Breast Cancer expert William Irvin MD
October is Breast Cancer Awareness Month, which provides an opportunity to learn more about a disease that impacts the lives of approximately 300,000 people, mostly women, in the U.S. each year. Did you know that breast cancer impacts African Americans in different ways than other populations?
For example, breast cancer incidence rates are higher among African Americans than whites for women under age 45. [Source: American Cancer Society. “Cancer Facts & Figures for African Americans 2016-2018.” Atlanta: American Cancer Society, 2016.]
Below is a Q&A discussion with William J. Irvin, Jr., M.D., director of medical oncology and director of clinical research for Bon Secours Cancer Institute. He is a member of the breast team of experienced physicians, nurses and technicians at Bon Secours.
What is unique about the way that breast cancer affects African American populations?
Breast cancer in women younger than age 40 and a form of aggressive breast cancer – triple-negative – appear to be more common in African American women than in other racial groups. Also, while the highest rates of breast cancer occur in white women, African American women more commonly present with advanced or higher stages of the disease and have higher breast cancer mortality rates.
Why is this the case?
Access to health care and biologic differences that make breast cancer more aggressive in the African American population contribute to this disparity.
What types of breast cancer are most prevalent in African American populations?
The Carolina Breast Cancer Study, conducted from 1993-1996, showed that the basal-like breast cancer subtype (mostly the triple-negative, or estrogen receptor negative, progesterone receptor negative and HER 2 negative breast cancer) is more prevalent among young or premenopausal African American women, while the less aggressive luminal A subtype (mostly estrogen receptor positive) is less prevalent.
Why are clinical trials for breast cancer so important?
Clinical trials are the only way that we have improved the lives of people with cancer. All of our technologies for detection, treatment and symptom management have been developed through clinical trials. Today’s clinical trials are tomorrow’s therapies. They are the roadmap for the cure of this disease.
What types of clinical trials are conducted by Bon Secours to learn more about treatment of cancers that impact African American women?
We have a strong interest and passion for clinical trials with women who have triple-negative breast cancer, which disproportionally affects young African American women.
Is there any downside to participating in a clinical trial?
History has horrible examples of evil and corruption in clinical trials (eg., theTuskegee, state sterilization programs). Fortunately, we now have federal and international safeguards to prevent history from repeating itself. Participation in cancer clinical trials may provide access to a novel therapy, as well as access to well-trained physicians and nurses who are experts in their field to manage the symptoms of cancer treatment. Any therapy has potential side effects. The known risks must be discussed during the informed consent process. Participating in a clinical trial means that the knowledge gained from the study may or may not help you, but it will definitely help a patient in the future.
Is it possible that I might be given a placebo in a clinical trial?
Placebo-controlled studies have an important role in proving that a therapy works, thus protecting us all from our own biases towards success. Placebos are either added to standard-of-care therapies (so everyone gets medication) or given in trials where the absence of medication is not harmful. The discussion and role of placebos is crucial to the informed-consent process and should be crystal clear prior to participation in a clinical trial.
How long does a clinical trial take?
This depends on the question that the trial is trying to answer. A trial focusing on symptoms may take only one or two visits, while a trial focusing on a novel therapy for metastatic breast cancer – cancer that has spread to other places in the body – may take many years to conclude.
How can African American women participate in these trials?
The most important thing one can do is ask. Ask questions about what trials are offered, either at your place of treatment or elsewhere in the area. Clinicaltrials.gov is an excellent website that is searchable by disease, drug, state and city.
Do you have any recommendations on how African American women can reduce the risk of developing breast cancer?
This is a difficult question to answer because several factors are not able to be controlled such as one’s genetics, family history, gender and aging. Factors that definitely are within a person’s control are engaging in regular physical activity and avoiding smoking and heavy alcohol use.
What if a woman is diagnosed with an aggressive form of breast cancer?
Aggressive forms of breast cancer require state of the art therapies, including chemotherapy, for the goal of a cure.
Do men get breast cancer?
Yes, but at a rate much lower than women.
What advice can you share to promote breast health for African American women?
Find a physician who will be a trusted partner in the care of your health. Also, from age 40 onward, have a mammogram annually. Early detection through the use of screening mammography is important, but some forms of breast cancer, such as triple-negative, may be very aggressive no matter how small it is when detected.
Where can I get more information about breast cancer research, treatment, etc.?
Two good starting points are bonsecours.com/richmond and cancer.org
