Each October, when breast cancer awareness month comes around, I find myself thinking about “awareness” and what the messages need to be. Most of us know breast cancer exists, but how deep is our understanding of where we are with this disease? Do we know what is needed to make real progress and save more lives?
One of the most critical breast cancer awareness messages is about the urgent need to end breast cancer disparities.
The National Cancer Institute defines cancer health disparities as “adverse differences between certain population groups in cancer measures.” Such measures include, for example, number of new cases, number of deaths, and cancer-related health complications.
In breast cancer, the adverse differences are particularly egregious. In the United States, the rate of death from breast cancer is a striking 39 percent higher for African American women than for women of European descent.
The American Association for Cancer Research (AACR) recently published its first annual Cancer Disparities Progress Report. The report contains a wealth of information about cancer health disparities in general, and also has a lot to say about breast cancer disparities specifically.
Among the many factors that contribute to disparities in outcomes for different populations is disparities in treatment. Disparities in breast cancer treatment noted in the report include these:
- Radiation therapy decreases the risk of breast cancer recurrence for women with early stage breast cancer. Research shows that African American women are half as likely to be treated with radiation therapy as European American women. African American and Hispanic women are also more likely to experience delays in beginning radiation treatment.
- Targeted therapies are an important part of current standard-of-care treatment for women with HER2-positive breast cancer. The report notes that among women with stage III HER2-positive breast cancer, only 56 percent of African American patients received the targeted therapy trastuzumab (Herceptin) compared with 74 percent of women of European descent.
There are also disparities in the late and long-term effects of cancer treatment, the report notes. It goes on to say that these disparities are found in particular among women who have been diagnosed with breast cancer. These striking disparities for African American women compared with European American women are cited:
- A two-fold increased risk of breast cancer-related lymphedema, a swelling in the arms that can cause pain and problems in functioning.
- For women being treated with taxanes (a type of chemotherapy), a significantly higher likelihood of chemotherapy-induced peripheral neuropathy, which affects the nerves in the hands and feet and can cause numbness or pain.
- For women being treated with HER2-targeted therapies such as Herceptin, more than twice the rate of heart damage.
What can be done to address these disparities?
There’s a lot we already know. According to the report, there is increasing evidence that disparities in outcomes are much less of a problem when patients from minority ethnic groups receive access to quality clinical care. There are a variety of strategies that can help achieve this. Some of those mentioned include:
- improved use of real-time signals from electronic health records
- intensive training in overcoming implicit bias (among health care workers)
- implementation of patient navigation programs
- careful design of clinical trials to remove as much as possible restrictive eligibility requirements and any logistical or other barriers that may make it harder for members of minority populations to participate.
Fully resolving disparities–in breast cancer, in all cancers, and in health care in general–will be a complex undertaking. Some aspects of the work need more research. For example, the report includes an interesting discussion of how better understanding molecular differences in cancers across populations and ethnicities is expected to lead to better targeting treatments to the needs of individuals.
But most importantly, we already have the evidence to support many actions that will make a big difference now. Some of this work is underway in some areas. These efforts need to be expanded and broadened without delay.
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The Value of Patient Navigation for Cancer Patients
Breast Cancer: Are We Still Making Progress?
5 Cancer Research Stories Worth Following – Fall 2015
What Do Young Women and Men Need to Know About Breast Cancer?
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