Stefan Gluck, MD: Latinas With Breast Cancer Face Higher Mortality Rates
Dr. Stefan Gluck, a Miami-based medical oncologist who deals with not only breast cancer, but a diverse Hispanic community, discusses data released at the 34th Annual CTRC-AACR San Antonio Breast Cancer Symposium by Dr. Kathy Baumgartner showing that Latinas are about 20 percent more likely to die from breast cancer than non-Hispanic white women.
Dr. Gluck is a Professor of Medicine, University of Miami, Associate Division Chief for Clinical Affaris, Division of Hematology/Oncology Sylvester Comprehensive Cancer Center, University of Miami Health Systems and the Clinical Director, Braman Family Breast Cancer Institute.
The Group Room at the 34th Annual CTRC-AACR San Antonio Breast Cancer Symposium was made possible by support from:
VIDEO TRANSCRIPT:
Selma Schimmel, Founder & CEO, Vital Options International:
Hello and welcome to the Group Room where we’re at the 34th Annual CTRC-AACR San Antonio Breast Cancer Symposium. I’m very glad to be back with you, Professor-Doctor Stefan Gluck. You are the Associate Division Chief of Clinical Affairs in the Division of Hematology/Oncology at the Sylvester Comprehensive Cancer Center at the University of Miami Health Systems, where you’re also the clinical director of the Braman Family and Breast Cancer Institute and Professor of Medicine at the University of Miami, and you love your work in the area of breast cancer.
Stefan Gluck, MD, Assoc. Division Chief, Sylvester Comprehensive Cancer Center, Univ. of Miami:
Absolutely. It’s my professional life, I do anything and everything for the patients and for those who might be patients in the future.
Selma Schimmel:
Well, you also deal with the unique patient group in Miami, and that happens to be the Hispanic patient of which there is some information being presented at this meeting, and the concern about breast cancer mortality being higher in Hispanic women.
Stefan Gluck, MD:
Ethnic diversity if you may call it is a big issue and this country is changing as we speak. Some people from the NCI who visited us last year said that Miami and its population is a model how the United States population will look in about 50 years, so be prepared for these changes. How do we look today?
Miami is a very transitional city. Many immigrants come through Miami, and they could be Islanders, which includes of course Cubans from the ‘50s, ‘60s, but increasingly so other islands including Haiti, so we have these populations, and they’re completely different than Hispanics from South America or other Latin people like Brazilian. We have a huge increasing immigration flow from South America and Central America so Cubans are not necessarily what people think. Miami is not Cuban anymore, it’s Hispanic, and Latin actually, including French, Haiti, Creole, and Latin. And we have a larger than national average population of black African American – I specifically say black African American – because we also have black Hispanics and black Latin, which is another thing. And finally we have white African American, so it’s not so easy to just say African American. The diversity teaches you also how to identify these sub-populations.
We also have a large population of elderly women – or elderly people – who are so-called Snowbirds, and they became part of Miami, Miami Beach, Hallandale, and Southeast Florida, and of those are huge populations is actually Jewish Ashkenazi. Now why is it important? Because all these subsets of people who we are seeing in Miami and in the area have different risk for breast cancer than the average western population. And it’s the key. Number one African American, as you know, black African American. Two, Jewish Ashkenazi, and now newer data – not quite new but newer data – added Hispanics, which are the Spanish speaking Latin people may have also a different type of cancer. And what they have in common that these women – this very small proportion, 0.7% of men get cancer also – is been diagnosed earlier in life than the average western white, Caucasian population that came from somewhere in Europe, which is about 63 years.
Now both African American and Hispanics and Latin, they are being diagnosed in late 40s and 50s, or late 50s, so anywhere between five and 15 years earlier on average than we are diagnosing women who have the standard, if I may, Caucasian background. And this explains something, explains two things. Breast cancer in younger people – women – is usually differently distributed. It tends to be more frequent triple negative, or at least low on estrogen levels. Why? We’re not sure but I can tell you why the elderly have more estrogen. Because estrogen as such – and we heard the environmental talk yesterday – estrogen as such exposure to estrogen over time, the longer it is, the more the risk of breast cancer is rising, but only for ER positive. So in a younger women, let’s say 40- 45-years old, she didn’t have so much estrogen like 65, who have another 10, 15 years longer estrogen, higher estrogen levels before she became menopausal- but this is one of the explanation. Also, estrogen may or may not be function so it does not produce or encode for the subsequent gene such as the estrogen receptor, and about 200 and some other genes that have to be activated.
And now these are the cancers that are more aggressive. So this is the whole story going all the way back and it’s the poster or paper that we are referring to Hispanics have more aggressive breast cancer. So do black African American, and they have it actually less frequently than Caucasians but if they get it it’s more aggressive and they die more. And that’s basically the message of this certain paper it was presented.
Selma Schimmel:
So it’s way beyond access to care, or delayed diagnosis. It’s the whole biology of the disease.
Stefan Gluck, MD:
Correct. Yes, obviously. Particularly in Miami, we have a fresh immigrant population, and the last thing on their mind is to health. They need to get the papers, they need to get a job and doing mammograms so even going to the dentist is not on highest priority.
Selma Schimmel:
As we’re speaking of the issue of biology of cancer, and in particular these subgroups, maybe we can talk a little bit about the genomics of cancer and genomic profiling.
Stefan Gluck, MD:
There’s a great transition because I think this is where the future goes. If I may say a silly thing, breast cancer is not breast cancer is not breast cancer. And it’s of course estrogen receptor positive, negative, progesterone receptor positive, negative, and Her2 positive or negative, and we have known this estrogen thing probably about 50 years. Actually, indirectly we knew it since the 1898 published data that removing ovaries which is estrogen deprivation improves outcome in breast cancer. But he didn’t know about estrogen receptor at the time, of course. More recently 20 or so years we know the HER-2 receptors but let me tell you there is much more behind it than just these three markers and there’s about 20 interesting markers. But I think if you look at the genomic profiling as we think we should be using it there is a different genetic composition of the cancer cell in different cancers.
And one of the pioneers was of course Oncotypes of genomic health. The other one was on a completely different way MammaPrint through Agendia and in the meanwhile we have probably half a dozen such tests available, many of them commercially available. The newest is PAM50, and there’s a whole number of abstracts this year in San Antonio showing that PAM50 identifies what we call the Chuck Perou’s intrinsic subtyping the molecular subtyping. The so-called Luminal A and B, the so-called Basil, the Her2 enriched, and probably also claudin-low, and maybe normal-like, but it turns out they really are normal tissues. And these molecule subtypes they behave completely differently, they correlate loosely with estrogen and Her2 receptors, but only about 70-75 percent. And I think with these new knowledge and the targeted therapy that we heard from many, many other speakers today and yesterday and will tomorrow, we will identify subtypes – molecular subtypes – that will be actually the real targeted, that will be one target like M-tor, or like estrogen, or a combination of two or three. My prediction is it won’t; it will be a whole area of genes that we have to target.
Selma Schimmel:
Thank you, Doctor Gluck, Associate Division of Clinical Affairs at the Sylvester Comprehensive Cancer Center, University of Miami, Professor at the University of Miami, School of Medicine and Clinical Director of the Braman Family Breast Cancer Institute. Thank you always for making time. I love your passion.
Stefan Gluck, MD:
Thank you, Selma. It is a pleasure to be here.
END OF VIDEO