Science can barely explain why black women die of breast cancer more so than women of any other ethnic group in the United States. But the fact is they do. And that’s especially perplexing because black women don’t have a high incidence of the cancer as compared with white women.

The reasons behind this deadly disparity are multi-faceted and complex, says the National Cancer Institute (NCI), but the simple key to it all may just be a matter of M-O-N-E-Y (or more precisely a lack thereof).

“This sweeping generalization reflects the grim fact that the African-American community is also affected by poverty,” says Lidia Schapira, MD, a physician at the Gillette Center for Breast Oncology at the Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School in Boston. “This limits access to preventive services and routine medical care.”

According to the NCI, these limitations are a direct result of people’s socioeconomic status, determined by income, level of education, occupation, social status and where a person lives.

Furthermore, socioeconomic status also predicts people’s access to education, the jobs they take, the type of health insurance that’s available and their living conditions—and some of these conditions expose people to environmental toxins. (These are all risk factors for developing cancer and likelihood of surviving the disease.)

What’s more, socioeconomic factors also influence the popularity of widespread behaviors that increase the risk of cancer, such as smoking, inactivity, obesity alcohol abuse and health status.

These factors can stop women from getting valuable and timely information about where to go for breast cancer exams, how often to get checkups, how to apply for health insurance or discounted medical procedures, where to go for follow-up treatment and what follow-up treatments to request.

It’s no surprise then that, according to the NCI, black women also lag behind in getting prompt, cutting-edge breast cancer treatments. The result? More black women die of breast cancer.

Doctors also cite biology as a reason African-American women suffer higher breast cancer death rates. “The increased mortality rates may also be explained by breast cancers being more aggressive [among black women],” Schapira says.

Indeed, doctors find that aggressive breast cancers are more common among women of color who live in low socioeconomic areas.

Specifically, African-American women and women of Caribbean origin are more likely to develop biologically aggressive breast cancers, Schapira says. Aggressive breast cancers are those that are typically less responsive to standard cancer treatments and associated with worse outcomes.

Why this happens, is unclear. But complicated genetic reasons might be linked to lifestyle, childbearing, nutrition and environmental exposures. The good news, as Schapira points out, is that many of these factors can be modified.

Yet another aspect fuels black women’s grim breast cancer outcomes: The lack of access to good health care can lead to diagnosis and treatment delays and inadequate treatment solutions.

Still, it may be possible to narrow the breast cancer disparities gap between African-American women and other women. Potential solutions are being explored now.

First, health care agencies such as the National Institutes of Health (NIH) are creating community prevention education programs and campaigns that stress the value of regular tests and address the negative view some women have of mammography.

In addition, other health organizations are also working to improve overall access to cancer screening and testing, especially for uninsured women.
“To level the playing field, it is important to promote awareness of the benefits of screening mammography through education in communities and also by making access to mammography easier,” Schapira says.
This can be accomplished, she says, by using mammography vans to bring services directly to the women, by offering evening or weekend appointments at clinics and by involving community health workers to connect with patients.

The NCI suggests breaking down language barriers and providing information in a way that makes sense culturally.

Also doing its part, the NIH is working to expand clinical trials and establish partnerships between large health care centers and their smaller community counterparts. By linking smaller centers to bigger hospitals, the NIH hopes smaller hospitals will learn how to build and sustain more comprehensive cancer care centers.

The agency hopes this will also attract physicians to centers that cater to medically underserved, low-income and ethnic populations who don’t usually participate in clinical trials. (Trials help provide ethnic populations with the most up-to-date cancer treatments.)

But the biggest drop in breast cancer deaths will not be triggered by doctors or prevention campaigns. The main element that will change this dynamic is African-American women themselves—those women who practice prevention and get early testing.

The American Cancer Society recommends that women older than 40 get a mammogram and a clinical breast exam each year. Schapira agrees, but adds: “There are currently no different guidelines for African-American women. I would suggest they discuss their own risks individually with their physician.”

The bottom line is that the existing breast cancer disparities between African-American women and other groups can be closed. As Schapira says, “Breast cancer is very treatable in this day and age.”

For more information about breast cancer, screening, prevention and treatment, check out the National Cancer Institute’s What You Need to Know About Breast Cancer booklet here. And to learn more about what is being done to close the gap, click here.