Black Patients Play Key Role in Advancing Breast Cancer Research
It’s common for people to ask friends to donate to a favorite charitable cause in lieu of birthday gifts, but Charlene Cheatham is taking it a step further. She’s asking her friends to donate their breast tissue.
Some friends have questioned why she can’t just have a birthday dinner, but Cheatham, wants to help them understand how vital it is for Black women to be involved in breast cancer research.
“I tell them we’re doing this to help our families—the next generation—so if they’re diagnosed, they won’t have to suffer, or maybe there will be a cure. This is our contribution,” she said.
While White women are more likely to develop breast cancer in their lifetimes, Black women are more likely to have aggressive types of cancers that occur at a younger age—and to die from breast cancer.
Harikrishna Nakshatri, PhD
These disparities were once thought to be caused by socioeconomic factors, but medical scientists have discovered genetics are also at play. Researchers at the Vera Bradley Foundation Center for Breast Cancer Research are studying how treatments can be tailored for people of different ethnicities to fight breast cancer more effectively and with fewer side effects.
“The outcome in women of African ancestry is far worse than women of European ancestry—even if they have the same cancer type and even if they get the same access to care. My lab is very interested in finding out why,” said Harikrishna Nakshatri, PhD, co-leader of the breast cancer working group at the Vera Bradley Foundation Center for Breast Cancer Research.
Nakshatri is leading a project to map the breast at the single-cell level as part of the Human Cell Atlas initiative. In the more than 5,000 samples of normal breast tissue that have been donated at the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, differences have been discovered based on the genetic ancestries of donors, Nakshatri noted.
This is why Cheatham and other community advocates are partnering with the Indiana University School of Medicine and the Vera Bradley Foundation Center for Breast Cancer Research to spread the word about the importance of including Black women in clinical research for breast cancer.
Collaboration Key to Ending Disparities
Bryan Schneider, MD, with community advocates
“If you don’t have high enough participation from Black women, we’re kind of left out of the research, and they don’t know how different cancer drugs affect us,” said Lisa Hayes, breast cancer survivor and Executive Director of Pink-4-Ever Ending Disparities.
In 2007, she and board president Nadia E. Miller were both diagnosed with triple negative breast cancer (TNBC)—an often deadly form of breast cancer that is not responsive to hormone therapies and is resistant to chemotherapy. Only recently have medical scientists discovered that African American women are more likely to carry a gene mutation which makes them at higher risk for developing TNBC—and having it recur.
“The solution to being able to eradicate disparities is to substantially focus our efforts on understanding why there are differences and then attacking the cancer more effectively,” said Bryan Schneider, MD, the Vera Bradley Professor of Oncology at IU School of Medicine and researcher at the Vera Bradley Foundation Center for Breast Cancer Research.
He discovered another issue contributing to the higher mortality rate for Black breast cancer patients. Peripheral neuropathy—a common side effect of some chemotherapy drugs—causes numbness or pain in the hands, feet or limbs and disproportionately affects African American patients.
“We found, because this toxicity is so significant in our Black patient population, that it has resulted in physicians needing to reduce the dose of this curative chemotherapy, and this is one of the reasons Black patients have inferior outcomes for breast cancer—so it’s a very significant side effect to study,” Schneider said.
A ‘Renaissance’ in Breast Cancer Discoveries
LIsa Hayes and Nadia Miller
In 2017, IU School of Medicine launched a TNBC study, led by Schneider, with the goal of discovering blood-based biomarkers to predict which patients were likely to have a recurrence of the disease. It was important to recruit Black patients to participate.
“We had marketing images with Black women in them, but they weren’t performing well on social media,” said Casey Bales, MPH, program manager for the Triple Negative Breast Cancer Precision Health Initiative and Vera Bradley Monogrammed Medicine. “We realized we needed more help.”
Schneider’s team reached out to Hayes and Miller for advice. They took a look at the existing imagery used in recruitment materials and gave their frank opinions: the pictures looked unwelcoming and “scary.”
“It was an eye-opening experience for our entire group. We sat back and tried to learn from their amazing guidance,” Schneider said.
Hayes and Miller connected the IU team with a local Black photographer and helped recruit breast cancer survivors to be featured in an image library that conveyed hope and courage and connected with the Black community’s values of faith and family.
As a result of this collaborative effort, 30 percent of the BRE12-158 study participants were Black—a number that is significantly higher than the national average of 5 percent participation from Black patients in clinical trials, Bales noted.
“Our partnership gave us an opportunity to create and brand materials that yielded great results. And we got new friends—it was a true collaboration,” Miller said.
Community advocates like Miller, Hayes and Cheatham share resources—and their personal stories—at community outreach events and in everyday settings like church meetings.
“The message is about how their participation can really help—how important it is particularly for Black women to donate breast tissue. It’s a small sacrifice for something that can have a large impact in the future for their families.”
Now a new Phase 2 clinical trial called PERSEVERE is being launched and led by one of our very own researchers, Dr. Bryan Schneider. It aims to enroll 200 participants who are at high risk for a recurrence of TNBC to study the effectiveness of personalized cancer treatment combinations based on patients’ unique genetic data. Participation from Black patients will, again, be vital.
With rapid advances in precision medicine, the medical community is figuring out what treatments work best for which people—and why. Breast cancer research is no longer a sluggish field but an energizing one, Schneider said.
“You’re going to really see massive advances as we begin to learn at a really rapid pace, and our ability to personalize medicine will be markedly better,” he said. “The drugs that are designed to attack these genetic vulnerabilities will be much sharper, much more effective, and have fewer side effects. I think we’re going to improve the cure rates for many patients.”