By Hannah-Simone Lubbe
Picture a room filled with people who have breast cancer. The same medication, tamoxifen, a life-saving treatment for hormone-positive breast cancer, has been administered to each of them. Now consider that the medicine may not function at all or may not work as well for some of them, especially the African women present. Not due to their cancerous condition but because no one has ever investigated how their genes impact the drug’s effectiveness.
Researchers at the University of Cape Town have discovered this unsettling reality. A seemingly straightforward question was posed by the team in this review: Do genetic variations impact the effectiveness of tamoxifen in women of African descent? The response: Since hardly anyone has looked, we are unsure.
Only eight of the more than 100 relevant studies on the pharmacogenetics of tamoxifen specifically mentioned women of African descent. Africa has the highest breast cancer mortality rate in the world, despite the fact that the majority of research guiding therapy today is centred on populations in Europe or Asia.
Our genes must shape the enzymes that transform tamoxifen into its active form. A frequent variation in African populations, CYP2D6*17, may decrease the drug’s effectiveness. However, it has received little attention and is frequently overlooked or included in collective statistics.
The lesson learnt? We run the risk of providing African communities with a place at the table but denying them a voice in drug research if we exclude them. For the sake of survival as much as research, it is imperative that this gap be filled.
Reference:
Kruger B, Shamley D, Soko ND, Dandara C. Pharmacogenetics of tamoxifen in breast cancer patients of African descent: Lack of data. Clin Transl Sci. 2024;17(3). doi:10.1111/cts.13761
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