Racial disparity in breast cancer: can it be mattered for prognosis and therapy

Abstract

Breast cancer (BC) has emerged as a deadly disease that affects the lives of millions of women worldwide. It is the second leading cause of cancer-related deaths in the United States. Advancements in BC screening, preventive measures and treatment have resulted in significant decline in BC related deaths. However, unacceptable levels of racial disparity have been consistently reported, especially in African-American (AA) women compared to European American (EA). AA women go through worse prognosis, shorter survival time and higher mortality rates, despite higher cancer incidence reported in EA. These disparities are independent of socioeconomic status, access to healthcare or age, or even the stage of BC. Recent race-specific genetic and epigenetic studies have reported biological causes, which form the crux of this review. However, the developments are just the tip of the iceberg. Prioritizing primary research towards studying race-specific tumor microenvironment and biological composition of the host system in delineating the cause of these disparities is utmost necessary to ameliorate the disparity and design appropriate diagnosis/treatment regimen for AA women suffering from BC. In this review article, we discuss emerging trends and exciting discoveries that reveal how genetic/epigenetic circuitry contributed to racial disparity and discussed the strategies that may help in future therapeutic development.

Keywords: African-American; Breast cancer; European American; Racial disparity; Tumor microenvironment; microRNAs.

Fig. 1

a. Histology of a normal human mammary duct and cell types. b. Subtypes of breast cancer and the heterogeneity within these types

Fig. 2

A model depicting different factors which contribute to breast cancer disparities in African American and European American women

Fig. 3

A pictorial representation showing how the current breast cancer diagnosis modality needs to be altered to include racial factors, tumor biology, lifestyle and diet and use this cumulative data to design appropriate treatment modality for breast cancer patients