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Test May Be ‘Misguiding’ Breast Cancer Treatment for Black Women

February 1, 2024

Brielle Benyon

NewsArticle

The 21-gene breast recurrence score may lead clinicians away from prescribing chemotherapy to Black women who could benefit from the therapy.

Utilizing a specific biomarker test may not be the most beneficial approach for Black women with breast cancer, a study found.

A common test used to inform breast cancer care decisions may be making wrong treatment recommendations for Black women, according to recent research published in the Journal of the National Comprehensive Cancer Network.

The researchers from the study analyzed data from more than 73,363 women with early-stage, estrogen receptor (ER)-positive breast cancer who underwent the 21-gene breast recurrence score, which is the most commonly ordered biomarker test for this patient population. More specifically, the test lends insight into the prognosis of patients, as well as how effective post-surgical chemotherapy is. The goal is to mitigate the use of unnecessary chemotherapy.

However, these findings showed that test results are actually underestimating the potential benefit of chemotherapy for Black women — and younger black women, in particular — who may benefit from the treatment.

“This test could be misguiding treatment,” study author, Dr. Kent Hoskins, a professor of oncology at the University of Illinois Chicago, said in a news release about the findings.

The standard-of-care treatment for ER-positive breast cancer is estrogen blockade, with or without chemotherapy (a decision that is guided by the 21-gene breast recurrence score). However, Black women may be less likely to respond to this type of hormone therapy and could experience more benefit from the addition of chemotherapy, according to the study authors.

In fact, another study published in 2018 in the journal, Breast Cancer Research and Treatment, found a racial disparity in survival for women with ER/progesterone-receptor (PR)-positive breast cancer, regardless of tumor stage, grade or therapy, “suggesting that there may be racial differences in the molecular characteristics of hormone receptor-positive tumors, such that ER/PR positive tumors in black patients may be less responsive to standard treatments.”

That said, the researchers of this recent study believe that the test cutoffs that determine chemotherapy treatment may need to be scrutinized and evaluated for each patient, especially as Black individuals were found to have a higher likelihood of breast cancer recurrence despite having a low-risk 21-gene breast recurrence score.