There is a health care disparity between African American women white women, especially with breast cancer.
Dr. Lauren McCullough, Assistant Professor of Epidemiology at Rollins School of Public Health, discusses this disparity and how to reduce breast mortality among African American women.
Selected Podcast
Breast Cancer Disparities
Featuring:
Lauren McCullough, PhD, MSPH
Lauren McCullough, PhD earned her PhD from University of North Carolina at Chapel Hill in North Carolina. She obtained a Master's of Science in Public Health from Meharry Medical College in Nashville, Tennessee. Transcription:
Bill Klaproth (Host): Doctors from Emory’s Glenn Family Breast Center at Winship Cancer Institute advocate that women be aware of their breast health and family history and be proactive about their healthcare. African Americans in particular, have the highest mortality rate of any racial and ethnic group for all cancers combined and for most major cancers. Here to talk with us about racial disparities and cancer prevention, breast cancer detection and breast cancer outcomes is Dr. Lauren McCullough, a member of the cancer prevention and control research program at Winship Cancer Institute.
Dr. McCullough, thank you so much for your time today. So, as I mentioned, mortality rates are twice as high among African American women than white women. What factors impact this health disparity issue?
Lauren McCullough PhD, MSPH (Guest): Well there are a number of different factors. I think one that’s most common is that African American women are diagnosed at later stages. So, generally, we have a higher portion of African American women that are diagnosed at stage three and stage four and those tumors are usually more aggressive thus leading to higher mortality rate. There are a number of other reasons including sociodemographic factors, access to care, adherence to treatment, all of those things play a vital role in the disparity and breast cancer mortality.
Bill: So, why are African American women being diagnosed at a later stage?
Lauren: So, the research on that is still up for debate. Some investigators have found that black women may have delays in their screenings and so that causes interval cancer so, interval cancers are those that show up in between your normal mammogram screening. And those cancers tend to be more aggressive. It’s also thought that there are some biologic differences. Black women are more likely to have triple negative breast cancer which is a type of breast cancer that does not have any targeted therapies and is typically also more aggressive. So, there are a number of factors that range from biologic to social demographic that causes women to present at much later stages.
Bill: So, the mortality rate is twice as high. Women are being diagnosed at a later stage. Just trying to get this in focus. Are more African American women getting breast cancer as well as compared to white women?
Lauren: So, no, actually black women are about four percent less likely to develop breast cancer than white women. I will say that that number was a lot bigger so, black women have – we have seen increases in the incidence of breast cancer among black women over time, but right now, their incidence rate is no higher than a white woman. So, they are pretty comparable in terms of incidence, but the mortality disparity is really where we are focusing.
Bill: And does Georgia and the southeast have more rates of breast cancer in non-white women as compared to the nation?
Lauren: So, in comparison to the US, African American women in the southeast region do not have a more substantial risk of developing breast cancer. There is some evidence to suggest that the mortality is much higher than compared to African American women in other geographic regions, but in terms of incidence; they are pretty much on par with the nation.
Bill: So, how has breast cancer occurrence among non-white women changed over time then?
Lauren: So, over time, it has increased. When you sort of look at the trends, white women have always been more likely to develop breast cancer than an African American woman; but over time, that gap has closed. So, now African American women are almost just as likely as their white counterparts to develop breast cancer. And the reasons for that are multifactorial. We know that there are a number of epidemiologic risk factors for breast cancer including those related to reproductive characteristics like age at menarche, age at first birth, parity, breast feeding or lactation as well as lifestyle factors like diet, physical activity and obesity. And so, it’s suggested that changes in some of those lifestyle and reproductive factors within the African American community is what has caused that incidence to increase over time to where it is now comparable with that of a white woman.
Bill: So, then how should we address healthcare disparities in the African American population when it comes to breast cancer?
