This story was reported and written by our media partner the Virginia Mercury.
Tasha Cade was more than two months pregnant when she was diagnosed with breast cancer. For nearly two years, a painful, discolored lump had been growing in the 43-year-old Virginia Beach resident’s left breast.
“I find out that I am pregnant, one of the happiest times of my life, only to be dealt such devastating news,” Cade said. “I was so happy — yet so sad, scared and uncertain of the diagnosis, of what was going to happen.
Cade is a Black woman. In the U.S., Black women die from breast cancer more than any other racial group.
They are slightly less likely than white women to develop breast cancer but are about 42% more likely to die from it. Breast cancer deaths for all women in the U.S. have decreased, but the mortality gap between Black and white women persists.
As a group, Black women diagnosed before age 50 are 50% more likely to die from the disease than white women diagnosed before age 50.
In Virginia, the situation is worse. The state has the nation’s ninth highest breast cancer death rate and is one of only four states in which Black women develop cancer at a higher rate than white women, according to recent data from the Leroy T. Canoles Jr. Cancer Research Center at Old Dominion University and the American Cancer Society.
Virginia’s eastern Tidewater region, where Cade lives, is one of the ten metro areas in the U.S. with the highest number of Black women dying from breast cancer, a 2021 report by Susan G. Komen shows.
In 2020, Black women in Tidewater were 60% more likely to die of breast cancer than white women, up from 41% in 2014, according to data from Komen.
Suffolk and Chesapeake stand out for having the biggest gap between Black and white women in late-stage diagnosis and survival rates.
In February of 2021, before her pregnancy, Cade expressed her worries about the lump in her breast to a local radiologist, medical records show. But findings from a mammogram followed by a breast ultrasound didn’t indicate cancer, the physician said. Cade sought a second opinion and records show both physicians agreed that the lump wasn’t cancer.
They instead connected the problem to Cade’s dense breast tissue. Breast tissue varies among women; breasts that are dense have more glandular and connective tissue than fat.
“They said you’re fine, it’s nothing to be concerned about,” Cade said. “They considered it … fibroglandular tissue, (and said) it is not unusual for it to get larger or to be more painful; it’s not cancerous.”
Dense breast tissue can prevent a mammogram from detecting cancer and can increase a woman’s overall cancer risk. Physicians said that readings from both mammograms and breast ultrasounds were normal for Cade, but she was doubtful. She knew she had multiple risk factors linked to developing or dying from breast cancer.
“I asked questions like, why is it getting larger? Can I have a biopsy?” Cade said. “They didn’t want to do a biopsy despite (me) having dense breast tissue, despite me being a Black woman.”
In October 2022, Cade found out she was pregnant with her son, whom she calls her unexpected “miracle baby.” She worried more about the lump, which her OBGYN insisted be biopsied by a local surgeon. The biopsy revealed that it was cancerous at stage zero and could spread during pregnancy.
“Anger was one of my biggest emotions,” Cade said. “I knew something was wrong. I know my body and I knew this lump was a problem.”
What is fueling the disparity?
The reasons for the breast cancer mortality disparity are multifaceted. Studies show that tumor biology and the interplay of genetics and environmental factors explain part of the problem. Both factors partially explain why Black women are more likely to develop highly aggressive tumors and to be diagnosed at an earlier age, negatively impacting survivorship.
Black women are also more likely to be obese, have heart disease, and to not breastfeed after pregnancy — all risk factors for breast cancer.
But other factors — including racism in medicine and systemic racism that drives high poverty among Black women, and the lack of insurance and access to quality breast health facilities — are also greatly to blame.
“The differences in death rates are not explained by Black women having more aggressive tumors,” said Rebecca Siegel, an American Cancer Society epidemiologist.
“It is time for health systems to take a really hard look at how they are treating Black women differently.”
Breast cancer deaths in Tidewater Virginia are driven significantly by “where a person lives and their race,” Komen wrote in its report.
Part of the problem is poor access to transportation tied to poverty, in an area connected by bridges and tolls, which often prevents Black women from seeking follow-up mammograms to diagnose suspected cancers, said Natasha Mmeje, a Komen spokesperson.
Some progress has been made. New national guidance lowers the recommended age most women should start mammography, which helps early cancer detection. States that adopted Medicaid expansion earlier than Virginia have improved access to care for Back women, positively impacting cancer outcomes. And more scientific research is focused on finding out why Black women are less likely to survive a cancer diagnosis.
The fight to prevent more Black women from dying of breast cancer at disproportionate rates is on multiple fronts and more must be done, Mmeje said.
“Black women should have the same chance of surviving breast cancer as anyone else,” she said. “We must work together — researchers, lawmakers and key stakeholders — to decrease breast cancer disparities in the Black community.
Failings in medicine and science
Cade was rushed into an emergency lumpectomy in Hampton Roads to remove her tumor the same week her cancer was diagnosed in December 2022. But scans showed that the cancer had spread to another part of her left breast.
