Why are black women less likely to follow breast cancer treatment?

Niasha Fray, while she was pursuing graduate school in public health, found a job she loved: advising women with breast cancer on maintaining their treatment.

She proposed what is called "motivational interviewing", a type of therapy designed to help women overcome the barriers that prevent them from taking their medication, which can have unpleasant side effects.

"They had just given up so much of their lives, their bodies, their families," Fray said. "They wanted to come back to life as usual."

Fray was doing counseling in a research project on disparities in cancer outcomes at the University of North Carolina, Chapel Hill.

Then in 2017, Fray found a mass in his chest. Suddenly, she was the patient.

And all her work with women – especially black women, who are more likely to die of breast cancer than their white counterparts – has become very personal.

"Please take care of yourself." Please remember to slow down. "These were things I had told many women," he says. says Fray, "Sometimes we are our worst patients."

Breast cancer is less common among black women, whereas they are about 40% more likely to die than white women. One of the reasons is that black women more often have advanced cancer once they are in treatment, in part because they are less likely to take out health insurance or to have a mammogram of screening.

According to a new study, another reason might be that black women are less likely to take the long-standing treatment of endocrine for years that is prescribed for some common types of breast cancer.

The study, recently published in the Journal of the National Cancer Institute, found that black women were more likely than white women to have difficulty accessing endocrine therapy, a 10-year treatment for women with certain types of breast cancer. It is prescribed after surgery, chemotherapy or radiation therapy (or a combination of these treatments) and can help halve the risk of recurrence.

"It's not the fault of women to have difficulty with their therapy – it's a tough medication to take," says Stephanie Wheeler, associate professor of health policy and management at the University of Toronto. University of North Carolina, Chapel Hill, and the main author of the paper. "I think we can do a better job supporting women."

The study followed nearly 1,300 women between 2008 and 2013 in North Carolina with breast cancer. About 43% identified themselves as black.

Black and white women were also likely to stop endocrine therapy before treatment started: about 10% of women had stopped treatment early.

But more often, black women said they did not take prescribed medications – skipping doses or taking breaks. Nearly 14% of black women did not take the drug every day, while about 5% of white women said they were not observed.

The reasons are complex, according to the researchers, and it may take more research to unravel them. They note that black women were more likely to indicate that paying for the drug was a financial burden, although the study showed that even wealthy black women were less likely to stick to it. treatment than white women. They also more often found that side effects were bothersome, as endocrine therapy can cause menopausal symptoms such as hot flushes and joint pain.

"I think the big problem is probably the relationship they have with their health care providers," says Dr. Doris Browne, former president of the Black Medical Group of the National Medical Association and former National Cancer Executive. Institute.

If black patients do not feel comfortable with their doctor, it will not raise these concerns and can not be addressed.

"Patients tend to disclose some of these underlying factors to a claimant belonging to their own racial and ethnic group," said Browne. "They have a relationship that seems to be a more open relationship."

She cites research that shows that black patients can get better results when they see black doctors. Only 4% of doctors are black.

Fray, who is currently program director of the Center for the Improvement of Population and Community Health Duke, thinks that this disparity could have something to do with the fact that black women strongly identify with to their role as caregivers.

When Fray advised patients to take their endocrine therapy, she often found that black women were so used to taking care of other people that it was difficult for them to accept the treatment. Helps during their treatment.

"There has been a lot of talk about the stress of being a caregiver," Fray says. She and her patients often spoke of the "stress of being black in America and the fact that doctors do not listen to you and employers do not care about you".

Motivational counseling, such as the work done by Fray, can be part of the solution. Wheeler and his colleagues are currently analyzing data on the counseling program Fray was involved in. She hopes this program will provide evidence that a tailor-made therapy will help black women to "clearly define their health goals."

According to Ms. Fray, during her treatment, she appealed to her family and friends for her care and meals. She has completed surgery, chemotherapy and radiation therapy last summer. "I had all enchilada," she says.

Now, her prognosis is good, she adds, but considering the next 10 years of endocrine therapy can be overwhelming.

"You must have the spirit in order," says Fray. "You can not change the scenario or the situation, how to change your mind?"

For the moment, Fray spends time with her family and resumes her career, which is now focusing on tackling health inequities in Durham, NC.

"Black women like me have to wear protective armor," says Fray. "We have to create it for ourselves and be intentional about it … no one will do it for us."

Copyright NPR 2018.