In Houston and surrounding Harris County, older Black women face persistent cancer challenges that merit closer attention. While much national rhetoric rightly focuses on younger patients, the demographic of women aged 65 and older deserves specific focus.
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Incidence and mortality
In Texas from 2017 to 2021, the age-adjusted incidence rate of female breast cancer was approximately 121 cases per 100,000 women. Within that period, non-Hispanic Black women had a mortality rate from breast cancer that was approximately 41% higher than for non-Hispanic white women.
For the Houston area, the MD Anderson Cancer Center reports that roughly 650 Black women are diagnosed annually with breast cancer, and that their mortality rate is around 30% higher than that of white women in the same region.
Nationally, from 2010-2014, breast cancer death rates among Black women were about 41% higher than for white women (29.2 vs. 20.6 deaths per 100,000).
Age 65+ considerations
Although much of the published data is for “all ages,” the trend among women aged 50 and older indicates that mortality declines have been slower for Black women.
For example, among women aged 60-69, breast cancer death rates decreased by about 2% per year among White women but only 1% per year among Black women, according to the Centers for Disease Control and Prevention data.
A recent comprehensive cancer-survival study finds that Black cancer patients, across many cancer types and age groups, including older adults (age 71-85), continue to have lower cancer-specific survival rates than white patients, even after adjusting for age, stage, and other factors.
Contributing factors
Several analyses suggest that later stages of diagnosis and differences in receipt of recommended treatment contribute to racial disparities in outcomes. For instance, in a large U.S. cohort of women with triple-negative breast cancer, Black women had lower odds of receiving surgery and chemotherapy compared to white women. After adjustment, the hazard ratio for mortality was 1.16 for Black versus White women.
In the Houston region, a report by Susan G. Komen noted that Black women in four of five Houston‐area counties were more likely to die from breast cancer than White women, citing economic vulnerability, underinsurance, and access issues as contributing factors.
In these counties, the demographic is also more likely to be diagnosed with late-stage breast cancer than white women, and more likely to die. While free screening exists, Black women often delay screening due to restrictive work policies and fear of losing their jobs.
Implications for older Black women in Houston
In Houston, older Black women face elevated cancer mortality risks, particularly for breast cancer, that are documented in state and local data. While advances in detection and treatment have improved overall survival, the benefits are not equally distributed across racial groups and age brackets. By focusing on age 65+ Black women and aligning screening and outreach accordingly, public-health stakeholders and healthcare systems in Houston have the opportunity to reduce a clear disparity that affects the lives of many older Black women and their families.
For Black women aged 65+ in Houston, these data suggest several key points:
- Age remains a risk factor for many cancers; older age groups bear a higher incidence and worse survival across many cancer types. The survival study cited earlier shows that the 71-85 age group had the worst cancer‐specific survival across racial groups.
- Although Medicare eligibility typically begins at age 65, disparities in treatment, diagnosis timing, and screening uptake may persist in this age bracket.
- Geographic variation within the Houston region indicates that racial disparities are not uniform. Local county and ZIP‐code level studies, including for Houston, have documented higher breast cancer mortality for Black women, especially in areas of higher poverty.
When asked what drives that gap, Dr. Meha Shah, M.D., Houston’s vice president of health services for Humana, pointed first to biology and the timing of diagnosis.
“Black women have a higher risk of triple-negative breast cancer, more than any other racial or ethnic group,” Shah told the Defender. “What that means is there are various hormones that our drugs are not receptive to. Those types of cancers are more aggressive. According to the American Cancer Society, a significant portion of this is attributed to delayed diagnosis. There are so many disparities that Black woman face when it comes to their overall health and screening, including breast cancer.”
Current U.S. Preventive Services Task Force guidelines recommend mammograms every two years for women 40 to 74 and leave decisions beyond that to patient-clinician judgment.
Dr. Shah emphasized that age alone should not be the sole determinant of when to stop.
“I don’t think that there is any specific age at which anyone should stop getting mammograms. It’s highly dependent on the overall health, low longevity, and that’s why it’s so important to have that conversation with your primary care physician,” Shah said.
For Houston women 75 and older, continuing screening through Medicare, which covers annual mammograms without cost-sharing, can be lifesaving, provided access barriers are addressed.
Many older patients face logistical obstacles long before they reach a mammography unit. Transportation, coverage, and caregiving are prevalent concerns.
“The easiest things to do…is the self-breast exam,” she advised. “That is free for women to do on their own.”
