Drug-Resistant Breast Cancer Afflicts Blacks - Scientists Look at Genes, Breast-Feeding Patterns

Source: Washington Post

Drug-Resistant Breast Cancer Afflicts Blacks
Scientists Look at Genes, Breast-Feeding Patterns

By Rob Stein
Washington Post Staff Writer
Saturday, June 23, 2007; A01



Lorie Williams thought for months that she might have a lump in her breast. But when the doctor said it was cancer, she was still stunned. After all, she was just 29 years old, no one in her family had ever had breast cancer, and she had never heard of anyone getting the disease so young.

"I was just numb," said Williams, who lives in Holly Springs, N.C. "I couldn't believe it was really happening. Then I just became hysterical."

Women such as Williams have become the focus of an intense effort to solve one of the most pressing mysteries about breast cancer: Why are black women, who are less likely to get the disease than white women, more likely to get it when they are young -- and much more likely to die from it?

Now, researchers have uncovered a crucial clue: Black women, particularly young ones, get hit much more often by an aggressive form of breast cancer that is invulnerable to many of the latest treatments.

That discovery, however, has raised a thicket of new questions and an intense debate. Are black women prone to the deadlier cancer for genetic reasons? The same deadly form of breast cancer turns out to be extremely common in parts of Africa where the slave trade was centered, indicating that genes play a role. Or is it something else? Researchers have also found evidence that other factors, such as breast-feeding patterns, may be key.



Read more: http://www.washingtonpost.com/wp-dyn/content/article/2007/06/22/AR2007062201902_pf.html

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If they are looking at breast feeding patters, maybe they should address prenatal education and get some health care coverage for the country.

Most first world countries offer much longer time off for the birth of a baby than US employers do, precisely because it's understood that doing so improves breastfeeding rates and is vital both to the health of the mother and of the baby (and effects that child's health even when they're grown- former breastfed babies have lower rates of allergies, diabetes and some cancers.) When mom does go back to work, many jobs don't have a place to pump and store milk or offer time off to do so, and for low to moderate income mothers WIC offers free formula at great government expense but in many communities they don't have breastpumps or competent breastfeeding assistance.

They've done dozens and dozens of studies on breastfeeding and breast cancer. No impact overall.

There is a strong case to make for genetic predisposition, however. All the more reason why AA women need to have fast access to high quality health care if they are diagnosed with breast cancer. Basal-type br ca responds well to chemotherapy as opposed to other types of br ca. It grows very quickly, though, so you need to begin treatment early.

Sadly, many AA women get bounced around the health care system quite a bit before they get treatment for br ca, and when they do its not always good quality care.

breastfeeding cuts breast cancer rates by 4.5-5% for each year of breastfeeding. Alot of people don't believe this, but there are a substantial number of women who breastfeed for the full year as recommended by the AAP, and on to two years as recommended by WHO. I've cut my risk for breast cancer by about 30% by nursing both of my children long term.

The average age for weaning thorughout the world is close to four years. That's a 18-20% decrease in risk.

didn't smoke, ran 30 miles a week, ate a vegetarian diet, had no family history lived a health life, and still got breast cancer at age 44.

Women need to stop picking on each other and rely on scientific evidence for understanding, treating and preventing diseases like breast cancer.

There's no fast, easy answer for this one yet and continuing to find ways to blame victims for it will get us nowhere.

Even of the known modifiable risk factors listed at the link below, most of them (with the exception of prophylactic mastectomy for those at genetic risk) will reduce your chances of getting breast cancer by any significant amount.

http://www.cancer.gov/cancertopics/pdq/prevention/breast/Patient/page3

women about breastfeeding. Just looking for trends, including duration of breastfeeding and other lifestyle concerns. I'm not making a judment, just looking at facts and that I had read information from numerous studies several years ago that came to a different conclusion.