She consulted physicians at Virginia Commonwealth University Massey Cancer Center who said that the breast should be removed. They performed a mastectomy while Cade was four months pregnant and frightened for her life and her unborn baby. Surgeons removed her right breast in a later procedure.
“I remember being wheeled into that operating room, and I’m crying so hard,” Cade said. “I was just thinking about my child — I’ve wanted this child all of my life.”
Early cancer detection improves chances of survival and often results in less invasive treatment. But Black women in the U.S. are far more likely to be diagnosed with breast cancer at later stages — despite being screened for it at higher rates than other races.
In Tidewater Virginia, Komen found that Black women have roughly the same rate of regular mammography screening as white women. And in about half of the cities Komen studied in the region — Newport News, Hampton and Portsmouth — white women are diagnosed with more late-stage cancers than Black women.
But Black women are still dying disproportionately of breast cancer throughout the metro area.
“Systemic racism is a huge part of why Black women are still dying [disproportionately], and that is regardless of the economic status for Black women,” Mmeje said.
In the Komen report, undiagnosed women and breast cancer survivors in the area said they experienced discrimination while seeking care. Bias held by healthcare providers is part of the problem, though its impact is difficult to prove, said Arnethea Sutton, a breast cancer health equity researcher at Virginia Commonwealth University.
“It’s what’s happening once women get to care — they’re not being treated fairly, and their process is being delayed or they’re not being listened to,” Sutton said. “Those are the kind of things we can’t capture in hospital metrics.”
The history of racism in healthcare institutions has also slowed the development of treatments that could be more effective for Black women. The collective cultural memory in the Black community of medical wrongdoings, such as the Tuskegee syphilis study, has contributed to low participation in clinical trials by Black women.
And less health research has focused on women, and Black women in particular, than white men. To fill the information gap, the American Cancer Society is conducting what would be at completion the largest ever study on Black women and cancer.
American Cancer Society researchers aim to enroll at least 100,000 women from Virginia, 19 other states, and Washington D.C. for the Voices of Black Women study, which would shed more light on why Black women have some of the highest mortality rates for most cancers. The states represent where 90% of Black women live in the U.S.
Realizing that eastern Virginia is a breast cancer hotspot, The American Cancer Society partnered with Macon & Joan Brock Health Sciences at Old Dominion University to recruit women in Hampton Roads for a pilot study in 2023. Atlanta was another pilot site. A target of 3,000 participants has been set for Virginia.
Researchers aim to gather a wide range of environmental, behavioral and health data from a cohort of women ages 25 to 55, over 30 years.
“This study really puts us in an extremely powerful position to be able to understand cancer and other health outcomes in black women, and then identify opportunities to intervene in a way that will be successful for black women,” said study co-investigator Alpa Patel.
Early detection is key
Cade’s grandmother, Judy Hall, died from breast cancer at the age of 64. Cade had worried for years that breast cancer could run in her family.
“My anxiety was through the roof, I would constantly think about the possibility of getting cancer, passing away from cancer,” Cade said. “Then for it to actually happen, it just takes a toll thinking about it constantly.”
Cade began receiving mammograms in her late 30s, slightly earlier than the recommended age of 40, due to her family history. Her employer’s insurance plan partially covered the early screenings.
But many Black women face significant insurance and financial hurdles to receiving preventive screening and testing, diagnostics and treatment — all factors that impact survivorship.
Screening for breast cancer at an earlier age is even more impactful for Black women, who tend to develop breast cancer younger.
In April, The U.S. Preventive Services Task Force, a leading independent panel of experts, lowered its recommendation on when women should start biennial mammography screening from age 50 to 40, and said the change would improve early detection for Black women. The panel had previously recommended that women at high risk of breast cancer consider screening earlier than 50.
Under the Affordable Care Act, USPSTF recommendations guide insurance coverage for mammograms and other preventive screenings. But nearly all insurers are currently required to fully cover more frequent, annual mammograms, for women 40 and older, under a federal law up for renewal in 2026. Komen and other advocacy organizations favor annual screening.
The guideline changes don’t fully address the needs of Black women, said Ifeoma Udoh, a policy advisor for the Black Women’s Health Imperative.
“We’re suffering from late-[stage] diagnoses — we’re getting screening too late,” Udoh said. “We have 35-year-olds being diagnosed with breast cancer, particularly if there’s some genetic predisposition.”
Women should speak to their primary care physicians about their family history of breast cancer and ask about genetic testing. High risk women may benefit from screening as early as age 30, even if genetic testing is negative, said Rachel Burke, a professor of surgery at ODU.
Women experiencing barriers to screening, diagnosis or treatment can contact Komen patient navigators for information about health services and financial resources. Women without insurance who are low income are eligible for free or low-cost breast cancer screening and diagnostics under the National Breast and Cervical Cancer Early Detection Program. And patients diagnosed through the NBCCED may be eligible for Medicaid coverage for treatment.
Patients who feel they are receiving poor treatment should seek a second opinion or find a new provider, Cade said.
“Women must feel empowered to advocate for their health,” she said. “Your voice matters in every healthcare conversation.”
In May of 2023, Cade gave birth to a healthy son. She is now cancer free.
