Key Takeaways

Breast cancer rates are rising in U.S. women under age 50

Some types are more aggressive in younger women

Experts urge women to consider annual mammograms if they’re at higher risk, no matter the age

MONDAY, June 9, 2025 (HealthDay News) — More young women in the United States are being diagnosed with breast cancer and several celebrities have helped raise awareness by sharing their stories.

Singer Jessie J, 37, said last week that she has early-stage breast cancer and will have surgery this month. “Bachelorette” star Katie Thurston, 34, is documenting her treatment for stage 4 breast cancer. Actress Danielle Fishel, 43, also shared her diagnosis last summer, NBC News said in a new report.

The rise in cases reflects a national trend. Between 2012 and 2021, breast cancer rates rose 1.4% each year in women under 50, compared with 0.7% each year in those 50 and older.

Rates have increased across all racial and ethnic groups, especially among Asian American and Pacific Islander women under 50. Their breast cancer rates have jumped nearly 50% since 2000.

Black women are more likely than other groups to be diagnosed with breast cancer before age 40, and they are also more likely to die from the disease, NBC News said.

Routine mammograms usually start at age 40, and younger women are rarely screened unless they’re at high risk — such as those with a family history or certain genetic mutation.

Doctors say this delay in screening can make it harder to catch breast cancer early, when it is easier to treat.

“The thought was always, if you had a change in your breast but you were a young woman, it was probably nothing,” said Dr. Rani Bansal of Duke University School of Medicine. “As we’re seeing more and more younger women get diagnosed … we need to take these cases seriously.”

Symptoms to watch for include lumps or nipple discharge.

Dr. Oluwadamilola Fayanju, chief of breast surgery at Penn Medicine, said her youngest breast cancer patient was just 17.

She said young women should consider getting care at a clinic that specializes in breast imaging.

Experts suspect many factors may play a role, including:

Hormones

A diet high in processed foods

Obesity

Increased alcohol use

Exposure to harmful chemicals

Environmental toxins like BPA and Teflon have been widely used for decades. Researchers are now studying how those early exposures might raise cancer risk later on, NBC News reported.

Some studies suggest that chemical hair straighteners — often used by Black women — may increase breast cancer risk, possibly by affecting hormones in the body.

Delaying childbirth may also play a role. Women who have babies later in life are more likely to develop postpartum breast cancer — cancers that appear within five to 10 years of giving birth.

Each year, about 18,000 U.S. women are diagnosed with postpartum breast cancer, said Dr. Virginia Borges of the University of Colorado Cancer Center.

Younger women are more likely to be diagnosed with triple-negative breast cancer, a fast-growing type that has fewer treatment options.

Even though overall survival rates are improving, Borges said breast cancer diagnosed before age 35 often spreads more easily. Doctors are still trying to understand why.

“We need more data to better tailor our treatments towards younger women,” Bansal added. “A lot of the studies that are done are in older women.”

Experts suggest that women who are at higher risk begin screenings as early as age 30. This may include yearly mammograms and breast MRIs.

More information

The American Cancer Society has more on breast cancer screening guidelines.

SOURCE: NBC News, June 8, 2025

What This Means For You

If you’re under 50 and notice breast changes, speak with your doctor. Younger women are being diagnosed more often — and earlier — with breast cancer.

Key Takeaways

Biden did not receive a cognitive test during his 2024 annual check-up

A former White House doctor says age alone should have encouraged more testing

There are no clear rules for when or how a president should be tested for cognitive decline

MONDAY, June 9, 2025 (HealthDay News) — A former White House physician says former President Joe Biden should have had a cognitive test during his 2024 physical, given his age and the demands of being president.

Dr. Jeffrey Kuhlman, who served as President Barack Obama’s doctor, said a mental fitness test would have helped the White House and public better understand whether the then-81-year-old Biden was capable of serving another term, The Washington Post reported.

“Sometimes those closest to the tree miss the forest,” Kuhlman said, talking about Dr. Kevin O’Connor, Biden’s longtime physician and author of the 2024 health report that did not include cognitive testing.

O’Connor has served as Biden’s doctor since 2009 and did not respond to requests for comment from The Post.

Kuhlman said the role of the president is too demanding to only consider basic health.

“It shouldn’t be just health, it should be fitness,” he said. “Fitness is: Do you have that robust mind, body, spirit that you can do this physically, mentally, emotionally demanding job?”

Biden’s medical report in early 2024 concluded he was “fit for duty” and listed results from 10 medical specialists, including a neurologist. It described Biden as “a healthy, active, robust 81-year-old male.”

The lack of a cognitive assessment has drawn scrutiny with House Republicans subpoenaing O’Connor as part of a wider effort to understand the former president’s health.

Meanwhile, President Donald Trump has ordered White House attorneys to find out if Biden’s inner circle tried to hide his alleged cognitive decline, The Post reported.

A book by journalists Jake Tapper and Alex Thompson published last month also raised concerns. It described Biden as sometimes forgetful and fatigued, citing interviews with Democratic insiders conducted after the 2024 election.

The book also said O’Connor was hesitant to give Biden a cognitive test, although a neurologist had screened him for conditions like Parkinson’s disease.

