Breast cancer deaths have been declining since 1990. Earlier detection through mammograms and therapy improvements have helped move the trends in this direction. But the decline is not happening at the same rate across demographics.

A 2019 report from the American Cancer Society found that the mortality rate between Black and white women is expanding. While Black women are 3% less likely to be diagnosed with breast cancer, they have a 41% higher death rate from the illness.

Black women are often diagnosed with breast cancer at a younger age than white women, and they have a “three-fold increased risk” of triple-negative breast cancer, one of the least treatable subtypes. Despite these factors, Black women continue to be underrepresented in clinical trials.

In an article for Roll Call, Jenn Higgins, vice president of public affairs at Guardant Health, wrote that Black Americans make up about 14% of the population but only account for 3.1% of participants in clinical trials for cancer drugs.

“This lack of proportional representation is damaging to science and limits our ability to consider potential differences — and develop effective treatments — across population subgroups,” Higgins wrote. “It calls into question the accuracy of screening recommendations, which could foment distrust of the medical system. It also means that Black patients with advanced cancer who have exhausted other treatment options are not getting access to experimental drugs that might extend their lifespan.”

The National Cancer Institute has addressed these disparities in health care. The organization said there are several ways to improve the inequities, including creating statewide cancer screening programs that are accessible to everyone, regardless of physical location or economic status.

A Philadelphia Inquirer article written by two Black breast cancer physicians says the current suggestions for mammogram screenings do not “protect the specific screening needs of Black women.” In the United States, mammogram screenings are annual appointments beginning at age 40. Among women under 45, it’s Black women who have higher rates of diagnoses, according to the Inquirer article.

“Some people speculate that Black women don’t get best practices because they sometimes come in with more co-morbidities—such as hypertension, diabetes, or obesity—that may not permit them to get standard treatment,” Dr. Abenaa Brewster, an associate professor at the University of Texas MD Anderson Cancer Center, told The Birmingham Times. “But I don’t know if that is the whole story. It may also have to do with poverty, lack of education, physician bias, or other factors. I really think it’s a problem on many levels.”

It’s been well-documented that Black women face high barriers to treatment across the medical field. Jamelle Singleton, 35, documented her breast cancer journey for SELF, and the story begins with her doctor not taking her discomfort as seriously as she was. 

“Knowing what I know now, I wish I would have questioned my doctor more and advocated for myself earlier,” Singleton wrote in the SELF piece. “It’s not easy as a woman of color. You may feel a little intimidated from speaking up, especially if you feel like you have to push through a doctor’s biases.”