Understanding the Biological and Social Complexities of Triple-Negative Breast Cancer

In the landscape of oncology, triple-negative breast cancer (TNBC) remains one of the most challenging subtypes to treat due to its aggressive nature and the lack of traditional hormonal targets. However, for Samilia Obeng-Gyasi, MD, MPH, a surgical oncology specialist at The James, The Ohio State University Comprehensive Cancer Center, the challenge is not just biological; it is deeply rooted in ancestry, social environment, and patient experience.

In an interview with Targeted Oncology regarding the diagnosis and treatment of TNBC, Obeng-Gyasi highlighted the stark disparities that exist within the patient population and the evolving ways the medical community is addressing them.

The Ancestry and Adherence Connection

One of the most pressing issues in breast cancer equity is the disproportionate impact of TNBC on specific communities. Obeng-Gyasi noted that the disease does not affect all groups equally.

"In the diagnosis, it tends to affect certain populations more than others," she explains. "Specifically, Black women of West African ancestry^1,2 have the highest incidence of triple-negative breast cancer."

The challenge extends beyond the initial diagnosis into the reality of treatment. For many patients, the toxicity of standard care can be a barrier to survival. Obeng-Gyasi pointed out that "some of the things that have been noted in the literature is that sometimes some of the side effects that Black women may face, such as neuropathy, may result in treatment discontinuation, which can sometimes have implications for long-term survival."

To combat this, researchers are looking at how to refine existing protocols to mitigate adverse effects and improve outcomes. For example, the ECOG-ACRIN EAZ171 study (NCT04001829), presented at the 2024 ASCO Annual Meeting, identified that paclitaxel was associated with more grade 2 to 4 taxane-induced peripheral neuropathy in Black women and required more dose reductions compared with docetaxel, suggesting the latter might be a preferable chemotherapy option in this population.³

A Multimodal and Value-Based Approach

When a patient is diagnosed with TNBC, the conversation between the physician and the patient must be both honest and holistic. Obeng-Gyasi emphasized that the first step is clarity.

"What would be important for any patient who has [TNBC] is being very transparent about the aggressiveness of the cancer, but also the various treatment modalities that we have available to patients,” she said.

Among these modalities, the rise of immunotherapy has been a gamechanger. Obeng-Gyasi identified this as "one of the biggest advances that we've had," noting that these drugs have "been shown to improve survival in this population."

However, medical success isn't just about the latest drug; it’s about the patient receiving it. She advocates for a deeply personalized approach to care: "The key is to understand what the patient's values are, to have a discussion with them about the multimodal approach to triple negative breast cancer, and then work with the patient within their value system to figure out which of the treatment modalities we have works well with their value system, but also, more importantly, will result in the best oncologic outcome."

The Intersection of Environment and Biology

Perhaps the most cutting-edge aspect of Obeng-Gyasi’s insights involved the "social-environmental factors" that may predispose certain individuals to TNBC. Research is beginning to show that the environment a person lives in can physically manifest as a cancer risk.

"Studies have started to show, for example, that women who live in neighborhoods with high deprivation... are more likely to be diagnosed with triple negative breast cancer," she said.⁴

This link between environment and biology is often measured through allostatic load—the "wear and tear" on the body caused by chronic stress. Obeng-Gyasi noted that her own work has shown that "women who have higher biological stress, which is operationalized as allostatic load, are also more likely to have [TNBC].”

This suggests that the stress of navigating certain social environments may trigger a biological response that influences cancer development. While she cautioned that this is early work, it highlights the necessity of viewing cancer as a multifactorial disease.

The Path Forward

Understanding TNBC requires looking at the intersection of genetics, ancestry, and social-environmental factors. By combining advanced treatments like immunotherapy with a deeper understanding of patient adherence and the social determinants of health, specialists like Dr. Obeng-Gyasi are working toward a future where a TNBC diagnosis is no longer defined by a patient's zip code or ancestry.

REFERENCES

1. Hippalgaonkar N, Calip GS, Akbar Z, et al. Association of West African ancestry, reproductive factors, and deprivation with incidence of triple-negative breast cancer among Black women in the U.S. J Clin Oncol. 43, 1609-1609(2025). doi:10.1200/JCO.2025.43.16_suppl.1609

2. Hercules SM, Alnajar M, Chen C, et al. Triple-negative breast cancer prevalence in Africa: a systematic review and meta-analysis. BMJ Open. 2022 May 27;12(5):e055735. doi: 10.1136/bmjopen-2021-055735.

3. Schneider BP, Zhao F, Ballinger T, et al.. ECOG-ACRIN EAZ171: Prospective validation trial of germline predictors of taxane-induced peripheral neuropathy in Black women with early-stage breast cancer. J Clin Oncol. 42, 2899-2907(2024). doi:10.1200/JCO.24.00526

4. Hernandez AE, Mazul A, Goel N, et al. Social adversity and triple-negative breast cancer incidence among US Black women. JAMA Netw Open. 2025 Oct 1;8(10):e2537378. doi: 10.1001/jamanetworko