Why women of color may respond differently to breast cancer treatments

Many doctors pride themselves on treating every patient the same—but when it comes to breast cancer, one-size-fits-all care can overlook critical differences.

Breast cancer surgeon Monique Gary, DO, pointed out in a recent Instagram Reel that while the anatomy of the breast is the same across races, how cells respond to treatment, stress, and environmental factors can differ.

It may not just be social determinants at play. Gene expression and metabolic differences, including variations in liver enzyme activity, may also affect treatment response.

The science behind disparities

For decades, disparities in breast cancer outcomes for Black women were often attributed to socioeconomic barriers.

"For example, things like environment, things like food insecurity and poverty to generational trauma to cancer treatment response—those things might be different," she said.

While these factors remain critical, Dr. Gary emphasized that science is beginning to uncover biologic contributors as well.

"There is an emerging science to suggest that there are some differences in both gene expression and in things like liver enzymes and how we metabolize those enzymes," she said.

Understanding these nuances could help clinicians tailor therapies more effectively and reduce inequities in outcomes.

What this means for practice

Considering both social and molecular factors could enhance personalized care and improve outcomes for Black patients with breast cancer.

When reviewing treatment plans for patients, particularly those from historically underserved populations, consider both social determinants and emerging biologic research.

Incorporating this dual perspective may help identify patients who might benefit from more aggressive monitoring, earlier intervention, or tailored therapy approaches.