I went through that link and didn't see that conclusion that breastfeeding has no impact on breast cancer. It appears to me that your link is to longitudinal studies on food contamination dietary patterns, including breastmilk consumption. Is there a specific page where the researchers have drawn conclusions? I don't have time to take on that job.

Frankly, I am suspicious of environmental toxins being a big part of the increase in BrCa rates, as well as autism.

And I am very sorry you had to go through your illness. I hope you are well and thriving. A good friend of mine going all the way back to high school is living with metasticized BrCa.

I agree with the negligent state of available healthcare for AA women in this country. I've observed that first-hand ages ago in Dallas.

http://64.233.167.104/search?q=cache:WvKglIy3XJ4J:www.cancer.gov/cancertopics/factsheet/Risk/pregnancy+breast+cancer+risk+breastfeeding&hl=en&ct=clnk&cd=17&gl=us&client=firefox-a

http://jnci.oxfordjournals.org/cgi/content/abstract/97/19/1446

Most studies show no correlation for breastfeeding only. One study showed slightly lower risk for premenopausal women if they breastfed for 1 1/2 to 2 years, an extremely long time to expect anyone to breastfeed a child.

The only possible cause would be the reduction in menstruation cycles, and that's purely speculative.

If there were enough data to suggest a real risk reduction because of breastfeeding, it would be listed as such in the NCI fact sheets.

risk for postmenopausal women. I think one of the journals was J. of Epidemiology. I can't remember the others (CRS syndrome), but I think one was a UK study.

The Oxford Study you cite is about having been breastfed, not cancer risk by the breastfeeding mother, unless the study changes course:
Background: Having been breast-fed has been suggested to influence cancer risk in adulthood. We investigated associations between breast-feeding during infancy and adult cancer incidence and mortality in a cohort study and meta-analyses of published studies. snip

The Fact Sheet says:
After pregnancy, breastfeeding for a long period of time (for example, a year or longer) further reduces breast cancer risk by a small amount.

The statistics I am familiar with indicated that the rate was about 4.3 to 5% for each year of lactation. I've reduced my risk by over 30% if this is the case. It does add up, whether it is by having a large family or nursing longer, as is done in many other places in the world.

1-2 years may seem like alot to most Amercian women, but I know quite a few, including myself, that went beyond that, and yes, many were working outside the home. But they were motivated and had good support at home and also through policies at work and jobs where they had some degree of control over their time. I recognize that this isn't the case for all mothers. This isn't about judgment. Everyone has to walk their own path. But I don't think it can be ignored as a possibility for helping some women reduce certain types of risk.

Lactation Amenorrhea tends to last longer in older nursing mothers. It would be interesting to see a longitudinal study with this as a factor.

Another study was reported on today's news correlating higher degrees of nausea in pregnancy to lower BrCa rates. Maybe that is also tied to pre-eclampsia. It will be interesting to see if the study holds up.

Its fine if women want to breast feed thinking it will reduce their risk of breast cancer, as long as the public and policy makers understand the lack of real evidence so far and that it is probably not likely to offer protection for women who have a genetic predisposition.

The study quoted in the OP is including breastfeeding, but is focusing primarily on genetic factors.

I also included the link for the meta analysis on bc & breastfeeding re women who got breast cancer and were breast fed to illustrate the confusion, conflicts and misconceptions about the topic.

Bottom line, there has only been one study that showed benefit, and that's not definitive enough. I'm sure there are more studies coming down the pike - its a topic that, no matter how little benefit is shown, people have an obsession with continuing to spend money on it. Its cheap and easy to do - get a group of women who've had breast cancer and ask how many of them breast fed their children.

As Dr. Brawley points out in the OP, a major reason for disparity in breast cancer mortality in AA women is access to health care for both diagnosis and treatment. He mentions some studies done comparing bc mortality rates for AA women in the general population vs. women in the military. The study found that AA women in the military (where access to health care is automatic) had the same breast cancer mortality rate as caucasian women. IOW, in the military, there was no disparity. He said its likely a similar result would be found in low income caucasian women - that the disparity is based on income level and access to health care. (the study isn't quoted in the article, its from a lecture I saw him give last summer.)

