Table Of ContentBREASTCANCERINWOMEN OFAFRICAN DESCENT
Breast Cancer in Women
ofAfrican Descent
Editedby
SeniorEditor:
CHRISTOPHERKWESI O.WILLIAMS
BritishColumbiaCancerAgencyandUniversityofBritishColumbia,
NanaimoandVancouver. Canada
Editors:
OLUFUNMILAYO I. OLOPADE
UniversityofChicago, Chicago, IL,U.S.A.
and
CARLAI. FALKSON
UniversityofAlabamaatBirminghamComprehensiveCancerCenter.
Birmingham,AL,U.S.A.
~
Springer
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ISBN-IO 1-4020-3664-7(e-book)
ISBN-13 978-1-4020-3682-8(HB)
ISBN-13 978-1-4020-3664-4(e-book)
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TABLE OF CONTENTS
Preface ix
List ofContributors xiii
Acknowledgements xvii
Introduction xix
Chapter 1
Burden ofBreast Cancer inDevelopingandDeveloped
Countries 1
D.Max Parkin
Chapter 2
Genetics ofBreast Cancer in Women of African Descent: An
Overview 23
Offiong Francis Ikpatt and Olufunmilayo I. Olopade
Chapter 3
Biology OfBreast Cancer:
Molecular and Pathologic Features ofDuctal Neoplasia ofthe
Breast: Racial Considerations 39
David F. Chhieng, Andra R. Frost, Lynya I. Talley, William E.
Grizzle
Chapter 4
Screening and Early Detection ofBreast Cancer in Women in
Africa andthe Middle East 71
B.1.Rapoport
BreastCancerinWomen ofAfricanDescent
VI
Chapter 5
Breast CancerAt Diagnosis inWomen ofAfrica and the Middle
East 81
Hussein M.Khaled
Chapter 6
BreastCancer Aggressiveness inWomen ofAfrican Descent. 91
Paul H. Levineand CarmelaVeneroso
Chapter 7
Radiotherapy ofBreast Cancer. 119
01usegun Agboola
Chapter 8
AdjuvantTherapy ofBreast Cancer 153
ChristopherK. O.Williams and CarlaFalkson
Chapter 9
Endocrine TherapyofBreast Cancer 221
Kathrin Strasser-Weippl and Paul E.Goss
Chapter 10
Palliative Care for Breast Cancer in the African-American
Population 249
Joseph O'Donnell
Chapter 11
Outcome of African American Women with Breast Cancer in
CooperativeGroup Clinical Trials 267
Joseph M.Unger,Stephanie Green and Kathy S.Albain
Chapter 12
Traditional Medicine in Breast Cancer Management with a
Focus onthe Chinese IntegrativeApproach 297
StevenK. H.Aung
Chapter 13
Impact ofCulture,Education and Socio-economic Status 313
Rhonda S.Moore
Contents VII
Chapter 14
Barriersto SuccessfulManagementofBreastCancer 334
ChristopherK. O.Williams
Index 365
PREFACE
Cancer is a global problem and, increasingly, cancer research is a
collaborative international enterprise. Breast Cancer in Women ofAfrican
Descent is an important contribution to our understanding of the global
dimensions of this problem in black women around the world. Not only
does it summarize key information and place it in context, it helps define
many ofthe relevant research questions and methodological issues that must
be addressed if black women are to benefit fully from the many advances
thatarebeing madeagainst breastcancer.
For some time, it has been recognized that although black women in the
United States have a lower incidence of breast cancer than white women,
they have a higher mortality rate. The importance and relevance ofrace for
the genetics and biology of the disease are controversial and poorly
understood and remain the subject of research. However, it appears certain
that some of the disparity in outcome can be attributed to lack ofaccess to
high quality medical care, both for screening and early detection and for
treatment. Less access to, or utilization of, screening services, such as
mammograms, may explain in part the tendency toward more advanced
disease at presentation that contributes to a higher mortality rate in black
women.
This book highlights the even greater obstacles faced by black women in
the developing world where modem technology and treatments may be
largely unavailable. It also addresses the context of cultural attitudes and
beliefs inwhich breast cancer inblackwomen mustbe addressed.
