By Julie Davis, WebMD

Medically Reviewed by Melinda Ratini, MS, DO

Breast cancer is the second most common type of cancer in women after skin cancer. But it doesn’t affect all women in the same way. This includes people within the various Latina and Hispanic communities. For instance, breast cancer affects women who are of Mexican descent in different numbers than women who are of Brazilian descent. But all Latina and Hispanic women have one thing in common: not enough access to screenings and treatment.

Breast Cancer and Your Ancestry
Latina and Hispanic women account for 29 percent of the 24,000 new breast cancer cases diagnosed each year. Yet few studies on breast cancer have included women other than non-Hispanic white women. And even fewer have taken into account the diversity among Hispanic and Latina women. There’s a lack of understanding in the health community about the many different backgrounds represented. This means research often considers everyone as one large group. But there can be differences in cancer rates and gene mutations in people from Mexico, the Caribbean, Central or South America, or in a European country like Spain or beyond.

Most Common Types of Breast Cancer
Doctors define most types of breast cancers by whether certain receptors are present. Some breast cancers feed off the female hormones estrogen and progesterone, for instance. Breast cancer subtypes are often named with the terms for hormone receptor (HR) or estrogen receptor/progesterone receptor (ER/PR), and human epidermal growth factor receptor 2 (HER2). If they’re present, you’ll see the + sign after the letters; if not, you’ll see the minus sign.

The most common subtype among Latina and Hispanic women is HR+/HER2-, or luminal A. This subtype accounts for up to 71 percent of this group’s breast cancers. It has a higher survival rate than other types. This is in part because it responds well to hormonal therapy. Other subtypes include HR+/HER2+, HR-/HER2+, HR-/HER2-, and triple-negative breast cancers.

Triple-negative breast cancer, or TNBC, is very aggressive because it has no hormone receptors to target with treatment. It accounts for 15 to 20 percent of all newly diagnosed breast cancer cases in the United States. But among Latina and Hispanic women, it’s 15 to 33 percent. Also, they’re often diagnosed with TNBC at an earlier age – about 11 years younger than non-Hispanic white women – and at an advanced stage.

Gene Mutations at Fault
Many faulty genes play a role in breast cancer. Hispanic women are carriers of the BRCA gene mutations at the same rate as non-Hispanic white women. But they’re between roughly four and five times less likely to have the genetic testing that would uncover it.

Small studies have found other gene mutations that are more common in Hispanic and Latina women. For example, the CCNB1 and AURKA genes were seen in early-stage HR+/HER2– breast cancer. In Hispanic and Latina women with TNBC, TP53 mutations were the most common. But the NOTCH1, NOTCH2, NOTCH3, and PIK3CA mutations were the most dangerous. A better understanding of their roles could lead to new and better treatments.

Breast Cancer Rates and Risk Factors
Overall, Hispanic and Latina women in the U.S. have about a 20 percent lower incidence of breast cancer than the general population. This is a 1 in 10 chance compared to the national rate of 1 in 8.

But one study found that this group has higher breast cancer rates than the women in their countries of origin. For instance, among Mexican-American women, there are 71.4 cases per 100,000 people. But in Mexico that number is just 34.7. There’s concern that the U.S. numbers may increase if Hispanic and Latina women adopt certain parts of the American lifestyle. These include things like:

• Not breastfeeding
• A diet that exposes them to more cancer risk factors like type 2 diabetes and obesity

Some studies have already shown increases in the number of breast cancer cases among Hispanic and Latina women.

Stages at Diagnosis
Hispanic and Latina women are less likely to get a breast cancer diagnosis when it’s at a local stage. This is often because of a lack of screening. That means the cancer is more advanced when detected. Sometimes there’s a delay in follow-up and treatment after an abnormal screening. Early detection remains important. In Hispanic women, the 5-year survival rate for local breast cancer is 96 percent and 85 percent for regional breast cancer. But it drops to 32 percent for distant-stage breast cancer.

By the numbers, Hispanic and Latina women in the United States have had a lower incidence of breast cancer than non-Hispanic women. But that isn’t the reality everywhere. One study over a 10-year period found that in the newly diagnosed breast cancer population, 21.3 percent of Hispanic patients under age 50 had advanced breast cancer compared to 13.5 percent of non-Hispanic women.

Mortality
Breast cancer is the leading cause of cancer death among Latina and Hispanic women. It causes an estimated 3,200 deaths a year, or about 16 percent of breast cancer deaths. Greater awareness, early diagnosis, and treatment have led to an overall 40 percent decline in breast cancer deaths in the U.S. over the last 30 years. But the decline among Hispanic and Latina women (and other racial groups) has been slower. From 2007 to 2016, breast cancer death rates went down by 1.8 percent per year among non-Hispanic white women. They dropped by only 1.1 percent per year among Hispanic women.

Also, Hispanic and Latina women are more likely to be diagnosed at a later stage and get less aggressive therapy. That leads to a lower survival rate: They’re about 30 percent more likely to die from their breast cancer than non-Hispanic white women.

There are also differences based on ethnicity. For example, Latina women of Cuban ethnicity have the highest mortality rate at 18.9 per 100,000 cases each year. For those of Puerto Rican ethnicity it’s 17.0, and Mexican, 15. For those with a Central or South American background, it’s 10.15 deaths per 100,000.

Challenges to Early Detection
There are many reasons to explain why many cases of breast cancer aren’t found in early stages or treated early. One is not enough access to health care. Among the millions of Americans still uninsured, Hispanic and Latino people represent the highest group. Sometimes language barriers get in the way of finding care.

Fewer Latina and Hispanic women get cancer screenings with mammograms than non-Hispanic white women. They’re also less likely to get genetic tests that could help with early detection and prevention.

There are problems after a breast cancer diagnosis, too. Hispanic and Latina women have fewer consultations with oncologists. They have fewer genetic tests like the Oncotype DX assay to help plan treatment, and less aggressive chemo. They’re more likely to stop treatment than non-Hispanic white women. These differences all impact survival rates. Hispanic and Latina women in the U.S. aren’t well represented in cancer research, including clinical trials for drugs. For this reason, the best treatment options aren’t always clear.

For some women, strong cultural beliefs, like “Faith in God can protect you from breast cancer,” may prompt them to delay doctor visits for breast cancer symptoms, and in turn diagnosis and treatment.

Turn the Tide
Since Hispanic and Latina women share many of the same breast cancer risk factors as other women, strategies for women in general, such as a healthier lifestyle, can play a role in prevention.

One reason Hispanic and Latina women in the U.S. have a higher incidence of breast cancer than those in Latin America may be a lower-quality diet, especially after menopause. The traditional diets of many ethnic groups in Latin America are high in vegetables, fruits, and whole grains and low in red meat and alcohol. They’re linked to lower breast cancer risk.

While there are treatment disparities in care for Hispanic and Latina women, options do exist. Seek out early detection and education programs in your area. The Moffit Cancer Center in Tampa, for instance, has created the Yo me cuido (YMC) program to close the health gap among Hispanic women in Florida. The Basser Center for BRCA in Philadelphia has the LATINX & BRCA initiative with educational resources in Spanish and Spanish-speaking genetic counselors.

  breast cancer, health, hispanics, latina women, United States