In partnership with The Estée Lauder Companies Charitable Foundation, BCRF launched the Health Equity Initiative to significantly reduce breast cancer disparities and improve outcomes for Black women by advancing personalized, evidence-based care. Understanding tumor, genetic, and environmental factors that play a role in Black women’s breast cancer is key to improving the experience of Black patients, who suffer the worst breast cancer outcomes of any of the major racial and ethnic populations in the U.S. This is evidenced by some stark facts. Black women are:
• 40 percent more likely to die from their breast cancer than white women
• more likely to be diagnosed with later stage disease, in fact, twice as likely to be diagnosed with metastatic breast cancer than their white counterparts
• more likely to be diagnosed at younger ages and with aggressive breast cancer such as triple-negative breast cancer (TNBC)
BCRF has a long track record of supporting innovative research to address disparities. Thanks to BCRF-supported research, significant inroads have been made in our understanding of gene mutations and tumor biology in breast cancer as well as characteristics of aggressive forms like triple-negative breast cancers. We know that certain health conditions (comorbidities) such as obesity, diabetes, and heart disease, are more likely to affect Black women. Black women are 50 percent more likely to be obese and have a two-fold increased risk of being overweight compared with their white peers. They also have a two-fold increased risk of diabetes and are 60 percent more likely to develop or be diagnosed with diabetes after breast cancer treatment than white women.
These comorbidities not only affect breast cancer outcomes—breast cancer mortality, for example, is 30 percent higher for women who are obese—but they are also known to worsen treatment side effects. Women with diabetes, for instance, have more than twice the likelihood of painful neuropathy following chemotherapy. When women experience worse side effects, they may not finish treatment as planned, leading to poorer outcomes. Finally, because Black women have higher rates of cardiovascular disease and risk factors for cardiovascular disease, they don’t always receive the best available breast cancer treatments because of associated complications.
We also know that where a woman lives impacts the healthcare they receive: Access to affordable, quality healthcare coupled with a multitude of other environmental and social drivers of health broadly affect health outcomes. Black women are 73 percent more likely to initiate treatment more than 60 days from diagnosis; 31 percent more likely to require longer time to complete therapy; 50 percent more likely to suffer financial toxicity; and are nearly three times more likely to not take risk-reducing anticancer medicines as prescribed.
The HEI is a unique study that looks at Black women with breast cancer: BCRF has assembled key investigators across the U.S. that are examining how biology and social drivers of health intersect to impact breast cancer outcomes in Black women. They have collated information—including genetic, tumor biology, and social drivers of health elements—from over 5000 Black women with breast cancer, the largest dataset of its kind. Analysis is ongoing to develop a comprehensive picture of how these elements interact to influence breast cancer outcomes with the goal to improve the experience of Black patients and narrow the existing disparities gap.
Read more about the initial results here.
The steering committee has crafted a dynamic plan to understand how these elements intersect to impact Black women’s breast cancer risk and outcomes, which includes:
- Constructing contemporary and comprehensive social determinants of health and genomic profiles—leveraging existing datasets to determine what elements are needed to create uniformity and to fully address the project’s goals
- Compiling data on social determinants of health, treatment, and outcomes and conducting comprehensive tumor genomic sequencing
- Integrating and linking datasets; conducting analysis to determine the most relevant social, clinical, and genomic prognostic features and how they intersect
- Developing potential interventions and expanding the initiative to investigate breast cancer drivers in other populations
Health Equity Initiative Steering Committee
Chair: Lori J. Pierce, MD
University of Michigan
Christine B. Ambrosone, PhD
Roswell Park Comprehensive Cancer Center
Dawn Hershman, MD, MS
Columbia University
Co-chair: Lisa A. Carey, MD, ScM
University of North Carolina at Chapel Hill
Melissa B. Davis, PhD
Morehouse School of Medicine
Lisa Newman, MD
Weill Cornell Medical College
Subcommittee Members
Elisa Bandera, MD, PhD
Rutgers University
Scarlett Gomez, PhD, MPH
University of California, San Francisco
Julie Palmer, ScD
Boston University
Charles M. Perou, PhD
University of North Carolina at Chapel Hill
Tuya Pal, MD
Vanderbilt University Cancer Center
Neha Goel, MD
Memorial Sloan Kettering Cancer Center
Julienne E. Bower, PhD
University of California, Los Angeles
Terry Hyslop, PhD
Thomas Jefferson University
Celeste Leigh Pearce, PhD, MPH
University of Michigan
Melissa Troester, PhD, MPH
University of North Carolina at Chapel Hill
Sonya Reid, MD, MPH
Vanderbilt University Cancer Center
