Breast cancer toll among black women fed in part by fear, silence

Sandra Yates knew.

As soon as she felt the pea-size lump in her breast, she was sure it was cancer. Still, she refused to acknowledge it. She wouldn’t go to the doctor. She didn’t tell anyone. And when Breast Cancer Awareness Month rolled around that fall, she wanted no part of it.

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“I would turn down the radio or change the channel on the TV when an ad came on. I was flipping pages in magazines,” she said. “I didn’t want to hear it. I wasn’t trying to put on no pink ribbons. That wasn’t me.”

It would be nearly nine months before she told herself it was time to act. By then, the lump was the size of a small egg. The diagnosis was Stage 3 breast cancer.

Yates, a witty, fiercely independent woman who raised two daughters on her own, doesn’t seem the type to back down from a challenge. Doctors and advocates say the fear that kept her from acting quickly is all too common among black women. It is among the factors that contribute to a disturbing trend: Although they are less likely than white women to get breast cancer, black women are more likely to die from it. The difference in mortality began to emerge in the early 1980s. By 2007, according to the American Cancer Society, even though rates for both groups were going down, death rates were 41 percent higher among African American women than among white women.

Some health-care professionals and advocates contend that the disparate mortality rates argue for a more urgent effort to reach more black women. They are frustrated that, with all of the information available about the importance of early detection and treatment, the statistics remain so dire.

In a survey focusing on African American women by The Washington Post and the Kaiser Family Foundation, 75 percent of black women rated their health as good or excellent, about the same percentage as white women, black men and white men.

Health data, however, tell a different story. Across the country, women of color report higher rates of disease and health problems, are more likely to be uninsured and have had fewer doctor visits for preventive care. A 2009 Kaiser study noted “consistently higher rates of health challenges among black women, ranging from poor health status to chronic illness to obesity and cancer deaths.”

For breast cancer in particular, experts cite some additional factors: Black women often get their diagnoses at later stages and appear to be more susceptible to aggressive tumors. They also have a higher rate than white women of a diagnosis before age 40.

Poverty and racial inequities are the primary factors driving the disparity, according to a study released Wednesday at a breast cancer forum sponsored by the Avon Foundation. The study, which compared mortality rates between black and white women in the nation’s 25 largest cities, states that “nearly five black women die needlessly per day from breast cancer” because they don’t have information about the importance of breast screening and they don’t have access to high quality care. The authors of the study, conducted by Sinai Urban Health Institute and published Wednesday in Cancer Epidemiology, said genetics play only a small role in the disparity.