Tailored breast cancer care urged for black women
NEW YORK (Reuters Health) - African-American breast cancer patients may be harder hit by the disease than whites due to the type of tumors they tend to develop, rather than socioeconomic factors alone, a new study suggests.
Based on the findings, more efforts must be made to tailor treatments to the more-aggressive tumor types that frequently occur in black women, Dr. Wendy A. Woodward told Reuters Health.
"We're coming into an era where breast cancer therapy is more and more individualized. We really need to be sure that that individualized therapy is benefiting everyone," said Woodward, of the University of Texas M. D. Anderson Cancer Center in Houston.
Worse access to health care, poverty and similar factors are frequently blamed for black women's lower rate of survival after a breast cancer diagnosis, Woodward and her colleagues note in the medical journal Cancer. On the other hand, it is possible that African-American women may have more severe disease than whites due to biological characteristics of their tumors, they add.
To investigate, the researchers looked at 2,140 women participating in two clinical trials of chemotherapy for breast cancer.
In both trials, the researchers found, black women were diagnosed with later-stage cancer, and were also more likely to have tumors that did not carry an estrogen receptor, which is usually a poor sign.
Black women's survival rates were lower than for whites and for Hispanic women. In one trial, 52% of black women survived for 10 years, compared to 62% of whites and Hispanics. In the other, 10-year survival for blacks was 40%, while it was 50% for whites and 56% for Hispanics.
The socioeconomic profile of Hispanic women living in the Houston area is similar to that of African-American women, but Hispanic women consistently fared as well as or better than blacks, Woodward and her team note.
Moreover, they add, given that all the women were in the same clinical trial, they were likely receiving virtually identical treatment. This suggests that something beyond socioeconomic factors may be influencing black women's breast cancer survival.
Woodward pointed out in an interview that the aggressive breast cancer seen in many black women is similar to the virulent disease that often strikes younger women diagnosed with breast cancer.
Known as "triple negative" disease, it involves tumors that do not carry the HER2/neu gene or receptors to estrogen or progesterone. This means that the estrogen-blocking drug tamoxifen will not help them, nor will Herceptin, which targets HER2/neu. There are currently no treatments specifically for women with triple-negative disease, Woodward said.
Large clinical trials will be necessary, Woodward added, to fully understand whether black women's tumor biology is indeed different, and if so how to treat it more effectively.
SOURCE: Cancer, December 1, 2006.
What breastcancer.org says about this article…
Tailored breast cancer care urged for black women
The study reviewed here adds to evidence that strongly suggests that breast cancers in African American women are biologically different than breast cancers in white women. This means that the genes in the cancer are different. These differences may explain why African American women are hit harder by the disease. Breast cancer diagnosis and treatment in African American women should be tailored to better address these differences.
In the past, researchers thought that the differences between white and African American women in the likelihood of surviving after a breast cancer diagnosis were because of differences in socioeconomic factors—income, access to healthcare, etc. While these factors DO affect the health of African American women with breast cancer, this study suggests that biological differences in the cancers also play a role.
The African American women in this study were already enrolled in clinical trials. Clinical trials must be carefully controlled to ensure that everyone in the trial gets the same care. So access and timeliness of care should be the same for all women in the trials. Still, despite receiving the same care as white and Hispanic women, the African American women in the trials usually had more aggressive breast cancers and poorer survival rates.
One breast cancer type that was diagnosed more frequently in African American women was what's called "triple negative" breast cancer. These breast cancers are hormone-receptor-negative (no estrogen and no progesterone receptors) and HER2-negative. Breast cancers that are hormone-receptor-negative and HER2-negative are typically more aggressive and harder to treat.
If you're an African American woman recently diagnosed or being treated for breast cancer, talk to your doctor about this study. Ask your doctor about the personality of the breast cancer and about the treatment options that are the best for YOU and your unique situation.
