How Healthcare Disparities Worsen Breast Cancer Outcomes for Native Women

Breast cancer deaths have dropped significantly in the U.S., but not for Native women. BCRF discusses how systemic barriers to screening, treatment, and research leave this community behind

Breast cancer outcomes have drastically improved over the past few decades, thanks to advances in awareness, early detection, and treatment. But progress hasn’t been equal for all communities. Native women—who are commonly referred to as American Indians and Alaska Natives (AIAN) in scientific literature and by the U.S. government—typically receive later-stage diagnoses, face poorer treatment options, and experience slightly higher mortality rates—despite having a lower incidence of breast cancer than white women.

Furthermore, breast cancer may place an even greater burden on this community than statistics suggest. Health databases often misclassify Native people in other racial and ethnic groups, resulting in an incomplete picture of the disease’s true impact. What is clear, however, is that Native communities face critical disparities in access to healthcare, including lower screening rates, geographic and financial barriers to treatment, and systemic inequities that make early detection more difficult.

Here, we dive into the data on how breast cancer affects Native women, and why they face worse outcomes from the disease.

How breast cancer impacts Native women

According to data from the American Cancer Society (ACS), breast cancer is less common among Native women than among white and Black women, affecting approximately 1 in 809 women in this community.

While Native women are diagnosed with breast cancer 10 percent less frequently than white women, their mortality rate is six percent higher. Unlike the overall breast cancer death rate, which has declined by 44 percent since 1989, mortality rates among Native women have remained unchanged—a disparity that reflects persistent gaps in access to early detection and treatment.

Native women have the lowest breast cancer screening rates of all racial and ethnic groups. Data from ACS show that just 31 percent of women in this community who are 40 and over received a mammogram within the last year, far below rates for other racial groups. Over the last two years, just 51 percent of Native women underwent breast cancer screening, compared to 73 percent of Black women and 68 percent of white women.

These low screening rates put Native women at greater risk of being diagnosed at a later stage, when treatment options are more limited and survival rates decline. Sixty percent of breast cancer cases in this community are caught at the localized stage (just in the breast), compared to 68 percent of cases in white individuals.

Meanwhile, 29 percent of Native women with breast cancer are diagnosed with regional-stage disease (in the breast and lymph nodes), and seven percent have distant-stage disease (spread to other organs). Hormone receptor–positive breast cancer is the most common subtype among Native women, which is the case for all other racial and ethnic groups, as well. Compared with white and Asian American/Pacific Islander women, they experience elevated rates of triple-negative breast cancer (TNBC) , an aggressive subtype with fewer treatment options and less favorable outcomes. In addition, they are less likely to receive genetic testing of tumor specimens, which means they may not be fully informed about their risk of recurrence or available treatment options, according to ACS’ CA: A Cancer Journal for Clinicians.

Beyond gaps in screening rates and early-stage diagnoses, Native women also face disparities in breast cancer treatments. A 2022 study in Annals of Surgical Oncology found that Native women with early-stage breast cancer were more likely to undergo mastectomies (surgery to remove the entire breast) rather than lumpectomies (removal of cancerous and surrounding tissues), compared to non-Hispanic white women. Lumpectomies are less invasive and don’t require reconstruction surgeries.

More specifically, 41 percent of these patients received mastectomies (compared with about 34 percent of white patients), and 59 percent received lumpectomies (compared with almost 66 percent of white patients). Those in the Northern Plains and Alaska experienced the most significant disparities, with 47 percent to 49 percent of Native women in these areas receiving mastectomies for early-stage breast cancer, compared with 33 percent to 36 percent of white women in the same regions.

Native women also have slightly higher breast cancer mortality rates (20.5 deaths per 100,000 cases) than white women (19.4 per 100,000 cases), according to ACS. Furthermore, survival rates in this community haven’t improved at the same pace as overall survival rates. Between 1999 and 2020, breast cancer mortality among Native women declined by just 0.8 percent per year—half the rate of decline seen in white women (1.6 percent annually), according to the Centers for Disease Control.

What accounts for the breast cancer disparities that Native women experience?

Limited funding for and availability of healthcare services put Native women at a higher risk of delayed breast cancer diagnoses, reduced access to treatment, and poorer outcomes. A perpetual lack of funding and staff prevents the Indian Health Service, the federal agency responsible for serving these communities, from offering sufficient resources for early detection and breast cancer treatment.

High poverty rates compound these challenges. Native people experience the highest poverty-to-population ratio of any racial or ethnic group in the U.S., according to 2023 U.S. Census Bureau data. This further limits their access to medical care, insurance, and time off work for screenings and treatment. In fact, 27 percent of Native people have no health insurance (compared with 10 percent of white individuals), and 12 percent have no regular source of medical care, according to ACS.

Certain lifestyle and health factors may also play a role in breast cancer risk and outcomes for Native women in some communities. Higher rates of smoking, heavy alcohol use, and type 2 diabetes within this ethnic group can contribute to both their risk of breast cancer and outcomes after a diagnosis. However, these risk factors are not consistent across all Native populations. For example, Native individuals in the Midwest census region have lower obesity rates than white individuals. More research is needed to assess differences in risk factors among various Native communities.

Geography also creates barriers to healthcare access for breast cancer screening and treatment. More than half of Native people live in small towns or rural communities, which often lack healthcare professionals, hospital services, and specialty care. In addition to these barriers, cultural sensitivities may cause some women to feel uncomfortable openly discussing mammography and health concerns in general. All of these factors contribute to low screening rates and reduce the likelihood of both detecting breast cancer at an early stage and pursuing follow-up diagnostics or care.

Native women who live in poverty may find it particularly difficult to travel long distances for care, due to a lack of reliable transportation, childcare, or paid time off from work. These barriers may drive some women to choose mastectomies over lumpectomy and radiation because the latter may require more return visits for care, according to researchers from the University of Arizona. Financial challenges can also make it harder to complete treatment, especially if ongoing medical expenses or lost wages force women to delay or skip necessary follow-up care.

Data limitations make it challenging to get a complete picture of the disparate impact of breast cancer among Native people. ACS notes that these communities “have the highest racial misclassification in health data of any group,” which may lead to artificially low estimates of the burden of breast cancer and other diseases. In some cases, they’re excluded from health data altogether, notes the Kaiser Family Foundation.

What’s more, Native people are not a monolithic group—the term encompasses more than 500 federally recognized Indian tribes (including 229 Alaska Native groups), whose members may have significant differences in breast cancer risks, access to screening and treatment, and outcomes.

Working toward a solution

More specific, culturally nuanced research is required to gain a better understanding of how breast cancer affects different Native subpopulations, determine key risk factors for more fatal breast cancer subtypes (such as TNBC), identify the unique barriers these communities face in screening and treatment, and _­­­advance breast cancer screening and care.

BCRF has made significant investments in research to reduce breast cancer disparities that lead to poor outcomes and higher mortality. Additionally, BCRF investigators are working on a number of projects that are particularly relevant to Native women. That includes understanding and treating TNBC, improving screening, diversifying clinical trials, and reducing treatment delays.

For resources and to learn more about breast cancer in Native women, visit the American Indian Cancer Foundation’s website here.