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Exploring Disparities in Breast Cancer Treatment for Women of Color

Exploring Disparities in Breast Cancer Treatment for Women of Color

When it comes to breast cancer, the statistics paint a stark reality for women of color. Non-Hispanic black women face a higher mortality rate compared to other racial groups, highlighting the pressing need for targeted interventions to address these disparities.

The Importance of Timely Treatment

Metastatic breast cancer poses a unique challenge for women of color, as they are less likely to receive treatment adhering to national guidelines. Dr. Grace Suh emphasizes the role of access to healthcare and health education in fueling these disparities, underscoring the need for comprehensive interventions.

Medical centers are actively working to bridge the gaps in screening, diagnosis, and treatment disparities based on race. Despite these efforts, a significant gap in health equity still persists, calling for continued advocacy and action.

Best Practices for Metastatic Breast Cancer

Experts recommend systemic drug therapies for metastatic breast cancer, tailored to each individual’s unique biological factors. Hormone therapy, chemotherapy, targeted therapy, and immunotherapy are among the treatment options, emphasizing the importance of personalized care.

Factors Influencing Treatment Decisions

Various health conditions can impact the choice of breast cancer treatment, such as cardiovascular risk factors, diabetes, and autoimmune conditions. Physicians must carefully consider pre-existing medical issues to ensure the effectiveness and safety of the selected treatment plan.

Identifying Health Disparities

Barriers to care, physician bias, and fear of treatment contribute to disparities in breast cancer treatment for women of color. Socioeconomic factors, coupled with inadequate access to healthcare services, further exacerbate these challenges.

Advocating for Quality Care

Empowering patients to advocate for the best breast cancer care is essential in addressing disparities. Initiating open discussions with healthcare providers, addressing personal obstacles to treatment, and maintaining ongoing communication can lead to improved outcomes and tailored treatment plans.

Enhancing Patient Support

Seeking support for mental health, childcare, transportation, and other essential needs is crucial in ensuring holistic cancer care. Patients should feel empowered to communicate their challenges and seek assistance from healthcare professionals to address barriers to treatment.

The Path to Health Equity

Reducing racial disparities in breast cancer treatment requires a multi-faceted approach, encompassing education, advocacy, and patient-centered care. By addressing systemic issues and promoting equity in healthcare access, we can strive towards better outcomes for all women facing breast cancer.


Many women of color face disparities in breast cancer treatment, with non-Hispanic black women experiencing higher mortality rates. Access to healthcare, personalized treatment plans, and patient advocacy are crucial in addressing these disparities. By exploring the factors influencing treatment decisions and advocating for quality care, we can work towards achieving health equity for all individuals affected by breast cancer.


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Many women suffer from breast cancer. But the disease is deadlier for non-Hispanic black women. And when it comes to metastatic breast cancer, women of color are less likely to receive timely treatment that follows national guidelines.

According to Grace Suh, MD, medical director at Northwestern Medicine Cancer Center Delnor, lack of access to health education and regular medical care is a big part of what is fueling this disparity. And medical centers are actively trying to find and correct differences in breast cancer screening, diagnosis and treatment that fall along racial lines.

“Still, despite all of these efforts, there is still a significant gap in health equity,” Suh ​​says, “and we recognize that.”

Here's some of what we know so far about what affects breast cancer treatment in women of color.

What are best practices for metastatic breast cancer?

Medical experts meet and agree on what type of treatment is best for certain diseases. These national guidelines are often called best practices, standard care, or standard therapy.

Systemic drug therapies are often the ideal option for breast cancer that has spread to other parts of the body, also known as stage IV or metastatic breast cancer. But surgery and/or radiation therapy may be beneficial for some people.

Treatment of metastatic breast cancer typically includes one or more of the following medications:

  • Hormone therapy
  • Chemotherapy
  • Targeted therapy
  • Immunotherapy

But metastatic breast cancer is not the same in everyone.

“In general, these are actually multiple different diseases,” says Sarah Schellhorn, MD, breast oncologist at Yale Cancer Center and Smilow Cancer Hospital and associate professor of medicine at Yale School of Medicine. “And we tailor the therapy based on the biology and what's causing the cancer.”

The types of medications your doctor chooses for you depend on factors such as whether your cancer is aggressive, fueled by hormones, or whether you test positive for HER2 (a protein that helps cancer cells grow). But they will also consider how the treatment will affect your overall health and well-being.

What health conditions affect breast cancer treatment?

Treatment can shrink your tumors, decrease symptoms caused by cancer, and help you live longer. But these are strong medications that have side effects. Sometimes a pre-existing medical problem can influence the type of treatment your doctor thinks is best.