Biden responded to the book with sarcasm: “You can see that I’m mentally incompetent, and I can’t walk, and I can beat the hell out of both of them,” he said during a Memorial Day event.

His granddaughter, Naomi Biden, called the book “political fairy smut,” The Post reported.

After his stint as White House physician, Kuhlman wrote a book arguing that presidents — especially older ones — should be tested for cognitive function often.

“No one has a vested interest in hearing the truth about the president’s health — except for the American people and the world,” Barbara Perry, a presidential historian at the University of Virginia, told The Post.

There’s no law that says how often a president should be examined or what those exams should include.

White House doctors usually do an annual physical and release a memo with blood work, exam results and a statement on whether the president is fit for duty.

Doctors for both Biden and Trump have followed this tradition, but Biden’s reports were always more thorough than Trump’s, according to The Post.

Some former White House doctors say they were never pressured to hide information.

“You never lie,” said Dr. Lawrence Mohr, who served as physician to Ronald Reagan and George H.W. Bush. “You put out a clear press release about what’s going on, what to expect and you get it out there. If you don’t do that, you end up with all sorts of speculation.”

Over the nation’s history, some presidents have gone to great lengths to hide serious illnesses.

President Grover Cleveland secretly had surgery aboard a yacht to remove a tumor in 1893. Woodrow Wilson’s wife and doctor kept the extent of his 1919 stroke — which left him paralyzed on one side — hidden from even his Cabinet members.

On the other hand, President Dwight D. Eisenhower told his team to “tell them everything” after his 1955 heart attack. His doctors gave the public regular updates, The Post said.

Still, experts say the lack of support on the president’s willingness to share information with the public makes medical transparency unknown.

“I was fortunate to have 50-year-old patients instead of 80-year-old ones,” Kuhlman said, referring to Obama and former President George W. Bush, who didn’t take cognitive tests during their time in office.

More information

Read President Donald Trump’s 2025 health report.

SOURCE: The Washington Post, June 7, 2025

What This Means For You

Experts say that clear guidelines and transparency around cognitive testing could help ensure that presidents are truly fit to serve.

CNN —

A new report on cancer in the US shows a steady decline in overall deaths from 2001 through 2022. The rate of diagnoses among men fell from 2001 through 2013 and then stabilized through 2021 but these incidence rates among women increased slightly every year between 2003 and 2021.

Those trends were interrupted in 2020, when cancer incidence rates fell significantly, the report shows, possibly because of disruptions in medical care related to the Covid-19 pandemic. After 2020, they returned to expected levels. “Because fewer cancers were diagnosed in 2020, especially through screening, we may see a larger percentage of cancers diagnosed at a late stage in future years,” the report says.

The 2024 Annual Report to the Nation on the Status of Cancer was published Monday in the journal Cancer. It’s based on data from cancer registries funded by the US Centers for Disease Control and Prevention and the US National Institutes of Health’s National Cancer Institute, and it’s released by those institutions, the American Cancer Society and the North American Association of Central Cancer Registries.

“Overall, cancer incidence and death rates continue to decline, representing changes in risk factors, increases in screening utilization, and advances in treatment,” the researchers write. “However, sustained disparities by race and ethnicity emphasize the need to fully understand the factors that create these differences so that they can be mitigated.”

Fewer people in the US are using tobacco, helping lower incidence and death rates for smoking-related cancers like lung, bladder and larynx, the report says. And these sustained declines in lung cancer have been a major contributor to the overall improvements in cancer death.

However, incidence rates are on the rise for several other cancers, including those linked with excess weight, such as pancreas and kidney cancers; uterine, breast and liver cancers among women; and colon and rectal cancers among adolescents and young adults.

Previously published research has shown that cancer diagnoses are shifting from older to younger adults and from men to women. Middle‐age women now have a slightly higher cancer risk than their male counterparts, and young women are nearly twice as likely to be diagnosed with the disease as young men, according to an American Cancer Society report published earlier this year.

The new report shows that incidence rates among women have risen 0.3% each year. The largest observed increase among women was for stomach cancer, which the researchers say may be largely due to a change in the classification of tumors by the World Health Organization.

Rates of breast cancer diagnoses are also gradually increasing, driven mostly by types of cancer that have been associated with factors like obesity, alcohol use and age when someone gives birth for the first time.

The data continues to show large racial disparities. For example, Black women have a 40% higher rate of death from breast cancer than White women, and their rate of death from uterine cancer is double that of White women.

Differences in access to care and less use of diagnostic procedures and treatment may account for some of the difference, the researchers say. “One additional potential risk factor disproportionately affecting Black women is the use of chemical hair relaxers, which may be associated with an increased risk of uterine cancer among postmenopausal women.”

Changing habits such as stopping tobacco use, staying at a healthy weight, eating a healthy diet with fruits and vegetables, avoiding alcohol and protecting skin can all reduce risk of cancer. Screening can help find and treat cancers early, before they spread. Screenings are available and recommended for certain people for breast cancer, colon and rectal cancer, cervical cancer, endometrial cancer, lung cancer and prostate cancer.

