NEW YORKAfrican-American women face a substantially
higher risk of dying from breast cancer than others in this country
and tend to be diagnosed with the disease at a younger age,
Lisa A. Newman, MD, assistant professor of surgery at M.D.
Andersons Nellie B. Connally Breast Center, said at a Komen
Foundation press briefing on clinical trials. The explanation for
these variations is unclear at this point, she said.
Regrettably also true is the fact that African-American women
tend to underutilize two extremely powerful weapons against breast
cancer: screening mammography and enrollment in clinical trials.
Pitfalls in Determining Socioeconomic Status
Ethnicity-related breast cancer survival disparities may be linked,
Thats potentially misleading because African Americans of
The best way to determine socioeconomic status is to
Failure of black women to enroll in large numbers in clinical trials
of breast cancer may leave unanswered important questions related to
the racial disparity in breast cancer survival. For example, in the
NSABP clinical trial in which tamoxifen (Nolvadex) was found to
reduce breast cancer by nearly 50% in high-risk women, only 1.7% of
the participants were black, Dr. Newman said.
Tamoxifen, she noted, appears to be most effective in preventing
estrogen-receptor (ER)-positive cancers, and there is
substantial evidence that African-American women are more likely to
be diagnosed with cancers that are ER negative. On the other
hand, she pointed out, taxmoxifen produces few side effects in
younger women, and black women are at higher risk for being diagnosed
with breast cancer at a younger age.
How do these two lines of data shake out in terms of the
applicability of tamoxifen as a chemoprevention agent in African-American
women? We really do not have adequate scientific data to answer that
question at this point, she said.
Learning From a Tragedy
In part, the reluctance of blacks to enroll in clinical trials is a
legacy of the Tuskegee syphilis study, Dr. Newman said. In the 1930s,
the US Public Health Service offered free medical care to 399 black
men in Macon County, Alabama; all were infected with syphilis. The
purpose of the study was to determine the effects of syphilis on the
body. The men were not told they had syphilis, and were not offered
treatment when penicillin became available in 1947. Follow-up
continued until the 1970s, by which time 28 men had died of syphilis.
Dr. Newman called the study an awful experience for African
Americans, who were subjected to unethical medical follow-up and care
in a government-sponsored study.
Yet even this tragedy offers valuable lessions, she said,
on how to improve trial participation in the black community. To
recruit the men, the researchers went out to the workplaces,
churches, and community-based organizations, she said. The
researchers were able to keep track of the men over a span of 40
years in part because they addressed transportation issues. The
investigators made sure that the men were able to return to the
medical care institutions for appropriate follow-up, Dr. Newman said.
As the chief national medical advisor for the Sisters Network, Inc.,
an organization of black women who are breast cancer survivors, Dr.
Newman is involved in reaching out to the black community on the
importance of breast health awareness, including the role of clinical
By giving people transportation access and educating people
appropriately, we can improve enrollment in clinical trials,
she said, and we can overcome some of the mistrust that does
exist between many parts of the community and the medical care
To get the message out, she would like to see education about breast
cancer offered by civic organizations and church groups as well as
media outlets targeted to particular ethnic groups.