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November 8, 2018

Black women are 40% more likely to die from breast cancer than white women. Here's why.

Daily Briefing

    A recent study suggests black women are less likely to adhere to long-term breast cancer treatment than white women, and Niasha Fray—a black woman who used to help others stick to their treatment regimens—is now experiencing the hardship firsthand as a breast cancer patient herself, Mara Gordon reports for NPR's "Shots."

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    Disparities in breast cancer outcomes

    Gordon notes that black women are 40% more likely to die from breast cancer than white women, even though they are less likely to develop breast cancer. According to Gordon, that's because black women are less likely to get mammograms or have health insurance when compared with white women, so they commonly have advanced breast cancer by the time they seek treatment.

    Further, the study, recently published in the Journal of the National Cancer Institute, found that black women with breast cancer who are prescribed endocrine therapy—a 10-year treatment for certain types of breast cancer that can reduce the risk of recurrence by 50%—are less likely to adhere to the therapy than white women.

    The study followed almost 1,300 women with breast cancer in North Carolina who were prescribed endocrine therapy between 2008 and 2013 after undergoing surgery and chemotherapy, radiation therapy, or some combination of the treatments. About 43% of participants identified as black.

    The study found that 10% of black women and white women reported discontinuing their endocrine medication before the conclusion of the treatment. According to the study, about 14% of black women reported skipping doses or not taking the medication as prescribed, compared with 5% of white women.

    Why do black women struggle to adhere to treatment?

    Black women were more likely to encounter obstacles to adhering to endocrine therapy, the study found. For instance, more black women reported having trouble affording endocrine therapy when compared with white women.

    Black women were also more likely to report that the side effects of the treatment, including joint pain and hot flashes, were burdensome when compared with white women, the study found.

    Doris Browne, former president of the National Medical Association, said, "The relationship [black patients] have with their health care providers" also could explain the disparity. According to Browne, if a black patient doesn't feel comfortable with their physician, they are less likely to mention side effects, cost barriers, or any other issues that might prevent them from adhering to treatment. "Patients tend to divulge some of those underlying factors to a provider that is in their own racial and ethnic group," she said, adding, "They have a relationship that seems to be a more open relationship."

    Brown said research has shown black patients have better outcomes with black doctors, but she noted that only 4% of physicians in the United States are black.

    Further, Fray—who used to work with the University of North Carolina, Chapel Hill, to counsel breast cancer patients on sticking to their treatment regimens—said, her patients often mentioned "the stress of being a caregiver" and "the stress of being a black person in America and having doctors not listen to you, having employers that don't care about you."

    Stephanie Wheeler—a lead author of the study and associate professor of health policy and management at the University of North Carolina, Chapel Hill—said, "It's not women's fault" that adhering to endocrine therapy is so difficult, adding, "It's a hard medication to take." She said, "I think we can do a better job supporting women."

    Wheeler adds that therapy, like Fray's motivational interviewing, might provide a solution. Currently, Wheeler and her colleagues are analyzing data on Fray's counseling program to see whether such counseling could help black women better "articulate ... their health goals."

    Becoming the patient

    Fray now is experiencing the difficulty of adhering to breast cancer treatment firsthand. In 2017, Fray found a lump in her breast and was diagnosed with breast cancer. Suddenly, the advice she gave to her patients applied to her, as well.

    According to Fray, who currently is a program director at the Duke Center for Community and Population Health Improvement, breast cancer treatment—and especially endocrine therapy—can be overwhelming.

    "You gotta get your mind right," she said, explaining, "You can't change the scenario or the situation," so one needs to ask, "How do I change my mind?"

    Fray said, "Black women like me have to put on the armor of self-care. We have to create it for ourselves and be intentional about it ... No one is going to do it for us" (Gordon, "Shots," NPR, 10/9).

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