Key Points on Disparities in Cancer Care - prIME Oncology
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Key Points on Disparities in Cancer Care

Identifying & Correcting Cancer Care Disparities for Minority Populations: Importance of Non-Oncologist Participation

Breast Cancer in African Americans: Opportunities for Reducing Disparities

Based on the presentation by Lisa A. Newman, MD, MPH, FACS, FASCO, Henry Ford Health System, Detroit, Michigan

Key Points

  • African American patients have a higher risk of mortality from breast cancer and are more likely to be diagnosed with aggressive disease (eg, triple-negative breast cancer)
  • Earlier breast cancer screening mammography can detect triple-negative breast cancers and improve patient outcomes

Breast cancer survival rates continue to improve due to advances in screening and novel imaging, earlier diagnosis, better surgical techniques, more effective and well-tolerated chemotherapy regimens, and the use of targeted therapies. Unfortunately, African American women have benefited less from most of these advances compared to white women. In fact, the gap in breast cancer mortality between African Americans and white Americans has widened to 42%, emphasizing the need to address existing racial disparities.1

“I think that it is very important for all of us to continue advocating strongly in favor of screening mammography for all of our patients but especially for African American women beginning at age 40.”
– L. Newman

Socioeconomic differences are important factors in the racial disparity associated with breast cancer, contributing to delayed diagnosis and advanced disease stage distribution.2 However, socioeconomic status (SES) is not the sole determinate of racial disparity in breast cancer; tumor biology, genetics, lifestyle, and environmental factors all play a role. Retrospective studies suggest that even when SES is either accounted for statistically or equalized in clinical trials, breast cancer mortality remains higher among African American women compared to white women.3,4

African American women are also more likely to have adverse tumor characteristics, including a two-fold increase in the incidence of triple-negative breast cancer (TNBC).5 TNBCs are clinically more aggressive and have fewer treatment options than other breast cancer subtypes, contributing to increased mortality. Interestingly, while the lifetime incidence of breast cancer is similar between African American women and white women, the incidence in women under the age of 40 is significantly higher in African American women.1,6 Thus, early screening is an important topic.

It is generally agreed that earlier screening will not improve disparities in breast cancer care given the difficulty in identifying and treating TNBC. Despite these concerns, several studies have shown that early detection of TNBC with mammography screening is feasible and can greatly improve patient outcomes.7,8 Thus, delayed mammography screening may inadvertently worsen breast cancer disparities between African American women and white women by disproportionately increasing the breast cancer burden in African American women. Current guidelines vary widely with regards to the initial age mammography screening should be routinely performed (age 40, 45, or 50), though all the guidelines have a provision for screening beginning at age 40 based on individualized analysis of the risks and benefits.9-11

Conclusions: Ongoing research to improve breast cancer screening and treatment in diverse patient populations will be essential to improve patient outcomes in these populations.

References

  1. DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A. Breast cancer statistics, 2015: Convergence of incidence rates between black and white women. CA Cancer J Clin. 2016;66(1):31-42.
  2. Newman LA, Kalijee LM. Health Disparities and Triple-Negative Breast Cancer in African American Women: A Review. JAMA Surg. 2017;152(5):485-493.
  3. Newman LA, Griffith KA, Jatoi I, Simon MS, Crowe JP, Colditz GA. Meta-analysis of survival in African American and white American patients with breast cancer: ethnicity compared with socioeconomic status. J Clin Oncol. 2006;24(9):1342-1349.
  4. Albain KS, Unger JM, Crowley JJ, Coltman CA Jr, Hershman DL. Racial disparities in cancer survival among randomized clinical trials patients of the Southwest Oncology Group. J Natl Cancer Inst. 2009;101(14):984-992.
  5. Kohler BA, Sherman RL, Howlader N, et al. Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State. J Natl Cancer Inst. 2015;107(6):djv048.
  6. Danforth DN. Disparities in breast cancer outcomes between Caucasian and African American women: a model for describing the relationship of biological and nonbiological factors. Breast Cancer Res. 2013;15(3):208.
  7. Ho AY, Gupta G, King TA, et al. Favorable prognosis in patients with T1a/T1bN0 triple-negative breast cancers treated with multimodality therapy. Cancer. 2012;118(20):4944-4952.
  8. Kim J, Lee S, Bae S, et al. Comparison between screen-detected and symptomatic breast cancers according to molecular subtypes. Breast Cancer Res Treat. 2012;131(2):527-540.
  9. National Comprehensive Cancer Network. Breast Cancer Screening and Diagnosis. Version 1.2017. www.nccn.org/professionals/physician_gls/PDF/breast-screening.pdf. Accessed August 28, 2017.
  10. American Cancer Society Breast Cancer Screening Guideline. www.cancer.org/content/cancer/en/latest-news/special-coverage/american-cancer-society-breast-cancer-screening-guidelines/. Accessed August 28, 2017.
  11. S. Preventive Services Task Force. Breast Cancer: Screening. www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening. Accessed August 28, 2017.

