Jane Zones, Board Member

Presenting Abstract 37,  researchers set out to look at the effect of race on treatment outcomes from a previous study of women with aggressive disease.

Black women in the trial experienced poorer outcomes, as measured by disease free survival (DFS) and mortality. The greatest differences in both outcomes were in women with HR-positive/HER2-negative disease (Black women whose tumors had these characteristics had almost 50% higher rates of death over the study period.) Because all the women in the trial received the same treatment the researchers ruled out disparities in treatment as a contributing factor.

Examination of the role played by obesity was not entirely clear. Obesity was related to poorer outcomes in all women in the study, but it interestingly did not play a more significant role for Black women compared with white women. In fact, when DFS was reviewed looking at race and obesity together, the group with the worst outcome where Black women who were not obese. The researchers suggested a number of possible contributing factors, including hyperinsulinemia (excess levels of circulating insulin) associated with obesity, ability to metabolize tamoxifen or aromatase inhibitors, and unknown biological factors.

Because the focus of medical researchers in cancer is so narrow, the study leaders did not consider other factors that might contribute to differences in outcomes that include both economic factors (for example, where these women all working or not, and, if so, did that add to stresses that might affect outcomes?) and social ones (for example, what kind of social support networks did the study participants have in place?).

One other note about this study: the researchers where looking at data from a previously completed trial (E1199, published in the New England Journal of Medicine in 2008). In that study, though many of the women were Her2 positive, none of the women received Herceptin treatment. This is not the current standard of care.