By Jonesa Rodriguez - October 14, 2021
One in three Black women have reported experiencing racial discrimination at a health provider visit, according to the American Cancer Society. These experiences often lead Black women to have a major distrust in the health care system, which usually causes a ripple effect, such as hindering their ability or willingness to communicate with their provider.
Could this same distrust be a factor for why Black women stop taking their hormone therapy medication early?
Hormone therapy or hormone-blocking medications are used to treat breast cancers that express hormone receptors such as estrogen and progesterone. These types of cancer feed off hormones in the body, so hormone therapy decreases the levels of these hormones, essentially starving the cancer of the food it needs.
After surgery, breast cancer patients are given the medication to reduce their risk of recurrence and are prescribed to take it for five to 10 years.
This hormone therapy medication is needed to prevent a relapse or possibly death, but data shows that Black women are less likely to take the medication every day. Not many studies have been done to try to understand why.
Researching the Why
Dr. Kimberley Lee, medical oncologist in Moffitt Cancer Center’s Department of Breast Oncology, wants to know the why. It’s the focus of her new project, which is funded by the American Association for Cancer Research and the Breast Cancer Research Foundation.
“I am interested in the racial disparities in hormone receptor-positive breast cancer patients because the mainstay of treatment is a pill that has to be taken for five to 10 years. We know that it’s difficult to take these medications every day, yet that is how you get the most benefit,” said Lee.
Lee is also interested in the question of whether some of the disparities we see in survival for hormone receptor-positive breast cancer are due to racial differences in starting, taking and staying on hormone therapy as prescribed.
She believes that many contributing barriers may lead Black women to stop taking the medication early such as cost, lack of understanding or communication.
“Certainly, mistrust in the health care system may play a role here. Many Black women experience discrimination in their everyday lives and unfortunately, these lived experiences are not shed at the doors of medical institutions. Not having a trusting relationship with the oncologist could hinder ability or willingness to communicate difficulties such as cost or symptoms,” Lee said.
The other major limitation to taking hormone therapy as prescribed is symptoms. The medications cause symptoms similar to menopause, as well as others, and can be distressing if not managed appropriately. Some studies have shown that Black women have worse symptoms from the medications than white women, but Lee says this has not been fully borne out.
Black women have similar rates of being diagnosed with breast cancer compared to white women, yet they are 40% more likely to die from the disease. They are more likely to get triple negative breast cancer, which is more aggressive, but even among the hormone receptor-positive breast cancers, Black women have worse survival compared to non-Black women.
Hormone Therapy by Race
"Certainly, mistrust in the health care system may play a role here. Many Black women experience discrimination in their everyday lives and unfortunately, these lived experiences are not shed at the doors of medical institutions. Not having a trusting relationship with the oncologist could hinder ability or willingness to communicate difficulties such as cost or symptoms"- Dr. Kimberley Lee, medical oncologist, Breast Oncology
Within her research, which will be a two-part format, Lee will use national data to answer the question of how hormone therapy varies by race and look for factors associated with not taking medications as recommended.
Digging a little deeper into the cause, she will interview Black women with hormone receptor-positive breast cancer to understand their experiences with taking the medication and their discussion with their doctors.
The ultimate goal is to not only get to the why, but also find solutions that will help Black women take the medications as prescribed.
Cancer in our Community Podcast
Moffitt Cancer Center is working to better understand how breast cancer arises and how this knowledge can be used to improve cancer care. In the latest episode of our Cancer in our Community podcast, Dr. Iman Washington, a radiation oncologist at Moffitt, discusses therapy, clinical trials and the importance of breast cancer screening in the Black community and beyond.