By Chris Hoenig
Black women under age 45 are more likely than women of any other race or ethnicity to be diagnosed with breast cancer, but surviving it may depend on where you live.
Breast cancer is the most common form of cancer in Black women and is the leading cause of cancer-related deaths for Black women between the ages of 4564. While white women are more likely to be diagnosed with breast cancer after the age of 45, Black women are up to 60 percent more likely to die from it than their white counterparts. But the racial gaps in the mortality rates of breast-cancer patients vary significantly by state.
Tennessee is the worst state for Black women with breast cancer. At 35.5 percent, the mortality rate for Black women is higher in the Volunteer State than anywhere else in the nation, while the racial gap in breast cancer survivabilitynearly 14 percentage points (down from a peak of nearly 15 percentage points in 2007)is also the largest in the United States (21.6 percent of white women diagnosed with breast cancer in Tennessee ultimately die from the disease). Mississippi (12.8 percentage points), Texas (12.6), Washington, D.C. (11.9), and Michigan (11.6) follow close behind, making up the five largest racial gaps in the country.
With the exception of Texas, the Black population in each of these states is higher than the national average. More than half of Washington, D.C., residents (50.7 percent) and more than one-third of those living in Mississippi (37 percent) are Black, compared to just 12.6 percent of the total U.S. population. More than 1 million Blacks live in Tennessee, making up 16.7 percent of the state’s population. And even though Texas is below the national average (11.8 percent), only New York and Florida are home to more Black Americansthe 2.98 million Blacks living in the Lone Star State make up nearly 8 percent of the entire population of Black Americans.
These states also rank among the poorest in the United States. With a median household income of barely $37,000, Mississippi is the poorest state in the country and has the highest percentage of its population (24.2 percent) living below the poverty line. Tennessee ranks 44th in household income, while Michigan ranks 33rd and Texas, at 24th, still sits below the national average.
Even in the states with the smallest racial gaps in breast-cancer survivability, the trend is moving in the wrong direction. In Massachusetts, New York, Connecticut and New Jersey, the states with the smallest gaps, white women were actually more likely than Black women to die from breast cancer in the 1980s. In each of these states, however, there has been a sharper decline in the death rates for white women than Blacks. Still, survival rates for Black women with breast cancer are higher in these states than in most others. Less than a quarter of the Black women diagnosed with breast cancer in Massachusetts die from the disease (23.5 percent), only 2 percentage points more than white women. In New York, where the racial gap is 3.3 percentage points, nearly 75 percent of Black women survive the disease. In Connecticut and New Jersey, where the racial gaps are 5.8 percentage points each, the mortality rates are 27.1 and 30.9 percent, respectively.
Wealth also separates these states from the likes of Tennessee, Mississippi, Michigan and Texas. New Jersey ranks second in median household income at nearly $70,000. Connecticut is fourth at more than $67,000 and Massachusetts is close behind (ranking sixth overall with the average family earning more than $65,000). Even New York, which ranks 15th, still comes in ahead of the national average.
Previous studies suggest that inferior care and a lack of access to affordable healthcare are behind the increased mortality rates for Black women with breast cancer, and these new statistics on racial gaps not only appear to affirm those studies’ findings, but also increase the hope that the Affordable Care Act can help close these gaps. Massachusetts has not only the smallest racial gaps in the country, but it also has the health-reform law nicknamed Romneycarethe successful measure that the Affordable Care Act was modeled after. Signed into law by then-Governor Mitt Romney, the legislation, like the ACA, requires Massachusetts residents to have health insurance or face a penalty, while providing subsidies for low-income households to be able to afford coverage and preventing insurance companies from denying coverage because of preexisting conditions. The ACA takes the law a step further, increasing the limited Medicaid expansion used in Massachusetts and including preventative caresuch as cancer screenings and mammogramsat no cost to the patient (Massachusetts allows for a copay to be required for these screenings).
There are still hurdles to closing the gaps, and some of it starts with the research and understanding of breast cancer. One of the largest fundraisers for breast-cancer research, the Susan G. Komen Foundation, has a board of directors, senior-leadership team and Scientific Advisory Board made up almost entirely of white womenonly one Black woman, Dr. Olufunmilayo “Funmi” Olopade, a Nigerian-American based at the University of Chicago, holds any of these leadership positions. While the Scientific Advisory Board has a majority that are men, all of them are white.