Lauren: So, I think the biggest thing to think about is the huge disparity in breast cancer mortality. So, one angle would be that women actually get screened. They go and get their mammogram one time. They get to know your breasts. Different primary care physicians have different sort of thoughts about self-breast exam, but I think in general, what most people would agree with, is that you should know your breasts. You should know when there is something suspicious and seek advice about that. That will do one thing which is if you do have a suspected lesion; then hopefully, we are catching it at an earlier stage where it is more amenable to treatment. So, that’s one. Number two is that I think women should be aware of what the treatment options are. You should talk to your clinician about what’s right for you. There are a number of tests that are available in the genetic space that can tell you whether or not you are going to be at a high risk of recurrence. And you should ask your clinician about those things and whether or not they are available to you if you are diagnosed with breast cancer. And finally, adherence is a big issue. I think joining social support groups or having family members that can accompany you to treatments or keep up with the treatments particularly those that are in the adjuvant setting can be really helpful because there are available therapies that we know will reduce mortality and reduce recurrence risk, but they are not going to work if you are not getting them. So, making sure that you are being adherent to your treatment regimen.
On the incidence end, I think the typical things that we think about eating well, getting enough exercise, trying to regulate our body weight are all important things to think about in terms of decreasing your risk of breast cancer.
Bill: So, when it comes to screening, as you were talking about that, I was thinking do more African American women skip it or delay it because it sounds like early detection is really a big part of the process and really a key to those mortality rates. Is that right?
Lauren: Yeah, so that’s a common thought in terms of thinking about these late stage breast cancers. The CDC’s data actually shows that black women are as likely as white women to get screened, but those data may not be as precise as we would like them to be. So, we don’t know if that’s just that they are getting screened or that they are getting screened on time and so a lot of those questions are still open for debate. But just based on the CDC data; it does suggest that African American women are getting screened and equal proportions as white women.
Bill: And you were mentioning earlier ways to decrease risks of breast cancer. What about for someone who may have it in their family, family history of breast cancer, someone who may be at a higher risk; how should that person approach screening and self-testing?
Lauren: Right, so there are a number of different guidelines around screening particularly if you have a family history of breast cancer. I would definitely advocate talking to your clinician and making them aware of your family history; that way you all can decide on the best avenue for screening for you. There are also a number of genetic tests that can be done to see if you are at increased risk of breast cancer based on a number of genes, BRACA I and BRACA II sort of being the most well-known of those. So, I think the best thing to do is to one, know your family history of breast cancer. Often in the African American community, we don’t talk about cancer and it’s important to know whether or not you do have a history of breast cancer in your family. That way you can be your best advocate when you go to talk to your primary care physician.
Bill: Well Dr. McCullough, thank you so much for your time today. This has been very informative and for more information please visit www.emoryhealthcare.org/cancer, that’s www.emoryhealthcare.org/cancer. You’re listening to Advancing Your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Doctors from Emory’s Glenn Family Breast Center at Winship Cancer Institute advocate that women be aware of their breast health and family history and be proactive about their healthcare. African Americans in particular, have the highest mortality rate of any racial and ethnic group for all cancers combined and for most major cancers. Here to talk with us about racial disparities and cancer prevention, breast cancer detection and breast cancer outcomes is Dr. Lauren McCullough, a member of the cancer prevention and control research program at Winship Cancer Institute.
Dr. McCullough, thank you so much for your time today. So, as I mentioned, mortality rates are twice as high among African American women than white women. What factors impact this health disparity issue?
Lauren McCullough PhD, MSPH (Guest): Well there are a number of different factors. I think one that’s most common is that African American women are diagnosed at later stages. So, generally, we have a higher portion of African American women that are diagnosed at stage three and stage four and those tumors are usually more aggressive thus leading to higher mortality rate. There are a number of other reasons including sociodemographic factors, access to care, adherence to treatment, all of those things play a vital role in the disparity and breast cancer mortality.
Bill: So, why are African American women being diagnosed at a later stage?
Lauren: So, the research on that is still up for debate. Some investigators have found that black women may have delays in their screenings and so that causes interval cancer so, interval cancers are those that show up in between your normal mammogram screening. And those cancers tend to be more aggressive. It’s also thought that there are some biologic differences. Black women are more likely to have triple negative breast cancer which is a type of breast cancer that does not have any targeted therapies and is typically also more aggressive. So, there are a number of factors that range from biologic to social demographic that causes women to present at much later stages.
Bill: So, the mortality rate is twice as high. Women are being diagnosed at a later stage. Just trying to get this in focus. Are more African American women getting breast cancer as well as compared to white women?
