treatment, but I think also related to those…I think… institutional and structural racism also play into these outcomes because they create barriers for women…for Black women…getting to highquality healthcare and being able to follow through with their treatment, or accessing screening. So, I think they all kind of work together, unfortunately, against Black women. Whereas, I think the part of your question about White women in rural areas is probably more likely due to access…maybe putting off screening…or not going to as high-quality places to detect, or treat/service, cancer could be part of it, but I think there are different issues facing those two groups. Celeste: Specifically, what can be done to decrease the death rates for those populations and others? Dr. Charlton: That is a really good question. I think in order to figure out how to decrease the death rates, we need to figure out why Black women have a higher proportion of triple-negative breast cancer… and is there something modifiable that can be done. There are numerous factors… obesity is something that has been linked to breast cancer and breast cancer outcomes, but certainly doesn’t explain all the differences between Black and White women. So, it is one area of focus helping to understand the barriers and really addressing the components of the institutional and structural racism. Maybe doctors, without even realizing, are making different recommendations, or making assumptions…but they are not checking with the patient. Here in Iowa, overall our mortality rate among Blacks is among the highest in the United States. It makes me wonder…if there isn’t a very good infrastructure here… or support here. I only know of one breast cancer support group in the state that is specifically for Black women, the Splash of Color support group in Waterloo. Maybe in places like the South, or in Detroit, or places where there is a much larger Black population…maybe there are more support groups…more navigation services…more just kind of all-around support systems to make sure that people are educated on where they need to go…what they need to have…and support that we lack here in Iowa. So, that is definitely a target…I think…for further research and activities as to what types of support structures can we build for our Black population here to make sure that they are getting the highest quality of care possible. Celeste: In conclusion, what would you like the readers to know about the importance of metastatic breast cancer awareness? Dr. Mary Charlton Dr. Charlton: Breast cancer is 15 one of those…that if you catch it early, the prognosis is so much better. One of the best ways to catch it early is to have regular mammograms… and also just to be aware of any changes in your breasts. So, I think those types of things can be really helpful in detecting breast cancer before it metastasizes to other parts of the body…but really, for Black women, knowing that they are at higher risk for triple-negative breast cancer…which can, and often does, strike people at a much younger age than other types of breast cancers. So, to always be aware…and to start getting mammograms early and often…look for any changes… and report them immediately to your healthcare provider so that if it is breast cancer…it can be detected early. Celeste: Thank you, Dr. Charlton. NOTE: In order to view a copy of Cancer in Iowa 2021 go to (https://shri.public-health.uiowa.edu/ wp-content/uploads/2021/03/2021cancer-registry-annual-reportFINAL.pdf).
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