By: Katherine Watson, DO

Editor’s Note: This week, we feature a review article by Anstey et al titled, “Breastfeeding and Breast Cancer Risk Reduction: Implications for Black Mothers.” [1] Dr. Katherine Watson summarized the article while on the FACTS elective. The review ends with a call to action to address research and educational needs to increase breastfeeding among Black mothers and potentially reduce breast cancer incidence as well.

Introduction

According to the Centers for Disease Control and Prevention (CDC), breast cancer is one of the leading causes of death among women in the United States, and breast cancer mortality affects Black women disproportionately. The risk for breast cancer is determined by non-modifiable and modifiable risk factors. Reproductive risk factors for women are of particular interest. They include age of menarche, time between menarche and first pregnancy, number of pregnancies, age of menopause, exposure to hormone therapies, and lifetime of breastfeeding. Studies confirm breastfeeding is a protective measure and a modifiable risk factor to prevent some breast cancers, and this knowledge could help close the gap of breast cancer mortality for Black mothers.

“Breast cancer is one of the leading causes of death among women in the United States, and breast cancer mortality affects Black women disproportionately… Studies confirm breastfeeding is a protective measure and a modifiable risk factor to prevent some breast cancers.”

Breastfeeding May Lower Breast Cancer Risk

Dr. Erica Anstey and her colleagues address this topic in the article, “Breastfeeding and Breast Cancer Risk Reduction: Implications for Black Mothers.” [1] The authors note that Black women are more susceptible to triple-negative breast cancer and have the lowest rates of breastfeeding. According to a 2013 systematic review and meta-analysis of more than 30 studies, women who had ever breastfed were 14% less likely to develop breast cancer, and 28% less likely if they breastfed for 12 months or longer. [2] Although studies show ER negative and triple-negative breast cancer subtypes are associated with parity, longer durations of breastfeeding may be protective in reducing this risk. [1]

“According to a 2013 systematic review and meta-analysis of more than 30 studies, women who had ever breastfed were 14% less likely to develop breast cancer, and 28% less likely if they breastfed for 12 months or longer.”

Breastfeeding can protect via two mechanisms: (1) differentiated mammary cells that are present postpartum are less likely to become cancerous, and (2) the process of breastfeeding removes cells with DNA damage from breast tissue. Further research is needed to fully grasp the protective pathophysiology of breastfeeding to reduce the risk of breast cancer.

Removing Barriers to Breastfeeding

Despite the many proven benefits of breastfeeding for both mother and child, Black mothers have a much lower rate of initiation and continuation of breastfeeding for the first 6 months of a baby’s life. This could be due to a number of factors. Breastfeeding is a personal choice for all mothers. Given that Black women have a higher risk of mortality from triple-negative breast cancer, they stand to benefit the most by implementing breastfeeding to reduce that risk. According to Anstey, “if Black women breastfed at the same rate as non-Hispanic White women, the incidence of triple-negative breast cancer in the U.S. could be reduced by two thirds among parous Black women.”

Unique barriers Black women face to breastfeeding include scarce education from medical professionals during the prenatal and postpartum period, lack of community and employer support, and limited cultural acceptance within the Black community. There is also a disparity of lactation consultants as well as lactation consultants of color who can support communities of color in their unique breastfeeding needs. Other barriers include being employed in jobs with minimal maternity leave, demanding work schedules, and a lack of facilities and support for breastfeeding mothers. There may also be a lack of experience or understanding among family members of the best ways to support mothers who are breastfeeding.

“Unique barriers Black women face to breastfeeding include scarce education from medical professionals during the prenatal and postpartum period, lack of community and employer support, and limited cultural acceptance within the Black community.”

Addressing breastfeeding disparities and barriers among Black women could reduce the incidence of breast cancer. A comprehensive public health initiative is needed to implement healthcare policy changes, breastfeeding education programs, and more comprehensive postpartum care to women of color.

Addressing Research and Educational Needs

A question that remains is how to isolate the benefits of breastfeeding to prevent breast cancer from other risk factors that can also play a role, such as parity, obesity, and anovulation. Research is still needed to better understand how frequently and for how long women need to breastfeed to reach its full protective effect, and how breastfeeding affects the susceptibility to certain subtypes of breast cancer. Additionally, there are no standard measures for breastfeeding to quantify the impact of recommendations given to Black women.

Information abounds regarding breastfeeding and its proven benefits to both mother and child. Breastfeeding expedites postpartum uterine recovery time, reduces the risk of breast and ovarian cancers, and provides a natural form of anovulation to prevent pregnancy. These are only a few of the benefits of breastfeeding for women, families, and communities.

The lactational amenorrhea method (LAM) is a well-researched natural fertility awareness-based method (FABM) of family planning. Medical professionals who are versed in FABMs could reach this patient population and educate them on the health and economic benefits of breastfeeding. By breastfeeding using LAM, women of color would be able to prevent or delay pregnancy naturally without sacrificing their sexual health. Making this information more available and accessible to women of color could not only address their breastfeeding needs but also reduce their risk of breast cancer.

Editor’s Note: Follow the links to learn more about the lactational amenorrhea method:

• The Lactational Amenorrhea Method: Effectiveness Data Combats Myths
• Working Women and the Lactational Amenorrhea Method: A Review of Research

References

[1] Anstey EH, Shoemaker ML, Barrera CM, O’Neil ME, Verma AB, Holman DM. Breastfeeding and Breast Cancer Risk Reduction: Implications for Black Mothers. Am J Prev Med. 2017;53(3S1):S40-S46. doi:10.1016/j.amepre.2017.04.024

[2] Anothaisintawee T, Wiratkapun C, Lerdsitthichai P, et al. Risk factors of breast cancer: a systematic review and meta-analysis. Asia Pac J Public Health. 2013;25(5):368-387. doi:10.1177/1010539513488795

ABOUT THE AUTHOR

Katherine Watson, DO
Katherine Watson, DO wrote this review as a fourth-year medical student at Lincoln Memorial University-DeBusk College of Osteopathic Medicine. She hopes to improve women’s health and is pursuing a career in obstetrics and gynecology. She is a mother of two from Texas, an Army officer, and worked as a registered nurse before pursuing a career in medicine.

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