Breast cancer: confronting a major killer of black women - includes related information about warning signs and sources of help

Ebony, Oct, 1997 by Laura B. Randolph

Every woman wants to know: Will I get breast cancer? For Black women in particular, the question has a special urgency since researchers have found that we are twice as likely as White women to die from the disease.

These are the facts:

* Breast cancer is the leading cause of cancer death among African-American women between the ages 30 and 54.

* Black women develop the disease at a younger age then White women.

* Breast tumors may be more aggressive in Black women (In a recent study of 1,200 Black and White women with breast cancer, researchers at George Washington University Hospital found that, although treatment varied little, Black women typically had more aggressive cancer cell types. Said Robert Siegel, medical director of the hospital's cancer center: "We didn't find a single area in which White women tended to have more aggressive tumors than Black women. It's disturbing and unexplained").

* For Black women, the five-year, post-diagnosis survival rate in only 69 percent, compared to 84 percent for White women.

* Breast cancer deaths among Black women are rising while they are falling among White women (between 1989 and 1993, mortality rates among Whites decline about 6 percent, while rates among black women increase 1 percent, says the National Cancer Institute).

* Although White women are more likely than Black women to get breast cancer, Black women who get the disease face twice the risk of dying from it.

What's behind these chilling statistics? Why do far more White women survive the disease than Black women? And how do we explain why breast cancer deaths among Black women are rising when they are falling among White women?

While recent studies suggest that breast cancer might appear in a more deadly form among Black women, experts, activists and breast cancer survivors agree that a substantial part of the difference in the survival rates of Black an White women comes down to one simple fact: Breast cancer in White women are detected at earlier stages than they are in Black women. That finding is so crucial, doctors say, because the earlier the detection of the disease, the better the odds of beating it. In fact, the National Cancer Institute reports that when breast cancer is diagnoses at a local stage (confined to the breast), a whopping 96 percent of the women who get it will live.

The obvious question: Since we know early detection can almost surely save our lives, why are Black women failing to seek treatment until the disease is more advance, when our tumors are larger and treatment is more difficult? The answers are dismaying. For one thing, say experts, Black women lack access to cancer prevention educational programs, early screening and early care. As More-house Medical School President Dr. Louis W. Sullivan put it when he was Secretary of Health and Human Services: "Minority women, particularly Black women, do not have sufficient access to breast cancer information or screening facilities."

Zora Kramer Brown, a breast cancer survivor who founded the Washington, D.C.-based Breast Cancer Resource Committee in 1989, agrees with Dr. Sullivan, but believes there is a second, equally troubling reason why the mortality rate is higher among Black women. The fact is, says Brown, breast cancer research, not to mention the whole national breast cancer movement, has focused more on White women than Black women. "We don't have enough clinical trial research on African-American women to understand the biology of the disease as it affects us," says Brown, who discovered her cancer through a routine self-exam.

How, then, can Black women protect themselves and what, if anything, can we do to reduce our risk of developing the disease? Since breast cancer cannot yet be prevented and most breast cancer risk factors cannot be modified, experts agree there is only one answer: Black women must educate themselves with the vast amount of information that is available and then use that information to take care of themselves. It is imperative that they do monthly breast self-exams, get mammograms, stop disregarding evidence of breast problems and get past their fear.

"Patients are often afraid of finding out the truth," says Dr. Robert DeWitty Jr., associate professor of surgery at Howard University and a general surgeon specializing in surgical oncology. "Many women tell me they don't do breast exams because they don't want to know. I tell them not knowing doesn't help but knowing can very likely save their lives."

Dr. Vivian Pinn, director of the Office of Research of Women's Health at the National Institutes of Health, agrees. "I tell Black women they must get past their fear and do everything in their power to defend against this disease," says Dr. Pinn who, during her tenure as president of the National Medical Association, made breast and cervical cancer screening for African-American women a personal priority. "Mammography may not be perfect yet, but it is still the best technique we have to detect breast cancer early."