For black women the news is good and bad. Good because black women are significantly less likely (one-third less likely) to develop breast cancer than white women. The bad news is that a higher percentage of black women die from breast cancer than white women. Studies in the US have shown that black women are 30% more likely to die from breast cancer and in the UK it has been shown that black women are two times more likely to die from breast cancer. In addition to this, numerous studies have shown that when black women do get cancer they tend to get it at a much younger age than white women with a recent study in the UK showing that black women are diagnosed with breast cancer 20 years younger than white women, (an average of 46 years old compared to an average of 67 years old for white women).
The key question has been why there is this difference between black and white women and the answer has been confirmed in the past few years. It has been found that black women tend to get a different type of breast cancer called Triple Negative Breast Cancer. This type of breast cancer is found to be three times more common in black women than white women. In addition, studies in the US have found that 20-40% of black women diagnosed with breast cancer have triple negative breast cancer. Whilst studies in Ghana have shown that as many as 60% of women diagnosed with breast cancer have triple negative breast cancer. In Nigeria and Senegal the same trend is seen with 55% of cases being triple negative. A first study in the UK has shown that 22% of black women diagnosed with breast cancer at an East London hospital had triple negative breast cancer.
Triple Negative Cancer is a newly identified type of breast cancer and because of this it is not yet fully understood and there are no specific treatments for it. The current treatments that have been used to successfully treat some of the other types of breast cancer are ineffective in treating triple negative breast cancer. The best treatment option for triple negative breast cancer is surgical removal followed by a combination of chemotherapy drugs but there isn’t yet any formal recommendation of a chemotherapy combination to use for triple negative breast cancer. Much needed work is being conducted to try and understand triple negative breast cancer – why it develops, risk factors and treatment options- with the aim of improving the high
mortality rate associated with this form of breast cancer.
When it comes to breast cancer black women need to be more aware of the facts. The national statistics would have us believe that our rate of breast cancer is in line if not less than normal society but we must look closer. Breast cancer is the most common female cancer in the UK and worldwide. Black women have a significantly lower risk of developing breast cancer but a higher percentage of black women die from breast cancer because we tend to get a more aggressive form of breast cancer called triple negative breast cancer. For this reason it is important that we catch breast cancer early enough to ensure a better outcome. Knowing the signs and symptoms of breast cancer is one way we can ensure early diagnosis, the other way is for the health authorities to develop a more effective screening programme for black women. Ultimately we should be aiming for the prevention of breast cancer and we can make our own contribution towards this by adopting a healthy lifestyle – mind, body and soul. Breast Cancer is the most common cancer affecting women in the UK with approximately 40, 000 new cases diagnosed each year. Recent studies conducted in the UK have highlighted some of the differences that exist in breast cancer survival in the UK with respect to ethnic groups. Paradoxically even though black women are significantly less likely to develop breast cancer than their white counterparts, a higher percentage of black women die from breast cancer than white women. Studies in the US have shown that black women are 30% more likely to die from breast cancer and in the UK it has been shown that black women are twice as likely to die from breast cancer as white women. There are a number of reasons for the increased mortality observed in black women, these include delayed diagnosis and in a number of cases black women being affected by more aggressive forms of breast cancer (triple negative breast cancer and inflammatory breast cancer). In addition, studies have shown that when black women do get breast cancer they tend to develop it at a much younger age with one study showing that black women were on average 20 years younger than their white counterparts when they were diagnosed (an average of 46 years old compared to an average of 67 years old for white women). The more aggressive nature of the disease in black women and the younger age of onset both means the disease can quickly progress to a late stage before it is diagnosed. Taking all of this into account it is extremely important that breast cancer is detected at an early stage in black women. In addition to this another inequality exists and this is in the area of breast screening uptake with uptake being worse amongst black women than white. This has resulted from a community perception that black women are not at significant risk of developing breast cancer and therefore not feeling that there is a need to be screened. To correct these inequalities there is a need for more focused research and policy development to ensure that the health care system provides a service that is relevant to black women with breast cancer. This includes exploring the most appropriate age and method to screen black women, developing culturally appropriate health education programmes in collaboration with community organisations and eliminating any barriers to screening uptake and the timely diagnosis of black women. In addition, there is a need for greater awareness amongst GPs and nurses of the way in which breast cancer affects black women ensuring that there is that realisation the black women may develop this disease at a younger age and that early diagnosis will be of the upmost importance as the risk of developing more aggressive forms are higher. Finally, the collection of data on patients diagnosed with breast cancer needs to be complete and thorough with ethnicity data recorded as well as the type of breast cancer diagnosed especially the hormone receptor status of the tumour. This will allow full statistical evaluation so that the full picture of the epidemiology of breast cancer in black women in the UK can be established; trends monitored and progress on reducing the inequalities easily determined. A good example of a community-health care system partnership to tackle the inequalities specifically the low screening uptake amongst African Caribbean women is the Patient Navigation Project being piloted in South London. The aim of this project is to improve breast cancer awareness and screening uptake in black women in this area and is a partnership between Better Days Cancer Care, Cancer Black Care and the NHS. The PNP is based on the Harold P Freeman Patient Navigation Programme which has been shown to significantly increase uptake of breast screening in low income BME groups in the USA. The full programme, as developed in the USA, has different navigation focus areas for different parts of the cancer diagnosis and treatment pathway. The Better Days Cancer Care programme will focus on community outreach and screening as this is regarded as the biggest deficit in current UK services. Patient Navigators from Better Days Cancer Care and Cancer Black Care will be assigned to work within the community to guide women through the breast screening process; act as advocates; assist in locating relevant resources and support; raise awareness and ensure that any barriers to accessing breast health services are addressed. In this way the factors preventing black women from attending screening will be identified and addressed encouraging more black women to utilise breast screening services. It is hoped that by providing a more personalised approach it will improve the patient experience, ensure early detection and ultimately improve breast cancer survival. It is hoped that following the pilot the Patient Navigation Programme can be expanded to include more London boroughs and other cancers.