Drug-Resistant Breast Cancer Afflicts Blacks

"We know it's probably not just the genes. It's the genes working in concert with the environment," said Olopade, who is working with a team to study women with triple-negative cancer in poor, crime-ridden Chicago neighborhoods to explore the effects of stress.

"We're looking at whether racism and violence over a lifetime might matter. That is a hypothesis that's being tested," Olopade said.

Other research suggests that racial differences may play a role in other cancers as well. Analyzing more than 19,000 patients involved in decades of clinical studies, Kathy S. Albain of Loyola University found evidence that this might be the case for prostate and ovarian cancer.

"We want to go beyond triple-negative," Albain said. "Triple-negative is not the whole story. Our hypothesis is there must be molecular, biological, pharmacogenetic and hormonal aspects involved."

Whatever the cause, the realization that black women develop triple-negative cancer more frequently suggests that current strategies to fight breast cancer are inadequate.

"The problem with mammograms is we recommend to do it once a year. But if a cancer doubles in two or three months, it would be less likely that a mammogram would pick it up for early diagnosis," Olopade said.

Because triple-negative tumors do not respond to some of the newest drugs to prevent and treat breast cancer, and to reduce the risk of recurrences, researchers are urgently trying to develop new therapies.

"We now know that this one special subtype of tumor is the bad player here. We need to understand more about the biology of this tumor so we can develop therapies against it," said Charles Perou of the University of North Carolina, who is testing experimental protocols.

But some are cautious about the idea of using race to classify people biologically.

"Racial classifications as we use them in this country are not based on biology," said Harold P. Freeman, who advises the director of the National Cancer Institute on cancer disparities. "We have to be very careful not to imply that race is a biological category, when it really isn't."

Freeman and others worry that the focus on such biological differences distracts from efforts to improve access to care, which has been shown to be a major factor.

"So much attention is being put on this problem that we may be missing other very important problems that are actually easier to address," said Brawley, the Emory oncologist. "Even if we find a great new treatment for triple-negative breast cancer tomorrow, I already have the data to show that a large proportion of black women aren't going to get it."

For their part, women such as Williams and others who have been diagnosed with breast cancer at a young age hope the focus on triple-negative cancer will help save others from being struck by the disease.

"I have nothing I can take to protect me from a recurrence," said Nicole Sudler, a Chicago secretary who was treated for the disease when she was 28. "I think about that every day. That scares me."