Nathalie McDowell Johnson, MD, FACS, surgical oncologist, medical director, Legacy Cancer Institute, Legacy Breast Health Centers, president, the American Society of Breast Surgeons, discusses the accuracy of genomic testing in Black women with estrogen receptor (ER)–positive breast cancer.

Genomic testing conducted for patients with ER-positive breast cancer is not as accurate in Black women with breast cancer compared with White women, particularly in regard to recurrence score, Johnson begins.

, findings showed that the prognostic accuracy of the recurrence score was significantly lower for Black women, with a C index of 0.656 (95% CI, 0.592-0.720) compared with 0.700 (95% CI, 0.677-0.722) for non-Hispanic White women (

 = .002). Study authors wrote that a lower prognostic accuracy in Black women with the Oncotype DX Breast Recurrence Score test suggests that genomic assays used to identify candidates for adjuvant chemotherapy may require model calibration in populations with greater racial and ethnic diversity. Findings also showed that Black women in the United States were more likely to have a high-risk recurrence score and to die of axillary node–negative breast cancer vs non-Hispanic White women with comparable recurrence scores.

Kent F. Hoskins, MD, of the University of Illinois Cancer Center, and colleagues examined the Surveillance, Epidemiology, and End Results (SEER) Oncotype registry to complete the in-depth analysis of breast cancer–specific mortality in regard to race and ethnicity.

Notably, when looking at Black women with higher-risk recurrence scores, which lead to treatment with chemotherapy, their outcomes tended to be better. Therefore, improved recurrence score testing is needed to better identify women with low-risk scores are not truly low risk, Johnson explains.

Further works must be done to examine which recurrence scores are being used for Black women to provide a more accurate understanding of the biology of their tumor and better identify patients who should be candidates for chemotherapy, Johnson notes. The findings from the retrospective study were similar to those from the phase 3 TAILORx trial (NCT00310180), where Blakc patients had worse outcomes compared with White women with similar recurrence scores, Johnson concludes.

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Nathalie McDowell Johnson, MD, FACS, discusses the accuracy of genomic testing in Black women with estrogen receptor-positive breast cancer.

Dr Johnson the Accuracy of Genomic Testing in Black Women With ER+ Breast Cancer

Nathalie McDowell Johnson, MD, FACS, surgical oncologist, medical director, Legacy Cancer Institute, Legacy Breast Health Centers, president, the American Society of Breast Surgeons, discusses the importance of diverse representation in breast cancer clinical trials.

It is important to continue to include underrepresented minorities, such as African American women, in clinical trials for breast cancer, Johnson begins. This area of unmet need was underscored in data borne out by the phase 3 TAILORx (NCT00310180) and RxPONDER (NCT01272037) trials, which showed that African American women didn’t do as well as their White counterparts, Johnson emphasizes.

In the RxPONDER trial, one of the questions that researchers aimed to address was whether African American women were adherent to their endocrine therapy, Johnson continues, adding that it was hypothesized that this was the reason for the differences in outcomes. However, with further investigation into the data from the trial, investigators found that African American women were the most adherent to therapy on the study, yet they still had worse outcomes, Johnson explains. Additionally, investigators saw that some of these outcomes may be associated with metabolic syndrome or obesity, Johnson adds.

Because investigators had enough women enrolled from underserved populations in both trials, it was possible to obtain this information for clinicians to do better for their patients moving forward, Johnson says. Based on these outcomes, another area to look at is metabolic syndrome and obesity in these women. Further investigation into this topic may address whether clinicians are able to help patients with physical exercise and weight loss and if that can ultimately affect outcomes, Johnson notes. These areas of further investigation are all exciting and the better that clinicians do at enrolling different groups, the better oncologists will understand and begin to reduce disparate outcomes, Johnson concludes.

Nathalie McDowell Johnson, MD, FACS, discusses the importance of diverse representation in breast cancer clinical trials.

Nathalie McDowell Johnson, MD, FACS

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Dr Johnson the Accuracy of Genomic Testing in Black Women With ER+ Breast Cancer

Dr. Johnson on the Importance of Diverse Representation in Breast Cancer Clinical Trials