Cancer type afflicts Latinas

SACRAMENTO, Calif. – An aggressive and hard-to-treat type of breast cancer known to plague young black women also disproportionately affects Latinas, new research in California shows.

Known as triple-negative or “basal-like” carcinomas, these tumors do not respond to the kind of newer, more targeted therapies that have curbed the spread of the disease in many women, lengthening their lives.

The findings are alarming not only because triple-negative cancers can be so deadly, but also because many Latinas can face multiple barriers to obtaining comprehensive health care, from the most basic preventive screenings to sophisticated treatment regimens.

“Most of the women we work with – low-income, Spanish-speaking – aren’t even aware of what type of breast cancer they have,” explained Ysabel Duron, who runs the grass-roots Latinas Contra Cancer organization in San Jose, Calif. “We haven’t even gotten to the point where we can begin to talk about these complex diagnoses.”

Triple-negative cancers are fairly rare; between 1999 and 2003, only 12 percent of California breast cancers were listed as such.

The term “triple negative” refers to tumors unlike those fed by the hormone estrogen. This means drugs that counter the effects of estrogen, such as Tamoxifen, Raloxifene or aromatase inhibitors, are useless against them.

Similarly, triple-negative cancers do not respond to the antibody drug Herceptin, developed against tumors that have too much of a cell surface protein called HER-2.

The triple-negative cancer finding, presented in December at the annual Breast Cancer Symposium in San Antonio, was the result of a collaboration between Sutter Cancer Center oncologist Vincent Caggiano and Monica Brown, an epidemiologist with the California Cancer Registry. The registry collects demographic and medical data on every California resident diagnosed with cancer.

Researchers looked at all cases of female invasive breast cancers in which a tumor type was reported from 1999 to 2003. Of the 51,074 cases, 12.5 percent were found to be triple-negative.

Of those, 11 percent were found in non-Hispanic white women, almost one-quarter were detected in African American women, and 17 percent afflicted Latinas.

Overall, women with triple-negative cancers were more likely to live in low-income areas than other patients.

The finding is important because triple-negative tumors are typically diagnosed at later stages, are more likely to spread to other parts of the body and have a higher mortality rate than other breast cancers.

Treatment options are fewer, as well, Caggiano said. “Many women with early breast cancer undergo surgery, followed by chemotherapy and/or hormone therapy,” he said. “When you have triple-negative cancer, hormone therapy is out.”

Complicating the picture for Latinas are barriers such as language, which can make it difficult for patients to understand their risks and treatment options, and a lack of health insurance, said Carmen Ortiz, a breast cancer survivor and founder of Circulo de Vida, a cancer support and resource center for Latinos in San Francisco.

“If you don’t have health insurance, you are not going to go to the doctor on a regular basis,” Ortiz said.

“You are going to go when your symptoms are already fairly severe. If you have very few (treatment) options and you are diagnosed late, it’s a real problem.”