Black Women Face Higher Breast Cancer Mortality Due to Structural Racism

The findings highlight that racial disparities, not biological differences, are the primary drivers of the higher mortality rates among Black women.

While Black and white women are diagnosed with breast cancer at similar rates, Black women are 40% more likely to die from the disease.

“Within health care, there was this notion that an important contributor to disparities was that Black women have higher rates of triple-negative,” said lead author Erica Warner, a cancer epidemiologist at Massachusetts General Hospital.

While that aggressive subtype plays a role, Warner emphasized, “based on these results, it isn’t a significant or even a primary reason.”

The research team analyzed 18 studies involving nearly 230,000 breast cancer patients, including 34,000 Black women, to compare mortality rates across different breast cancer subtypes.

For hormone receptor-positive (HR-positive), HER2-negative tumors – the most common subtype accounting for 60%-70% of cases – Black women were 50% more likely to die compared to white women.

For HR-positive, HER2-positive tumors, Black women were 34% more likely to die.

Even for triple-negative breast cancer, the most difficult to treat, Black women faced a 17% higher risk of death.

“We thought that the hormone receptor-positive tumors is where we would see the biggest disparities and that we would not see a difference in the triple-negative tumors,” Warner said.

“In reality, we saw disparities of similar magnitudes across all breast cancer subtypes that we looked at.”

Dr. Eric Winer, director of the Yale Cancer Center, pointed to economic and structural barriers.

“In these cancers, people need to be on extended treatment with hormonal therapy for five years or more, which is often associated with out-of-pocket cost, so economics play a role,” Winer said.

Black women are also more likely to experience delays in diagnosis.

“Black women tend to get breast cancer at a younger age,” said Dr. Marissa Howard-McNatt, director of the Breast Care Center at Atrium Health Wake Forest Baptist.

“Screening doesn’t start until age 40, but a lot of Black women can get breast cancer in their 30s.”

Experts stressed that addressing these disparities requires improving early detection, access to care, and representation in clinical trials.

“If you look at breast cancer data from 40 years ago, there really weren’t differences in mortality for breast cancer between Black and white women,” Warner said.

“But as we’ve gotten better, the gap between white and Black women has grown.”

“That is problematic, but that also tells us we have our foot on the pedal for these differences. If we can create them, we can eliminate them.”