Breast Cancer and African American Women
...omen. For nearly all factors analyzed, the researchers identified race-specific differences among the cancers, and tumors from African American women almost always exhibited more aggressive characteristics than those from whites. For example, 13 percent of white women had stage III or higher diseases, while nearly 20 percent of African American women had this level of advanced disease. The odds of having a higher-grade tumor, an indication of aggressiveness as judged by microscopic examination of cells, was more than five times higher for black women than for white women. The findings from the Fred Hutchinson study lay the groundwork for future studies to identify the specific risk factors that cause tumors from African American women to develop dangerous characteristics, which could lead to new strategies to prevent and treat the disease. The use of oral contraceptives, particularly at a young age and for long periods of time, is a factor affecting the risk for breast cancer in African American women (Oisson & Borg, 1998). It is clear that young black women have had a higher rate of early oral contraceptive pill (OCP) use than young white women. This trend has continued from the mid-1970s through at least the early 1990s and is even noted in the very young women aged 15-17 according to the cited data from 1982. The early use of OCPs by young women, especially young black women, could certainly account for part of the increase in breast cancer in young black women. It should also be noted that many young black and white women have used OCPs either before a first-live birth or after an induced abortion, making them especially vulnerable since they would now have two risk factors (Oisson & Borg, 1998). Studies have shown that early OCP use, especially when used before a woman has ever had a child, increases the risk of breast cancer. In 1990, a scientist named Andrew Borg conducted an analysis on women who took OCPs. Borgs’ meta-analysis showed women under age 45 who had taken OCPs for four or more years prior to their first term pregnancy had a 72% increased of breast cancer. Some studies have also suggested that use before the first pregnancy is a risk factor for breast cancer development and high survival rates in African American women. Many characteristics of oral contraceptive use in black women are similar to those seen in white women. However, it tends to be higher in black women (Oisson & Borg, 1998). Approximately 80% of women of childbearing age in either race have used oral contraceptives at some time in their reproductive life. The average duration of use is similar in black and white women (5 years), and the proportion of long-term (more than equals 10 years) users is also similar (15% to 20%). The only notable differences in usage patterns are a consistently earlier age at the start of oral contraceptive use by black women and a lower incidence of use before the first pregnancy by black women. These two characteristics would have potentially opposite effects on the development of breast cancer. Currently, the actual influence of oral contraceptive use on the risk for breast cancer in black women compared with white women awaits further epidemiologic studies that more clearly define the importance of specific usage patterns on cancer risk. PERCENT OF WOMEN AGE 15-19 USING ORAL CONTRACEPTIVES Abortion Rates also contribute to the high survival rate in African American women (Campbell et. al., 1998). The table below shows the abortion rates for both black and white women for different age groups. Data on the abortion rate in young black women became available in 1981, and the rates of abortion for this period as well as for the 1990-91 periods are shown. Young black women obviously had a higher rate of abortions performed early in a woman's reproductive life than young white women. Although few statistics are available from the 1970s, it is highly probable that this trend was also true for the 1970s. One can also see that very young blacks (ie, those under 15) have an especially high relative rate of abortion compared to young whites specifically they have more than five times the abortion rate at this age, for both the 1981 and the 1990-91 time periods (Campbell et. al., 1998). ABORTION RATES IN YOUNG WHITE AND BLACK WOMEN Young black women also have more early live births than young white women, causing them to be more at risk of dying from breast cancer, but those who have a live birth, in any given year, are almost always different women than those who had received an abortion that year. Young black women have a higher abortion rate as well as a higher birth rate than young white women. It is also likely that many women who had an abortion performed early in their reproductive life, especially those under age 15 and many of those aged 15-17, will be choosing to abort their first child. These young women would be at an especially high risk, since the risk of having an abortion before a full term birth in young women has been noted to carry a 150% increased risk according to at least one large study. BLACK WOMEN AND RISK OF NON-SPECIFIC OCP USE Specific studies of the oral contraceptive pill and breast cancer has shown interesting facts about breast cancer survival rates among young black women. The table above presents a number of specific studies regarding OCP use and young blacks. The noted results should certainly be taken seriously, especially since each of then is statistically significant. These studies have shown that early OCP use could carry a serious risk at affecting the survival rates among African American women. When researchers commented upon the probable connection between early OCPs, abortion and breast cancer when taken/performed in young women, it was already noted that oral contraceptive use before a first pregnancy