Disease-free probability after the first primary ductal carcinoma in situ of the breast: a comparison between African-American and White-American women

Abstract

BACKGROUND Compelling evidence about the differences in the biology and behavior of invasive breast cancer between African-American (AA) and White-American (WA) women motivate inquiry into comparing the clinicopathology of non-invasive breast cancer (ductal carcinoma in situ, DCIS). METHODS AA and WA women diagnosed with their first primary DCIS between 1990 and1999 were identified from the institutional tumor registry. Data on method of presentation, treatment, pateint characteristics were retreived from electronic medical records. Patients were followed up through the medical records until the diagnosis of a subsequent cancer or the last-day of contact with the institution. RESULTS A total of 100 (29.6%) AAs and 236 (70.4%) WAs with the mean age of 60 (SD±13) and 57 (SD±12), respectively, contributed to this study. DCIS was detected during routine screening mammography for 81% (n=81) of AAs and 88.4% (n=206) of WAs (P=0.073). Differences in the distributions of grade, margin status, necrosis, or treatment modalities were not statistically significant between AAs and WAs. Analysis of competing risks Cox proportional hazard multivariate modeling yielded a significant 8-year cumulative risk of a second cancer for AAs but only in the ipsilateral breast (HR=3.96, 95% CI 1.42–11.04, P=.01). CONCLUSION Despite comparable clinical presentation and treatment, 8 years after the initial treatment, AAs expereinced a higher risk of second breast cancer in ipsilateral but not in the contralateral breast. The observed excess risk of a second cancer in the ipsilateral breast may suggest of intrinsic differences in the biology of cancer.

Racial and ethnic differences in risk of second primary cancers among breast cancer survivors

“…They conclude that further studies are required to investigate reasons for this higher risk. Among 100 matched Black and White women with DCIS, Stark et al [36] also reported greater risk of subsequent invasive BC among Black women, finding that differences in stage at presentation, treatments received or histopathological characteristics did not account for racial/ethnic differences in risk of second primary BC.…”

Racial disparities in risk of second breast tumors after ductal carcinoma in situ

“…Prompt initiation and completion of adjuvant therapy are also important for breast cancer patients with BCS to lower their risks of local recurrence and mortality [39–41]. Studies reported no racial difference in surgical margins or receipt of hormone therapy in DCIS patients [13, 14, 16, 42, 43]. However, black race was associated with longer waiting time for and lower probabilities of completing radiotherapy following BCS [40, 41].…”

Breast conserving therapy for DCIS—Does size matter?

“…In retrospective review of 336 women with DCIS treated with either BCS or mastectomy, there were no statistically significant differences in the distribution of grade, margin status, necrosis, or treatment modality in African American or white women. However, despite similar clinical presentations and treatment, multivariate analysis demonstrated an increased risk of ipsilateral breast cancer recurrence (HR 3.96) in African American women versus white women [42]. In contrast, Nassar et al reported on 358 women with DCIS.…”