Building Capacity for Early Detection to Reduce Breast Cancer Morbidity

Breast cancer is on the rise in low- and middle- income countries and a leading cause of death and disability among women, especially young women. In part, this is due to late diagnosis. In 2010, 57.8% of breast cancers in Peru were stage 3 or higher at diagnosis. As part of a multi-modal approach, federal and regional Peruvian institutions partnered with UCSF’s Dr. Ronald Balassanian and other experts to develop a program for community breast health in rural underserved areas of Peru, using fine-needle aspiration biopsy (FNAB) as a triage tool.

Establishing Peru’s New Standards of Breast Care in Resource-Limited Areas
Phase 1 involved implementation of (1) effective curricula for clinical breast examination, (2) a community-based referral system for women with masses and (3) lesion evaluation using FNAB performed by trained physicians. Malignancies are treated at the Peru Regional Cancer Institute North (IREN). Recognizing the reality that in-country FNAB expertise is limited, phase 2’s focused on (1) solidifying local capacity for high-quality FNAB and (2) strengthening interpretation and reporting of results. Programs such as these can serve as models for improving breast cancer care in developing countries and resource-constrained areas generally.

Publications:

Ng D, Ljung B, Bardales R, Abad M, Cedano M, Hayes Constant T, Winkler J, Balassanian R. Developing a breast fine needle aspiration biopsy service in Peru. Annals of Global Health. 82, 3, May 2016.

New Breast Cancer Treatments through Cross-Population Studies

Breast cancer is the most common cancer among women worldwide. In the United States alone, it affects 1 in 8 women and is responsible for over 40,000 deaths per year. Breast cancer risk varies across different populations, even within the U.S. However, the factors responsible for differences in incidence are still poorly understood. Dr. Laura Fejerman and collaborators from the Instituto Nancional De Enfermedades Neoplasicas (INEN, Lima, Peru) are understanding these differences by studying Latina populations.

Discovery and Understanding of a Protective Genetic Variant
Breast cancer incidence among Latinas is 33% lower than in non-Latina white women. Focusing in Peru, Dr. Fejerman’s team recently discovered a protective genetic variant that is only present in populations with Indigenous American ancestry, specifically, genetic ancestry from one of the original groups that populated the American continent before colonization. This variation is located near the estrogen receptor 1 gene (ESR1) on chromosome 6. Estrogen receptors such as these are strongly linked to breast cancer.

To verify the genetic variant’s role in protecting against breast cancer, Dr. Fejerman is collaborating with INEN to create a large repository of biospecimens from thousands of Peruvian women. This repository will be combined with clinical data, tumor histology, and treatment and progression information. The UCSF-INEN collaboration will allow exploration of the biological implications of the ESR1 protective genetic variant in all populations. In addition, the team will study breast tumors in women of high Indigenous American ancestry, a component of human population diversity understudied in relation to cancer etiology and prognoses.