and abortion before first term pregnancy could be risk factors. Campbell also noted that "below age 45, the higher rates (of breast cancer) in blacks than in whites in recent years have been hypothesized to reflect more frequent abortion and use of oral contraceptives among young women". Lastly, Mayberry noted that "..the higher breast cancer incidence rate among young black women may be explained by a higher prevalence and duration of oral contraceptive use". There have been many questions between researchers regarding whether or not breast cancer cases are worse in African American women than in Caucasian women. Steven Joyner estimated that when comparing white and black women who had breast cancer, black women had between a 70-90% increased risk of dying from breast cancer than white women, independent of the stage in which the cancer was diagnosed. He also found that black women had a 2.3 fold risk (ie, a 130% increased risk) of having estrogen negative breast tumors. [In general, estrogen negative tumors respond more poorly to treatment than do estrogen positive tumors (Joyner, 1994). Some have argued that the difference in breast cancer mortality between black and white women is a reflection of the different standards of care of women who have different incomes. Although this statement could certainly be true, it does not answer the question as to why in general, black women have more aggressive breast cancer than white women, nor does it answer the question of why breast cancer mortality rates are have risen faster in young black women than in young white women. In addition, several studies have shown that African American women consume more alcohol than most Caucasian women which can also contribute to the increased amount of deaths related to breast cancer in African American women (ACS, 1994). These studies all come to the same conclusion: drinking alcohol is a risk factor for developing breast cancer. And, most importantly, it doesn’t take much to have an effect. Study authors reported that less than one drink a day on average increased an African American postmenopausal woman’s chances of dying from breast cancer by 30% compared to Caucasian menopausal women who did not consume any alcohol. This large study, performed by the American Cancer Society and which followed both black and white women in the United States for over 14 years, did not show any evidence that women who were either about to enter menopause or were premenopausal had any increased risk of dying from breast cancer due to alcohol use. However, other studies suggest that African American premenopausal women who drink alcohol do have an increased risk of breast cancer, so women in this group cannot yet dismiss the link between alcohol and breast cancer. More research is needed to answer this question decisively. In the outcome of the study, more African American women were known to consume more alcohol than Caucasian women. It always pays to be prudent when it comes to your health, and that applies to alcohol and breast cancer. Excessive drinking will cause many problems, and it can certainly have negative effects when it comes to developing breast cancer or surviving it. People don’t realize it, but the biggest factor contributing to the increased amount of breast cancer deaths in African American women is their lack of knowledge about the disease. We recently passed around a survey about the knowledge of breast cancer and were shocked to find out that many African American girls don’t know as much about breast cancer as they should. A similar study was conducted a few years ago in which it included a review of breast cancer research targeting young African American women and 214 existing breast health education materials, 33 regional focus groups and 240 telephone surveys with young women. A follow-up Harris Poll telephone survey with 522 women confirmed many of the ideas and practices revealed in the needs assessment. Some of the key findings of the study were: • More than half of young African American women are not performing monthly breast self-examinations (BSE). • Young African American women inaccurately believe that breast cancer can be prevented. • More than half of young African American women do not believe that they are at risk for breast cancer. • Forty percent of young African American women incorrectly believe that mammograms prevent breast cancer rather than screen for the disease. According to the study, more than half of the women surveyed do not perform monthly BSE, citing that they are unsure of how to do the procedure, do not remember to doe the exam, or simply don’t have the time. The study also found that there are few relevant, targeted breast health materials for young women and that these women prefer to receive breast health information from their doctors or other health care providers. Nearly 70% of the women surveyed tried to seek out information on breast cancer and trust their health care provider as a credible source. Many doctors and breast cancer awareness programs are developing more educational programs about breast cancer for young and old African American women. With these programs, it is expected to reach young women at an early age and empower them to adopt life-long, positive breast health habits. In conclusion to this research proposal, there are many factors that contribute to the increasing amount of deaths in African American women as opposed to Caucasian women who are affected by breast cancer. The different studies conducted show how these factors are related to African American women and how they are related to Caucasian women. Overall, until further studies can prove otherwise, African American women are at more of a risk of dying from breast cancer. Included in this paper are questions and answers that you may have regarding breast cancer whether you are