Breast Cancer Rates for Blacks Catch Up to Whites

by MAGGIE FOX

Black women have long been more likely to die of breast cancer than white women, but this frightening statistic was once tempered a bit because black women were less likely than whites to get breast cancer in the first place.

No more. A new report from the American Cancer Society finds black women are just as likely to get breast cancer as their white neighbors, and they are 42 percent more likely to die of it.

"From 1989 to 2012, breast cancer death rates have decreased by 36 percent; and, as a result, 249,000 U.S. breast cancer deaths have been averted during this time period," the American Cancer Society's Carol DeSantis and colleagues write in their report.

"Widening racial disparities in breast cancer mortality are likely to continue, at least in the short term, in view of the increasing trends in breast cancer incidence rates in black women," DeSantis's team writes in CA: A Cancer Journal for Clinicians.

"Although the overall breast cancer incidence rate is slightly lower in black women than in white women, the breast cancer death rate is 42 percent higher in blacks than in whites."

A combination of factors is likely to blame. Black women are often diagnosed when their breast cancer is at a later stage; they are more likely to be obese and to have other conditions, such as diabetes; they're more likely to get aggressive and hard-to-treat tumors; they're less likely to have access to good health care; and they're less likely to be offered, and to accept, the best treatment options.

Several studies offer clues — there may be genetic differences, there may be disparities in getting medical care, and black women may simply avoid doctors more. A 2013 study found black women were often sicker to start with, suffering other conditions besides breast cancer.

"Black women are also disproportionately diagnosed with triple-negative breast cancers," DeSantis's group wrote. This type of tumor is very difficult to treat.

According to the National Cancer Institute, 25 in every 100,000 white women die of breast cancer. Nearly 34 in every 100,000 African-American women die of breast cancer. Just 16 out 100,000 Hispanic and American Indian women die of breast cancer.

This week's study finds similar patterns. Hispanic women may have lower breast cancer rates, DeSantis and colleagues said, because they have children at younger ages and have more children than women from other ethnic groups. Having children younger protects from breast cancer, as does breastfeeding those children.

"About 12 percent of women in the U.S. (or 1 in 8) will be diagnosed with breast cancer in their lifetime," the researchers wrote.

"This lifetime risk represents an average of the risks of different women, rather than the risk of any one woman. Lifetime risk includes the possibility that women will die from other causes before being diagnosed with breast cancer and is often misinterpreted to apply only to women who live to very old ages."

What can women do?

"The World Cancer Research Fund International estimates that one third of breast cancers could be prevented through healthy behaviors, including maintaining a healthy body weight, engaging in regular physical activity, and not drinking alcohol," the researchers noted.

"There is growing evidence that high levels of fruit and vegetable consumption may reduce the risk of hormone-receptor-negative breast cancer." That's the kind that cannot be treated with the most common hormone-based drugs, including tamoxifen and Herceptin.

New breast cancer guidelines: screen later, less often

(CNN) In a move sure to befuddle women -- and anger some breast cancer survivors -- the American Cancer Society has issued new guidelines saying less screening for breast cancer is better than more.

The venerated cancer organization says women should start getting mammograms at 45 instead of 40, and that everyone can skip the routine manual breast checks by doctors.

An exhaustive review of the medical literature shows these measures just aren't very effective, according to the group. "The chance that you're going to find a cancer and save a life is actually very small," said Dr. Otis Brawley, the society's chief medical officer.

Now three key groups -- the American College of Obstetricians and Gynecologists, the American Cancer Society, and the U.S. Preventive Services Task Force -- recommend different ages for starting regular mammograms: 40, 45 and 50 respectively.

While mammograms save lives, they can also cause harm, and each group does a different job of balancing the pros and cons.

Earlier testing is not necessarily better

The problem with mammograms is that they have a relatively high false positive rate, which means women sometimes have to undergo painful and time-consuming tests only to find out they never had cancer in the first place.

The chances of false positives are especially high for women under 45, as they have denser breasts and tumors are harder to spot on an image. "If she starts screening at age 40, she increases the risk that she'll need a breast cancer biopsy that turns out with the doctor saying 'You don't have cancer, so sorry we put you through all this,'" Brawley said.

