If you’re a minority woman, you’re more likely to have a scarier, more-aggressive type of breast cancer and get diagnosed at a later stage, and you’re less likely to receive the recommended treatments. That’s the upsetting conclusion of new research published today in the journal Cancer Epidemiology, Biomarkers & Prevention.

Previous, smaller studies have shown that racial disparities exist in survival rates and when doctors catch the disease, but this study&,dash;which analyzed 18 U.S. population-based cancer registries with data from more than 100,000 American women—was the first to also look at what kind of breast cancer women get. “We found that there is a consistent pattern of late diagnosis and not receiving recommended treatment for some racial and ethnic groups across all breast cancer subtypes,” study author Lu Chen, MPH, a researcher at Fred Hutchinson Cancer Research Center, said in a press release.

The review of studies found that, compared to white women, black women were more likely to have the most aggressive type of breast cancer, have big tumors, and be diagnosed at stage 4. Hispanic women were also more likely than white women to be diagnosed at stage 2 or 3.

These disparities persisted even after Chen controlled for health insurance, which suggests that access to care—which is, according to the National Cancer Institute, one strong possible explanation—isn’t the only factor at play.

Chen also found that women who aren’t white or Asian were less likely to receive appropriate care across all subtypes of breast cancer. The study noted there are two expert-approved, “guideline-concordant” treatments for breast cancer: surgery plus radiation, or a total mastectomy. Black and Hispanic women with breast cancer were significantly less likely to receive either treatment option.

This is bad news on top of existing bad news, but again, scientists aren’t clear on the why. “Socioeconomic factors probably play a role, as women with less resources are less likely to seek care and follow through with recommended treatments,” Stephanie Bernik, MD, chief of surgical oncology at Lenox Hill Hospital in NYC, told U.S. News and World Report (she wasn’t involved in the study). “There needs to be more study as to how to optimize treatment for these women, as current strategies are not effective enough.”

Chen echoed the call for scientists to figure out the underlying causes behind these figures so we can help provide early detection and proper care for all women. “Given the racial and ethnic disparities, targeted, culturally appropriate interventions in breast cancer screening and care have the potential to reduce the disparities and close the existing survival gaps,” she said.