Breast Cancer Awareness: Clinical trials could help understand outcomes among Black women battling the disease

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INDIANAPOLIS — As Breast Cancer Awareness Month continues, we continue to highlight the disease, its impacts and disparities.

Research shows Black women are more likely to have worse outcomes when battling the disease compared to other racial groups.

“There can be genetic reasons, socio-economic reasons. There can be anything that kind of has to do with a background and in terms of what people have available to them,” said Dr. Carla Fisher, breast surgery director at IU Health.

Fisher, who is also an associate professor of surgery at IU School of Medicine, says Black women are also more likely to be diagnosed with triple negative breast cancer.

“When we look, about 10 to 15 percent of the population has triple negative breast cancer,” Fisher said. “So it’s not the most common type of breast cancer, but if you look at white women, it’s about 10 percent of the types of breast cancers that they’re diagnosed with, and in Black women, it’s 21 percent.”

While it is not the most common, Fisher says it is one of the most aggressive, often requiring chemotherapy and associated with higher mortality.

“The majority of patients diagnosed with breast cancer are estrogen receptor positive, usually progesterone receptor positive and HER2 negative,” she said, “but there’s all sorts of different iterations of those three that you can see. So triple negative, essentially, prefers to being negative for those receptors on your breast cancer.”

Fisher says genetics are most often tied to the risks, but part of understanding how and why is through clinical trials and studies. However, historically, participation rates are low among Black women.

“We’re working a lot on that, and we know that sort of underrepresentation hinders development and optimization of treatment regimens that may benefit Black women,” Fisher said, “and so I think the first thing is getting that message out because it’s going to help women, who sort of participate in that.”

In 2019, we told you about a national study through IU School of Medicine, focusing on the side-effects of chemotherapy in Black women. At the time of our report, 240 Black women across the country were participating.

“We’ve noted that African American women have worse side effects with this type of chemotherapy, which leads to us not giving them the chemotherapy as often or stopping it early because of the side effects, and that can happen with people, but we see that more commonly in African American women,” Fisher said, “but if you’re not getting the medication that you need because of those side effects, that can also lead to those poor outcomes.”

Fisher says these studies are critical in helping them understand why and how changes happen, however, she understands why there might be hesitation.

“We know that there’ve been sort of historical mistrusts of clinical trials, related to clinical trials, done on Black men that were not done in the best situation. So even though that happened a long time ago, and things have changed quite a bit, I think there’s a mistrust,” she said.

“I think clinical trial for a lot of people can sometimes mean experimentation, and that’s not really the case,” she added. “We screen patients very carefully. We’re very careful in terms of monitoring them, and many times patients benefit directly from a clinical trial they might be on, and if not, they’re benefitting a lot of other women.”

Fisher says they’re continuing to do more outreach in speaking with the Black community on clinical study participation, speaking at churches, community centers and reaching people where they are. While participation numbers are improving, she says there’s still plenty of room to grow.

Right now, Fisher says Komen Tissue Bank at IU Simon Cancer Center is actively recruiting Black women for its latest study on breast tissue. A meeting, regarding the study, is planned for early November.

“What we do is we take benign and normal breast tissue because what we feel is you can’t figure out what’s abnormal without learning what’s normal, and so one of our researchers has recently received a grant sort of specifically looking at what’s normal in Black women,” Fisher said.

“We have tissue from a lot of white women and what’s normal there. Again, looking at those genetic differences, it helps us to figure out when changes happen,” she added. “So really active and interesting research, and a lot of women tend to be kind of curious about that. It’s kind of neat to learn what’s normal and what’s there.”

If you’re interested in the study, or would like to learn more about participating, you can call the IU Simon Cancer Center at (317) 278-0070 or visit them online.

Meanwhile, another key to identifying and addressing disparities is by looking at the risks and ways to combat it. While it’s recommended the average woman start breast cancer screenings at 40, Fisher says Black women should consider starting the conversation with their doctor as early as 30.

“Because of the triple negative breast cancer, because Black women, we know, are going to be diagnosed with breast cancer on average at a younger age, that that one size fits all starting screening at 40 probably doesn’t make sense for all of those patients,” Fisher said. “We’ve asked women, if you’re African American and at age 30, you should really be talking to your doctor about breast cancer screening and where you should fall because you might need to start screening a little bit earlier.”

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