Greater Survival Improvement in African American vs. Caucasian Women with Hormone Negative Breast Cancer

Abstract

Background: African American women have not benefited equally from recently improved breast cancer survival. We investigated if this was true for all subsets. Methods: We identified 395,170 patients with breast adenocarcinoma from the SEER database from 1990 to 2011 with designated race, age, stage, grade, ER and PR status, marital status and laterality, as control. We grouped patients into two time periods, 1990-2000 and 2001-2011, three age categories, under 40, 40-69 and > 70 years and two stage categories, I-III and IV. We used the Kaplan-Meier and logrank tests to compare survival curves. We stratified data by patient-and tumor-associated variables to determine co-variation among confounding factors using the Pearson Chi-square test and Cox proportional hazards regression to determine hazard ratios (HR) to compare survival. Results: Stage I-III patients of both races > 70 years old, African American widowed patients and Caucasians with ER-and PR-tumors had worse improvements in survival in 2001-2011 than younger, married or hormone receptor positive patients, respectively. In contrast, African Americans with ER-(Cox HR 0.70 [95% CI 0.65-0.76]) and PR-(Cox HR 0.67 [95% CI 0.62-0.72]) had greater improvement in survival in 2001-2011 than Caucasians with ER-(Cox HR 0.81 [95% CI 0.78-0.84]) and PR-disease (Cox HR 0.75 [95% CI 0.73-0.78]). This was not associated with changes in distribution of tumor or patient attributes. Conclusions: African American women with stage I-III ER-and PR-breast cancer had greater improvement in survival than Caucasians in 2001-2011. This is the first report of an improvement in racial disparities in survival from breast cancer in a subset of patients.

The role of AKR1 family in tamoxifen resistant invasive lobular breast cancer based on data mining

“…The incidence of breast cancer is increasing gradually recently, which seriously threatens the life and health of women [1]. Invasive lobular breast cancer is one of the common pathological types of breast cancer, which is second only to invasive ductal cancer, with strong metastasis and invasion, and it has a high mortality and recurrence rate [2].…”

Racial Disparities in Breast Cancer Treatments and Adverse Events in the SEER-Medicare Data

“…Prima facie, the demographics of the two datasets appeared indistinguishable. Patient distributions by stage and race were identical and correlated with well-known characteristic differences between the two races [2,3,14,19,34]. AA patients were universally younger than W patients in every category and had lower rates of early-stage cancers and higher rates of more advanced-stage cancers than W patients.…”

“…Significant societal efforts to ameliorate social disparities have resulted in a glimmer of hope of shrinking the differences in rates of screening [33]. The differences in survival of patients with hormone-negative localized disease have also narrowed, likely from closing the gap in the administration of standard-of-care treatment in this highly aggressive disease [34]. Nevertheless, disparities in survival and every other measure of treatment success remain unabated.…”

Fibroblasts as Turned Agents in Cancer Progression

“…Variable social and disease factors contribute to a disparity in survival of African American (AA) patients with BC [ 375 , 376 , 377 ], but emerging data are making it evident that differences in the molecular characteristics of the cancer and the tumor microenvironment also contribute to the disparities [ 375 , 378 , 379 , 380 , 381 , 382 , 383 , 384 ]. The differences in the molecular characteristics of the epithelial cancer cells and pluripotential stem cells have been and continue to be investigated extensively [ 380 , 384 , 385 , 386 , 387 ].…”