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Abstract

  1. Top of page
  2. Abstract
  3. LIST OF PRIORITY ANSWERS
  4. RISK ASSESSMENT MODELS
  5. ACCURACY OF EXISTING DATA ON BREAST CANCER IN AFRICAN AMERICANS
  6. BREAST CANCER SCREENING
  7. BREAST CANCER GENETICS
  8. THE IMPACT OF BREAST CANCER IN YOUNG AFRICAN-AMERICAN WOMEN
  9. HISTOPATHOLOGY OF BREAST CANCER IN AFRICAN-AMERICAN WOMEN
  10. BREAST CANCER TREATMENT
  11. QUALITY OF LIFE/PAIN MANAGEMENT
  12. INCREASING THE POOL OF ACADEMICALLY ORIENTED AFRICAN-AMERICAN MEDICAL AND SURGICAL ONCOLOGISTS
  13. PSYCHOSOCIAL/BEHAVIORAL ISSUES
  14. PERSPECTIVE OF AFRICAN-AMERICAN BREAST CANCER SURVIVORS
  15. NUTRITION ISSUES
  16. REFERENCES

There is a disparity in the breast cancer survival rate among African-American women compared with the rate among white women. The summit meeting addressed the breast cancer crisis among African-American women by bringing together scientists, breast cancer advocates, and policy makers. The goal of the meeting was to develop a research agenda. For breast cancer research to advance, priority areas must be identified. The current article suggests questions and issues which are addressed in this cancer monograph. Cancer 2003;97(1 Suppl):207–10. © 2003 American Cancer Society.

DOI 10.1002/cncr.11028

Intensive research sponsored by a diverse group of researchers at universities and at public and private research organizations and foundations has led to many important discoveries about all aspects of breast cancer.1 However, not all populations appear to benefit equally from advances being made in the area of breast cancer research.2

For decades, we have known of the disparity in survival rates between African-American and white women with breast cancer.3 The American Cancer Society, the National Cancer Institute, and the Centers for Disease Control and Prevention together with its subsidiary, the National Center for Health Statistics, collaborate to produce an annual report card to the nation on progress related to cancer prevention and control in the United States.4, 5 In 1998, the initial report card offered documentation of the first continuing decline in cancer mortality rates in the United States since national record-keeping was instituted in the 1930s.4 However, despite this success, the report also noted the disproportionate breast cancer incidence and mortality rates in African-American women compared with white women. The 1998 report card provided evidence that the number of deaths from cancer was declining.4 This same report also suggested that progress in some areas among some populations will be slow.2 Breast cancer incidence rates continue to increase among African-American women, who are diagnosed at a later stage of disease and have lower survival and higher mortality rates.4

The United States has made great strides in recognizing and addressing what the Institute of Medicine has termed the “unequal burden of cancer.” We know why some breast cells become cancerous, how the disease spreads, why some types of cancer are more aggressive than others, and why some women have more aggressive disease and/or are more likely to die.1 Medical discoveries are leading to increasingly advanced technologies for detecting and diagnosing breast cancer, better clinical and supportive care, and improved outcomes for patients during and after treatment.1

This overview contains a collection of articles presented at the 2-day “Summit Meeting on Breast Cancer Among African American Women” (Washington, DC, September 8–10, 2000). We have compiled a list of the predefined priority areas and the questions that fueled the topics for discussion among health advocates, breast cancer survivors, and more than 130 researchers from the basic, clinical, and behavioral sciences, including, but not limited to, oncology, radiology, psychology, genetics, epidemiology, and demography. In addition, other predefined priority areas and questions pertaining to African-American women were derived from the scientific literature and from a 16-year effort, the Biennial Symposium on Minorities, the Medically Underserved and Cancer, a unique conference where scientific presentations and thoughtful discussion covered ethnically diverse topics.6 In addition, information related to cancer and communities of color and/or other medically underserved populations was disseminated at the symposium.

In an effort to understand and explain the differences in breast cancer rates among population groups, the objective of the summit meeting was to address the breast cancer crisis among African-American women in a “sound, scientific manner” by bringing together scientists, breast cancer advocates, and policy makers. A series of general sessions that evaluated current research and “laid the groundwork” for the development of a research agenda was followed by breakout sessions that encouraged a discussion of “what we need to know.” The summit format was organized around the conference topics. Included in the articles in this supplement are recommendations for addressing the identified gaps in the research.