Lauren: So, no, actually black women are about four percent less likely to develop breast cancer than white women. I will say that that number was a lot bigger so, black women have – we have seen increases in the incidence of breast cancer among black women over time, but right now, their incidence rate is no higher than a white woman. So, they are pretty comparable in terms of incidence, but the mortality disparity is really where we are focusing.
Bill: And does Georgia and the southeast have more rates of breast cancer in non-white women as compared to the nation?
Lauren: So, in comparison to the US, African American women in the southeast region do not have a more substantial risk of developing breast cancer. There is some evidence to suggest that the mortality is much higher than compared to African American women in other geographic regions, but in terms of incidence; they are pretty much on par with the nation.
Bill: So, how has breast cancer occurrence among non-white women changed over time then?
Lauren: So, over time, it has increased. When you sort of look at the trends, white women have always been more likely to develop breast cancer than an African American woman; but over time, that gap has closed. So, now African American women are almost just as likely as their white counterparts to develop breast cancer. And the reasons for that are multifactorial. We know that there are a number of epidemiologic risk factors for breast cancer including those related to reproductive characteristics like age at menarche, age at first birth, parity, breast feeding or lactation as well as lifestyle factors like diet, physical activity and obesity. And so, it’s suggested that changes in some of those lifestyle and reproductive factors within the African American community is what has caused that incidence to increase over time to where it is now comparable with that of a white woman.
Bill: So, then how should we address healthcare disparities in the African American population when it comes to breast cancer?
Lauren: So, I think the biggest thing to think about is the huge disparity in breast cancer mortality. So, one angle would be that women actually get screened. They go and get their mammogram one time. They get to know your breasts. Different primary care physicians have different sort of thoughts about self-breast exam, but I think in general, what most people would agree with, is that you should know your breasts. You should know when there is something suspicious and seek advice about that. That will do one thing which is if you do have a suspected lesion; then hopefully, we are catching it at an earlier stage where it is more amenable to treatment. So, that’s one. Number two is that I think women should be aware of what the treatment options are. You should talk to your clinician about what’s right for you. There are a number of tests that are available in the genetic space that can tell you whether or not you are going to be at a high risk of recurrence. And you should ask your clinician about those things and whether or not they are available to you if you are diagnosed with breast cancer. And finally, adherence is a big issue. I think joining social support groups or having family members that can accompany you to treatments or keep up with the treatments particularly those that are in the adjuvant setting can be really helpful because there are available therapies that we know will reduce mortality and reduce recurrence risk, but they are not going to work if you are not getting them. So, making sure that you are being adherent to your treatment regimen.
On the incidence end, I think the typical things that we think about eating well, getting enough exercise, trying to regulate our body weight are all important things to think about in terms of decreasing your risk of breast cancer.
Bill: So, when it comes to screening, as you were talking about that, I was thinking do more African American women skip it or delay it because it sounds like early detection is really a big part of the process and really a key to those mortality rates. Is that right?
Lauren: Yeah, so that’s a common thought in terms of thinking about these late stage breast cancers. The CDC’s data actually shows that black women are as likely as white women to get screened, but those data may not be as precise as we would like them to be. So, we don’t know if that’s just that they are getting screened or that they are getting screened on time and so a lot of those questions are still open for debate. But just based on the CDC data; it does suggest that African American women are getting screened and equal proportions as white women.
Bill: And you were mentioning earlier ways to decrease risks of breast cancer. What about for someone who may have it in their family, family history of breast cancer, someone who may be at a higher risk; how should that person approach screening and self-testing?
Lauren: Right, so there are a number of different guidelines around screening particularly if you have a family history of breast cancer. I would definitely advocate talking to your clinician and making them aware of your family history; that way you all can decide on the best avenue for screening for you. There are also a number of genetic tests that can be done to see if you are at increased risk of breast cancer based on a number of genes, BRACA I and BRACA II sort of being the most well-known of those. So, I think the best thing to do is to one, know your family history of breast cancer. Often in the African American community, we don’t talk about cancer and it’s important to know whether or not you do have a history of breast cancer in your family. That way you can be your best advocate when you go to talk to your primary care physician.
Bill: Well Dr. McCullough, thank you so much for your time today. This has been very informative and for more information please visit www.emoryhealthcare.org/cancer, that’s www.emoryhealthcare.org/cancer. You’re listening to Advancing Your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.