Breaking Down Disparities to Improve Breast Cancer Outcomes

What you need to know and how BCRF makes an impact

Breakthroughs in early detection, treatment and care have extended lives and the quality of life for many breast cancer patients. Not everyone, however, benefits equally from these medical advances. Many factors contribute to disparities in the prevalence (all existing cases), incidence (new cases), mortality (deaths) and survivorship of breast cancer across populations. These include age, disability, education, ethnicity, gender, geographic location, income, or race¹ . Below are three distinct areas in which disparities exist among those diagnosed with breast cancer.

Breast Cancer in Black Women

In the U.S., the number of cases of breast cancer are approximately equal among white women and African American women, but black women are more likely than white women to die from their disease ². Some of this difference can be explained by access to health care and other factors related to socio-economic status, but we have also learned that there are biological differences in the types of breast cancer in black women vs. white women. For instance, black women are more likely to be diagnosed with triple negative breast cancer, an aggressive form of the disease for which no targeted therapies currently exist. Read more about the incidence of breast cancer in black women in our earlier blog.

Breast Cancer in Older Women

Women younger, or older, than the typical age of a breast cancer diagnosis (less than 40 and over 70) also experience disparities in outcome and quality of life that can be exacerbated by one or more factors listed above.  A young woman with breast cancer may be trying to build a career, start a family or find a life partner, all of which can be delayed or impacted by breast cancer surgery, treatments, and long term side effects of those treatments. An older woman may be dealing with other chronic illness or disability that could affect her choice or duration of therapy, access to clinical trials or mobility and access to regular care.

Men Living with Breast Cancer

Approximately one percent of breast cancers (about 2500 cases) occur in men³ who then find themselves in an unfamiliar world of pink and uncomfortable diagnosis of a “woman’s disease.” Breast cancers in men are often more advanced when diagnosed, because neither they nor their doctors think of breast cancer when there are unusual symptoms in the chest area. As in female breast cancer, young black men are more likely to die from breast cancer than young white men⁴.

• Due to its rarity, we know very little about male breast cancer and so breast cancer in men is typically treated as it is in women. BCRF is supporting the largest international trial in male breast cancer totaling more than $1.8 million to date through support of Drs. Fatima Cardoso and Dr. Sharon Giordano. These efforts will yield valuable information on the biology of this rare and often overlooked disease.  In fact recent reports have revealed characteristics of breast cancers in men that distinguish them from those in women, and as we learn more about male breast cancer the disparities in outcome and support for men with breast cancer will likely diminish.

How BCRF Is Making An Impact

BCRF is committed to ending all breast cancer disparities and to improve outcome and quality of life for all women and men diagnosed with breast cancer. In 2016 BCRF invested over $2 million in new projects supporting disparities research in basic biology, prevention, treatment, quality care and survivorship.

Highlights include, research to:

• Understand racial differences at the DNA and gene level and validate risk prediction tests in diverse populations. Read more about the research of Drs. Christine Ambrosone, Yoo-Jeong Han, Nikhil Wagle, and Dennis Sgroi.
• Ensure that all breast cancer patients receive appropriate and quality care by evaluating patterns of follow-up care, overuse of tests and radiographic imaging, and the cost-effectiveness of interoperative radiation therapy in women with ductal carcinoma in situ. Read more about the research of Dr. Dawn Hershman.
• Examine the role of diet, exercise, medication adherence, and body weight on breast cancer and survivorship issues in women at high risk for breast cancer, test innovative biomedical and behavioral interventions for preventing breast cancer that can be integrated into large-scale, federally funded prevention studies, and to examine late effects of treatment among cancer survivors. Read more about the research of Dr. Electra Paskett.
• Develop interventions and assessment tools to improve outcomes and quality of life in older breast cancer patients. Read more about the research of Drs. Arti Hurria and Hyman Muss.
• Evaluate decision-making regarding endocrine therapy and how this relates to issues unique to young women, including fertility concerns to inform interventions to optimize endocrine therapy adherence among young women with breast cancer. Read more about the research of Dr. Ann Partridge.
• Develop approaches to address drug price trends, improve patient access to affordable and effective treatments, and encourage innovations that address significant needs in health care for all patients. Read more about the research for Dr. Sharyl Nass.
• Increase access to screening and quality breast cancer care in low resource settings such as Africa, South America and Mexico. Read more about the research of Drs. Funmi Olopade, Lawrence Shulman, and Jeffrey Weitzel.

Sources:

^{[1] Cancer Health Disparities Fact Sheet. National Cancer Institute (https://www.cancer.gov/about-nci/organization/crchd/cancer-health-disparities-fact-sheet)}

^{[2] Breast cancer statistics, 2015: Convergence of incidence rates between black and white women, DeSantis et al. CA Cancer J Clin. 2016 Jan-Feb;66(1):31-42}

^{[3]Cancer Facts and Figures, 2017 http://www.cancer.org/research/cancerfactsstatistics/cancer-facts-and-figures-2017}

^{(http://www.cancer.org/cancer/breastcancerinmen/detailedguide/breast-cancer-in-men-key-statistics) Last updated 9/5/2016}

^{[4] Sineshaw,HM;  Freedman, RA; Ward, EM; Flanders,WD, Jemal, A. J Clin Oncol 33:2337-2344, 2015}