- Black women are 40% more likely than white women to die of breast cancer.
- The disease is now the leading cause of cancer death among Black women.
- The disparities are particularly acute in the South, experts say.
Lathesia McClenney first noticed a lump in her breast at age 29.
A resident of Wilcox County, Alabama — a rural, majority-Black community southwest of Montgomery — she’d driven 35 miles north to Selma to see a specialist.
After examining her, a doctor said she was too young for concern, despite her great aunt and cousins having breast cancer. He sent her home with a vitamin regimen, she said.
Two months later at a follow-up appointment, clinicians finally performed the necessary biopsy. McClenney had cancer: ductal carcinoma.
Then last year at 45, the social worker grappled with a second diagnosis, this time with triple negative breast cancer, an aggressive type that’s harder to treat.
Black women like McClenney are 40% more likely than white women to die of breast cancer, and the disease is now the leading cause of cancer death among Black women, surpassing lung cancer. Black women are also more likely to be diagnosed at an earlier age and have twice the risk of developing triple negative breast cancer.
“It is a national emergency the way that Black women are dying from breast cancer,” said Dr. Versha Pleasant, an obstetrician and gynecologist who specializes in clinical cancer genetics. She has seen the disparities play out in her own family: her late aunt had breast and uterine cancer, and her great grandmother died of breast cancer.
Breast cancer is among the most well-funded cancers researched. But Black women and people of color are missing from much of the early data and ongoing clinical trials in which today’s effective treatments were tested. Efforts have been underway to diversify clinical trials and ease hesitation caused largely by historical medical injustices Black patients suffered.
Pleasant, a University of Michigan assistant professor, is also director of the Cancer Genetics and Breast Health Clinic at Von Voigtlander Women’s Hospital. She and other experts pointed to the lack of data, and several other layers that contribute to the disparities, including a lack of insurance coverage, socioeconomic and transportation barriers, comorbid health issues, medical biases, and lack of access to care and timely screenings. But these all have a single root.
“Underlying all of these potential reasons, we have to acknowledge that we live in a country where Black bodies are oftentimes undervalued,” Pleasant said. “That is the structural racism component – that there is racism embedded in so many layers of our culture, society, and our healthcare system, unfortunately. It manifests in this really terrible way.”
The disparities are particularly acute in the South, experts say. The region, where more than half of the nation’s Black population lives, has high rates of uninsured patients and poverty.
A study published in Cancer Causes Control found Black breast cancer deaths were more concentrated in Southern counties.
The researchers mapped mortality by county and found the majority of cancer death “hot spots” were in Southern, poor counties. The majority of the hot spots for Black women were in the South, with many along the Mississippi River, said lead author Justin Xavier Moore, an epidemiologist at the University of Augusta’s Georgia Cancer Center. Other clusters were in North and South Carolina, Southern Virginia, Georgia and Texas. For Hispanic women, these hot spots were in the Southwest as well as Florida.
In these counties, “Black and Hispanic women were more likely to have lower household income and higher unemployment,” Moore and his colleagues wrote. Hot spot counties for Black women also had larger portions of adults “who couldn’t visit the doctor within the past year due to cost,” as well as higher rates of no insurance.
“That’s why place matters,” Moore told USA TODAY. “Because they’re living in communities in which they have been disenfranchised.”
Overall, Black women living in southern states have the highest breast cancer death rate in the nation, researchers including Moore noted in another study published last year.
Sandra Melvin is an epidemiologist and CEO of the Institute for the Advancement of Minority Health in Mississippi, where the mortality rate for Black women with breast cancer is more than 50% higher than white women.
Melvin said lack of transportation to screenings throughout rural parts of her state is a significant barrier to early detection and care.
“If you can’t pay for something, if it’s going to cost you something to go and be screened, you’re less likely to go – and you’re less likely to go until it has progressed to the stage that it’d be harder to treat,” she said.
Dr. Ryland Gore, an Atlanta-based breast surgical oncologist said by the time many of her Black patients reach her, the cancer is more advanced.
“When it’s found, it’s oftentimes too late,” she said. “Especially my Black patients. Unfortunately, they’re more likely to present with stage three or four disease.”
Gore sees many patients who drive to her from rural parts of Georgia, where 1 in 5 women lack health insurance and the breast cancer death rate among Black women is roughly 40% higher than white women.
“Most of my young patients, their tumors are triple negative. Most of my African and African American patients, their tumors are triple negative,” she said, recalling her youngest patient, a 19-year-old woman.
Like McClenney, Gore said several of her patients have tried to seek care early but were dismissed – told they were “too young” to have cancer and weren’t tested.
“It makes me angry. And it makes me very sad. Because those times where they’ve shown up for themselves and tried to advocate for themselves, it represents an intervention point – and it represents a missed opportunity,” said Gore, who is starting her own practice. Gore also noted while male breast cancer is less common, Black men also have a higher risk of developing it.
Fear and a culture of silence can also hinder important conversations about family history within households, she and Pleasant said.
That was the case in the family of Karen Jackson, founder of Sisters Network, a Texas-based advocacy and survivorship support organization. Jackson, 79, survived breast cancer four times. She coined the group’s slogan “stop the silence” to encourage women to share their family history and get screened early.
Her own late aunt had a double mastectomy “and nobody knew about it,” she said.
“A baseline should be given to any woman who feels that there’s something going on in their breasts,” said Jackson, who started the organization while undergoing treatment for her first diagnosis in 1993. “Because most of us are diagnosed without family history some reasons (are) because we don’t know our family history.”
Between 2016 and 2020, Black women were also diagnosed at higher rates than white women in McClenney’s Alabama, as well as Mississippi, Louisiana and Virginia, according to the American Cancer Society.
“We still have this huge divide,” said Gore. “When I read these studies, I feel like I’m in a matrix – how is this still happening in 2022?”
Since her diagnosis last year, McClenney started the first Alabama chapter of Jackson’s group, the Sisters Network. She hopes to continue to raise awareness of mobile mammogram units, to encourage health systems to continue and grow such efforts, and advocate for Black women while supporting each other through and post-illness.
“Oftentimes women are just not aware of those resources that are out there to support them and help them,” she said.
“A lot has been done,” McClenney said. “There’s still work to do.”