The experience of Black/African American and Latina breast cancer survivors in the Washington metropolitan area during the COVID-19 pandemic
Project overview
This work is the culmination of a project developed by researchers at the Georgetown University Medical Center and Lombardi Comprehensive Cancer Center, in collaboration with community partners at Nueva Vida and the Thelma D. Jones Breast Cancer Fund. We started this work in Spring 2020, in order to better understand health disparities related to the COVID-19 pandemic, especially those affecting Black/African American and Latinx/Hispanic individuals in the Washington metropolitan area (Washington, DC and parts of Maryland and Virginia) who are also affected by breast cancer. We surveyed and interviewed Black/African American and Latina breast cancer survivors in order to understand their experience during the pandemic, as well as their ability and willingness to be vaccinated against COVID-19.
Impact of COVID-19 pandemic
The COVID-19 pandemic has been devastating on a global scale. The pandemic is not over yet — our best chance to stop the spread of the virus and substantially reduce death and suffering is to vaccinate the majority of the population!
Cases over time and deaths over time using data from the New York Times, up to and including June 15, 2021, in the US as a whole and in Washington, DC. Plot display averages over 7 days:
Health disparities during the COVID-19 pandemic
African American and Latinx/Hispanic individuals have been at greater risk to contract the virus that causes COVID-19 due to a variety of factors, including increased presence as frontline or critical workers and living environments consisting of multigenerational homes or crowded building. Health disparities, including pre-existing conditions such as heart disease and diabetes, lead to an even larger chance of hospitalization or death once diagnosed.
By May 1, 2021, it is estimated that:
- approximately 1 in 313 Hispanic Americans
- approximately 1 in 414 Black Americans
- approximately 1 in 1263 White Americans between the ages of 50 and 64 died of COVID-19.
For ages 64-74, the numbers were:
- approximately 1 in 108 Hispanic Americans
- approximately 1 in 140 Black Americans
- approximately 1 in 357 White Americans
For ages 75-84, the numbers were:
- approximately 1 in 57 Hispanic Americans
- approximately 1 in 68 Black Americans
- approximately 1 in 121 White Americans
For ages 85 and over, the numbers were more similar, although still higher in Hispanic and Black individuals:
- approximately 1 in 31 Hispanic Americans
- approximately 1 in 34 Black Americans
- approximately 1 in 40 White Americans
Overall, an African American has a risk of death that is 1.9 times as high as a non-Hispanic White of the same age, and a Latinx/Hispanic individual has a risk that is 2.3 times as high.
Estimated number of deaths per 1,000 individuals within different age groups:
Ages 50-64:
Ages 65-74:
Ages 75-84:
Ages 85 and over:
Data from the CDC (page updated April 23, 2021) show how much more likely African American and Latinx/Hispanic individuals are to be diagnosed with, hospitalized with, and die from COVID-19, compared to White individuals who are not Hispanic, looking at individuals of the same age:
The study led by our team showed that a large percent of Black/African American and Latina breast cancer survivors had either lost their job, had COVID-19, and/or are an essential worker (either themselves or a family member):
Vaccination against COVID-19
- Vaccines are our best chance to protect ourselves and our loved ones and leave the pandemic behind.
- In the US, 3 vaccines are currently available: Pfizer-BioNTech, Moderna, and Johnson & Johnson. The first 2 are available as 2 doses and the third as a single dose.
- The vaccines against COVID-19 are very new, so it is natural to feel a bit apprehensive about them! While all medical treatments come with some risks, risks related to these vaccines are very low. All vaccines have been tested on tens of thousands of volunteers and over 200 million doses have been administered in the US so far. The Johnson & Johnson vaccine may lead to a rare and serious adverse event — a potentially fatal blood clot — in an estimated 7 out of 1 million women between the ages of 18 and 49 years old and less than 1 out of 1 million women 50 years or older. Women younger than 50 years old may choose to have the Pfizer-BioNTech or Moderna vaccines instead, which do not carry this risk. If you have had the Johnson & Johnson vaccine within the past 3 weeks, check out this list for concerning symptoms and alert your doctor if you have them about your recent vaccination.
- Most people who have vaccine side effects get mild symptoms that may include headache, fever, nausea, aching, and are usually resolved within 1-3 days after vaccination. Individuals generally report that these are worse after the second dose of the two-dose vaccines (Pfizer and Moderna) and thus it is sometimes recommended to take a day off after vaccination, if possible.
- Estimates from April 23, 2021 show that 90 percent of doctors have received at least one vaccine dose.
Facts to combat vaccine myths
Vaccines cannot give you COVID-19
Vaccines expose your immune system to either a small component of a virus or bacteria or a weak or dead version of it, in order for your immune system to mount a response and be prepared if and when it meets the real thing. In the US, there are 3 available vaccines, based on 2 technologies: mRNA vaccines (Pfizer-BioNTech and Moderna) and adenovirus vector vaccines (Johnson & Johnson). All 3 vaccines contain instructions for your body to produce one of the proteins in the COVID-19 virus (the spike protein), so that the immune system can recognize that it does not belong and become activated and ready to fight if it meet the actual COVID-19 virus. Thus, none of the vaccines used in the US contain the actual COVID-19 virus and thus cannot give you COVID-19. You may see side effects (details below) related to the immune system being activated, but these generally go away within a few days.
