Breast Cancer Aggressivenesss and Racial Disparity (CANCER-03)
Venue: Park Hyatt Washington
|Event Date/Time: May 05, 2003|
Socio-economic status (SES), lack of access to medical care, less utilization of screening, variations in treatment, co-morbid conditions, dietary habits, lack of compliance with treatment recommendations, and late stage presentation have all been offered as explanations for the lower survival rates in African American women. Although SES, even more than race, is considered by many the most important predictor of outcome, studies continue to show that basic biological differences exist in breast cancers from African American women compared with those from white women.
Determining the root causes for this disparity is critical in order to improve breast cancer survival in African American women. There is accumulating evidence that African American women have a higher frequency of more aggressive tumor types, which may have prognostic implications. This aggressive phenotype, which has been consistently reported, is revealed by a number of clinical-pathologic features -- 1) higher histologic grade, 2) worse prognostic markers, 3) more advanced stage at presentation, and 4) unfavorable clinical outcome. For example, significant racial differences were found in eight pathological features associated with poor prognosis. While advanced stage at presentation may reflect less screening, the higher histological grade and worse prognostic markers may reflect other factors in the environment. Attempts to explain the survival disadvantage of African American women as a result of SES factors have in part accounted for the disparity. In general, however, investigators have found that SES alone does not explain all the racial/ethnic differences in tumor characteristics.
The significance of aggressive tumor behavior in relation to survival disparity has not been fully addressed, and calls for more extensive pathology case reviews in different populations have been made. Aggressive tumor behavior was not considered in a "Summit Meeting on Breast Cancer in African American Women" recently published as a supplement to the journal Cancer. One reason is our lack of understanding of the various SES and other sociodemographic factors in relation to biological behavior. Most published studies on disparity have focused on associating SES factors with survival as well as on describing the different tumor characteristics between African American women and white women. While observers have recognized the more aggressive tumor types, no efforts have been made to associate specific SES or other factors with aggressive behavior or to determine whether these factors can cause aggressive disease.
Aggressive tumor behavior and its possible relation to SES and other sociodemographic factors in breast cancer is the focus of "Breast Cancer Aggressiveness and Racial Disparity" on September 8 and 9, 2003 in Washington, DC. The conference will address the role of aggressive tumor behavior in survival disparity. It will consider the clinical implications of aggressive behavior, laboratory markers of aggressiveness, histological manifestations of tumor aggressive behavior; and molecular mechanisms responsible for tumor aggressiveness.
There will be practical considerations that result from the conference. Relating environmental and other sociodemographic factors directly to histological based markers of aggressiveness may improve our understanding of issues that bear on treatment, stage of disease, management strategies, and survival in studies on disparity, since a higher histological grade indicates shorter survival. However, criteria for aggressive disease should be defined so that studies can be consistent and reproducible. Moreover, the conferees also need to determine whether known histological based prognostic markers can serve as a surrogate for clinical outcome.
Major objectives of the conference are:
To assess aggressive behavior on the basis of tumor characteristics alone;
To evaluate the utility of histological markers as surrogates for aggressive disease;
To develop a consensus on a working definition of aggressiveness so that future studies can be compared;
To evaluate the clinical implications of aggressive breast cancer in racial/ethnic disparity,
To determine whether current programs in health care delivery and access take into account aggressive disease, and
To formulate recommendations for future research.
The significance of this conference is threefold. If the conferees agree that aggressive tumor behavior has a role biologically in survival disparity, then this will influence policies for cancer control and standards for clinical management.
First, it may affect screening and early detection programs. Efforts to detect early stage disease through screening for breast cancer, while improving survival, may not significantly reduce the survival disadvantage because of the aggressive tumors already present in early stage disease in African American women. (16) Closer screening intervals and increased compliance may be necessary for African Americans.
Second, the conference will consider whether new systems of staging are needed for specific populations, whether a separate staging system should be developed that takes aggressive behavior into account (especially for stage category "T1c"), and whether initial treatment and subsequent management should not only be stratified by extent of disease but also by racial/ethnic background.
Third, the conference will consider whether changes should be made in health care delivery and access, health services, education, and outreach in view of aggressive breast cancer in the population.