Benefield honored with Michael S. O’Malley Alumni Award for research to identify racial differences in breast cancer outcomes

September 18, 2020

Dr. Halei Benefield

Dr. Halei Benefield

Halei Benefield, PhD, has been named the 2020 recipient of the Michael S. O’Malley Alumni Award for Publication Excellence in Cancer Population Sciences.

The award, which includes a $3,000 prize, is presented by UNC Lineberger Comprehensive Cancer Center in recognition of an outstanding publication by a graduate of the UNC Gillings School of Global Public Health that advances knowledge in population-based cancer research. It is named in memory of the late O’Malley, who was a leader in cancer prevention and control at UNC-Chapel Hill and across the nation and was respected widely for his commitment and passion for mentoring students.

Benefield — who earned a doctorate in epidemiology from the Gillings School in 2019 and is pursuing a medical degree from the UNC School of Medicine as part of the Medical Scientist Training Program — was first author of a paper titled “Borderline Estrogen Receptor-Positive Breast Cancers in Black and White Women” published in the Journal of National Cancer Institute. Limited research has been published about this rare tumor type, making it challenging to make evidence-based clinical decisions. This is especially the case with minority women, who are underrepresented in the studies that are used to inform clinical guidelines.

Determining whether a breast tumor is estrogen receptor (ER)-positive or ER-negative provides important diagnostic information. ER-positive breast tumors respond to endocrine therapy and typically carry a favorable disease prognosis. ER-negative tumors are clinically aggressive and respond minimally to endocrine therapy. While most breast cancer tumors either strongly express ER positivity or not at all, approximately 10% of breast cancers express 1–10% ER positivity and are known as ER-borderline.

Benefield and her colleagues identified 217 ER-borderline tumor cases from the Carolina Breast Cancer Study (CBCS) and compared them to 1,885 ER-positive tumors and 757 ER-negative tumors. With approximately half of the CBCS Phase III participants being black, the study made it possible to investigate both race and genomics in ER-borderline breast cancer.

Among their findings, a race-stratified analyses indicated that white women experienced greater benefits from endocrine therapy, and black women with borderline ER-positive tumors had higher genomic risk scores.

“The results from this study add to a scant body of literature on the uncommon ER-borderline tumor subtype, and deepen existing knowledge by reporting outcomes among black women, who are historically underrepresented in breast cancer studies yet suffer worse survival outcomes than white women, particularly among ER-positive subtypes,” Benefield said. “Overall, our findings underscore the importance of considering both tumor biology and breast cancer care patterns, and future studies should consider how these factors interact in order to improve outcomes equitably for all women.”

UNC Lineberger’s Melissa Troester, PhD, professor of epidemiology at the Gillings School and the paper’s senior author, praised Benefield’s approach to research.

“Halei applied strong quantitative and biological research methods to study a group of patients that face substantial uncertainty in their clinical care,” Troester said. “Her focus on clinical impact was central to the success of this research.”

Benefield will graduate from medical school in May and begin a residency in pediatrics. Her professional goals include using her research and clinical training to practice as a physician-scientist with a focus on public health.

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