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

Abstract 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. Competing Interest Statement The authors have declared no competing interest. Funding Statement The ethnographic results presented here are a part of a larger, 7-year research project on The Influence of Sociality in Cancer Decision Making, funded by the National Science Foundation Grant 1354336. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee of Washington University in Saint Louis gave ethical approval for this work (IRB no. 202403075, 18 April 2014). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Minor presentation corrections; information on qualitative methods; sensitivity analyses on quantitative results; addition of 2 annexes (supplementary information). Data Availability Minimal dataset that can be publicly accessed in Zenodo depository.