“If We Save Just One Life, Our Efforts Are Not in Vain”: Reducing the Black Breast Cancer Mortality Gap in Richmond, Virginia

Black women in Virginia have a 39 percent higher breast cancer mortality rate than their white counterparts, according to a 2016 Virginia Department of Health report. (Photo courtesy: Pexels.com)

When Zelma Watkins first heard the words, “You have triple-negative breast cancer,” she thought it was a mistake. After all, her family didn’t have a history of the disease. She knew nothing about breast cancer, let alone anyone else who had it.

As the diagnosis sunk in, she knew if she wanted to survive, she needed to act now. Watkins began reading everything she could about breast cancer and met with her surgeon to weigh treatment options.

After months of treatment, Watkins beat breast cancer. She considers her survival a sign that her life’s purpose is to empower other Black women through breast cancer education and awareness. “I figured if I was feeling uninformed, there must be other women who feel uninformed too,” says Watkins, a Richmond, Virginia, native. In 2005 she co-founded the Central Virginia chapter of Sisters Network, the only national Black breast cancer survivorship organization in the United States.

Over a quarter of a million women in the United States are diagnosed with breast cancer every year. But for Black women, the stakes are higher. They’re more likely to be diagnosed with an aggressive type of breast cancer called triple-negative breast cancer (TNBC).

Although white and Black women have similar breast cancer incidence rates, Black women in Virginia have a 39 percent higher breast cancer mortality rate than their white counterparts, according to a 2016 Virginia Department of Health report.

Scientists are still researching why Black women are more likely be diagnosed with aggressive types of breast cancer and to die from the disease. Factors currently being investigated include lack of health insurance, lack of timely breast cancer screenings, and clinical trial underrepresentation, among others.

Lack of Health Insurance

Research suggests that a lack of health insurance hinders women from receiving prompt, top-quality breast cancer prevention and care. In a 2008 study from Virginia Commonwealth University (VCU), researchers reported that breast cancer stage and tumor size are more advanced in uninsured women compared to insured women. The researchers also found that uninsured women are more likely to be Black compared to non-Black women. Similarly, a 2018 US Census Bureau Report found that almost 14 percent of Black women are uninsured, compared to 8 percent of white women.

Lack of Timely Breast Cancer Screenings

Researchers have noted cultural barriers to breast cancer mortality that include a low perception of breast cancer risk, a general mistrust of medical institutions, and norms within the Black community that discourage breast cancer dialogues. “My grandmother didn’t get mammograms regularly, even though her mother had breast cancer,” says Jodi, a Black breast cancer survivor who asked that her last name not be used. Jodi was diagnosed with invasive ductal carcinoma in 2020.

Because of these cultural norms, Black women may delay seeking treatment for breast abnormalities, according to a Cancer Epidemiology, Biomarkers & Prevention journal article. With a staged diagnosis like breast cancer, what could have been caught earlier will continue to advance and become more difficult to treat.

Recently, COVID-19 has further impeded women from keeping important mammogram appointments. “Our concern now is women being diagnosed with cancer later because of quarantine,” says Christina Benton, Cancer Control Supervisor at the Virginia Department of Health. 

Clinical Trial Underrepresentation

A growing body of evidence shows that Black men and women are underrepresented in clinical trials. Researchers have found several different factors that may present barriers to participation, including financial hurdles, insufficient efforts by research institutions to recruit Black participants, and a lack of trust in scientific institutions based on past injustices. “Even with all my education, I don’t trust medical trials. I wouldn’t sign up for one,” says Jodi. A 2017 study from VCU found that improving patient-provider communication may encourage more diversity in clinical trials.

Bridging the Gap in Richmond, Virginia

Several health care organizations in Virginia are working to improve breast cancer survival rates throughout the Commonwealth. Among those is VCU’s Massey Cancer Center, one of two National Cancer Institute-designated cancer centers in the state and a top 5 percent cancer center nationwide. The center regularly conducts clinical trials that bring research from the bench to the bedside. VCU manages the Health Communication and Digital Innovation Core, a shared resource platform for researchers and practitioners. Among other services, the platform provides consultation for providers to improve communication with patients and recruit Black clinical trial participants.

Aside from research and education, the state provides accessible preventative public health programs, such as Every Woman’s Life, which connects low-income, uninsured symptomatic women between ages 18–64 to providers offering free breast screening services. Community health workers and patient navigators serve as links between the community and health systems.

“We’re trying our best to target those women and get them the care that they need and deserve,” says Benton, who, in addition to her role with the Virginia Department of Health, oversees the Every Woman’s Life program. 

For women ages 18–39 who are at a high risk for breast cancer but are asymptomatic, nonprofit organizations such as Reach Out for Life are a safety net. The group provides free mammograms for uninsured, low-income women via a voucher system and can often be found at community health fairs to ensure the most vulnerable populations are assisted.  

“Outreach is equally as important as providing services. We’re out in the community letting people know where they can find a free mammogram if they need it,” says Reach Out for Life Executive Director Norah Lind.

As a breast cancer survivor, Watkins understands the fear of having an annual mammogram that some women experience. She encourages women to lean on support networks such as Sisters Network to ease anxiety. In addition to promoting breast health education, organizations like Sisters Network build camaraderie within the Black breast cancer community, says Watkins.

Watkins and her chapter host the annual Gift for Life Block Walk and Health Fair in Richmond. During the walk, volunteers distribute information on resources such as sites offering free mammograms. “If we save just one life, our efforts are not in vain,” says Watkins.  

Despite the uphill battle, Nadine Kom, a Black Virginian breast cancer survivor diagnosed with stage 2 invasive ductal carcinoma in 2019, feels hopeful about the future of Black women and breast cancer. “Breast cancer is becoming less of a taboo subject,” she says. “People used to think if you had breast cancer, you were going to die tomorrow. But now, people are saying, ‘I had breast cancer last year. This was my journey.’”