The Before Forty Initiative advocates early screening for African American women.
A recent study has been released detailing how deadly this disease can be for African American Women and only makes us work harder to get the word out to every young woman we can.
WHY WE NEED THE BEFORE FORTY INITIATIVE!
Black women have less breast cancer overall than other women. But when they get it, they get it so young, in such a virulent form, that they should start mammograms and other diagnostic exams at age 33 rather than the usual age of 40.
That's the conclusion of a study of more than 60,000 Florida women by researchers from the University of Miami School of Medicine published in the current issue of the Journal of the American College of Surgeons.
''Current screening guidelines are not sufficient in detecting breast cancer in African-American patients because the disease has already developed in so many of these women by age 40,'' said Dr. Leonidas Koniaris, surgical oncologist at the UM medical school's Sylvester Comprehensive Cancer Center, the study's lead author.
The likelihood of finding breast cancer in black women at age 33 is the same as in finding it in Caucasian women at age 40 -- one in 10,000, he said.
And even when black women are diagnosed, poverty and cultural issues may prevent them from receiving the newest, best treatment, the study said.
The irony is that, while black women are one-third less likely to develop cancer during their lives, when they do get it, they are 30 percent more likely to die from it, according to the study.
Overall, breast cancer kills 40,000 American women each year, making it the second-biggest cancer killer after lung cancer, according to the American Cancer Society,
Koniaris called for public awareness campaigns to alert black women to the problem, and said their doctors should consider using ultrasound in addition to mammograms in diagnosis because mammograms have trouble detecting it in younger, denser breasts.
MRIs would be even better, he said.
Early diagnosis of breast cancer can be difficult, he said.
''A patient in her 30s who finds a lump may not get it investigated. At that age she isn't thinking about breast cancer,'' he said.
``There are also cultural reasons. Some people mistrust doctors. Some in the Haitian community first see alternative healthcare workers. Also, if you're working and you can't get time off, you can't get tested.''
In the study, 72.1 percent of black women who had breast cancer were diagnosed before age 65, compared with only 50.3 percent among non-Hispanic white women.
Also, when breast cancer was diagnosed, it had metastasized beyond the breast in 5.9 percent of black women, compared to 3.1 percent of other women.
Koniaris said genetics could be part of the reason that black women get breast cancer earlier. The fact that they have a more virulent strain of cancer explains two-thirds of their increased mortality from it.
Even when diagnosed, the study said, black women were less likely than others to undergo surgery. And even those who did have surgery had lower survival rages.
Part of this is lack of access to medical care, he said. Part is that black women tend to have later-stage cancer when diagnosed.
Poverty played a role. Patients in the lowest socioeconomic category were treated less frequently with surgery and had a lower five-year survival rate.
The study looked at 63,472 patients with invasive breast cancer using the Florida Cancer Data System and data from the Florida Agency for Health Care Administration.
Triple-Negative Breast Cancer Disproportionally Affects African American and Hispanic Communities
Debra L. Winkeljohn, RN, MSN, AOCN®, CNS, is the clinical director at Hematology Oncology Associates in Albuquerque, NM.
TNBC accounts for about 10%–17% of all types of breast cancer (Reis-Filho & Tutt, 2008). Similarities are seen between TNBC and basal-like breast cancers (Reis-Filho & Tutt), so much so that some healthcare professionals consider them to be the same. Basal-like tumors can account for about 15% of breast tumors and also generally are ER- and PR-negative (some may have positive receptor status), HER2/neu-negative, and affect younger women (Reis-Filho & Tutt). Almost 85% of TNBCs are deemed to be synonymous to basal-like cancer when tested by immunohistocompatibility (Bauer, Brown, Cress, Parise, & Caggiano, 2007).
Bauer et al. (2007) examined 6,370 patients who had TNBC and 44,704 patients with other breast cancers and found that patients with TNBC were diagnosed at a median age of 54 years compared to a median age of 60 years for the other breast cancer group. In addition, a significantly higher amount of African American and Hispanic women had TNBC compared to the other breast cancer group. Tumor size also was significantly larger in the TNBC group and patients often presented at a more advanced stage. Relative survival also was found to be poorer for women with TNBC, with 77% surviving five years compared to 93% with other breast cancers.
Mary Jo B. Lund, PhD, a researcher at Winship Cancer Center at Emory University in Atlanta, GA, examined tumor tissue from 117 African American and 362 Caucasian women from the Atlanta metropolitan area (Tuma, 2007) and found that, of the 29.5% of women who had TNBC, 47% were African American and 22% Caucasian. Lund also found that only 39% of African Americans (compared with 64% of Caucasian women) showed the most favorable prognostic indicators: ER-positive, PR-positive, and HER2/neu-negative. More than 50% of African American women younger than 40 had TNBC.
In a study of 482 patients with breast cancer by Haffty et al. (2006), 117 (24%) had TNBC. As noted in other studies, younger women (aged 50 years or younger) were more likely to have TNBC (63%). Haffty et al. also found that 8 of 10 BRCA1 mutation patients had TNBC. Patients with TNBC also were found to have a stronger family history of breast cancer. Many patients with TNBC also were African American women and presented with higher pathologic stage. With median follow up of 7.9 years, results showed that, despite adjuvant chemotherapy, patients with TNBC had poorer prognosis, with only 71% being metastases-free at five years.
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