Dr Feldman on the Recognition of Racial Disparities in Breast Cancer

Sheldon M. Feldman, MD, chief, Division of Breast Surgery and Breast Surgical Oncology, director, Breast Cancer Services, professor, Department of Surgery, Montefiore Einstein, discusses the recognition of racial disparities in breast cancer, sharing how oncologists can mitigate treatment-related toxicities in underserved patient populations.

Addressing racial disparities in breast cancer is crucial for optimizing patient outcomes, particularly among underserved populations, Feldman begins. This is due to several factors including cancer biology, individual genetic profiles, and variations in cancer characteristics across racial subgroups, all of which significantly affect treatment efficacy and prognosis, according to Feldman. Among African American women, for example, breast cancer is often diagnosed at a younger age and frequently presents as triple-negative breast cancer, he explains. This form of breast cancer poses unique challenges, as it lacks defined treatment targets; this disease is neither estrogen receptor positive nor progesterone receptor positive, nor is it HER2 positive, making it particularly challenging to manage effectively, Feldman reports.

Acknowledging these disparities has spurred a focus on improving early detection and preventive screening among African American women, especially for those with a familial history of breast cancer, Feldman says. Screening at a younger age is increasingly recommended, and supplemental screening techniques, such as ultrasound and MRI, have proven valuable for younger women with dense breast tissue across all racial groups, he reiterates.

Moreover, there is a growing awareness of the heightened susceptibility of African American women to treatment-related toxicities, Feldman continues. Chemotherapy-induced neuropathy, particularly from taxane-based treatments, has shown a greater prevalence in this population, he emphasizes. Common taxanes include paclitaxel and docetaxel; however, recent research indicates that docetaxel may pose a slightly lower neuropathy risk for African American patients compared with other taxanes, he adds, stating that studies exploring modified chemotherapy dosing schedules have shown promise in mitigating neuropathy risk. This development is significant, given the severe effect of neuropathy on quality of life, he expands. Ongoing research is also revealing genetic markers linked to neuropathy risk, offering potential avenues for targeted preventive strategies, he says. Advances from anti-HER2 therapies hint at future innovations in reducing neuropathy risk in high-risk subgroups, bringing hope for better-tailored interventions that could prevent this debilitating adverse effect, Feldman concludes.