World Cancer Day Highlights Ways to Address Gaps in Care for Black Patients With Breast Cancer

Dorraya El-Ashry, PhD

World Cancer Day is held every year on February 4th, prompting individuals across the globe to expand awareness within cancer care. Furthermore, the theme for World Cancer Day is ‘Close the Care Gap,’ which serves as a call for health care providers to commit to prioritizing the fight against cancer in underserved patient populations.¹

“World Cancer Day is a platform to [increase] awareness about the outcomes and effects of cancer across the globe,” Dorraya El-Ashry, PhD, explained. “One of the reasons it’s so critical to highlight the gaps in outcomes is to encourage Black patients to talk to their doctors about their personal risk, know their family history, and understand what lifestyle factors can play a role in increasing breast cancer risk.”

In an interview with OncLive, El-Ashry, chief scientific officer of the Breast Cancer Research Foundation (BCRF), discussed the importance of reducing disparities, specifically for Black women, highlighting current initiatives led by the BCRF; and addressed the interplay of social determinants of health and biological factors and their impact on disparities in breast cancer.

OncLive: World Cancer Day serves as a platform to unite efforts in the global fight against cancer. What BCRF initiatives, campaigns, or research have been impactful in raising awareness about breast cancer?

El-Ashry: The pink ribbon has become this ubiquitous symbol of breast cancer, helping to reduce and even eliminate the stigma that was associated with the disease back in the 80s and early 90s. [Since then], advancements in research have resulted in a 43% decline in deaths from breast cancer in the United States. This has been largely because of tremendous progress in earlier diagnosis, and even more so in the development of effective treatments.

A new study has just come out that looks at cancer over the past [44] years and shows a 58% decline in breast cancer deaths.2 What’s particularly interesting about the study that they did is that they went deeper and showed where the impact of earlier diagnosis through screening could be attributed to that decline in breast cancer deaths and effective therapies, as well as [in which subtypes] we’re having more success in preventing deaths from breast cancer compared with others.

One of the highlights that came out of the study is that although the decline in breast cancer deaths for patients with metastatic disease was less than that overall, there was a substantial decline in deaths for women with metastatic breast cancer. [This shows us] the progress that has been made over these years in [developing] more effective therapies, not only for women with early breast cancer but for women with metastatic breast cancer. We’re getting close to the point where we can hopefully say the word cure for what has been an incurable cancer. Even with all this tremendous progress, it has not been experienced equitably around the world, even right here in the United States.

We know that the stark reality is that African American women are 40% more likely to die from breast cancer than their White counterparts. Those disparities also extend globally. We have scientists working around the globe in 15 countries, including Kenya and Nigeria, to improve diagnoses, treatment, and outcomes for women around the world, particularly for those with little to no access to breast cancer care.

What research is BCRF doing to address specific challenges faced by Black patients with breast cancer?

One of the things we can talk about is the many ways that BCRF has been and remains committed to addressing these unacceptable disparities in breast cancer outcomes. The Estée Lauder Companies Charitable Foundation last year committed $15 million over 5 years in support of BCRF, which is the largest corporate donation in BCRF history to fund innovative research that addresses breast cancer disparities. This will further our shared goal of reducing breast cancer disparities and improving outcomes. This is done by addressing the complex questions of how multiple biological and social factors, namely social determinants of health intersect to influence breast cancer risk and poor outcomes for Black women.

Ultimately, reducing disparities requires a multi-pronged approach and BCRF researchers are working to close these gaps through science that aims to improve outcomes from multiple directions. Understanding the genetic components and biology of breast cancer in Black women, as well as other inherited susceptibility genes that can inform screening and preventive decisions are all important for Black women to know so that they can be screened for them.

We also have researchers looking for targeted treatments for triple-negative breast cancer [TNBC]. This is a particularly aggressive subtype of breast cancer, for which there have been few targeted therapies. [Over the past 5 or 6 years, researchers in the field] have been knocking down that door and discovering more targeted therapies. However, [TNBC] disproportionately impacts younger Black women. We’ve also been supporting research with our clinical trials colleagues to actively recruit and increase the recruitment of Black women in clinical trials.

