Table of ContentsView AllTable of ContentsMistrust in the Healthcare SystemAccess to CareCost of CareDelayed DiagnosisHow to Seek Equitable CareFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Mistrust in the Healthcare System
Access to Care
Cost of Care
Delayed Diagnosis
How to Seek Equitable Care
Frequently Asked Questions
This article is part ofBreast Cancer and Black Women, a destination in our Health Divide series.
Breast canceris the second most common cancer affecting American women. The rate of new diagnoses of breast cancer in 2019 in the U.S. was 125.4 cases per 100,000 for Black women and 130.3 cases per 100,000 for non-Hispanic White women.Although they have a slightly lower rate of diagnosis, Black women are more likely to die from breast cancer than White women.
Social disparitiesmake it harder for Black women to get early diagnoses and appropriate treatment for breast cancer. According to the research, Black women face the worst poverty rates, limiting their ability to be insured and have access to quality education, health care, and financial resources.
This article covers the barriers to cancer care for Black women that lead to delayed breast cancer diagnoses and inaccessibility to treatment as well as how to seek equitable care.
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Medical mistrust based on skin color is not new, especially for Black Americans. This mistrust comes from many factors, including frequent misdiagnoses and reduced treatment access. Research shows this mistrust is warranted, as Black Americans receive less-quality care than White Americans.With reduced healthcare quality, their health outcomes will be much worse.
Medical mistrust affects thedoctor-patient relationshipand can lead to negative patient behavior and health outcomes, according to a 2021Annals of Family Medicinereport.Perceived discrimination from the medical community also affects healthcare options for Black Americans.
It is also possible physicians might offer lower-quality care to Black patients compared to White patients, even in situations where insurance, age, income, and severity of a medical condition might be similar.
Some reports suggest this occurs because Black patients will see different types of physicians. Others suggest this is due to a lack of medical school education about the health issues that affect Black Americans.These physicians might also have less access to clinical resources.
Many of the biases and barriers in health care primarily affect Black females. For example, maternal mortality and injury rates are higher for Black women.Black women are also significantly underrepresented inclinical trials, especially in trials for health conditions that disproportionately impact them, including breast cancer.
According to a 2019 Food and Drug Administration (FDA) report, Black study participants comprised only 4% of clinical trial subjects for oncology drugs (used to treat cancer).Studies like this one identify difficulties healthcare providers face when trying to answer Black women’s questions on how a drug might help or hurt them, which can further add to mistrust in the healthcare system.
Black women are more likely to developtriple-negative breast cancer(TNBC). This invasive breast cancer has cells without receptors commonly found in other types of breast cancer.It does not respond well to hormone therapy and medicines targetingHER2 proteins.
One report from the Tigerlily Foundation found that 53% of TNBC cases were diagnosed in Black women under 50, compared to 16% of White women.People with TNBC will have worse outcomes than other breast cancer types. They also have higher frequencies of relapse and metastases (cancer spread) to the lungs, liver, or brain and a lower survival rate.
Where Breast Cancer Spreads
A 2020Frontiers in Public Healthreview cites poverty, social stress, unsafe neighborhoods, and lack of healthcare access as factors to poorer TNBC outcomes.These factors also negatively affect the ability to get a timely diagnosis and length of survival after diagnosis.
Lower-quality care also exists in treating cancer for Black women. For example, a study reported in 2020 in theAmerican Journal of Obstetrics and Gynecologyfound Black and Hispanic women were less likely than White women to receive guideline-consistent treatment for endometrial cancer.Not receiving the guideline-recommended treatment course meant survival was significantly reduced.
Breast cancer care is expensive, even with insurance. People diagnosed with this type of cancer will need surgery—either a lumpectomy or a mastectomy. They might also need chemotherapy, radiation, or other cancer treatments after the surgery. Those costs and follow-up care can present a financial strain for people with cancer and their families, and this burden affects Black women the hardest.
One 2018Journal of Clinical Oncologyreport finds Black women diagnosed with breast cancer have more financial problems than White women diagnosed with breast cancer.That report also finds that financial hardship plays a role in delayed diagnosis, discontinuation of treatment, and omission of treatment. According to the report’s authors, these racial disparities are connected to higherbreast cancer death ratesamong Black women.
