Breast Cancer

Breast cancer is the uncontrolled growth of cells in the breast, most often starting in the ducts that carry milk (ductal carcinoma) or the lobules that make it (lobular carcinoma). It is the most commonly diagnosed cancer in American women and, after lung cancer, the second leading cause of cancer death in women. Most cases are found as a lump, a change in the breast, or a spot on a mammogram, and most occur in women with no family history of the disease.

Breast cancer is not one disease. Pathologists sort it by what drives the tumor: hormone-receptor-positive cancers (estrogen and/or progesterone receptor positive, the most common and generally most treatable), HER2-positive cancers (driven by the HER2 protein, now highly targetable), and triple-negative breast cancer, which lacks all three receptors and is more aggressive. These subtypes are treated differently and carry different outlooks, which is why the receptor status from a biopsy shapes every decision that follows. Black women are diagnosed with the aggressive triple-negative subtype about twice as often as white women (American Cancer Society, Cancer Facts and Figures for African American/Black People 2022-2024), one reason a single "breast cancer" label hides very different realities.

• A new lump or thickening in the breast or armpit, often painless and firm with irregular edges
• A change in the size, shape, or contour of one breast
• Skin changes: dimpling, puckering, or a texture like an orange peel (peau d'orange)
• Redness, warmth, swelling, or a rash on the breast, which can signal aggressive inflammatory breast cancer and needs urgent evaluation
• Nipple changes: a newly inverted or pulled-in nipple, scaling, or crusting
• Nipple discharge that is bloody or clear and comes from one duct without squeezing
• A sore or ulcer on the breast that does not heal
• Persistent pain in one spot of the breast or nipple, though most breast cancer is painless
• New swelling or a lump under the arm or around the collarbone

Screening mammography finds breast cancer before it can be felt, when it is most curable. The starting age is genuinely debated, and the debate matters more for Black women than for anyone else because they develop cancer younger.

• USPSTF (2024): the U.S. Preventive Services Task Force now recommends mammography every two years for all women from age 40 through 74 (Grade B). It states plainly that Black women are about 40% more likely to die of breast cancer and that starting at 40 has "even greater potential benefit" for them, but it stops short of recommending earlier or annual screening specifically for Black women (USPSTF, Breast Cancer: Screening final recommendation, 2024).
• American College of Radiology (2023): the ACR recommends every woman get a formal breast cancer risk assessment by age 25, "especially Black women," so that those at higher-than-average risk are found early, and it supports annual (not every-other-year) mammography starting at 40 for average risk (Monticciolo et al., Journal of the American College of Radiology, 2023).
• What the modeling shows: a 2023 analysis found that Black women reach the same breast cancer death risk that prompts screening in white women about six years earlier, around age 42 rather than 50, which the authors argue supports race-adapted starting ages (Chen, Kharazmi, and Fallah, JAMA Network Open, 2023).

The practical takeaway: if you are a Black woman, talk with your clinician about starting mammography at 40 at the latest, ask whether family history or dense breasts justify starting earlier or adding MRI, and get a risk assessment in your 20s or 30s rather than waiting. If you have a first-degree relative with breast or ovarian cancer, or any male relative with breast cancer, ask about genetic counseling and BRCA testing, because that can move your screening start age earlier and change which tests you need.

Breast cancer treatment is decided by the tumor's stage (how far it has spread) and its receptor profile (hormone receptors and HER2). Most people receive some combination of surgery, radiation, and drug therapy, sequenced to their specific tumor. This is high-level only; your oncology team sets the actual plan.

Surgery is either breast-conserving (lumpectomy) followed by radiation, or mastectomy. For early-stage disease the two approaches give equal survival, so the choice depends on tumor size, breast size, genetics, and preference. The lymph nodes under the arm are checked with a sentinel node biopsy to see whether cancer has spread.

Drug therapy is matched to the subtype. Hormone-receptor-positive cancers are treated with endocrine (anti-estrogen) therapy such as tamoxifen or an aromatase inhibitor for five to ten years, often with a gene-expression test (like Oncotype DX) to decide whether chemotherapy adds benefit. HER2-positive cancers are treated with HER2-targeted antibodies such as trastuzumab, which turned a once-aggressive subtype into a highly treatable one. Triple-negative disease is treated with chemotherapy and, increasingly, immunotherapy; that treatment is covered in depth on our triple-negative breast cancer page.

Radiation after lumpectomy, and after some mastectomies, lowers the chance the cancer returns in the chest wall.

Where the disparity hides in treatment. Black women are more likely to face delays and gaps: longer waits to surgery, lower rates of complete, guideline-concordant treatment, and lower enrollment in clinical trials. Ask your team directly whether your treatment matches national guidelines, whether a genomic test applies to you, and whether there is a clinical trial you qualify for. A nurse navigator or social worker can help hold the timeline together; ask for one by name.