Disparities in Breast Cancer Associated With African American Identity

Abstract

Persistent disparities in the burden of breast cancer between African Americans and White Americans have been documented over many decades. Features characterizing breast cancer in the African American community include a 40% higher mortality rate, younger age distribution, greater advanced-stage distribution, increased risk of biologically aggressive disease such as the triple-negative phenotype, and increased incidence of male breast cancer. Public health experts, genetics researchers, clinical trialists, multidisciplinary oncology teams, and advocates must collaborate to comprehensively address the multifactorial etiology of and remedies for breast cancer disparities. Efforts to achieve breast health equity through improved access to affordable, high-quality care are especially imperative in the context of the COVID-19 pandemic and its disproportionately high economic toll on African Americans.

Practical Applications

  • Racial/ethnic identity, rurality, social determinants of health, allostatic load, genetics/genomics, access to care, and clinical trial enrollment opportunities contribute to breast health disparities.
  • Disparities in breast cancer treatment and survival have been extensively documented between African American and White American women.
  • The younger age distribution of breast cancer in women, higher incidence of triple-negative breast cancer, and higher incidence of male breast cancer among African Americans suggest that the genetics of African ancestry also contribute to the explanation of disparities.
  • Allostatic load is the biologic impact of chronic environmental challenges that trigger stress signals, leading to heightened neuroendocrine response and epigenetic changes; associations between allostatic load and systemic racism may also account for breast cancer disparities.
  • Racial/ethnic diversity in clinical trial accrual is necessary to enhance pertinent safety data and vital to advancement in therapeutics.

TABLE 1. Demographic Characteristics of Breast Cancer and Risk Factors for Incidence/Outcome, Stratified by Race/Ethnicity

ASCO Educational Book
Author(s): Erica M. Stringer-Reasor, MD1; Ahmed Elkhanany, MD1; Katia Khoury, MD1; Melissa A. Simon, MD2; and Lisa A. Newman, MD, MPH, FACS, FASCO3
Affiliations: 1Division of Hematology Oncology, Department of Medicine, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; 2Department of Obstetrics and Gynecology and the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL; 3Department of Surgery, Weill Cornell Medicine/New York Presbyterian Hospital Network, New York, NY
Citation: American Society of Clinical Oncology Educational Book 41 (May 27, 2021) e29-e46.

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