Black women in the United States are less likely than white women to be diagnosed with breast cancer, yet they are more likely to die from the disease.

In a study of more than 1,000 women, researchers at Vanderbilt Health and Agendia, which specializes in genomic testing, found that Black women were more likely to have early, high-risk breast cancer that is hormone receptor positive (HR+) and negative for the human epidermal growth factor receptor 2 (HER2-).

These findings, reported March 19 in the Nature partner journal npj Breast Cancer, highlight the critical need for tumor genomic testing for all patients to identify those with high-risk tumors, which occur more frequently in Black women, and which require more aggressive treatment to prevent recurrence.

“By moving beyond traditional clinicopathologic features and incorporating genomic classification, we can more accurately identify biologically aggressive disease and tailor more precise, personalized treatment,” said the paper’s corresponding author, Sonya Reid, MD, MPH, associate professor of Medicine at Vanderbilt Health.

“The risk of recurrence of breast cancer in Black women has often been underestimated by traditional clinical features, driven largely by their underrepresentation in clinical trials,” study co-author William Audeh, MD, Agendia’s Chief Medical Officer, said in a news release.

“By providing a genomic assessment of tumor biology, we can ensure that women with breast cancer will receive individualized care that improves their long-term outcomes,” Audeh said. The collaboration with Vanderbilt Health “underscores our shared commitment to bringing precision medicine to all women.”

The research included 1,018 women with HR+, HER2- early-stage breast cancer who were enrolled in the Breast Cancer Etiology, Survival and Treatment Outcomes (BEST) study, and the Full-genome Data Linked with Clinical Data to Evaluate New Gene Expression Profiles (FLEX) study.

The BEST study is a population-based observational cohort of women identified through state cancer registries in Florida and Tennessee who were diagnosed with breast cancer between 2005 and 2015. FLEX is a multicenter, prospective observational study of genomic profiling and its impact on prognosis, treatment decisions and clinical outcomes.

The researchers applied two RNA-based technologies developed by Agendia to evaluate tumors: “MammaPrint,” which analyzes the 70 most important genes associated with breast cancer recurrence, and “BluePrint,” which classifies tumors into subtypes based on an expression profile of 80 different genes.

They found that Black women had a higher proportion of genomically high-risk luminal B and basal-type tumors compared to white women and that survival at three years was determined by the molecular subtype of their tumors.

“Understanding the biological and tumor genomic differences by race could improve treatment decisions and promote optimal care for Black females with early-stage breast cancer,” the researchers concluded, “ultimately improving long-term outcomes.”

Co-authors from Vanderbilt Health were Lindsay Venton, Jennifer Whisenant, PhD, Anne Weidner, MPH, and Tuya Pal, MD.

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