Many women get breast cancer. But the disease is deadliest for non-Hispanic Black women. And when it comes to metastatic breast cancer, women of color are less likely to get timely treatment that follows national guidelines. 

According to Grace Suh, MD, medical director at Northwestern Medicine Cancer Center Delnor, lack of access to health education and regular medical care is a big part of what’s fueling this disparity. And medical centers are actively trying to find and fix differences in breast cancer screening, diagnosis, and treatment that fall along racial lines. 

“Regardless, despite all these efforts, there still remains a significant gap in health equity,” Suh says, “And we recognize that.” 

Here’s some of what we know so far about what affects breast cancer treatment in women of color. 

What Are Best Practices for Metastatic Breast Cancer?

Medical experts get together and agree on what kind of treatment is best for certain diseases. These national guidelines are usually referred to as best practices, standard of care, or standard therapy. 

Systemic drug therapies are typically the go-to for breast cancer that’s spread to other parts of your body, also known as stage IV or metastatic breast cancer. But there may be a benefit to surgery and/or radiation therapy for some people. 

Treatment of metastatic breast cancer typically includes one or more of the following drugs: 

• Hormone therapy
• Chemotherapy 
• Targeted therapy
• Immunotherapy

But metastatic breast cancer isn’t the same in everyone. 

“In general, it’s actually multiple different diseases,” says Sarah Schellhorn, MD, a breast oncologist with Yale Cancer Center and Smilow Cancer Hospital and an associate professor of medicine at Yale School of Medicine. “And we tailor therapy based on biology and what’s driving the cancer.” 

The types of drugs your doctor chooses for you depend on things like whether your cancer is aggressive, fueled by hormones, or tests positive for HER2 (a protein that helps cancer cells grow). But they’ll also consider how treatment will impact your overall health and well-being.

Which Health Conditions Affect Breast Cancer Treatment?

Treatment can shrink your tumors, lessen symptoms caused by cancer, and help you live longer. But these are strong drugs that come with side effects. Sometimes a pre-existing medical problem can influence the type of treatment your doctor thinks is best. 

“One of the problems is you have to be healthy enough to receive chemo,” Schellhorn says. “And that’s not really a yes or no question. But you want to be able to give enough chemotherapy that it treats the cancer but not too much that it actually harms someone or decreases their quality of life.” 

Here are some health conditions that may affect your breast cancer treatment:   

Cardiovascular risk factors. Common cancer treatments can be “toxic to the heart,” Schellhorn says. For example, some therapies can make it hard for your heart to pump blood, or they may speed up other heart and blood vessel problems. 

Heart issues caused by cancer drugs may go back to normal if you ever stop treatment. 

Other Factors That Affect Breast Cancer Treatment

Here’s a breakdown of a few more reasons why women of color may not get standard care when it comes to metastatic breast cancer: 

Barriers to care. Due to racial disadvantages, many Black people live in poverty. And low-income women are less likely to have a regular doctor, health insurance, or easy access to follow-up breast cancer care. 

And some women of color may not have jobs that offer paid time off or medical leave. “People do forgo care or delay it because they can’t afford to stop working,” Suh says. 

Physician bias. Studies show some doctors look down on Black people and those from poorer backgrounds compared to white or people with a lot of money. But we need more research to know how this kind of judgment might fuel racial and ethnic differences in breast cancer treatment. 

There’s no evidence that doctors routinely choose nonstandard treatments because they’re worried people can’t pay for it. But is it possible? 

How to Advocate for the Best Breast Cancer Care

There’s still a long way to go to reduce racial disparities in breast cancer treatment. But there are steps you can take to get the best care. 

Ask for treatment details. You may not know what standard of care is for your type of breast cancer. But it’s fine to ask your doctor about it. Go a step further and get them to explain exactly why you’re getting one treatment over another. 

“I very much try to have that conversation,” Schellhorn says. “Here’s what the standard of care is. Here’s what I’m worried about using standard treatments with you. Here’s why I think another breast cancer treatment option is better for you.” 

Bring up personal hurdles to treatment. Financial strain may not be top of mind for your cancer doctor. But it’s something you should bring up. No one should delay or avoid treatment because of cost. Your cancer care team can help you apply for drug assistance programs or find the funds another way. 

“There is a whole wealth of resources that may be out there that we can tap into,” Suh says. “But it doesn’t happen automatically.” 

You can also tell your doctor that you’re having problems in other ways not specifically related to the cancer itself. Ask to speak with a social worker, navigator, or financial counselor if you need: 

• Mental health support
• Help with childcare
• Transportation to and from treatment 
• Healthy food for you and your family
• Assistance with your housing or utility bills
• Legal or financial help
• Interpreter services 

Keep the conversation going. You may need to constantly weigh the pros and cons of drug side effects and your quality of life. And when it comes to if you want to continue treatment, the final decision lies with you. 

“Some (people) say, listen, I don’t want to get chemotherapy. Other people say, I want to live as long as possible,” Schellhorn says. “That’s a very personal decision that requires a frank conversation with the (person) and the oncologist.” 

