Comprehensive Cancer Center Consultations May Improve Breast Cancer Care for African American Women

September 25, 2019

African American women are less likely to receive care from leading specialists at Comprehensive Cancer Care centers, but seeking opinions from one can improve outcomes in breast cancer.

Second opinions from a National Cancer Institute-designated Comprehensive Cancer Center (CCC) could lead to changes in the treatment of breast cancer in African American women, according to a pilot study presented at the 12th American Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved. The conference was held in San Francisco, California from Sept. 20-23.

“African Americans are less likely to receive care by leading specialists due to cost and other access limitations,” Professor Rena J. Pasick, DrPh, of the University of California San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center told CancerNetwork®.

She went on to explain this means African American people are less likely to receive care from oncologists in CCCs, which are the nation’s elite cancer research, teaching, and clinical institutions. Previously reported research has shown that CCC care is associated with superior outcomes compared to other clinical settings. But African American women and other ethnic minorities are more likely to seek care elsewhere and face worse outcomes. African American women also experience more aggressive breast tumors at younger ages.

“CCC clinicians not only closely follow the latest developments; they are often the ones doing the research and translating it directly into practice,” she added.

Pasick and colleagues enrolled 14 African American women with breast cancer in the San Francisco Bay Area to participate in a pilot study of free in-person or video second-opinion consultations with CCC clinicians. Patients received second opinions and were taught how to seek clarification in conversations with their own clinicians. They were then interviewed 3 weeks and 1 year later to describe how the second opinions affected their treatment.

Consultations led to changes in treatment plans for all 14 women. Some of the changes were “significant,” including additional or different medications, changes to patient monitoring, and recurrence-prevention plans. One patient’s stage 3, p53 mutation-positive breast tumor had been treated without success using carboplatin and Taxol at a public hospital, Pasick’s team reported. The CCC physician recommended treatment with doxorubicin and cyclophosphamide instead, leading to the patient experiencing remission.

“This is definitely a promising finding,” said Tomi Akinyemiju, PhD, MS, associate professor, Department of Population Health Sciences at the Duke University School of Medicine and the Duke Global Health Institute in Durham, North Carolina. Akinyemiju was not involved in the pilot study.

Additional studies are needed with larger numbers of patients, Pasick and Akinyemiju both said.

The level of specialization and higher patient volumes lead to better expertise at CCCs, Akinyemiju said. Improving Black women’s breast cancer outcomes involves removing barriers to the best available care, including transportation and child-care cost barriers, she said.

“Second opinions are always a good idea for cancer patients in general,” Pasick said. “I believe this is even more important for African American women because of their higher risk of poor outcomes. Those with aggressive cancer would likely benefit the most from a CCC consultation.”