Unraveling Disparities and Genomic Advances Across Breast Cancer Care

Breast cancer research increasingly highlights the role of genomic testing in refining treatment strategies, particularly for African American women, who face distinct challenges in diagnosis and treatment, according to Dr. Regina Hampton, who added that understanding these genetic differences is critical to advancing personalized treatment.

In an interview with CURE, Hampton shared case studies from her own practice, illustrating how genomic insights have reshaped treatment plans and improved patient outcomes for those with breast cancer. She also highlights the continued need for expanded access to genomic testing and research into racial disparities in breast cancer care.

Read more from our conversation with Hampton, a breast surgeon and the chief of Breast Surgery at Doctors Community Medical Center, Luminous Health, in Lanham, Maryland, where she expands on the importance of genomic testing, here.

CURE: Ongoing research into gene testing suggests that race can influence breast tumor biology. How does this impact treatment decision making and what advancements in genomic testing are helping to refine treatment plans for African American women?

Hampton: It's not just the tumor itself, knowing the size and the type of tumor it is. Instead, it's really digging deep and finding out what are the genetics of the tumor. There are many tests out there that look at the genes in the tumor, as we talked about with the FLEX study, and using that information to give us as clinicians information on if we should be aggressive or not; if these patients just need hormone therapy alone; or if chemotherapy [should] be given.

Where the MAMMAPRINT test stands out from a lot of the other tests is that it looks at 150 different genes in the tumor. Not only does it tell us whether the patient needs hormone therapy or chemotherapy, it is giving us a guide to the type of tumor. Where I think this is important for African American women is that the tumors are different in some way, but we didn't know why. Yes, they're younger women. Yes, they're more aggressive tumors. However, we found, even in tumors that are hormone-positive, they tend to be very aggressive tumors. The question is, “Why is that?” Where MAMAPRINT is superior to some of the other tests is that it's giving us that information.

Do you have any personal examples from your own practice on why genomic testing is vital?

For example, a patient that I just treated — she's about 48 and is African American — presented with a tumor that was about 4 centimeters, estrogen– and progesterone-positive. Those are tumors where we would do surgery and then give [the patient] a hormone pill for five years. Well, we tested the tumor, and what the tumor told us is that even though it's a hormone-sensitive tumor, it biologically acts like a triple-negative tumor. Triple-negative tumors are the more aggressive tumors and are not hormone responsive.

What's interesting is that this patient has a hormone-sensitive, estrogen– and progesterone-positive tumor, but her test showed that it is a basal tumor which is like a triple-negative tumor. We did her surgery and we recommended she get chemotherapy, and she was nervous, wanted to think about. She thereby delayed it a little bit. After I did her surgery and took it out, her margins were negative, her cancer had grown back in three months. The [test] explains why and it is because her tumor is acting just like a triple-negative tumor despite her being hormone-positive.

This is where clinicians can get that additional information, go to the patient and say, "You have a hormone-positive tumor, and we are going to put you on the hormone pill for five years," but you have that added benefit of needing chemotherapy so we can wipe this tumor out and not have it come back in the future. These are the kinds of things that I hope can be available to all clinicians and get to know why Black [patients’] tumors are different compared with what we see in other populations.

What message do you have for clinicians, researchers, and policymakers working to reduce breast cancer disparities in Black women?

We need to have more conversation and share more information, have advocates that understand the differences in populations. I think — especially for clinicians who may not have a large population of African American women or women of color in general — that they seek out resources of how to best treat these tumors. Using these genomic tests can be very helpful in helping to answer a lot of those questions. Also, on the patient side, patients don't often know that these genomic tests are available.

We spoke to a group of women and found that this genomic type of test was available. We could be missing out on information, especially as we just talked about my patient, and that information is invaluable and will be lifesaving for her. It is a multiprong approach and we just need to keep having conversations. Educating patients so that they know to go armed with information, websites, and that they can go in and have a good conversation with their providers.

Transcript has been edited for clarity and conciseness

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