I was pleased to see that one of the top tweets in the first hours of the San Antonio Breast Cancer Symposium focused on health inequities.
I was doubly pleased when health equity was raised as one of the three major challenges over the next decade by Dr. Eric Winer, who gave an incredibly brave and moving William McGuire Memorial Lecture—which I hope to write about separately. Although I would have liked for Winer to expand his narrow focus on access to quality healthcare—which is absolutely necessary but insufficient in and of itself to remedy the disparities in breast cancer outcomes which stem from deep social inequities—I was again pleased at the prominence of the subject.
But this talk of the importance of health equity was belied by the actual studies reported at the conference today. For one thing, I would like some evaluation on why the incidence of breast cancer has risen for black women. But SABCS focuses on diagnosis and treatment issues, and where prevention is mentioned it is only with regard to medical risk reduction from surgery or “chemoprevention”.
And yet even within these known boundaries, black women didn’t make it in to the studies reported today. At the world’s largest breast cancer conference, with hundreds of studies reported publicly, two—yes TWO! —of the studies (NSARP B-42 and CLEOPATRA) which reported results on Wednesday morning had exactly 4% of patients in the clinical trial who are black. How can we possibly address the differences in survival outcomes if black women aren’t even included in the trials?
And then the first session of Wednesday afternoon, which was presented by Dr. Couch, who worked in collaboration with Ambry Genetics to find genes other than BRCA 1&2 associated with increased risk of breast cancer, only looked at Caucasian breast cancer patients! We know how this worked out for the BRCA 1 and 2 genes – and we know it’s not good for women of color! Because researchers working to identify the BRCA genes focused largely on Jewish and white communities, less is known about some of the genetic mutations which are carried more often by women of color. The result is that women of color are more likely to get the devastating result that they have a “variant of unknown significance” or VUS, which essentially says there is a mutation but they don’t know if that mutation is harmful and increases their risk of cancer or not!
Surely we can do better. We must.