Jovita Oruwari, MD FACS

Cancer affects more than half a million Americans and is the second leading cause of death in the United States, exceeded only by heart disease. It occurs when the normal orderly process of cell growth and division fail, therefore cells grow uncontrollably forming growths or tumors.  One in three Americans will get some form of cancer in their lifetime and it will account for one of every four deaths.

Cancer can be caused by both modifiable factors like tobacco or radiation or by non-modifiable factors like genetic mutations or hormones. These factors may act together to initiate or promote the start of cancer. Often times some years will pass between exposure to detectable cancer.

For women, regardless of ethnicity, breast cancer is the most common cancer type and will start in the breast tissue.  Over 200,000 women in the United States will be diagnosed with breast cancer annually and over 40,000 will die from the disease. It is interesting to note that although Caucasian women are more likely to develop breast cancer, African American women are more likely to die from the disease. Even when diagnosed at the same stage, African American women still have a lower survival. And at diagnosis, the cancers tend to be at a later and more advanced stage. African American women are more likely to have more aggressive subtypes like the triple negative breast cancer which is more likely to metastasize, recur and less responsive to standard therapy. Furthermore when cancers are diagnosed at later or advanced stages the likelihood of chemotherapy and mastectomy are higher.

What is not entirely clear is why the disparity. The causes are believed to be complex and probably reflect social,  economic and biological differences associated with race.  Social and economic barriers to early detection and screening could be lack of medical coverage, therefore not being able to get health care and not following up after getting abnormal results.  Other reasons may include distrust of the health care system and the belief that mammograms are not needed. Unequal access to improvements in cancer treatment may also contribute to observed differences in survival. Biologic differences are seen in recent research indicating that aggressive breast tumors are more common in African American women. These more aggressive forms are also seen in women in African countries. More research is underway to better fully understand what the implications are.

Currently, we do not know how to prevent breast cancer, so risk reduction strategies are encouraged. Breast cancer screening is done with mammograms and clinical breast exam and means looking for cancer signs before there are symptoms. With clinical breast exam, a doctor examines the breast for any signs of abnormalities. Both allow us to find the cancer earlier when it is most treatable and gives a woman more treatment options.

Women at higher risk may need mammograms and breast exams at an earlier age or more often. The doctor might want to use other tests too. It is important that a woman let her doctor know of any changes in her breast, such as a lumps, skin changes or nipple discharge. Other ways for risk reduction include limiting alcohol intake, not smoking,exercise and eating a healthy diet.

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Not biological differences...but rather economic differences associated with the quality of healthcare many African American women that is available to them. This indeed includes the competency levels and quality of training of the physicians they seek services from. Not all persons with MD's are the same in terms of competency and qualifications. Far too many who serve African American communities were trained at mediocre medical schools such as Meharry (ranking at the very bottom of medical schools in the United States. African American women need to seriously research the qualifications of the medical providers they use and try to select those with the highest competency ratings and strongest medical school and residency qualifications. Physicians should not be chosen just because they too may be African American.

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