Does race predict survival for women with invasive breast cancer?

Abstract

BACKGROUND: Black women with breast cancer have lower survival rates and higher recurrence rates in comparison with white women. This study compared treatment and survival outcomes for black and white women at a highly specialized tertiary care cancer center. METHODS: An institutional review board-approved, retrospective institutional database review was performed to identify all black women treated for invasive breast cancer between 2005 and 2010. Women with a prior history of breast cancer, stage IV cancer, or bilateral breast cancer were excluded. White women had similar exclusion criteria applied and were then matched to black women 1:1 by age and diagnosis year. Clinicopathologic and treatment variables were compared by race. Kaplan-Meier methodology was used to estimate overall survival (OS) and disease-free survival (DFS); a multivariable analysis was conducted with Cox regression models. RESULTS: The study group consisted of 1332 women (666 black). The median tumor size was larger in black women (1.6 vs 1.3 cm; P < .001). Black women had more nodal disease (41.1% vs 32%; P < .001) and had tumors that were more frequently an estrogen receptor-negative (32.9% vs 15%; P < .001), progesterone receptor-negative (47.1% vs 30.2%; P < .001), or triple-negative (TN) subtype (24% vs 8.9%; P < .001) in comparison with white women. Black women also had inferior DFS and OS; race was not an independent prognostic indicator in the multivariable analysis. CONCLUSIONS: Black women had more advanced disease and adverse prognostic indicators at diagnosis, but race was not an independent predictor of outcome. Black women were significantly more likely to have TN breast cancer. Further research is necessary to understand the differences in tumor biology associated with race. Cancer 2019;125:3139-3146.

Race, breast cancer, and prognosis: Where biology is queen?

“…Clearly, this study by Walsh et al 6 does not obviate the need to address socioeconomic disparities in care.…”

“…9 Walsh et al 6 found in their study that although TNBC was more common in black women, the incidence of genetic testing was far less frequent, with 10% of black women and 74% of white women undergoing genetic testing. Poly(adenosine diphosphate ribose) polymerase inhibition is promising for patients with germline BRCA mutations and triplenegative disease, and we know that rates of BRCA mutations are much higher in TNBC than estrogen receptor-positive and/or HER2-positive disease.…”

“…One study of 802 women with TNBC who had no family history of breast cancer found a 15.8% germline BRCA mutation rate. 9 Walsh et al 6 found in their study that although TNBC was more common in black women, the incidence of genetic testing was far less frequent, with 10% of black women and 74% of white women undergoing genetic testing. Mutations in BRCA1/2 occurred in 14% of black women tested and in 2% of white women tested.…”

“…[2][3][4][5] In the current issue of Cancer, Walsh et al 6 investigate the association between race and breast cancer outcomes by comparing black and white women treated at Memorial Sloan Kettering Cancer Center, a highly specialized tertiary care cancer center in Manhattan. Socioeconomic factors such as body mass index, reproductive patterns, access to health care, and treatment adherence clearly play a role.…”

“…Compared with their white counterparts, black women tend to be diagnosed at younger ages and are more likely to be diagnosed with triple-negative breast cancer (TNBC); in comparison with white women who do have TNBC, there are compelling data showing that black women have tumors that behave more aggressively. [2][3][4][5] In the current issue of Cancer, Walsh et al 6 investigate the association between race and breast cancer outcomes by comparing black and white women treated at Memorial Sloan Kettering Cancer Center, a highly specialized tertiary care cancer center in Manhattan. Black women had inferior disease-free survival (5-year disease-free survival, 86% for black women vs 91% for white women) and overall survival (5-year overall survival, 88% for black women vs 94% for white women).…”