breast cancer in African American Women

Breast Cancer Is Most Aggressive in African American Women
Breast cancer is the second leading cause of deaths in American women, with lung cancer being the first. It is the most common cancer in women not including non-melanoma skin cancers. Breast cancer is a group of related diseases in which cells in the breast, most commonly in the lining of the milk ducts or milk producing glands become abnormal and divide without control or order as a normal cell would. When cancer cells break away from the original tumor and enter the blood stream or the lymphatic system, secondary tumors may form, invading or damaging other parts of the body including vital organs. According to the World Health Organization about more than 1.2 million people are diagnosed with breast cancer a year worldwide. The WHO also states that there were 7.6 million deaths related to breast cancer in 2008, which was a huge 6.4 million rise from the deaths in 2001 that’s an estimated 625,000 new cases of invasive breast cancer, including stages 1-4 were diagnosed among women in the United States. Another
55,400 were diagnosed with Ductal Carcinoma in Situ, (DCIS) a noninvasive breast cancer. DCIS is the earliest form of breast cancer, confined to the milk ducts of the breast. Although much less common of course, breast cancer also occurs in men. It was estimated that there will be 40,600 deaths related to breast cancer, with 40,200 in women and only 400 deaths in men in the United States. The incidence rate of breast cancer (number of new breast cancers per 100,000 women) increased approximately 4% during the 80’s but leveled off to 100.6 cases per 100,000 women in the 90’s. The statistics rose 40% by the twenty-first century.
These risk models were based on population averages. Each woman’s breast cancer risk may be higher or lower depending upon several factors such as family history,
Genetics, age of menstruation and other factors that have not yet been identified. While breast cancer is less common among younger women, younger women tend to become victims of more aggressive forms of breast cancers than older women, which may explain why survival rates are lower in younger women. All women are at risk for developing breast cancer. The older a woman is of course the greater the risk of developing it. Approximately 77% of breast cancer cases occur in women over 50 years of age.
According to the Surveillance, Epidemiology, and End Results (SEER) Program of the National cancer Institute, White, African American and Hawaiian women have the highest incidence of invasive breast cancer in the United States. African Americans are more likely to be diagnosed with a later stage of breast cancer than white women. Breast cancer is more aggressive in African American women for many reasons. Like in all women family history or genetics can be a factor in breast cancer, but in African Americans they have a higher incidence rate at earlier ages, they are diagnosed with more severe forms of breast cancer and there are higher death rates among African American women.
Everyone has the BRCA1 gene included in their d.n.a. Not to say that everyone will get breast cancer but it is the mutations that are caused by genetics and family history that in the future may develop cancers in someone. Outlined in a study done at the Center for Clinical Cancer Genetics at the University of Chicago, out of 26 distinct BRCA1 pathogenic mutations, including protein- truncating, disease- associated missense, and splice variants, detected in African Americans 15 (58%) have not been previously reported. In addition, 18 deleterious (meaning that there is something missing from the d.n.a) mutations have been identified and 56% of these are unique to the group. There have been several deleterious mutations reported in at least two un related families and mutations that have been characterized by haplotype studies and each likely arose from a common ancestor including one ancestor that could be traced back to the Ivory Coast in West Africa.
Although only a few African American families were tested for the mutations, the probability of finding a mutation is invariably dependent on the age of onset and the number of breast cancer and/or ovarian cancer cases in that particular family. The Psychosocial implications of genetic testing for African Americans have not been well studied, so that high risk African Americans may underestimate their risks of cancer.
Human genetics information is complex, abstract, and technical, requiring that receivers of genetic-related information be literate if understanding is to occur. One study found that when parents receive information about a prenatal diagnosis of sex chromosome abnormality, 26.2 % of parents reported that reading materials were not helpful because they were too scientific and clinical to understand which can make it harder for parents to figure out the d.n.a. abnormalities that may lie in their children.
Since the media began reporting about a “breast cancer gene,” women have increased their efforts to seek information about their individual breast cancer risk. Evidence suggests that messages have failed to convey which women are more likely to be at greater risk in association with genes and breast cancer incidence. “Many of these women will/may not have a family history that suggests the presence of a highly penetrant breast cancer susceptibility gene. However, a small subset of such women will come from families with a striking incidence of breast and other cancers often associated with inherited mutations”(Litton, 2011, p 4).