The percentage of Black women who had delayed treatment was 13.4%, compared to 7.9% for White women. The study also found cancer care for Black women was more likely to have a longer duration than for all women under 50 receiving breast cancer treatment.
The study’s authors reported various patient factors that could be blamed for delaying or prolonging treatment. Factors included access to care, tumor status, and socioeconomic status. Interestingly, while socioeconomic stress was a factor for delayed or prolonged treatment, it was not as strong as race.
Early detection and treatment are vital to improving survival, especially for invasive and more aggressive cancer types like TNBC. But Black women are often diagnosed with breast cancer later than White women, leading to treatment delays.
One study reported in 2021 in theJournal of the American College of Radiologyevaluated personal characteristics that could contribute to delays in diagnosis of breast cancers that could generally be detected through preventive screenings and how those delays affected progression and mortality.Researchers found racial disparities often led to larger tumors and a higher rate of malignancies resulting from delayed screenings.
The ability to get a preventivemammogram screeningis yet another healthcare barrier for Black women. According to a 2021Policy, Politics, & Nursing Practicereport, there are five negative factors in mammography care Black women face: “accessibility, affordability, availability, accommodation, and acceptability.”
Accessibility relates to lack of transportation or too few care locations. Affordability covers lack of health insurance and cost of care, while availability points to child care issues and not having a primary care provider.
Accommodation covers the failure to provide information and education, negative healthcare experiences and mistrust, and scheduling difficulties. Last, acceptability covers fear of results, embarrassment, racism, and religious or cultural beliefs.
The report’s authors conclude that access to mammograms is unique to Black women’s experiences, and interventions must be tailored to cultural needs. Those interventions need to exist at local, state, and national levels forcancer screeningsand prevention using healthcare practices that include Black women.
Breast Cancer in Black Women
To effectively manage breast cancer, every person must receive regular care, including having access to providers and cancer treatments. While barriers might limit your care compared to someone else’s, self-advocacy can increase access to necessary care.
One of the best ways to advocate for yourself is to do what you can to stop breast cancer early in its tracks. Make sure you are aware of any changes in your breasts, which can include doing abreast self-examregularly. If you are over 40, you should get a mammogram every one to two years.
If you are younger than 40 and have risk factors for cancer, ask a healthcare provider about the frequency of your screenings. But whatever your age, don’t avoid getting a mammogram because of the cost.
You have options for getting a low-cost or no-cost mammogram. Options include:
If you do not have health insurance or are struggling financially, the cost of cancer care treatment might seem overwhelming. Before you skip care, know that resources are available to help you.
Your healthcare provider’s office might be able to give a list of organizations that offer financial options for medicine and care. They might also have information for local organizations that assist people with cancer with child care and transportation expenses.Pharmaceutical companiesare another option for financial assistance to cover the cost of medication.
You might also consider looking into community-based agencies that help people diagnosed with breast cancer overcome healthcare barriers, including financial hardship. Ask your healthcare provider, a social worker, or a patient advocate for a list of local support organizations.
Several organizations provide support to communities of color, including breast cancer support. These can be valuable resources throughout your cancer care journey. These include:
Where to Find Financial Assistance If You Have Cancer
Summary
Black women are at a higher risk of developing aggressive breast cancer subtypes. They might also have worse health outcomes and higher mortality rates. Black women also face barriers to breast cancer care, including delayed diagnoses and inaccessibility to treatment.
All women should be aware of changes in their breasts and report any changes to a healthcare provider. Mammograms are recommended for women aged 40 and older and women younger than 40 with risk factors for breast cancer.
If you are uninsured or underinsured, you have options for getting a mammogram with the help of various cancer care organizations. If you are diagnosed with breast cancer and worried about the cost of care, reach out to your healthcare provider, a social worker, or a patient advocate to help you find local and financial resources that assist with breast cancer care costs.
A Word From Verywell
Early detection and aggressive treatment are vital to determining your outlook for breast cancer. Breast cancer that is found in its early stages can be cured. Talk to a healthcare provider about your screening options for breast cancer, especially if you have risk factors like race and family history.
Be aware of the early signs of breast cancer—irritated or itchy breasts, changes in color and shape, a breast lump or thickness, nipple discharge, or nipple inversion. You should tell a healthcare provider immediately if you experience symptoms, even if you recently had a mammogram with no abnormal findings.
