Racial disparities in breast cancer outcome

Demicheli, Romano; Retsky, Michael; Hrushesky, William J. M.; Baum, Michael; Gukas, Isaac D.; Jatoi, Ismail

doi:10.1002/cncr.22998

Cited by 42 publications

(18 citation statements)

References 62 publications

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“…There is a controversy concerning when women should start getting mammograms; such tests are currently recommended for women between 45 and 50 years of age, depending on case and family history. This might turn out to be too late for some women, considering the fact that the highest incidence rate for ethnic minorities is age 50 and below and that those with early onset are likely to have more aggressive disease 26. Our data indicates that studies on genetic markers in early-onset breast cancer patients may encourage women to rethink when they should start getting mammograms or other types of screening procedures 27,28…”

Section: Cancer Surveillance Reportmentioning

confidence: 88%

Apolipoprotein E Allelic Frequency Altered in Women with Early-onset Breast Cancer

Porrata-Doria

Matta

Acevedo

2010

Breast Cancer�(Auckl)

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Among women, the most prevalent type of cancer is breast cancer, affecting 1 out of every 8 women in the United States; in Puerto Rico, 70 out of every 100,000 will develop some type of breast cancer. Therefore, a better understand of the potential risk factors for breast cancer could lead to the development of early detection tools. A gene that has been proposed as a risk factor in several populations around the world is Apolipoprotein E (apoE). ApoE functions as a mechanism of transport for lipoproteins and cholesterol throughout the body, with 3 main isoforms present in humans (apoE2, apoE3, and apoE4). Whether or not apoE4 is a risk factor for breast cancer remains controversial. Previous studies have either included test subjects of all ages (20–80) or have focused on late-onset (after age 50) breast cancer; none has concentrated specifically on early-onset (aged 50 and younger) breast cancer. The objectives of this study was to examine (in a Puerto Rican population) the differences in the relative frequency of occurrence of apoE4 in non-breast cancer versus breast cancer patients and to examine, as well, the potential differences of same in early- versus late-onset patients. We found an increased frequency of apoE4 (odds ratio 2.15) only in early-onset breast cancer survivors, which is similar to the findings of those studies that combined or adjusted for age as well as for an association between apoE4 and decreased tumor size. ApoE is also a potential risk factor for long-term cognitive effects after chemotherapy and affects response to hormone replacement. Our data supports the theory that knowing the apoE genotype of women who are at risk of developing breast cancer may be beneficial, as such knowledge would aid in the prediction of tumor size and the development of treatment regimens.

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Section: Cancer Surveillance Reportmentioning

confidence: 88%

Apolipoprotein E Allelic Frequency Altered in Women with Early-onset Breast Cancer

Porrata-Doria

Matta

Acevedo

2010

Breast Cancer�(Auckl)

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“…With earlier diagnosis and better treatments, survival has been improving in all groups of breast cancer patients. However, disparities still exist between AA and White women, with possible contributors including differences in socioeconomic status (SES), access to health care, especially screening and adjuvant therapy, and molecular and pathologic mechanisms (3–6). In a recent, large, population-based study using SEER Medicare data to examine racial differences in breast cancer survival, Silber et al (7) found that, after accounting for the effects of demographics, clinical presentation, and treatment modalities, there remained a 4.4% 5-year survival disparity, suggesting additional factors contribute to these disparities in survival (7).…”

Section: Introductionmentioning

confidence: 99%

Race, Age, and Obesity Disparities in Adult Physical Activity Levels in Breast Cancer Patients And Controls

Thompson

Owusu

Nock

et al. 2014

Front. Public Health

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Physical activity has been shown to be inversely associated with breast cancer recurrence and survival. Although physical activity is known to decline with age, rates of change in physical activity have not been well characterized in breast cancer patients and subgroups with known disparities in breast cancer survival, especially in minorities, the elderly, and the obese. We evaluated moderate and strenuous physical activity from high school through diagnosis in 1,220 breast cancer patients, and from high school to recruitment in 935 controls. We compared the proportion of patients and controls meeting the American Cancer Society (ACS) guidelines for physical activity and differences in declines in level of physical activity by race, age, and obesity. At diagnosis, only 33.2% of breast cancer patients met the ACS physical activity guidelines. Only 13.2, 24.7, and 30.5% of African-American (AA), obese, and older (≥65 years) patients met the guidelines, respectively. Controls showed slightly higher rates, with 36.4% overall, 23.7% of AA, 29.0% of obese, and 32.4% of older women meeting the guidelines. AA patients were less likely to meet guidelines compared to White patients (p < 0.0001). Obese patients were less likely to meet guidelines compared to non-obese (p < 0.0001). We found that both moderate and strenuous physical activity declined after high school in patients and controls. AA patients reported steeper declines in strenuous (p = 0.0027), and total (p = 0.0009) physical activity compared to Whites. Obese patients reported steeper declines in total physical activity compared to non-obese (p = 0.022). Differences in average slopes of declines in physical activity were not observed by age. Our results suggest that strategies and programs to encourage women to maintain recommended levels of physical activity after high school are needed. Furthermore, breast cancer patients, particularly AA and obese patients, should be targeted to help reduce disparities.

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“…[4] These comparable incidence rates underscore the importance of equal access to health care in closing the breast cancer disparity gap across racial lines and socioeconomic strata; however, elimination of disparity expands beyond the concept of health care access but implies identification of disease-specific risk for different sub-populations. [5,6] Published findings comparing the treatment outcome of DCIS between African-American and White-American are inconclusive. Studies that have adjusted for pathologic prognostic indicators, i.e.…”

Section: Introductionmentioning

confidence: 99%

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

Stark

Stapp

Raghunathan

et al. 2011

Breast Cancer Res Treat

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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.

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Racial disparities in breast cancer outcome

Cited by 42 publications

References 62 publications

Apolipoprotein E Allelic Frequency Altered in Women with Early-onset Breast Cancer

Apolipoprotein E Allelic Frequency Altered in Women with Early-onset Breast Cancer

Race, Age, and Obesity Disparities in Adult Physical Activity Levels in Breast Cancer Patients And Controls

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

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