York-Presbyterian Hospital/Columbia University Medical Center in New York City, says she performs more radical surgeries on younger patients these days. A 28-year-old patient of hers, who has a very strong family history of cancer and a genetic predisposition, had both breasts removed after being diagnosed with cancer in her left breast for the second time, although no cancer was found in the right.
“Many women are saying, ‘Hey, I’ve had enough and can’t live like this; I feel like a ticking time bomb,'” Joseph says. “Younger patients want the best odds at survival, and many younger women don’t want to have to do this again.”
HIGHER RISK
The American Cancer Society reports that 178,480 new cases of invasive breast cancer are expected this year. Excluding cancers of the skin, breast cancer is the most common cancer among all women, accounting for nearly one in three cancers diagnosed in U.S. women. The incidence rate of breast cancer is about 12% lower in African American women than in white women; however, among women under 40, the incidence is higher. The disease is the most common cancer for African American women, affecting 27%, followed by lung cancer at 13%.
Regardless of age, the death rate for breast cancer among African American women was 36% higher in 2004 than for white women, according to the American Cancer Society. The organization estimates that more than 40,000 women will succumb to breast cancer this year, and of those, almost 6,000 will be African American. The five-year survival rate among African American women with breast cancer diagnosed between 1996 and 2002 was 77%, compared to 90% among whites — numbers the American Cancer Society attributes to the disparity in detection and poorer stage-specific survival.
Of all breast cancers diagnosed among African American women, 52% of cases are diagnosed at a localized stage, meaning they are confined to the breast, compared to 62% among white women. The stage of detection among all women is critical because survival rates increase drastically the earlier the cancer is _discovered. In African American women diagnosed when the disease was at its localized stage, the five-year survival rate from 1996 to 2002 was 94%; at the regional stage (spread to surrounding tissue) it was 77%; 16% at the distant stage (after it has metastasized); and 45% at unstaged. Some evidence suggests that African _Americans have more aggressive and larger tumors than white women, according to the American Cancer Society.
Although Joseph says she sees more African American women being diagnosed at earlier stages, it’s not at the level she would like and definitely not at the level she sees with her white patients. In August she said she saw a 62-year-old woman who had just had her first mammogram and was diagnosed with an advanced stage of breast cancer. She _attributes the recurring late diagnosis to a combination of factors. “I think it’s fear of the doctors,” Joseph says. “It’s almost like a fatalistic thing, like if it’s meant to be it’s meant to be and there’s nothing that