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What BIPOC Doctors Want You to Know About Treatment for Early-Stage Breast Cancer

MSM's Dr. Melissa Davis and other cancer experts shared their top advice for women of color with early-stage breast cancer to address hurdles to early treatment.

By Claire Gillespie, HealthCentral

Facing a diagnosis of early-stage breast cancer (EBC) is tough. And it can feel even tougher when you're a person of color.

On the one hand, a diagnosis of EBC comes with a far better prognosis than it once did. In fact, women diagnosed with stage 1, stage 2 or even stage 3 breast cancer today are 66% less likely to die from the disease within five years than they were 20 years ago, according to research published in the British Medical Journal. But despite this positive news, there remains a mortality gap between Black women and white women with EBC.

There's a huge body of research showing that across the board, Black people and other minority groups in the United States experience more illness, worse outcomes and early death, compared with white people. When it comes to breast cancer, studies tell us that Black women have a 38% higher death rate from early-stage disease than white women, with the disparity even greater among women under age 50. Plus, Black women remain massively underrepresented in clinical trials for breast cancer, meaning their experiences and needs aren't getting the consideration they deserve when new therapies are being researched and developed.

Mistrust about medical treatment and the medical profession in general can keep some women of color from seeking early treatment for breast cancer. Here, BIPOC cancer docs share their best advice for women of color with EBC so that they can get the high-quality care they need to heal and thrive.

Get a Second (or Third) Opinion if You Need One

Having a cancer team you trust is a priority. But it can feel daunting to know where to turn — and to what degree you have power over that.

Your doctor may have initially referred you to a certain oncologist, but know that that's not the end of the story: You can get a second opinion, says Regina Hampton, MD, the division chief of breast surgery at Luminis Health Doctors Community Medical Center in Lanham, MD.

It's important to listen to your doctor's advice, but if something doesn't ring true, or your chemistry just feels "off," you're entitled to seek another doctor's advice, she explains. "You want a provider who is knowledgeable but also appreciates you as a patient, and your feelings and thoughts about your care," Dr. Hampton says.

You can ask for recommendations from other physicians that already take care of you, or family and friends who had a good experience with their oncologist. If you already have an oncologist but want to explore other options, you can ask them for recommendations as well — in fact, this is perfectly natural, says board-certified hematologist/oncologist Nan Chen, MD, an assistant professor of medicine at the University of Chicago Medicine. "If my patients ask me for second opinions, I always encourage them and offer options," says Dr. Chen. "It's important for people to feel comfortable and confident in their care."

There is also help out there to guide your search: The Susan G. Komen Foundation has tips for finding doctors on your care team, including links to search providers based on their board certifications as a cancer specialist. If you're African American and you'd feel more comfortable with an oncologist who shares some of your cultural experiences, go to BlackDoctor.org and click on the "Find a Doctor" tab to see who might be in your area.

Ask Questions to Feel Empowered

There is a lot of information — and misinformation — out there about EBC. And the latter may be producing fears that your doctors can debunk.

There's no such thing as too many questions as you go through your EBC journey, whether they are medical questions about the cancer and treatment itself or about additional resources that may be available, says Dr. Chen. Some key starters to ask might include:

• Why do you recommend this treatment approach?
• What are the treatment goals?
• What will my treatments look like?

It might feel uncomfortable at first, but it's all part of advocating for yourself. You know best how you feel and what you need.

"There is a wealth of data and more forthcoming that helps to understand why breast cancer is so diverse and unique among women with certain genetic backgrounds and environmental or social stressors," adds Melissa B. Davis, PhD, director of the Institute of Translational Genomic Medicine (ITGM) at Morehouse School of Medicine in Atlanta, GA. "Having this knowledge in combination with positive support partnerships can make a world of difference."

Lean on the Resources in Your Care Team

How can you trust you're getting the treatment you deserve — or that your treatment is the same quality as someone who is not BIPOC? Start by leaning on the care team and knowing what each ones does and how they can help you.

Your care team is more than the medical pros — your oncologist, surgeon, radiologist — who deliver treatments. Often, you'll be in contact with social workers, case managers, nurses and patient  navigators who have expertise in different areas. Dr. Chen stresses that these are resources you can reach out to for the other issues that come with EBC care, including dealing with the paperwork and issues of accessing care.

If you're still feeling unsure, check out apps like BC Navi, designed by an African American breast cancer survivor in conjunction with Penn Medicine to help BIPOC women make sure they are receiving equal care. Penn Medicine also partners with the Chrysalis Initiative to increase EBC support — such as one-on-one coaching — and clinical trial enrollment especially for BIPOC women.

"Often, patients are inundated with so much information, and they do not know when or how to utilize all of it. This is especially important for discussions regarding support services, financial navigation, clinical trials," says Monique Gary, DO, the medical director of the Grand View Health/Penn Cancer Network cancer program in Sellersville and Dublin, PA, where she also serves as director of the breast program. "Just because we offered it at the physician's office does not mean the patient understands when and how to access and utilize information. Having a strong relationship with the navigator is one of the most valuable resources a newly diagnosed patient has."

These navigators have knowledge to deal with a wide variety of hurdles to care, whether it's filling out financial forms or accessing providers who take Medicare.

Get Connected with BIPOC Support

During this challenging period, it is essential to surround yourself with supportive and loving individuals — "especially those who have already navigated the path you are about to take," says Dr. Davis. "For Black women in particular, establishing a patient advocacy network can make a significant difference, by providing knowledge of and access to potentially life-changing clinical trials and other resources, empowering you to explore every viable option for care and treatment."

National support groups for BIPOC women with breast cancer you can connect with include Carrie's TOUCH and the Sisters Network, which serve Black women facing EBC; ALAS Wings, a.k.a. the Latina Association for Breast Cancer; and the National Asian Breast Cancer Initiative.

If you feel you're facing any disparities when it comes to your cancer care, the African American Breast Cancer Alliance offers a virtual support group via Zoom for Black women, as well as financial assistance to help with non-medical expenses during active treatment.

Make Self-Care a Priority

A breast cancer diagnosis often comes with a huge amount of information about the type of cancer and the treatment options, often using unfamiliar terminology. "All of this will be critical to making decisions about your journey toward survivorship," says Dr. Davis. But it's not just about medical treatment (although that's clearly critical). How you take care of your body and your stress levels during this time is also essential: Research shows that stress is both a risk factor and outcome determinant with breast cancer.

What that looks like is entirely down to you: yoga, being creative, spending time in nature or relaxing with your favorite people. Sometimes, the simplest things can be acts of self-care. "Take a deep breath, exhale and think positive thoughts about your journey," says Dr. Hampton. You can also try these in-the-moment stress relievers anytime.

Taking Charge of Your EBC Treatment

It's a big deal managing early breast cancer treatment and it's easy to feel like there are roadblocks in your way. The message from our experts is that they want BIPOC women to know that they are not in it alone and that early treatment is the goal. You can use this practical advice to power your journey and hopefully dispel any hesitancy.

It's also great to get advice from family and friends, but Dr. Hampton advises being cautious before following their recommendations. They may have the best of intentions but may be basing their views on outdated information, she explains. "Breast cancer treatments evolve every two to three years, so information from before that time is probably out of the current standard of care."

You can learn about the latest second-line treatments available and even cutting-edge treatments to come to give yourself even more confidence in your care — and hope for your EBC journey ahead.

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