Breast Cancer and Black Women

Despite advancements in breast cancer treatment, why are black women still dying of the disease at the same rates they were twenty years ago? Dr Sharon Giordano, of the MD Anderson Cancer Center at the University of Texas, analyzes the disparity with Farai Chideya.

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FARAI CHIDEYA, host:

This is NEWS & NOTES. I'm Farai Chideya.

This week, we turn our health spotlight to women and breast cancer. The good news is, over the last two decades, treatment has improved and more women with advanced breast cancer are living longer. The bad news is black women have not been a part of that positive trend.

This comes from the MD Anderson Cancer Center at the University of Texas. Researchers there found that black women with breast cancer aren't doing any better than they were 20 years ago.

Sharon Giordano is the senior author of the study. Dr. Giordano, thanks for coming on.

Dr. SHARON GIORDANO (Senior Researcher, MD Anderson Cancer Center): Oh, it's a pleasure to be here.

CHIDEYA: So your goal was to look at survival over time. What did you your study entail and what did you find?

Dr. GIORDANO: Yeah, we wanted to look and see whether survival on a national level had improved for patients with metastatic breast cancer. So we used data from the SEER database, and SEER is the national cancer registry data. We looked at about 15,000 women who were diagnosed between 1988 and 2003 with metastatic breast cancer and looked at their survival over time.

And what we found is that overall survival was improving. People now are living longer than they were diagnosed back in the 1980s. But what was somewhat disturbing was that the improvements and survival seemed to be limited to white women with breast cancer. And for the - for black patients with breast cancer, the survival time really hadn't changed at all.

CHIDEYA: So, on average, white women in the advanced stage of breast cancer are living up to 10 months longer than black women in the same stage, and we're talking about stage four cancer. So talk about the length of time that this difference is happening between black and white women and what exactly is stage four cancer?

Dr. GIORDANO: So I'll start with your last question. Stage four cancer is the same thing as metastatic breast cancer, which means that the cancer has spread to other organs in the body. So it's not just in the breast or the lymph nodes, but it spread to other spots like the lungs, the liver, the bones. And when breast cancer spreads to other organs, unfortunately, it's no longer curable. So patients with metastatic disease have a pretty limited life expectancy.

And on - what we found as overall, the median survival was about 18 months for women with metastatic disease. And for black women, it was only 17 months, and for white women, it increased to about 23 months overall.

But there's some research previously showing that black women do have more aggressive types of breast cancer, so we weren't all together surprised to find the difference in survival. But we were really disturbed to see was the difference is getting bigger. So if you looked at one-year survival rates back in the 1980s, there was only about three percent difference. But by the time in the early 2000, there was a nine percent difference. So to find that this disparity was getting worse over time was surprising to us.

CHIDEYA: You know, there's a huge debate over race and genetics and how much you can even define race based on genetic factors. Because so many African-Americans, for example, have some other ancestry, be it Native American…

Dr. GIORDANO: Sure.

CHIDEYA: …white, some people even have South Asian ancestry, they found. But speaking as best as you can, is there a biological difference in African-American women that may make us more prone to certain aggressive cancers?

Dr. GIORDANO: There is, I mean, there's some information from just comparing nationally women, white women with breast cancer and black women with breast cancer that shows that black women with breast cancer are more likely to have higher grade disease and - or less likely to have estrogen-receptor positive disease. And those are both signs of more aggressive cancers.

So there is some suggestion that there is - that black women do have more aggressive disease.

CHIDEYA: What about socio-economic factors, does that play a role in this?

Dr. GIORDANO: Well, I suspect that - I mean, I wouldn't expect the biology of the disease to be changing over time. So, you know, I think that finding increasing disparities is almost entirely due to access to care and to socio-economic factors.

CHIDEYA: When it comes to treatments, is there any difference? There are so many different types of treatment these days for cancers, but I know that chemotherapy, chemicals and radiation are two of the major ones. Is there a difference in a way that black and white women might be treated once they're diagnosed?

Dr. GIORDANO: We couldn't really answer that from our particular study because we don't have any information in our database about the way these women were treated. So I can't say, for our study, whether or not any difference in treatment accounted for differences in survival. Other research has looked at this in the past and really has found conflicting reports. There's some information for women with early stage breast cancer that shows that black women were less likely to get radiation therapy after a lumpectomy, which all patients should get.

But the absolute difference is only a couple of percentage points, and not a big absolute difference.

CHIDEYA: When it comes down to the personal side of it, if you're a woman who's just been diagnosed with breast cancer, what kind of questions should you be asking your doctors in order - reflecting some of the things that you, Dr. Giordano, has found?

Dr. GIORDANO: Well, I think, you would want to know - I think it's very important to be taken care of by somebody who has a lot of expertise in that particular disease or somebody who's used to treating breast cancer patients and has seen a lot of patients with breast cancer. And also to find out what the newer therapies are that may be available to you for your treatment.

CHIDEYA: When it comes to diagnosing early stage breast cancer, if you've been diagnosed with a small lump versus being diagnosed at a later stage, how would that play out in terms of what you should be asking, what should you be doing?

Dr. GIORDANO: Well, your treatment is different depending on how big your tumor is and whether or not it's spread to the lymph nodes. So, I mean, the main components of your therapy for early breast cancer are going to be surgery, radiation, chemotherapy and hormone therapy. And you have to get a lot of specific information from the doctor about the characteristics of the tumor that you may have.

CHIDEYA: So how has treatment improved over the past 20 years? You really have been talking about how African-American women don't seem to have benefited in terms of late stage breast cancer treatment over the past 20 years. But what has improved in general?

Dr. GIORDANO: There's been a real dramatic increase in the number of drugs available to treat metastatic breast cancer. If you look back in the 1970s, and in the early 1980s, there were only a handful of drugs approved by the FDA that worked against breast cancer. And over the '90s and 2000s, there's been all different kinds of new chemotherapy drugs that have been developed. There have been new hormone-blocking drugs such as aromatase inhibitors that are more effective than our old treatments. And there's been a whole new class of targeted therapies of drugs like Herceptin that have made a huge impact on survival for patients with breast cancer.

CHIDEYA: We're almost out of time but where are you going with this research? Are you going to do a follow up?

Dr. GIORDANO: Yeah, I think it will be really important to look in other data sets where we have information about socioeconomic factors, about whether or not patients have insurance or not, and about the type of treatment the patients receive to try to sort out what actually is causing these differences in survival.

CHIDEYA: Well, Dr. Giordano, thank you so much.

Dr. GIORDANO: It's my pleasure. Thank you.

CHIDEYA: We've been talking with Dr. Sharon Giordano of MD Andersons' Department of Breast Medical Oncology at the University of Texas. She directed a new study that found disparities in the survival rates of black and white breast cancer patients.

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