Cancer is the leading cause of death among Hispanics, and breast cancer tops the list of cancer-related deaths in Hispanic women. The probability of developing invasive breast cancer in Latinas is lower than in Non-Hispanic whites (currently, the lifetime risk is 1-in-10 for Latinas vs. 1-in-8 for non-Hispanic whites). However, Latinas are significantly more likely to present at a later stage with larger tumors that are hormone-receptor negative2,3, which are more difficult to treat.
Economic and Socio-Cultural Barriers Fuel Limited Understanding of Risk
Breast cancer is less likely to be diagnosed at the earliest stage in Hispanic women compared to non-Hispanic white women, contributing to the higher mortality rate. Lower rates of mammography screening, delayed follow-up of abnormal screening results and more aggressive biology contribute to this difference.4,5,6
Although economics and access to healthcare are believed to play a role, studies have shown that sociocultural barriers also exist, particularly among monolingual Hispanics, which deter women from seeking medical attention when they experience changes in their breasts. These barriers include anxiety, embarrassment, and the proliferation by the Spanish media (particularly in soap operas) of a more traditional female role of women as caregivers who put the well-being of others ahead of their own. The lower incidence of breast cancer in Hispanic women also leads to misconceptions for Latinas who interpret the lower rates to mean they don’t have to worry about breast cancer. Several studies have reported that low-income Latinas tend to have more medically inaccurate beliefs about what causes breast cancer; such as the consideration of breast trauma, breast fondling or self-exam, wearing underwire bras, and use of illegal drugs, none of which have been shown to be risk factors for the disease.7,8,9
There is mounting evidence that descendants of Hispanic immigrants to the US adopt the American lifestyle and as a result have cancer rates that approach those of non-Hispanic whites. For example, within the Hispanic population, the breast cancer incidence rate is 50% lower in foreign-born Latinas than in U.S.-born Latinas.10 As the Hispanic population grows to a projected one-third of the U.S. population by 2050, the effects of acculturation will have both positive and negative effects on these cancer statistics. While more Hispanics are gaining better access to healthcare and preventative services, the adoption of unhealthy behaviors (e.g., higher alcohol consumption) and declines in dietary quality and physical activity will take their toll, which may result in higher incidence and death rates.
“Within the Latina community, a certain amount of cultural taboo still exists regarding female health issues, along with misconceptions about risk factors,” said Dr. Susan Love, Founder and Chief Visionary Officer of Dr. Susan Love Foundation for Breast Cancer Research and author of Dr Susan Love’s Breast Book which has recently been translated into Spanish (El Libro de La Mama available on Amazon.com). “Unless we can gain momentum with more discussion and education about breast cancer and more research into specific causes and prevention of breast cancer in Hispanics, the mortality rate could soon surpass that of non-Hispanic whites. This is a problem that has to be addressed by putting more focus on the Hispanic community now.”
Ancestral and Genetic Diversity = an Incomplete Picture of Hispanic Breast Cancer Risk
The ancestral origins of Hispanics in the United States span the globe from Mexico, Central and South America, the Caribbean, and Europe, creating a multitude of diverse subgroups with distinct cancer patterns. The heterogeneous nature of the U.S. Hispanic community presents a challenge to identifying specific risk factors for breast cancer. For example, a study of 3,181 women with breast cancer showed that Hispanic women have a higher likelihood of carrying the BRCA1 gene mutation than non-Hispanic white women.11
Recent research into the prevalence and type of BRCA gene mutations among Hispanic sub-groups in the Southwestern United States found BRCA mutations in 25% of cases with a personal or family history of breast and/or ovarian cancer.12 To aid researchers in uncovering new data that is relevant to individual sub-groups, Dr. Susan Love Foundation for Breast Cancer Research believes that a large and diverse population of Latina volunteers is needed to participate in clinical studies as well as long-range epidemiological studies that track incidence and risk factors in foreign-born versus U.S.-born Latinas.
Hispanic Women Can Help Accelerate Progress in Breast Cancer Research
Two programs of the Dr. Susan Love Foundation for Breast Cancer Research are designed to engage the public in important research that will help identify risks, cause(s), and prevention of breast cancer. Although both programs are well subscribed, only about 3 percent of current participants are registered as Hispanic/Latina. Given the growing proportion of Hispanics in the U.S. population, Dr. Susan Love Foundation for Breast Cancer Research believes that this community is seriously underrepresented in breast cancer research.
Love Research Army
Dr. Susan Love Foundation for Breast Cancer Research’s Love Research Army is a program designed to give all women and men, with or without breast cancer, the opportunity to participate in research that will take breast cancer beyond a cure to identify risk factors, the cause, and ultimately, ways to prevent the disease.
The Love Research Army program has two key goals:
• To shift more research out of the lab by recruiting volunteers of every age and ethnicity, including breast cancer survivors, people at high-risk for the disease, and healthy women and men, who are willing to partner with breast cancer researchers and directly participate in research.
• To challenge the scientific community to shift the emphasis of research beyond the cure to focus on breast cancer prevention by identifying the cause.
