What Black Women Should Know About Metastatic Breast Cancer

Although breast cancer is more common in white women, Black women are more likely to develop先期疾病，一项研究于2018年9月由期刊发布Cancer成立。

它们也更有可能被诊断为较年轻的年龄，并且根据疾病控制的中心，具有更具侵袭性的乳腺癌 - 包括转移性癌症，意味着该疾病的疾病蔓延到与白人女性的淋巴结和淋巴结。和预防（CDC）。

因此，黑人女性也可能高达40％die from the diseasethan women from other racial and ethnic backgrounds and to develop breast cancer before turning 50, the CDC says. This is also likely due to Black women beingtwiceas likely as white women to develop triple-negative breast cancer, the National Institutes of Health (NIH) reports.

什么是三重阴性乳腺癌

虽然只有三重阴性乳腺癌弥补10到20％of breast cancer diagnoses overall, it accounts for20 to 30 percent基于乳腺癌和NIH的估计，诊断为黑人女性的乳腺癌。

Thankfully, in recent years, significant strides have been made in identifying risk factors that make Black women more vulnerable to aggressive forms of the disease, which can improve the chances of survival.

A triple-negative diagnosis means that the breastcancer testsnegative for three receptors:progesterone那estrogen和美国癌症协会（ACS）的统计，和她2。

HER-2, or the human epidermal growth factor receptor 2, is a protein found wrapped around the surface of breast cells that promotes normal growth, the ACS says. When breast cancer is HER-2 negative, there can sometimes be a lack of protein production.

According to theACS.，三阴性乳腺癌细胞没有雌激素或孕酮受体或足够的Her-2蛋白，用于激素治疗或其他靶向药物，以有效，限制治疗方案，并使其比其他形式的乳腺癌更具侵略性。

Unfortunately, this also results in triple-negative breast cancer having a worse prognosis and a higher likelihood that it will return. That said, remission is possible, depending on the stage of cancer at diagnosis, and treatment varies among surgery, chemotherapy, radiation, and targeted medications, such as sacituzumab govitecan-hziy (brand name Trodelvy).

Triple-Negative Breast Cancer in Black Women

Being被诊断为乳腺癌can be devastating, and receiving a triple-negative diagnosis can be downright earth shattering, especially for Black women, given their risk for more severe disease compared with women of other racial and ethnic backgrounds.

这是米歇尔·托马斯,46岁first diagnosed with triple-negative breast cancer at age 39. Although the disease returned less than a year after the end of her first round of treatment, she has been in remission for two years after a second surgery and second round of chemotherapy.

“当我第一次收到我的诊断,我是definitely beside myself. But when I was told it was triple negative, I felt like my life was crashing around me,” she says. “The only good news was that we found it early, at stage 2.”

Monique Gary，做，乳房手术肿瘤学家and the medical director of the Grand View Health Cancer Program in Sellersville, Pennsylvania, underscores how vital early detection is intreating breast cancer。仍然，对于一些黑人女性，这比听起来更难。一项研究published in the September 2018 issue of the journalCancerfound that Black women with breast cancer often report distrust of the healthcare system and lower access to care, including regular screenings, than white women.

黑人女性早期乳腺癌检测的障碍

了解早期检测中的障碍黑人女性面临的障碍，并让他们容易受到更具侵袭性的乳腺癌，可以帮助提供有价值的洞察力来提高预后。根据加里博士的说法，一些风险因素包括：

1. Lack of knowledge about breast cancer and family history

托马斯亲切地熟悉乳腺癌，因为她的母亲和祖母在转弯之前都被诊断出患有这种疾病。结果，她开始获得年度乳房X线照片at age 35 and was diagnosed just four years later.

This was critical, because heredity is one of the largest risk factors for developing breast cancer.

“I remember feeling a lump about a month before my mammogram and insisting on being seen before my appointment,” Thomas recalls. “The mammogram did not find anything, and I was told not to worry. After several weeks of going back and forth with my primary care doctor, I was finally able to get anultrasound，揭示了癌症。我没有知道乳腺癌或如何自我检查，或者没有推动我的医生，结果可能看起来很不同。“

Not all Black women are as lucky as Thomas. According to Gary, one of the largest risk factors for Black women is lack of knowledge or access to information about the disease. “Health literacy is sorely needed in our communities, in our homes, and in our places of worship,” she says.

