More progress needs to be made to improve outcomes for Black women with breast cancer. Here’s how BCRF investigators are addressing the challenge.
In the United States, breast cancer continues to be the most common cancer and the leading cause of cancer death in women. In 2024, the American Cancer Society (ACS) estimates that more than 310,720 new cases of invasive breast cancer and 56,500 new cases of ductal carcinoma in situ/stage 0 breast cancer will be diagnosed in women in the United States. While there has been an overall 44 percent decline in breast cancer deaths since 1989—thanks to gains in awareness, earlier diagnoses, and more effective treatments—there is a persistent mortality gap between Black women and white women.
Data compiled by ACS highlight the need to close this devastating gap. While breast cancer incidence rates among Black and white women are similar, mortality rates are markedly different, with Black women having a roughly 40 percent higher death rate from breast cancer. Among women under 50, the disparity is even greater: While young women have a higher incidence of aggressive cancers, young Black women have double the mortality rate of young white women.
Advances in early detection and treatment have dramatically reduced breast cancer’s ability to take lives overall, but it’s clear that these breakthroughs haven’t benefitted all groups equally—and this disparity has remained unchanged for more than a decade.
What accounts for breast cancer disparities among Black women?
The gap in breast cancer incidence and outcome among Black women is complex and multifactorial. Social, economic, geographic, and lifestyle factors may partially account for disparities. Black women are statistically more likely to have diabetes, heart disease, and obesity, and are less likely to breastfeed after childbirth—all of which are risk factors for breast cancer. They are more likely than white women to have inadequate health insurance or access to health care facilities, which may affect screening, follow-up care, and completion of therapy.
Through continued research, it’s clear that biology also plays a role. Black women are disproportionately affected by more aggressive subtypes, such as triple-negative breast cancer (TNBC) and inflammatory breast cancer, and they are more likely to be diagnosed at younger ages and at more advanced stages of the disease.
Moreover, results from two large clinical trials—TAILORx and RxPONDER, supported in part by BCRF—have revealed distinct differences in recurrence and outcomes in Black women compared to white women. Previously, BCRF investigator and study lead Dr. Joseph Sparano reported on the TAILORx trial, which showed that while the number of late recurrences exceeded early recurrence rates in all participants, disparities between Black women and white women were observed in early recurrences but not in late recurrences. Looking at the connection between race and clinical outcomes, RxPONDER investigators found that despite having similar recurrence scores, Black women with hormone receptor–positive/HER2-negative, lymph node–positive breast cancer had worse outcomes compared to Asian, Hispanic, and non-Hispanic white women. Other studies have examined this disparity and indicate that breast tumors in Black women respond differently to endocrine therapy and may more frequently become resistant to therapy.
A 2017 study looking at women between the ages of 18 to 64 who were diagnosed with early-stage breast cancer found that four key factors accounted for 76.3 percent of the total excess mortality risk in Black patients: 37 percent of Black women’s excess mortality risk could be explained by a lack of private health insurance; tumor characteristics explained 23.2 percent; comorbidities 11.3 percent; and treatment differences (when it started or stopped, what was given) 4.8 percent.
Working toward a solution
According to the National Cancer Institute, disparities in cancer care can be improved in several ways. These include creating statewide cancer screening programs that are accessible to underserved populations and by addressing the biological differences in breast cancer across racial and ethnic groups.
A 2019 study that analyzed characteristics of breast cancer patients on a city level showed that women with more resources (such as education and income) may be better equipped to take advantage of healthcare advances. Indeed, cities that have confronted this problem by increasing access to state-of-the art mammography facilities made significant progress in narrowing the breast cancer mortality gap between Black and white women.
BCRF investigator Dr. Marianna Chavez MacGregor underscored the importance of healthcare access in a 2023 study, which found that among patients with stage 4 breast cancer, survival disparities between white women and other racial/ethnic groups were no longer present in states that expanded Medicaid (healthcare coverage for low-income Americans) after the Affordable Care Act.
In December 2024 at the San Antonio Breast Cancer Symposium, researchers from BCRF’s Health Equity Initiative—a groundbreaking study made possible by The Estée Lauder Companies Charitable Foundation (ELCCF)—reported first findings from the largest study to date on how social determinants of health impact breast cancer outcomes in Black women. Based on an analysis of 5,000 women, the authors found that:
- Black women who didn’t get mammograms on a regular basis were three times more likely to be diagnosed with later-stage (3 or 4) breast cancer versus stage 1.
- Black women living below the federal poverty line were almost twice as likely to be diagnosed with later-stage (3 or 4) breast cancer versus stage 1.
These findings drove home the need for interventions that could improve Black women’s outcomes, including those that increase mammography access and address economic and insurance barriers to care.
“This study is a major step forward in helping us unravel the key causes underpinning disparities in breast cancer outcomes,” BCRF’s Chief Scientific Officer Dr. Dorraya El-Ashry said at the time. “By identifying specific determinants for individuals at this scale, we can inform potential interventions to improve breast cancer survival and reduce disparities.”
The biology of breast cancer is inherently complex, which is why we often hear the phrase, “Every woman’s breast cancer is unique.” While we have made significant progress in understanding the molecular drivers of breast cancer, most studies and clinical trials are conducted in white women. Expanding Black women’s participation in research is critical.
We have only recently been able to decipher some of the underlying biology to explain the higher incidence of aggressive tumors in Black women and to identify biomarkers that could ultimately inform personalized therapies and improve outcomes for Black women diagnosed with breast cancer.
