Dr Hatem Soliman on Disparities in Metastatic Breast Cancer

A combination of biology, access issues, and delayed diagnoses have contributed to disparities experienced by Black women with metastatic breast cancer, explained Hatem Soliman, MD, medical director of the Clinical Trials Office, Moffitt Cancer Center.

Hatem Soliman, MD, medical director of the Clinical Trials Office, Moffitt Cancer Center, discusses his presentation at the National Association of Managed Care Physicians Spring Managed Care Forum, which highlighted disparities experienced by Black women with metastatic breast cancer.


You note in your presentation that Black women are 40% more likely to die from metastatic breast cancer. Can you explain what disease pathophysiologies contribute to this disparity?

The issues of disparities and outcomes for minority women with metastatic breast cancer is a persistent and stubborn problem, which stems from a number of factors and has been the subject of research for many, many years. Researchers have tried to look at various elements of health care in order to try to figure out what are the main drivers of the disparities that have been noted in minority, and in particular African American women, with metastatic disease.

Some of this disparity does center around the fact that women who are African American have been shown to have a higher predisposition, in many cases, to getting diagnosed with more aggressive subtypes of breast cancer, such as triple negative breast cancer, which is a type of breast cancer that is not sensitive to anti-estrogen treatments and also does not respond to HER2 targeted therapies as well.

Recently, that has required us to look at other avenues to treat these patients because, historically, their treatments were mostly focused around cytotoxic chemotherapy. With the advent of certain treatments like immunotherapy for women with triple negative breast cancer, and also certain other targeted agents and antibody drug conjugates, our options in the space are increasing. And, accordingly, we are getting some patients that can respond nicely to these drugs.

However, I would say that, particularly in younger African American women, we do see fairly drug resistant types of triple negative breast cancer that can be difficult to treat successfully, and then can lead to their death earlier than women with other subtypes of breast cancer that may be more treatment responsive or have more treatment options.

The other issue that I think that is important to point out is that, it is not all just about biology contributing to disparities. There's a wealth of research out there that suggests that there are also disparities in access and in timely diagnosis for African American women in disadvantaged or socioeconomically challenged areas, whereby their ability to seek prompt care and get timely diagnosis and rapid access to treatment is challenging. That delay and difficulty in seeking care can lead to an inferior outcome in many cases. So, much of the work is looking at the biologic cases or reasons for disparity in African American women. There's also a lot of attention being focused on how do we address barriers to timely and efficient care for women in minority communities.

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