black or white. Breast cancer is a serious disease and should not be overlooked. Questions and Answers How Can You Be Tested For Breast Cancer? Mammography Mammograms are x-rays focused on the breast. Mammography is most often used as a screening tool for breast cancer in a woman who has no symptoms. Though mammograms do not show every breast mass, it is a very good tool for initial screening. There is a general consensus that women age 50 and older should get a mammogram annually. There is some controversy as to how often women age 40-50 should have a screening mammogram, but the American Cancer Society now recommends a mammogram every year for women over 40. During a mammogram, the breast is compressed or flattened and an x-ray is taken, producing a black and white image of the breast. A radiologist will then look at the x-ray focusing on areas of calcium deposits (also called calcifications or micro-calcifications) or masses. Mammography can also be used as a diagnostic tool to evaluate changes in the breast found on examination. How often and when should the Breast Self Exam (BSE) be done? Experts recommend monthly self-examination of the breasts. The BSE should be done 7-10 days from the beginning of your menstrual cycle. If your periods are not regular, perform the BSE on the same day each month. How is the BSE done? 1. Start by standing in front of a mirror. Inspect each breast separately. Note any asymmetry of size, contour, color, or shape. 2. Raise your hands over your head. Note any changes, particularly in the skin, such as wrinkling, dimpling, or retraction in a specific area. 3. Lie down with a pillow under your right shoulder and place your right arm behind your head. 4. Place the finger pads of the three middle fingers of the left hand on the outer part of your bare right breast. 5. Using small dime-sized circular motions without lifting your fingers, press first with light pressure then with medium pressure, and finally with firm pressure. You should be able to feel different layers of breast tissue using these different pressures. Make note of any masses or abnormalities that you feel. 6. In this same fashion, examine all areas of the breast and chest area from the collarbone to below the breast and including the armpit. You can do this by going in lines, circles around the nipple, or wedges from the nipple. Whichever method you choose, do it the same each time. 7. Once you are finished examining the breast, gently squeeze the nipple and look for any discharge. (Note: Overstimulation of the nipple may cause a normal discharge). 8. Switch positions and examine the left side in the same way. What Happens if a Suspicious Lump is Found? While a mammogram or examination can identify a suspicious lump or mass, neither test can establish with certainty the presence of cancer. Biopsy (obtaining cells or tissue from the tumor) is the only way to tell if cancer is really present. In some cases, a more detailed mammogram or ultrasound may be completed prior to biopsy. What are the factors that place a woman at increased risk of breast cancer? The risk of breast cancer increases gradually as a woman gets older. However, the risk of developing breast cancer is not the same for all women. Research has shown that the following factors increase a woman’s chance of developing this disease: Personal history of breast cancer—Women who have had breast cancer are more likely to develop a second breast cancer. Family history—A woman’s chance of developing breast cancer increases if her mother, sister, and/or daughter have a history of breast cancer (especially if they were diagnosed before age 50). Certain breast changes on biopsy—Having a diagnosis of atypical hyperplasia (a noncancerous condition in which cells have abnormal features and are increased in number) or lobular carcinoma in situ (LCIS) (abnormal cells found in the lobules of the breast) increases a woman’s risk of breast cancer. Women who have had two or more breast biopsies for other benign conditions also have an increased chance of developing breast cancer. This increase is due to the condition that led to the biopsy, and not to the biopsy itself. Genetic alterations—Specific alterations in certain genes (BRCA1, BRCA2, and others) increase the risk of breast cancer. These alterations are rare; they are estimated to account for no more than 10 percent of all breast cancers. Reproductive and menstrual history—Evidence indicates that: — The older a woman is when she has her first child, the greater her chance of developing breast cancer. — Women who started menstruating at an early age (age 11 or younger), experienced menopause late (after age 55), or never had children are also at an increased risk of developing breast cancer. — Women who take hormone replacement therapy for a long time also appear to have an increased chance of developing breast cancer. Breast density—Breasts appear dense on a mammogram if they contain many glands and ligaments (called dense tissue), and do not have much fatty tissue. Because breast cancers nearly always develop in the dense tissue of the breast (not in the fatty tissue), older women who have mostly dense tissue on a mammogram are at an increased risk of breast cancer. Abnormalities in dense breasts can be more difficult to detect on a mammogram. Radiation therapy (“x-ray therapy”)—Women who had radiation therapy to the chest (including the breasts) before age 30 are at an increased risk of developing breast cancer throughout their lives. This includes women treated for Hodgkin’s disease. Studies show that the younger a woman was when she received her treatment, the higher her risk of developing breast cancer later in life. Diet and lifestyle factors—Diet is thought to play a role in breast cancer risk, although researchers have not yet identified specific dietary factors that affect risk. D...