He said he knows women who've had false positives year after year. "False positives are a huge deal," he said. "These women are so frightened and inconvenienced they swear off mammography for the rest of their lives."

Six years ago, the federal government's Preventive Services Task Force caused a furor when it declared that women in their 40s didn't need to get routine mammograms. Younger women whose breast cancers were caught by mammograms angrily responded that they would have been dead if they'd followed that guideline.

They said they'd gladly risk a false positive, with all the inconvenient and sometimes painful followup, for the chance of finding a cancer.

Learning from that experience, the American Cancer Society has sought to soften its message, emphasizing that women in their early 40s should still be able to get mammograms if they want them, as long as they understand the risks.

There's the risk of a false positive, plus the risk that a mammogram could catch a very small breast cancer that will go away on its own, or never progress to the point that it hurts a woman. In other words, a mammogram could catch a tumor that isn't really worth catching.

But since doctors can't reliably discern the harmful from the harmless cancers, they treat them all. This means some women are getting potentially harmful treatments, such as radiation, chemotherapy and surgery, when their tumor would never have caused a problem, Brawley says.

A Canadian study looked at 44,925 women who were screened for breast cancer, and 106 of them fell into this category and were treated for breast cancer "unnecessarily," according to a review in the New England Journal of Medicine.

New guidelines have their critics

While agreeing with the American Cancer Society that mammograms aren't perfect, some advocates for women criticized the group's new guidelines. First, they said the society looked mostly at studies of film mammography, which in the United States has almost been entirely replaced by digital mammography.

Digital mammograms generate clearer images and do a better job of finding cancer and have a lower false positive rate.

"It's like standard versus HD TV," said Dr. Therese Bevers, the chair of the National Comprehensive Cancer Network's guidelines panel for breast cancer screening and diagnosis, and the medical director of the Cancer Prevention Center at the MD Anderson Cancer Center.

Second, critics said the cancer society looked only at whether screening saved a woman's life, and not at whether screening caught a cancer early, so the woman could avoid the most drastic treatments, such as chemotherapy or mastectomy.

"The American Cancer Society made the value judgment that screening is only worth it if improves survival," said Dr. Marisa Weiss, a breast cancer survivor and president of Breastcancer.org. "There's an arrogance to that. Let women decide what's meaningful to them."

Insurance companies also decide

The new guidelines also state that women over age 55 can choose to get a mammogram every other year, since breast cancers in post-menopausal women tend to develop more slowly.

To a great extent it will be insurance companies that decide at what age women get mammograms. In 2009, they typically continued to pay for mammograms starting at age 40 even though the government's task for force recommended mammograms starting at age 50.

But it's not clear what they'll do now that the American Cancer Society has also raised the age for mammograms.

"(Insurance) plans will certainly take these updated recommendations into account when evaluating their coverage policies," Clare Krusing, a spokeswoman for America's Health Insurance Plans, wrote to CNN in an email.

The new guidelines are meant for women at average risk of breast cancer. The society says women with a family history or who carry a gene that predisposes them to breast cancer may need to start screening earlier and more frequently.

As for the recommendation to discontinue routine manual breast exams by doctors, many advocates for women with breast cancer agree there's a lack of good evidence that they save lives, but some said they saw no reason to get rid of them.

"It's a free and added way of knowing whether or not a lump is there," said Leigh Hurst, founder of the Feel Your Boobies Foundation.

In the end, with so many different opinions on preventing breast cancer, experts are worried women will throw up their hands.

"Our biggest concern is that this will create a lot of potential havoc in the day-to-day practice of caring for women," said Dr. Christopher Zahn, the vice president of practice activities for ACOG.

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Black Women More Likely to Get Wrong Breast Cancer Care, Study Confirms

by MAGGIE FOX

Black women are much more likely to get the wrong treatment for breast cancer, be diagnosed later and have bigger tumors than white women, researchers reported Tuesday.

