HemOnc Today, January 25, 2018

Black individuals with cancer are 25% more likely to die of their disease than white patients.

Although persisting across tumor types, this disparity is particularly evident among black women, whose population-based breast cancer mortality rate is 42% higher than white women, and among black men with prostate cancer, who are more than twice as likely to die as white men.

For decades, researchers attributed higher mortality rates to socioeconomic factors such as inadequate health insurance, fewer years of education and lower income. However, research now supports the hypothesis that tumor biologic differences among blacks could have a greater impact on response to treatment and outcomes.

“I do not dispute that socioeconomic disadvantages are always going to play a huge role in terms of access to care and, ultimately, outcomes from any health threat,” Lisa A. Newman, MD, MPH, FACS, director of the breast oncology program at Henry Ford Health System, told HemOnc Today. “But, when it comes to breast cancer, there are so many powerful clues suggesting the contribution of tumor biology linked to African ancestry that it’s bad science for us to close our eyes to it and not explore it fully.”

However, large clinical trials that recruit, retain and follow minorities for extended periods are needed to further explore this association.

“This is not straightforward, but rather a very complex issue we’re dealing with,” John D. Carpten, PhD, professor and chair of translational genomics and director of Institute of Translational Genomics at Keck School of Medicine of University of Southern California, told HemOnc Today. “We’re starting to see that it’s not one size fits all. It’s likely certain cancer disparities will be associated with socioeconomics and some will be associated with biologic differences associated with race and ancestry.

“Perhaps even more interesting, some disparities are a function of environmental stressors influenced by race that affect biology,” Carpten added. “Although we need to disentangle these factors, we also have to consider how they coalesce to drive cancer disparities.”

HemOnc Today spoke with oncologists, researchers and epidemiologists about the biologic differences that may lead to worse outcomes among black patients with breast, prostate, lung or colorectal cancers; efforts to develop precision medicine strategies to identify and treat those mutations; and disparities that exist in the treatment approaches for black patients.

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[Editor’s Note: This is page 1 of an 11-page article.]