We are grateful for the summit sponsor, the Center for Research on Minority Health at The University of Texas M. D. Anderson Cancer Center, and co-sponsors: the University of Texas M. D. Anderson Cancer Center, the Intercultural Cancer Council, the Howard University Cancer Center, the Jean Sindab African American Breast Cancer Research Project at Colombia Presbyterian Hospital, the Susan G. Komen Breast Cancer Research Foundation, Y-Me, the Office of the Director of the National Institutes of Health, the National Institute of Environmental Health Sciences, the National Human Genome Research Institute, the National Center for Minority Health Disparaties, and the National Cancer Institute.

Although advances have been significant and provide hope for the future, we still have far to go to remove the threat of breast cancer from the lives of all women.1 Because of the enormity of the impact of breast cancer in our society, breast cancer is firmly entrenched on the national cancer research agenda. It is imperative, however, that we define priority research areas such that research issues for minority women with breast cancer can become a part of the overall cancer research agenda. Further, we need to identify, based on expert testimony and the literature, other priority research areas, including those related to psychosocial and behavioral issues, survivorship, and the quality of life. It is our hope that these articles will be the beginning of identifying solutions to the breast cancer disparity among African-American women, especially women younger than the age of 50 years.

LIST OF PRIORITY ANSWERS

  1. Top of page
  2. Abstract
  3. LIST OF PRIORITY ANSWERS
  4. RISK ASSESSMENT MODELS
  5. ACCURACY OF EXISTING DATA ON BREAST CANCER IN AFRICAN AMERICANS
  6. BREAST CANCER SCREENING
  7. BREAST CANCER GENETICS
  8. THE IMPACT OF BREAST CANCER IN YOUNG AFRICAN-AMERICAN WOMEN
  9. HISTOPATHOLOGY OF BREAST CANCER IN AFRICAN-AMERICAN WOMEN
  10. BREAST CANCER TREATMENT
  11. QUALITY OF LIFE/PAIN MANAGEMENT
  12. INCREASING THE POOL OF ACADEMICALLY ORIENTED AFRICAN-AMERICAN MEDICAL AND SURGICAL ONCOLOGISTS
  13. PSYCHOSOCIAL/BEHAVIORAL ISSUES
  14. PERSPECTIVE OF AFRICAN-AMERICAN BREAST CANCER SURVIVORS
  15. NUTRITION ISSUES
  16. REFERENCES

Ethnicity-Related Variation in Breast Cancer Risk Factors

  • 1
    Patterns of familial breast cancer (comment on parallels between breast and prostate cancer; is there data supporting a genetic common denominator?)
  • 2
    Parity and menstrual factors
  • 3
    Exogenous hormones (comment on possible ethnicity-related variation in oral contraceptives/hormone replacement therapy use, if this data are available, especially in light of high rates of uterine fibroids resulting in high rates of surgical menopause among African-American women)
  • 4
    Postmenopausal obesity (comment on ethnicity-related variation in incidence and associated circulating hormone levels)
  • 5
    Pathologic markers: atypical hyperplasia or lobular carcinoma in situ
  • 6
    Mammographic density

Environmental Exposures/Carcinogens

  • 1
    What are the possible agents?
  • 2
    Comment on geographic variation in pesticide exposure and any correlation that may exist with ethnicity
  • 3
    Comment on possible association between pesticide/carcinogen exposure, metabolism, and ethnicity
  • 4
    What are the markers for pesticide/carcinogen exposure and is there any ethnicity-related variation?

RISK ASSESSMENT MODELS

  1. Top of page
  2. Abstract
  3. LIST OF PRIORITY ANSWERS
  4. RISK ASSESSMENT MODELS
  5. ACCURACY OF EXISTING DATA ON BREAST CANCER IN AFRICAN AMERICANS
  6. BREAST CANCER SCREENING
  7. BREAST CANCER GENETICS
  8. THE IMPACT OF BREAST CANCER IN YOUNG AFRICAN-AMERICAN WOMEN
  9. HISTOPATHOLOGY OF BREAST CANCER IN AFRICAN-AMERICAN WOMEN
  10. BREAST CANCER TREATMENT
  11. QUALITY OF LIFE/PAIN MANAGEMENT
  12. INCREASING THE POOL OF ACADEMICALLY ORIENTED AFRICAN-AMERICAN MEDICAL AND SURGICAL ONCOLOGISTS
  13. PSYCHOSOCIAL/BEHAVIORAL ISSUES
  14. PERSPECTIVE OF AFRICAN-AMERICAN BREAST CANCER SURVIVORS
  15. NUTRITION ISSUES
  16. REFERENCES
  • 1
    Comment on currently available models (Gail, Claus) and the populations utilized to develop them, including ethnic background
  • 2
    Comment on ethnic background of populations used to validate these models
  • 3
    Comment on data demonstrating the failure of these models to accurately assess risk (need to have comparative statistics on whites and African Americans who underwent risk assessments for Breast Cancer Prevention Trial [BCPT] and Study of Tamoxifen and Raloxifene [STAR], but who were deemed ineligible based on risk assessment)
  • 4
    How large does the sample size need to be for validation of existing models in African Americans?
  • 5
    What other factors might need to be incorporated into a risk model for African Americans?

