Tammie Denyse a longterm breast cancer survivor, who entered clinical trial years ago is a part-time youth pastor at Cho Un Korean United Method Church in Orangevale, Calif., on Wednesday, April 12, 2017. Manny Crisostomo mcrisostomo@sacbee.com
Tammie Denyse a longterm breast cancer survivor, who entered clinical trial years ago is a part-time youth pastor at Cho Un Korean United Method Church in Orangevale, Calif., on Wednesday, April 12, 2017. Manny Crisostomo mcrisostomo@sacbee.com

Health & Medicine

How African-American parents can lower their daughters’ risk of breast cancer

By Cathie Anderson

canderson@sacbee.com

November 21, 2017 05:00 AM

UPDATED November 21, 2017 02:51 PM

African-American women in the United States are about twice as likely as women of all other races to develop an aggressive form of breast cancer known as triple negative. Many believe it’s a product of their race or genetics, but science has found that the risk of this deadly disease can be drastically reduced if parents help their daughters do just one thing – help them stay lean.

This goes to the heart of reducing the risk of ever getting this cancer in the first place, said Dr. Otis Brawley, the chief medical officer for the American Cancer Society, and it requires managing diet and exercise in childhood years. A key risk factor in developing any type of breast cancer is how early girls start their menstrual cycle: The earlier they do, the greater their risk.

“It’s actually widely known among doctors that age of menstruation is correlated with risk of breast cancer,” Brawley said. “What’s not widely known is that younger-age menstruation is correlated with certain types of breast cancer like triple negative. … It’s how long it takes you to get to 100 pounds is another way of looking at it. The girls who get to 100 pounds first are the girls who menstruate first. ”

What is triple-negative breast cancer, a diagnosis that strikes deep fear in women? There is not one single type of breast cancer. Rather, there are subtypes and they are identified by the presences or absence of three so-called receptors known to fuel most breast cancers: estrogen receptors, progesterone receptors and human epidermal growth factor receptor 2.

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The most successful treatments target these receptors, but in the case of triple-negative breast cancer, none of the three is present. This breast cancer affects comparatively fewer women than do other subtypes – 24 for every 100,000 non-Hispanic black women; 12 per 100,000, non-Hispanic whites; 10 per 100,000, Hispanics; and 8 per 100,000 Asian Americans – but if the disease is caught at later stages, it is aggressive and is more likely to recur after treatment.

If caught early, this type of cancer can be fought effectively with chemotherapy. Although the medical community and many advocacy groups stress the importance of annual breast cancer screenings, Brawley said, African-American women are not seeking this care at the same rate as white women. Even among the poor, he said, white women seek treatment at a disproportionately higher number than do African-American women.

“In one large urban area where we studied this 15 years ago, it was 8 percent of black women who were diagnosed with localized treatable breast cancer who … didn’t get it treated within the first two years of diagnosis, versus 2 percent of white women,” Brawley said. “Whenever we look at black-white data, there is a proportion of white women who get less than adequate care as well, it’s just that the proportion of black women is larger.”

In some cases, Brawley said, fear keeps women from seeking treatment. There’s a belief he said that, “if they cut me, it will spread.” Already hobbled by some combination of denial, shock, depression and fear, they confront other mountains: a lack of insurance, transportation, child care, paid time off and the know-how to navigate the medical system, Brawley said. These women actually may get to surgery, he said, but then disappear in the middle of a six-month round of chemotherapy or radiation.

Take a cancer that is tough to beat if caught late and put it together with these issues, Brawley said, you begin to understand why breast cancer mortality rates are highest among African-American women, with rates 42 percent higher for non-Hispanic black women than for non-Hispanic white women in 2015. The figures are the latest available, part of a biannual comprehensive report by the American Cancer Society, released in October.