Some women will continue to believe all the myths and half truths about breast cancer risk. There's no overcoming the popular news media and Good Houskeeping Magazine. But fortunately, there's a significant number of breast cancer activists who are trained to understand breast cancer research and are staying on the forefront. Many of us attend all the yearly cancer conferences and read the research results every day. We're happy to be of service; though not everyone wants to give up old beliefs (researchers struggle with it, too), that's ok. We just keep moving forward.

"As Dr. Brawley points out in the OP, a major reason for disparity in breast cancer mortality in AA women is access to health care for both diagnosis and treatment." I completely agree with that and about the genetics. It is time for the media to work on promoting the major causes and known factors of BrCa and treatment.

As for the breastfeeding study I mentioned, that was the only one I could remember. I think there have been others, but I haven't been receiving abstracts on women's health research for about two years. I wouldn't know about Good Housekeeping or anything being promoted in pop literature. In the past, the formula industry had some control over alot of that information, even if they appeared to be promoting breastfeeding.

Right now it is easier to find the women who breastfed their children and still got breast cancer. The impossible research would be to find the ones with similar genetic markers who breastfed their children and did not get BrCa possibly due to protective effects of either lactation amenorrhea or something else related to bf. The fact that there is any effect at all means there could be more to the story.

Thanks again for the conversation. These are always helpful. Again, best wishes to you in staying healthy.

proven to be cancer causing. there are reports. some time ago I posted a thread on it.

breast feeding, in any pattern, shouldn't be the focus.

and that the breastfeeding rate in African American communities is extremely low. So why on earth shouldn't that be a focus of the investigation?

always wearing a tight brassier is more of a cause then breastfeeding or not.

(breasts need to jiggle and bounce to get rid of toxins)

The whole point of a scientific investigation is to figure out what role that variable plays.

Certainly we do know that breastfeeding has a role in reducing breast cancer and that any reduction in time spent having menstrual cycles (whether as a result of pregnancy, lactation, late onset or early menopause) reduces breast cancer risk. As we also know that AA women tend to have earlier menarche than the general population, they may derive greater benefit from breastfeeding or be at greater risk when they do not breastfeed. Or it may be something else entirely, but it's a simple enough thing to investigate.

I'd also look at diet, especially in a relatively young population.

that's not it either. You were kidding, right?

Do you have a link to something that supports this? With your two post, the only thing missing was the titless argument. By the way, we are mammals so don't try that one.

the tightness of a bra has nothing to do with breast cancer. If it's a strain that was already dominate in the women who were kidnapped from a particular area of the African continent and sold into slavery, and they weren't wearing tight bras and still got it, then no, bra size has nothing to do with it. Gawd!

Hasn't THAT also been linked to breast cancer?

nt

Try not to buy into the myths about breast cancer. Better to stick with scientific evidence.

And in the case of breast cancer in African American women, your statement blaming it on anti-perspirants is racist, sexist and highly inappropriate.

It takes a special kind of person to blame AA women's breast cancer on their use of deodorant. In this case, ignorance kills.

"(breasts need to jiggle and bounce to get rid of toxins)"

:-)

Most studies show no benefit, a couple have shown some benefit and a couple have shown it increases risk. Generally, on a meta level, that means no effect.

makes a difference. If they only nurse for a month, the effect would be minimal.

have followed women for more than 2 years. Its been studied for short duration, long duration, etc.

Still nothing conclusive and nothing to justify further research into what the actual causation may be.

mother in decisionmaking also make a difference in whether a very young mother (such as a teen) decides to nurse. I've heard the prospective grandmother tell the doctor or Physician Assistant, "She isn't going to breastfeed! We're using formula!" This might be true for any ethnic group. The difficulties in getting breastfeeding assistance of a mother from a previous generation can have an impact on the new mom's decision, including how early to wean.