“One of the problems is that you have to be healthy enough to receive chemotherapy,” Schellhorn says. “And that's not really a yes or no question. But you have to be able to give enough chemotherapy to treat the cancer, but not so much that it harms someone or decreases their quality of life.”

These are some health conditions that may affect your breast cancer treatment:

Cardiovascular risk factors. Common cancer treatments can be “toxic to the heart,” Schellhorn says. For example, some therapies may make it harder for the heart to pump blood or may speed up other heart and blood vessel problems.

Heart problems caused by cancer drugs can return to normal if you ever stop treatment.

But if you already have a weak heart or are at risk for cardiovascular disease, your doctor may need to delay your care while you talk to your cardiologist. Or they may opt for a non-standard treatment with fewer cardiac risks.

In general, black and Hispanic women are more likely to have other health problems that affect the heart and blood vessels. These usually include:

  • Obesity
  • Diabetes
  • Hypertension

Diabetes. Anticancer medications can cause or worsen neuropathy. That is a common nervous condition among people with diabetes. It causes problems such as numbness, tingling, and weakness, usually in the fingers and toes.

“If someone has diabetes, I would be very careful about prescribing a medication that could cause or worsen their neuropathy,” Suh ​​says.

Medications given along with chemotherapy, such as steroids, can also cause blood sugar to rise.

Autoimmune conditions. Immunotherapy drugs “rev up” the immune system to kill cancer cells, Schellhorn says. But that can cause other problems if you are one of the 10% to 30% of people with cancer who already have an overactive immune system.

That means your doctor may think twice before giving you newer medications, such as immunotherapy, if you have lupus, rheumatoid arthritis, multiple sclerosis, or other autoimmune conditions.

Other factors affecting breast cancer treatment

Here's a breakdown of a few more reasons why women of color may not receive standard care when it comes to metastatic breast cancer:

Barriers to care. Due to racial disadvantages, many blacks live in poverty. And low-income women are less likely to have a primary care doctor, health insurance, or easy access to breast cancer follow-up care.

And some women of color may not have jobs that offer paid time off or medical leave. “People forgo care or delay it because they can't afford to stop working,” Suh ​​says.

Physician bias. Studies show that some doctors look down on black people and those from poorer backgrounds compared to white people or people with a lot of money. But we need more research to know how this type of judgment could fuel racial and ethnic differences in breast cancer treatment.

There is no evidence that doctors routinely choose non-standard treatments because they are concerned that people will not be able to afford them. But it is possible?

“I'd love to say that never happens because we don't see the costs,” Schellhorn says. “But I'm sure it is.”

Fear of treatment. According to Suh, communities of color often face a lot of stigma when it comes to mental health treatment. And someone with uncontrolled anxiety or depression may say no to chemotherapy, surgery, or other standard-of-care therapy.

“Often, we try to encourage (people) and help alleviate some of these fears,” Suh ​​says. “But if their anxiety is overwhelming, sometimes they will choose not to seek medical care. And they are also lost to follow-up.”

How to Advocate for the Best Breast Cancer Care

There is still a long way to go to reduce racial disparities in breast cancer treatment. But there are steps you can take to get the best care.

Ask about the details of the treatment. You may not know what the standard of care is for your type of breast cancer. But it's okay to ask your doctor about it. Go a step further and ask them to explain exactly why you are receiving one treatment instead of another.

“I try a lot to have that conversation,” Schellhorn says. “This is the standard of care. This is what worries me about using standard treatments with you. Here's why I think another breast cancer treatment option is better for you.”

Mention personal obstacles to treatment. Financial strain may not be a priority for your oncologist. But it's something you should mention. No one should delay or avoid treatment because of cost. Your cancer care team can help you apply for drug assistance programs or otherwise find funds.

“There are a lot of resources we can tap into,” Suh says. “But it doesn't happen automatically.”

You can also tell your doctor that you are having problems in other ways that are not specifically related to the cancer itself. Ask to speak to a social worker, navigator, or financial counselor if you need:

  • Mental health support
  • Help with childcare
  • Transportation to and from treatment.
  • Healthy foods for you and your family.
  • Assistance with your housing or utility bills.
  • Legal or financial help
  • Interpreter services

Keep the conversation going. You may need to constantly weigh the pros and cons of medication side effects and your quality of life. And when it comes to continuing treatment, the final decision is yours.

“Some (people) say, listen, I don't want to have chemotherapy. Others say: I want to live as long as possible,” says Schellhorn. “That is a very personal decision that requires a frank conversation with the (person) and the oncologist.”

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