Dr. Alice J. Cohen, M.D., F.A.C.P., is the director of the Frederick B. Cohen Cancer and Blood Disorders Center in Newark, N.J. She spoke with DiversityInc to set the record straight about what breast cancer is, why more Black women die from the disease and why self-breast examinations are so important.

What is breast cancer and how does someone get it?

• Breast cancer is a tumor that occurs in women as well as men.
• Only 1 percent of all breast cancers occur in men predominately based on the fact that men have much less breast tissue than women.
• It is the second most common tumor seen in women; lung cancer is No. 1.
• 1 in every 8 women have a lifetime risk of developing breast cancer.
• The biggest concern is that the breast cancer should be eradicated before it spreads to other parts of the body.

The Risks:

·         The No. 1 risk is family history. If you've had someone else in your immediate family, especially a mother (and now we even say a father, aunts, cousins, brothers, sisters), you have an increased risk of breast cancer.

·         If you've had breast cancer once before, you have a greater risk of getting breast cancer in the other breast.

·         Women who have begun menstruation very early in life and have their menopause occur very late in life have an increased risk of breast cancer.

·         Women who have never had a pregnancy have an increased risk of breast cancer, so having children particularly at a younger age, before the age of 30, gives a protected effect to women and helps to prevent breast cancer.

·         There's a lot of controversy about the use of estrogens, either hormone-replacement therapy or oral contraceptives, but the most recent data suggests that there's a slight increase in risk for breast cancer in women who take exogenous estrogen.

·         Women in higher socioeconomic classes tend to have an increased risk of breast cancer, and that may have more to do with how much money you can spend on better food and on higher fatty content in the diet.

Doctor's Note: If you look at families in the Far East and in some of the third-world countries, they tend to have a lower risk of breast cancer, particularly women in China. Yet if you move those families to Western Europe or the United States, their risk of breast cancer increases closer to women who live in those environments. So what exactly it is about the environment still isn't perfectly well defined, but it suggests that the higher socioeconomic class with change in the diet somehow affects the risk of breast cancer.  

So why are Black women 36 percent more likely to die from breast cancer than white women?

• Late diagnosis
• Triple-negative diagnosis

 Doctor's Note: What's going on with Black women that we've now started to recognize is an increase in a certain type of breast cancer, which has a poorer prognosis, known as triple-negative breast cancer. When we look at breast cancer we look at how big the tumor is at diagnosis, whether or not it spread to the lymph glands or anywhere else in the body, and a number of biochemical features of that breast cancer.

First we can look at it under the microscope and see if it looks "scary," what I call poorly differentiated breast cancer, suggesting it's a more aggressive tumor. But then we can test for something known as estrogen receptor [ER], progesterone receptor [PR], and finally a genetic mutation known as the her2/neu. Those are all prognostic features for breast cancer.

A subset is a group of patients who are what we call triple-negative. That ER, PR and her2/neu are all negative, and these patients seem to have a worse prognosis. By that, I mean the chance for recurrence of their breast cancer outside the breast is greater and occurring earlier in their breast-cancer course and responding less to the known treatments that we have. That seems to be more common in African-American women.

So is breast cancer more common in Black women than in other groups?

Overall, breast cancer is not any more common in African Americans than in Caucasians, but that particular aspect is of concern. We are seeing sometimes late presentations in minority individuals or people who are underserved so that if we see patients that have no health insurance, the likelihood is that they will be diagnosed later because they're not going to have the opportunity for a screening mammogram to pick up these tumors [when they're] smaller. Or if they feel a lump, they're less likely to seek medical attention because they don't have a primary doctor to go to and talk about it. So then they present with very large tumors and more advanced disease.

What's your advice for early detection?

American Cancer Society guidelines suggest that women be taught self--breast examinations from an early age. Women should undergo a screening mammogram between the ages of 35 and 40, and a mammogram every one to two years between 40 and 50 and yearly thereafter.

Now, if we're talking about women who don't have insurance and do not go regularly to a healthcare professional to examine them because they have no health insurance, who's going to find the lump? It can only be found through self--breast examinations. And that can make the difference between one of those women potentially taking the risk and going to seek attention when they don't have health insurance because they found something of concern.

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