And quite frankly, that makes a lot more sense. There are many women genetically predisposed to breast cancer; this type of cancer (Triple negative) seems to center on a particular geographic region (Senegal, Nigera, parts of West Africa.) In addition, the article states:

"Other research suggests that racial differences may play a role in other cancers as well. Analyzing more than 19,000 patients involved in decades of clinical studies, Kathy S. Albain of Loyola University found evidence that this might be the case for prostate and ovarian cancer."

There is a lot of research on genetics and cancer out there.

Its worth further research, that's why they're following up on it so quickly. This type of breast cancer (called triple negative or basal type) is very aggressive, but has been under-researched.

Its also similar to IBC - inflammatory breast cancer - the type that has a very quick onset, is connected to the lymphatic system and difficult to control.

Also, this subset of breast cancer is very difficult to detect through mammography.

one of my heroes. I've met him a couple of times and greatly admire his work, his advocacy and his courage in speaking out frankly about issues related to minorities, the poor and cancer disparities.

As Dr. Brawley points out - while making everyone uncomfortable,as they should - we're also ignoring the lack of access to quality health care as a reason why there is such a high mortality rate. In fact, many of these kinds of aggressive breast cancers respond well to chemotherapy, the hard part for AA women is getting them into good care.

From the article in the link above:

"The findings have prompted a flurry of research, but the intensifying effort is also raising concern among some doctors. They fear that the focus on biology is distracting from the more critical problem of eliminating racial disparities in care, and that it is reinforcing old prejudices about biological differences among races.

"There is this prejudice that blacks are genetically different than whites," said Otis W. Brawley, an Emory University oncologist. "This reinforces the mind-set that blacks have some kind of biologic inferiority."

PS Don't let Dr. Brawley hear you say AA breast cancer is caused by jiggling breasts, breast feeding or lack of deodorant. He may give you a well deserved dressing down.

I said breasts needed to jiggle and bounce to rid the body of toxins that collect in the breasts. I did not make this up. it came from a research article that I posted here at DU some time ago.

http://www.cancer.gov/cancertopics/factsheet/Risk/AP-Deo

Link from Susan Love, MD about antiperspirants and underwire bras

http://www.susanlovemd.com/breastcancer/content.asp?CATID=0&L2=1&L3=4&L4=0&PID=&sid=130&cid=422

There are more important risk factors to be considered and researched. These just happen to be the ones that catch everyone's attention in the news media.

The harm that can come from focusing on inconclusive risk factors like these is that it makes it very easy for the community and policymakers to ignore addressing the real issues known to reduce breast cancer risks. Many a legislator has declined to act on improving access to health care for breast cancer patients by saying that women don't need screening or treatment if they would just...then follows a list of things that don't really reduce risk, but are touted as such in the popular news media.

tight bras holding toxins in the breast tissue. Deoderants are applied underarm right next to the breast. Systemic assaults on the body from other sources such as chemicals in the hair / body products. Not to mention what is in the air, water and food.

Someone might be genetically predisposed towards cancer but it still takes something to kick it off.

Its ok to accept that bad things happen like breast cancer that we can't personally control. Its also ok to accept that women aren't to blame for getting breast cancer, that there may not have been anything they could have changed in their life for a different outcome.

If we are ever to find a way to treat, cure and really prevent breast cancer, we have to follow the evidence.

There are many different kinds of breast cancer. Those that occur in young women have a strong genetic predisposition and we don't know what all those genetic mutations are. The chain of events that results in a genetic mutation turning into breast cancer in young women is thought to occur early in puberty, at the very beginning of breast development.

As women, we have to be the strongest and most thorough advocates we can be to eradicate this disease. In order to do that, we have to do our homework, understand the research and apply principles of evidence based medicine.
That means we have to set aside certain beliefs when the evidence doesn't support them and keep looking for answers.

Women deserve the very best of our efforts, so lets stick with the evidence and in the meantime, reduce mortality by ensuring access to health care.