Five Thousand (5,000)+ years after the discovery of breast cancer, triple negative breast cancer (TNBC) was officially recognized as a distinct type of breast cancer in 2006.
That was just 11 years before my diagnosis.
That discovery was quickly followed by a massive amount of research funds for TNBC. The Komen Foundation, for example, invested more than $74 million in over 100 research grants focused on triple negative breast cancer. The Triple Negative Breast Cancer Foundation teamed up with the Komen Foundation in 2009, pledging a total of $6.4 million over five years to fund research to support the discovery of new TNBC treatments. That may sound like A LOT of money and for sure, it is.
Overall, breast cancer is one of the best research-funded diseases in this country. According to Cancer Health (www.cancerhealth.com), breast cancer research received over $460 million for research. That figure is twice as high as the next highest-research-funded cancer, leukemia at $201 million. I fully am aware that I have benefited from such research funding over the years. The past 20 years uncovered so much about breast cancer. Those discoveries are a direct effect of funding for research and clinical trials. I wanted to very much further that work and my participation in the TNBC clinical trial serves this purpose for me.
And the discovery of TNBC, the focus on the disease, the funds for research and trials, and the success of the research all seem to be paying off!
In 2011 – just 5 years after the discovery of TNBC - six different subtypes of TNBC were identified by a project, led by Komen Scholar Dr. Jennifer Pietenpol and funded by Komen and the Milburn Foundation. As of 2017, several clinical trials are now underway that will test new, targeted treatments for the TNBC subtypes.
Just FYI, I do not know my TNBC subtype. I was diagnosed on the crisp of the discovery of the TNBC subtypes and regular testing for the biomarkers was not available. I fell under – as still most TNBC’ers do – with the tried and true but brutal, chemotherapy treatment of an anthracycline such as Adriamycin – one of if not the most powerful chemo drug invented, affectionately known as the “red devil” (its red in color) - and Cyclophosphamide (the twins otherwise known as “A/C”), followed by a Taxane, such as Taxol or Taxotere. Eleven years after the discovery of TNBC, I was fortunate to be on the cutting edge – following a successful clinical trial - of introducing to the “chemo party” a fourth chemotherapy drug, Capecitabine, also known as Xeloda. Xeloda is now part of the standard of care for TNBC patients with residue tumor post A/C, T.
Clearly, the pace of research, thus knowledge about the biological terms of TNBC, has picked up in just the last few years. But back to my original topic of this – now VERY long blog series: WHO tends to be diagnosed with TNBC? And WHY is that? AND how does that relate to me?
So, it’s back to “Dr. Google”. From another trusted site, Triple Negative Breast Cancer Foundation (tnbcFoundation.org), “several studies suggest that being premenopausal or of African ancestry increases your risk of developing basal-like or triple-negative breast cancer. Among African American women who develop breast cancer, there is an estimated 20 to 40 percent chance of the breast cancer being triple-negative. Researchers do not yet understand why premenopausal women and women in some ethnic groups have higher rates of triple-negative breast cancer than other groups of women.”
Let that sink in a bit. Of all the Black and Brown women diagnosed with breast cancer, up to 40% of them have TNBC.
Previous studies have reported that Black women in the US are twice as likely as white women to be diagnosed with TNBC. However, a 2019 ground-breaking study from the American Cancer Society (ACS) suggests that saying that all Black women have a higher risk of being diagnosed with TNBC may be too general of a statement. According to ACS, “the study reported the prevalence of TNBC in Black women varies significantly depending on where the women were born. More specifically, Black women born in the US and Western Africa were diagnosed more often with TNBC than women born in East Africa.”
The study continues, “compared with the prevalence of TNBC among Black women born in the US, Black women born in West Africa had similar rates to Black women born in the US; the Caribbean had a 13% lower prevalence; and those born in East Africa had a 47% lower prevalence rate.”
So, I don’t know. Was the slowness surrounding the discovery and subsequent push for research of TNBC because the disease affected a smaller % of breast cancer patients on the whole than other types of breast cancer? Recall the power grid analogy, if you will. Was it because a drug, Taxoifen, was already used in women for birth control and thus was an “easy” treatment win for some types of breast cancer but not for TNBC? IN other words, had that drug-relationship in women not already been made, would it have taken longer for the first breast cancer treatments to arrive? Did the pace of research and knowledge of TNBC have anything at all to do with WHO was more commonly affected with TNBC?
Maybe a combination of all factors. Maybe.
What I do know is, widely speaking, Black people die from disease in far larger numbers than white people who have the same disease. And so, the remainder of this post will be about the education of these facts. To better myself, my anti-racist self, I will use my voice to speak truth on this. I hope you will continue to read on and join me on this journey.
According to WebMD.com, “Blacks are 3 times more likely to die of asthma than whites; Black Americans are 3 times more likely to suffer sarcoidosis than white Americans; Black American children are 3 times as likely as white American children to have sleep apnea; Black American men are 50% more likely to get lung cancer than white American men; and for goodness-sake: Black Americans are half as likely to get flu and pneumonia vaccinations as white Americans.”
Dr Yancy continues, “We must recognize there are some arbitrary issues that are present in the way we practice medicine and dole out health care. It forces us to think very carefully about the very volatile issue of race and what race means. At the end of the day, all of us acknowledge that race is a very poor physiological construct. Race is a placeholder for something else. That something is less likely to be genetic. It is more likely to have to do with socioeconomics and political issues of bias as well as physiologic and genetic issues that go into that same bucket. Some racial differences are more nuances. But there are issues of disparity and there are issues relative to racism that operate in a very broad context."
What I can do is
use my voice, my blog, to talk about the diagnosis and outcome disparities between
white women with TNBC and Black women with TNBC. Because they are stark. Even
though as Dr. Yancy says, “all humans have the same
physiology, are vulnerable to the same illnesses, and respond to the same
medicines”. Outside factors such as systematic racial inequalities to access and/or affordable preventative and general health care should be considered. And certainly the lack of medical research focusing on why these disparities exist and how to resolve them needs to be highlighted.
Just as the discovery of TNBC in 2006 spearheaded a massive amount of funding and knowledge about TNBC, so may the knowledge, acceptance, and actions to reverse the health effects of racial inequalities in this country provide an avenue and an opportunity to close the diagnosis and survival gaps. Everyone - everyone - living with Cancer has HOPE for a cure, HOPE for the speed and success of medical research, HOPE to live a long life.
It seems I have more in common with Black and Brown women after all. Perhaps we ALL do.
In solidarity. #BLM #KeepRooting4Me #BreastCancerAwarenessMonth