Disparities in breast cancer care among ethnic minority women are significant, with cultural and systemic barriers hindering early detection and treatment. This article discusses the urgent need for inclusive healthcare approaches to ensure equitable outcomes for all women

Abstract Inclusive care is critical in breast cancer screening, diagnosis, treatment and outcomes. Disparities in access to and outcomes from breast cancer healthcare services significantly affect women’s health and wellbeing. By drawing on a diverse range of sources, this article explores the complex nature of these disparities and proposes effective strategies to address them. Citation: Roye J (2025) Equitable breast cancer care and outcomes for diverse ethnic women. Nursing Times [online]; 121: 5. Author: Julie Roye is head of nursing primary care at East London NHS Foundation Trust. This article has been double-blind peer reviewed

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Introduction

Inclusive care is not just an aspirational concept but a critical requirement in healthcare policy and practice, particularly in the context of breast cancer screening, diagnosis, treatment and outcomes. Disparities in access to and outcomes from breast cancer services have significant public health and equity implications (Wilkerson et al, 2024). This article seeks to examine these disparities, drawing on various sources to provide a comprehensive understanding of the issue. It is important to note that throughout this article, the term ‘global majority’ is used rarely. Instead, references will be made to Black, Asian and minority ethnic (BAME) women, including Black, South Asian and other ethnically diverse women.

The principle of inclusive care asserts that every individual, regardless of their background or circumstances, should have equal access to healthcare services. In the realm of breast cancer, this means addressing disparities across screening, diagnosis, treatment and outcomes for different demographic groups (Wilkerson et al, 2024; Brown et al, 2017). Achieving equity in breast cancer care requires confronting and eliminating systemic barriers that prevent access to these vital services.

The NHS’s (2019) long-term plan outlines a commitment to reducing cancer-related health inequalities over the next decade by improving early diagnosis, expanding screening programmes, and enhancing treatment pathways. One such initiative aimed at addressing these challenges is the Core20PLUS5 strategy from NHS England, which focuses on improving health outcomes for the 20% most deprived populations in England (NHS England, 2022a).

Cancer, particularly breast cancer, is a key area of focus within this framework, aiming to increase knowledge and awareness in communities that face higher barriers to healthcare access. The initiative emphasises tailored community engagement, public health campaigns, and enhanced access to screening and early diagnosis services, particularly among BAME and lower socioeconomic groups. Other NHS England programmes, such as the National Cancer Screening Programme, continue to target at-risk populations by promoting early detection through education and accessibility improvements. These efforts align with broader global strategies to address cancer disparities among non-White and deprived populations, aiming to reduce late-stage diagnoses and improve survival outcomes.

Breast cancer is the most common cancer among women of all ethnicities. However, despite more than 3 million people from global majority backgrounds in the UK, breast cancer incidence rates among Black British women are still unclear, largely due to insufficient data collection (Smith, 2023a). Compared with White women, women of Black African, Black Caribbean and South Asian descent in the UK tend to have lower awareness of breast cancer (Forbes et al, 2011) and its risk factors (Jones et al, 2015).

According to Clarke et al (2022), women of African descent are 40% more likely to die from breast cancer compared to women of European descent, and have the highest breast cancer mortality rates among all racial groups. Many Black women view breast cancer as a ‘White women’s disease’ and feel that breast health campaigns do not apply to them (Bamidele et al, 2017; Jones et al, 2015). Additionally, they are less likely to participate in breast cancer awareness practices (Forbes et al, 2011) and mammograms (Bamidele et al, 2017; Jack et al, 2014). Key barriers include:

Fear of diagnosis;

Lack of time;

Confusion about the screening process (Bamidele et al, 2017).

Clarke et al (2022) found that there was:

Lack of trust in healthcare systems;

Limited access to high-quality care and to academic cancer centres;

Longer waiting times for treatment;

Implicit bias;

Residential disparities.

Emotional factors, such as fear and fatalistic attitudes towards cancer, also contribute to delays in early detection and diagnosis among BAME women (Brown et al, 2017; Vrinten et al, 2016). By exploring these challenges, this article underscores the need for targeted interventions to address both cultural and systemic barriers in breast cancer care, ensuring a more inclusive and equitable healthcare system for all.

Bowen et al’s (2008) research revealed that British Black women were diagnosed with breast cancer at a significantly younger median age of 46, compared to 67 for White British women. Additionally, this group displayed a higher prevalence of aggressive tumour types, particularly triple-negative breast cancer (TNBC), which does not respond to common hormone therapies. These findings suggest that Black British women may require earlier and more frequent screenings to improve early detection rates and treatment outcomes.

Research also found that Black women in England are more likely to be diagnosed with breast cancer at a later stage compared to White women (Smith, 2023a). Late-stage diagnosis is strongly associated with poorer survival rates, as treatment options become more limited. These findings underscore the urgent need for targeted outreach programmes to encourage early diagnosis and regular screening among Black British women.

Basal-like breast cancer (BLBC) is a subtype of breast cancer that shares molecular characteristics with basal cells in the breast. These tumours are typically TNBC, meaning they lack oestrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER2). Because of this, BLBCs do not respond to hormone therapy or HER2-targeted treatments, making them more challenging to treat (Malhotra, no date; Reid et al, 2022). The prevalence and molecular charac­teristics of BLBC in British Black women have not been extensively studied, despite their potential implications for breast cancer care in the UK (Limb, 2023).

