Blood clots: What cancer patients need to know

Black Women Have A Higher Risk Of Death From All Types Of Breast Cancer

Black women are more likely to die of breast cancer than white women even when they have tumors that should be treatable and have good survival odds, a new study suggests.

For the new analysis, researchers examined data from 18 previously published studies that included more than 228,000 breast cancer patients with a variety of tumor types. Overall, Black women were significantly more likely to die of every type of breast cancer than white women, according to results published in the Journal of Clinical Oncology.

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Especially with the most treatable forms of breast cancer, the higher mortality rates for Black women point to a gap between what doctors know can be done for patients and the care some patients actually receive, says the senior study author, Erica Warner, ScD, MPH, an assistant investigator at Massachusetts General Hospital and an assistant professor at Harvard Medical School in Boston.

"We know that because of the legacy and ongoing effects of structural racism, Black women in the U.S. Have on average lower socioeconomic status, are more likely to be uninsured or underinsured, and receive care from lower-resourced institutions," Dr. Warner says.

"There's also the issue that when there's more we can do to intervene, to reduce risk, to find cancer early, to treat it with curative intent, there's more opportunity that some people receive those benefits and others don't, and that's where disparities are created," Warner adds.

Racial Disparities Exist for All Types of Breast Tumors Though breast cancer is often discussed as a single disease, it has multiple subtypes that differ in risk factors, treatment, and prognosis. These subtypes are defined according to whether the cancer cells carry hormone receptors for estrogen or progesterone, which can be targeted for treatment, and whether they have HER2 (human epidermal growth receptor 2), a protein associated with cancer aggressiveness that is another potential treatment target.

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The study identified a bigger racial disparity for hormone-positive tumors, with the mortality rates 34 to 50 percent higher among Black women than white women. Mortality rates were also 17 to 20 percent higher for Black women with harder-to-treat hormone-negative tumors, including so-called triple negative tumors, the study found.

"We'd hypothesized that we'd see the biggest disparities in the most treatable forms of the disease, namely the hormone receptor positive tumors," Warner says. "But we saw persistent disparities in the triple negative tumors, too."

This underscores the importance of timely treatment even for triple negative tumors that have limited targeted therapy options, Warner says. "Finding these tumors early and treating them quickly is lifesaving," Warner says.

Black Women Aren't Getting the Cancer Care They Need

The study wasn't a controlled experiment designed to prove whether or how any specific factors might directly worsen survival odds for Black women.

Even so, the results offer fresh evidence that Black women aren't getting the care they need to achieve the same survival rates as white women with the same types of breast cancer, says Katherine Reeder-Hayes, MD, a professor and the chief of breast oncology at the UNC Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina.

"For most Black women with breast cancer, the vast majority of the breakdowns that lead to disparities don't occur because the patient was unwilling to do something to cure their cancer," says Dr. Reeder-Hayes, who wasn't involved in the new study. "They occur because our health system and the other social systems around it, like our health insurance and medical education systems, failed to provide the opportunity that the patient needed to find their cancer early and get it treated most effectively."

Achievements In Fighting Breast Cancer

Virtua and long-time healthcare partner Penn Medicine opened a $45-million Proton Therapy Center in 2023. Based in Voorhees, the facility provides the most advanced form of radiation treatment, targeting cancer with pin-point precision, avoiding damage to surrounding tissue, and thereby reducing the risk of side effects.

Healthcare

By Lisa Goulian Twiste, Contributing Writer On Oct 3, 2024

Every two minutes in the United States a woman is diagnosed with breast cancer, with approximately one in eight women developing the disease at some point in her life. Incidences of breast cancer have not subsided – about 310,000 women will be diagnosed this year, a .06% increase over 2023 – but continued breakthroughs in diagnosis, treatment, and recovery are making the process easier and increasing chances of long-term survival.

Targeted breast cancer screening, more accurate tumor marking techniques, less visible incision scars, and combining mastectomies with other surgeries are some of the rising practices being embraced by New Jersey hospitals, many of which are at the forefront of advancements that make the process more comfortable and less invasive. 

 "I've been treating breast cancer patients for 30 years, and it's great to have so many improvements in the field," says M. Michele Blackwood, MD, FASC, director of breast surgery at RWJBarnabas Health and director of women's oncologic health at RWJBarnabas Health and Rutgers Cancer Institute of New Jersey. "We have a lot more options for patients than back in the 1980s and '90s. Today, it's about thinking outside the box and having the patience and resources to treat the whole person."

