Beating Breast Cancer

Shirley Gray of West Bloomfield was lying in bed performing a regular breast self-exam in August 2009 when she felt something abnormal in her left breast at the nipple.

"The lump didn't move," recalls Gray, who had fibrocystic breasts and was accustomed to somewhat regular lumps. "This was different."

The next morning she visited her OB-GYN, who agreed the lump in question was suspicious. A mammogram and biopsy followed, and within a few weeks, Gray learned that she had stage 1 breast cancer. 

"We hit the roller-coaster ride from there," says Gray, 62, who is the administrative director of clinical support services at Children's Hospital of Michigan in Detroit and married to Dr. Herman Gray, its CEO.

Gray underwent a mastectomy of her left breast in early October of that year, and two regimens of chemotherapy followed. Now, at the four-year mark since her diagnosis, Gray is healthy and more vigilant than ever about performing her monthly breast self-exam and having her annual mammogram performed on time, every time.

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When Gray detected her tumor, she was otherwise healthy. Her tumor was caught at an early stage, and she sought immediate treatment. Gray's experience at each step along the way-from screening to diagnosis to treatment-bucked the national trends when it comes to breast cancer among Black women.

Difference in diagnosis-and survival

According to the Susan G. Komen foundation, Black women are less likely to have an annual mammogram performed than non-Hispanic White women and are more likely to have breast cancers associated with poor prognosis, such as those with tumor cells that are more abnormal or have existed longer. Overall, breast cancer survival is three years shorter for Black women compared with White women. The reasons for these disparities are varied.

Susan Brown, managing director of health and science education at Susan G. Komen, explains that in decades past there were significant differences in the rate of Black women getting screened for breast cancer compared to White women. While the screening rate for Black women is now similar to that of White women, past differences may be influencing mortality rates today.

"The stage of the disease at diagnosis is related to survival," she explains.

Another contributing factor to disparities in breast cancer mortality rates is how Black women access care.

"African-American women may get screened, but there may be a delay in follow-up if something abnormal shows up," Brown says. "That then leads to a delay in getting a diagnosis."

A third compounding aspect is biological and genetic factors in the tumors more likely to develop in Black women.

"The personality of the tumors themselves can differ," she explains. "The tumors tend to be more aggressive and estrogen-receptor negative, which is associated with poorer outcomes. Triple-negative breast cancer, which is also associated with a poorer prognosis, is aggressive and often metastasizes early. This tumor is more commonly found in African-American women."

Lisa Braddix, breast cancer program specialist for Susan G. Komen Detroit Race for the Cure, points to systemic barriers among Black women that could contribute to the disparity.

"It can be things like lack of transportation to get to a screening facility," she says. "It can be that screening facilities are not open at times that work for these women's work schedules. It can be a lack of health insurance. It can be not realizing the importance of recognizing when there is a change in their body."

The importance of early detection

Research published in JAMA (The Journal of the American Medical Association) in July 2013 compared 7,375 Black women who were diagnosed with breast cancer to three separate groups of 7,375 White women also diagnosed during the same time period. The first group of White women were matched to the Black women on age, year of diagnosis and similarity of neighborhood. The second group of White women were matched to the Black women on these same criteria, as well as the type of tumor and co-morbidities (other health conditions, like diabetes). The third group of White women mirrored the group of Black women on all these criteria, as well as type of breast cancer treatment (surgery, radiation and chemotherapy).

With each successive layer of similarity, the difference in life expectancy between White and Black women dropped, so that the Black and White women who matched most closely on criteria experienced only a three-month difference in survival rate (favoring White women).

The study's lead researcher, Jeffrey Silber of The Children's Hospital of Philadelphia, has said this indicates that the problem is not necessarily differences in treatment but that Black women are seeking medical care when their cancer is further progressed. Had they pursued preventive care earlier, their cancer would not be as advanced. To combat this-and increase the survival rate of Black women with breast cancer-education is key. 

In 2013, the Susan G. Komen Detroit Race for a Cure awarded just over $1 million to fund grants for four local organizations that help with support and awareness in the tri-county area. One of those is the Sister & Sister Program in Pontiac.