ACCURACY OF EXISTING DATA ON BREAST CANCER IN AFRICAN AMERICANS

  1. Top of page
  2. Abstract
  3. LIST OF PRIORITY ANSWERS
  4. RISK ASSESSMENT MODELS
  5. ACCURACY OF EXISTING DATA ON BREAST CANCER IN AFRICAN AMERICANS
  6. BREAST CANCER SCREENING
  7. BREAST CANCER GENETICS
  8. THE IMPACT OF BREAST CANCER IN YOUNG AFRICAN-AMERICAN WOMEN
  9. HISTOPATHOLOGY OF BREAST CANCER IN AFRICAN-AMERICAN WOMEN
  10. BREAST CANCER TREATMENT
  11. QUALITY OF LIFE/PAIN MANAGEMENT
  12. INCREASING THE POOL OF ACADEMICALLY ORIENTED AFRICAN-AMERICAN MEDICAL AND SURGICAL ONCOLOGISTS
  13. PSYCHOSOCIAL/BEHAVIORAL ISSUES
  14. PERSPECTIVE OF AFRICAN-AMERICAN BREAST CANCER SURVIVORS
  15. NUTRITION ISSUES
  16. REFERENCES
  • 1
    Comment on relative contributions of African Americans with breast cancer from each of the 11 Surveillance, Epidemiology, and End Results (SEER) program sites
  • 2
    Comment on percentage of African-American patients in the National Cancer Database (NCDB)
  • 3
    Have these databases accurately reflected the impact of breast cancer in African Americans over the past several decades?
  • 4
    Do these databases consistently confirm the younger age distribution for African-American breast cancer patients?
  • 5
    Summarize current findings of SEER: age distribution; stage-controlled outcome; changes in incidence over time; correlation among ethnicity, age, stage, and breast cancer outcome

BREAST CANCER SCREENING

  1. Top of page
  2. Abstract
  3. LIST OF PRIORITY ANSWERS
  4. RISK ASSESSMENT MODELS
  5. ACCURACY OF EXISTING DATA ON BREAST CANCER IN AFRICAN AMERICANS
  6. BREAST CANCER SCREENING
  7. BREAST CANCER GENETICS
  8. THE IMPACT OF BREAST CANCER IN YOUNG AFRICAN-AMERICAN WOMEN
  9. HISTOPATHOLOGY OF BREAST CANCER IN AFRICAN-AMERICAN WOMEN
  10. BREAST CANCER TREATMENT
  11. QUALITY OF LIFE/PAIN MANAGEMENT
  12. INCREASING THE POOL OF ACADEMICALLY ORIENTED AFRICAN-AMERICAN MEDICAL AND SURGICAL ONCOLOGISTS
  13. PSYCHOSOCIAL/BEHAVIORAL ISSUES
  14. PERSPECTIVE OF AFRICAN-AMERICAN BREAST CANCER SURVIVORS
  15. NUTRITION ISSUES
  16. REFERENCES
  • 1
    Comment on past prospective, randomized mammography screening trials and fraction of African-American participants
  • 2
    Is screening mammography at younger ages likely to have a greater yield in African Americans because of the younger age distribution?
  • 3
    Is there evidence of ethnicity-related variation in mammographic densities?
  • 4
    What are the compliance rates for screening mammography in African Americans, especially related to different age groups?
  • 5
    Do ethnicity-related variations in obesity rates impact on mammography yield?
  • 6
    Are there other screening modalities that may be particularly useful for African Americans, e.g., breast ultrasound, particularly for younger women?