Participation in clinical trials across the board is abysmally low, and the participation of Black individuals in clinical trials is even lower. [Clinical trials are] such an important way to move validated treatments into the clinical space. We have funded the Translational Breast Cancer Research Consortium, which is a clinical trials collaborative, and they have worked over the years to achieve population-level participation in clinical trials. That is a huge move forward. Being able to [conduct] clinical trials for the patients who [may] eventually get the drug and know that that the drug will work in those populations [is vital].

We have other clinical collaborators that we support that are similarly working to increase the recruitment of Black women into clinical trials. We have projects identifying how social determinants of health, such as if you live in an urban area vs a rural area, [affect outcomes]. If you live in an urban area, you might be exposed to air pollution and may be living in a food desert. [You may] not [be] able to get optimal nutrition to have the kind of healthy diet to give you a reduced risk of cancer. If you live in a rural area, you might not have access to get screened or participate in a clinical trial.

Social determinants of health form all these things, including other comorbidities such as diabetes or obesity, which are both linked to poor outcomes from breast cancer and are linked to some of these other social determinants of health as well. It forms this big circle. Studying how social determinants of health coalesce to drive poor outcomes in breast cancer [is so important] so that ultimately interventions can be established and sent out to the community to reverse them.

Are there any specific ways that health care providers can tailor their approaches to better meet these needs?

We know that research is what moves the needle forward. The goal of BCRF-funded research is to be able to come up with the knowledge and the answers that will move the needle forward. For example, we know that last year, the task force moved the screening age from 50 back to 40. [That was] the result of tremendous amounts of research, particularly showing that Black women are more vulnerable to diagnosis at earlier ages. This is often [true] with more aggressive forms of breast cancer, such as TNBC. All that research pushed the Preventive Services Task Force to lower [the recommended age of screening] to the age of 40.

A key pillar of our approach is to advance the world’s most promising research through global collaboration across institutions and disciplines. Therefore, we bring scientists together every year to cross-pollinate for ideas and information to move research forward.

Some [work being done] in Africa is bringing the infrastructure and the resources to these areas in which patients have very little resources [or knowledge] about breast cancer, being screened for breast cancer, or being able to access treatments for breast cancer. [That work has] been very successful, and those learnings are coming back to the United States where we know we have low resource areas that are suffering from very similar problems.

They might be right next door to high-resource areas, but they are not gaining [any advantages] from that. All those findings are coming back here to the United States to help with our lower resource [areas]. That [work] is [being done] to continue to move the needle forward and be able to move policy changes forward, ultimately through research.

How can breast cancer researchers actively contribute to the objectives of World Cancer Day and work collaboratively to improve outcomes?

We as researchers need to do a better job of recruiting and providing access to clinical trials for Black patients so we know that these treatments are just as effective in this population [as they are in others]. BCRF will continue its efforts at fostering collaboration among investigators across the globe in these areas both globally and in the United States. Our collaborative initiatives will bring us forward to closing this gap, as research has already moved the needle by moving back the age of screening to a younger age. We will continue to do that.

This health equity initiative is a key example of the collaboration of bringing together multiple investigators from several disciplines to coalesce around the intersection of two areas that play a role in poor outcomes: social determinants of health and the biology and the specific biology of breast cancer in Black women. We are addressing how these 2 [areas] are intersecting with each other to drive those poor outcomes so that we can continue to come up with interventions that will close this gap.

References

1. World Cancer Day: a leading international awareness day. Accessed February 2, 2024. https://www.worldcancerday.org/about-us
2. Metastatic breast cancer treatments have aided decline in deaths, Stanford Medicine-led study finds. News release. Stanford Medicine News Center. January 17, 2024. Accessed February 2, 2024. https://med.stanford.edu/news/all-news/2024/01/breast-cancer-deaths.html