Different demographics face different risks from breast cancer

Breast cancer can strike any woman—and sometimes any man—at any time, but some demographics face a higher risk.

Dr. Rachel Ellsworth wants to understand why.

In her work as director of translational breast research in the Clinical Breast Care Project at Walter Reed’s Murtha Cancer Center Research program, Ellsworth explores how those different demographics are affected by breast cancer, and if there is an identifiable reason for why some groups are more at risk than others.

“African American women have significantly higher mortality from breast cancer than do non-Hispanic white women,” Ellsworth said. “We have been striving for 20 years now to try to understand, is it biological? Is it access to healthcare? What factors are really driving this mortality?”

Ellsworth’s research program is under the Henry M. Jackson Foundation for the advancement of military medicine, also known as HJF. She describes her work as the intermediary between laboratory research and clinical trials. Everything she studies is based on human samples or human data, with identifying information removed to protect individual privacy. The goal is bringing ideas from the lab into clinical trials and ultimately producing better outcomes when fighting breast cancer.

Her work has two primary areas of focus. The first is etiology: why women get breast cancer. The second is the previously mentioned disparities research: why different populations have varying cancer rates.

About a decade ago, Ellsworth and her team observed differences in how genes were being expressed between non-Hispanic Black and white women. However, what initially seemed to be a promising explanation ultimately yielded little insight into the varying cancer rates reported by different demographics.

“The differences we found were not just present in the breast, they were present in, let’s say, [your] retina and your spine and your skin and your blood, and they were also different between populations,” she said. “But if we looked at women with benign disease, they were really no different within that ethnic group. So, what that boiled down to is yes, there are differences in the tumor, but the differences are not causal, so they’re not really meaningful to breast cancer itself.”

That research helped identify one of the big challenges of fighting cancer: biology plays a role in the development of tumors, but there hasn’t yet been a smoking gun found to explain exactly why different bodies have different responses to cancer.

Research advantages

One advantage Ellsworth and her team have by working with Walter Reed, one of the nation’s largest military hospitals, is that it eliminates one of the big barriers to early cancer treatment: health insurance. Most veterans and active service member have health insurance.

Beyond health insurance, Ellsworth identifies two other challenges for the civilian population as well. The first is access to care; the second is provision of care, which is ensuring that women are actually getting the necessary care from providers when they do have access.

Among the general public, there is often a significant difference in surgical decision-making, with non-Hispanic Black women in particular seeing more frequent delays to surgical intervention than that of other demographics. In 2019, Walter Reed-Bethesda published a paper showing that among its military patients, there was not a significant difference in surgical decision-making between populations. There also was not a difference in survival rates.

“The tumor profiles are just as aggressive for the women treated within the DoD healthcare system as they are reported in the US general population but still the survival does not differ,” said Ellsworth. “So that means something in the military healthcare, sort of milieu, is different and it is improving survival tremendously in this at-risk non-Hispanic Black population.”

Raising awareness

There are any number of promotional campaigns to raise awareness during October, but finding the initiatives that motivate women to get screened is a challenge.

In 2011, Ellsworth participated in an outreach program hosted by Windber Research Institute in Pennsylvania. Taking place during Black History Month, the goal was to engage Black women who historically have been less likely to get regular screenings and benefit from early detection. At the event, Ellsworth learned that Black women often face challenges to breastfeeding due to lack of maternity leave or lack of access to lactation rooms, factors which correlated with higher rates of breast cancer. The event ultimately served a dual purpose: it motivated some attendees to go get mammograms, and also helped Ellsworth identify new angles to pursue in her research by understanding what challenges are faced by different demographics and exploring them to see if there’s a causal link.

That kind of engagement is key to raising awareness in a way that leads to results.

“A smaller group effort is probably more effective than a national campaign, " said Ellsworth. By engaging in discussion instead of just sharing scientific data, awareness advocates can really learn what people in their communities need and provide help finding the right resources to meet those needs.