Department of Surgery, Breast Oncology Program, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan.
Global Health Initiative, Henry Ford Health System, Detroit, Michigan.
JAMA Surg. 2017 May 1;152(5):485-493. doi: 10.1001/jamasurg.2017.0005.
Variation in cancer incidence and outcome has well-documented correlations with racial/ethnic identity. In the United States, the possible genetic and ancestral hereditary explanations for these associations are confounded by socioeconomic, cultural, and lifestyle patterns. Differences in the breast cancer burden of African American compared with European/white American women represent one of the most notable examples of disparities in oncology related to racial/ethnic identity. Elucidating the source of these associations is imperative in achieving the promise of the national Precision Medicine Initiative.
Population-based breast cancer mortality rates have been higher for African American compared with white American women since the early 1980s, largely reflecting declines in mortality that have been disproportionately experienced among white American patients and at least partly explained by the advent of endocrine therapy that is less effective in African American women because of the higher prevalence of estrogen receptor-negative disease. The increased risk of triple-negative breast cancer in African American women as well as western, sub-Saharan African women compared with white American, European, and east African women furthermore suggests that selected genetic components of geographically defined African ancestry are associated with hereditary susceptibility for specific patterns of mammary carcinogenesis. Disentangling health care access barriers, as well as reproductive, lifestyle, and dietary factors from genetic contributions to breast cancer disparities remains challenging. Epigenetics and experiences of societal inequality (allostatic load) increase the complexity of studying breast cancer risk related to racial/ethnic identity.
Oncologic anthropology represents a transdisciplinary field of research that can combine the expertise of population geneticists, multispecialty oncologists, molecular epidemiologists, and behavioral scientists to eliminate breast cancer disparities related to racial/ethnic identity and advance knowledge related to the pathogenesis of triple-negative breast cancer.
癌症发病率和结果的变化与种族/民族身份有明确的相关性。在美国，这些关联的可能遗传和祖先遗传解释因社会经济、文化和生活方式模式而变得复杂。与种族/民族身份相关的肿瘤学中，非裔美国女性与欧洲/白种美国女性的乳腺癌负担差异是最显著的例子之一。阐明这些关联的来源对于实现国家精准医学倡议的承诺至关重要。
自 20 世纪 80 年代初以来，非裔美国女性的乳腺癌死亡率一直高于白种美国女性，这主要反映了白种美国患者死亡率的大幅下降，至少部分原因是内分泌治疗的出现，由于雌激素受体阴性疾病的更高患病率，内分泌治疗对非裔美国女性的效果较差。非裔美国女性和西方、撒哈拉以南非洲女性的三阴性乳腺癌风险增加，以及白种美国、欧洲和东非女性相比，这表明特定地理定义的非洲血统的某些遗传成分与特定类型的乳腺癌发生的遗传易感性有关。将乳腺癌差异的医疗保健获取障碍，以及生殖、生活方式和饮食因素与遗传因素区分开来仍然具有挑战性。表观遗传学和社会不平等经历（应激负荷）增加了研究与种族/民族身份相关的乳腺癌风险的复杂性。
肿瘤人类学代表了一个跨学科的研究领域，它可以结合群体遗传学家、多专科肿瘤学家、分子流行病学家和行为科学家的专业知识，消除与种族/民族身份相关的乳腺癌差异，并推进与三阴性乳腺癌发病机制相关的知识。
