What Black women need to know
A leading expert shares four important tips for Black women
By Vivian J. Bea, M.D
For Black women, breast cancer
is the most commonly diagnosed
cancer and the secondleading
cause of cancer death
after lung cancer, according the
American Cancer Society. While
Black women and white women
get breast cancer at about the
same rate, Black women are
40% more likely to die from the
disease, according to a Centers
for Disease Control and Prevention
study.
“This is a mind-opening fact
that shows disparities exist
within breast health,” says
Dr. Vivian Bea, section chief
of breast surgical oncology at
NewYork-Presbyterian Brooklyn
Methodist Hospital and an
assistant professor of surgery
at Weill Cornell Medicine. “But
we can’t pin it to exactly one
thing.”
Dr. Bea, who is committed to
eliminating disparities through
research and health initiatives,
says many factors contribute to
breast cancer disparities, ranging
from social determinants
to genetics and tumor biology.
She spoke to us about what
Black women should know
about their breast cancer risk
and breast health, and dispels
myths about a breast cancer
diagnosis.
1. Know the facts
Researchers are working to
better understand why there’s
such a big disparity in breast
cancer outcomes between
Black and white women. Access
to care is an issue, but other
factors include genetics and
tumor biology, says Dr. Bea.
“We used to believe breast disparities
were primarily due to
lack of access to healthcare,
and then policies were implemented
that actually improved
mammography screening and
insurance availability, and yet
the disparity still exists,” she
says.
Research indicates that
genetics may play a part in
this higher risk disparity, and
the risk may differ depending
on a Black woman’s ancestry,
specifically in cases of triplenegative
breast cancer. Black
about breast cancer
women are more likely to have
triple-negative breast cancer,
a rarer but more aggressive
form that does not respond
to hormonal treatment.
According to the American
Caribbean L 22 ife, Oct. 9-15, 2020
Cancer Society,
triple-negative breast
cancer is about twice
as common in Black
women than white
women in the U.S., and
a contributor to the
lower breast cancer
survival rate among
Black patients. “It’s
important that
Black women know
their risk for breast
cancer, so that they
can educate themselves
and be proactive
about their health,” says
Dr. Bea.
2. Get screened — and
bring a friend
Early detection is the best
protection. “Even though Black
women are more likely to have
triple-negative breast cancer, if
we catch these women at the
earliest stage of that breast cancer,
there is a better chance for
survival,” says Dr. Bea.
The American Cancer Society
says women should have the
choice to start screening with
yearly mammograms as early as
age 40 if they want to, and recommends
women should begin
having yearly mammograms by
age 45, which can change to
every other year beginning at
age 55. If you have a family history,
you should start screenings
earlier. “Black women are
more likely to be diagnosed at
a younger age with the more
aggressive tumor subtype, so
I recommend going annually
starting at the age of 40,” says
Dr. Bea.
If you’re nervous about getting
a mammogram, Dr. Bea
recommends going with a
friend so you can hold each
other accountable and have
moral support. “I understand
that it is not a piece of cake
for everyone and can be nervewracking,”
she says. “Maybe do
a spa day or a girls’ day after
to ease the stress and anxiety
around the appointment. Take
the focus off the mammogram
and make it a whole ritual.”
Through a multi-institutional
grant she received from
the American Cancer Society
and Pfizer, Dr. Bea is focusing
on improving access to screening
mammography for Black
women in the Brooklyn community
by extending hours at
NewYork-Presbyterian Brooklyn
Methodist Hospital a few
times a month and providing
access to breast imaging.
“We are also working with
navigators within faith-based
organizations to help get the
word out and encourage women
in their church to receive their
annual mammogram, even in
the era of COVID-19,” she says.
3. Don’t believe myths
There is understandably a lot
of fear around a breast cancer
diagnosis, but it is important to
be aware of the many advances
made in care. For example,
Dr. Bea says some patients have
expressed concern that if they
receive a diagnosis of cancer and
have surgery, the surgery could
cause the cancer to spread. “This
is false,” she says.
Women may believe that surgeons
will have to remove their
breasts, which is also not true.
“We can offer modern approaches
to breast surgery, such as
lumpectomy or breast-conserving
surgery, which only removes
a portion of the breast,” says
Dr. Bea. “Those myths, coupled
with a valid fear of COVID, may
be widening the gap of women
not getting their mammograms
right now. But it’s important to
remember early detection saves
lives.”
She emphasizes that women
should not let a fear of COVID
stop them from getting their
mammograms. “COVID is real,
but women should know it is
safe to come into the hospital
to get their mammogram,”
she says. “It is a risk-benefit
situation. Wear a mask, practice
social distancing, and use hand
sanitizer to balance off that risk
and get your mammogram.”
4. Know your breasts
Dr. Bea encourages women
to do a breast self-exam every
month. “If there is an abnormality,
you’d be the first to
detect it,” she says. Signs to look
for include nipple discharge, a
palpable mass (a lump), or any
skin changes. “If you’ve never
had eczema, a condition that
makes your skin red and itchy,
in your life, and you see skin
changes on your breast, do not
assume it’s eczema. Go and see
your provider,” she advises.
Clinical breast exams are
important at least yearly with
a licensed practitioner.
Dr. Bea hopes that by building
trust with her patients and
prioritizing education, outreach,
and early diagnosis, she
can address disparities in the
community and save lives. “I
have a voice and it’s my duty to
use it and be at the forefront of
this conversation.” She says she
is active on social media to try
to reach even more patients.
Equally important is a diverse
care team. “NewYork-Presbyterian
Brooklyn Methodist Hospital
has a multidisciplinary team
of Black women who treat breast
cancer, which is rare,” says Dr.
Bea. “If you are diagnosed with
breast cancer, it’s important to
receive high-quality care, which
we offer here with a diverse
multidisciplinary department.”
“I love my position because
I know that every day I am
making a difference, even if it’s
touching just one life,” says Dr.
Bea. “When someone who looks
like me hears me explain breast
cancer risks and relate to them,
understanding from a cultural
standpoint where they are coming
from, we’re able to connect
and they are more likely to listen
to me and trust me. And that
trust can make the difference in
a life or death situation.”
Vivian J. Bea, M.D., is section
chief of breast surgical
oncology at NewYork-Presbyterian
Brooklyn Methodist Hospital
and an assistant professor
of surgery at Weill Cornell
Medicine. An expert in breast
cancer disparities, Dr. Bea
was selected as one of the 40
Under 40 Leaders in Minority
Health by the National Minority
Quality Forum for her dedication
to community outreach
and breast cancer disparities
research. She is on Twitter at
@IamDrVivian.
To make an appointment
with Dr. Bea, please call 718-
780-3022.
Dr. Vivian J. Bea, M.D. New York-Presbyterian Brooklyn Methodist Hospital