For more than two decades, cancer death rates in the U.S. have declined steadily among women, due in part to increased awareness and early detection. But for Black women — who still die from the disease at far higher rates than white women — that progress is decidedly mixed.
One in eight women in the overall U.S. population will develop breast cancer, yet Black women are slightly less likely to be diagnosed with breast cancer than white women. That’s even though Black women are far more likely to receive a breast cancer diagnosis at a younger age and are more likely to die from the disease. In fact, Black women are 38% more likely to die from breast cancer than White women.
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On Thursday, Word In Black held an online webinar on April 9 to discuss these issues identified in its report, “Understanding Breast Cancer Risks, Concerns, and Barriers to Screening in Black Women.”
Identifying Barriers
Moderated by Word In Black’s Shernay Williams, the virtual conversation included Dr. Uche Blackstock, a physician and nationally recognized health equity expert; breast cancer survivor and health advocate Asha Miller; Ricki Failrey, CEO of the Touch Black Breast Cancer Alliance; and Dr. Christa Mahlobo, a behavioral scientist who is Word In Black’s Iinsights and Rresearch director.
Over the course of an hour, the panelists explored why Black women face worse outcomes when confronting the disease. It includes a combination of systemic racism, biological factors, healthcare access barriers, and limited representation in clinical research. But they also identified solutions, including self-advocacy, the importance of family histories, understanding diagnostic tools, and leaning into early detection.
Mahlobo shared with the panel the results from a February survey on Black women’s thoughts and attitudes about breast cancer. The results revealed the barriers between Black women, early detection and positive outcomes: fear of mammograms, deep mistrust of the healthcare system, and institutional barriers that too often go unaddressed.
For example, according to the survey, 60% of Black women say they have fear and anxiety about mammograms. But Mahlobo also noted that the research found that fact-based messaging, with statistics, was most effective in motivating women to schedule mammograms.
Knowledge is Power
The panelists’ core message, however, was empowerment: Black women, they said, have the right and duty to be informed advocates for their own health, and should use their power to do so. They should also remember that they know their bodies best and should remind doctors of it.
Fairley, the Touch Black Breast Cancer Alliance CEO, is also a breast cancer survivor. She was diagnosed with stage three, triple-negative breast cancer during an annual checkup.
I was diagnosed with breast cancer and several women in my family were also, but I didn’t know that at the time … Breaking that silence is something I’m really passionate about so that we can live longer.”
asha miller, Breast cancer survivor
After the diagnosis, “I’d had all the things,” she says, including a double mastectomy. “I did six rounds of very aggressive chemo. I did radiation. My [doctor] told me it was okay. He said, ‘Come back in two months for a scan.’”
When she saw him again, however, she was diagnosed with advanced breast cancer and told she had two years to live.
Rather than accepting that fate, “I went to fight for myself,” Fairley says. “I found a clinical trial [and] a doc that would put me on [that] trial. I did a clinical trial drug, and I didn’t die, and it’s been 14 years. I’m very blessed.”
Knocking Down Barriers
An emergency medicine physician, Blackstock is the founder and CEO of Advancing Health Equity and author of Legacy: A Black Physician Reckons with Racism in Medicine.
She pointed to the history of racism within healthcare systems — including doctors giving short shrift to Black patients and the long shadow of experimentation on Black men and women without consent — as contributing to disparities.
“Part of my history, who I am, is being a second-generation Black woman physician,” says Blackstock, the daughter of a physician who practiced in New York. “I was able to see my mother, the original Dr. Blackstock here in Brooklyn, caring for our community. She and her colleagues in the 80s and 90s were doing the work of what we now call health equity.”
Blackstock described how white doctors often don’t listen to Black patients and tend not to help them adequately manage pain. The medical system as a whole, she says, hasn’t done much to dismantle systemic barriers such as lack of resources in Black communities.
Panelists stressed that the most durable solutions will come when the breast cancer is tackled at multiple levels—from healthcare system accountability and better screening to stronger patient education and family communication about health history. But they also noted Black families tend not to discuss histories of serious illnesses in the family — information that can be key to early detection.
‘Breaking that Silence’
Miller spoke about how harmful that silence can be.
“I was diagnosed with breast cancer and several women in my family were also, but I didn’t know that at the time because of the silence around it,” she says. “Breaking that silence is something I’m really passionate about so that we can live longer.”
Miller described finding a small lump that initially seemed harmless. Despite early self-advocacy, her cancer was later diagnosed as advanced, she says, illustrating how aggressive breast cancer can be in Black women.
Along with speaking up, Miller says, Black women should learn their family’s health history, and challenge silence within families about illness.
Fairley agreed: “Your generational health is your generational wealth,” she says.
It’s also important, Fairley says, for Black families to ask questions, document health histories and begin risk assessments as early as age 25.
“You are the expert in your body,” says Blackstock.