2. Poverty and access to quality medical care and mammography

According to the美国人口普查局那the poverty rate for Black Americans in 2019 was nearly 19 percent, compared with just over 7 percent of white Americans. In addition, in 2020 theHenry J. Kaiser Family Foundation报道，黑人美国人比白人美国人更容易获得1.5倍。

居住在贫困线上或低于综合医疗保险，为黑人女性创造了巨大的障碍。可悲的是，这通常会导致在后期或癌症传播后被诊断患有乳腺癌的黑人女性，这不可避免地增加了他们的死亡率。

Gary stresses the importance of receiving not only timely medical care but also “high-quality medical attention.” This means a doctor who will spend time with their patients, answer questions, and connect them with the diagnostic and treatment services needed.

Too often, people living in poverty in the United States or living in disadvantaged areas don’t have access to quality healthcare, according to theAmerican Academy of Family Physicians。

3.生活方式

The impact of poverty in the Black community is as broad as it is devastating. Similar to how poverty affects access to health insurance and healthcare, it also creates food insecurity and hinders access to healthy food options.

简单地说，吃健康可以昂贵，营养的更实惠的选择通常较低。缺乏对健康食品的进入是黑人社区高肥胖率的推动力。

According to theU.S. Department of Health and Human Services Office of Minority Health那in 2018 Black Americans were 1.3 times more likely to be obese than white Americans, and roughly four out of five Black women were overweight or obese. Because obesity is a known risk factor for cancer, according to the NIH, it’s no surprise that the prevalence in obesity among Black women makes them even more vulnerable to invasive forms of cancer and higher mortality rates.

4. Racism and bias in the medical profession

Some argue that the Black community in general and Black women in particular have cause to be cautious of the medical profession. Historically, researchers have experimented on Black Americans without their consent in the name of medical advancement.

Some improvements have been made, but racism and bias remain in the medical establishment. Astudy published in October 2019 in the journalSciencefound evidence of racial bias in many layers of the U.S. healthcare system — even in the medical records software many hospitals and practices use.

Although Thomas was knowledgeable about breast cancer, was in good health, and had access to quality healthcare and medical treatment, she couldn’t avoid racism and bias.

“Not only was I constantly dismissed by my doctor after I first discovered the lump in my breast, I had to switch oncologists after I was diagnosed because my first oncologist constantly challenged me when I would share with him my response to certain treatments,” she recalls. “It was bad enough that I had to fight cancer twice; I didn’t have the energy to also fight my doctor.”

“当他们找到一个触诊的肿块时，我不能告诉你年轻的黑人女性被他们的医生转过身去的人，并且被告知他们已经通过诊断成像而没有进一步调查牛奶管或其他良性调查结果，”Gary补充说。

“Rather than focus on the lack of trust in the medical establishment by Black women,” she adds, “I shift the focus to reflect that the medical community has not earned the trust of Black people.”

What Black Women Can Do

Although fighting cancer is not for the faint of heart, there are steps you, as a Black woman, can take to decrease the likelihood of developing an aggressive form of breast cancer or improve your prognosis if you’ve already been diagnosed.

1. Educate yourself about breast cancer and discuss your family history.

托马斯的储蓄恩典是了解她的家族史。加里鼓励黑人妇女“尽快讨论家庭历史”。

“Let’s get informed about our risk factors and discuss them with our families and our physicians,” she says.

因此，如果您是40或以上并且具有平均乳腺癌风险，年度筛查乳房X线照片应该是您的医疗保健计划的一部分。如果您的风险高于平均水平，请探索更具侵略性乳房的选项cancer screeningwith your physician and learn how to perform a breast self-exam.

2.教育自己的选择。

It might take a little more research, energy, or time, but there are options for women from all socioeconomic backgrounds. If cost is a concern, consider speaking with a doctor, local hospital social worker, nurse navigator, or staff member at a mammogram center and ask about free programs in your area.

3.移动并健康。

According to Gary, “Sedentary lifestyle is a known and high-risk factor for many癌症的类型，包括乳腺癌。甚至每天锻炼30分钟可以将女性的风险降低到20％，“她说。她还建议吃抗氧化剂和纤维高的食物。

If healthy eating is financially challenging for you, ask a social worker for help finding healthy eating programs in your area.

4.倡导，倡导，倡导！

You must feel empowered to ask your doctors questions and to identify resources.