Marc Hurlbert, executive director of the Avon Breast Cancer Crusade, said individual institutions need to coordinate better to make sure that women have access to high-quality breast-health care.

“We think most women want to do the right thing. It’s getting access to it,” Hurlbert said. “And institutions are doing their best to provide quality care, but no one can solve the problem on our own.”

Women in the Washington region who have no insurance and can’t pay for medical care can get free mammograms at the Capital Breast Care Center, which was started by Georgetown’s Lombardi Comprehensive Cancer Center in 2004 with a grant from Avon because of concern about the District’s high mortality rate.

Beth Beck, director of the center, near the Eastern Market Metro station on Pennsylvania Avenue SE, said that the center does about 2,000 mammograms each year and that 10 to 15 percent of the patients have abnormal findings, twice the national average. Almost all of the patients are African Americans or Latinas.

The center visits community health clinics, homeless shelters, and other neighborhood social and services organizations to encourage women to come in for mammograms. They have a van service for women who don’t have transportation. Women who receive a diagnosis of breast cancer are enrolled in Medicaid to cover the cost of their treatment.

Karen Crawford, who lives in the District, had not had a mammogram in more than 10 years, so when the center gave a presentation at her church, a cousin encouraged her to sign up.

Although she is employed, Crawford, 63, said she hasn’t had health insurance since her divorce 13 years ago.

Her mammogram last month turned up a shadow, and, after additional tests, she is awaiting a biopsy. She said she is “hoping for the best.”

‘It was surreal’

Most types of breast cancer are diagnosed based on the presence of cells that have receptors for estrogen, progesterone or a protein that promotes cell growth. None of these receptors are present in triple-negative breast cancer, meaning it can’t be treated with hormones or other drugs that target those specific types of breast cancer. Doctors and researchers do not know why black women are twice as likely as other women to get a diagnosis of triple-negative breast cancer.

The day after her doctor told her she had triple-negative breast cancer, Tiffany Mathis started thinking about arranging her funeral. Later that day, she called a friend who was a lawyer and told her she wanted her to help draw up a will.

Nothing suspicious had shown up on Mathis’s mammogram in January 2011, but six months later, during a self-examination, she found an unusual lump. She didn’t panic because the texture of her breasts is normally lumpy, but she decided to check it out. Her doctor determined that it was a malignant tumor and, after more tests, that she had triple-negative breast cancer.

“It was surreal,” Mathis recalls. “For three days, I was literally trying to plan a funeral.” Her husband and daughter, who researched the disease and told Mathis that most women survive breast cancer, helped her focus instead on a battle plan.

Mathis, 43, whose cancer was discovered in Stage 1, had a lumpectomy last fall. She is undergoing chemotherapy. There is still “a tiny piece of cancer in me,” she said, and doctors believe it can be eliminated with radiation. Her medical team has told her that her prognosis is good.

Lisa A. Newman, a surgical oncologist and professor of surgery at the University of Michigan, is studying whether the higher incidence of triple-negative breast cancer in black women is genetic.

Working closely with a clinic in Ghana, Newman has seen a higher incidence of triple-negative breast cancer, as well as estrogen-receptor-negative cancer, which also shows up more in black women in the United States.

“It’s been remarkable to see that the pattern of breast cancer in this part of Africa really does support our theory that African ancestry in and of itself may be putting us at risk for certain patterns of the disease,” said Newman, who also is director of the Breast Care Clinic at the University of Michigan.

Triple-negative breast cancer is treatable, and early detection is even more important because of its aggressiveness.

After Mathis shared her diagnosis with her circle of girlfriends, one of them confided that she had never had a mammogram. “She’s older than I am and had never had one. So she got one.”

Mathis said it is vitally important that women take ownership of their bodies and their health. Remember, she says, that she discovered the cancerous lump that the mammogram missed. “Knowing yourself and taking charge of your own health is so very important, especially for black women.”

Mathis, who lives in Owings Mills and works for a health-care firm, tapped into the Baltimore chapter of the Sisters Network, which she said has been “a lifesaver and a resource.”

“I feel good,” she said. “It is scary. It’s no joke. I’m not going to downplay it.” But, she added, laughter lightening her voice, it has helped that her husband has “accepted my bald head. So I’m good now.”