Brennan (2017) found that the UK and Australia have among the highest breast cancer incidence and survival rates worldwide. However, survival outcomes for certain minority groups, such as Aboriginal and Torres Strait Islander people in Australia, fall significantly below those of the general population. This trend is not unique to Australia; studies have shown that non-White women globally face poorer breast cancer outcomes. For example, Black women in the US are more likely to be diagnosed at a later stage and have higher mortality rates compared to White women (DeSantis et al, 2016). Similarly, research in Canada and the UK has identified disparities in access to early detection and treatment among South Asian and Black women, contributing to lower survival rates (Martins et al, 2022; Jack et al, 2014). These findings highlight the need to address these disparities on a global scale.

In the UK, Jack et al (2014) found that South Asian and Black women are more likely to be diagnosed with metastatic breast cancer compared to White women, indicating potential delays in early detection. Brown et al (2017) highlighted that individuals from minority ethnic backgrounds generally have lower awareness of cancer symptoms than their White counterparts. Additionally, Aliu et al (2025) identified cultural, socioeconomic and systemic barriers that prevent Black and South Asian women from participating in breast cancer screening programmes, further exacerbating disparities in early diagnosis.

Smith (2023b) recognised the critical need for more research focused on breast cancer within minority ethnic groups, particularly due to the lack of evidence and understanding surrounding how the disease affects these populations. He outlines a Cancer Research UK study, which aims to investigate why women from minority ethnic backgrounds are less likely to develop breast cancer but, when diagnosed, often present with more aggressive forms of the disease. This three-year project will use existing data from large national studies and the National Cancer Registry Service in England to examine breast cancer incidence rates and how risk factors such as weight, alcohol intake and reproductive history vary across different ethnic groups.

The Leanne Pero Foundation is a UK-based charity founded by breast cancer survivor Leanne Pero. It focuses on advocacy, education, and community-driven support to address disparities in cancer awareness, diagnosis, and treatment for Black and minority ethnic patients. Its flagship programme, Black Women Rising, tackles the lack of awareness and support for Black women facing cancer. Through educational workshops, it promotes early detection and ensures women have access to vital health information. The initiative also fosters peer-to-peer support groups, providing a safe space for those affected to share their experiences and find solidarity. Additionally, storytelling initiatives help challenge stigma and improve representation, ensuring that Black women’s voices and experiences are acknowledged in healthcare discussions. The project also advocates for greater healthcare equity, pushing for improvements in cancer research and treatment tailored to Black communities.

“Inclusive care in breast cancer isn’t just an aspiration — it’s a necessity to ensure all women, regardless of their background, receive the care they deserve”

Breast cancer inequalities

Early detection of breast cancer significantly improves survival rates. For instance, the five-year survival rate for stage 1 breast cancer is 98%, compared to 28% for stage 4 (NHS England, 2022b). Recognising the importance of early diagnosis, the NHS established the National Breast Screening Programme in 1988, aiming to detect breast cancer at earlier stages and improve survival outcomes (National Institute for Health and Care Excellence, 2022). This year, the NHS launched its first national campaign to boost screening attendance among more than 6 million eligible women, with data showing that almost three-quarters of a million women did not attend a screening appointment in 2023-24, with nearly one in four first-time invitees failing to respond (NHS England, 2025). Historically, participation remains disproportionately lower among BAME women compared to White women (Yedjou et al, 2019; Jack et al, 2014; Forbes et al, 2011), with few targeted interventions addressing this disparity (Bamidele et al, 2017; Brown et al, 2017; Vrinten et al, 2016).

Though around 85% of women survive breast cancer for five or more years after diagnosis, it remains a leading cause of death in women under 50 (Breast Cancer Now, no date; Cancer Research UK, 2023a). Each year in the UK, breast cancer claims around 11,500 women and 90 men, equating to one death every 45 minutes (Cancer Research UK, 2023a).

Despite overall improvements in survival, disparities persist:

By stage: 98% of women diagnosed at stage 1 survive five years, compared to 28% at stage 4 (NHS England, 2022b);

By deprivation: five-year survival rates are lower in the most deprived areas – 82% in England and 81% in Scotland – compared to 88% and 87% respectively in the least deprived (NHS Digital, 2023; Scottish Public Health Observatory, 2023);

By ethnicity: in England, three-year survival rates for women aged 15-64 are 85% for Black women, 89% for South Asian women, and 91% for White women (NHS England, 2023).

Breast cancer survival rates have steadily improved over time, increasing from 77% in 1996–1999 to 85% in 2016–2020 (Limb, 2023; Cancer Research UK, 2023b). This progress reflects advancements in early detection, screening programmes and treatment options, although the rate of improvement has slowed, indicating a need for further interventions to sustain and enhance survival outcomes. However, these statistics do not account for racial or ethnic disparities, and there is still a conspicuous lack of data on screening uptake, mortality, and survival rates among Black British, Black African, Black Caribbean, Asian and South Asian women in the UK (Limb, 2023; Yedjou et al, 2019). This gap in data highlights the need for more inclusive research and interventions that specifically address the barriers faced by BAME women in accessing breast cancer screening and care. While overall survival rates have improved, the lack of targeted support and data collection for BAME women suggests that these communities are not benefiting equally from advances in breast cancer care. Addressing these disparities is essential to ensuring equitable healthcare for all.