Frequently Asked QuestionsA healthcare provider can determine your breast cancer treatment options based on your cancer type, stage and grade, size, and whether the cancer cells are hormone sensitive. In general, treatment options for breast cancer include surgery (i.e., a lumpectomy or a mastectomy), chemotherapy, radiation therapy, hormone therapy, immunotherapy, and targeted therapy drugs.Learn MoreHow Breast Cancer is TreatedSurvival rates for breast cancer are higher with early diagnosis and treatment. Treatment with a combination of surgery, radiation, chemotherapy, or other medicines can cure breast cancer in its early stages. Breast cancer that has spread to other parts of the body (metastatic breast cancer) is not curable. But treatment can prolong and improve a person’s life, even with metastatic breast cancer.Learn MoreComplete and Partial Breast Cancer RemissionEven after cancer remission, breast cancer can recur months or years after treatment ends. Remission means you have no signs or symptoms of cancer.Learn MoreReducing the Risk of Breast Cancer Recurrence
A healthcare provider can determine your breast cancer treatment options based on your cancer type, stage and grade, size, and whether the cancer cells are hormone sensitive. In general, treatment options for breast cancer include surgery (i.e., a lumpectomy or a mastectomy), chemotherapy, radiation therapy, hormone therapy, immunotherapy, and targeted therapy drugs.Learn MoreHow Breast Cancer is Treated
A healthcare provider can determine your breast cancer treatment options based on your cancer type, stage and grade, size, and whether the cancer cells are hormone sensitive. In general, treatment options for breast cancer include surgery (i.e., a lumpectomy or a mastectomy), chemotherapy, radiation therapy, hormone therapy, immunotherapy, and targeted therapy drugs.
Learn MoreHow Breast Cancer is Treated
Survival rates for breast cancer are higher with early diagnosis and treatment. Treatment with a combination of surgery, radiation, chemotherapy, or other medicines can cure breast cancer in its early stages. Breast cancer that has spread to other parts of the body (metastatic breast cancer) is not curable. But treatment can prolong and improve a person’s life, even with metastatic breast cancer.Learn MoreComplete and Partial Breast Cancer Remission
Survival rates for breast cancer are higher with early diagnosis and treatment. Treatment with a combination of surgery, radiation, chemotherapy, or other medicines can cure breast cancer in its early stages. Breast cancer that has spread to other parts of the body (metastatic breast cancer) is not curable. But treatment can prolong and improve a person’s life, even with metastatic breast cancer.
Learn MoreComplete and Partial Breast Cancer Remission
Even after cancer remission, breast cancer can recur months or years after treatment ends. Remission means you have no signs or symptoms of cancer.Learn MoreReducing the Risk of Breast Cancer Recurrence
Even after cancer remission, breast cancer can recur months or years after treatment ends. Remission means you have no signs or symptoms of cancer.
Learn MoreReducing the Risk of Breast Cancer Recurrence
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.United States cancer statistics: data visualizations: female breast.
Centers for Disease Control and Prevention.Breast cancer statistics.
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Food & Drug Administration.2019 drug trial snapshots summary report.
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Tigerlily Foundation.Tigerlily Foundation releases a powerful new policy brief revealing egregious disparities in screening and diagnosis for triple negative breast cancer(TNBC).
Kaspers M, Llamocca E, Quick A, Dholakia J, Salani R, Felix AS.Black and Hispanic women are less likely than White women to receive guideline-concordant endometrial cancer treatment.Am J Obstet Gynecol. 2020;223(3):398.e1-398.e18. doi:10.1016/j.ajog.2020.02.041
Wheeler SB, Spencer JC, Pinheiro LC, et al.Financial impact of breast cancer in Black versus White women.J Clin Oncol. 2018;36(17):1695-1701. doi:10.1200/JCO.2017.77.6310
Miller-Kleinhenz JM, Collin LJ, Seidel R, et al.Racial disparities in diagnostic delay among women with breast cancer.J Am Coll Radiol. 2021;18(10):1384-1393. doi:10.1016/j.jacr.2021.06.019
Aleshire ME, Adegboyega A, Escontrías OA, Edward J, Hatcher J.Access to care as a barrier to mammography for Black women.Policy Polit Nurs Pract. 2021;22(1):28-40. doi:10.1177/1527154420965537
American Cancer Society.American Cancer Society recommendations for the early detection of breast cancer.
HealthCare.gov.Preventive care benefits for women.
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