BREAST CANCER IN WOMEN OF

COLOR:

IT’S COMPLICATED

DR. SUSAN LOVE RESEARCH FOUNDATION

Susan M Love, MD, MBA

Chief Visionary Officer,

Dr. Susan Love Research Foundation

DR. SUSAN LOVE RESEARCH FOUNDATION

OLAPADE 2015

WOMEN OF COLOR: THE PERFECT STORM

Differences in tumor biology and genomics

plus

Differences in patterns of care

equals

Breast cancer mortality gap

INCIDENCE AND DEATH RATESBREAST CANCER IN AFRICAN AMERICANS IS MORE DEADLY BUT

NOT IN HISPANIC WOMEN OR ASIAN/PACIFIC ISLANDERS

Death rates, however,

are higher

Incidence rates in AA women

are similar to other races and

ethnicities

ALTHOUGH THERE IS SOME IMPROVEMENT IN MORTALITY, THERE

ARE STILL LAGS OVER OTHER ETHNIC GROUPS

MORTALITY TRENDS BY RACE

SEER 1968-2008

WHY?

THE DEATH RATE IS HIGHER?

African American women are

more likely to die of breast

cancer than Caucasian women

at every age

• Why

• Less access to screening mammography

• Less access to state of the art care

• Biology

• Lifestyle

• ???

Newman JAMA Oncology

2017

WHY IS THE DEATH RATE HIGHER?

Its complicated!

SYSTEMIC AND LOCAL

IT’S THE NEIGHBORHOOD

SCREENING AND EARLY DETECTION

ACCESS TO CARE?

LOS ANGELES COUNTY

PER CENT BREAST CANCER CASES DIAGNOSED AT EARLY

STAGE

LATE DETECTION OR ACCESS TO CARE

non Hispanic whites 3,398 (72.6%)

African American 857 (64.9%)

Hispanic 2,069 (65.3%)

Asian/Pacific Islander 1,300 (69%)

Race

all races 80%

NH whites 80%

NH Blacks 87%

age 45-65 79%

age over 65 82%

no med care 47%

no insurance 50%

ACCESS TO CARE

BRCA 1/2

IS IT BE HEREDITARY ?

Northern California Breast Cancer Family Registry showed BRCA 1

mutation is 16.7% in African American Cases diagnosed under 35 and

7.2% in non Hispanic Jewish whites

• But in a study by Armstrong et al , AA women with a family

history of breast or ovarian cancer were (1/5 as often)

significantly less likely than white women to receive testing or

counseling regarding BRCA1/2 testing

Hispanic women of Mexican descent have been found to carry

hereditary mutations

• 35 mutations were identified in 3.4% including BRCA 1 and 2.

Only 5/34 had a family history

Term Latina or Hispanic Can Cover Several Ethnic/Racial Groups

LATINA GENETICS ARE COMPLICATED

COULD THERE BE AN AFRICAN MUTATION?

TRIPLE NEGATIVE BREAST CANCER IS MORE OFTEN GENETIC

Ghana

African American

GEOGRAPHICALLY

DEFINED ANCESTRY

INFLUENCES THE

RISK OF TNBC (NEWMAN 2017)

• Mammography process is broken with quality differences in the

manner in which centers provided care and reported results Ansel

et al 2009

• Delays in treatment 29.2 days AA vs 22.5 days for NHW

• African American women not receiving guideline concordant

treatment (19%-11%)

• Under treated

• Not enrolled in clinical trials

• Comorbidity such as obesity

QUALITY OF CARE

SOLUTIONS

QUALITY OF CARE

• Insurance

• Patient education and physician communication

• Patient navigation

• System change

• “Interventions aimed at health care system improvement are few, with the responsibility for

change resting with the patient rather than the care delivery system. “

• “The majority of interventions failed to involve major stakeholders, including providers,

health care institutions, its organizers and policy makers and accordingly were unlikely to

succeed in creating meaningful change. “

“successful strategies for reducing health disparities, are culturally tailored to meet

patient’s needs, employ multidisciplinary teams of care providers and target multiple

leverage points along a patients’s pathway of care. “Chin et al

ARE THERE OTHER FACTORS?

•

•

•

• Biology

• Subtype

• Age

• Hereditary

• Lifestyle

• Lactation

• Obesity

• Stress

ARE THERE OTHER FACTORS?

SUBTYPES OF BREAST CANCER

BIOLOGY: SUBTYPE

There are four molecular markers that we use to differentiate the biology of breast

cancer into three groups:

Luminal A and B (hormone positive): estrogen receptor +, progesterone receptor +

HER 2 positive: epidermal growth factor over expressing

Triple negative (basal): estrogen receptor -, progesterone receptor -, HER2 -

SUBTYPES AND AGES

AFRICAN AMERICAN WOMEN IN CALIFORNIA

GENETIC?

Triple negative (basal) breast cancer

• more likely to be hereditary (BRCA1)

• more common in AA women

• Less BRCA 1 in AA women

GENETICS ARE DIFFERENT

ARE THERE OTHER FACTORS?

•

•

•

• Biology

• Subtype

• Age

• Hereditary

• Lifestyle

• Obesity

• Stress

• Lactation

ARE THERE OTHER FACTORS?

ARE THERE FACTORS THAT INCREASE OR DECREASE

BREAST CANCER RISK

LIFESTYLE

It’s the neighborhood….

• Stress/Inflammation

• Breastfeeding

• Obesity

BREASTFEEDING BY ETHNICITY

INVOLUTING BREAST MORE CANCEROGENIC

• Women who breast feed have less

breast cancer

• AA women less likely to breast feed

• Involution biology is tumorigenic

• NSAIDS can reduce risk

MUZIK 2016

ENHANCING BREASTFEEDING AMONG AFRICAN AMERICAN WOMEN

OBESITY AND

BREAST CANCER

IT'S COMPLICATED

MORE RESEARCH

HOW WILL WE SORT THIS OUT?

We need to study all women

and men with breast cancer!

We need to study ALL stages of

breast cancer from in situ to

metastatic disease!

We need to move from

mice to people!

The only way to have the

research represent ALL of us, is

to have everybody participate!

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