Doris Browne

Health disparities in breast cancer: biology meets socioeconomic status

Breast cancer is the most common cancer in women worldwide, accounting for just over 1 million new cases annually. Population-based statistics show that globally, when compared to whites, women of African ancestry (AA) tend to have more aggressive breast cancers that present more frequently as estrogen receptor negative (ERneg) tumors. ERneg tumors fail to respond to current established targeted therapies, whether for treatment or prevention. Subsets of the ERneg phenotype include those that are also negative for the progesterone receptor (PR) and HER2; these are called “triple negative” (TN) breast cancers. TN tumors frequently have pathological characteristics resembling “basal-like” breast cancers. Hence, the latter two terms are often used interchangeably; yet, despite extensive overlap, they are not synonymous. The ERneg, TN, and basal-like phenotypic categories are important because they carry worse prognoses than ER-positive (ERpos) tumors, in addition to lacking obvious molecular targets, such as HER2 and the ER, for known therapies. Furthermore, among premenopausal women the three subsets occur more frequently in women of African descent compared to white women with breast cancer. The contribution of these three subtypes of poor-prognosis tumors to the higher breast cancer mortality in black women is the focus of this review. We will attempt to clarify some of the issues, including risk factors, in terms of their contribution to that component of health disparities that involves biological differences in breast cancer between women of AA and white women.

Breast cancer chemoprevention phase I evaluation of biomarker modulation by arzoxifene, a third generation selective estrogen receptor modulator

Purpose: Arzoxifene, a new selective estrogen receptor modulator with strong breast antiestrogen activity and absence of uterine agonist activity, was explored as a potential chemoprevention agent. We performed a multi-institutional evaluation of arzoxifene in women with newly diagnosed ductal carcinoma in situ or T1/T2 invasive cancer. Experimental Design: In a Phase IA trial, 50 pre- or postmenopausal women were randomized to 10, 20, or 50 mg of arzoxifene daily in the interval between biopsy and re-excision or were enrolled as no-treatment controls. In a Phase IB trial, 76 postmenopausal women were randomized to 20 mg of arzoxifene versus matched placebo. Serum specimens collected at entry and at re-excision were assayed for various hormones and growth factors. Tissue from biopsies (estrogen receptor + and/or progesterone receptor +) and re-excision specimens was evaluated immunohistochemically for proliferation (Ki-67 by MIB-1 and proliferating cell nuclear antigen) and other biomarkers. Results: In both trials, increases in serum sex hormone binding globulin were noted, as were decreases in insulin-like growth factor (IGF)-I and the IGF-I:IGF binding protein-3 ratio (P < 0.007 versus control/placebo). For 45 evaluable women in Phase IA, decreases in proliferation indices were more prevalent for arzoxifene (particularly 20 mg) than for controls. For 58 evaluable women in Phase IB, a decrease in estrogen receptor expression for arzoxifene was observed compared with no change with placebo (P = 0.0068). However, decreases in proliferation indices for arzoxifene were not statistically different from placebo, perhaps due to a confounding effect of stopping hormone replacement therapy before entry. Conclusion: Given the favorable side effect profile and the biomarker modulations reported here, arzoxifene remains a reasonable candidate for additional study as a breast cancer chemoprevention agent.

Comparison of Ductal Lavage and Random Periareolar Fine Needle Aspiration as Tissue Acquisition Methods in Early Breast Cancer Prevention Trials

Purpose: Short-term phase I and phase II breast cancer prevention trials require tissue acquisition at baseline and after intervention to evaluate modulation of potential biomarkers. Currently used tissue acquisition methods include ductal lavage (DL), random periareolar fine needle aspiration (RPFNA), and core needle biopsy. The optimum method to retrieve adequate samples and the most accepted method by study participants is not known. Experimental Design: We compared RPFNA and DL as breast tissue acquisition methods for short-term breast cancer prevention trials by evaluating sample adequacy and tolerability in subjects who participated in two prospective phase II breast cancer prevention trials. Eighty-six women at increased risk for breast cancer were included in this study and underwent baseline DL and RPFNA. High risk was defined as having a 5-year Gail score of >1.67% or a history of atypical hyperplasia (AH), lobular carcinoma, or breast cancer. Results: Median age was 54.5 years (range, 39-75 years); 75% of the women were postmenopausal. About 51% of the women yielded nipple aspiration fluid, and breast fluid samples via DL were retrieved in 73% of these subjects. Of these samples, 71% were adequate samples (greater than 10 epithelial cells). However, when the entire cohort was considered, only 31% of the subjects had adequate samples. RPFNA was also attempted in all subjects, and sample retrieval rate was 100%. Out of these, 96% of the subjects had adequate samples. In DL samples, AH rate was 3.7% was and hyperplasia (H) rate was 11.1%. In RPFNA samples, AH rate was 12.9%, and H rate was 24.7%. Cytology findings in RPFNA samples correlated with age, menopausal status, and breast cancer risk category (previous history of lobular carcinoma in situ). Both procedures were well tolerated, and no complications occurred among participants. Conclusions: Considering that the main end point for short-term prevention trials is the modulation of biomarkers, it is important to optimize adequate sample acquisition; therefore, RPFNA is a more practical option for future phase I and II breast cancer prevention trials compared with DL.