The research may lead to a better understanding of what causes the aggressive subtype of breast cancer, said dr. Eric Winer, director of the breast oncology center at Dana-Farber Cancer Institute in Boston, although he was not directly involved in the study. He said it is unclear whether this subtype is occurring because of an inherited predisposition or because of something in the environment that black women are more likely to be exposed to . He added that disparities in access to treatment still probably account for much of the higher mortality rate among young black women. In the study death rates remained higher for younger black women even when the basal -like subtype cases were removed from the data that suggested that other factors outside of genetics play a big role in the disparity of breast cancer. Biology is only part of the puzzle.
Women with inherited mutations may benefit greatly from awareness of genetics research in their decision to seek testing. Women without a family history may impose unnecessary fear, and undue emotional and financial burdens on themselves, perhaps increasing perceptions of cancer fatalism while decreasing perceptions of self-efficacy with regard to breast cancer incidence.
Besides the fact that African American women are prone to higher risk breast cancers because of the way it is passed down through their ancestry, they also have a higher incidence rate of breast cancer starting at younger stages in life. It was noted in a clinical study done by Janice Phillips at the University of Chicago Medical Center, that African American women age 45 and younger with breast cancer are more likely to have tumors characterized by poor prognostic factors, increasing the risk for recurrence and higher mortality rates. Women younger than 40 years are under the recommended age requirements for mammography screening, the gold standard for the early detection of breast cancer. To date, no established preventative measures exist for breast cancer, so therefore, the greatest hope for reducing breast cancer mortality and improving breast cancer survival lies in early detection and prompt follow up treatments. After conducting the study they found that twelve of the twenty participants had a personal history of breast cancer and eight of them had a family history of breast cancer.
For women with a known history of breast cancer, the age at which they were diagnosed ranged from 20 to 37 years. Thirteen of the women were unmarried. All had at least a high school education and nine had a college degree. Five of the women were on Medicaid and 14 women had private insurance. One participant reported having a state-issued women’s health card for women’s health services only. Eight participants had a first-degree relative with breast cancer. Seven had two first degree relatives with breast cancer and two had three or more first degree relatives with breast cancer.
Presently there are cases of women younger than 40 being diagnosed with breast cancer. These women are as young as in their early twenties. Although the chances of a woman so young getting breast cancer is very rare, it’s not completely unheard of. Young women are more than likely to be treated more aggressively for breast cancer than older women. Since they have barely had regular breast screenings or mammograms they are less likely to detect early stage tumors. Young age in African American women is an independent risk factor for recurrent cancer as well, outside of the evidence of a family history of cancer or a genetic predisposition to have BRCA gene mutations.
Starting menstruation cycles at an early age, environments and lifestyles are all factors in pre-menopausal African American women being diagnosed with breast cancer more than other races because of biological and hormonal changes inflicted on the body at an early age.
Besides the fact that African American women are prone to breast cancer at an early age, they are also diagnosed with more severe forms of the disease. This is why Caucasian women are more reported in having cancer but African American women somehow are diagnosed with worse forms of the mutation than Caucasian women are. Researcher Dr. Ruth O’Regan has been involved in a study at Emory university’s Winship Cancer institute that shows women from African decent are more affected by triple-negative breast cancer an aggressive form of breast cancer that affects black women twice as frequently than white women.
Reasons that are commonly unknown by the public, such as tumor biology also cause African American women to be prone to worst types of breast cancer. There are certain characteristics in the actual cancer tumor itself that play apart. Tumor grade is a histological grade that is typically scored as a three level variable. It is based on the Scarff Bloom Richardson System, where patients with grade three tumors have lower survival rates than those of levels one and two. 57% of African American women who are diagnosed with breast cancer possess a level three tumor, compared to white women which more than 10% less of them contain high level tumors.
Estrogen and Progesterone receptors are also characteristics in tumors. Women with Estrogen and Progesterone positive receptors have a higher rate of survival than those that contain Estrogen or Progesterone negative receptors. Again, (SEER) data collection 12-15% more of African American women contained the negative receptors than white women. African American women have a distinct tumor phenotypes characterized by aggressive molecular characteristics. To date, there are few clues to identification of genetic or non-genetic factors that may predict this early onset, aggressive breast cancer in African-American women.
Targeted efforts to determine risk factors for aggressive breast cancer in African-American women will likely lead to identification of women who are susceptible, particularly at a younger age, and enhance efforts for targeted screening and preventative interventions. Furthermore, evaluation of risk factors while accounting for factors related to socioeconomic status may also elucidate the proportion of higher mortality that may be accounted for by tumor characteristics.
