Black Women are More Likely to Develop Lymphedema Following Breast Cancer Treatment than White Women
Black women experienced higher rates of breast cancer-related lymphedema than white women, and Black race was the strongest predictor of lymphedema development, according to study results presented during Friday’s General Session.
“Lymphedema worsens quality of life for breast cancer patients,” said the study’s lead author, Andrea V. Barrio, MD, associate attending physician in the Breast Service, Department of Surgery, at Memorial Sloan Kettering Cancer Center. While there is some evidence that Black women are more likely than white women to experience lymphedema, she explained that most studies of lymphedema do not report the racial or ethnic breakdown of their study population.
Furthermore, most research on lymphedema has relied on patients’ self-reported symptoms or lymphedema diagnosis codes. In this study, Dr. Barrio and colleagues aimed to quantitatively assess lymphedema based on arm volume measurements, and to evaluate whether race was a factor in lymphedema risk.
The study showed that Black women had a 3.5-fold increased risk of lymphedema compared to white women.
The study also showed that women who received neoadjuvant chemotherapy followed by axillary lymph node dissection were twice as likely to develop lymphedema compared with women who had upfront surgery followed by axillary lymph node dissection.
Upon multivariable analysis, Dr. Barrio said Black race was the strongest predictor of lymphedema development. Receipt of neoadjuvant chemotherapy, older age, and increasing time from surgery were also independently associated with a higher risk of lymphedema.
Abstract: GS4-01 Impact of race and ethnicity on incidence and severity of breast cancer related lymphedema after axillary lymph node dissection: Results of a prospective screening study
Black and White Women Who Received Neoadjuvant Therapy Were Equally Likely to Have Pathologic Complete Response
Tumor biology, not race, was a more significant factor in predicting response to clinical trial treatment
Analysis of data from the I-SPY 2 clinical trial showed that race did not significantly affect several key measures of breast cancer treatment outcomes, including pathologic complete response and event-free survival, according to results presented during Friday’s General Session.
“Breast cancer treatment and management is constantly evolving, with advancements in immunotherapy leading the way. However, there remains a persistent mortality gap between white and Black women with breast cancer,” said lead author Beverly Kyalwazi, BS, a medical student at the University of Chicago Pritzker School of Medicine. According to recent estimates, Black women with breast cancer are about 40 percent more likely to die of the disease than white women.
Previous research has shown that pathologic complete response is a strong predictor of distant recurrence-free survival. In this study, Kyalwazi, working in conjunction with senior authors Olufunmilayo Olopade, MD, FAACR, Director of the University of Chicago Center for Clinical Cancer Genetics, and Laura Esserman, MD, MBA, Director of the University of California San Francisco Breast Care Center and the principal investigator of the I-SPY 2 trials, aimed to assess whether racial disparities exist in the achievement of pathologic complete response. As a secondary aim, the researchers studied the association between racial groups and 28 expression signatures related to immune cell types, checkpoint inhibitor targets, and immune signaling pathways.
The study showed that pathologic complete response rates did not significantly differ by racial groups. There were also no significant differences in event-free survival or residual cancer burden.
Among women who did not experience pathologic complete response however, HR-positive/HER2-negative breast cancer showed the greatest survival disparity between Black women and white women, with Black women almost twice as likely to experience mortality than white women.
“As long as racial disparities exist, race will continue to be a part of discussions regarding breast cancer,” Kyalwazi said. “Understanding that race is less likely than tumor biology to predict response to therapy places more of a focus on strategies to increase access to quality cancer care among women underrepresented in clinical trials.”
Abstract: GS4-02 Analysis of clinical outcomes and expression-based immune signatures by race in the I-SPY 2 trial
The following abstracts were also presented during Friday’s General Session. These presentations will be available to registered SABCS participants for on-demand viewing until March 10, 2022. Click here to find these and other abstracts presented this week at SABCS 2021.
GS4-03 Patient-reported outcomes (PROs) for the intergroup sentinel mamma study (INSEMA, GBG75, ABCSG43): Persistent impact of axillary surgery on arm and breast symptoms in early breast cancer
GS4-05 Preservation of axillary lymph nodes compared to complete dissection in T1-T2 breast cancer patients presenting 1-2 metastatic sentinel lymph nodes. A multicenter randomized clinical trial
GS4-06 Estimation of breast cancer over diagnosis in a US breast screening cohort
GS4-07 The Breast PreCancer Atlas DCIS genomic signatures define biology and correlate with clinical outcomes: An analysis of TBCRC 038 and RAHBT cohorts
GS4-08 Comprehensive genomic profiling of patients with breast cancer identifies germline-somatic interactions mediating therapy resistance
GS4-09 Quality of life results from OlympiA: A phase III, multicenter, randomized, placebo-controlled trial of adjuvant olaparib after (neo)-adjuvant chemotherapy in patients with germline BRCA1/2 mutations and high-risk HER-2 negative early breast cancer
GS4-10 Neratinib + fulvestrant + trastuzumab for hormone receptor-positive, HER2-mutant metastatic breast cancer and neratinib + trastuzumab for triple-negative disease: Latest updates from the SUMMIT trial