Over the course of my career I have witnessed a great many phenomenal advances in the detection and treatment of breast cancer, resulting in millions of survivorship stories throughout the world. It is an honor to have had opportunities to participate in the research that has fueled these advances, and it has moved me beyond anything that words can adequately express to see the courage and fervor with which my patients have battled their disease while also participating in this research. Fighting breast cancer involves a partnership between patients, their families, and health care providers as well as researchers and the advocacy community.
The entirety of my professional life has been characterized by repeatedly experiencing the full spectrum of emotional highs related to treatment success as well as the low points and heartbreak related to disease relapse and mortality. One of our most important areas of breast cancer research and discovery is the identification of breast cancer subtypes, with improved insights regarding the heterogeneity of this disease, which was previously approached with the “one size fits all” treatment paradigm. We have learned that our treatments are most effective and less toxic when they are tailored to the tumor biology of the individual patient. Unfortunately however, one particular pattern or subtype has remained elusive in our efforts to provide appropriate, targeted therapy. This pattern is widely known as triple negative breast cancer (TNBC), because these tumors fail to express the three microscopic markers for which “targeted” therapy is available. Hence, women diagnosed with TNBC face the immediate disadvantage of having a disease pattern for which therapeutic options are more limited. Furthermore, TNBC tumors tend to have an inherently more aggressive biology, enabling them to metastasize more rapidly than other subtypes. These lesions account for a minority (approximately 15%) of all breast cancers that we diagnose in the United States, but because they are more common among young breast cancer patients, they account for a disproportionately excessive loss of life among women in the prime of their professional and personal/childraising years. These cancers are twice as common among African American women. Hence, they also play a role in explaining the well-documented race/ethnicity-associated breast cancer disparities that are observed in this country, with African American women experiencing substantially higher breast cancer mortality rates compared to White American women. For these many reasons it is therefore imperative that we learn more about the causes of TNBC, and that we identify better ways to detect as well as treat these cancers.
My research has involved the study of breast cancer in populations that share ancestry with contemporary African Americans, and I lead a group of investigators at the University of Michigan in collaboration with health care providers at the Komfo Anoyke Teaching Hospital in Kumasi, Ghana. Ghana is located in western, sub-Saharan African, and was therefore a major site in the colonial-era slave trade. We have learned the TNBC accounts for a majority of the breast cancers in this region, leading us to speculate that African ancestry may be associated with a heritable marker placing women at increased risk for TNBC. This research has also generated novel information regarding breast cancer markers that are more common in TNBC tumors, and which are likely to be useful in targeted therapy of the future. Breast cancer disparities research here in the United States and in Africa is therefore a unique and powerful opportunity to learn more about the causes and improved treatments for TNBC, a disease that devastates women and families around the world, with a disproportionately negative impact on young women.
It was therefore a true highlight of my career when I had the pleasure of meeting the extraordinary Ms. Malaak Compton-Rock and learning about the Triple Negative Breast Cancer Foundation in October of 2008. We actually met halfway around the world, at a breast cancer conference in Ghana. I had of course already known of this remarkable young woman and her passionate yet focused drive to eliminate a variety of injustices in our global society, but being able to actually speak with her in person and learn about the incredible work of the TNBC Foundation was transformative! To see a group of advocates that were inspired and dedicated to fund research efforts aimed at TNBC was nothing less than amazing. One of my proudest achievements was being asked to serve on the medical advisory board for the TNBC Foundation, and I look forward to a longstanding partnership with this great organization as they continue funding research that will enable us to conquer this devastating pattern of breast cancer.
To the brilliant, visionary leadership of the Triple Negative Breast Cancer Foundation: I pledge my unending energy to working with you in seeking a cure. I commend you for your effort to reach out to the African American triple negative population as it is disproportionately affected by this disease. Through this website, its discussion forums, and the TNBC Helpline, the Foundation offers a great many resources to patients and their families from the point of diagnosis through treatment and beyond. To our African American sisters: I sincerely hope that you will continue to utilize these resources in your fight against TNBC. I thank you for being such brave and beautiful role models. You inspire all of us; you remind us to value and cherish every day of our lives as a blessed gift.