The violence epidemic in the African American community: a call by the National Medical Association for comprehensive reform

While much progress has occurred since the civil rights act of 1964, minorities have continued to suffer disparate and discriminatory access to economic opportunities, education, housing, health care and criminal justice. The latest challenge faced by the physicians and public health providers who serve the African American community is the detrimental, and seemingly insurmountable, causes and effects of violence in impoverished communities of color. According to statistics from the Centers for Disease Control (CDC), the number one killer of black males ages 10-35 is homicide, indicating a higher rate of violence than any other group. Black females are four times more likely to be murdered by a boyfriend or girlfriend than their white counterparts, and although intimate partner violence has declined for both black and white females, black women are still disproportionately killed. In addition, anxiety and depression that can lead to suicide is on the rise among African American adolescents and adults. Through an examination of the role of racism in the perpetuation of the violent environment and an exploration of the effects of gang violence, intimate partner violence/child maltreatment and police use of excessive force, this work attempts to highlight the repercussions of violence in the African American community. The members of the National Medical Association have served the African American community since 1895 and have been advocates for the patients they serve for more than a century. This paper, while not intended to be a comprehensive literature review, has been written to reinforce the need to treat violence as a public health issue, to emphasize the effect of particular forms of violence in the African American community and to advocate for comprehensive policy reforms that can lead to the eradication of this epidemic. The community of African American physicians must play a vital role in the treatment and prevention of violence as well as advocating for our patients, family members and neighbors who suffer from the preventable effects of violence.

Is Dental Amalgam Toxic to Children of Color

https://doi.org/10.1016/j.jnma.2018.07.007 Ppopulations. This appears to be the case with dental amalgam. Dental amalgam (sometimes marketed as “silver fillings”) is a filling material that is approximately 50% mercurye a heavy metal that poses known adverse effects on the human nervous system and the environment. Although no central authority is known to track who exactly gets amalgam and who does not, there is circumstantial evidence that this mercury product is now disproportionately used in low-income communities and communities of color. While the data are limited, according to the U.S. Geological Survey, “[d]ental amalgam constituted the largest amount of mercury in use in the United States,” accounting for between 35% and 57% of mercury consumption for use in products in 2010. (This high percentage is because the use of mercury has declined in other industries much faster than in dentistry.) People can be exposed to this mercury from amalgam both when it is in their teeth and when it is in their environment. When amalgam is used in a tooth, the U.S. Food and Drug Administration (“FDA”) explains that “Dental amalgam releases low levels of mercury vapor, with higher amounts released with mastication and gum chewing.... Higher levels of exposure to elemental mercury vapor are also associated with placement and removal of dental amalgams.” When amalgam reaches the environment e via pathways such as cremation and burial, dental clinic water and air emissions, and human waste e certain microorganisms can metabolize its elemental mercury into methylmercury that can build up in the fish and shellfish that people eat. This exposure is a concern because mercury is one of several toxicants affecting neurodevelopment for which the data on the association between the low-level exposures and neurodevelopmental disorders in developing fetuses and children is strong enough to demand immediate action to decrease or eliminate exposures, according to an expert panel. Within these vulnerable populations,

2017 Presidential Installation Speech

Now, in case, some of you missed the depth of these words once spoken by St. Francis of Assisi, I’ll say it again, “Start by doing what’s necessary; then do what’s possible and suddenly you are doing the impossible.” SPEAKER BROOKS, PRESIDENT WILLIAMS, CHAIRMAN CLUNIE, PAST PRESIDENTS, DISTINGUISHED GUESTS, AND MY FAMILY AND FRIENDS, good evening. Tonight, I humbly accept the Presidency of the National Medical Association, a journey that was not in my wheelhouse of plans. Because of my deep respect for this position and this great association, getting to this point required me to start by doing what is always necessary before I can assume a great responsibility. It was necessary for me to engage in great, great deliberation . counsel . and prayer. As a result, a little girl with dreams from Biloxi, Mississippi, who never knew she wasn’t rich and had dreams of becoming a doctor . a little girl who was never told she could not, so she did . grew up, became a doctor and now stands before you, with a clear vision for the future and a commitment and determination to advance the mission and goals of the National Medical Association. Throughout my life, there has been a light shining inside of me that is now brighter than ever. In the words of author Marianne Williamson “we are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It’s not just in some of us; it’s in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same” . As a long-standing member of this Association, I have seen the many, many ups and downs that most, if not all organizations experience while travelling on the road to greatness. During this precious time that I have with you, I would like to accomplish three things: first, I want to honor the men and women who labored to open the doors I passed through along my journey to becoming the 118 President of NMA.