The possibility of developing breast cancer can feel daunting. While the likelihood of diagnosis varies by factors such as age, family history, breast density and more, one fact is certain: early detection from breast screenings can save lives.
“I was diagnosed on my 35th birthday, and the doctor didn’t want to originally give me a mammogram,” says Bridgette Hempstead, a breast cancer survivor and patient advocate.
Anyone with breasts has the potential to get breast cancer, but Black women are diagnosed at earlier ages than white women.
“Black women are diagnosed with breast cancer about four years earlier than white women, around age 59 versus 63,” says Dr. Janie Lee, professor of radiology at the University of Washington School of Medicine and director of Breast Imaging at Seattle Cancer Care Alliance.
For context, most people who are assigned female at birth and transgender women receiving hormone therapy can choose to get their first mammogram between age 40-44 if they wish to do so, or earlier if they are at high risk of developing breast cancer. The American Cancer Society suggests beginning annual screenings between age 45-54, and a screening every two years for those over 55.
Transgender women who are over the age of 50 and have undergone hormone replacement therapy (HRT) for 5-10 years should talk to their provider to see if and when a mammogram is right for them.
Despite the higher rates of diagnosis at an earlier age, the breast cancer mortality rate is 39% higher among Black women. If breast cancer is a potential threat for all people with breasts, why are Black women dying at higher rates?
What we know about breast cancer in Black women
According to the American Cancer Society, breast cancer is the most commonly diagnosed cancer among Black women. It’s the second-most common cause of death by cancer in Black women, right behind lung cancer. Black women are also twice as likely to be diagnosed with triple negative breast cancers — a more dangerous tumor with fewer effective treatment options.
“Twenty-two percent of breast cancers in Black women are triple negative, compared to 10-12% of women in other races,” Lee says. “If you’re a Black woman, getting your screening mammogram could be crucial to catching an early breast cancer and treating it.”
So, if we have these statistics, why aren’t more Black women getting screened for breast cancer? The answer is a bit more complex than it seems.
Medical anxieties in the Black community
Historically, Black Americans have been the victims of medical abuse. The most popular example is demonstrated through the harrowing stories that came from the infamous Tuskegee experiment, a decades-long study led by the United States Public Health Service and the Center for Disease Control and Prevention.
The study, which ended in 1972, consisted of observing the effects of untreated syphilis on Black Americans — despite the disease being fully treatable before the end of the experiment. Over 100 Black Americans died during this study, which resulted in a culture of widespread mistrust of medical professionals throughout the Black community.
“Because of Tuskegee and other horrific moments that have happened to the Black community, the fear is real,” says Hempstead.
In addition to anxiety from decades of mistrust, other barriers that prevent Black women from getting a breast screen include mixed messaging around the safety of going to the doctor amid the COVID-19 pandemic.
“I think one of the current barriers that prevent Black women from getting a breast cancer screening is the scare of the pandemic and going to doctors. In the beginning of the pandemic, the message was that the hospital beds were full and not to go to the doctor,” Hempstead says. “The messaging needs to change to say that you need to still do your screening, and not to cancel your mammogram appointments.”
Knowing this, it's important to clear the path and empower Black women to get screened.
How to encourage more Black women to get screened
Unfortunately, the obstacles faced by Black women that block access to care are not limited to anxiety and mistrust of medical professionals. We identify some of these challenges below, paired with actionable suggestions from our experts.
Navigate the barriers
If you live in King County and lack of insurance coverage is a reason that prevents you or a loved one from getting much-needed screening, you can call Seattle King County Public Health. They can connect you to the Breast, Cervical, and Colon Health Program who will help you get coverage for your first mammogram. If you are diagnosed with breast cancer, your care could be entirely covered. Statewide resources are also available for those who don’t live in King County.
It’s also necessary to highlight that getting a mammogram during the pandemic is safe. The exam room will consist of only the patient and the technician, creating a low risk of contracting COVID-19.
However, it’s valid to feel some hesitation around venturing into public spaces, especially if you live outside of King County. And there are options other than going to a doctor’s office. Currently, the Seattle Cancer Care Alliance has a Mobile Mammogram Van that travels to different cities in King and Snohomish counties to help women get breast cancer screenings closer to where they live and work. In 2019, the Mobile Mammogram Van reported they performed over 5,000 screenings annually, with additional focus in underserved areas.
Regardless of how thorough a doctor may (or may not) seem, it’s essential for Black women to advocate for themselves during their patient visits. This may seem scary, especially if it’s around complicated subjects that relate to your well-being. Come to your appointment with a list of questions you want to address about your breast health. Do you feel like something is off and a doctor won’t address it? You, as the patient, have the right to push back.
"The younger you are, the harder it is to be heard,” Hempstead says. “When clinics and doctors ignore signs of breast cancer in Black women, it’s an early death sentence. We have to advocate and fight for our own lives.”
Provide low-stress options
At the end of the day, getting screened is an act of self-love and a form of self-care. If you’re wanting an accountability partner or looking for ways to make the appointment less stressful, Hempstead recommends bringing a sister, friend, mother or other loved one to the appointment. You may even consider scheduling appointments together, and making a day out of it by celebrating your bravery by having an after-appointment lunch date or exploring the city when you’re done.
“Screening is a part of a program of self-care and wellness. It’s a way of helping women stay healthy by finding a cancer when it’s early, and before symptoms develop if the cancer is present,” Lee says.
If you are a Black woman and you’re hesitant to get screened for breast cancer, that’s a completely normal and justified feeling. But in the words of Hempstead, “It’s an exam that could find an early-stage cancer and give you the opportunity to continue to love on your loved ones and live your life. There is life after breast cancer.”