The disparity in breast cancer and breastfeeding rates is black and white

Oct 31, 2019

October is the month healthcare professionals dedicate to making the rest of us aware of breast cancer and its prevention. Their advice usually emphasizes healthy living habits, regular self-examinations and mammograms and limiting hormone use. However, lesser known is how breastfeeding can reduce a woman's risk of breast cancer.

Breast cancer is the most commonly diagnosed cancer, affecting 1 in 8 women. White women get the cancer more often, but the rate for black women has increased over the last decade and cases are more deadly. Breast cancer kills about 20% of white women compared to 30% of black women.

One way to reduce the numbers is breastfeeding. Major studies have documented that women who breastfeed have a lower risk of breast cancer than women who use formula or have not had children.
 

Credit National Institutes of Health

However, breastfeeding does not come naturally or easily for some mothers, especially black mothers. A disparity has existed since the government began collecting data on breastfeeding rates. The most recent data from the Centers for Disease Control and Prevention found 85% of white mothers breastfeed, while only 69% of black mothers do the same.

Rev. Diann Holt, a member of the New York State Task Force on Maternal Mortality and Disparate Racial Outcomes, said the biggest reason found for the disparity in breast cancer and breastfeeding rates was implicit bias.

"We heard a theme that constantly went through: 'They don't respect me. I'm ignored. I can tell them I'm in pain and they don't listen. I don't get any respect until I get loud and become that angry black woman, but now they're just doing it because I'm disrupting their place of employment,'" said Holt. "There were all kinds of things that were said across the state."

To help address the disparity, Holt founded the first licensed Baby Cafe in New York State. Since it opened in Buffalo in 2013, the Durham Baby Cafe has provided free "peer-to-peer, mother-to-mother" breastfeeding support for people going through pregnancy and parenthood.

Rev. Diann Holt is founder and Executive Director of the Durham Baby Cafe, a registered nurse and DONA birth doula.
Credit Marian Hetherly / WBFO News

"I heard so much ignorance," Holt said. "You got a 15-year-old, a 35-year-old, let's say a 55-year-old - we've got like almost four generations - and I would hear things like, 'Only poor people do that (breastfeed).' Really? 'Why would she want to breastfeed and mess up her body?' And I'd go, 'That's not true, sweetheart.' Give me a reason why your daughter should not breastfeed and I can give you 10 reasons why she should."

Durham gave birth to several other Baby Cafes around Western New York that are also trying to address the disparity. One is located at Sisters of Charity Hospital.

"Which translates to having a certified lactation consultant, who is also a registered nurse," said Aimee Gomlak, vice president for Women's Services at the Catholic Health System. "So a mom can come into the Baby Cafe, she can bring her baby and without an appointment - and this is every week - come in and get free education and support, and try to troubleshoot with the mom and see if there's anything she could be doing differently and to help the mom understand more about breastfeeding overall."

Gomlak said Sisters sees people from all ages and backgrounds, but does not see as many African American mothers initiating breastfeeding as white, Hispanic or Asian moms.

"In the case of many of the African American women who were used as wet nurses several generations ago, it may have been perceived as something that was not appropriate for African American women except for white women," she said. "So there's some cultural context that can be carried over generation to generation."

She said mothers are more likely to follow what they are accustomed to seeing, but also what their closest informers advise.

Aimee Gomlak is Vice President of Women's Services for the Catholic Health System.
Credit Catholic Health System

"There is a relative shortage of African American physicians, midwives and even professional nurses, so that people may not feel comfortable taking direction from someone of a different gender than they are or a different race or background or lifestyle than they are," Gomlak said. "So there is opportunity, certainly, in the African American community for women who do breastfeed to support other women in their community to breastfeed."

"When I gave birth to my first child in 1970, there was no help for me other than my mother and my grandmother," said Holt. "So the first six months that I breastfed him was torture for me, because the latch never became correct. I couldn't figure out what I was doing wrong."

