Why now is the time to close the ethnic disparities in breast cancer

Why now is the time to close the ethnic disparities in breast cancer

7 minute watch
Throughout Breast Cancer Awareness Month we're speaking to a number of people who've been affected by breast cancer, hearing about their personal experiences and the breast cancer issues they feel passionately about.

This week we caught up with Ms. Georgette Oni, a consultant plastic, reconstructive and oncoplastic surgeon, based at the Nottingham Breast Institute in the UK.

Georgette is also the founder of the ‘Let’s talk about… Black Women and Breast Cancer’ conference, so we wanted to find out more about the disparities in breast cancer survival for ethnic minorities and what can be done to help improve outcomes.

Q) What motivated you to become a surgeon?

GO: The reason I actually went into breast oncology is because I had an interest in the inequalities that women faced. In particular it became apparent that women of colour had worse outcomes in terms of their overall survival, in terms of the stage in which they’re presenting and so my research interest is actually looking at the reasons why that may be.

Q) What are you most focused on this Breast Cancer Awareness Month?

GO: Breast cancer is a really prevalent disease. One in eight women will have a diagnosis of breast cancer in their lifetime and some are revising that estimate now to around one in seven.

What we are seeing is that the majority of women are actually surviving that diagnosis and living for many years beyond However, there are still ethnic disparities in the outcomes.

"We have seen that black women have worse outcomes in terms of survival."

They present in a later stage and therefore will require more aggressive treatment in order to try and achieve a long term survival for them.

So that was really the emphasis behind the ‘Let’s talk about… Black Women and Breast Cancer’ conference because it’s an issue that is still quite taboo in many cultures. Black women are a broad spectrum and we felt that if we had an initiative which targeted them directly, hopefully we can make some inroads in addressing these inequalities.

Q) Can you tell us more about the conference?

GO: So ‘Let’s talk about… Black Women and Breast Cancer’ originated last year from a group of enthusiastic individuals really keen to see what we can do to try and improve the outcomes for black women with breast cancer.

It’s a mixed group, not just healthcare professionals. We’ve got breast cancer survivors and people that have supported black women through breast cancer.

We previously had an in-person conference, which was sponsored by many companies – including Endomag – and 200 women registered to come and just learn about things that can be done to try to improve outcomes.

This year, unfortunately due to COVID-19, we are unable to have an in-person conference. However it has really opened up the opportunities for us for to expand to an international conference in which we’re able to hear about the experiences of women all around the world and the initiatives in place to try and improve outcomes for black women across the globe.

Q) Research shows that worse breast cancer outcomes are common for Black women in some health care systems – why is this?

GO: So I think that’s a really good question, and there are going to be geographical reasons in part for that. So if I look at the United Kingdom in particular, do we have a lot of data on this? No we do not. A lot of the information we have is fairly old and we don’t have up to date research on the actual figures and outcomes.

"A lot of the research that we have comes from the United States and we know that in circumstances where you have to fund your own health, there may be differences that are related to access to care."

Certainly this conference is looking at the international picture – we’ve got speakers from Africa and the Caribbean. And again, I would expect that there will be barriers towards accessing care and different kinds of care that they’re going to receive when they do present.

Q) Why are Black women more likely to suffer from aggressive forms of breast cancer?

GO: So there’s a lot of research going on in general for breast cancer and there’s a lot of interest in this topic.

We know that black women are more likely to have something called a triple negative breast cancer which means that they do not produce an EU receptor or HER2 protein, for which we have targeted treatments.

There’s a lot of basic science work going on there to look at all the things that we can now generate that we can use to treat this particular form of cancer.

Q) How can research be adapted to better help Black women with breast cancer?

GO: I think that what really needs to happen is a bigger engagement in terms of participants in trials. We know that it is difficult to recruit people from a black or minority ethnic background into trials and it’s one of the things we talked about at length at the last conference.

Research has shown that if your health professional spends that time to talk to you about why it’s important to be part of that trial, women are more likely to take it up. So that’s something I think we need to try and engage more with.

It’s understandable why people don’t want to engage but it’s incumbent upon us health care professionals to get into the reasons behind that and try to reassure patients that it’s being done in their best interest, and also for women coming behind them.

"One of the things that the COVID 19 has brought to the fore again is the ethnic differences in the way that people are responding to diseases"

It’s generated an interest in acknowledging that we are not all one homogeneous group, and that in order to truly have an equitable health outcome you need to represent the people within your population.

Q) What can black women do to improve their outcomes from breast cancer?

GO: In terms of general health, things like weight, diet and exercise are all critical things that help reduce risk across the board. Self-examination is key too – be breast aware.

We know that black women do present younger outside of the screen age. In the UK, our screening age is 50-70 years old but about 50% of black women present younger than 50. You need to know what’s normal for you so when you examine yourself and feel a lump, you can present promptly to a healthcare professional to have that investigated.

"We need to engage with the screening program. The point of the program is to pick up cancers at an earlier stage. The earlier you get the cancer, the better your outcomes are long term."

And then I’ve already talked about participating in research. If we are not represented in that research then it means the outcomes may not necessarily apply to us. We’re seeing that there are disparities already. I think there’s a variety of things that we can do but certainly I think the science needs to catch up with us. We are behind on that.

Q) And finally how can people sign up for the 'Let's talk about... Black Women and Breast Cancer' conference?

GO: We’re all over social media. So you can find us on Twitter, Instagram, and Facebook. We’ve even got a hashtag #BWBC2020.

You can also find the registration link for the ‘Let’s talk about… Black Women and Breast Cancer’ conference here. ♦