BREAST CANCER GENETICS

  1. Top of page
  2. Abstract
  3. LIST OF PRIORITY ANSWERS
  4. RISK ASSESSMENT MODELS
  5. ACCURACY OF EXISTING DATA ON BREAST CANCER IN AFRICAN AMERICANS
  6. BREAST CANCER SCREENING
  7. BREAST CANCER GENETICS
  8. THE IMPACT OF BREAST CANCER IN YOUNG AFRICAN-AMERICAN WOMEN
  9. HISTOPATHOLOGY OF BREAST CANCER IN AFRICAN-AMERICAN WOMEN
  10. BREAST CANCER TREATMENT
  11. QUALITY OF LIFE/PAIN MANAGEMENT
  12. INCREASING THE POOL OF ACADEMICALLY ORIENTED AFRICAN-AMERICAN MEDICAL AND SURGICAL ONCOLOGISTS
  13. PSYCHOSOCIAL/BEHAVIORAL ISSUES
  14. PERSPECTIVE OF AFRICAN-AMERICAN BREAST CANCER SURVIVORS
  15. NUTRITION ISSUES
  16. REFERENCES
  • 1
    Comment on the parallels between BRCA-related cancers and breast tumors among African Americans (younger age distribution, higher rates of estrogen receptor negativity, more anaplastic lesions, more medullary lesions)
  • 2
    What is the incidence of currently known deleterious BRCA mutations among African Americans?
  • 3
    What founder mutations have been identified among African Americans, with a comment on the parallels between the impact of breast cancer on African Americans and native Africans (lower overall incidence, younger age distribution)?
  • 4
    What do we know about familial cancer syndromes that are prevalent among African Americans?
  • 5
    How can we best identify African-American families that may benefit from genetic testing?
  • 6
    Are genetic counselors likely to be sensitive to cultural/ethnic issues?

THE IMPACT OF BREAST CANCER IN YOUNG AFRICAN-AMERICAN WOMEN

  1. Top of page
  2. Abstract
  3. LIST OF PRIORITY ANSWERS
  4. RISK ASSESSMENT MODELS
  5. ACCURACY OF EXISTING DATA ON BREAST CANCER IN AFRICAN AMERICANS
  6. BREAST CANCER SCREENING
  7. BREAST CANCER GENETICS
  8. THE IMPACT OF BREAST CANCER IN YOUNG AFRICAN-AMERICAN WOMEN
  9. HISTOPATHOLOGY OF BREAST CANCER IN AFRICAN-AMERICAN WOMEN
  10. BREAST CANCER TREATMENT
  11. QUALITY OF LIFE/PAIN MANAGEMENT
  12. INCREASING THE POOL OF ACADEMICALLY ORIENTED AFRICAN-AMERICAN MEDICAL AND SURGICAL ONCOLOGISTS
  13. PSYCHOSOCIAL/BEHAVIORAL ISSUES
  14. PERSPECTIVE OF AFRICAN-AMERICAN BREAST CANCER SURVIVORS
  15. NUTRITION ISSUES
  16. REFERENCES
  • 1
    Comment on the age distribution for African-American women, based on SEER statistics
  • 2
    Comment on data indicating that breast cancer may be biologically more aggressive in younger women
  • 3
    To what extent might the younger age distribution for breast cancer in African-American breast cancer patients contribute to the higher mortality rates that are seen?

HISTOPATHOLOGY OF BREAST CANCER IN AFRICAN-AMERICAN WOMEN

  1. Top of page
  2. Abstract
  3. LIST OF PRIORITY ANSWERS
  4. RISK ASSESSMENT MODELS
  5. ACCURACY OF EXISTING DATA ON BREAST CANCER IN AFRICAN AMERICANS
  6. BREAST CANCER SCREENING
  7. BREAST CANCER GENETICS
  8. THE IMPACT OF BREAST CANCER IN YOUNG AFRICAN-AMERICAN WOMEN
  9. HISTOPATHOLOGY OF BREAST CANCER IN AFRICAN-AMERICAN WOMEN
  10. BREAST CANCER TREATMENT
  11. QUALITY OF LIFE/PAIN MANAGEMENT
  12. INCREASING THE POOL OF ACADEMICALLY ORIENTED AFRICAN-AMERICAN MEDICAL AND SURGICAL ONCOLOGISTS
  13. PSYCHOSOCIAL/BEHAVIORAL ISSUES
  14. PERSPECTIVE OF AFRICAN-AMERICAN BREAST CANCER SURVIVORS
  15. NUTRITION ISSUES
  16. REFERENCES
  • 1
    What differences exist in distribution of histopathologic patterns among African-American breast cancer patients (with comment on studies indicating higher rates of medullary lesions)?
  • 2
    Comment on data regarding possible ethnicity-related variation in expression of breast tumor markers (hormone receptors, p53, HER-2/neu)

