[00:00:00] Adam Walker: Support for the Real Pink podcast comes from Merck.
From Susan G Komen, this is Real Pink, a podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room.
Welcome to the Komen Health Equity Revolution podcast series. Each month we invite in patients, community organizations, health care providers, researchers, and policy advocates. to discuss strategies and solutions that drive the health equity revolution forward for multiple populations experiencing breast health inequities in honor of Black History Month.
This common health equity revolution episode of the Real Pink podcast takes a deep dive into the unique challenges and disparities black women face in breast cancer care. Joining me is Komen Scientific Advisory Board member, Dr. Lisa Newman, a trailblazing breast surgical oncologist and researcher. In this episode, we’ll explore the lack of representation of black bodies in the medical space and its impact on care and treatment.
We’ll also discuss culturally responsive care, the transformative role of diverse healthcare providers, and ways to advocate for yourself as a patient. Let’s dive into this important conversation. Dr. Newman, welcome back.
[00:01:24] Dr Lisa Newman: Thank you so much for having me and, so appreciate you dedicating time to this issue of, breast cancer disparities and the importance of diversity in research.
[00:01:36] Adam Walker: It’s critical. And we’ve talked about it, from a few different angles on this show. I’m really looking forward to hearing what you have to say about it. But first, how did your journey as a breast surgeon and researcher lead you to focus on health equity and the unique challenges faced by African and Black breast cancer patients?
[00:01:54] Dr Lisa Newman: My journey actually was fairly circuitous before getting to the point where I am now as a dedicated surgical breast oncologist with a platform of research focusing on breast cancer disparities. And within that focus, largely looking at the differences in breast cancer burden between women with African ancestry and women with European ancestry or white American women.
And today we see so many of our physicians and. clinicians in the oncology space are very focused and super specialized. And my area of specialization is,
as you mentioned, surgical breast oncology. But in the beginning of my career, the first seven years of my career as a surgeon, actually, I was a practicing general surgeon.
So I took care of a lot of different problems, benign and malignant involving a lot of different, organ sites and a lot of trauma, critical care. That was when I was young, that a lot more energy. I love the practice of general surgery, but in that era, there were actually very few women surgeons.
Fortunately, that has changed, and that’s another advance that I think has made a big difference in the, the success and effectiveness of cancer care that we deliver today. But back then, there were few women surgeons, and so my practice very naturally attracted a lot of women. who wanted a female surgeon to take care of their breast problems.
My general surgery practice was in Brooklyn and Brooklyn, New York, as is an incredibly diverse area. And so in the context of my own clinical practice, I was just seeing really heartbreaking differences in the breast cancers that my black patients were experiencing compared to my white breast cancer patients.
It goes back to the 1990s where we didn’t know a whole lot about the subtypes of breast cancer. My black breast cancer patients were presenting at much younger ages, bigger, bulkier cancers, and they were more likely to fail treatment. So that’s what led me to end up specializing in surgical breast oncology.
And so for the last 20 plus years, my career has been focused in managing breast cancer and conducting research looking at breast cancer disparities.
[00:04:06] Adam Walker: I love the work that you’re doing. That’s so great. so you’ve already mentioned one, which is that black communities tend to, get diagnosed at later stages, right?
Are there any other differences between black communities and other communities that you can talk about?
[00:04:21] Dr Lisa Newman: For a long time, it was assumed that socioeconomic differences accounted predominantly for breast cancer disparities, and absolutely the higher poverty rates and the higher rates of being uninsured in the African American community will lead to delays in diagnosis, delays in breast cancer treatment, and sometimes inadequate treatment for breast cancer.
And all of that will indeed play out into the 40 percent higher breast cancer mortality rates that we see today in black women compared to white women. But there are other differences, as you correctly inquired about. Black women are also more likely to be diagnosed with breast cancer at younger ages.
Black women are more likely to have biologically aggressive patterns of the disease patterns that we refer to as being high grade triple negative breast cancers, the cancers that are more difficult to treat successfully. And there’s also a very poorly understood higher incidence of male breast cancer in the african american compared to white american community.
So because of these different characteristics It’s very clear that we need to explore tumor biology and genetics in addition to social determinants of health and socioeconomic differences as we try to comprehensively understand disparities and even more importantly achieve health equity and eliminate those disparities.
