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The most commonly ordered test for breast cancer patients may lead doctors down the wrong path when it comes to chemotherapy recommendations for Black patients, a January study from the University of Illinois Chicago (UIC) found.
The test, known as the 21-gene recurrence score assay, identifies aggressive tumors in patients with estrogen receptor-positive breast cancer and assigns a recurrence score (RS) to the cancer’s aggression level. A lower RS represents a lower risk of breast cancer returning after hormone treatment—meaning the benefits of chemotherapy are unlikely to be greater than the side effects—and vice versa for a higher score.
The cutoff range for RS is different depending on if patients are over or under the age of 50, but it stays the same regardless of the ethnicity or race of the patient. However, according to the study, there are “significant racial differences in the association between chemotherapy treatment and breast cancer death.”
Nearly all patients with estrogen receptor-positive breast cancer—the most common type of breast cancer—receive hormone treatment, regardless of chemotherapy recommendation, in the form of estrogen blocker pills. However, the researchers found that estrogen blockers have less of an effect on the tumors in Black patients than they do on tumors in patients of different ethnicities and races, showing a “biological difference” between tumors in Black and white patients, according to a statement in UIC Today.
Another exploratory finding in the study suggested that “there may be a reduction in breast cancer death with chemotherapy at a lower RS cutoff for [non-Hispanic Black] compared with [non-Hispanic white] women.”
Despite the finding, Kent Hoskins, a UIC oncology professor and one of the senior writers on the study, told UIC Today that a fuller study needs to be done before researchers can recommend doctors lower the RS threshold for Black patients. He also emphasized that the biological difference doesn’t negate structural racism as a reason that Black patients have worse outcomes within the healthcare system.
“We believe that it’s actually the same forces that lead to inequities in care that are driving this more aggressive biology,” Hoskins said in the statement.