It's the largest study yet to look at the disparities in breast cancer treatment in the U.S., and it confirms what many other studies have found — that African-American women are prone to a nastier type of breast cancer, and that they don't get the same standard of care as white women.

Native American women also appear to be at higher risk of more aggressive cancer, the study found — and they also tend to get poor care.

"We found that there is a consistent pattern of late diagnosis and not receiving recommended treatment for some racial and ethnic groups across all breast cancer subtypes," said Lu Chen of the at Fred Hutchinson Cancer Research Center in Seattle, who led the study.

Her team looked at data on more than 100,000 American women listed in a National Cancer Institute cancer registry.

"Women in several racial/ethnic groups are more likely to be diagnosed with more advanced stage breast cancer," they wrote in their report, published in the journal Cancer Epidemiology, Biomarkers and Prevention.

"African-American and American Indian/Alaska Native women in particular had the highest risk of being diagnosed with stage IV triple-negative breast cancer," they added. Black women had a 40 percent to 70 percent higher risk of having stage IV cancer - which has spread through the body and which can no longer be eradicated -than whites.

Native American women where nearly four times as likely to have stage IV triple-negative cancer, a particularly hard-to-treat type.

And black and Hispanic women were 30 percent to 40 percent more likely than whites to get the wrong treatment for their cancer type, the team found. There are several subtypes of cancer and now there are tailored therapies for certain types.

It's long been known that black women are far more likely to die of their breast cancer than white women. Studies have offered all sorts of clues — there may begenetic differences, there may be disparities in getting medical care, black women may get inferior treatment, and black women may simply avoid doctors more.

A 2013 study found black women were often sicker to start with, suffering other conditions besides breast cancer.

According to the National Cancer Institute, 25 in every 100,000 white women die of breast cancer. Nearly 34 in every 100,000 black women die of breast cancer. Just 16 out 100,000 Hispanic and American Indian women die of breast cancer. 

Research suggests compulsive behaviors like nail-biting can help soothe boredom, irritation and dissatisfaction

SUSAN COSIER, SCIENTIFIC AMERICAN

Many people think of nail biting as a nervous habit, but the driving force may not be anxiety. Mounting evidence shows that people who compulsively bite their nails, pick their skin or pull their hair are often perfectionists, and their actions may help soothe boredom, irritation and dissatisfaction.

As many as one in 20 people suffer from body-focused repetitive disorders, engaging in behaviors such as biting their nails or plucking out hair until they damage their appearance or cause themselves pain. These disorders are related to tic disorders and, more distantly, obsessive-compulsive disorder. As such, the repetitive behavior is extremely difficult to quit—yet many people continue to think they simply have a nervous habit and are too weak-willed to overcome it.

A new study adds evidence to a theory that perfectionism rather than anxiety is at the root of these behaviors. The researchers first surveyed 48 participants, half of whom had these disorders and half of whom did not, on their organizational behavior and ability to regulate their emotions. Those with the disorders scored as organizational perfectionists, indicating a tendency to overplan, overwork themselves and get frustrated quickly without high levels of activity.

Researchers then put the subjects in situations designed to provoke four different emotions: to incite stress, they showed a movie of a plane crash; to promote relaxation, they showed a movie of waves; to elicit frustration, they presented a difficult puzzle but said it was easy; and to evoke boredom, they made participants sit in a room alone. People who had the disorders engaged in the body-focused behaviors during all the situations except the relaxing movie.

The work, which was published earlier this year in the Journal of Behavior Therapy and Experimental Psychiatry, jibes with a recent theory that stress is far from the sole cause of these compulsions. Boredom and frustration, easily elicited by an underlying perfectionist personality, may be more important triggers. Past research suggests that the biting or scratching indeed makes people feel better temporarily—perhaps satisfying the perfectionist urge to be doing something rather than nothing. After the initial relief, however, comes pain, shame and embarrassment.

The findings could help therapists treat patients who suffer from the disorders; studies have shown that these types of perfectionist beliefs and behaviors can be eased with cognitive-behavior therapy. If patients can learn to think and act differently when tension builds, they may be able to stop the urge before it starts.

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