"This program provides free mammograms to African-American and Hispanic women," explains Braddix. "These women lack insurance or are underinsured. Those in need of follow-up care after their mammogram will be guided to appropriate care."

Another program to receive grant money is the Witness Project of Detroit, which centers around faith-based intervention.

"Breast cancer survivors witness to others in the church setting," Braddix says. "They share their story, encourage screening and help facilitate the process."

Can happen at any age

Jacqueline Howard of Farmington Hills was 28 years old, mom of a 2-month-old and a career woman with a busy travel schedule when she first discovered a lump in her right breast in the spring of 2009. An ultrasound showed nothing abnormal, and Howard and her physician believed the suspicious lump had gone away. That is until two years later, when she began to feel pain and discomfort in the same breast around her menstrual cycle.

Confident that again it was nothing serious, Howard put off having it checked out for a few more months. Even then, the breast specialist assured her that it was very unlikely a woman of her age would have breast cancer. A breast biopsy proved otherwise: Howard had stage 2 HER2-positive breast cancer. One tumor had become three, and the cancer had spread to her lymph nodes.

"Never in a million years did I think I had breast cancer," Howard recalls. "Breast cancer doesn't run in my family. Heart disease does, so I always worked out and ate healthy."

Howard's experience reflects a broader trend. Black women have a higher breast cancer incidence rate before age 40-the age at which most women are generally encouraged to begin pursuing yearly mammograms, according to Susan G. Komen.

Howard underwent aggressive treatment including chemotherapy, a mastectomy of her right breast, radiation and a prophylactic mastectomy of her left breast. Feeling good these days, she is not taking anything for granted.

"Cancer forced me to live in the present," says Howard, a community relations manager at Ally Financial. "When faced with your own mortality, you gain a different perspective. I had to develop an intimate relationship with God to stay sane. You develop so much fear."

Howard also found solace in the Young Survivors Coalition specifically for women under 40.

"The difference between having breast cancer at 30 and at 50 is huge," Howard says. "A 50-year-old may be retired. Her kids may be grown. In my case, not only did I have cancer, I had a 2-year-old."

It was meeting women who were part of this group and seeing how many of them continued to work during treatment that encouraged Howard to do the same.

"I could have taken disability, but I thought, 'If they can work through treatment, I can too,'" she recalls. "Also, working gave me something to look forward to. You can't let life stop."

Coming together

To take back the power and control that breast cancer had taken from her, Howard channeled her focus into forming a team to raise money for the American Cancer Society's 2012 Relay for Life.

"I wanted to direct my energies toward something positive while increasing awareness," she explains.

Howard's team, Jack's Joy Warriors, raised $22,000 that year and was named rookie team of the year. This year, her team raised $13,000 for the cause.

Shirley Gray has also found comfort in being part of something bigger than herself-and makes it an annual tradition to walk in Detroit's Susan G. Komen Race for the Cure. It was at the May 2013 event that she noticed a professional acquaintance, Dianne Robinson of Detroit, who was also sporting a pink survivor T-shirt. Neither had known the other's breast cancer experience.

Unlike Gray, Robinson's journey was just beginning. Diagnosed with stage 1 breast cancer in April 2013, Robinson's tumor was spotted during a routine mammogram. The tumor measured less than 1 centimeter, and the margins were clear. It hadn't spread to her lymph nodes, but it was fast-growing.

So, shortly after diagnosis, Robinson, then 64, underwent a lumpectomy and began daily radiation treatments that lasted for six weeks.

Each Sunday evening during her treatment, Robinson knew she could count on a call from Gray.

"She called me every week without fail," Robinson recalls. "I talked to her honestly."

And Robinson tried to pay that kindness forward.

"During radiation treatment, I could tell who the newbies were in the dressing room," she says. "You could just tell by the expression on their faces. I took it upon myself to inquire, to comfort them through the process."

Robinson finished up treatment in July and celebrated her 65th birthday-and the start of a new journey with family and friends. Her physicians will continue to monitor her closely for the next 15 years, and Robinson stresses that she won't ever be late for her annual mammogram.

"Even though I went for my yearly mammogram, it was a month or two off," Robinson recalls. "Women tend to allow other things to get in the way. We take care of everyone else first and don't think of taking care of ourselves first, so we can take care of others."

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