Dr. Regina Hampton, a breast surgeon and the chief of Breast Surgery at Doctors Community Medical Center, Luminous Health, in Lanham, Maryland.

Dr. Regina Hampton

Dr. Regina Hampton discusses key factors contributing to this disparity, and how healthcare systems can address these challenges.

Research Shines Light on Disparities Across Breast Cancer Care 

Black women are approximately 40% more likely to die due to their breast cancer diagnosis compared with their White counterparts, according to the Mass General Brigham website, which goes on to state that this number can be as high as 50% depending on the type of breast cancer.

In a study which was led by Mass General Brigham researchers and published in 

, these higher mortality rates can be partially attributable to factors such as socioeconomic inequality, delays in diagnosis and inadequate access to timely quality cancer treatment. To note, these factors are independent of tumor biology, according to the research.

Dr. Regina Hampton, a breast surgeon and the chief of Breast Surgery at Doctors Community Medical Center, Luminous Health, in Lanham, Maryland, sat down for an interview with CURE where she discussed key factors contributing to this disparity, and how healthcare systems can address these challenges.

Black women that develop breast cancer tend to be pretty unique in that they [typically] develop breast cancer at younger ages, oftentimes under the age of 50, when in the general population, we often see it over the age of 60. When these women are young, and especially if they're under the age of 40, it presents a challenge because they're not at the age when we would recommend getting mammograms. We usually recommend getting mammograms starting at age 40.

A young woman who's in her 30s who comes in with a breast mass and is African American, oftentimes many providers say, “You're not 40. You don't need a mammogram. Come back at 40.” [This is an unmet need because we then] are missing a lot of breast cancers. One of the challenges is that not enough people, patients and providers, understand the uniqueness of African American women [presenting] at a younger [age], so we can't miss that opportunity.

There have been some who've advocated that we should look at doing more population-specific screening guidelines so that we can hopefully catch more of these breast cancers. I think the other thing is, as we see in other disease states, many times African American patients are not seen or heard when they do have complaints. I think it's been well covered throughout the media about different biases.

[Many times] it is a lot of miseducation and people not understanding or taking the time to see and hear [their] patient, which is a whole other part of the medical system that I think we're all really struggling with.

Transcript has been edited for clarity and conciseness

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WHEN SOMEONE RECEIVES A cancer diagnosis, one of the first questions the patient or a family member asks the oncology team is: How advanced is the disease?

Staging is the process used to summarize how early or advanced a cancer is — whether or not it is curable and, if so, the approximate expected cure rate. Cancers in each area of the body have unique staging systems based on anatomy. In breast cancer, staging involves the size of the tumor and whether it has spread to nearby lymph nodes or other organs (known as metastasis).

Two types of staging are used: clinical and pathological. Clinical staging is done prior to surgery using physical examination and imaging such as mammogram, ultrasound, MRI and/or PET/CT scans. Pathologic stage is assigned after surgery has been performed and the tumor and lymph nodes have been evaluated.

In January 2018, the American Joint Committee on Cancer made significant changes to the breast cancer staging process. Previously, staging was determined strictly from tumor size (T), lymph node involvement (N) and metastasis to other organs (M). Each element was assigned a number from zero to 4, which were combined to give the stage, also described as a number from zero to 4.

As research has proved, tumor biology is an important factor in determining prognosis. To account for this, physicians now look to a patient’s pathology report and include the tumor’s grade and receptor status as factors in staging. The grade, which is determined when the tumor is viewed under a microscope, describes how similar or different the cells look compared with normal breast tissue, measured on a scale from 1 to 3. The receptor status is based on whether the tumor is driven by the hormones estrogen or progesterone or by the growth factor receptor HER2.

Being positive for estrogen and progesterone receptors is a favorable prognostic factor, because it makes patients eligible for five years of treatment with oral endocrine medications that can help decrease the risk of cancer’s recurrence.

HER2-positive tumors are aggressive, but research has brought effective therapy. For example, two targeted agents, Herceptin (trastuzumab) and Perjeta (pertuzumab), interfere with HER2’s activity. These powerful agents work in combination, along with chemotherapy, to shrink the tumor before surgery but are also used after surgery, and they have made the prognosis for patients with this disease subtype much better. Before Perjeta was approved, the introduction of Herceptin alone improved survival rates in this population by one-third. Now that grade and receptor status are considered along with tumor size and lymph node status, breast cancers can be more accurately staged, and this can be beneficial to patients. For instance, before 2018, tumors larger than 3 centimeters always had a stage of 2 or 3. But now, if the tumor has good prognostic features, such as being estrogen- or progesteronepositive, a tumor this size can be assigned a lower stage. For example, the stage has changed for a grade 2, 5.3-centimeter tumor that is nonmetastatic, has spread to one lymph node and is estrogen-, progesterone- and HER2-positive. Previously, this tumor would have been categorized as stage 3a. Now it’s considered stage 1b. A tumor with all the same characteristics except for its smaller size — 3 centimeters &mdash; previously would have been categorized as stage 2b but now is also considered stage 1b.

The improvements in treatments for breast cancer offer patients many advantages.

Evaluating the biologic makeup of a tumor can help oncologists better predict outcomes, assuming standard therapies are used. And seeing a lower stage number can give patients the inspiration and hope they need to stick with their treatments, improving their chances of survival.

Regina Hampton, M.D., FACS, is medical director of the breast center at Doctors Community Hospital in Lanham, Maryland, and a board member of the American Society of Breast Surgeons Foundation. The foundation hosts an informational website for patients, survivors and caregivers (breast360.org).

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