Breast cancer risk and ethnicity: Explained

Black women from Caribbean and African backgrounds are up to two times more likely to receive a late-stage diagnosis for some cancers than white British women in England. 

What the research tells us 

In a review of NHS Digital cancer data published in BMJ Open (1), Cancer Research UK found that ethnicity is a “significant factor in the stage of diagnosis” for women in England. The findings were “deeply troubling” and warned that inequalities in cancer care could widen. Additionally, South Asian women, which includes those from Indian, Bangladeshi and Pakistani backgrounds, are at higher odds of being diagnosed with late-stage breast cancers. 

In the UK, breast cancer is more common in white women than in black Caribbean and African women (2). The reasons for this are thought to be due to differences in reproductive and lifestyle factors such as breastfeeding. Also, having a lower body mass index post-menopause, having more children at a younger age, lower alcohol consumption and less use of hormone replacement therapy (HRT) (2,3,4). 

A survey by Cancer Research UK found that women from ethnic minority backgrounds were more likely to report they didn’t know any warning signs and symptoms of cancer compared to white women (23% vs 12%).  

When asked what would delay them speaking to a medical professional about their health, ethnic minority women reported feeling less confident talking about their symptoms than white women. 

Diagnosis and treatment 

Despite a lower number of breast cancer compared to the white population, it is also true that black Caribbean, black African, Indian and Pakistani UK women are at greater risk of being diagnosed with breast cancers that are more difficult to treat (including later stage, more aggressive, more difficult to treat sub-types). 

Evidence suggests that factors, such as obesity and smoking, in people from black, Asian or mixed ethnic backgrounds could become similar to those in white people in future – leading to higher rates of cancer in some groups. These differences are greater in older than younger women, and in black rather than South Asian ethnic groups (5).  

In comparison to white women, black African women are around twice as likely to be diagnosed with late stage and high-grade breast cancer. Black African women are almost three times more likely to have a type of breast cancer that is particularly hard to treat, namely oestrogen receptor-negative (ER-), and are more likely to be diagnosed with human epidermal growth factor receptor positive (HER2+) cancer which can also present a treatment challenge (5). 

Black women tend to have poorer outcomes following a diagnosis (6).  Reasons for this may be associated with lower uptake of screening (in general, black and minority ethnic group women have disproportionally lower breast screening attendance (8)), socioeconomic deprivation, more advanced tumour stage, more biologically aggressive tumours and higher incidence of triple-negative breast cancer, as well as less awareness of breast cancer and its risk factors (7,8,9).  

What does Breast Cancer UK suggest? 

We encourage everyone to take action to reduce their risk of breast cancer, for example, having a healthy diet, maintaining a healthy weight, doing plenty of exercises, reducing alcohol consumption and avoiding potentially harmful chemicals. For more information on breast cancer prevention, please visit our Prevention Hub: https://breastcancerprevention.org.uk/. 

What are Breast Cancer UK doing to help engage ethnic minorities? 

We continue to reach out to organisations that work closely with people from black, Asian or mixed ethnic backgrounds so we can develop our communications to engage and help everyone start their breast cancer prevention journey.  

To start your journey today, we suggest taking our breast cancer Prevention Quiz, which provides you with your own personal action plan for reducing your risk of breast cancer. We also recommend reading the information on our website to make informed decisions on your lifestyle and what you can do to live healthier and prevent breast cancer. 

Any organisations wishing to get in touch and help develop our communications to engage ethnic minorities, please do get in touch at [email protected]. We are always looking for ways to make our messaging digestible to anyone who reads it and ultimately help everyone prevent breast cancer.  

References 

1. Fry A, White B, Nagarwalla D, et al. (2023). Relationship between ethnicity and stage at diagnosis in England: a national analysis of six cancer sites. BMJ Open 2023;13:e062079. doi: 10.1136/bmjopen-2022-062079 
2. Delon, C. et al. (2022). Differences in cancer incidence by broad ethnic group in England, 2013–2017. British Journal of Cancer 126: 1765–1773. https://www.nature.com/articles/s41416-022-01718-5 
3.   Gathani et al (2014). Ethnic differences in breast cancer incidence in England are due to differences in known risk factors for the disease: prospective study. British Journal of Cancer 110: 224–229. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3887283/pdf/bjc2013632a.pdf 
4.  Shirley et al (2014). Incidence of breast and gynaecological cancers by ethnic group in England, 2001–2007: a descriptive study. BMC Cancer 14:979. https://bmccancer.biomedcentral.com/track/pdf/10.1186/1471-2407-14-979.pdf 
5.  Gathani et al. (2021). Ethnicity and the tumour characteristics of invasive breast cancer in over 116,500 women in England. British Journal of Cancer 125: 611–617. https://doi.org/10.1038/s41416-021-01409-7). 
6.  Copson et al (2014). Ethnicity and outcome of young breast cancer patients in the United Kingdom: the POSH study. British Journal of Cancer 110, 230–241. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3887284/pdf/bjc2013650a.pdf 
7.  Moller et al (2016). Short-term breast cancer survival in relation to ethnicity, stage, grade and receptor status: national cohort study in England. British Journal of Cancer 115, 1408–1415. https://pubmed.ncbi.nlm.nih.gov/27780193/ 
8.  Baird et al (2021). What can be done to encourage women from Black, Asian and minority ethnic backgrounds to attend breast screening? A qualitative synthesis of barriers and facilitators. Public Health 190: 152-159. https://pubmed.ncbi.nlm.nih.gov/33419526/ 
9.  Marcu, A. et al. (2022). Adapting a breast cancer early presentation intervention for Black women: A focus group study with women of Black African and Black Caribbean descent in the United Kingdom. European Journal of Cancer Care , e13652. https://onlinelibrary.wiley.com/doi/10.1111/ecc.13652 

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