Ongoing Disparities in Outcomes for Breast Cancer Patients

The recent decline in breast cancer mortality rates around the world is attributed to an increase in patient education, advances in breast imaging and screening and breast cancer therapy innovations. The emerging discoveries about the biology of this disease and the introduction of molecular targeted therapy (a treatment to target specific molecules to destroy cancer cells or to slow their growth) could potentially further reduce breast cancer mortality.

Despite all the advances made, early breast cancer detection, treatment and control have not equally benefitted all patient populations. Breast cancer patients who are African American suffer from a higher mortality rate compared to their white counterparts in the United States.

Breast cancer is still the second-leading cause of cancer death among African American women, with 40% more likely to die than white women in the U.S. and other world regions. The incidence of breast cancer in African American women is continuously increasing, while there is no marked decrease in mortality trends.

Another disparity is the age factor for African American women — they are more likely to get breast cancer at a younger age.

In addition, they are more likely to present at a later stage of the disease at diagnosis than white women. These factors show African Americans lag behind the progress made in breast cancer screening, diagnosis and treatment, causing these patients to continue to suffer disproportionally from this disease.

Several recent studies have focused on identifying factors that may contribute to the current disparities. Socioeconomic status, access to care and late-stage presentation have been considered as a few reasons why African American breast cancer patients experience poor outcomes. Breast cancer is often associated with aggressive cancer subtypes, such as triple-negative breast cancer, which lacks three markers associated with breast cancer: estrogen, progesterone and human epidermal growth factor receptors.

As a result, the biology of individual breast cancer cases among African American patients has been considered as one of the predisposing factors for poor outcomes.

These observations suggest a critical need for comprehensive genomic analysis of breast cancer among African Americans vs. white patients to better understand the distinct genomic profile in different ethnic groups. Another measure to increase understanding is encouraging African American breast cancer patients to enroll in clinical trials to benefit from the opportunities of new discoveries.

The National Academy of Medicine recognizes the breast cancer disparities among African Americans and recommends a multilevel approach to either eliminate or reduce disparities. This can be accomplished by removing key barriers to care.

• Develop effective programs to increase public breast health education on important topics. These topics include behavioral lifestyle changes, such as diet, exercise and reducing stress, as well as which preventive health screenings are required to catch breast cancer early.
• Establish effective follow-up measures for recommended tests following initial screenings. These may include letters, phone calls and digital communications.
• Increase equitable access to care for all patients. Access barriers may include transportation, hours of operation and finances.

The implementation of community-centered and team-based approaches to care has also shown promise in reducing local breast cancer disparities. Leveraging the advancements in breast cancer screenings and therapies to reach and educate African American women and allowing easier and more equitable access to health care will make a difference in outcomes for African American breast cancer patients.

A Persian born physician, Dr. Shahla Masood currently holds the positions of Professor and Chair of the Department of Pathology at University of Florida College of Medicine – Jacksonville and Chief of Pathology and Laboratory Medicine at UF Health Jacksonville. She is also the Director of the Cytopathology and Breast Pathology Fellowship Training Programs. In addition, Dr. Masood is the Medical Director of UF Health Breast Center, Chair of the Cancer Committee, as well as the Interim Director of Cancer Programs at UF Health Jacksonville. As an internationally recognized expert in breast cancer diagnosis and prognosis, Dr. Masood has fostered the concept of an integrated multidisciplinary approach in breast cancer care, research, and education.