Breast cancer research studying black women is fraught with many
methodological issues and challenges which are discussed throughout this
text.They includetherelatively smallnumbers ofblack women participating
in research studies and clinical trials which makes even most randomized
Phase 3 trials grossly underpowered to detect significant differences in
ix
x BreastCancer inWomen ofAfricanDescent
outcome, or other factors, attributable to race. Often potentially relevant
factors such as socioeconomic status, age, and important tumor
characteristics, which could confound our understanding of the outcomes,
arenot well studied orcontrolled.
Complexities in performing risk assessments and providing management
advice for black women based on genetic differences of unknown
significance, such as mis-sense variants in BRCA I and 2 are also
highlighted. Furthermore, many of the models used to determine risk and
develop molecular diagnostic markers have been developed in largely non
hispanic white populations and their direct applicability to women from
other racial groups may be uncertain. Eventually, technology may enable a
molecular classification of each individual's risk and each patient's tumor
andrender race atrivial and irrelevantbiological issue. Untilthen,thisbook
provides useful and provocative insights into possible biological variables,
while at the same time reminding us of some of the critical social and
cultural issuesthat contributetoapooreroutcome forblackwomen.
Beyond the challenges of doing effective research regarding breast
cancer in black women is the whole area of effective treatment. Because
black women are distributed throughout the Diaspora, cultural issues may
differ significantly from community to community. Several chapters
describe the impact of cultural beliefs and traditions on the treatment and
course ofbreast cancer. In addition, issues related to attitudes toward and
access to end of life care are raised that clearly have implications beyond
breast cancer.
For health careprofessionals whose experience is limitedprimarily to the
United States, many ofthe attitudes that influence patient behavior in other
cultures may be particularly unfamiliar. The ramifications of shame are
discussed, not only forthe cancer patient butpotentially also fortheir family
and may have a significant bearing onhow patients relate to theirphysicians
and health care providers and ultimately onthe management oftheir cancer.
The importance of increasing the cultural competence of medical
professionals as a whole and of increasing the number of non-white
physicians and other health care professionals who may understand relevant
cultural issues and bring that insight to research and practice settings is also
discussed inanumber ofchapters.
The answers to some ofthe important questions regarding this common
cancer in black women lie in rigorous research to help us better understand
the underlying complex biology and will be limited by our general
understanding ofcancer biology. However,this bookalso drawsattention to
the critical role that appropriate social policies might play to address the
barriers that limitthe access blackwomen have to high quality medical care,
both in the United States and in many other parts ofthe world. By placing
Preface xi
breast cancer in black women in context and highlighting many ofthe most
challenging issues, new research approaches will be apparent and it is likely
that this new text will stimulate high quality research that will address some
ofthe many remaining questions utilizing rigorous methodologies. Issues of
importance inpractice managementand the care ofbreast cancer patients are
also covered and will make this book ofinterest to practitioners. Hopefully,
itwill also be useful to policy-makers who are working to solve some ofthe
access problems that contributeto disparate outcomes for black women with
breast cancer and other life-threateningdiseases.
MichaeleC.Christian,M.D.
Associate Director
Division ofCancerTreatmentand Diagnosis
Cancer Therapy Evaluation Program
National Cancer Institute, National Institutes ofHealth
LIST OF CONTRIBUTORS
Olusegun Agboola MB,BS (IE); DABR (T);FRCPC
Ottawa Regional Cancer Centre and University ofOttawa, Ottawa, Ontario,
Canada
Kathy S.Albain,MD
Loyola University Chicago Medical Center, Cardinal Bernardin Cancer
Center, Maywood,IL,USA
StevenK. H. Aung,MD, FAAFP
Departments of Medicine and Family Medicine, University of Alberta,
Edmonton, Canada
David F.Chhieng, MD
Department of Pathology, University of Alabama at Birmingham,
Birmingham, Alabama, USA
Andra R. Frost, MD
Department of Pathology, University of Alabama at Birmingham,
Birmingham, Alabama, USA
Paul E.Goss, MD, FRCPC, FRCP (UK), PhD
Department of Medical Oncology and Hematology, Princess Margaret
Hospital, University Health Network, Toronto, ON, Canada, and Harvard
Medical School, Boston, MA, USA.
Stephanie Green, PhD
Southwest Oncology Group Statistical Center, Seattle, WA, USA
Xlll
