| Statistics show that African-American
women diagnosed with breast cancer are more than twice as likely to die from the disease
than white women. Some researchers have suggested that this may be due to poor access to mammography and less frequent breast cancer screenings among
many African-American women. However, a recent study conducted by William M. Butler, MD of
the South Carolina Comprehensive Cancer Center and his colleagues shows that the
characteristics of breast cancer tumors may differ among African-Americans and Caucasians,
which could help explain the lower breast cancer survival rates among African-American
women. In a retrospective study
of 384 women diagnosed with breast cancer at the South Carolina Comprehensive Cancer
Center in Columbia, South Carolina, Dr. Butler and his team investigated specific
characteristics of the tumors, such as grade and hormone receptor status, according to the
women’s ethnicity. Their findings, which were presented at the 23rd Annual
San Antonio Breast Cancer Symposium, showed that twice as many African-American women had
breast cancer tumors that were estrogen-receptor negative (contained no estrogen
receptors) and were also more likely to have high-grade tumors than white women. This was
especially true among African-American women who were diagnosed with early-stagecancers.
Both hormone receptor status and
histologic grade are important when determining the most effective course of treatment for
breast cancer. Many breast cancers contain estrogen receptors within their cells. These
types of cancers are dependent on the hormone estrogen to grow and survive. Women whose
tumors are estrogen-receptor positive may benefit from therapies such as the drug tamoxifen, which block estrogen from the cells’ estrogen
receptors, thereby "starving" the cancer cells.
In addition, determining a tumor’s
histologic grade helps physicians to know how aggressive a woman’s cancer may be. A
low-grade tumor tends to indicate a less aggressive tumor whose cells are
well-differentiated and less likely to spread (metastasize) quickly. A high-grade tumor
tends to indicate an aggressive tumor, which is likely to grow and spread quickly to other
areas of the body (such as the bone, liver, lung or brain).
Because African-Americans may be more
likely to be diagnosed with high grade, estrogen-receptor negative breast cancers, they
may require more aggressive treatment than Caucasian women with the same stage tumor,
according to Dr. Butler. Also, many African-American women may not benefit from drug
therapies such as tamoxifen, which are designed to treat estrogen sensitive breast
cancers. Tamoxifen is also the only drug approved by the U.S. Food and Drug Administration
(FDA) to help prevent breast cancer in high-risk women (such as those with a strong family
history of breast cancer, etc.). However, tamoxifen may not help prevent breast cancer in
women likely to develop non-estrogen receptors.
The results of the study re-confirm the
importance of monthly breast self-exams, physician-performed clinical breast exams and annual screening mammograms (beginning at age 40). All women,
especially African-American women, should also be aware of the potential benefits and
risks of taking hormone replacement therapy (HRT) to ease
menopausal symptoms, since some studies have shown HRT to be associated with an increased
risk of breast cancer, according to Herman Kattlove, an oncologist with the American
Cancer Society. While the benefits of taking HRT to relieve menopausal symptoms and
prevent other conditions such as osteoporosis outweigh
the small increased risk of breast cancer for many women, the decision to take HRT should
be made by taking into account each woman’s medical situation. All women should also
maintain a low-fat, well-balanced diet, which may help reduce breast cancer risk. Healthy
diets have also been shown to reduce the chances for several other conditions, including heart disease and colon cancer.
Guidelines for the early detection of
breast cancer:
- All women between 20 and 39 years of age
should practice monthly breast self-exams and have a physician performed clinical breast
exam at least every three years.
- All women 40 years of age and older
should have annual screening mammograms, practice monthly breast self-exams, and have
yearly clinical breast exams.
- Women with a family history of breast
cancer or those who test positive for the BRCA1 (breast
cancer gene 1) or BRCA2 (breast cancer gene 2)
mutations may want to talk to their physicians about beginning annual screening mammograms
earlier than age 40, as early as age 25 in some cases.
Additional Resources and References
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