of-pocket cost, so economics play a role,” he explained. “People are falling through the cracks, whether that is because they are unable to afford hormone therapy, not as able to take it or not, or not able to pick up their medication.”
Doctors might also be less likely to offer extended treatments to Black or low-income patients. And while not all Black women are low-income or uninsured, statistics from the Centers for Disease Control and Prevention show that Black patients are more likely than white patients to be uninsured.
“There are all these things we don’t tend to think about when we think about treating breast cancer, but they absolutely have an effect,” said Dr. Wendy Wilcox, chief women’s health officer at New York City Health + Hospitals.
Factors like access to quality healthcare, transportation, paid time off, healthy food, and living in areas with fewer pollutants—all play a role in overall health outcomes, Wilcox noted. She also pointed out that Black women have been historically underrepresented in clinical trials, which impacts how well treatment protocols address their specific needs. “From the very beginning, the breast cancer treatment research phase, Black women are not being represented.”
The Importance of Early Detection
Black women are not only more likely to develop breast cancer at a younger age than white women but are often diagnosed at a later stage when treatment options become more limited. “Regardless of subtype it’s about early detection,” said Dr. Marissa Howard-McNatt, director of the Breast Care Center at Atrium Health Wake Forest Baptist in North Carolina. “Black women tend to get breast cancer at a younger age. Screening doesn’t start until age 40, but a lot of Black women can get breast cancer in their 30s.”
She urged women to know their family history. “Anyone who has a history of breast cancer in their family should start screening with mammograms 10 years before a sibling or parent was diagnosed,” Howard-McNatt added. Navigating healthcare systems can be overwhelming, which is why Howard-McNatt emphasized the importance of patient navigators who help patients understand treatment options, schedule appointments, and even arrange transportation. These resources, she said, could significantly reduce the disparities Black women face when battling breast cancer.
Eliminating Racial Disparities in Breast Cancer
While breast cancer mortality rates between Black and white women weren’t always so different, they’ve worsened over time. “If you look at breast cancer data from 40 years ago, there really weren’t differences in mortality for breast cancer between Black and white women. We weren’t very good at treating and diagnosing it. But as we’ve gotten better, the gap between white and Black women has grown,” Warner explained.But Warner sees this as a call to action. “That is problematic, but that also tells us we have our foot on the pedal for these differences. If we can create them, we can eliminate them.”