A study by Bowen et al (2008) discovered a higher prevalence of grade 3 tumours in Black women (62%) compared to White women (42%), even after age adjustments. Black women with smaller tumours (<2cm) had a twofold higher risk of death, despite receiving more adjuvant therapy than White women. These findings suggest breast cancers in young Black women are biologically distinct, not merely due to the person’s age.

The Bowen et al (2008) study also identified that British Black women not only develop breast cancer at younger ages, but their small tumours display more aggressive behaviour compared to those in White women. Gathani et al (2021a) also found that younger Black women had small tumours, but their presentation and diagnosis was more progressive. However, breast tumours in women over 60 behaved similarly regardless of ethnicity. There was no significant disparity in lymph node status and stage at presentation between both ethnic groups, which contrasts with findings in African American populations. Gupta et al (2019) found that TNBCs account for approximately 15% of all breast cancer cases and are known for their aggressive metastatic nature. The study also noted that TNBC incidence was significantly higher among younger Pakistani, Black African and Black Caribbean women compared to White and Indian women.

In the US, Yunzi et al (2022) studied a cohort of 910,415 women diagnosed with breast cancer between 1975 and 2016 (Fig 1). Among these women, 7% were Asian (n=63,405). Within this Asian group, Filipino women made up the largest subgroup at 27%, followed by Chinese (20%), Japanese (18%), and other Asian subgroups. The findings revealed significant differences in diagnosis and treatment among Asian subgroups. Additionally, there were notable disparities in insurance coverage, with 94% of Japanese women being insured, compared to 82% of the overall Asian cohort. South East Asian women had the highest proportion of Medicaid coverage (33%), while Korean women represented the highest rate of uninsured individuals (4%).

These findings highlighted specific challenges faced by Asian women in the breast cancer care continuum. The relatively younger age of diagnosis among several Asian subgroups underscores the need for targeted awareness and screening initiatives. Insurance disparities suggest that access to care varies widely within the Asian community, which could impact treatment outcomes. For example, the high Medicaid coverage among South East Asian women and the higher uninsured rate among Korean women may point to economic and systemic barriers that need to be addressed to ensure equitable healthcare access. Overall, these insights emphasise the importance of recognising and addressing the unique needs of Asian women in breast cancer prevention, diagnosis and treatment efforts.

According to Cancer Research UK, there is a significant racial disparity in the diagnosis of advanced breast cancers in England. Specifically, Black women are more likely to be diagnosed with later-stage and more aggressive forms of the disease. For instance, around 25% of Black African women and 22% of Black Caribbean women in England are diagnosed at stage 3 or 4, compared to 13% of White women. Additionally, Black women are disproportionately diagnosed with TNBC (Cancer Research UK, 2023b).

Black African women in England have approximately double the likelihood of being diagnosed with late-stage and high-grade breast cancer compared to White women. Similarly, they are nearly three times more susceptible to ER-negative breast cancer, a subtype that is particularly challenging to treat. Furthermore, Black African women are at an increased risk of being diagnosed with HER2-positive breast cancer, which can also pose treatment challenges (Gathani et al, 2021a). In a separate study conducted in 2019, Hispanic women were found to have 1.3 to 7.1 times higher odds of being diagnosed with stage 4 breast cancer and were more likely to have HER2-positive disease, especially Black and Puerto Rican women (2.4- and 1.9-times higher odds, respectively). Black, Hawaiian, Puerto Rican, and Samoan patients had a 1.5 to 1.8 times higher risk of breast cancer-specific mortality compared to White women (Yedjou et al, 2019).

A study by Fry et al (2023) found that Black Caribbean women were more likely than White women to be diagnosed at a late stage for all six cancer types. African women had higher odds of late-stage diagnoses for breast, uterine, colon, and ovarian cancers. Additionally, South Asian women (Indian, Bangladeshi, and Pakistani) had higher odds of late-stage breast and ovarian cancer diagnoses. Martins et al (2022) analysed data from over 1.2 million cancer patients in the UK and found that BAME groups, particularly Black and South Asian populations, were more likely to be diagnosed through emergency presentations rather than through standard referral pathways. Fry et al (2023) completed a large retrospective data study of 743,659 diagnoses of several cancer types. They found that ethnicity was a significant predictor of late-stage breast cancer diagnosis. After adjustments for age, comorbidity and deprivation, Caribbean and African women were more likely to be diagnosed at a late stage (odds ratios (ORs) of 1.27 and 1.71, respectively) compared with White British women. Asian women also had an increased likelihood of late-stage breast cancer (OR 1.12). Even after further statistical adjustments, these patterns persisted, highlighting the disparity in late-stage diagnoses among minority ethnic women.