[00:05:50] Adam Walker: I’ve never actually heard, we’ve talked about this a lot on this podcast and I hadn’t heard some of those, especially about, men in that community. That’s fascinating. Okay. Can you talk a bit about your international breast cancer research on TNBC as well as the training program and how this work changes outcomes for African and black communities?
[00:06:09] Dr Lisa Newman: So I’ve been so very, fortunate and blessed in some of the opportunities that I’ve had to be able to pursue my dream of trying to understand breast cancer disparities through research. And that research platform led me to an international program that I established called the International Center for the Study of Breast Cancer Subtypes.
We just celebrated our 20 year anniversary and this international program has been established to try to expand. I’m going to explore the genetic aspects of African ancestry and how African ancestry as a genetic feature contributes to the greater likelihood of having triple negative breast cancers, the biologically more aggressive pattern that I mentioned.
So our work in Africa has included partners. In different regions of Africa, because Africa is obviously a huge continent, the founder population for all of humankind. So it has tremendous genetic diversity. And in terms of the peoples on the continent of Africa, a lot of diversity with regard to culture, diet, lifestyle.
So it became very clear to us early on that in trying to understand African ancestry and its impact on breast cancer burden and how it affects African
Americans today, we knew that we were going to need to study African women with breast cancer in different regions of Africa. one of the things that we learned early on was that this pattern of breast cancer called triple negative breast cancer that we see twice as commonly.
In African American compared to white American women, it’s very common, even more common than we see it in African American women. When you look at Ghanaian women on Western Sub Saharan coast of Africa and triple negative breast cancers are rather uncommon in women on the east coast of Africa represented by the Ethiopian patients that we care for.
And this actually makes sense. If you just think back to grade school social studies. The transatlantic slave trade brought the ancestors of contemporary West Africans across the ocean to serve as slaves in the colonies. And so today, as contemporary African Americans, we have quite a bit of shared ancestry with contemporary West Africans.
The slave trade from East Africa, including Ethiopia, largely went further eastward to the Mideast to Asia. And as African Americans, we don’t have quite so much shared ancestry with East Africans. the genetics of African ancestry that impacts on triple negative breast cancer is specifically related to our West.
African sub Saharan African ancestral roots. And now we’re doing a deeper, and even deeper dive into some of that research, because Africa, as many of you will call is the area that’s been subject to a lot of different infectious diseases, and those different infectious diseases led to the human genome in those different regions of Africa.
Developing a whole host of genetic variants, allowing the populations in those different regions to survive many of those diseases, malaria being a big one and extremely deadly one. And so you see many variants that are specific to people on one region of Africa compared to a different region of Africa that are associated to these immune responses to different infectious diseases and those variants that were acquired to develop resistance to those diseases came across with the transatlantic slave trade.
And so we see them in contemporary African Americans. So these genetic immune variants have downstream consequences. on the immune landscape of the breast tissue and the breast tissue microenvironment. And this impacts on breast cancer risk. In particular, it impacts on the likelihood of a woman developing a triple negative breast cancer compared to having a non triple negative breast cancer. And so our research has indeed been very informative when it comes to understanding breast cancer disparities today.
[00:10:26] Adam Walker: That research sounds, amazing and profoundly in depth. It sounds like you’re, making a lot of good progress there. So I appreciate you sharing that with us. So that’s your, research.
Let’s talk a little bit about representation. I know representation matters deeply within the healthcare system and there’s a lack of representation of black bodies in the healthcare space. We see this in providers, medical illustrations, in office models, and education materials. Can you help us understand how this lack of representation impacts Black patients?
[00:10:58] Dr Lisa Newman: It really impacts everybody. Because cancer at its root is It’s a genetic aberration. And so if we don’t understand the genetics of cancer in diverse people, then we’re not going to understand the basic biology and the pathogenesis, the causes of cancer. And so this becomes very relevant when we talk about breast cancer, because we know, as we’ve already discussed, there are such huge variations in the different subtypes of breast cancer that correlate with your racial ethnic identity.
And so we really have to do research that robustly represents. the diverse cancer patient population so that we understand the causes of these different types of breast cancer and so that we develop better targeted treatments against these different subtypes. Our research in cancers, especially in breast cancer, is totally dependent on being able to complete what we call phase three clinical trials, prospective randomized clinical trials that evaluate one form of treatment to a novel form of treatment.
