Doctors can’t totally explain why Black women are disproportionately affected by some health conditions and not others. “It’s a complex issue,” says Dr. Tiffany Woodus, MD, an obstetrics and gynecology specialist in Dallas, Texas. She says systematic racism could be the primary factor, as a Black woman’s socioeconomic status isn’t the issue. “A highly educated, accomplished professional Black woman is still at increased risk for some of the adverse outcomes,” she says of diseases such as breast and cervical cancer. “It has to do more with the emotional toll and physical manifestations of dealing with implicit and explicit biases," she says, and how that may accelerate and impact the body. For example, the markers of biological aging are more accelerated in Black women as compared to white women.
“Race is so prevalent in American society that we forget race is cultural and social, not biological,” says Dr. Sharon Thompson, MD, an obstetrics and gynecology specialist in Phoenix, Arizona. “When we see things stratified along racial lines, it doesn't indicate biological reasons. So, we really don't know the biological reason Black women are more frequently affected.”
Even as doctors continue to figure out the whys, most agree that Black women need to know what these conditions are, regularly screen for them, and follow some preventive measures. Below, find out more about the conditions and how to move forward.
Giving birth before 37 weeks is considered premature and can cause developmental issues for babies, and may be detrimental to the growth of their brain, liver, and lungs. And, according to studies, seventy percent of babies born prematurely may not make it. The rate of premature delivery among African American women is 50 percent higher than white women (which is 9 percent).
Currently, there is no available screening that tells doctors, without a doubt, a baby will be delivered before the scheduled due date, says Dr. Thompson. “We can't do a blood check and say, ‘Oh, you're going to have your baby early.’ But what we can do is check the length of your cervix during pregnancy, which is routine, and that could give us a clue.” Mothers can also be at a higher risk if they were born prematurely, and because Black women deliver more premature babies, the cycle seems endless.
Other signs to look out for are early contractions and the frequency and changes of your vaginal discharge (you can have a lot of vaginal discharge throughout pregnancy, but a sudden increase in discharge could be odd). “When you're going through your prenatal course,” says Dr. Woodus, and “you are having regular contractions earlier than expected, or if you are having an increase in pelvic pain or pressure or even discharge, those can be symptoms that perhaps the cervix is dilating painlessly or that preterm labor is imminent.”
These tumors grow on the wall of the uterus (aka your womb). Black women are three times more likely to develop fibroids and have a higher risk of infertility (one in four) because of them than white women. They also get fibroids at a younger age (as early as in their 20s) with more alarming symptoms like anemia, pain during sex, a swollen stomach, and heavy and longer periods.
Since fibroids are not cancerous and don’t always present signs, Dr. Woodus recommends leaving them alone unless it’s causing severe discomfort. For example, you should see a doctor “if you feel like your bleeding is excessive and outside of your normal schedule, or if you have significant pain where your symptoms are debilitating, and they're interfering with activities of daily living.” Some women can’t bear the pain of fibroids and end up going to extreme lengths, such as having a hysterectomy (removing the uterus). Dr. Woodus says that’s fine, especially if you’re done having children.
Cervical cancer is caused by the human papillomavirus (HPV). So, it’s actually an infectious disease that is sexually transmitted. But Dr. Thompson says not to “think about it like other STDs because the virus behaves a little bit differently than, say, chlamydia or gonorrhea. Before we can even figure out what it is, we need to do a pap smear screening,” and that’s where the disparities among Black and white women become obvious. More Black women get cervical cancer than white women because of decreased access to pap smear testing and other associated follow-up treatments.
When a woman frequently goes in for a pap smear screening, the likelihood of getting cervical cancer will be much lower, adds Dr. Thompson, assuming the service is regularly accessible. “We know that in areas where cervical cancer screening or pap smears are not available, the rate of cervical cancer is very high. Like in some developing countries, where it’s the number one cause of cancer death in women.”
Some signs of cervical cancer to know and pay attention to are “pelvic pain, changes with your urinary system, and vaginal bleeding, especially bleeding after intercourse or bleeding in between your periods,” says Dr. Woodus. “And then there are 'constitutional symptoms.’ So, symptoms like unexplained weight loss, night sweats, and changes in appetite.”
One in nine Black women has breast cancer, compared to one in eight white women. It may not sound like a major difference in diagnosis or when compared to other diseases, but Black women are more likely to die (one in 32) from breast cancer than white women (one in 39). They are also more likely to get triple-negative breast cancer—the kind that’s often more aggressive and tends to come back even after treatment. And according to studies, social barriers (including poverty, lack of a primary care physician, inadequate health insurance, poor access to health care, and a mistrust of the health care system) to getting treatment is higher for Black women and usually makes the outcome worse.
Dr. Woodus encourages Black women 35 and older (for white women, between 40 and 45) to regularly do self-breast exams and let your primary doctor (or go to a clinic) know if something doesn’t feel or look right. “It could be skin changes like dimpling or retractions in the skin, a mass in the armpit, or even in the breast tissue itself where there’s discomfort or pain that is not explained. For example, if there was no trauma or anything that would explain the discomfort, and it persists and doesn't respond to routine interventions.” She also recommends being familiar with your body because when you go to your doctor, they only really “see you for about twenty minutes, maybe once a year. So if you are in tune with what is your norm, if you are experiencing something that is outside of that, you will be more likely and more quickly to identify that in yourself.”
What You Can Do Now
First, if you’re at a higher risk for any of these conditions (i.e., does it run in your family?), be sure to do frequent screenings and speak to a doctor about your concerns sooner than later. And ask about preventive steps you can begin taking today. Though prevention cannot entirely free you from getting any disease, Dr. Woodus and Dr. Thompson agree that including smart and easy changes to your daily lifestyle can impact your overall health grade.
What are some recommendations, you ask? Do at least 30 minutes a day of cardiovascular exercise most days of the week, drink half your weight in ounces of water (so, if you weigh 160, drink at least 80 ounces) a day, and “make sure that you’re paying attention to your diet. We need to transition ourselves to a more green-based diet and one that is less dependent on things like red meats, processed foods, and saturated fats,” says Dr. Woodus. “We need to also pay more attention to vitamin supplementation. Some of these conditions, like fibroids, have been linked to a deficiency in vitamin D.” Black women “are already at risk for vitamin D deficiency because vitamin D is made not only in the gut but also through exposure to sunlight. And because of our darker skin, the melanin in our skin makes that process less efficient."