Breast cancer mortality higher in black women

Black women with breast cancer have faster-growing, more aggressive tumors than white women, even when the malignant growths are compared at the same stage, according to a new study led by researchers at the Fred Hutchinson Cancer Research Center.

The research suggests a biological explanation for black women's poorer odds of surviving breast cancer.

Although African American women are less likely to be diagnosed with breast cancer than white women, they're more likely to be diagnosed at a later stage and to die from the disease.

Experts have attributed the disparity in mortality rates to increased poverty among African Americans, differences in cultural beliefs and a lack of access to medical care.

"They may have some biological features of their cancers that are also working against them," said Dr. Peggy Porter, lead author of the study and member of Fred Hutchinson's Human Biology and Public Health Sciences division.

The study, which appears in today's issue of the American Cancer Society journal Cancer, involved 124 African American women and 397 white women, ages 20 to 54, who lived in Atlanta.

Previous studies have also suggested that breast cancer tumors might be more aggressive in black women. In the current study, researchers found that African American women were more likely to have high levels of the proteins that control the pace of cell division. Elevated levels of such proteins are associated with faster-growing cancers.

Porter said it's not yet clear whether the difference in tumors is linked to higher mortality rates among black women.

"The question is are those abnormalities partly responsible for later-stage disease (diagnosis)," she said.

Black women might be more prone to aggressive tumors for a variety of reasons, including higher rates of obesity, younger age at first menstruation or the number of children they have, suggest researchers.

"All of those things translate to a difference in lifetime exposure to estrogen," Porter said. "So we really want to explore whether those differences could be what is really driving the kinds of tumors one group might get."

Dr. Hannah Linden, an oncologist at Harborview Medical Center who specializes in treating breast cancer patients, called the findings "provocative." However, differences in socioeconomic status, she said, are likely more responsible for the later diagnosis of breast cancer in black women.

"I think those frankly are bigger issues," said Linden, adding that if the diseases were truly distinct, white and black patients would respond differently to breast cancer treatments.

"Blacks and whites do the same with similar treatments," said Linden. "As a practicing oncologist, it's not going to change anything (I do), but as a scientist, I think this is fascinating and needs more study."

Betty Mewborn founded a breast cancer support group for women of color in Tacoma after she was diagnosed in 1997.

She attributes the higher rates of breast cancer to a fear of doctors and black women's tendency to put their own bodies last.

"I guess it's our culture to take care of others first," Mewborn said.

Mewborn said she and many other African American women she's met were reared on the myth that cancer surgery can cause the disease to spread.

"The thing is they wait too long, and by the time they have the surgery it's too late," said Mewborn, 65, who had a mastectomy shortly after her diagnosis. "I'm a living example that once you're opened up it's not a death sentence."

P-I reporter Julie Davidow can be reached at 206-448-8180 or juliedavidow@seattlepi.com

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