Issues

The cover image is adapted from Figure 1A in the article “The landscape of immune microenvironments in racially-diverse breast cancer patients,” by Hamilton and colleagues. The original image shows a heatmap of RNA immune expression, with top dendrogram ordered by consensus clustering and displaying adaptive-enriched, innate-enriched and immune-quiet classes. Immunotherapy is a rapidly evolving treatment option in breast cancer (BC); However, the BC immune microenvironment is understudied in Black and younger (<50 years) patients. The authors used histological and RNA-based immunoprofiling methods to characterize the BC immune landscape in 1,952 tumors from the Carolina Breast Cancer Study, a population-based study that oversampled Black and young women. Younger patients had higher proportions of adaptive-enriched tumors, particularly among estrogen receptor (ER)-negative cases. Black patients had higher frequencies of both adaptive-enriched and innate-enriched tumors. Immune clusters were associated with recurrence among ER-negative tumors, with adaptive-enriched showing the best and innate-enriched showing the poorest 5-year recurrence-free survival. These data suggest that immune microenvironments are intricately related to race, age, tumor subtype, and grade. Given higher mortality among Black and young women, more defined immune classification using cell-type specific panels could help explain higher recurrence and ultimately lead to targetable interventions. For more information, see the article beginning on page 1259.