NEW YORK--White women have
a higher incidence of breast cancer than
African-American women, but African-
American women develop the disease at
a younger age, are diagnosed later, and
are more likely to die of the disease, according
to the National Cancer Institute.
These concerns were front and center
when physicians, researchers, and survivors
gathered at "Breast Cancer in
Women of Color," a public meeting organized
by New York Presbyterian/Columbia
University Medical Center to raise
awareness, reassure women that help is
available, even for the uninsured, and
urge women to be proactive, even when
their doctors are not.
Kathie-Ann Joseph, MD, MPH, a
breast surgeon and assistant professor of
surgery at Columbia University Medical
Center, urged black women with a strong
family history of breast cancer to get genetic
testing. She cited a University of
Pennsylvania study (JAMA 293:1729-
1736, 2005) showing that African-American
women with a family history of breast
cancer are significantly less likely to be
referred for genetic counseling than white
women--regardless of differences based
on income, education level, or risk. Dr.
Joseph told the audience, "If your doctor
is not comfortable referring you to a genetic
counselor, go to another doctor."
She also pointed out that African-
American women have genetic variations
of unknown significance. "We will send
a woman for testing because she has a
strong family history, and they will say
this person has a variant in their genetic
makeup, but we don't know what it
means because we have not tested enough
African-American women. We need to
test more women of color so we understand
these variations," Dr. Joseph said.
The Gail Model for breast cancer risk has
not been validated in women of color or
in some other ethnic groups, she added.
Part of the reason there is less genetic
information in African-Americans, she
stressed, is that patients may have concerns
about privacy and whether they
will be discriminated against if a test is
positive. They also may not want to share
information with other family members.
"That is one of the reasons we make sure
you see a genetic counselor, so all these
issues are addressed," she said.
Annette Brown, MD, of the Long Island
College Hospital Mammography
Division and president of the American
Women's Medical Association of New
York City, urged black women to return
to the American Cancer Society breast
screening guidelines of the 1980s, which
recommended that all women receive a
baseline mammogram sometime between
ages 35 and 39. (Dr. Brown recommends
"This is my bias and that of many
other black physicians I know," she said.
"There are so many young black women
who have breast cancer and so many with
first-degree relatives who have cancer.
Who is paying attention to this part of
the story? The answer is, nobody. I encourage
black women to follow the old