If you don’t have a patient population participating in that clinical trial, then. You’re not going to know anything about how to generalize the results of that clinical trial. So it’s extremely important that we have a diverse representation of our patients participating in clinical trials so that we know how to generalize the results of these trials to our actual management of our very diverse patient population in real time.
[00:12:41] Adam Walker: That’s great. And I’ve heard people talk about that before. And I think the more nuanced. Our approaches are the more we need that diverse population in those trials to make it even more nuanced, right? That’s my very layman’s terms version of that.
So can you talk a little bit about how having a black breast surgeon and oncologist can positively influence patient care and outcomes for black women?
[00:13:11] Dr Lisa Newman: Yeah, we do indeed, as you’re alluding to have, underrepresentation of, African American, Hispanic, Latinx communities of
color in the health care workforce overall, and. Definitely, the individuals from these diverse backgrounds are disproportionately underrepresented in the cancer care workforce and in the research workforce.
So this is problematic for many reasons. Number one, if we don’t have diverse representation in individuals from diverse backgrounds, then we’re losing out on tremendous talent that could be strengthening. The work that we do, we’re missing out on experiences that will lend important perspectives to the design of the research and the clinical trials that we conduct.
And so this research, the clinical trials are going to be. Less well, perceived or accepted by our diverse general patient population. So that’s the problem on a big picture side. We need a diverse cancer care workforce so that the work that we do is. stronger and more effective on the patient level. I think that just in general, our patients, regardless of their race, ethnicity, have greater trust if they see a health care, a cancer care workforce that better reflects their own communities and neighborhoods.
And I think it also elevates the work that we do and the treatment that we provide as clinicians when we have a more diverse group of colleagues. We’re likely to feel more comfortable with our diverse patients. I think that there are many, physicians, cancer clinicians and researchers from the majority white American population that may have great intentions in terms of accruing diverse patients on to their clinical research. But unfortunately, I think that they often feel nervous about offering clinical research opportunities to their minority patients because they’re fearful that it’s going to alienate the patient somehow. That’s a real problem.
We have to improve the communication between physicians, clinicians, researchers. And patients in order to make sure that the clinical trial opportunities are offered equitably. what? One of the number 1 reasons is for a patient not participating in a clinical against a clinical trial today, you can probably take a guess.
[00:15:52] Adam Walker: They don’t get asked, right?
[00:15:53] Dr Lisa Newman: Exactly. That’s it. Yeah, they don’t know. They don’t know. Yeah, they’re not offered the opportunity. But there have been a number of studies showing that regardless of race, ethnicity, if you are offered clinical trial participation, you’re equally likely to agree to participate.
We do need to make sure that our physician research colleagues are comfortable offering research opportunities to their patients. And I think that these clinicians
feel more comfortable dealing with a diverse patient population when their own colleagues have diversity.
[00:16:25] Adam Walker: That’s right. Yeah. the more you are.
In diverse environments, the more comfortable you are in those environments and I think the more and the more capable you are, right?
[00:16:34] Dr Lisa Newman: Again, perfectly stated. Yeah.
[00:16:36] Adam Walker: Yeah, that’s well, I don’t know. I don’t know about perfect, but i’m doing my best so so do you have any examples like any specific any stories?
Any examples where representation or culturally responsive care has made a significant difference in a patient’s breast cancer experience?
[00:16:54] Dr Lisa Newman: I can cite you a general example without talking about one particular.
[00:16:59] Adam Walker: Of course. Yeah, of course.
[00:17:00] Dr Lisa Newman: But, I think that as a general pattern. One of the things that I’ve witnessed is that is related to the strength of patient navigators.
So these are individuals, sometimes they’re nurses, sometimes they’re community navigators, but these are individuals that specifically take on the responsibility of making sure that patients with a diagnosis of cancer, and for the context of our population for breast cancer, that they have a relatively seamless progression across the population.
The full domains of their cancer care, because that cancer care is very complex. It’s what we call multidisciplinary. So it starts with the, breast imaging, which is in itself. complex mammogram, ultrasound, sometimes M. R. I. The biopsy, which is often done as a needle guided by as an image guided biopsy by the radiologist, but sometimes done as a surgical biopsy by the surgeon.
