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Disparities in care: Is breast cancer treatment black and white?

This article is a part of BG BrandLab’s Breast Cancer Special Report, assessing the progress we’ve made in the battle against breast cancer and the barriers that we still need to overcome.

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Naomi Ko, M.D.

Breast cancer mortality has steadily declined over the last four decades, largely due to improvements in early detection and treatment, according to the American Cancer Society (ACS). But not all women have benefited equally from this progress. Since 1990, breast cancer death rates have dropped by 40% among white women, yet only 26 percent among black women. The disparity is caused by a number of factors, says Dr. Naomi Ko, an oncologist specializing in breast cancer at Boston Medical Center. She described it as a “biosocial problem,” or in other words, one with both biological and societal factors.

These factors include:

  • Cancer type

Black women are more likely to have more aggressive cancers, such as “triple negative” breast cancers, which means they test negative for estrogen receptors, progesterone receptors, and excess HER2 proteins.

  • The cancer stage at diagnosis

Historically, the ACS finds that black women are at a more advanced stage when they are diagnosed.

  • Comorbidity

Some research suggests black women are more likely to struggle with obesity, which can lead to other health issues and is proven to be a risk factor for breast cancer.

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  • Reduced access or delays to care

Many women in underserved communities face barriers that include lack of insurance, transportation, social support, and time to access treatment, as well as limited quality care options.

Boston Breast Cancer Equity Coalition (BBCEC) meeting

It is not just black women who are underserved. “Anyone who is not a white, middle-aged woman is probably undertreated or underserved in some way,” says Dr. Rachel Freedman, a practicing breast oncologist at Dana-Farber Cancer Institute and co-chair of the Boston Breast Cancer Equity Coalition (BBCEC). The BBCEC works to eliminate differences in breast cancer care and outcomes by promoting equity and excellence in care among all women in the city of Boston.

One of BBCEC’s programs, the Translating Research into Practice (TRIP) project, aims to address barriers to care and reduce delays in time to treatment for black women in Boston. Funded by a five-year grant from the National Institutes of Health (NIH), it offers a coordinated care delivery model that connects newly diagnosed patients with a patient navigator to guide them through the healthcare system, helping arrange treatment and transportation.

“Despite a city replete with options, black women face tremendous challenges,” says Dr. Tracy Battaglia, a practicing internist and breast health specialist at Boston Medical Center, steering committee member of the BBCEC, and principal investigator of the TRIP project. “Black women don’t start and finish treatment at the same rate as their white, educated, insured counterparts,” she explains.

While there is evidence that a patient navigator is effective at helping at-risk populations get the breast cancer screening and early detection they need, more research is needed to show the benefits a patient navigator could provide patients after the diagnosis, Battaglia says. TRIP aims to quantify whether patient navigators can improve outcomes for these newly diagnosed women by making sure they get the treatment they need without delay.

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BBCEC executive steering committee

“Efforts like BBCEC and TRIP are crucial because they bring diverse voices to the table to identify solutions that we otherwise wouldn’t find,” Battaglia says. “I am proud of the work I do, not just with doctors and researchers, but with patient advocates, cancer survivors, public health experts, community groups like Pink and Black Ambassadors, and other foundations like the Susan G. Komen Foundation. Synthesizing these unique perspectives may be where the answers lie.”

This content was produced by Boston Globe Media's BG BrandLab. The news and editorial departments of The Boston Globe had no role in its production or display.

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