This weekend marks the end of National Breast Cancer Awareness Month. Each year, throughout the month of October, cancer charities, organizations, and companies across the U.S. enact initiatives to raise awareness and funding for fighting breast cancer.

As this year’s National Breast Cancer Awareness Month comes to a close, we celebrate these awareness and fundraising initiatives that have led to increased research and have helped improve survival rates. When it comes to survival rates in the United States, however, there still remains disparities around economic and racial lines that is linked to the accessibility of care.


Celebrating Progress in Breast Cancer Awareness

There is evidence that breast cancer awareness initiatives have led to the rising survival rates of the last two decades. Beyond raising money for improved research funding, raising awareness of symptoms has led to increases in earlier detection. This is a critical aspect of surviving a diagnosis. Because of  efforts to improve early detection, 64 percent of initial diagnoses now happen when breast cancer is in a localized stage. When caught in a localized stage, those diagnosed with cancer have a five-year survival rate of 99 percent. Even for cancer diagnosed in a regional stage–which makes up 27 percent of diagnosis–the relatively high five-year survival rate (86 percent) is a sign of progress.

For those diagnosed with breast cancer, the initial diagnosis is a life changing moment. Ever improving survival rates means more people who are diagnosed have longer and longer life expectancy following treatment. That is more time with friends, family, and loved ones. And that is progress worth celebrating.


Continuing the Work

However, as breast cancer survival rates continue to improve, the gap in racial and economic status of survivors widens. As of January 2020, a study found that black women have an incident rate of 125.1 per 100,000 people resulting in a death rate of 29.2 people per 100,000, the highest rate among all racial and ethnic groups. Despite a lower incident rate when compared to white women (127.7), the death rate of black women is nearly nine people more per 100,000. And a 2016 study from the Center for Disease Control has also found that death rates for white women are decreasing more rapidly than for black women.

This gap has been explained in many ways, including the disparities in care racial and ethnic minorities tend to receive in healthcare settings. However, these disparities can partially be attributed to larger socioeconomic disparities and wealth gaps faced by minority populations. A 2018 study of 1,280 women, of which 43.2 percent self-identified as black, found that black women are significantly more likely than white women to avoid taking pills for endocrine therapy treatment due to cost (17.1% vs. 6.7%). As an effective combatant in the recurrence of cancer following surgery, access to endocrine therapy is a key factor in long-term survival rates.

Beyond this, 0ther factors do play a role in the survival gap. According to a 2020 study, cultural factors such as spirituality, cultural beliefs, or even medical mistrust is more common among black women. The study also found that educational outreach may be less prominent in areas of higher black populations, which leads to misconceptions about treatment surgeries being more prominent among black women than white women.


Bridging the Gap

In the same 2016 report mentioned above, the CDC proposed pathways forward to help close the survival rate gap for black women. This report includes making access to endocrine therapy more accessible for low-income populations. However, the reports also suggests more immediate approaches such as improving follow-up appointments with black women who have abnormal screenings, and developing research into cancer subtypes, of which recent advancements in understanding have shown that black women are more likely to be diagnosed with more aggressive subtypes such as triple negative breast cancer.


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