The analysis of breast cancer diagnosis and its characteristics among younger women of various ethnic backgrounds highlights ongoing disparities, particularly among women of colour, when comparing recent data with older studies. This comparison underscores the persistence of unfavourable outcomes in these groups, despite overall advances in breast cancer detection and treatment.

Demographic and socioeconomic characteristics

Gathani et al (2021a) carried out a large research study on breast cancer in ethnically diverse women. Data on 24,022 women aged 30–46 years reveals a racial composition predominantly of White women (93%), with smaller proportions of Indian (3%), Black Caribbean (1%), Pakistani (2%), and Black African (3%) women.

The average age at diagnosis was relatively consistent across these groups, ranging from 39.9 years in Black African and Pakistani women to 40.7 years in White and Black Caribbean women (Table 1). However, significant differences were observed in socioeconomic factors, such as deprivation scores and comorbidity rates: nearly half of the Black Caribbean, Pakistani and Black African women were in the most deprived quintile, contrasting sharply with less than a fifth of Indian and White women (Table 1). Additionally, Pakistani women were noted to have the poorest overall health, with 19.0% reporting at least one comorbidity (Table 1).

Tumour characteristics also varied by ethnicity: for instance, compared with White women, Black African women presented with notably higher rates of advanced-stage disease (26.6% versus 17.6%), high-grade disease (57.4% versus 47.6%) and ER-negative disease (30.1% versus 23.0%) (Table 1). These findings indicate a greater prevalence of more aggressive and less favourable tumour characteristics among minority ethnic women.

The comparison of recent data with older studies reveals that there has been little improvement in the rates of late diagnosis and higher-grade tumours among women of colour. The persistence of these disparities suggests that factors such as socioeconomic status, access to healthcare, and biological differences

may continue to contribute to less favourable outcomes seen in these populations. The higher proportion of missing data for minority ethnic women in recent studies further complicates the ability to fully understand and address these disparities, indicating potential gaps in data collection and reporting that need to be addressed.

Breast cancer disparities

Breast cancer disparities reflect differences in incidence rates, screening participation, and survival outcomes among various demographic groups, influenced by socioeconomic status, cultural beliefs, healthcare access, and environmental factors (Yedjou et al, 2019). Limited research exists on the impact of breast cancer on minority ethnic women in the UK.

Black Caribbean, Pakistani and Black African women experience poorer outcomes after diagnosis due to lower screening participation, socioeconomic challenges, a higher prevalence of more aggressive tumour types, and reduced awareness of breast cancer risk factors (Copson et al, 2014). A study by Marcu et al (2022) revealed the role of cultural factors in Black communities, such as taboos and beliefs that breast cancer only affects White women, leading to delays in diagnosis. Additionally, a lack of awareness about family history and reluctance to discuss cancer further complicate early detection.

Sarkar et al (2016) examined how socioeconomic status influences breast cancer outcomes, finding higher incidence rates and poorer survival among individuals from lower socioeconomic status backgrounds. Bowen et al (2008) similarly reported high breast cancer risks in socioeconomically deprived areas of East London due to financial and healthcare barriers.

Forbes et al (2011) identified emotional barriers to seeking medical care, with South Asian women reporting higher rates of fear and embarrassment compared to White and Black women. Cultural beliefs, language barriers, mistrust of healthcare providers, and societal taboos contribute to disparities in healthcare access (Brennan, 2017; Aliu et al, 2025). Cancer Research UK (2024) and Bonafede et al (2019) also found that structural barriers, such as lack of transportation and childcare, exacerbate disparities, particularly for vulnerable populations. Additionally, practical challenges like difficulty in contacting local screening services to book or reschedule appointments, and inability to take time off work or from caring responsibilities, further impede access to screening services. Addressing these structural issues is crucial for improving healthcare access and reducing disparities in breast cancer outcomes.

The Core20Plus5 initiative targets breast cancer prevention and care, focusing on underserved communities through culturally sensitive screening programmes and improved healthcare access (NHS England, 2022a). Addressing these barriers is critical to improving breast cancer outcomes and ensuring equitable healthcare access for all women.

Discussion

Access to public healthcare for ethnic minority women highlights significant unmet needs in breast cancer care. While national databases provide extensive data on tumour biology and treatment, targeted research into health-seeking behaviours and the quality of care within these communities remains critically lacking (Gathani et al, 2021b). Progress in breast cancer outcomes must be equitable, ensuring all demographic groups receive the highest standard of care.

Addressing disparities in breast cancer screening and treatment requires a comprehensive approach that considers the socioeconomic, cultural, and systemic factors affecting access to care. Charities such as Black Women Rising play a crucial role in promoting awareness, encouraging self-examination, and breaking taboos that hinder women from seeking timely medical help. These initiatives are instrumental in increasing early detection rates, particularly by urging women to attend regular checkups and respond to mammogram invitations.

The lack of sufficient research on breast cancer among minority ethnic women in the UK is concerning. Data shows that Black women of Caribbean and African descent are up to twice as likely as their White British counterparts to receive late-stage cancer diagnoses at younger ages (Limb, 2023). Women from South Asian backgrounds also experience poorer outcomes due to limited awareness of early screening.

