HIT ConsultantQ/A: Dr. Johnson Talks Racial Disparities in Breast Cancer Care

Learn about the precise genomic tests and compassionate treatments one doctor is using to address racial inequities in breast cancer care.

JAMA’s latest study highlights a discrepancy in breast cancer care for Black women. The accuracy of widely used genomic tests for breast cancer, such as Oncotype DX, is notably less reliable for Black women. Hence, there’s an urgent call to address racial disparities in breast cancer care, especially as Black women currently face 41% higher mortality rates than white women.

Dr. Nathalie Johnson, President of The American Society of Breast Cancer Surgeons, advocates for Agendia’s tests, which focus solely on biological factors. Such tests disregard race, ethnicity, age, or menopausal status, allowing for truly personalized treatment selection. Moreover, understanding every woman’s unique cancer empowers not only the patients but also their care teams.

Recent research confirms that Black women are more likely to experience high-risk recurrence and death from axillary node-negative breast cancer compared to their non-Hispanic white counterparts. It reveals that Oncotype DX tests have lower prognostic accuracy for Black women. It points to the need for model calibration in genomic assays for populations with more racial/ethnic diversity.

Dr. Johnson emphasizes personalized medicine and stresses the importance of understanding each patient’s unique circumstances. She believes that empowering patients with knowledge about recurrence scores and the genomics of cancer can level the playing field, especially for Black women. Disparity arises when genomic tests like Oncotype DX don’t adequately represent the biology of African American women.

Addressing racial disparities involves initiating conversations around ‘ethnically representative tumor biology.’ With Black women experiencing higher mortality rates despite having the same Oncotype recurrence scores as white women, this logic can extend to other ethnically marginalized communities. Furthermore, Dr. Johnson identifies trust as a significant barrier to enrolling more Black women in clinical trials. Building trust and explaining study objectives can help overcome these barriers.

Lastly, advanced gene expression profiling solutions like Agendia’s MammaPrint provide higher prognostic value for Black women. Unlike Oncotype DX that tests 21 genes, MammaPrint evaluates 150 genes, offering a more comprehensive understanding of the tumor.