How the International Center for the Study of Breast Cancer Subtypes Is Helping Close Disparities in the U.S. and Abroad

BCRF investigator Dr. Lisa Newman talks about investigating African ancestry, ICSBCS’ findings on triple-negative breast cancer, and more

Asked what first sparked her interest in breast cancer disparities, BCRF investigator Dr. Lisa Newman says: “I became appalled at the disparities that I was seeing in my own office waiting room.”

As one of only a few practicing female surgeons in 1990s Brooklyn, Dr. Newman saw breast cancer patients who wanted to be treated by a physician who looked like them. As her breast cancer practice grew, she began noticing stark divides in how the disease was impacting her Black and white patients.

“My Black patients tended to be younger than my white patients, and they had more frequent recurrences,” she said. “Our understanding of breast cancer disparities related to tumor biology was even more limited than it is today.”

From that experience, she went on to pursue surgical oncology fellowship training—and dedicate her career to breast cancer care. While directing the Breast Cancer Clinic at the University of Michigan Rogel Cancer Center, she had a unique opportunity to pursue research to understand what she’d observed in her practice.

Two fellow UM physicians—Drs. Tim Johnson and Senait Fisseha, who had launched maternal and fetal health training exchange programs in Ghana—introduced Dr. Newman to their collaborators to begin studying how African ancestry impacts breast cancer risk and outcomes. The International Center for the Study of Breast Cancer Subtypes (ICSBCS) was born.

For the last 20 years, ICSBCS has advanced breast cancer research and care through partnerships with physicians and surgeons in Africa (Ghana, Ethiopia, Nigeria, Uganda) and the Caribbean (Antigua). ICSBCS not only aims to improve care and outcomes for patients in lower-resourced countries but to answer several fundamental questions about the disease itself.

“Achieving breast health equity by addressing and eliminating barriers to cancer care is essential, but it is also critical that we conduct disparities research that defines the genetic components of variation in breast cancer,” she said.

Breast cancer knows no borders and affects people worldwide. An estimated 2.3 million women are diagnosed and nearly 700,000 will die from the disease each year. Although incidence and mortality rates have steadily declined in countries like the United States, the disease is on the rise in lower-resources countries as infectious diseases have become less lethal and people have adopted Western diets and other lifestyle factors associated with a higher risk of breast cancer.

And in the United States, even our incredible progress against breast cancer has not been experienced equally. Black women are about 40 percent more likely to die from breast cancer than white women, and they’re more likely to be diagnosed at younger ages and at later stages of the disease. They’re also more likely to be diagnosed with biologically aggressive forms like triple-negative breast cancer (TNBC). While social determinants of health—like income, education, and health care access—account for many of these differences, it’s clear that genetic and biological factors are at play, too.

That’s what makes ICSBCS’s focus that much more important. Dr. Newman and her team have coined the term “oncologic anthropology” for the multidisciplinary work that ICSBCS conducts, studying how genetic ancestry, population migration patterns, and social determinants of health collide to perpetuate the disparities Black women experience after a breast cancer diagnosis in the U.S. and abroad. She notes that only about two percent of people in genome-wide association studies—those that scan many people’s DNA looking for variants that might be associated with disease—have had African ancestry, leaving many questions unanswered.

“The oncology research community has the tools that allow us to quantify the genetics of ancestry,” Dr. Newman said. “The genetics of our heritage was influenced by environmental exposures faced by our ancestors and includes genetic variants that improved survival by adaptation to different climates, or food sources, or altitudes. We can detect and measure these variants in the descendent populations today, regardless of where contemporary individuals reside.”

ICSBCS has already helped advance our understanding of how breast cancer impacts Black women in unique ways. ICSBCS-based research, for example, has shown that TNBC is more prevalent in women from West Africa (Ghana), but low among East Africans (Ethiopia) and white Americans. African Americans experience rates of TNBC between those observed in Ghanaians and white Americans.

“These patterns can be explained by the forced population migration patterns of the Transatlantic Slave Trade,” Dr. Newman said. “There’s substantial shared ancestry between contemporary African Americans and Ghanaians.”

The ICSBCS team has also investigated genetic variants that can protect against malaria in people of West African descent and how these impact breast cancer risk, reporting that certain variants are associated with a higher risk of TNBC in both African American and Ghanian women.

One of the secrets of ICSBCS’ success has been its commitment to a “two-way exchange of ideas” between Dr. Newman and her colleagues in the U.S. and their partners in Africa and the Caribbean. ICSBCS team members care for breast cancer patients alongside their African colleagues on frequent visits, host observerships and educational conferences, and invest in pathology and diagnostic programs, supplies, and equipment.

Since 2022, BCRF has supported the ICSBCS’ biobank based at Weill Cornell Medicine, where Dr. Newman is chief of the Division of Breast Surgery. Her BCRF grant is supported by The Estée Lauder Companies’ Award in honor of employees, and she serves on the steering committee of BCRF’s Health Equity Initiative, made possible by The Estée Lauder Companies Charitable Foundation.

Housing thousands of primary breast tumor samples and blood and saliva specimens from patients in the U.S. and East and West Africa, this biobank represents two decades of ICSBCS’ work. BCRF is now supporting the biobank’s next expansion: Dr. Newman partnered with the American Society of Breast Surgeons to give Black breast surgeons—who tend to care for more diverse patient populations—the opportunity to add patient samples to the ICSBCS biobank.

“Expanding the ICSBCS biobank here in the United States will also support important research regarding the impact of social determinants of health on breast cancer disparities,” she said.

While ICSBCS and Dr. Newman have made TNBC in women of African ancestry a major focus, their research has broader relevance.

“Expanding this research to characterize the genetics of TNBC will be important to all women. TNBC accounts for a disproportionately high rate of breast cancer mortality in women around the world, and the TNBC burden is especially high in young women,” she said. “More inclusive research that involves diverse patient populations is fundamental to addressing breast cancer disparities, and it is also critical in efforts to clarify the genetic root causes of cancer.”