Breast Tumor a Greater Risk for Young Black Women: UNC-CH Team Finds Double Chance of a Cancer That is Aggressive and Responds Poorly to New Drugs

By Catherine Clabby, The News & Observer, Raleigh, N.C.

Jun. 7–Young black women appear more likely to develop an aggressive form of breast cancer that is resistant to the newest drugs, UNC researchers say.

That may partly explain why black women die at a higher rate from breast cancer than white women, even though fewer African-Americans get the disease. And it magnifies the need to expand breast cancer screening among women of color — a group that typically gets less preventive care, researchers say.

“Death from breast cancer has dropped more than 25 percent in the last 10 years. But you can’t take advantage of the advances if you are not in the health system,” said Dr. Lisa Carey, an oncologist and medical director of the UNC-Chapel Hill Breast Center. Carey was lead author on the study published today in the Journal of the American Medical Association.

Higher death rates among black women with breast cancer are most startling among younger cancer patients. Black patients younger than 50 are 77 percent more likely to die from breast cancer than are younger white women who develop breast cancer, according to the UNC-CH findings.

One explanation might be that a larger portion of the younger black women develop what oncologists call basallike tumors. Cells in those tumors look more abnormal under a microscope, appear to grow more aggressively and don’t respond to newer cancer drugs, including tamoxifen, Carey said.

Oncologists must use some combination of surgery, chemotherapy and radiation to fight the aggressive tumors. Early detection improves the chances of saving patients.

Among 496 women studied by the UNC-CH team, 39 percent of younger black women developed the basal-like tumors, compared with 14 percent of older black women. Only 16 percent of all white women in the study group developed them.

It’s not clear whether vulnerability to the tumors is inherited, triggered by environmental exposures or some combination of the two. Very few young black women with the hard-to-fight tumors in the UNC-CH study had mutations in the BRC gene, an inheritance that makes some women more vulnerable to cancer.

Science is making progress in recognizing molecular differences among breast cancers. UNC-CH geneticist Charles M. Perou identified the different cancer types for the study by analyzing tumor samples collected from eastern and central North Carolina women between 1993 and 2001.

It’s hoped that better precision in diagnosis will yield more effective treatments.

“Breast cancer is not one disease but many different diseases,” said Robert Millikan, leader of the Carolina Breast Cancer Study, whose data Carey’s team used to detect different tumor types among black and white women.

Millikan and others, in a separate study, are also hunting for the risk factors that increase a woman’s chances of developing basal-like tumors. By finding such risk factors, scientists hope that women will one day be able to modify their behavior and control their environment to help reduce their risk.

“We can’t yet say what is a risk factor for breast cancer anymore,” Carey said. “We have to go back to the drawing board and think in terms of risk factors for subtypes of breast cancer.”

In North Carolina, death rates among both black and white women from breast cancer have declined slightly in recent years, but black women remain more likely to die.

Brenda Muckelvene, mother of Tar Heel basketball standouts Rashanda McCants and Rashad McCants, says black women must do more to protect themselves in this fight. She was diagnosed with breast cancer at age 50, the same age her mother developed it.

Unlike her mother, Muckelvene survived. She takes her message to hair salons and other spots in the Triangle where African-American women gather. She urges the women she meets to get mammograms, examine their breasts regularly and otherwise be on alert for the disease.

“We need to stop putting ourselves last. We need to be first,” Muckelvene said. “Our families need us.”

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Copyright (c) 2006, The News & Observer, Raleigh, N.C.

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