Breast cancer is not an equal opportunity disease. Whether looking at incidence, stage at diagnosis, treatment, outcomes, clinical trial enrollment, cancer subtype, or other measures, Black women fare worse than white women.
“The systemic racism that pervades all aspects of our health care system affects outcome disparities seen with many cancers, but the magnitude of these disparities is especially wide with regard to breast cancer in Black/African American women,” said Lisa Ann Newman, MD, MPH, FACS, chief of breast surgery, director of the Interdisciplinary Breast Program, and medical director and founder of the International Center for the Study of Breast Cancer Subtypes, Weill Cornell Medicine/New York Presbyterian Hospital Network, New York, NY.
“Breast cancer is a very high-incident malignancy among American women overall,” she said. “Breast cancer disparities have a multifactorial etiology, involving social determinants of health as well as variation in genetics and tumor biology. It is essential that we mobilize a robust, multidisciplinary force in the effort to address and eliminate breast cancer disparities.”
Dr. Newman will discuss factors that play into breast cancer disparities during the Commission on Cancer Oncology Lecture: Genetics and Genomics in the Study of Breast Cancer Disparities on Wednesday, October 27, at 1:00 pm Central Time. The lecture, established in 1988, examines major developments in oncology and focuses on the surgeon’s role in caring for cancer patients. Racial and ethnic disparities in breast and other cancers have been long documented, but the social climate and society’s willingness to engage in meaningful conversation regarding those disparities has evolved, Dr. Newman said.
The 21st century brought an explosion of advances in precision medicine that have transformed care of cancer patients. Personalized approaches to breast cancer management have allowed clinicians to deliver more effective targeted treatment. But not to all patients. There is clear evidence that Black women with breast cancer in the U.S. are more likely to present at a more advanced stage compared with white women. Black women also are less likely to receive timely and comprehensive multidisciplinary care for breast cancer. Furthermore, while the biologically aggressive and poorly understood triple negative breast cancers are twice as common in Black women compared with white women in the U.S., Black Americans are significantly underrepresented in breast cancer clinical trials.
A new willingness to talk about the impact of race on health care has underlined the limited understanding of cancer genetics and genomics in non-white populations, Dr. Newman noted.
“Our failure to accrue appropriate numbers of Black/African Americans into breast cancer clinical trials has handicapped our ability to understand race-associated differences in tumor biology,” she said. “It has also jeopardized our ability to characterize the pathogenesis of triple negative breast cancer. Genetics and genomics represent essential elements of precision medicine as well as disparities research.”
The dual impact of COVID-19 with its disproportionately devastating morbidity among Black Americans and the exponential growth of the Black Lives Matter movement following the death of George Floyd has created a unique moment in disparities research, she added. Disparities researchers as well as diverse patient populations have been advocating for a more vigorous and intentional approach to the health equity mission over many generations. Their calls for new approaches are no longer falling on ears that would rather not hear.
“Today, the oncology community is listening to those voices with heightened acuity,” Dr. Newman said. “If we can sustain this moment, we will make meaningful advances in comprehensively understanding the heterogeneity of cancer in diverse populations. We will strengthen the health care workforce by increasing its diversity. And we will ensure that all individuals have equitable access to optimal care.”
This lecture will be available to registered attendees for on-demand viewing for a full year following the Clinical Congress on the virtual meeting platform. Also, be sure to tune into Clinical Congress Daily Highlights for an interview with Dr. Newman and Frederick L. Greene, MD, FACS, for more details about the lecture.