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Triple-Negative Breast Cancer Deadlier for Black Women, Partially Due to Lower Surgery, Chemotherapy Rates

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Black women who are diagnosed with triple-negative breast cancer are 28% more likely to die than white women with the same diagnosis, and are also less likely to be treated with surgery and chemotherapy, according to a study.

The research was published online on May 13, 2021, by the journal JAMA Oncology. Read the abstract of “Evaluation of Racial/Ethnic Differences in Treatment and Mortality Among Women With Triple-Negative Breast Cancer.”

What is triple-negative breast cancer?
Breast cancer in Black women
About the study
What this means for you

What is triple-negative breast cancer?

Triple-negative breast cancer is:

  • estrogen-receptor-negative
  • progesterone-receptor-negative
  • HER2-negative

So, neither the hormones estrogen and progesterone nor the presence of too many HER2 receptors drive triple-negative disease growth. This means that triple-negative breast cancer doesn’t respond to hormonal therapy or therapies that target HER2 receptors.

About 10% to 12% of breast cancers — more than one out of every 10 — are triple-negative. Triple-negative breast cancer tends to be more aggressive than other types of breast cancer.

Triple-negative breast cancer usually is treated with a combination of surgery and chemotherapy, and possibly radiation therapy.

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Breast cancer in Black women

Research has shown that Black women are more likely to die from breast cancer than any other racial group. Black women:

  • are twice as likely to be diagnosed with triple-negative breast cancer compared with white women
  • are more likely to be diagnosed with later-stage disease than other women
  • have the lowest survival rates in each stage of diagnosis

Many studies have documented differences in treatment and outcomes between Black and white women diagnosed with all types of breast cancer. Compared with white women, Black women are less likely to receive treatment that follows nationally recommended guidelines.

Still, studies looking specifically at triple-negative disease have had mixed results, possibly because the people in these studies were from only one hospital or one geographic area.

In this study, the researchers looked at the differences in treatment and outcomes between Black and white women diagnosed with triple-negative breast cancer using a nationally representative sample that accounted for differences in demographics, health insurance, cancer characteristics, treatments, and neighborhoods.

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About the study

To do the study, the researchers analyzed information in the SEER databases. The SEER databases are large registries of cancer cases from sources throughout the United States maintained by the National Cancer Institute of the National Institutes of Health.

The study included 23,213 Black or white women diagnosed with stage I to stage III triple-negative breast cancer between 2010 and 2015. Of these women:

  • 5,881 were Black
  • 17,332 were white

Compared with white women, Black women were:

  • younger when diagnosed with breast cancer (56.3 years vs. 59.7 years)
  • more likely to be insured through Medicaid (20.6% vs. 8.8%)
  • more likely to live in areas with the lowest incomes (14.7% vs. 7.1%)

When looking at the characteristics of the triple-negative breast cancers, researchers found that the cancers in Black women were more aggressive than the cancers in white women. Triple-negative breast cancers in Black women were:

  • more likely to be stage III (20.3% vs. 15.2%)
  • more likely to be larger than 5 cm (14.3% vs. 9.6%)
  • more likely to have spread to the lymph nodes (39.0% vs. 31.6%)

When looking at the treatments women received for triple-negative cancers, researchers found that overall:

  • 94.7% of the women had surgery
  • 74.5% of the women had chemotherapy
  • 51.9% of the women had radiation therapy

Still, compared with white women, Black women were less likely than white women to be treated with surgery and chemotherapy:

  • Black women were 31% less likely to have surgery
  • Black women were 11% less likely to have chemotherapy

The researchers found no difference in radiation rates between the two groups.

The researchers followed half the women for more than 43 months and followed half the women for shorter periods of time.

During follow-up:

  • 987 Black women died from breast cancer (16.8%)
  • 2,289 white women died from breast cancer (13.2%)
  • 263 Black women died from other causes (4.5%)
  • 875 white women died from other causes (5.0%)

Five-year breast cancer survival rates were:

  • 76.9% in Black women
  • 82.9% in white women

The researchers took into account the various factors that may affect breast cancer survival, including age, insurance, and income levels, and found that Black women were 28% more likely to die from triple-negative breast cancer than white women.

When the researchers adjusted the results to take the breast cancer characteristics into account, Black women were still 16% more likely to die from triple-negative disease than white women.

The researchers also noted that even Black women who received chemotherapy might still die from triple-negative disease at greater rates than white women because some studies have suggested that chemotherapy may be less effective in Black women.

“This suggests there may be differences in tumor biology or tumor environment between [Black] and white patients,” senior author Ying Liu, M.D., Ph.D., assistant professor of surgery at the Washington University School of Medicine in St. Louis, said in a statement. “We need more research to understand if any differences exist between these tumors in their molecular biology or in their immune landscape, for example, so we can try to address them with different targeted therapies.

“There are a lot of factors beyond tumor biology that are likely contributing to these disparities,” she continued. “Our study couldn’t measure many of these factors, but we know, for example, that [Black] patients are more likely to have unsatisfying communications with their doctors, experience discrimination in the health-care system, and have more difficulty with transportation to and from their appointments.”

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What this means for you

All women — no matter their age, ethnicity, economic status, or other health conditions — deserve the best breast cancer care and the best prognosis possible. Any systemic racism that affects prognosis must be eliminated.

If you’ve been diagnosed with triple-negative breast cancer, surgery and chemotherapy — and possibly radiation therapy — are the standard of care. If your doctor does not recommend these three treatments for you, especially surgery and chemotherapy, it’s a good idea to ask your doctor why.

If you’re a Black woman, you may want to bring up this study and ask your doctor if your treatment plan follows nationally recommended treatment guidelines for triple-negative breast cancer.

If you’re not satisfied with the answer, it makes sense to get a second opinion from another doctor.

Find out more about getting a second opinion.

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Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser

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