Social disparities in triple-negative breast cancer incidence and severity at diagnosis in Greater Paris, France: confronting race and ethnic blindness

Triple-negative breast cancer (TNBC), an aggressive subtype with poor prognosis, is of higher frequency in African-American women and women of Sub-Saharan African origin. In France, legal constraints on obtaining health data on race, ethnicity, or nationality in cancer registries and medical records make it difficult to estimate the prevalence of TNBC according to women’s origins. These constraints result from a historical “universalist” approach to French citizenship which prohibits the routine collection of ethno-racial data. An anonymous, statistical survey we conducted from the medical records of 780 women with breast cancer followed in a university hospital in Paris showed that TNBCs were at least 3 times more common in women born in Sub-Saharan Africa than in women born in France. The former consulted at a more advanced stage of the disease than the latter. The results of an ethnographic study of African women in the Paris region with breast cancer, conducted for several years, highlighted some explanatory factors: low breast cancer awareness, perceived causes far from biomedical etiology, the weight of shame and secrecy, prior recourse to local healing, difficulties in communicating with health professionals and navigating the healthcare system. Considered a public health priority, TNBCs are an emblematic example of the limits produced by French race and ethnicity blindness in public health, epidemiology, prevention and health care.