To date, more than 376,000 women and men have registered with the Love Research Army to learn about new breast cancer research and to sign up to participate in research projects. More than 80 researchers have utilized the Love Research Army to recruit participants into their studies. Studies on Latina women that have recruited from the Love Research Army include:
- Chemotherapy-induced Premature Menopause in Latina Women with Breast Cancer (University of Massachusetts Medical School)
- Latina Breast Cancer Research Initiative (University of California, Los Angeles)
- Breast Cancer Risk in Hispanic Women (City of Hope)
Increasing the pool of Latinas who are willing to participate in breast cancer research will help inspire and accelerate more research into the unique characteristics of breast cancer risk, occurrence and response to treatment in Hispanic women. For more information and to register, visit www.armyofwomen.org
Health of Women [HOW] Study™
Dr. Susan Love Foundation for Breast Cancer Research created the innovative Health of Women [HOW] Study in 2012 to identify the cause and cost of the disease through an online cohort. The [HOW] Study is the largest long-term breast cancer study that is open to anyone aged 18 and over, including those with and without a history of breast cancer. The Health of Women Study will track thousands of women (and men) over time to learn what causes breast cancer, and how to prevent it.
Participants in the [HOW] Study are invited to complete questionnaires to track trends and factors such as basic demographics, reproductive history, general health measures, family health history, diet and exercise, and environmental exposures. Participants with a history of breast cancer are invited to complete questionnaires related to their diagnosis and treatment. This is the first time a study of this size and magnitude is collecting data entirely online. Participants are notified by email every few months when new questionnaires are available. Questionnaires typically take around 30 minutes to complete.
More than 50,000 women and men have registered for the [HOW] Study and the number is growing every day. By increasing the Hispanic participation in the [HOW] Study, Dr. Susan Love Foundation for Breast Cancer Research will gain greater insight into unique backgrounds, behaviors, environmental factors, and other data common within the Latina population that may lead to new insights into risk factors and prevention of breast cancer. While the study is in English, the Foundation is seeking funding to translate it into Spanish. For more information, visit www.healthofwomenstudy.org
About Dr. Susan Love Foundation for Breast Cancer Research
Dr. Susan Love Foundation for Breast Cancer Research is dedicated to achieving a future without breast cancer by engaging the public and the scientific communities in innovative research on cause and prevention. We do this through performing and facilitating innovative and collaborative research, translating science to engage the public as informed partners, and inspiring novel research.
Dr. Susan Love Foundation for Breast Cancer Research has received a 4-star Charity Navigator rating for three consecutive years, putting it in the top 12% of rated charities in terms of fiscal performance, accountability, and transparency. The Foundation is also a GuideStar Exchange Silver Level participant and a member of the Better Business Bureau Wise Giving Alliance.
Dr. Susan Love Foundation for Breast Cancer Research, and its more than 376,000 volunteers nationwide, invite you become part of a movement to engage the public in breast cancer research with the goal of eradicating the disease once and for all. To learn more and show your support, visit www.actwithlove.org
1: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.6.1 Statistical Research and Applications Branch, National Cancer Institute 2012. Http://srab.cancer.gov/devcan
2: Ooi SL, Martinez ME, Li CI. Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Res Treat. Jun 2011;127(3):729-738.
3: Miller BA, Hankey BF, Thomas TL. Impact of sociodemographic factors, hormone receptor status, and tumor grade on ethnic differences in tumor stage and size for breast cancer in US women. Am J Epidemiol. March 15 2002;155(6):534-545.
4: American Cancer Society. Cancer prevention & Early Detection Facts & Figures 2012. Atlanta, CA: American Cancer Society; 2012. 5: Press R, et al. Racial/ethnic disparities in time to follow-up after an abnormal mammogram. J Womens Health (Larchmt). Jul-Aug 2008;17(6):923-930.
6: Stuver SO, et al. Identifying women at risk of delayed breast cancer diagnosis. Jt Com J Qual Patient Saf. Dec 2011;37(12):568-575.
7: Chavez LR, et al. Understanding knowledge and attitudes about breast cancer. A cultural analysis. Arch Fam Med February 1995 4(2):145-52.
8: Hubbell FA, et al. Differing beliefs about breast cancer among Latinas and Anglo women. West J Med. May 1996;164(5):405-409.
9: Ramirez AG, et al. Hispanic women’s breast and cervical cancer knowledge, attitudes, and screening behaviors. Am J Health Promot May-June 2000; 14(5):292-300.
10: Chlebowski RT, et al. Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst. March 16 2005;97(6):439-448.
11: John EM, et al. Prevalence of Pathogenic BRCA1 Mutation Carriers in 5 US Racial/Ethnic Groups. JAMA Dec. 2007; 298(24):2869-2876.
12: Weitzel JN, et al. Prevalence and Type of BRCA Mutations in Hispanics Undergoing Genetic Cancer Risk Assessment in the Southwestern United States: A Report from the Clinical Cancer Genetics Community Research Network. J Clin Oncol Jan. 2013; 31:210-216