The lessons learned from gene expression studies in breast cancer are leading us in the direction of more clinically relevant, molecular classifications of this disease and provide us with new tools and a different perspective with which to address the disparities and ethnic differences that have been described for breast cancer patients. Given the biological diversity and spectrum of clinical behaviors and outcomes that can be seen in a single population, it seems likely that racial differences will ultimately be explained by differences in the molecular and genetic alterations that caused tumors in these populations and drive the clinical course of the disease. Finally, a better understanding of the key molecular determinants and genetic alterations that underlie clinical behavior in these different populations will almost certainly lead to more rational and objective criteria to guide the selection of appropriate and effective therapies for breast cancer patients.
One of the most common reasons why fatalities among African American women are more evident than in other races is from the lack of resources and finances to afford treatment when they are diagnosed. Cancer was once assumed to be a death sentence because the disease was often incurable, but a new survey suggests the crisis for many today is paying for available treatments. The American Cancer Society says that 20 percent of people diagnosed with breast cancer who have insurance still are not able to afford the care they need to live. A survey, jointly conducted by ACS and the Kaiser Family Foundation, includes 20 profiles of cancer patients and their struggles to find affordable medical coverage. The survey, based in part on requests for financial assistance received by the American Cancer Society, found several consistent factors facing those who otherwise had medical insurance. They include high cost-sharing, where the cancer patient is responsible for some of the expense; caps on insurance benefits that are far lower than what today's cancer treatments can cost; and limitations on policies when an employee becomes too sick to work. For decades, doctors assumed the lower survival rate was due primarily to societal issues. Societal issues no doubt play a significant role in death rates, researchers say. Some published studies show that black women are far less likely to get regular mammograms than white women, which could lead to delayed diagnoses and complicate treatment. Most importantly, that black women were less likely to have health insurance, and therefore less likely to get mammograms that can spot early, and highly treatable, cancers. Health care access is still considered a part of the problem. A large percentage of women do take precaution to perform their own self-exams regularly and talk to the health care professionals that they can because they may already be aware of a family history of breast cancer. But with the aggressiveness of some breast cancers a self-check isn’t always enough. Sometimes women don’t even know what they are feeling for because not only can they not afford proper health care to get annual checkups, they haven’t been properly educated on the facts of breast cancer and how African American women are more affected by it.
Dr. Amal Trivedi, who conducted a study at Brown University, explained that mammograms are an essential service for older women. Yet many women avoid that service if it’s going to cost them out-of-pocket expenses. Most health care providers require a co-pay that most low income women cannot afford. Since they can’t afford the service, they don’t bother to pursue it. A mammogram or ultrasound is the best ways to view tumors that you cannot feel. They aid in early detection when you get them regularly. 5-35 percent. But this does not necessarily help much at all if most African American women can’t even afford the service, by the time they are diagnosed with cancer it is often in the late stages and impossible to treat.
Women are advised to get a mammogram every 1-2 years. There are some state funded programs that help provide these services to women of certain income status. There are also age restrictions on who can receive these state funded benefits. The programs usually aim toward women at menopausal stage to prevent or treat breast cancers. But if women are starting to get cancer at an earlier age, those restrictions need to be renegotiated and more funding should go into such programs to accommodate a wider variety of patients in need of the services. Even if one is diagnosed in the early stages, they can’t be treated without the income to pay for the many sequences of chemotherapy, surgery’s, and recovery care that can sometimes put a cancer patient hundreds of thousands of dollars in debt especially if the cancer returns in the future.
In conclusion, there are many factors that can help understand why breast cancer is more aggressive in African American women. African Americans have different genetics and family history that can be traced back as far as the West African Ivory Coast. African American women have more commonly than other nationalities, been diagnosed with breast cancer starting as early as there early twenties. Researchers are still not sure about everything that causes this to happen. The only explanation as of now is life style, environmental differences and differences in Tumor Biology. African American women are also diagnosed with far more worse conditions of the cancer and have higher death rates. This is caused by the lack of awareness and education on how differently it can affect African Americans. It is also due to societal issues and economic status. As a minority group and a majority of the lower and middle working class that cannot afford the outrageous health care expenses that go into regular prevention procedures, diagnosis and treatments of breast cancer.