Black Women And Breast Cancer: The Questions Worth Asking

When it comes to women’s health, there are no one-size-fits-all solutions. And for Black women, that gap in care is felt every single day. Whether it’s standardized assessment tools and medicines that have been developed without Black bodies in mind, or systemic and structural factors that contribute to stark health disparities, Black women face many obstacles throughout their healthcare journeys. And when it comes to breast cancer, those obstacles may contribute to late-stage discoveries, more aggressive tumor types, and significantly higher death rates. The American Cancer Society and other organizations are working to close the disparity gap through education and access. 

With a multitude of factors at play—environment, genetics, healthcare access—staying informed is a key factor in taking care of your health. Your doctor will use the latest information and your individual circumstances to make expert recommendations—but ultimately, the best decisions are made together. That’s why your education is essential. Below, you’ll find an overview of the risks Black women face and questions that can help navigate breast health conversations with your physician.

Why Breast Health Matters So Much

According to the American Cancer Society, Black women are 41% more likely to die from breast cancer than White women, despite being less likely to be diagnosed with it. Black women also have lower survival rates at any stage of breast cancer. Research shows there are many factors contributing to these stats:

• Genetics: Black American women develop more aggressive types of cancer, like triple-negative breast cancer (TNBC), at disproportionate rates. Fortunately, advances in research and awareness of the differences in tumor types has led to the development of various treatment options for TNBC.

• Comorbidities: Having comorbidities means an individual has two or more distinct diseases occurring at the same time. For example, diabetes is more commonly diagnosed in Black Americans than white Americans, and is also associated with a negative influence on cancer survival.

• Structural Inequity: Inequity and bias within healthcare systems and the economic barriers blocking access to healthcare in the U.S. mean Black women are more likely to be diagnosed at advanced stages of the disease.

You Are Your Own Best Advocate

The stats may seem intimidating, but gathering information and advocating for yourself can help you feel empowered. Here are two things you can do:

• Write down questions you want to ask before you go into medical appointments. The information you get from your questions can make a big difference.

• Speak up when you have questions during your appointment. Your doctor won’t know what you need explained if you don’t ask.

Discover What’s In Your Family Tree

Even before bringing questions to your doctor, consider asking the women in your family about your family health history. Gathering detailed histories from both sides of your family can be a helpful tool for self-advocacy. The American Cancer Society suggests asking the following questions: 

• Have you ever been diagnosed with cancer?
• If so, how old were you when you were diagnosed with cancer?
• Have you ever talked to a genetic counselor or had genetic testing? If so, what were the results?

Let’s Talk to Your Doctor

Once you’re armed with information and an understanding of your family health history, you can step into your annual exam with confidence and questions in hand.

To help, here are five questions about breast health to take to your primary care provider or OB/GYN:

• Based on my risk factors, when should I start getting mammograms and how often? Guidelines suggest starting regular mammograms around age 40, but some providers, like the Mayo Clinic, suggest Black women have a personalized risk assessment, starting in their 30s, to determine when regular screenings should begin.

• Does my family history of cancer qualify me for genetic testing? Genetic testing can help detect gene variations that identify the risk of developing breast cancer. But, since only 5-10% of all cancers are hereditary, it’s important to continue regular preventative measures regardless of the outcome of genetic testing.

• Do I have dense breast tissue? If so, how does that affect my breast cancer risk? Is a supplemental screening test like a 3D mammogram, an ultrasound, or a breast MRI a better option for me than a traditional mammogram? Black women may be more likely to have higher breast density than white women, and dense breast tissue can mask tumors, making them harder to detect on a mammogram. Dense breasts are also associated with an increased risk of breast cancer.

• Can you walk me through the best way to do a breast self-exam and how often I should do them? Get familiar with the look and feel of your own breasts. If you feel changes—like a lump—don’t wait for your annual physical to bring it up. Check in with your physician to learn how to do a self-breast exam and how often you should do them.

• If I notice a change in the texture of the skin on my breast/nipple, should I be concerned? Always talk with your doctor about any changes or concerns with your breasts.  

What If I’m Diagnosed With Breast Cancer?

If you receive a breast cancer diagnosis, here are nine questions to ask your doctor:

• What do you know about my diagnosis and treatment options?
  Your test results will help explain your specific cancer and what they mean for your treatment options. Ask your doctor for recommended treatment options as they will depend on the type of breast cancer you have.
  
  
• Will you do genomic tests?
  Testing for tumor gene mutations involves examining the cancer tissue to assess genes within cancer cells. This can help inform treatment for certain types of metastatic breast cancer.
  
  
• How much time do I have to consider treatment options?
  The type and stage of breast cancer, including whether it has spread to other parts of the body, can influence treatment recommendations and the order they’re given. It’s important to gather as much information as you can about your treatment options and consider discussing your preferences with your family or support system. It’s important to be open and honest with your doctor about your choices.
  
  
• How long will my treatment last, what are the potential side effects, and how will it make me feel?
  Treatment affects every part of your life. Knowing what to expect—the timeline, the side effects, and how you may feel—allows you to plan ahead for your family, your work, and your own peace of mind.
  
  
• If I have a genetic mutation, should my family members be screened?
  Breast cancer that is genetically inherited by parents makes up approximately 5-10% of all breast cancers. It may be helpful to discuss whether or not there are benefits to genetic testing for you or your family members.
  
  
• Will my breast(s) be removed?
  Some factors that can impact whether or not your doctor may suggest a mastectomy include: the size of the tumor, whether or not the cancer tissue is present in multiple areas, whether the patient can safely receive radiation therapy, and genetics.
  
  
• If I have to have a mastectomy, will I be able to have breast reconstruction surgery after? If yes, when is the best time to do so?
  If you have to have a mastectomy, be open and honest with your healthcare team about your desire to undergo breast reconstruction. This way, your doctors can let you know about availability and timing of post-treatment options.
  
  
• Will I still be able to get pregnant after treatment?
  If you’re considering growing your family—or building one—have a transparent conversation with your doctor. The ability to conceive post-treatment depends on a variety of factors, but the first step is making sure your healthcare team is aware of your needs and concerns.
  
  
• Is there someone in your office who can help me navigate billing and insurance coverage for my treatment?
  Navigating financial realities, like insurance coverage, can be challenging. Take advantage of any assistance your doctor’s office may provide. Patient and billing services are there to help you navigate the process. It’s also good to know some pharmaceutical companies may have financial assistance options available for patients.

Conversations about breast health and breast cancer can feel heavy, but they’re necessary. Regular screening and self-advocacy are just the beginning. The more informed you are, the better equipped you are to make decisions that reflect your needs, your values, and your future. Because at the end of the day, caring for yourself is also how you show up for the people who need you most. It starts with knowing your worth, knowing your body, and never being afraid to ask about every option—including treatments like TRODELVY® (sacituzumab govitecan-hziy), which certain patients with metastatic breast cancer can discuss with their care team.

This content was created for Gilead as part of a paid partnership.