The Yunzi et al (2022) study confirmed that many minority ethnic women face barriers to breast cancer care, including fear of outcomes, lack of insurance coverage, and limited understanding of breast cancer risk. These issues may stem from traditional beliefs or a lack of education about the disease. Data from the late 1970s to the present consistently shows that late diagnoses and aggressive cancers remain more prevalent among BAME women. Given that cancers diagnosed at later stages typically have poorer treatment outcomes, these disparities further exacerbate health inequalities.

Aliu et al (2025) suggest that the Breast Cancer Research Foundation in the US is expanding research on inherited mutations in breast cancer susceptibility genes, particularly their role in increasing the risk of TNBC among high-risk Black women. The study, conducted on a diverse population of American women, identified that mutations in the BARD1, RAD51C, and RAD51D genes, though rare, occur more frequently in Black women with breast cancer and are linked to a higher risk of TNBC and ER-negative breast cancer. Given these findings, further research is needed in the UK to better understand these genetic risks and their implications for screening and early detection in BAME women.

The impact of ethnicity on cancer diagnosis is evident across multiple cancer types, including breast, ovarian, and uterine cancers in women, and prostate cancer in men. The persistence of these disparities is alarming and underscores the urgency of addressing the root causes. Ensuring progress in cancer outcomes benefits all groups equally is critical. It is disappointing that BAME women continue to face gaps in research, education, and healthcare access, leading to misconceptions about their cancer risk. The overarching goal must be to provide the highest quality of care and the best outcomes for all women, regardless of racial or ethnic background.

Conclusion

Breast cancer disparities among BAME women are multifaceted, underscoring the need for targeted interventions and policies. Significant variations in diagnosis and treatment have been highlighted among Asian subgroups in the US, where insurance disparities further complicate access to care. For instance, South East Asian women heavily rely on Medicaid, while Korean women face high uninsured rates. In the UK, while healthcare is free, misconceptions persist among some BAME women that they must pay for services, further delaying presentation and treatment. Combined with cultural barriers, this misunderstanding highlights the need for better communication and outreach. Additionally, raising awareness about the importance of discussing breast cancer and understanding family history is crucial for early detection. By ensuring equitable access to care and addressing these unique challenges, we can improve breast cancer outcomes for all women and ensure that advances in care benefit every demographic equally.

Key points Disparities in breast cancer care disproportionately affect minority women

Cultural taboos and misconceptions discourage early screening and self-examinations, leading to late diagnosis

The NHS breast screening programme has saved lives, but participation from minority ethnic women remains low

Comprehensive strategies addressing systemic barriers are essential for equitable breast cancer care

CNN —

Charmella Roark remembers the shock that stopped her in her tracks when she learned about her younger sister’s cancer diagnosis.

In 2018, Kiki Roark wrote in their family’s group text that she had been diagnosed with stage I breast cancer – the same disease that had taken their aunt’s life just a few years prior.

“I was in disbelief,” Charmella said of her sister’s diagnosis. “That’s my first best friend.”

The New Jersey sisters never would have guessed that four years later, Charmella would receive the same diagnosis.

The Roark sisters represent an ongoing trend emerging in the United States: More younger women are being diagnosed with cancer.

Cancer rates have generally declined among men in the US early this century before leveling out, yet they appear to be climbing among women – especially young women. Cancer diagnoses are shifting from older to younger adults and from men to women, according to a report released Thursday by the American Cancer Society.

Middle‐age women now have a slightly higher cancer risk than their male counterparts, and young women are nearly twice as likely to be diagnosed with the disease as young men, according to the report, published in CA: A Cancer Journal for Clinicians. It appears that breast and thyroid cancers in women are driving this increasing trend.

“Breast and thyroid cancer account for almost half of all cancer diagnoses in women younger than 50,” said Rebecca Siegel, lead author of the report and senior scientific director of surveillance research at the American Cancer Society.

‘We’re seeing some shifting’

Kiki was 37 when she was diagnosed with breast cancer in August 2018.

Sharp pain in her armpit had radiated to her breast, and she had asked three of her doctors to order a mammogram to check for cancer. But each told her that a mammogram was unnecessary at her age, she said.

“Just because I was younger, I feel like they didn’t take me seriously,” Kiki said. “But I kept pushing the issue, saying, ‘No, something’s not right.’”

It took months, Kiki said, but she eventually got a mammogram. It showed signs of cancer, and a biopsy confirmed the diagnosis.

“I was an early stage,” said Kiki, a mother of three who works from home.

For treatment, she had both breasts removed in a double mastectomy and received the hormone therapy drug tamoxifen.

Charmella stayed by her sister’s side throughout the illness. And in the years after, Charmella said, she was inspired to stay on top of her routine breast cancer screenings by getting mammograms.

In the summer of 2022, one of those mammograms revealed that Charmella, a high school teacher and mother of two, had stage I breast cancer. She was 44 at the time.

After getting her own diagnosis, Charmella immediately called Kiki.

“I was devastated,” Kiki said. “The first thing I thought: not again.”

Charmella quickly started treatment: six rounds of chemotherapy and a month of radiation.

Charmella and Kiki had found themselves among the estimated 1 in 3 women in the US who will be diagnosed with cancer at some point in their lifetime.