Evaluate and Claim Credit

This educational activity is specifically designed to meet the needs of internists, general practitioners, surgeons, obstetricians/gynecologists, urologists, gastroenterologists, and other healthcare providers.

After successful completion of this educational activity, participants should be able to:

  • Employ current evidence-based best practices regarding the utilization of diagnostic tools for patients with prostate cancer
  • Assess the implications of disparities on the diagnosis of patients with breast cancer and utilize strategies to overcome these disparities to improve outcomes
  • Integrate recent data regarding the potential influence of racial disparities on the diagnosis and, ultimately, clinical outcomes of patients with cervical cancer
  • Evaluate the implications of disparities on screening and diagnosis for patients with Lynch syndrome

This educational activity is supported by grants from Astellas; Lilly USA, LLC; and Merck and Co, Inc.

Continuing Education

prIME Oncology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Key Points on Disparities in Cancer Care - prIME Oncology

prIME Oncology designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Each newsletter may provide the following credits:

  • Prostate Cancer: 0.25
  • Breast Cancer: 0.25
  • Cervical Cancer: 0.25
  • Lynch Syndrome: 0.25

Provider

This activity is provided by prIME Oncology.

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There are no fees for participating in and receiving CME credit for this activity. In order to receive credit, participants must successfully complete the online posttest and activity evaluation. Your participation in this CME activity will be recorded in prIME Oncology’s database. However, upon request, your CME credit certificate will be emailed to you. Technical requirements may be found under the Terms of Use.

A link to the posttest is available on the newsletter page.

In order to receive credit, participants must successfully complete the online posttest with 75% or higher.

Disclosure of Relevant Financial Relationships

prIME Oncology assesses relevant financial relationships with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. Any potential conflicts of interest that are identified are thoroughly vetted by prIME Oncology for fairness, balance, and scientific objectivity of data, as well as patient care recommendations. prIME Oncology is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial entity.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interest related to the content of this activity:

Dr Brown has disclosed that she has no relevant financial relationships to report. She has agreed to disclose any unlabeled/unapproved uses of drugs or products referenced in her presentation.

Dr Burnett has disclosed that he has received consulting fees from Astellas, Auxillium, Inc., Genomic Health Inc., Reflexonic LLC, and Vivus. He also received contracted research fees from American Medical Systems/Boston Scientific, Coloplast, Endo Pharmaceuticals, Medispec, and Pfizer. He has agreed to disclose any unlabeled/unapproved uses of drugs or products referenced in his presentation.

Dr Hall has disclosed that he has no relevant financial relationships to report. He has agreed to disclose any unlabeled/unapproved uses of drugs or products referenced in his presentation.

Dr Mitchell has disclosed that she has received fees for participation in advisory or review activities from Novartis. She has agreed to disclose any unlabeled/unapproved uses of drugs or products referenced in her presentation.

Dr Newman has disclosed that she has no relevant financial relationships to report. She has agreed to disclose any unlabeled/unapproved uses of drugs or products referenced in her presentation.

The employees of prIME Oncology have disclosed:

  • Lee Lokey, MD (medical director content reviewer/planner) – no relevant financial relationships
  • Zach Hartman, PhD (scientific content reviewer/planner) – Stock ownership in Advaxis, Inc., and Ariad Pharmaceuticals.
  • Amy Furedy, RN, OCN (scientific content reviewer/planner) – no relevant financial relationships
  • Jessica Mastrodomenico, MPH (editorial content reviewer) – no relevant financial relationships

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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This activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration or European Medicines Agency. Please refer to the official prescribing information for each product discussed for discussions of approved indications, contraindications, and warnings.