So it starts out with the imaging. The treatment once a breast cancer has been diagnosed includes specialists from surgery, specialists from medical oncology, specialists from radiation oncology. It includes the long term follow up, the survivorship episode where patients need to understand the long term sequela of that multidisciplinary care that they received.
So coordinating all of those facets of care is difficult. Patient navigators assume the responsibility of helping patients Complete that, could that process seamlessly without the ball ever being dropped and navigators do tend to be more diverse. Compared to the healthcare professionals, such as the physicians, the researchers, and I’ve definitely observed that the impact of the navigators, especially a diverse navigation workforce.
It improves the ability of patients to get through clinical trial participation and to complete the entire treatment process.
[00:19:09] Adam Walker: Yeah, I’m glad you shared that. patient navigators, I’ve interviewed many and they are amazing. Oh, yes, they are. Yeah, they’re so great and so important, because it’s a, complex thing to navigate.
That’s, for sure. Okay, so last question. For patients whose providers might not share the same cultural background or experiences, what advice do you have for them for advocating for their needs to ensure equitable care?
[00:19:37] Dr Lisa Newman: Wow, that’s a great question. And, we’re all familiar with the golden rules.
Do you treat others as you would want to be treated. And this is very true in medicine and health care, certainly in cancer care. It is unfortunately, it has been well documented that, physicians in the oncology space spend less time talking to their black patients compared to their white patients, and they spend even more disproportionately less time discussing it.
Clinical trial opportunities, but they’re African American compared to white American patients. And I’m sure this is for a variety of different reasons. Implicit biases, maybe sometimes not so implicit and sometimes overt biases and discriminatory practices. I’d like to think that’s. The minority of cases, but the bottom line is that the African American patients tend to have less time invested in their care, especially when it comes to discussion of clinical trial opportunities.
My best advice to my colleagues from the white American, the majority community is to just take more time talking to your patients and making sure that all of your patients, regardless. of what they look like and regardless of what you might assume to be their interests or their preferences. Make sure that all of those patients have the benefit of your expertise with regard to offering them all of the things that are available because we have great tools in conquering breast cancer. All of our patients need to have opportunities to take advantage of those wonderful resources that we have.
[00:21:23] Adam Walker: Yeah. And on the flip side, right? Like patients should advocate for that time for themselves and ask those questions and, draw out information if they need to, make sure that they’re not, they’re not missing out on an opportunity that, that might be there.
[00:21:38] Dr Lisa Newman: Yeah, very true. And we hate to place one more burden on the shoulders of our patients. They’re already saddled with so much and having to learn about their new diagnosis. It’s like they have to take a crash course in the medical school to understand what’s going on with them and what treatment needs are.
But yes, it is true that we need patients to advocate on behalf of themselves. And if they are not getting answers to the questions that they are posing to their health care team, that they need to seek multiple opinions, right?
[00:22:12] Adam Walker: That’s right. Yeah. Advocate. Advocate. I would talk about that on the show all the time.
Advocate for yourself. Advocate for yourself. Advocate for yourself and advocate for yourself. This has been so helpful. Dr. Newman, I’m so thankful for the work that you’re doing. Thank you so much for joining us on the show today.
[00:22:28] Dr Lisa Newman: Thank you very much, Adam, it’s been a pleasure.
[00:22:31] Adam Walker: And thank you for joining us on another powerful Komen Health Equity Revolution episode of Real Pink. A special thanks to Dr. Lisa Newman for sharing her invaluable insights and experiences. Her dedication to addressing health disparities and improving breast cancer outcomes for Black women is truly inspiring. If you or someone you love is facing breast cancer, The Susan G Komen Patient Care Center is here to help.
Whether it’s finding resources, connecting with support, or navigating treatment options, the Komen team is just a call or click away. Call the Patient Care Center at 1 877 465 6636 or email helpline@komen.org. Be sure to subscribe to the Real Pink Podcast so you don’t miss future episodes and share this discussion with anyone who might benefit.
Together we can make a difference in the fight against breast cancer because ending breast cancer needs all of us. Thank you for listening and we’ll see you next time. Thanks to Merck for supporting the RealPink podcast.
Thanks for listening to Real Pink, a weekly podcast by Susan G. Komen. For more episodes, visit realpink. komen. org. For more on breast cancer, visit komen.org. Make sure to check out @SusanGkomen on social media. I’m your host, Adam. You can find me on Twitter @AJWalker or on my blog, adamjwalker.com.