Most efforts to close this gap have focused on improving access to care and providing social workers to navigate the system, Brawley said, and that has worked in states such as Massachusetts, Delaware and Rhode Island, states where the poor have had better access to care than elsewhere in the United States. There was statistically no difference between breast-cancer mortality rates for white and black women in those states and four others – Nebraska, Minnesota, Iowa and Connecticut, according to the cancer society research.

The statistics show that expansion of health care to the poor can work, Brawley said, but it’s time as a society for the nation’s populace to also address long-term causal issues that are leading to higher incidences of these cancers. And although childhood obesity is not the only factor in determining whether a girl will develop this cancer in later years, Brawley said, it has been shown to significantly elevate risk. The research that really brought this home to the medical community was actually done in Scotland, Brawley said, among a more homogenous population in Scotland.

“Scotland started realizing that among the women in their 40s, 50s and 60s who got breast cancer, there was a higher proportion of poor women who had triple-negative disease, versus the middle-class women,” Brawley said. “They started wondering: ‘What is it about poverty that is correlated with triple-negative breast cancer?’”

Freed from the confines of race as a potential factor, they actually worked it out, Brawley said. The pre-teen girl born into poverty, whether it be in the United States or Scotland, usually ends up with a higher-calorie, higher-carbohydrate diet than the girl who is born into the middle class, he said, and it is a fact that girls born into poverty in the United States tend to menstruate about two years earlier than girls born into the middle class.

Parents and guardians play a key role in determining diet, introducing their children to exercise and modeling behavior.

“The key things to focus on are keeping your kids lean, keep your kids exercising,” Brawley said. “Girls who run cross-country end up doing themselves a favor 20 years later. The exercise lowers risk, and it’s not just cross-country. Aerobic exercise … lowers the risk of cancer in 40s, 50s and 60s.”

Oak Park resident Andrea Green, a psychologist with Kaiser Permanente, recently gave birth to her infant daughter, Olive, and she said she expects her to eat the same healthy food that she and her husband, Al Foreman, eat. That’s how the couple reared their son, the lean 6-year-old Miles Foreman.

“We go for the healthy carbs like brown rice and whole wheat breads,” Green said. “We make sure he gets 60 minutes of activity a day, and we limit TV and screen time. But I also think the biggest thing was exposing him to fruits and vegetables very early on, especially vegetables. … We’ll tell him: ‘It’s broccoli or salad tonight,’ and he’ll say, ‘I’ll have salad.’ It’s into his routine.”

Reducing ethnic cancer disparities proud moment for De Vere White

Dr. Ralph de Vere White, UC Davis cancer center director, describes efforts to reduce ethnic cancer disparities; including high rates of liver cancer among Asian Americans, breast cancer deaths among American Indian women and advanced-stage colon cancer among Latinos.

Claudia Buck The Sacramento Bee

Cathie Anderson: 916-321-1193, @CathieA_SacBee

How to get kids to eat healthy stuff

Sacramento-based nutritionist Renae D’Andrea of New Ways Nutrition specializes in helping families struggling with their relationship with food. She shares these tips:

  • Yes, Mom and Dad, you will have to eat your veggies, too. “One of the biggest determinants of whether kids will eat vegetables is what the parents eat,” D’Andrea said. “If vegetables are just a part of your life and you sit down with your kids at a family meal and you have vegetables and you all eat the vegetables, kids are much more likely to eat their vegetables just by watching their parents.”
  • Integrate complex, high-quality carbohydrates into your diet such as fruits, vegetables, oatmeal, whole-grain cereal, whole-wheat bread and brown rice.
  • Ugh, gross! Yes, you may well hear that or some variation of it anywhere from 14 to 80 times before a child tries a new vegetable.
  • Cook vegetables in different ways because broccoli might be more appealing stir-fried than steamed.
  • Allow kids to smell, touch, look at and be in the presence of vegetables until they become familiar to them.
  • Use these websites to try a meatless meal once a week or to find plant-based side dishes: minimalistbaker.com, plantbasedonabudget.com, wellvegan.com, and www.thefullhelping.com.