Addressing Disparities in Breast Cancer Care for Black Women

Black women face a myriad of health disparities that complicate the treatment of breast cancer. Not only are they more likely to be diagnosed with more advanced and aggressive breast cancer, but they are also more likely to face cardiovascular comorbidities. A groundbreaking new study shows that proton therapy – which can minimize damage to the cardiovascular system – holds promise for women with breast cancer, particularly Black women.

The study, published in the February issue of JNCI Cancer Spectrum, retrospectively looked at 599 patients who were treated for breast cancer at the Maryland Proton Treatment Center between 2016 and 2021. Black women, who comprised 31 percent of the patients, were more likely to be diagnosed with Stage III or IV breast cancer and also more likely to have aggressive triple negative breast cancer. In addition, they were also more likely to have high blood pressure and other cardiovascular conditions.

The study also showed that Black women were more likely to face logistical barriers in every stage of diagnosis and treatment. They experienced longer gaps between an abnormal mammogram and a follow-up appointment, more difficulties obtaining transportation to treatment, and, most troubling, were more likely to not receive guideline-concordant care, regardless of their insurance status.

Melissa Vyfhuis, MD, PhD

Physician, Maryland Proton Treatment Center and Chesapeake Oncology Hematology Associates 
Assistant Professor of Radiation Oncology, University of Maryland School of Medicine

Traditional radiation therapy for breast cancer presents a tricky challenge: clinicians must target the tumor while minimizing damage to the heart, lungs and blood vessels. Studies have shown that damage to the cardiovascular system is not uniform, and is dependent on the location of the tumor, among other factors.

Proton therapy, particularly innovative pencil-beam scanning, enables clinicians to target the tumor and minimize damage to surrounding organs. Proton therapy reduces the risk of toxicity by up to 2.9%, and the benefits are likely to be even greater for breast cancer patients who already have cardiac conditions. Moreover, clinicians can often arrange a treatment plan for proton therapy that enables patients to obtain the same results in fewer visits– a particular benefit for those with limited access to transportation.

Yet, Black women are currently 33 percent less likely than white women to receive proton therapy, especially for cancers in which it is recommended.  This is according to an American Cancer Society study that examined 45 proton treatment centers across the country. This means that there is a tremendous opportunity for clinicians to expand access to proton therapy for Black women, to not only treat breast cancer, but protect their cardiovascular systems for longer, healthier lives.