Medicine is full of mysteries to solve. Among these are why black women frequently develop breast cancer at younger ages than white women, why they have more aggressive tumors, and why they have poorer survival rates despite having a lower incidence of the disease.
For most of OctoberNational Breast Cancer Awareness Monthcancer organizations dutifully focus on breast cancer risks, prevention, treatment, and survival rates, often with only a passing mention of the fact that African American women with breast cancer have a 29 percent higher mortality rate than white women. A November 1999 study by the National Cancer Institute, published in the Archives of Family Medicine, showed that the five-year survival rate for black women with breast cancer is 71 percent, compared with 87 percent for white women.
Likewise, the complex and curious aspects of breast cancer as it occurs in women across racial and ethnic groups are infrequently tackled in mainstream media, which means black women are often shut out from information on prevention and treatment.
But certain women may be more at risk no matter their raceolder women, and those with a family history of the disease, early onset of menstruation, and previous benign breast biopsies.
Theories about why breast cancer outcomes differ for African American women range from the genetic (black women often have breast cancers that resist popular estrogen-blocking drugs such as tamoxifen, which starve tumors of the hormone they need to grow) to the socioeconomic (low income and poor access to health care account for about half the difference in the death rate among black women) to the cultural (five times as many blacks believe that only God can cure them).
One study, launched in September at NewYork-Presbyterian Hospital and the Harlem Hospital Center, seeks to determine which women are at higher risk for developing breast cancer by comparing levels of certain proteins in two groups of premenopausal African American women: 150 who have recently been diagnosed with breast cancer and 150 who don't have the disease but have similar risk factors. Sixty white and 60 Hispanic women will also participate in the study.
The lead investigator for the study is oncologist Linda Vahdat, assistant professor of medicine at Columbia University and an assistant attending physician at NYPH. She says, "If you can figure out what's going on at the molecular levelwhat goes wrongyou can target prevention. Not all breast cancer is equal across ethnic groups. There are different reasons for the development of breast cancer. There are big differences on the genetic level." She suggests that one result of data gathered in the study could be the development of a "compound to lower protein levels."
Abby Siegel, who recently finished her internal medicine residency at NYPH and is one of three investigators, says that another study found higher levels of proteins in minority women with cancer than in those without. So far, 45 black women with cancer have enrolled; 15 of them have donated blood for protein analysis. Most of the women will come from NYPH and Harlem Hospital clinics, although efforts are under way to recruit women from outside of New York City.
One Thursday afternoon, on the sixth floor of the Milstein Pavilion at NYPH in Upper Manhattan, two white women and one black woman arrive within 20 minutes of each other to donate blood samples for the study. Mary Hopkins, 58, and her daughter, Shannon Hopkins, 35, were diagnosed with breast cancer within five weeks of each other last year. Both have since had bilateral mastectomies.
Mary's mother, grandmother, and maternal aunts all had breast cancer. "We found a whole branch of the family that we didn't know about who [breast cancer] is running through," says Mary. "So anything we can do to help lead to a cure or a way of eradicating breast cancer, we'll do."
Lynell Jeffrey, a 38-year-old black woman diagnosed with breast cancer last February, is a lawyer and singer who's undergone six months of chemotherapy and will soon begin radiation treatment. "I don't want anyone to have to go through chemotherapy. So, I hope this study can help find some answers."
Participants receive $25 for giving a blood sample and completing a 27-item questionnaire. African American women (both those with breast cancer and those without the disease) are not able to volunteer for the study if they are pregnant, breast-feeding, using steroids or oral contraceptives, or have liver disease, diabetes, endocrine problems, or other types of cancer. Siegel is pleased with the response. "Women are eager to participate," she says. "No one has refused."
For more information, or to take part in the study, call 212-305-2486.
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