Black breast cancer patients less likely to benefit from chemo before surgery

CANCER DIGEST – Dec. 1, 2015 – Among minority women treated with early chemotherapy, black women have worse outcomes than the other groups, a Yale Cancer Center analysis of the National Cancer Database shows.  

Black, Hispanic, and Asian women typically develop advanced-stage breast cancer more often than white women. As a result, black women are more likely to receive chemotherapy prior to surgery, or neoadjuvant chemotherapy, to reduce the tumor volume before the surgeon attempts to remove it in hopes of improving outcomes.

For the study, researchers analyzed the outcomes of 121,446 women for whom the timing of chemotherapy was known. Of those, 27,300 had received chemotherapy before surgery. In analyzing the racial disparities in the use of, and response to, neoadjuvant chemotherapy in the 17,970 women with stage I-III cancer with known outcomes. They found that compared to white women, black women, but not Hispanic or Asian women had a lower rate of achieving a pathologic complete response (pCR) to chemotherapy. The study appears in the Nov. 23, Journal of Clinical Oncology.

When the pathologist examines the tissue removed during surgery and sees no active cancer cells, it is called a pathologic complete response. It is not the same as eradication of the cancer, but it is a marker for how well the chemotherapy worked. Patients with a pathologic complete response often have good outcomes.

In the analysis, in the women whose tumors did not have receptors for the hormones estrogen or progesterone (ER/PR negative) but did have receptors for a specific protein, called HER2, 43 percent of black women achieved a pathologic complete response compared to 54 percent of white women.

In tumors that were negative for all three receptors, 37 percent of black women achieved a pCR compared to 43 percent of white women.

It is unknown whether the difference is due to biologic differences in chemosensitivity, or differences in treatment, or socioeconomic differences that could not be adjusted for in the analysis.

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