A breast cancer diagnosis is devastating. For some Black women, the good fortune of having an oncologist who also happens to be a Black woman is a real comfort. Meet Dr. Lisa A. Newman. A renowned African American surgical oncologist, she is the Professor of Surgery and Director of the Breast Care Center for the University of Michigan. Even her downtime is invested in the fight against breast cancer; she currently serves as Chief National Medical Advisor for Sister’s Network, Inc., and on the Triple Negative Cancer Foundation’s Scientific Advisory Board.
Dr. Newman recently sat down with EBONY.com to provide answers and make it plain why Black women really need to participate in clinical trials.
EBONY: Why is breast cancer screening and early detection important?
Dr. Newman: It is essential for African American women to understand the importance of breast cancer screening and early detection. Finding a breast cancer at a small size through a screening mammogram and seeking prompt medical attention when a danger sign appears (regardless of age and regardless of the mammogram report)— such as a new breast lump or bloody nipple discharge—is essential. If the cancer is diagnosed at an early stage, then the woman is more likely to be able to avoid chemotherapy; she has more surgical treatment options; and most importantly, she is more likely to receive treatment that will turn out to be curative.
EBONY: Curative is a great word. Speaking of moving toward a cure, what are some of the advances in breast cancer treatment?
Dr. Newman: Many breast cancers require a multimodality or multidisciplinary treatment approach, which means that we combine surgery with nonsurgical treatments, such as radiation therapy, chemotherapy, and/or hormonally-active cancer-fighting pills. This multi-layered treatment approach is lifesaving because it is the most effective way to eradicate the cancer in the woman’s breast as well as the microscopic breast cancer cells that can hide in other parts of her body, such as the liver, lungs, bones, etc. We have made some wonderful advances in the surgical, as well as non-surgical, treatments of breast cancer over the past couple of decades, and many more improvements are on the horizon.
EBONY: What are some of the surgical options available for women with breast cancer?
Dr. Newman: We have come a long way from the horrific days in the past when the only option for a woman with a breast lump was to go into the hospital for surgery to evaluate that lump, and the surgeon would decide while the woman was under anesthesia whether or not complete removal of the breast with mastectomy was necessary. Today, we can offer less-disfiguring procedures to many patients, such as lumpectomy with radiation therapy, thereby saving the breast. Patients that do require a mastectomy can choose from a variety of breast reconstruction procedures that are usually performed at the same time as the mastectomy, and the Women’s Health and Cancer Rights Act of 1998 (WHCRA), mandates that the insurance policy cover these breast reconstruction procedures, even if they are performed many years after the mastectomy surgery.
EBONY: What are some of the non-surgical treatment options for women with breast cancer?
Dr. Newman: We now have more powerful therapies that can kill the cancer cells hiding throughout the body, and this is important because the life-threatening aspect of breast cancer is related to the risk of the cancer damaging our critical organs such as the brain, liver, lungs, or bones. Chemotherapy is therefore lifesaving for many breast cancer patients, but it remains unpleasant treatment because it [may cause] temporary hair loss, nausea, and other side effects. Today however, we not only have more effective chemotherapy that can target the particular pattern of the cancer with fewer toxicities, but we also have better medications to combat chemotherapy side effects. We also have special genetic profiling tests that we can perform on the cancer to help us determine whether it is an aggressive type for which chemotherapy will be necessary.
EBONY: What are some of the breast cancer risks that are specific to African American women?
Dr. Newman: African American women are more likely to be diagnosed with breast cancers at younger ages compared to White American/Caucasian women. Although breast cancer can occur at any age, the average age at breast cancer diagnosis is 62 years for White American women compared to 57 years for African Americans. We are also more likely to be diagnosed with biologically aggressive tumors, called triple negative breast cancer. The name triple negative relates to the fact that these tumors are negative for three microscopic markers that we look for on breast cancers: the estrogen receptor, the progesterone receptor, and the HER2/neu marker. Male breast cancer is rare, but it occurs more commonly in African Americans and Africans compared to White Americans and Europeans.
EBONY: While there have been medical advances and breast cancer has become more treatable and curable in the last two decades, why does it seem that African American women haven't benefited from these advances?
Dr. Newman: One of the most important reasons that African American have been less likely to benefit from many breast cancer treatments is related to the socioeconomic disadvantages that are more prevalent in the African American community. Poverty and inadequate health care access results in more African American women being diagnosed with bulky and advanced breast cancers, where the treatment options are less likely to be curative.
Another reason is that African American breast cancer patients are also more likely to be treated in large safety net institutions that might not have breast cancer surgical or medical specialists available, and so the multidisciplinary treatment advances or clinical trial opportunities are less likely to be available at these facilities as well.
A final and hugely important reason why African American women have benefited less from the treatment advances that we have made is related to patterns of breast tumor biology that are more common in women with African ancestry. African American women and women from sub-Saharan African are more likely to be diagnosed with tumors that we call “triple negative breast cancer”.
The name triple negative relates to the fact that these tumors are negative for three microscopic markers that we look for on breast cancers: the estrogen receptor, the progesterone receptor, and the HER2/neu marker. For each of these markers we can tailor the medical/non-surgical treatments so that they target, or focus on the particular marker. While general chemotherapy can work very well for triple negative breast cancers, we would prefer to find a targeted therapeutic approach, which would have fewer side effects. Unfortunately, the triple negative breast cancers also tend to be more aggressive biologically and therefore more challenging to treat.
Why is it important for Black women to participate in breast cancer clinical trials?
Dr. Newman: Clinical trials are important because they represent our most powerful strategy for developing better breast cancer treatments. Breast cancer treatments are more effective when they target the particular pattern of the tumor, and so we need clinical trials that address the patterns that are more common among African American women. As health care providers, we need to make sure that we take the time to discuss clinical trials whenever they are appropriate options for our breast cancer patients. Several studies have demonstrated that the most important determinant of clinical trial participation is simply whether or not the doctor offered it to the patient.
EBONY: What should we know about clinical trials?
Dr. Newman: Patients should know that clinical trials are extremely carefully regulated to ensure their safety, and to monitor participants. Breast cancer treatment trials can be designed as long-term studies to evaluate the side effects and results of treatment, or they might be designed as comparative studies where the most common and widely accepted known treatment is compared to some new treatment for which research evidence suggests that it might be better than the older approach. Clinical trials for breast cancer treatment however, will never involve use of a placebo, or sugar-pill.
EBONY: How can an African American woman participate in a breast cancer clinical trial?
Dr. Newman: The cancer-treating team (surgeon, medical oncologist, and/or the radiation oncologist) will usually be the best resource for the breast cancer patient in determining whether or not clinical trial participation is reasonable and appropriate. Alternative resources include advocacy organizations or institutions such as the Sisters Network Inc., Susan G. Komen for the Cure, the Triple Negative Breast Cancer Foundation, the American Cancer Society, and the National Cancer Institute.
Clinical trials are expensive to conduct and so patients can often strengthen their options for participation by seeking additional opinions and/or care at an established comprehensive cancer center. These specialized cancer centers are more likely to have the infrastructure that can support the conduct and regulatory requirements of a clinical trial. It is important for patients to also understand however, that clinical trial participation does not necessarily require patients to completely discontinue care with their original physicians. Many clinical trials allow for physicians at different facilities to work together in coordinating cancer care, as long as the doctors agree to share information.
For a comprehensive resource to help you understand complex medical and personal information about breast health, visit: Breastcancer.org – a nonprofit organization dedicated to providing the most reliable, complete, and up-to-date information about breast cancer.