Unique Aspects of Breast Cancer in African American Women: TRIPLE NEGATIVE BREAST CANCER

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2 Angel A. Rodriguez, M.D. Assistant Professor Weill Cornell Medical College Methodist Cancer Center January 26, 2013 Unique Aspects of Breast Cancer in African American Women: TRIPLE NEGATIVE BREAST CANCER

3 Awareness Early Detection Advocacy Diagnosis Survivorship Treatment

4 Breast Cancer Facts Breast cancer is the most common cancer among American women. 1 in 8 women will be diagnosed with breast cancer in her lifetime About 26,840 new cases of breast cancer among African American women 4

5 White women are slightly more likely to develop breast cancer than African-American women

6 Breast Cancer Survival Facts About 39,520 women will die from breast cancer Death rates from breast cancer have been declining since

7 Death rates from breast cancer have been declining since 1990 About 6,040 African american women die each year because of breast cancer

8 Survival Facts The 5-year survival rate for breast cancer diagnosed in : All 89.1 % African American 77.0 % White women 90.4 % Stage at Diagnosis 5-YR OS Localized 60 % 98.6 % Regional 33 % 83.8 % Distant 5 % 23.3 % 8

9 We have a problem We currently have some solutions: Identify women at risk Prevention Early detection Treatment 9

10 Hereditary Breast Cancer Sporadic Family Clusters Clearly Hereditary

11 ** Men can develop breast cancer too. ** Started/end menses ** Children ** Breast Feeding ** Diet ** Exercise ** Alcohol ** Risk of breast cancer increases with age ** Females have higher risk of breast cancer ** Family history matters ** Race matters ** Use of Hormones ** Environment Picture: Courtesy Web

12 Most cases of breast cancer are not hereditary Red Flags Triple Negative Breast Cancer Breast cancer before age 50 Ovarian cancer at any age Male breast cancer at any age Multiple primary cancers Ashkenazi Jewish ancestry Relatives of a BRCA mutation carrier AJHG 1998;62: JCO 2002;20:

13 BRCA: Lifetime Cancer Risks Type of Cancer General Population BRCA Female Breast Cancer 12% (mostly ER+) 80% (mostly TNBC) 2 nd Breast Cancer 6% 50% Ovarian Cancer 1.8% 40%

14 SCREENING Mammogram between age 35 and 40 Mammogram every year beginning age 40 Annual breast exam by a physician Talk to your doctor about ultrasound, MRI, and the newer technologies Body awareness, self breast exam

15 Staging 1. Early stage patients are highly curable Stage 0 (in situ) 99.9 % cure Stage 1 - >90% cure 2. Late stage disease is curable, but chances are lower Stage % cure Stage 4 Treatable

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18 Breast Cancer is Not One Disease Breast Cancer ER- ER % ER+ HER % TNBC 15% BRCA1 <2%

19 TNBC Epidemiology Etiology Biology Prognosis Treatment options Who Why How What Current Future

20 Consistent Risk Modifiers for TNBC Age <50 African-American Family History Premenopausal overweight Breastfeeding!! 20

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22 Triple Negative Breast Cancer TNBC HER2+ ER+ AA < 50 y/o AA > 50 y/o White < 50 y/o White > 50 y/o 39% 14% 16% 16% 9% 7% 6% 6% 36% 59% 51% 58% Carey LA et al, JAMA 2006 These findings have been observed in North Carolina, south Carolina, Atlanta, California and Pennsylvania

23 Current Treatments for TNBC Stage 1-3: Curable, but more difficult to treat than other breast cancer Surgery Chemotherapy 4 to 6 months Anthracycline: Adriamycin or Epirubicin Taxane: weekly or every 3 weeks Possibly radiation We need more effective and safer treatments

24 Current Treatments for Stage 4 TNBC Treatable with chemotherapy only, can shrink tumors The response of these treatments, although initially effective, are usually not long lasting. We need more effective and safer treatments. We need to find the switch!

25 After a Cancer Diagnosis You should be well informed You may have several treatment choices Learn about your options A. Standard of Care B. Clinical Trials, especially if high risk Make an informed decision about your treatment that you are comfortable with

26 Cancer Clinical Trial Done to find new ways to treat cancer We want more effective treatments We want safer treatments A new drug A new combination of drugs All cancer treatments you take now have been studied in past clinical trials

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28 Example of TNBC Clinical Trial ARM 1 ARM 2 What your doctor recommended Same treatment as ARM 1 plus Herceptin 28

29 Clinical Trials Tuskegee Experiment An unethical and racist clinical study that tarnished the reputation of clinical research Black patients were deprived of curative treatment Led to the establishment of the Office for Human Research Protections

30 Institutional Review Boards Federal Law requires IRB for the protection of human subjects in studies involving human subjects Not just victims.heroes Charlie Pollard Herman Shaw Patients can now participate in clinical trials with secure feelings.

31 Awareness Early Detection Advocacy Diagnosis Survivorship Treatment

32 Tissue Understanding Of Cancer Resistance New Target New Treatments Clinical Trials

33 Cure Awareness Early Detection Tissue Understanding Of Cancer Advocacy Diagnosis Resistance Research Institutions New Target Survivorship Treatment New Treatments Clinical Trials

34 Goals Of Clinical Research Discover more effective therapies Decrease side effects Understand why cancer returns Understand why treatments stop working Access to newer therapies

35 Conclusion Get Mammograms Annually Take care of yourself Discuss your risk with your doctor Treatments for breast cancer are available Consider clinical trials, it s the only way we can find more cures Participate and educate 35

36 Thank you!! 36