Low Breast Cancer Guideline-Concordant Care Use Indicates Racial Disparities

Guideline-concordant care should be the goal for all patients with breast cancer, but as therapies become more optimized, disparities may continue to grow across different racial and ethnic populations, according to Oluwadamilola “Lola” Fayanju, MD, MA, MPHS, FACS.

In a conversation with CancerNetwork^®, Fayanju highlighted the primary implications of a study she published in JAMA Network Open, which showed that most patients with inflammatory breast cancer do not appear to receive all available types of guideline-concordant care they are eligible for.¹ Results showed that 25.1% (n = 1740) of patients included in the analysis received guideline-concordant care across the entire study period.

According to Fayanju, a possible reason for this outcome may relate to the National Cancer Database (NCDB) potentially underreporting or miscategorizing trends in guideline-concordant care across different cancer centers. Regardless, she highlighted that receipt of guideline-concordant care was more common among White populations compared with people of color, which raises questions about thoughtfully developing breast cancer therapies and conducting trials across diverse populations.

Fayanju is the Helen O. Dickens Presidential Associate Professor, chief in the Division of Breast Surgery at Penn Medicine, surgical director of Rena Rowan Breast Center, director of Health Equity Innovation at Penn Center for Cancer Care Innovation (PC3I), and senior fellow at Leonard Davis Institute of Health Economics (LDI), Perelman School of Medicine at the University of Pennsylvania.

Transcript:

Despite the fact that we have experts as well as various types of research studies contributing to our sense of what should happen, receipt of guideline-concordant care may not be as universal and pervasive as we would imagine it would be. Probably the most striking finding was that only 25% of patients received all the components of guideline-concordant care that would be expected for inflammatory breast cancer.

There are reasons why that might be. One [reason is] the fact that the NCDB pulls from various types of cancer centers that are doing their own internal review and then offering that information to the pooled NCDB. Is there a possibility of underreporting or miscategorization? Possibly. Nonetheless, not only in this study looking at all forms of inflammatory breast cancer but also in a study that our teams worked on looking at inflammatory lobular breast cancer, it does appear that rates of inflammatory breast cancer guideline-concordant care receipt are fairly low at [approximately] 25%. That was a very striking finding.

We also found that guideline-concordant care receipt was a little bit more common amongst White people than it was amongst people of color. But what was powerful is that, if guideline-concordant care was received for triple-negative breast cancer, then racial disparities disappear. That is, if we can get people the treatment that they’re supposed to get, then we can potentially reduce the gap between Black and White women. Now, that being said, one might argue that the reason we saw this with regards to triple-negative breast cancer, especially as our data set largely predated the advent of the KEYNOTE-522 [NCT03036488] regimen [of pembrolizumab (Keytruda) plus chemotherapy] for triple-negative breast cancer, is [because] the treatments for triple-negative breast cancer were so unideal that everyone was similarly [having outcomes that were] not great.² That is, for the treatments that we know work really well, so just for HER2-positive disease, it’s a little disturbing to see that even when guideline-concordant care was provided to patients, Black patients still did worse than White patients.

Our big takeaway was that guideline-concordant care should still be striven for and should be the goal for all people. But as the treatments get better overall, we may actually see a widening disparity between different racial and ethnic groups, which then makes us question, “OK, are we really being thoughtful in the development of these drugs and in the trials of these drugs amongst diverse populations, such as to ensure that guideline-concordant care achieves the same quality of outcome and likelihood of outcome for everyone?”

References

1. Tadros A, Diskin B, Sevilimedu V, et al. Trends in guideline-concordant care for inflammatory breast cancer. JAMA Netw Open. 2025;8(2):e2454506. doi:10.1001/jamanetworkopen.2024.54506
2. Schmid P, Cortes J, Dent R, et al. Overall Survival with pembrolizumab in early-stage triple-negative breast cancer. N Engl J Med. 2024;391(21):1981-1991. doi:10.1056/NEJMoa2409932.