African-American Women and Breast Cancer
Although their overall rate of developing breast cancer is lower than white women, African-American women tend to have worse breast cancer outcomes.
Kimmel Cancer Center breast cancer experts are currently studying novel treatments and improved early detection and risk assessment techniques speciﬁcally in African-American women. This includes studying genetics and other inherent diﬀerences in this group so we may better tailor prevention and treatment options.
As with all of our patients, our providers work with every African-American breast cancer survivor to ensure individualized treatment plans are created that account for tumor characteristics, patient preferences, potential comorbidities, lifestyle factors, age, family history and racial/ethnic diﬀerences.
The Caregiver’s Cancer Journey
Darlene Young is a caregiver, always putting others ﬁrst. Her consideration for others’ well-being ahead of her own almost kept her from receiving lifesaving treatment for her breast cancer. Last year, when she felt a lump in her breast—so large that she awoke in the middle of the night thinking her TV remote control was on her chest—she waited two months before going to the doctor.
“I was thinking about my mom, who just had surgery,” says Darlene. “I didn’t want her to be alarmed.”
When she ﬁnally went to the doctor, the diagnosis was breast cancer and a recommendation to go to the Kimmel Cancer Center.
“I have to admit: I was hesitant at ﬁrst. My inclination was to stick with my community hospital,” says Darlene. “Johns Hopkins is so big. I didn’t think I would matter.”
Despite her concerns, she decided to follow the doctor’s advice, and after meeting with breast cancer expert Roisin Connolly and the nurses, she changed her mind.
“I felt the love and support of the people that work there,” she says. “Everyone is so sweet and supportive. I come home from my treatments energized. My husband has to tell me to slow down.”
Darlene has a type of breast cancer classiﬁed as estrogen receptor-negative and HER2-positive, referring to speciﬁc characteristics that could inﬂuence the growth of the cancer and can be targeted with drug treatments. Dr. Connolly says it accounts for about 8 percent of all breast cancers. Standard treatment calls for surgery to remove the tumor, followed by a combination of antibody therapy to cut oﬀ the ability of the HER2 gene to support the growth of breast cancer cells and chemotherapy to directly kill any lingering cancer cells that escaped surgery. Dr. Connolly says a proportion of patients—about one-third—can have complete shrinkage of the cancer at the time of surgery with use of antibody therapy alone and may in the future be spared chemotherapy. This approach can minimize unpleasant side eﬀects for patients, including nausea, hair loss, fatigue and increased risk of infection.
“The challenge is that we don’t yet have a good way to diﬀerentiate the patients who could be treated with antibody therapy alone and those who need the addition of chemotherapy,” she says.
Darlene is among the patients whose experience is helping Connolly and collaborators ﬁgure it out. Working with colleagues in nuclear medicine, Connolly is using Positron Emission Tomography (PET) scans as a biomarker to distinguish patients who will need antibody therapy and chemotherapy from those who can be treated only with antibody therapy.
“PET scans illustrate sugar uptake in cancer cells. If the PET scan still lights up brightly two weeks after starting antibody therapy, we know the cancer is active, and those patients should receive the combined antibody/chemotherapy treatment. They are very unlikely to get a complete response with antibody therapy alone,” says Connolly. “If it does not light up, antibody therapy may be enough to keep the cancer in check, and those patients may in the future be spared the toxic eﬀects of chemotherapy. Further research is still required to investigate this before it can become standard practice in the clinic to make treatment decisions, but it is extremely promising.”
Darlene had a lumpectomy to surgically remove her tumor followed by radiation therapy. She initially received the antibody/chemotherapy combination, but struggling with side eﬀects, she opted to stop chemotherapy after a few rounds of the treatment. Today, she receives only antibody therapy, and her breast cancer remains in check.
“We know many patients with this type of breast cancer will not need chemotherapy. We owe it to them to ﬁgure it out. PET scans may be the way,” says Connolly.
At a recent meeting of the American Society of Clinical Oncology, she presented ﬁndings to breast cancer doctors from across the country on a multicenter clinical trial she is heading to evaluate PET as a biomarker to guide treatment for patients like Darlene, who received the HER2 antibody treatment—a quick 30-minute infusion—through August.
Darlene says interacting with other patients and encouraging them through their journeys helped get her through her own.
“God gives me peace when I look after others,” Young says. “Cancer is hard. I’ve had some tough days, and bringing comfort and encouragement to others helps me through this too.”
Her joy and concern for others is magnetic, and it changed the dynamic of shared patient spaces.
“As I sat in the waiting room, I noticed that patients were looking at each other but not speaking to one another,” she says. “If you are going through treatment, you have to go through it right. There are no sour faces when I am in that waiting room.” Darlene has a way of putting patients at ease with a smile and words of encouragement.
She recalls a patient she met as they were both waiting to get CT scans. The woman looked distraught, but she did not speak English. Darlene couldn’t speak words of encouragement, but she provided the next best thing—a hug.
There is no language barrier with hugs,” says Darlene. “That’s a universal language.”
A few weeks later, the patient’s daughter stopped Darlene in the waiting room to thank her. She told Darlene that her mother was ready to give up, but the hug and encouragement she received that day gave her mother the strength to continue her battle.
“I’m energized by helping others. We all witness to one another,” she says. “I tell them, if I can do this, you can do it too.”
Darlene chose the Kimmel Cancer Center for its expertise in treating cancer, but her journey became much more than that.
“Johns Hopkins has been a blessing to me,” she says. “The doctors and nurses have taken wonderful care of me, but there are so many others who have helped me too. Social workers have helped me navigate ﬁnancial burdens, like the cost of driving back and forth for treatments. I’m so glad I picked this place.”
As Darlene’s radiant smile transforms the clinic area and patients seek her out to share updates in their own personal journeys, it is clear what truly inspires her.
“I made it about others because I love people,” she says.
Her mission is to put real faces and human spirit to this often impersonal and harrowing journey of cancer diagnosis and treatment. Her smiling face can be seen in the Kimmel Cancer Center even on days when she does not have an appointment. She is there to celebrate with patients who ﬁnish treatment and to support those going through difficult times.
Darlene’s is not the cancer experience most imagine. She is rewriting that script.
The people keep me coming back,” Darlene says. I want them to know they are strong. I’m happy when I see patients ﬁghting back against cancer. I can inspire them, and they inspire me.”