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 age 35.)
“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 guidelines.”