Breastfeeding is widely recommended for newborns. Even Mead Johnson, maker of the #1 recommended by pediatricians formula Enfamil, agrees "that breast milk has benefits that infant formula doesn't yet replicate."

The American Academy of Pediatrics recommends exclusive breastfeeding for about 6 months and then breastfeeding while introducing complementary foods until a child is 12 months or older. In their first 6 months, babies can breastfeed 8-12 times in a 24-hour period.

Not only is mother's milk considered the best source of nutrition for babies, but it provides long-term health benefits for mothers and infants. The Centers for Disease Control and Prevention found babies who are breastfed have a lower risk of ailments, including asthma, diabetes, infections, obesity and sudden infant death syndrome (SIDS), while mothers who breastfeed not only have a lower incidence of breast cancer, but also ovarian cancers, diabetes and high blood pressure.

Holt said the best way to get mothers to breastfeed is by allowing them to understand the importance of it.

"Knocking out all of those myths, eliminating all those negative things that have been said through the centuries about breastfeeding throughout the centuries," Holt said. "So if we can do that, we've got a better, happier, prepared mother. So when that baby's born, you will not be able to stop mom from breastfeeding."

Bags of donated milk are used by mothers who cannot or should not breastfeed.
Credit Catholic Health System

New York Milk Bank

For mothers who want to feed their infants breast milk, but cannot or should not breastfeed, there is the New York Milk Bank. Founder and Executive Director Julie Bouchet-Horwitz said the bank has distributed more than 400,000 ounces of milk since it opened in 2016.

"There is a thorough screening process involved for donors who say they have extra milk," she said. "We start preliminary screening asking them specific questions to see if we can immediately rule them out - if they're on any medicines, their lifestyle - then we go into much more depth if they pass the first screening."

She said that includes a 17-page lifestyle and history review plus medical clearance from the doctor of the mother and baby confirming both are healthy. Once that screening level is passed, the mother's blood is tested for infectious diseases by a lab.

"When that comes back negative, we can accept that person as a donor," Bouchet-Horwitz said, "and they don't get paid for this. They're donating because they do not want their extra milk to go to waste. We generally ask for 150 oz. of milk to cover our expenses, but they generally donate far more than that."

New York Milk Bank founder and Executive Director Julie Bouchet-Horwitz.
Credit New York Milk Bank

The milk is then pasteurized, lab-certified for quality and distributed to babies in need. All this is done within the standards set by New York State and the Human Milk Banking Association of North America.

"We want people to know we don't have to restrict milk just to sick babies and preemies," she said. "We have enough for adopted babies, foster babies, mothers who've had mastectomies or cancer and can't provide milk for their babies, babies born through surrogacy, babies born in gay families."

Bouchet-Horwitz said since opening, the Milk Bank has screened about 2,500 donors and deals with about 100 donors at any one time. The bank charges $4 per ounce of milk, which covers the cost of its processing, and a prescription is needed to receive it.

She said "mother's milk is so important" that New York State law requires companies to have a space for pumping. She said mother's milk is now covered by Medicaid in New York and commercial insurance companies are coming onboard, as well.

"Eventhough milk is considered a tissue in New York, it's also a food. It's nutrition going through the digestive system," she said. So any healthy mom can donate her milk to any mother's baby.

Gomlak said the Neonatal Intensive Care Unit at Sisters, which cares for the most vulnerable babies, sees about 40-50 mothers annually who use donor milk.

The New York Milk Bank is a partner with the nationwide network of Baby Cafes, including in Western New York. Accepted donors can drop off their milk or ship it to the Milk Bank, located in Valhalla, NY. The American Academy of Pediatrics and the Food and Drug Administration recommend avoiding Internet-based milk sharing sites, as some milk samples sold online have been contaminated with a range of bacteria.

NOTE: According to the CDC, each year in the United States, about 2,200 cases of breast cancer are diagnosed in men, while about 460 men die from breast cancer.