I was reading today's abstract from the Chemotherapy Advisor. The lead story focused on African-American women being less likely to survive breast cancer than other racial and ethnic groups. This mortality cannot be attributed entirely to subtype, according to a study presented at the American Association for Cancer Research's annual meeting in Washington, DC.
"The results seem to indicate that although African-American women are more likely to be diagnosed with less treatable subtypes of breast cancer compared with white women, it is not the only reason they have worse breast cancer mortality," said Candyce Kroenke, MPH, ScD, a research scientist in Oakland for Kaiser Permanente. She and colleagues examined associations between race and breast cancer survival by breast cancer subtypes (luminal A, luminal B, basal-like, HER2 enriched) in a prospective cohort of 1,688 breast cancer survivors.1
After a median followup of 6.3 years (range: 0.3-15.5 years), 499 women had died, 268 of them from breast cancer. In a finding consistent with previous research, breast cancer mortality was significantly higher in African-American women (and lower in Latinas and Asians) than in white women. The researchers found that African-American women also had a lower likelihood of developing luminal A and luminal B breast cancer subtypes and a greater likelihood of developing the less treatable basal subtype. "African Americans were more likely to have the hard-to-treat triple-negative breast cancer subtype and had a lower likelihood of having the luminal A subtype, which tends to be the most treatable subtype of breast cancer and has the best prognosis," Dr. Kroenke said.1,2
When social indicators such as quality of life, access to healthcare, and BMI were added to the context of genetics, it appeared that African-American women were still at higher risk of higher-grade tumors and poorer prognosis than their racial counterparts.3
As oncology clinicians, we need to continue to monitor the disparities in our patient populations. We also need to find community outreach strategies to engage our at-risk women to find available early detection modalities. Data has shown that beauty salons and churches can be appropriate locations for outreach, with mobile mammography playing a role in reaching those with access issues.
- Kroenke, Candyce. American Association for Cancer Research (AACR) Annual Meeting 2013, in Washington, DC.
- Pacheco JM, Gao F, Bumb C, Ellis MJ, Ma CX. Racial differences in outcomes of triple-negative breast cancer. Breast Cancer Res Treat. 2013 Feb;138(1):281-9.
- Grimes TS, Hou SI. A Breast Ain't Nothing but a Sandwich": narratives of Ella, an African American social worker breast cancer survivor. Soc Work Public Health. 2013 Jan;28(1):44-53.