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ASCO 2021: BCRF Investigators Highlight Work on Racial Disparities in Breast Cancer
Improving health equity and outcomes, particularly for Black women, was a central theme of this year’s meeting
The 57th annual meeting of the American Society of Clinical Oncology (ASCO), held virtually in early June, reflected this moment in societal history with an emphasis on health equity and cancer disparities.
The meeting marked the culmination of Dr. Lori Pierce’s year as ASCO president. Dr. Pierce, a BCRF investigator since 2003 and Scientific Advisory Board member, chose a timely theme for her tenure as president: “Equity: Every Patient. Every Day. Everywhere.”
In her presidential address, Dr. Pierce highlighted the progress ASCO has made toward achieving equity in cancer through initiatives to increase diversity in clinical trials and educate physicians on how social determinants of health (where one grows up, works, and lives) and key modifiable risk factors (including smoking, obesity and alcohol use) impact patient experiences and outcomes.
In spite of this progress, Dr. Pierce emphasized that systemic racism and other societal issues continue to influence access to quality care.
“We are at a pivotal time in the history of our society and the social history of the world,” she said. “We must capitalize on the momentum and hold ourselves accountable. In other words, it is our time, and it is our responsibility.”
As health equity and cancer disparities were themes of Dr. Pierce’s agenda as ASCO president, they were reflected throughout the meeting.
The BCRF-sponsored Dr. Bernard Fisher Annual Clinical Science Symposium featured presentations from studies that explored some of the biological and societal aspects underlying disparities in breast cancer outcomes experienced by women of African descent. Among the scientific session’s highlights:
- While often-aggressive triple-negative breast cancer disproportionately affects Black women, two studies featured found that both ethnicity and societal factors are likely associated with worse outcomes in hormone receptor (HR)–positive (luminal) breast cancer—the most common type. One study, presented by BCRF investigator Dr. Tarah Ballinger, found that while women of African descent with severe obesity (a BMI over 40) and HR–positive breast cancer had significantly worse outcomes compared to obese women of European ancestry, the effect did not worsen with increasing ratio of African ancestry, suggesting that societal factors likely also play a role in these disparate outcomes.
- Following these results, another study co-authored by BCRF investigator Dr. Dipali Sharma found that luminal tumors in women of African ancestry were more likely to be high-risk, based on genetic analysis. Investigators identified five genes known to be altered in aggressive, basal-like breast cancers that were also altered in more aggressive HR–positive tumors of African American women, suggesting that specific gene alterations may be driving tumor aggressiveness in Black women with breast cancer regardless of tumor subtype.
In his award lecture as the 2021 recipient of the prestigious Gianni Bonadonna Breast Cancer Award BCRF investigator Dr. Joseph Sparano described the rapid pace of progress since Dr. Bonadonna’s seminal clinical trial studies established the effectiveness of chemotherapy following breast cancer surgery—a standard of care that has largely driven the 40 percent decline in breast cancer deaths of the last 30 years. Since then, the TAILORx, MINDACT, and RxPONDER clinical trials have demonstrated the utility of tumor profiling in clinical decision making and bringing precision medicine out of theory and into practice to make it possible to identify the right treatment for the right patient.
But as Dr. Sparano pointed out, we are far from achieving similar milestones in precision medicine among Black women. As cited in the presentations during the Fisher Symposium, studies are emerging that consistently point to biologic and genomic differences in Black women’s breast cancers. Not only are their cancers more aggressive, but Black women are also more likely to experience worse treatment side effects, such as neuropathy, than white women.
These studies and others presented during the meeting underscore the importance of improving the racial and ethnic diversity of cancer clinical trials; recognizing and eliminating conscious and unconscious bias at the point of cancer care; acknowledging the impact of social determinants and modifiable risk factors on cancer outcomes; and abolishing the structural racism that has allowed these conditions to exist and persist.
BCRF is committed to improving health outcomes for people of color. The Foundation’s grants portfolio includes a deep, long-standing investment in research to eliminate breast cancer disparities. Through partnerships with a number of organizations including Conquer Cancer, the ASCO Foundation, BCRF supports a number of career development awards to underrepresented minority investigators and to researchers working in breast cancer disparities—all with the goal of diversifying the entire field and ending breast cancer for everyone.
Read the rest of BCRF's coverage of the 2021 ASCO annual meeting here.