BREAST CANCER TREATMENT

  1. Top of page
  2. Abstract
  3. LIST OF PRIORITY ANSWERS
  4. RISK ASSESSMENT MODELS
  5. ACCURACY OF EXISTING DATA ON BREAST CANCER IN AFRICAN AMERICANS
  6. BREAST CANCER SCREENING
  7. BREAST CANCER GENETICS
  8. THE IMPACT OF BREAST CANCER IN YOUNG AFRICAN-AMERICAN WOMEN
  9. HISTOPATHOLOGY OF BREAST CANCER IN AFRICAN-AMERICAN WOMEN
  10. BREAST CANCER TREATMENT
  11. QUALITY OF LIFE/PAIN MANAGEMENT
  12. INCREASING THE POOL OF ACADEMICALLY ORIENTED AFRICAN-AMERICAN MEDICAL AND SURGICAL ONCOLOGISTS
  13. PSYCHOSOCIAL/BEHAVIORAL ISSUES
  14. PERSPECTIVE OF AFRICAN-AMERICAN BREAST CANCER SURVIVORS
  15. NUTRITION ISSUES
  16. REFERENCES
  • 1
    Comment on ethnicity-related differences in markers of tumor responsiveness to therapy (e.g., hormone receptors, HER-2/neu)
  • 2
    Are there differences in response to chemotherapy?
  • 3
    Are there differences in measures of micrometastases (e.g., bone marrow biopsies, sentinel lymph nodes)?
  • 4
    Do African-American women have different patterns of recurrence following breast conservation therapy?

INCREASING THE POOL OF ACADEMICALLY ORIENTED AFRICAN-AMERICAN MEDICAL AND SURGICAL ONCOLOGISTS

  1. Top of page
  2. Abstract
  3. LIST OF PRIORITY ANSWERS
  4. RISK ASSESSMENT MODELS
  5. ACCURACY OF EXISTING DATA ON BREAST CANCER IN AFRICAN AMERICANS
  6. BREAST CANCER SCREENING
  7. BREAST CANCER GENETICS
  8. THE IMPACT OF BREAST CANCER IN YOUNG AFRICAN-AMERICAN WOMEN
  9. HISTOPATHOLOGY OF BREAST CANCER IN AFRICAN-AMERICAN WOMEN
  10. BREAST CANCER TREATMENT
  11. QUALITY OF LIFE/PAIN MANAGEMENT
  12. INCREASING THE POOL OF ACADEMICALLY ORIENTED AFRICAN-AMERICAN MEDICAL AND SURGICAL ONCOLOGISTS
  13. PSYCHOSOCIAL/BEHAVIORAL ISSUES
  14. PERSPECTIVE OF AFRICAN-AMERICAN BREAST CANCER SURVIVORS
  15. NUTRITION ISSUES
  16. REFERENCES
  • 1
    Comment on the present statistics, based on ethnic distribution of current fellowship programs and membership in the American Society of Clinical Oncology and Society of Surgical Oncology (SSO)
  • 2
    Comment on the potential value of African-American scientists in designing clinical trials that are culturally and ethnically sensitive

REFERENCES

  1. Top of page
  2. Abstract
  3. LIST OF PRIORITY ANSWERS
  4. RISK ASSESSMENT MODELS
  5. ACCURACY OF EXISTING DATA ON BREAST CANCER IN AFRICAN AMERICANS
  6. BREAST CANCER SCREENING
  7. BREAST CANCER GENETICS
  8. THE IMPACT OF BREAST CANCER IN YOUNG AFRICAN-AMERICAN WOMEN
  9. HISTOPATHOLOGY OF BREAST CANCER IN AFRICAN-AMERICAN WOMEN
  10. BREAST CANCER TREATMENT
  11. QUALITY OF LIFE/PAIN MANAGEMENT
  12. INCREASING THE POOL OF ACADEMICALLY ORIENTED AFRICAN-AMERICAN MEDICAL AND SURGICAL ONCOLOGISTS
  13. PSYCHOSOCIAL/BEHAVIORAL ISSUES
  14. PERSPECTIVE OF AFRICAN-AMERICAN BREAST CANCER SURVIVORS
  15. NUTRITION ISSUES
  16. REFERENCES