Hospital food isn’t known for tasting good or even being all that good for you. But some U.S. hospitals are teaming up with farms to change that.

You probably think of hospital food as premade, prepackaged, bland, and colorless — except for the Jell-O, of course. Maybe you’ve brought a friend or relative soup or a sandwich to their hospital room because the place where you most expect a healthy meal is one of the places you’re least likely to get it.

So you might be surprised to know that some hospitals are teaming up with local farms to offer healthier, tastier food. A few even have their own farm on campus.

“Good food is good medicine,” says Santana Diaz, executive chef of food and nutrition services of UC Davis Medical Center in Davis, CA, and the first U.S.-born person in his family of generations of Mexican farmers.

“Patients are at the center of everything we do,” Diaz says. “I know I’m not a doctor or a nurse standing next to the patient, but I want to give everyone in our care the healthiest choices possible.”

Diaz and others are proving it’s possible to provide healthy meals for patients and help local growers at the same time.

Diaz and his team serve 1,530 patient meals a day and more than 4,000 meals in retail spaces.

Diaz puts his “boots on the ground of every farm we buy from to make sure it’s a real place,” then uses a local distributor for pick up and delivery.

“We get two pallets of produce every day. That’s about 2,000 pounds, or 1 ton,” Diaz says. “When we say we go through a ton of produce a day, we literally mean a ton of produce a day.”

This translates to local tomatoes in salads, local peaches for dessert, and black beans that become a fiber-filled side for taco Tuesday, and a black bean vinaigrette that keeps sugar levels in salad dressing low but the flavor profile high.

It’s also good for the farmers. With a large-scale operation, Diaz can forecast with farmers what his yields and needs are for the year or even years ahead.

More than half of the produce that John Muir Medical Centers serves to patients and visitors — 60% — comes from California. And 50% of that comes from farms within a 150-mile radius.

That’s possible thanks to their partnership with Bay Cities Produce Co. While Joe LaVilla, the culinary operations manager of nutrition services for John Muir, focuses on the meals, Bay Cities vets and works with local farms to make sure the necessary but less sexy side of food procurement — federally regulated standards like food safety, fair trade and field, soil and water testing — is up to speed.

“Hospitals don’t want people getting sick,” says Steve del Masso, president of Bay Cities Produce Co. “John Muir has the desire to do the right thing with small farms, and they’re dedicated to keeping local going. At the same time, there are food safety concerns. I think we’re a good go-between.”

For patients, this means the stir-fried vegetables or carrots in the carrot-ginger soup come fresh from farms, not out of freezer bags.

“Our overnight oats for breakfast feature local blood oranges. We serve local squashes, Brentwood corn in season, and up to four special salads a day — all based on what’s fresh and local,” DaVilla says. “Our best seller is a steak salad with arugula, endive, peppers, frisee, and shaved onion.” 

Built on a former golf course, Lankenau Medical Center’s 98-acre campus includes a 2-acre farm right across the street from the emergency room.

Since 2016, the Deaver Wellness Farm has produced more than 13,000 pounds of onions, greens, tomatoes, melons, beans, and peas.

“Anything you can grow, we grow,” says Phil Robinson, president of Lankenau Medical Center.

Education is a big part of the programming. School children visit the farm to learn about food that doesn’t come out of a wrapper or bag. Patients with food insecurity — those who don’t have access to fresh fruits and vegetables — talk with a dietitian about produce and recipes. Then they get fresh fruits and vegetables delivered to their homes.

“If you just patch them up and send them back where they came from, you’re not doing a lot of good,” Robinson says. “If we’re really going to make a difference and improve our patients’ health status, it has to be outside the four walls of this hospital.”

All 3,000-plus pounds of produce harvested from The Sky Farm at Eskenazi Health every year make their way into free food and nutrition classes. This helps patients at all Eskenazi locations — especially those with diabetes, heart disease, and other chronic diseases — learn how to control and even reverse their conditions.

Class topics include “Lifestyle Medicine,” “Growing Strong: Cooking Matters,” “Fresh Veggie Fridays,” and “What Can I Eat?”

Squash, peppers, tomatoes, eggplant, cucumbers, radishes, and herbs are just a few of the crops that grow on Boston Medical Center’s rooftop farm every year.

More than 5,000 pounds of food from the farm is used in hospital cafeterias, patient meals, demonstration kitchens, and the center’s preventive food pantry, which supplies nutritious food to those who can’t afford it.

The micro-farm on the third floor deck of the Health Science Center at Stony Brook Medicine has more than 2,000 square feet of gardening space that yields fresh fruits and vegetables used in patient meals.

Their “farm-to-bedside” concept often includes a tent card on the tray to let patients know some of their meal was harvested at the farm.

Through a partnership with the Rodale Institute, St. Luke’s University Health Network has St. Luke’s-Rodale Institute Organic Farm, 8 acres of crops that supply all 12 hospitals in their network with 100 varieties of chemical-free, certified organic produce.

Everything from salad greens, broccoli, and peppers to Swiss chard, garlic, beets, and herbs is incorporated into patient, visitor, and staff meals, and is available for purchase at on-site farmers markets at various hospital locations.