From the Division of Oncology, School of Medicine.
Cancer J. 2023;29(6):316-322. doi: 10.1097/PPO.0000000000000677.
Racial disparities in outcomes of breast cancer in the United States have widened over more than 3 decades, driven by complex biologic and social factors. In this review, we summarize the biological and social narratives that have shaped breast cancer disparities research across different scientific disciplines in the past, explore the underappreciated but crucial ways in which these 2 strands of the breast cancer story are interwoven, and present 5 key strategies for creating transformative interdisciplinary research to achieve equity in breast cancer treatment and outcomes.
We first review the key differences in tumor biology in the United States between patients racialized as Black versus White, including the overrepresentation of triple-negative breast cancer and differences in tumor histologic and molecular features by race for hormone-sensitive disease. We then summarize key social factors at the interpersonal, institutional, and social structural levels that drive inequitable treatment. Next, we explore how biologic and social determinants are interwoven and interactive, including historical and contemporary structural factors that shape the overrepresentation of triple-negative breast cancer among Black Americans, racial differences in tumor microenvironment, and the complex interplay of biologic and social drivers of difference in outcomes of hormone receptor positive disease, including utilization and effectiveness of endocrine therapies and the role of obesity. Finally, we present 5 principles to increase the impact and productivity of breast cancer equity research.
We find that social and biologic drivers of breast cancer disparities are often cyclical and are found at all levels of scientific investigation from cells to society. To break the cycle and effect change, we must acknowledge and measure the role of structural racism in breast cancer outcomes; frame biologic, psychosocial, and access factors as interwoven via mechanisms of cumulative stress, inflammation, and immune modulation; take responsibility for the impact of representativeness (or the lack thereof) in genomic and decision modeling on the ability to accurately predict the outcomes of Black patients; create research that incorporates the perspectives of people of color from inception to implementation; and rigorously evaluate innovations in equitable cancer care delivery and health policies.
Innovative, cross-disciplinary research across the biologic and social sciences is crucial to understanding and eliminating disparities in breast cancer outcomes.
在美国，由于复杂的生物学和社会因素，乳腺癌结局的种族差异在 30 多年来不断扩大。在本综述中，我们总结了过去不同科学学科中塑造乳腺癌差异研究的生物学和社会叙述，探讨了这些乳腺癌故事的两个方面相互交织的被低估但至关重要的方式，并提出了 5 项关键策略，以创建变革性的跨学科研究，实现乳腺癌治疗和结局的公平。
我们首先回顾了美国患者中黑人和白人之间肿瘤生物学的关键差异，包括三阴性乳腺癌的过度表现以及激素敏感疾病的种族间肿瘤组织学和分子特征的差异。然后，我们总结了导致治疗不平等的关键人际、机构和社会结构层面的社会因素。接下来，我们探讨了生物学和社会决定因素是如何相互交织和相互作用的，包括历史和当代结构因素，这些因素塑造了三阴性乳腺癌在美国黑人中的过度表现、肿瘤微环境的种族差异，以及激素受体阳性疾病结局中生物学和社会驱动因素差异的复杂相互作用，包括内分泌治疗的利用和有效性以及肥胖的作用。最后，我们提出了提高乳腺癌公平研究影响力和生产力的 5 项原则。
我们发现，乳腺癌差异的社会和生物学驱动因素往往是循环的，可以在从细胞到社会的科学研究的各个层面找到。为了打破这种循环并产生变化，我们必须承认并衡量结构性种族主义在乳腺癌结局中的作用；通过累积应激、炎症和免疫调节的机制，将生物学、心理社会和获得因素视为相互交织的；对基因组和决策建模中的代表性（或缺乏代表性）对准确预测黑人患者结局的能力产生影响负责；从开始到实施，纳入有色人种的观点来创建研究；并严格评估公平癌症护理提供和卫生政策方面的创新。
生物学和社会科学的创新性跨学科研究对于理解和消除乳腺癌结局的差异至关重要。
