Breast Cancer Differences by Race Due to Screening Disparities

To the Editor Black breast cancer patients have the highest breast cancer mortality rate, at least partly because black women are more likely to develop triple-negative breast cancer (TNBC). In addition, while outcomes for estrogen receptor/progesterone receptor–positive breast cancer are generally worse for blacks compared with whites, there are no significant differences in outcomes between blacks and whites for TNBC. Two potential reasons for the overall breast cancer survival gap are (1) disparities in access to care and (2) inherent biological differences. To address the latter, Huo and colleagues recently investigated genetic differences between breast cancers in white and black patients using data from The Cancer Genome Atlas (TCGA). They reported a number of biological differences between black and white breast cancers. Interestingly, most tumor genomic differences between races were explained by subtype. Taking all these past and present data into account, I am not convinced that there are inherent genetic differences between blacks and whites that explain the differences in breast cancer outcomes based on race or ancestry and the proportion of breast cancers that are TNBC. Rather, these differences can be largely explained by disparities in access to care.

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