Melissa Rojas did everything right. She was a young mother who made sure to eat nutritiously and stay physically active, but three years ago, she found a lump in her right breast. Days later, after rushing to a mammogram, she was told she had stage 3 cancer. She was 28.
“Everyone was surprised,” she said. “It was so unexpected.”
She had no known risk factors or family history. Yet Rojas’ case might be alarmingly typical. Though Hispanic women have lower breast cancer incidence rates than non-Hispanic whites, their cancer often is more aggressive and more invasive, characteristics that confound oncologists who believe many factors could influence the situation.
Grace Wang, a breast cancer oncologist at Baptist Health South Florida who is treating Rojas, has noticed that many of her Hispanic patients present both at a younger age and at a later stage. “Is there something different in their diets?” she asked rhetorically. “Does it have something to do with the access to healthcare? Something cultural? Are there genetic factors?”
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These questions remain largely unanswered.
The breast cancer incidence rate among Hispanic women is 28 percent lower than for their non-Hispanic white counterparts. Yet breast cancer remains the leading cause of cancer death for Hispanic women, with an estimated, 2,800 deaths in 2015, according to the American Cancer Society. This might be because breast cancer is less likely to be diagnosed at a local stage in Hispanics.
Between 2008 and 2012, for example, 57 percent of breast cancers among Hispanic women were found while they were local, that is, still confined to the organ of origin, compared with 65 percent of breast cancers among non-Hispanic white women, the American Cancer Society reports. Localized cancers have a much higher survival rate than cancers that have spread.
A recently released study by the Avon Foundation for Women, the first of its kind to look at the different countries of origin for U.S. Hispanics, underscored the seriousness of the problem. The three largest Hispanic groups in the United States had the highest mortality rates of breast cancer within their ethnic community: 19.04 deaths per 100,000 women for Puerto Ricans, 18.78 percent for Mexicans and 17.89 percent for Cubans. By comparison, the mortality rate for Central and South Americans in the United States was 10.5 percent.
These rates are still lower than for the non-Hispanic population. Between 2010 and 2014, the breast cancer mortality rate for non-Hispanic white women was 22.41 and for black women, 30.7, according to the Avon study.
The study’s author, epidemiologist Bijou Hunt, says more research needs to be done to explain why these subgroups have higher mortality rates, but she, as well as other public health specialists, suspect these rates are probably influenced by many factors.
“I don’t think it’s just one thing,” she said. “It’s probably a variety of factors. I think we have to dive in a little deeper to compare.”
Hunt believes “drilling down” for answers is a public health challenge. At more than 55 million, Hispanics remain the largest and fastest-growing minority group in the country and their health and access to healthcare “is going to become increasingly more important to this country.”
This is particularly true for the three states — California, Texas and Florida — in which most U.S. Hispanics reside.
“We have to start by educating those in healthcare to understand that Hispanics are not just one big, homogenous group,” she adds. “There are these individual countries of origin to consider and there are differences among them.”
Researchers and oncologists point to many factors for the disparity in mortality rates:
▪ Acculturation. Longer-residing and U.S.-born Hispanics have cancer rates that approach those of non-Hispanic whites as a result of the adoption of unhealthy attitudes, habits and behaviors, according to the American Cancer Society.
▪ Access to screening tests and timely treatment. Hispanic women tend to have less access to healthcare in general, including private insurance. In 2013, 64 percent of Hispanic women 45 years and older had had a mammogram within the past two years, compared with 69 percent of non-Hispanic whites. Among Hispanic groups, Cuban women were the least likely to have had a mammogram. Early detection and treatment are crucial for positive outcomes.
▪ Customs and beliefs. Some still believe that a cancer diagnosis is a death sentence and put off visiting a doctor or going for screening as long as they can. “Part of the problem may be fear,” Wang said. “I have patients who are well-educated and have a family history of [breast cancer] and they still put off getting mammograms.”
Aurora Luna, a diagnostic radiologist at Memorial Cancer Institute in Broward, came across a Hispanic patient who was diagnosed with breast cancer but did not follow up with treatment for months. The woman had chosen to try alternative medicine and by the time Luna saw her again, “the tumor had doubled in size and more lymph nodes were involved.”
▪ Priorities. As mothers and caregivers, women tend to put others’ health before their own. “We’re the main caretakers in the family,” Luna added, “so I consistently hear stories that a woman was too busy taking care of someone else or something else and put off screening.”
▪ Genetics and risk factors that are still unknown. Alejandra Perez, breast oncologist at Sylvester Comprehensive Cancer Center at the University of Miami, also has noticed that her Hispanic patients are about three times as likely to have a tumor that has metastasized, even those who are younger and healthy. “We may be missing something in the biology of the tumors,” she added.
Though educational outreach programs have proliferated, experts agree that much still needs to be done to ensure that Hispanic women take the threat of breast cancer seriously. Hunt, the Avon study author, maintains education has to go a step farther than billboards, fundraisers and pamphlets. She proposes using a community health worker model in which a designated person would help Hispanic women, particularly non-English speakers, navigate the system. These navigators would help dispel myths, schedule appointments and explain results and treatment alternatives.
“Sometimes,” Hunt said, “we just need a little push to help us along. Ultimately, they would teach women to advocate for themselves.”
Hispanic women, others say, should also be encouraged to participate in clinical trials. Perez of Sylvester cited a National Cancer Institute report that showed Hispanics make up only 2 to 5 percent of cancer clinical trial participants, though they comprise more than 17 percent of the population. Yet such trials are essential in discovering new forms of detection and diagnosis as well as in developing treatments.
“Right now that’s a big problem in research because we’re not well represented,” she said. “It takes a doctor who’s going to take the time to sit down and explain why a clinical trial is good for the patient but also good for the world.”
In the meantime, Rojas, the West Kendall woman who received months of treatment for her Stage 3 cancer, is back in doctors’ offices with a new concern. In August, an ultrasound discovered a tumor clinging to the scar tissue of her right breast. Now 31, with a 15-month-old son born after the initial cancer diagnosis, she remains optimistic.
“I’m here to tell people there is life after cancer,” she said. “You don’t have to be scared.”
If you go
Susan G. Komen Race for the Cure: The 5K run/walk will take place Oct. 15 at Bayfront Park, 301 Biscayne Blvd. The race site opens at 6 a.m. Saturday for on-site registration. Survivor procession starts at 7:30 a.m. The 5K timed run will start at 8:45 a.m., untimed walk/run, 9 a.m. Streets along the race route will be closed. The closed-off area is bordered by Biscayne Boulevard to the east, Northwest North River Drive to the west, from Northeast Fourth Street to Northwest Fifth Street to the north, and Biscayne Boulevard Way and Southeast Second Street to the south. To register, visit komenmmiaftl.org.