Vaccines cannot alter your DNA
In our bodies, we can think of our DNA as a cookbook of recipes, our RNA as specific recipes that must be made at a given time, and our proteins as the resulting foods. Our cells have a complicated machinery that produce RNA as needed, with certain types of RNA (mRNA) serving as “recipes” for making proteins. Our DNA however, generally stays the same over time. The 2 mRNA vaccines introduce RNA that serves as a recipe for making the COVID-19 virus’s spike protein, which then gets recognized by our immune system as foreign to our bodies, resulting in an immune response.
How mRNA COVID-19 vaccines work (from CDC)
The adenovirus viral vector vaccine instead uses a harmless virus (not the COVID-19 virus) that includes the DNA for the COVID-19 spike protein, which is read by our body into mRNA and from the mRNA, into the actual spike protein. Some are concerned that this may lead to DNA from either the COVID-19 virus or the adenovirus to people part of the DNA of the person taking the vaccine. However, the type of virus that is used to deliver this DNA - the adenovirus - cannot become part of our DNA, since it does not have the necessary instructions to do so.
How viral vector vaccines work (from CDC)
Vaccines have been thoroughly tested and not “rushed through”
One concern is that the COVID-19 vaccines have been developed so quickly that some question whether they have been “rushed through” in some way. In fact, the technologies for these vaccines have been around before the COVID-19 pandemic. Viruses related to the COVID-19 virus include SARS and MERS had been candidates for vaccination but the related epidemics ended before the vaccines were developed. However, many of the ideas used then were able to be quickly repurposed for the COVID-19 vaccines.
Vaccines have been developed by a diverse, multi-ethnic team
Read here about Dr. Kizzmekia Corbett, a Research Fellow at the National Institute of Health, who led many portions of the design of the Moderna vaccine. Get to know other individuals from underrepresented minorities who were involved in the funding, research, safety assurance, and clinical trial participation for COVID-19 vaccines and treatments here.
Dr. Corbett 
(from Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Kizzmekia_Corbett_portrait.jpg)
Studies testing the vaccines have included African Americans and Latinx/Hispanic individuals
All 3 vaccines available in the US have included diverse populations. Specifically:
- The Pfizer-BioNTech vaccine studies included 9.8% African Americans and 26.2% Hispanic or Latinx individuals.
- The Moderna vaccine studies included 9.7% African Americans and 20% Hispanic and Latinx individuals.
- The Johnson & Johnson Janssen vaccine studies included 17.2% African Americans and 45.1% Hispanic or Latino individuals.
Listen to Dr. Freeman A. Hrabowski III, President of the University of Maryland, Baltimore County and African American educational leader talk about Dr. Corbett, his participation in a COVID-19 vaccine trial, and the importance of reaching out to the Black community here.
Vaccines are free
You cannot be charged for a COVID-19 vaccine. The full cost is covered by the federal government, including the office visit. You may not be denied the vaccine if you do not have health insurance.
You do not need to be a citizen to get a COVID-19 vaccine
COVID-19 vaccines are provided to everyone living in the United States, regardless of immigration status.
Vaccination is a type of community service
Vaccines are our best chance to leave the pandemic behind us. Vaccination not only reduces risk for the individual, but also helps our entire community as well, including:
- those who are at higher risk of disease or serious illness (such as essential workers, elderly individual, those with other health conditions)
- those who cannot be vaccinated (individuals with severe allergies to a specific vaccine component)
- those in whom the vaccines do not work as well (such as individuals who are immunocompromised due to illness or medication for organ transplants or autoimmune diseases)
- those in whom vaccines have not yet been authorized (children under the age of 12). This is because data from vaccinated individuals is increasingly showing that vaccines lower not only the chance of disease, but also the chance of transmission. Experts currently believe that if 70-85% of the population is immune to the disease from either vaccination or previous infection, we will no longer see major outbreaks, but immunity from vaccination appears to be longer lasting than that from COVID-19 infection.
Special concerns for breast cancer survivors
Vaccines are safe for breast cancer patients
The only individuals in whom vaccines are not recommended are those who have a contraindication to a specific vaccine component. In general, cancer survivors may be vaccinated against COVID-19.
Vaccines may not work as well for immunocompromised individuals
Patients who are immunocompromised may not be able to mount the same immune response as individuals who are not immunocompromised. It may thus be more necessary for those patients to continue taking the masking, distancing, and ventilation precautions against COVID-19 until the pandemic is under control.
Getting a mammogram soon after a vaccine may lead to unnecessary concerns
For breast cancer survivors and other individuals undergoing breast or chest imaging (such as mammography), it is important to be aware that some lymph nodes may become inflamed days after either the first or second dose of the vaccines (axillary adenopathy). The Society for Breast Imaging thus recommends that, if possible, unless it delays care, to consider scheduling imaging exams either before the first dose of a COVID-19 vaccine or 4-6 weeks after the second dose.