Health Disparities and Breast Cancer

September 24, 2021

The content below is provided by VCU Massey Cancer Center, a sponsor of H4TG’s A Calendar to Live By. An abridged version of this content appears in A Calendar to Live By 2022.

Author:

Vanessa B. Sheppard, Ph.D.

Associate Director for Community Outreach, Engagement and Health Disparities at VCU Massey Cancer Center; Theresa A. Thomas Memorial Chair in Cancer Prevention and Control

The National Cancer Institute defines cancer health disparities as adverse differences between certain groups of people in various measures, including the number of new cases, number of existing cases, cancer-related health complications and deaths, survivorship and quality of life, screening rates and stage at diagnosis. Disproportionately affected populations may be characterized by race, ethnicity, disability, gender and sexual identity, geographic location, income, education, among other factors. People who have limited financial resources, lack health insurance, and are medically underserved with limited access to health care and racial/ethnic minority backgrounds such as African Americans (Black), American Indians/Alaska Natives and Latinos often endure a greater burden of disease than the general U.S. population.  

Addressing disparities and promoting health equity is a priority of VCU Massey Cancer Center. This is because we recognize the unique opportunity to serve our catchment area — central, eastern and southern areas of Virginia — by focusing on those groups most affected by cancer. Of approximately 4 million residents who live in Massey’s catchment area, more than 40% identify as racial/ethnic minorities and more than half live in a rural area. Compared to white women in these areas, Black women have a higher mortality rate for breast cancer. Additionally, Latino/Latinx residents living in these parts of the state have more than double the incidence of breast cancer and nearly three times the overall cancer mortality as Latino/Latinx residents who live in other parts of Virginia.

One way that Massey works to address disparities is through community outreach and engagement (COE). COE activities, coordinated by Massey’s Office of Health Equity and Disparities Research (OHEDR), include monitoring and communicating the cancer burden in our catchment; educating residents about and navigating them to appropriate screenings and treatment-guiding research opportunities; and supporting policy initiatives that can improve cancer outcomes for all Virginians with an emphasis on those disproportionately impacted by cancer.

Screening/Diagnosis

Over the years, there has been a steady decline in breast cancer cases overall, but an inconsistent decline across various populations. Black women in the U.S. experience double the rate of triple negative breast cancer — an aggressive form of disease — compared to white women, while Latina women are exponentially more likely to be diagnosed with advanced breast cancer. There has also been an increase in breast cancer diagnoses among younger women, who are also more frequently diagnosed with triple negative breast cancer. The good news is that when cancers are caught earlier survival outcomes are better. It is critical that women take charge of their health by staying up to date on mammograms, knowing their family history and genetic risk and practicing healthy lifestyle choices, including maintaining a healthy weight and exercising, avoiding tobacco and eating plant-based foods, among others.

Treatment

Not all breast cancers are the same, and where you go for your treatment matters. Nationally, African American women experience greater delays in the time between diagnosis and surgery or pre-surgical treatments. These delays are not just because women wait, but often because they experience systemic barriers that prevent them from getting timely diagnosis and treatment. I think it’s very important that women have access to and understand the information needed to ask questions and understand their treatment options. But it’s just as important that they don’t delay treatment. Some women experience delays because they’re told they’re too young to have breast cancer. It is important that women have a healthcare team that they trust, listens to them and takes action regarding their concerns. If you are diagnosed with breast cancer, a multidisciplinary breast health care team offers patients the best opportunity for high-quality treatment, access to innovative clinical trials and support services, compassionate care and hope for the best possible outcome.

Clinical Trials

Clinical trials offer patients early access to the latest promising cancer therapies not yet available elsewhere, and nearly all of today’s cancer drugs were tested using clinical trials. However, Black and Latino/Latinx cancer patients are significantly less likely than white patients to enroll in a clinical trial testing a new treatment for their cancer, and, racial and ethnic minorities are vastly underrepresented in trials. Increasing minority participation in clinical trials is a vital way to address and potentially overcome many of the disparities and barriers that currently exist in cancer screening, care and survivorship.If diagnosed with cancer, ask about clinical trials that may be a fit for you. It is often an opportunity to have access to even more medical care, be exposed to new information or even participate in a study that may provide more survivorship support.

Research

To really have an impact on reducing cancer disparities through research, it is critical to conduct community-engaged research focused on biological, clinical and social determinants of disparities, and it is necessary to increase study participation of minority and underserved groups.

As an NCI-designated cancer center, Massey is known for its state-of-the-art research. We are committed to conducting research that helps reduce or even eliminate disparities in cancer outcomes. The OHEDR launched the Cancer Disparities and Minority Health Research Initiative to facilitate transdisciplinary research collaborations, with the ultimate goal of improving cancer outcomes in Virginia.

The OHEDR launched the Virginia Living Well Research Registry, which works with communities to collect health and lifestyle behavior information and factors related to social determinants of health from residents to help guide the development of more effective cancer prevention and control information, programs and services.

The OHEDR COE team also facilitates research that is relevant to meeting the needs of African American women through studies focused on promoting exercise and health diets, updating genetic counseling and testing in those at increased risk of hereditary breast or ovarian cancer and facilitating patient-centered care to support treatment adherence. Other efforts include emphasizing the needs of rural cancer survivors and addressing disparities among minority men and the growing Hispanic/Latinx populations in Virginia.

Community partnerships are central to the OHDER COE team. Here for the Girls is a valued partner, participates in our yearly breast health forum and has added valuable feedback to ongoing initiatives. Currently, our team members are collaborating to help extend the reach of Here for the Girls to meet the needs and priorities of African American women in Virginia. This is an important and timely initiative!

For more information about the community research and outreach efforts at Massey, visit www.masseycancercenter.org, email masseycrrc@vcuhealth.org or call 804-827-0000.

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