Presurgical Endocrine Therapy Outcomes Are Better for Black Women With Early-Stage Breast Cancer, But Benefit Drops Off for Late-Stage Disease

In early-stage breast cancer, Black women are more likely to benefit than White women when treated with neoadjuvant (presurgical) endocrine therapy. However, in late-stage disease, White women tend to benefit more, according to study results presented at the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.

“Our findings suggest that neoadjuvant endocrine therapy alone may not be the best approach in black women who present with more advanced tumors,” Dr. Veronica Jones, an assistant professor in the Department of Surgery within the Division of Breast Surgery at City of Hope in Duarte, California, said in a press release.

Jones and colleagues analyzed data of 3,521 White women and 365 Black women with HR-positive breast cancer who received neoadjuvant endocrine therapy.

At the time of diagnosis, Black women were more likely to have cancer in their lymph nodes or be diagnosed at stage 3. They also tended to undergo neoadjuvant endocrine therapy for longer, with Black women receiving an average of 128 days of the treatment, compared to 114 days for White women. Similarly, Black women were 1.5 times more likely to receive neoadjuvant endocrine therapy for more than 24 weeks.

Findings showed that for cancers that were diagnosed at stage 1 or 2, Black women were 2.9 times more likely to have their tumor downstaged (meaning that it was changed to be classified as “in situ” or the earliest stage of breast cancer) or eliminated completely. Conversely, for stage 2 or 3 disease, Black women were found to be 2.6 times more likely to experience tumor upstaging (meaning that it was reclassified at stage 4) than their White counterparts.

“While lower-stage cancers in black women responded better to endocrine therapy compared to white women, higher-stage cancers in black women did more poorly in response to endocrine therapy,” Jones said. “This suggests a different tumor biology that may impact the treatment we give.”

Now, Jones and her team are investigating potential differences in mutations and gene expressions between White and Black women with breast cancer, with the hopes of establishing the groundwork for more targeted therapies for patient populations.

“This project is a critical step in unpacking the heterogeneity of hormone receptor tumor biology,” Jones said. “It brings into question how we can more effectively manage this disease to mitigate breast cancer racial disparities.”

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