Racial Disparities in Breast Cancer Survival: An Analysis by Age and Stage

Deshpande, Ashwini; Jeffe, Donna B.; Gnerlich, Jennifer L.; Iqbal, Ayesha; Thummalakunta, Abhishek; Margenthaler, Julie A.

doi:10.1016/j.jss.2008.05.020

Cited by 77 publications

(58 citation statements)

References 34 publications

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“…Our findings are consistent with some[2, 5] though not all[24] studies. In one study[2] of women ≥ 65 years, Black women who had received chemotherapy had no worse mortality than White women, though those that didn’t receive chemotherapy had significantly worse survival.…”

Section: Discussionsupporting

confidence: 94%

Race and breast cancer survival by intrinsic subtype based on PAM50 gene expression

Sweeney

Kwan

Quesenberry

et al. 2014

Breast Cancer Res Treat

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Purpose To evaluate whether differences in PAM50 breast cancer (BC) intrinsic (Luminal A, Luminal B, Basal-like, and HER2-enriched) subtype help explain the Black-White BC survival disparity. Methods Utilizing a stratified case-cohort design, this study included 1,635 women from the Pathways and Life After Cancer Epidemiology cohorts, selecting women with tumors based upon IHC classification, recurrences, and deaths. One millimeter punches were obtained from tumor tissue, and expression of the PAM50 genes for molecular subtype was determined by RT-qPCR of extracted RNA. Cox proportional hazards models were used to analyze associations between race and BC outcomes, adjusted for PAM50 BC subtype. All tests of statistical significance were two-sided. Results Black women had a higher prevalence of the Basal-like BC subtype. Adjusted for potential confounding variables and disease characteristics at diagnosis, Black women had higher risks of recurrence (HR=1.65, 95% CI: 1.06–2.57) and breast-cancer-specific mortality (HR=1.71, 95% CI: 1.02–2.86) than White women, but adjusting further for subtype did not attenuate survival disparities. By contrast, Hispanic women had a lower risk of recurrence (HR=0.54, 95% CI: 0.30–0.96) than Whites. Among those with the Basal-like subtype, Black women had a similar recurrence risk as women in other race groups but a higher recurrence risk for all other subtypes. Hispanic women had a lower recurrence risk within each subtype, though associations were not significant given limited power. Conclusions Although Black women had a higher risk of the Basal-like subtype, which has poor prognosis, this did not explain the Black-White breast cancer survival disparity.

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Section: Discussionsupporting

confidence: 94%

Race and breast cancer survival by intrinsic subtype based on PAM50 gene expression

Sweeney

Kwan

Quesenberry

et al. 2014

Breast Cancer Res Treat

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“…In our study, the tumors in patients aged 40-44 and 45-49 years had the highest frequencies of ER and PR positivity among the nine age groups examined and a high percentage of grade 1 histology. Even among very young patients, our study showed that patients aged ,35 years had significantly higher frequencies of tumor size #2 In terms of patient outcomes, the relapse risk among patients aged 40-49 years has not been reported to differ significantly from that in patients aged 50-59 years in Western countries [13][14][15][16]. However, in the current study, patients aged 40-44 and 45-49 years had significantly more favorable DFS in univariate analysis compared with patients in the other age groups.…”

Section: Discussionmentioning

confidence: 64%

Distinct Clinicopathological Features and Prognosis of Emerging Young-Female Breast Cancer in an East Asian Country: A Nationwide Cancer Registry-Based Study

et al. 2014

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Background. A rapid surge of young-female breast cancer (YFBC) has been observed in Taiwan and other East Asian countries. We recently reported that these cases of YFBC, in contrast to their Western counterparts, are predominantly luminal A subtype.YFBC inAsiamayhavedistinctclinicopathologicalfeaturesandoutcomes. Methods. Data collected prospectively by participating hospitals were retrieved from the Taiwan Cancer Database. A total of 15,881 women with newly diagnosed stage I-III breast cancer in 2002-2006 were included. The age at diagnosis was categorized into nine 5-year groups (from ,30 years to $65 years). Clinicopathological variables and patient disease-free survival (DFS) were compared by age group. Results. The rates of stage I, estrogen receptor-positive (ER1), and progesterone receptor-positive breast cancer were higher

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“…These within-stage disparities have been shown to be independent of other tumor characteristics and more pronounced among later stage tumors and among women younger than 65 years of age. 5,6 Therefore, factors other than tumor characteristics may be influential.…”

Section: Introductionmentioning

confidence: 99%

Racial variation in breast cancer treatment among Department of Defense beneficiaries

Enewold

Zhou

McGlynn

et al. 2011

Cancer

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BACKGROUND Although the overall age-adjusted incidence rates for female breast cancer are higher among whites than blacks, mortality rates are higher among blacks. Many attribute this discrepancy to disparities in healthcare access and to blacks presenting with later stage disease. Within the Department of Defense (DoD) Military Health System all beneficiaries have equal access to healthcare. The aim of this study was to determine if breast cancer treatment varied between white and black female breast cancer patients in the DoD system. METHODS The study data were drawn from the DoD cancer registry and medical claims databases. Study subjects included 2,308 white and 391 black female beneficiaries diagnosed with breast cancer between 1998 and 2000. Multivariate logistic regression analyses that controlled for demographic factors, tumor characteristics, and comorbidities were used to assess racial differences in the receipt of surgery, chemotherapy and hormonal therapy. RESULTS There was no significant difference in surgery type, particularly when mastectomy was compared to breast conserving surgery plus radiation (blacks vs. whites: OR=1.1; 95% CI=0.8–1.5). Among those with local stage tumors, blacks were as likely as whites to receive chemotherapy (OR=1.2; 95% CI=0.9–1.8) and hormonal therapy (OR=1.0; 95% CI=0.7–1.4). Among those with regional stage tumors, blacks were significantly less likely than whites to receive chemotherapy (OR=0.4; 95% CI=0.2–0.7) and hormonal therapy (OR=0.5; 95% CI=0.3–0.8). CONCLUSION Even within an equal access healthcare system, stage-related racial variations in breast cancer treatment are evident. Studies that identify driving factors behind these within-stage racial disparities are warranted.

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Racial Disparities in Breast Cancer Survival: An Analysis by Age and Stage

Cited by 77 publications

References 34 publications

Race and breast cancer survival by intrinsic subtype based on PAM50 gene expression

Race and breast cancer survival by intrinsic subtype based on PAM50 gene expression

Distinct Clinicopathological Features and Prognosis of Emerging Young-Female Breast Cancer in an East Asian Country: A Nationwide Cancer Registry-Based Study

Racial variation in breast cancer treatment among Department of Defense beneficiaries

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