Breast cancer mortality in African-American and non-hispanic white women by molecular subtype and stage at diagnosis: A population-based study

Li Tao, Scarlett Lin Gomez, Theresa H Keegan, Allison W. Kurian, Christina A. Clarke

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: Higher breast cancer mortality rates for African- American than non-Hispanic Whitewomen are well documented; however, it remains uncertain if this disparity occurs in disease subgroups defined by tumor molecular markers and stage at diagnosis. We examined racial differences in outcome according to subtype and stage in a diverse, population-based series of 103,498 patients. Methods: We obtained data for all invasive breast cancers diagnosed between January 1, 2005, and December 31, 2012, and followed through December 31, 2012, among 93,760 non- Hispanic White and 9,738 African-American women in California. Molecular subtypes were categorized according to tumor expression of hormone receptor (HR, based on estrogen and progesterone receptors) and human epidermal growth factor receptor 2 (HER2). Cox proportional hazards models were used to calculate relative hazard (RH) and 95% confidence intervals (CI) for breast cancer-specific mortality. Results: After adjustment for patient, tumor, and treatment characteristics, outcomes were comparable by race for stage I or IV cancer regardless of subtype, and HR+/HER2+ or HR/HER2 cancer regardless of stage. We found substantially higher hazards of breast cancer death among African-American women with stage II/III HR/HER2 (RH, 1.31; 95% CI, 1.03-1.65; and RH, 1.39; 95% CI, 1.10-1.75, respectively) and stage III triple-negative cancers relative to Whites. Conclusions: There are substantial racial/ethnic disparities among patients with stages II/III HR/HER2 and stage III triple-negative breast cancers but not for other subtype and stage. Impact: These data provide insights to assess barriers to targeted treatment (e.g., trastuzumab or endocrine therapy) of particular subtypes of breast cancer among African-American patients.

Original languageEnglish (US)
Pages (from-to)1039-1045
Number of pages7
JournalCancer Epidemiology Biomarkers and Prevention
Volume24
Issue number7
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

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African Americans
Breast Neoplasms
Mortality
Population
Confidence Intervals
Neoplasms
Triple Negative Breast Neoplasms
Progesterone Receptors
Tumor Biomarkers
Hispanic Americans
Proportional Hazards Models
Estrogen Receptors
human ERBB2 protein
Hormones
Therapeutics

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

Cite this

Breast cancer mortality in African-American and non-hispanic white women by molecular subtype and stage at diagnosis : A population-based study. / Tao, Li; Gomez, Scarlett Lin; Keegan, Theresa H; Kurian, Allison W.; Clarke, Christina A.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 24, No. 7, 01.07.2015, p. 1039-1045.

Research output: Contribution to journalArticle

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abstract = "Background: Higher breast cancer mortality rates for African- American than non-Hispanic Whitewomen are well documented; however, it remains uncertain if this disparity occurs in disease subgroups defined by tumor molecular markers and stage at diagnosis. We examined racial differences in outcome according to subtype and stage in a diverse, population-based series of 103,498 patients. Methods: We obtained data for all invasive breast cancers diagnosed between January 1, 2005, and December 31, 2012, and followed through December 31, 2012, among 93,760 non- Hispanic White and 9,738 African-American women in California. Molecular subtypes were categorized according to tumor expression of hormone receptor (HR, based on estrogen and progesterone receptors) and human epidermal growth factor receptor 2 (HER2). Cox proportional hazards models were used to calculate relative hazard (RH) and 95{\%} confidence intervals (CI) for breast cancer-specific mortality. Results: After adjustment for patient, tumor, and treatment characteristics, outcomes were comparable by race for stage I or IV cancer regardless of subtype, and HR+/HER2+ or HR/HER2 cancer regardless of stage. We found substantially higher hazards of breast cancer death among African-American women with stage II/III HR/HER2 (RH, 1.31; 95{\%} CI, 1.03-1.65; and RH, 1.39; 95{\%} CI, 1.10-1.75, respectively) and stage III triple-negative cancers relative to Whites. Conclusions: There are substantial racial/ethnic disparities among patients with stages II/III HR/HER2 and stage III triple-negative breast cancers but not for other subtype and stage. Impact: These data provide insights to assess barriers to targeted treatment (e.g., trastuzumab or endocrine therapy) of particular subtypes of breast cancer among African-American patients.",
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