Beating Breast Cancer
Three local women personify how breast cancer can be beat—and how you can reduce your own risks
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Shirley Gray of West Bloomfield was lying in bed performing a regular breast self-exam in August 2009 when she felt something abnormal in her left breast at the nipple.
"The lump didn't move," recalls Gray, who had fibrocystic breasts and was accustomed to somewhat regular lumps. "This was different."
The next morning she visited her OB-GYN, who agreed the lump in question was suspicious. A mammogram and biopsy followed, and within a few weeks, Gray learned that she had stage 1 breast cancer.
"We hit the roller-coaster ride from there," says Gray, 62, who is the administrative director of clinical support services at Children's Hospital of Michigan in Detroit and married to Dr. Herman Gray, its CEO.
Gray underwent a mastectomy of her left breast in early October of that year, and two regimens of chemotherapy followed. Now, at the four-year mark since her diagnosis, Gray is healthy and more vigilant than ever about performing her monthly breast self-exam and having her annual mammogram performed on time, every time.
When Gray detected her tumor, she was otherwise healthy. Her tumor was caught at an early stage, and she sought immediate treatment. Gray's experience at each step along the way—from screening to diagnosis to treatment—bucked the national trends when it comes to breast cancer among Black women.
Difference in diagnosis—and survival
According to the Susan G. Komen foundation, Black women are less likely to have an annual mammogram performed than non-Hispanic White women and are more likely to have breast cancers associated with poor prognosis, such as those with tumor cells that are more abnormal or have existed longer. Overall, breast cancer survival is three years shorter for Black women compared with White women. The reasons for these disparities are varied.
Susan Brown, managing director of health and science education at Susan G. Komen, explains that in decades past there were significant differences in the rate of Black women getting screened for breast cancer compared to White women. While the screening rate for Black women is now similar to that of White women, past differences may be influencing mortality rates today.
"The stage of the disease at diagnosis is related to survival," she explains.
Another contributing factor to disparities in breast cancer mortality rates is how Black women access care.
"African-American women may get screened, but there may be a delay in follow-up if something abnormal shows up," Brown says. "That then leads to a delay in getting a diagnosis."
A third compounding aspect is biological and genetic factors in the tumors more likely to develop in Black women.
"The personality of the tumors themselves can differ," she explains. "The tumors tend to be more aggressive and estrogen-receptor negative, which is associated with poorer outcomes. Triple-negative breast cancer, which is also associated with a poorer prognosis, is aggressive and often metastasizes early. This tumor is more commonly found in African-American women."
Lisa Braddix, breast cancer program specialist for Susan G. Komen Detroit Race for the Cure, points to systemic barriers among Black women that could contribute to the disparity.
"It can be things like lack of transportation to get to a screening facility," she says. "It can be that screening facilities are not open at times that work for these women's work schedules. It can be a lack of health insurance. It can be not realizing the importance of recognizing when there is a change in their body."
The importance of early detection
Research published in JAMA (The Journal of the American Medical Association) in July 2013 compared 7,375 Black women who were diagnosed with breast cancer to three separate groups of 7,375 White women also diagnosed during the same time period. The first group of White women were matched to the Black women on age, year of diagnosis and similarity of neighborhood. The second group of White women were matched to the Black women on these same criteria, as well as the type of tumor and co-morbidities (other health conditions, like diabetes). The third group of White women mirrored the group of Black women on all these criteria, as well as type of breast cancer treatment (surgery, radiation and chemotherapy).
With each successive layer of similarity, the difference in life expectancy between White and Black women dropped, so that the Black and White women who matched most closely on criteria experienced only a three-month difference in survival rate (favoring White women).
The study's lead researcher, Jeffrey Silber of The Children's Hospital of Philadelphia, has said this indicates that the problem is not necessarily differences in treatment but that Black women are seeking medical care when their cancer is further progressed. Had they pursued preventive care earlier, their cancer would not be as advanced. To combat this—and increase the survival rate of Black women with breast cancer—education is key.
In 2013, the Susan G. Komen Detroit Race for a Cure awarded just over $1 million to fund grants for four local organizations that help with support and awareness in the tri-county area. One of those is the Sister & Sister Program in Pontiac.
"This program provides free mammograms to African-American and Hispanic women," explains Braddix. "These women lack insurance or are underinsured. Those in need of follow-up care after their mammogram will be guided to appropriate care."
Another program to receive grant money is the Witness Project of Detroit, which centers around faith-based intervention.
"Breast cancer survivors witness to others in the church setting," Braddix says. "They share their story, encourage screening and help facilitate the process."