Diagnosis Marked by Targeted Screenings

In 1976, the American Cancer Society (ACS) began recommending mammograms as a screening method for breast cancer. While this is still the first line of defense for those 40 and older, women are becoming more proactive with care, including doing regular self-exams and learning more about breast density, breast health, genetic disposition and the importance of early detection. The goal is to catch the cancer early, which leads to better outcomes. For example, if breast cancer is caught in Stage 1, the five-year survival rate is 99%.

"What I've been seeing is more gynecologists looking at their patients' family histories and sending them to us for risk assessment," says Dr. Lori Timmerman, a breast oncologic surgeon at Virtua Health, South Jersey's largest healthcare provider. "Women who come back as having a lifetime risk of 20% or higher get additional screenings – in addition to a yearly mammogram, they get a screening MRI at the six-month mark. It's about being aware of what their risk factors are and if they need genetic testing."

Women who have a sister or cousin with a gene mutation should also be tested for that gene mutation, or if their mother had breast cancer at age 40, they should start screening at age 30 or even younger. There has also been a greater push for supplemental screenings for women with dense breasts, which is about 50% of the population.

"Choice of supplemental imaging depends on individual breast cancer risk factors," says Eleonora Teplinsky, MD, head of breast and gynecologic medical oncology at Valley-Mount Sinai Comprehensive Cancer Care. "There are increasing studies of contrast-enhanced mammography and using AI in breast cancer screening, which we will likely see more of in coming years."

Treatments Are More Thorough and Less Invasive

There have been a number of improvements in breast cancer treatment in recent years – everything from how to mark the tumor in preparation for surgery, to where the incision should go for better cosmetic effect, to combining breast surgery with other procedures to make the overall experience more positive.

"In breast cancer treatment right now, there's a major trend toward a combination of de-escalation and targeted treatment," says Deborah Capko, MD, FACS, a breast surgeon at Memorial Sloan Kettering, which now has four New Jersey locations. "With both of those, we're offering better options – and better tailored options."

Along these lines, MSK breast surgeons are using data from recent clinical trials to perform fewer surgical procedures removing the lymph nodes from the armpit – particularly in post-menopausal women – to decrease lymphedema risks. Care is coordinated by disease management teams, who decide if a patient is a good candidate for a clinical trial or may benefit from limiting the amount and duration of radiation. "We perform most breast surgeries in our Middletown location, and we have the full scale of treatment options, including breast and reconstructive surgery," Capko adds. 

According to Timmerman, lumpectomy technology has been updated from using a thin wire to guide a surgeon to the tumor on the day of surgery, to marking the breast with a metallic reflector – or Scout tag – that gives doctors a more accurate picture of where the tumor is, so they don't have to take as much tissue. This also leads to a better cosmetic effect, as the incision is hidden in the areola line or under the mammary fold so it's less noticeable. Once the tumor is out, the specimen goes on a Faxitron, which is like an x-ray machine, so doctors can do an immediate assessment of the tumor compared to the tissue around it to see if they need to take extra margins and prevent additional surgeries.

In addition, therapies after a lumpectomy are much more tumor directed, and whether or not the patient receives chemotherapy can be based on the genetics of the tumor. "After our oncologist is done with the tumor, the pathologist sends it to another lab to do a 21-gene assay on those tumor cells, and that information tells us how likely it is to spread," Timmerman says. "Based on that information, you may get a short course of chemotherapy to prevent the tumor from showing up again in 10 years. And even if you're Stage 1, you may have just caught it early, but it may be a really aggressive tumor. It's all very specific."

And for those who need radiation treatment, Virtua and long-time healthcare partner Penn Medicine opened a $45-million Proton Therapy Center in 2023, the first of its kind in South Jersey and one of about 50 across the US. Based in Voorhees, the facility provides the most advanced form of radiation treatment, Timmerman says, as proton therapy targets cancer with pin-point precision, avoiding damage to surrounding tissue, thereby reducing the risk of side effects.

Recovery, Quick Release and Follow-up

In the area of recovery, it seems to be about getting patients out of the hospital as quickly as possible – a trend brought on by COVID-19 when hospital beds were scarce and patients didn't want to be around infected people during the pandemic. Lumpectomy patients as well as many mastectomy patients go home the same day with pain control, Timmerman says, adding, "We use an injectable pain mediation when the patient is asleep – it's usually a local anesthetic, but one that lasts much longer – for three days. So, these patients come out feeling much more comfortable and using much less pain medication."

Capko says most patients, particularly those who have had reconstructive surgery, get nerve blocks and are often ready to go home two to three hours after surgery. "It's about reducing hospital stays, but more so about patient convenience and comfort," she says. "Our New Jersey patients don't have to go to Manhattan anymore. It's all done safely, and they're thrilled that this state-of-the-art care is right in their backyard."

