Y-S Yap
Outcomes in breast cancer—does ethnicity matter?
Duke-NUS Medical School|National University of Singapore|National Cancer Centre Singapore
ethnic differences bc outcomes though data limiteddrivers disparities include socioeconomic determinants well differing host tumor biologydissection intrinsic drivers extrinsic drivers challenging due complex interplaygreater diversity clinical translational research much needed address gaps knowledge ethnic racial differences breast cancer bc survival outcomes reported current data largely restricted comparisons african americans nonhispanic whites analyses traditionally based selfreported race may always accurate oversimplified classification increasing globalization quantification genetic ancestry genomic data may offer solution infer complex makeup admixture races focusing larger latest studies discuss recent findings differing host tumor biology may driving disparities addition extrinsic environmental lifestyle factors socioeconomic disparities lower cancer literacy may lead late presentation poorer adherence treatment lifestyle factors unhealthy diet obesity inadequate physical activity hardships may also result greater allostatic load turn associated aggressive bc features disadvantaged populations epigenetic reprogramming may mediate effects environment lifestyle factors gene expression ensuing differences bc characteristics outcome increasing evidence germline genetics influence somatic gene alterations expression well modulate tumor immune microenvironment although precise mechanisms remain elusive may account varying distribution different bc subtypes across ethnicities gaps knowledge highlight need interrogate multiomics landscape bc diverse populations ideally largescale collaborative settings standardized methodology comparisons statistically robust together improving bc awareness access good quality health care holistic approach insights biological underpinnings much needed eradicate ethnic disparities bc outcomes ethnic racial differences breast cancer bc survival outcomes reported current data largely restricted comparisons african americans nonhispanic whites analyses traditionally based selfreported race may always accurate oversimplified classification increasing globalization quantification genetic ancestry genomic data may offer solution infer complex makeup admixture races focusing larger latest studies discuss recent findings differing host tumor biology may driving disparities addition extrinsic environmental lifestyle factors socioeconomic disparities lower cancer literacy may lead late presentation poorer adherence treatment lifestyle factors unhealthy diet obesity inadequate physical activity hardships may also result greater allostatic load turn associated aggressive bc features disadvantaged populations epigenetic reprogramming may mediate effects environment lifestyle factors gene expression ensuing differences bc characteristics outcome increasing evidence germline genetics influence somatic gene alterations expression well modulate tumor immune microenvironment although precise mechanisms remain elusive may account varying distribution different bc subtypes across ethnicities gaps knowledge highlight need interrogate multiomics landscape bc diverse populations ideally largescale collaborative settings standardized methodology comparisons statistically robust together improving bc awareness access good quality health care holistic approach insights biological underpinnings much needed eradicate ethnic disparities bc outcomes