From time to time, Christine Ambrosone and some of her Roswell Park Cancer Institute colleagues get together after work to relax over a glass of wine and toss ideas around. On one occasion, Dr. Ambrosone brought up the similarities between breast cancer in African-American women and prostate cancer in African-American men: in both groups, patients are more likely to be diagnosed at a younger age, with more aggressive disease.

“And Kelvin [Kelvin Lee, MD, Chair of Immunology] said, ‘Well, maybe your immune system evolves in response to the environment around you, and in areas like Africa, where there are endemic infectious diseases like malaria, maybe you develop a more robust inflammatory milieu so you can make it through your reproductive years, but maybe that also increases your risk of aggressive breast or prostate cancer.’”

That germ of an idea led to a current study, led by Drs. Ambrosone and Lee, comparing the cytokine profiles of healthy black women and healthy white women. Funded by the Breast Cancer Research Foundation, the study also aims to identify gene variants that may explain why women in the two groups tend to develop different types of breast cancer.

It’s just one of several avenues Dr. Ambrosone is pursuing in her quest to explain why black women are almost twice as likely as white women to develop breast cancer before the age of 40—and to be diagnosed with a more aggressive form, known as “basal-like.” “Is it biologic or genetic differences?” she asks. “Is it due to factors related to exposures, lifestyle or diet?”

It’s a “super exciting” time to explore those questions, she says, especially as surprising patterns begin to emerge from ongoing research around the country. Dr. Ambrosone points to the Carolina Breast Cancer Study, which has enrolled several hundred women, both white and black, to try to pinpoint the causes of breast cancer.

“In general, having children at an early age reduces your risk of breast cancer, and the more children you have, the lower the risk,” she says. “But the Carolina study showed that among black women who had basal-like breast cancers, those who had children early and had more children were at the highest risk of breast cancer—twofold. The only other risk factor equal to that is a family history of breast cancer.

“The interesting thing is, even if women [who enrolled on the study] had children at a young age and had a lot of children, if they breast-fed, that increased risk totally went away. That’s groundbreaking.”

To see whether the same patterns will hold up with larger numbers, data from the Carolina study will be combined with those of three other studies—including The Women’s Circle of Health, initiated and co-led by Dr. Ambrosone. Launched in 2003, The Women’s Circle of Health collects biological samples and medical/lifestyle information from African-American and white women in New York City and New Jersey. It’s hoped that the multi-center data pool will help point the way toward prevention of basal-like breast cancer, for which there are no targeted therapies. “This is a really big question,” says Dr. Ambrosone.

Dr. Ambrosone is also collaborating with Carl Morrison, MD, Clinical Chief of Pathology; Helena Hwang, MD, Pathology; and Michael Higgins, PhD, Department of Molecular and Cellular Biology, on an NCI-funded R01 study comparing genome-wide methylation patterns in black and white women with breast cancer. “We’re interested in seeing if one of the mechanisms of more-aggressive breast cancer in black women has to do with different patterns of methylation,” explains Dr. Ambrosone. The study will employ tumor samples from both RPCI and the Women’s Circle of Health Study.

It’s likely that informal discussions at after-work get-togethers will lead to new collaborations, new hypotheses, and new inroads in breast cancer research in the future. “Being in a cancer center is so advantageous for research,” says Dr. Ambrosone. “Roswell Park is small enough that we all know each other, and we’re all focused on the same thing—understanding, preventing, and curing cancer.”