Men historically have had a higher overall cancer incidence than women, but in 2021, women younger than 50 in the United States had an 82% higher cancer incidence rate than their male peers, according to the new American Cancer Society report, which involved data from the National Cancer Institute, the US Centers for Disease Control and Prevention and the North American Association of Central Cancer Registries.

“We see for the first time, if you’re a woman under the age of 65, you’re now more likely to develop cancer than men in that same age group,” said Dr. William Dahut, chief scientific officer for the American Cancer Society.

“The other thing is, we’re seeing a change in – at the time of cancer diagnosis – the age of which patients develop cancer,” Dahut said.

“Age remains the number-one greatest risk factor for cancer overall, and that hasn’t changed. But we’re seeing some shifting,” he said. For men and women combined, “the only age group where we’re seeing actually an increase in cancer risk, in incidence going up, is under the age of 50.”

A call to ‘advocate for yourself’

Charmella, now 47, and Kiki, 44, are cancer-free and doing well, but they know that as Black women in the United States, they are part of a community facing significant disparities in cancer outcomes.

Charmella Roark, left, and Kiki Roark advocate for young women to prioritize their health amid a rising cancer incidence among adults under 50. Courtesy Charmella Roark

Even though Black women in the US have about a 4% lower incidence rate of breast cancer than White women, they are 41% more likely to die from the disease, previous data from the American Cancer Society showed.

The new report shows that these large disparities persist.

“You’re more likely to develop breast cancer as a White woman. You’re more likely to die of it as a Black woman, particularly when you look at the younger populations, where disparity numbers are greatest,” Dahut said.

Black people have a death rate that’s twice as high as White people’s for prostate, stomach and uterine corpus cancers, according to the report. Similarly, death rates for kidney, liver, stomach and cervical cancers among Native Americans are two to three times those seen in White people.

There are geographic differences in cancer occurrence and outcomes, too.

Across the country, the rates of people dying from cancer range from fewer than 150 deaths per 100,000 people in Utah, Hawaii and New York to more than 210 per 100,000 in West Virginia, Kentucky and Mississippi.

But the new report also offers some hopeful news.

Overall cancer survival rates are increasing, and the United States’ cancer mortality rate has continued to fall, averting nearly 4.5 million deaths from 1991 through 2022 – resulting in an overall drop of 34%, the new report said.

“Year after year, we observe a continued decline in cancer-related mortality, and that is very important,” said Dr. Mariana Chavez-MacGregor, a professor at The University of Texas MD Anderson Cancer Center in Houston, who was not involved in the new report.

This decline in cancer deaths has been largely due to reductions in people smoking cigarettes, the earlier detection of some cancer cases and advancements in treatment options, including the development of new immunotherapy medications and targeted therapies.

The Roark sisters want other women to know that it’s important to advocate for access to these medical advancements when it comes to screening and treatment. Screening mammograms are recommended for women every other year starting at age 40, unless the patient meets certain other criteria.

“I always say, advocate for yourself,” Kiki said.

“I had a breast specialist, a [gynecologist] and a family doctor tell me it was nothing,” she said. “If I would have listened to them, we don’t know where I would be right now.”

The American Cancer Society report projects that this year, there will be more than 2 million cancer diagnoses – or about 5,600 new cases each day – and more than 618,000 cancer deaths in the US, corresponding to about 1,700 lives lost per day.

What’s behind the trend?

As the cancer incidence among younger adults continues to rise, physicians are mulling over what could be behind the trend. Is it just that we have gotten better at screening and detecting cancers, or are there real-world factors putting people at risk?

“In my professional opinion, this phenomenon is multifactorial. We cannot point at one specific factor, but it’s possible that changes in fertility patterns play a role,” Chavez-MacGregor said, referring to how pregnancy and breastfeeding have been associated with a reduced risk of breast cancer later in life.

“Obesity and alcohol consumption are likely contributing factors, as is a potential lack of physical activity,” she said. “Other unknown variables may also be at play,” such as environmental risk factors.

A better understanding of the factors driving this increase can help inform ways to reduce the risk among younger adults, said Dr. Neil Iyengar, a medical oncologist at Memorial Sloan Kettering Cancer Center in New York, who was not involved in the new report.

“There is, and there needs to be, a greater shift in scientific research and the resources that are available for the scientific community to better understand how we can be more effective at preventing cancer, or at least reducing the risk of cancer,” Iyengar said.

“We certainly need to understand individual biology and how we can prevent cancer based on individual biology. But we need to expand that to understand a person’s lifestyle, their environmental risks,” he said. “The exposures and the risks of a younger person are likely very different than a traditional older person who’s at risk for cancer.”

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The rise in cancer incidence among younger ages also could have major implications for the future of cancer care, as some types of cancer in younger people may need more aggressive therapies, Iyengar said.

“We have to be prepared to support our younger men and women who are undergoing perhaps more aggressive cancer therapies while still dealing with young families and working in careers,” he said. “That ranges from practical considerations – like how we schedule chemotherapy treatments, for example, in a way that needs to be less disruptive to people’s lives and careers and families – to the types of treatments that we’re using.”