According to Teplinsky, the medical community is also paying more attention to "cancer survivorship." Many patients experience long-term side effects beyond their active cancer treatment, including risks to their mental health, bone health, cardiovascular health, brain health, and sexual health, as well as infertility and early and premature menopause. This has led the medical community to focus on addressing these long-term side effects and supporting patients both during and beyond active cancer treatment.

"We have seen tremendous advances in breast cancer treatments in the last few years that are improving outcomes for our patients," Teplinsky adds. "We are focusing on escalating care when necessary and de-escalating care when we can. There is an increasing focus on supporting patients beyond active treatment, focusing on survivorship and their overall well-being." 

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UCF Medical Researchers Earn Grants For Innovative Approaches To Breast Cancer

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Alicja Copik (left) and Debbie Altomare (right) are seeking innovative therapies that improve the quality of life for metastatic breast cancer patients. (Photo courtesy of the College of Medicine)

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Credit: UCF College of Medicine

As Breast Cancer Awareness Month begins, two College of Medicine cancer researchers have received statewide grants to support their innovative projects to fight a disease that strikes one in eight American women.

Alicja Copik and Debbie Altomare each received $100,000 from the Florida Breast Cancer Foundation (FBCF), a group focused on supporting innovative research that will create new and better ways to diagnose, treat and perhaps cure the disease.

Annette Khaled, who leads the College of Medicine's Cancer Research Division, noted that UCF competed with older, larger programs such as the University of Miami, the Moffitt Cancer Center and the University of Florida to earn the funding. Khaled received UCF's first FBCF grant in 2012 and since then, seven College of Medicine faculty researchers have earned funding totaling almost $1 million. This is the first year two College of Medicine cancer researchers have earned the state cancer support in the same year.

"This shows we have tremendous intellectual capital in cancer research," Khaled says. "FBCF is looking for new, innovative ideas in fighting breast cancer and they are supporting UCF."

Copik focuses her research on better arming the body's natural killer (NK) cells to wipe out cancer. NK cells are the first line of defense in warding off pathogens, such as viruses. Through genetic engineering and nanoparticle technology, Copik has developed NK cells that are better at recognizing and killing cancer cells. Such therapies are much easier on patients. NK cells can do their work without the debilitating impact that comes with current cancer treatments like chemotherapy and radiation. And these energized NK cells can be donated to cancer patients from complete strangers without a risk of rejection.

The FBCF grant will help Copik refine her technologies to specifically fight breast cancer. She will also study how the most recent and still experimental treatment strategies against metastatic breast cancer may affect patients' own NK cells. Because NK cells clear any residual tumor cells in the body, it's important that new treatments don't deplete the body's natural fighters. With this knowledge, scientists can design better clinical trials and create more combination therapies that incorporate NK cells as additional cancer fighters.

Copik's NK therapies are currently in clinical trials. She is also researching whether removing one of molecular "brakes" that cancer cells use to avoid being killed — either through antibodies or genetic engineering — can enhance NK cell anti-tumor power. In initial laboratory testing, this approach has shown strong results in killing neuroblastoma cancer cell lines, the most common cancer in infants.

"We need to focus on the quality of life for metastatic breast cancer patients," she says. "We know chemo and radiation work, but they have drastic side effects. We need to harness innovation and innovative thinking to improve care."

Altomare has vast experience in cancer biology. Her focus is on the cellular pathways that can signal cancer cells to grow or help immunity cells better fight the disease. She is examining the role that inflammation plays in pancreatic cancer — one of the deadliest forms of the disease — and harnessing the body's innate immunity to create new therapeutics for ovarian cancer.

One of the challenges of breast cancer research is the heterogeneity of breast tumors — meaning one patient may have a variety of cells in their tumor that is different from other patients. That makes it difficult for researchers and physicians to determine what exact molecular alternations occurred to cause the cancer and prescribe individualized treatments.

Altomare's lab at the College of Medicine has been studying a particular growth factor called FGFR4 (fibroblast growth factor receptor 4) in breast cancer cells. Her work has discovered that while encouraging the growth of cancer cells, the growth receptor may also suppress immune cells.

She will use the FBCF funding to examine how the presence and absence of the growth factor and pathways in specific tumors impact their ability to spread and how they impact immunity. Her hope is that the discoveries will help create new metastatic breast cancer therapies.

"We're looking at ways the tumor cells can be reprogramed to better react to therapies and not be so drug resistant," she says.

The College of Medicine's Cancer Research Division, housed in the Burnett School of Biomedical Sciences, focuses its work on a variety of areas, including how patients' genes play a role in their cancer risk, what causes cancer and cancer metastasis and discovering new ways to harness the body's immune system to fight cancer.

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