By: Susan G. Komen
Guest blog by Komen grantee Dr. Lisa A. Newman, MD, MPH, FACS, Professor of Surgery and Director of the Breast Care Center for the University of Michigan in Ann Arbor, Michigan. Dr. Newman has dedicated her career to fighting breast cancer disparities. Named one of the 2012 Michiganians of the Year, she was also featured on CNN’s 2009 documentary “Black in America 2.” She was even called a “Breast Cancer Hero” in the October 2012 issue of Oprah Magazine.
I am honored to celebrate Black History Month by sharing what I have learned over my career as a surgical oncologist studying the many factors that contribute to disparities in breast cancer outcome, especially as they relate to triple negative breast cancer and African ancestry.
When my training as a surgeon first began (more than twenty years ago), it was widely assumed that the higher breast cancer mortality rates observed in the African-American population were completely explained by the more prevalent socioeconomic disadvantages in this community, with its related diagnostic and treatment delays. Unfortunately, these socioeconomic factors persist today, and they undeniably play a major role in causing tragically higher degrees of pain and suffering from breast cancer.
Over the past few decades, however, we have also made tremendous advances in understanding breast tumor subtypes, and we have learned that African Americans face an increased risk for being diagnosed with more aggressive breast cancers, such as triple negative breast cancer (TNBC). Today, the study of breast cancer disparities related to racial/ethnic identity includes investigations of hereditary genetics and tumor genomics, as well as socioeconomic and health care access inequities.
Although my clinical responsibilities are based in Michigan, my research has led me to sub-Saharan Africa, to learn about the breast cancer burden of women that have shared ancestry with African-Americans dating back to the colonial slave trade era. I have had the privilege of working with the oncology team at the Komfo Anoyke Teaching Hospital in Kumasi, Ghana, for nearly ten years.
What we have learned is striking: similarities indeed exist between the breast cancers identified in Ghanaians and those detected in African Americans. TNBC accounts for approximately 15% of the tumors seen in White American and European patients; approximately 30% of those in African Americans, and the majority of those seen in Ghanaian breast cancer patients. Funding from Susan G. Komen has enabled us to document these patterns and has also supported our studies of novel patterns of expression for molecular markers that are associated with mammary stem cell and TNBC progression, such as EZH2 and ALDH1. This work has also led to a platform for creating a library of patient derived xenografts (PDXs) from TNBC patients of internationally diverse backgrounds. These PDXs are an exciting model for studying the biology of TNBC and treatment sensitivity that can more easily be studied by many scientists for years to come.
Our work at Komfo Anoyke has also provided wonderful opportunities for academic and educational exchange experiences, strengthening our efforts to improve breast cancer survivorship on both sides of the ocean. Students and trainees from the University of Michigan routinely participate in our research trips to Ghana, which have been partly funded by Komen, and our Komfo Anoyke colleagues come to Michigan regularly to participate in research projects and to learn about the latest strategies in breast cancer treatments. One of the Komfo Anoyke surgeons is currently nearing completion of her PhD work in Cancer Biology at the University of Michigan, after which she will return to Ghana to establish an independent Kumasi-based laboratory.
We have also invested in a state-of the-art, internet-based telemedicine conference facility at Komfo Anoyke. This program allows us to host ongoing live weekly meetings and educational conferences, uniting our teams in Michigan and at Komfo Anoyke as one, overcoming the thousand-mile geographic separation to review cases and strategize the treatments that will best benefit our patients.
Our international breast cancer research program now works with three different hospitals in Ghana, and we are also in the process of obtaining approvals for participating sites in Ethiopia, India, and China.
Research has brought us many clues about the origins of breast cancer, and why it may affect some groups of women differently. But there is still much to learn about the biology of breast cancer that affects women of African Ancestry. I am pleased that our work, which began in Michigan, continues to be strong in Ghana and is now spreading to other African countries.
Learn more about Komen’s work on breast cancer disparities in our Mission Fast Facts.
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