Drug-Resistant Breast Cancer Afflicts Blacks

Scientists Look at Genes, Breast-Feeding Patterns

Lorie Williams thought for months that she might have a lump in her breast. But when the doctor said it was cancer, she was still stunned. After all, she was just 29 years old, no one in her family had ever had breast cancer, and she had never heard of anyone getting the disease so young.

"I was just numb," said Williams, who lives in Holly Springs, N.C. "I couldn't believe it was really happening. Then I just became hysterical."

Women such as Williams have become the focus of an intense effort to solve one of the most pressing mysteries about breast cancer: Why are black women, who are less likely to get the disease than white women, more likely to get it when they are young -- and much more likely to die from it?

Now, researchers have uncovered a crucial clue: Black women, particularly young ones, get hit much more often by an aggressive form of breast cancer that is invulnerable to many of the latest treatments.

That discovery, however, has raised a thicket of new questions and an intense debate. Are black women prone to the deadlier cancer for genetic reasons? The same deadly form of breast cancer turns out to be extremely common in parts of Africa where the slave trade was centered, indicating that genes play a role. Or is it something else? Researchers have also found evidence that other factors, such as breast-feeding patterns, may be key.

The findings have prompted a flurry of research, but the intensifying effort is also raising concern among some doctors. They fear that the focus on biology is distracting from the more critical problem of eliminating racial disparities in care, and that it is reinforcing old prejudices about biological differences among races.

"There is this prejudice that blacks are genetically different than whites," said Otis W. Brawley, an Emory University oncologist. "This reinforces the mind-set that blacks have some kind of biologic inferiority."

But others argue that the emerging picture of breast cancer marks a transforming development in the battle against the disease, particularly for black women.

"It's a sea change for how we think about the problem of breast cancer in African American women," said Rowan T. Chlebowski, who studies breast cancer at Harbor-UCLA Medical Center. "It's really changing the debate."

Researchers have long thought that the reason black breast cancer patients were more likely to die was the stubborn inequities in the quality of care that minorities receive. Black women tend to get fewer mammograms, to get their diagnosis after their cancer has already spread and to receive less aggressive treatment once diagnosed, many studies have shown.

Those factors do play a significant role. But recent research has found that even when everything is equal, black women are less likely to survive.

At the same time, researchers using the latest molecular tools have discovered that breast cancer comes in at least five variations. One, called "triple-negative" because it lacks three key markers that distinguish tumors, grows quickly, recurs more often and kills more frequently. It is much harder to prevent and treat because it does not respond to the newest drugs, including those that block estrogen and targeted therapies such as Herceptin.