BCRF investigators’ research to improve outcomes for Black women
BCRF recognizes the continued need for more research to end disparities faced by Black women across the U.S. A snapshot of the current BCRF-supported projects specifically in this area include:
Drs. Christine Ambrosone and Chi-Chen Hong are studying the types of immune cells found in and around breast tumors from both Black and white women to determine if they affect tumor aggressiveness.
Dr. Fergus Couch has identified inherited mutations in breast cancer susceptibility genes that confer an increased risk of TNBC and may be important for screening in high-risk Black women. His team examined gene mutations in a large, racially diverse population of American women. This study showed that mutations in the BARD1, RAD51C, and RAD51D genes, while very uncommon, appear more frequently in Black women with breast cancer and are associated with an increased risk of both TNBC and estrogen receptor (ER)–negative breast cancer.
In a cohort of breast cancer patients with African ancestry, Dr. Melissa Davis is studying the relationships between social determinants of health, ancestry, the tumor microenvironment, and survival.
Dr. Neha Goel is evaluating how neighborhood factors and stress may affect the breast cancer tumor microenvironment in diverse populations.
Recognizing that access to clinical trials that test new therapies is vital to Black women’s survival, Dr. Carmen Guerra is investigating ways to mitigate unconscious bias that may decrease their enrollment.
In her BCRF project, Dr. MacGregor is looking at underrepresented or understudied populations, including racial and ethnic minorities as well as older people and evaluating the rates of treatment completion and how treatment-related toxicities and access to care impact these groups.
Dr. Kathy Miller is identifying differences in immune pathway activation between Black and white women with breast cancer to exploit any unique biologic vulnerabilities inherent in Black women’s tumors and thus improve outcomes.
Dr. Lisa Newman is conducting a pilot study to both tackle breast cancer disparities related to race and ethnicity and to provide a platform for Black physicians to be more engaged in research.
Work led by Dr. Charles Perou and BCRF collaborators has uncovered differences in the genes and gene mutations found in Black women’s breast tumors compared to those in white women. His team is building on their findings to identify the drivers of metastatic disease, determine the adaptive immune system’s role in breast tumor progression, and improve therapeutic targeting of TNBC tumors to decrease disparities in outcomes.
Utilizing data from completed and ongoing clinical trials, Dr. Priyanka Sharma is studying the relationship between race and treatment response biomarkers in TNBC. Ultimately, her research will move us closer to personalized medicine, tailoring treatments to an individual’s cancer biology.
Dr. Annette Stanton is conducting research on the unique psychological experiences of Black women diagnosed with breast cancer to help them better cope and decrease depressive symptoms.
Dr. Walter Willett has shown that a plant-based diet—one rich in carotenoids, cruciferous vegetables, berries, fiber, and vitamin D—is associated with a lower risk of breast cancer. He is expanding this project to determine if this result applies to a racially diverse cohort (via the Southern Community Cohort Study) consisting mainly of Black women.
Dr. Eric Winer seeks to understand the interplay between lifestyle factors, obesity, and breast cancer biomarkers that disproportionately impact low-income minority women and that are associated with poorer health outcomes. His team hopes to develop and implement lifestyle weight management counseling for these women to provide equitable care for all breast cancer patients.
BCRF’s global reach
In 2024, the World Health Organization announced that breast cancer is the most frequently diagnosed cancer globally in women. According to a recent report, 2.3 million women have been diagnosed with breast cancer and more than 670,000 women have succumbed to their disease—making global breast cancer research even more critical. BCRF investigators are addressing health care inequalities around the world, with a particular focus on Black women in low-resource areas. These studies have the potential to inform strategies to improve outcomes in underserved communities globally.
Drs. Lawrence Shulman and Cyprien Shyirambere have developed effective strategies to integrate early detection services into rural Rwanda’s health care system and reduce time to treatment. They are now working to expand these efforts to reach more women with the goal of reducing preventable breast cancer deaths in Rwanda and other countries.
Dr. Olufunmilayo (Funmi) Olopade is investigating differences in tumor biology, genetics, and health care delivery patterns that contribute to the mortality gap between Black and white women. She has expanded her studies to develop infrastructure for clinical trials in low-resource communities in Nigeria and sub-Saharan Africa. Clinical trials to test novel targeted treatments, increased access to quality diagnostic tools, and optimized standard-of-care treatments will improve outcomes for this population and potentially others in underserved areas.
Additional research investments
In addition to supporting the above BCRF investigators and others whose work may impact Black women in the U.S. and abroad, the Foundation grants a number of awards to early- and mid-career researchers. Read more about our commitment to diversifying the breast cancer research field and supporting disparities-focused researchers here.
To mark 30 years of The Estée Lauder Companies’ Breast Cancer Campaign in 2022, The Estée Lauder Companies Charitable Foundation announced that it would donate $15 million—the single largest corporate donation in BCRF history—to accelerate innovative research addressing breast cancer disparities. With this generous gift, BCRF launched the aforementioned Health Equity Initiative, which seeks to understand the intersection of social determinants of health, comorbidities, and the biology of breast cancer in Black women that impacts their outcomes.
Addressing and improving Black women’s representation in breast cancer clinic trials is critical to assuring equity in care. BCRF supports two large clinical trials networks that are working toward this goal: the Translational Breast Cancer Research Consortium and the Southwest Oncology Group.
A deeper understanding of tumor biology, its variations among people of different races, and the intersection of biology and social determinants of health holds the promise to improve prevention strategies, early detection, and treatment of breast cancer to reduce disparities. BCRF continues to work toward this goal.
This article was updated to reflect 2025 data and research projects.