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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 2/2017

01-06-2017 | Epidemiology

Racial disparity in survival from estrogen and progesterone receptor-positive breast cancer: implications for reducing breast cancer mortality disparities

Authors: Garth H. Rauscher, Abigail Silva, Heather Pauls, Jonna Frasor, Marcelo G. Bonini, Kent Hoskins

Published in: Breast Cancer Research and Treatment | Issue 2/2017

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Abstract

Introduction

Non-Latina black breast cancer patients experience a shorter survival from breast cancer than their non-Latina white counterparts. We compared breast cancer-specific survival for the subset of black and white patients with estrogen and/or progesterone receptor-positive tumors that are generally targeted with endocrine therapy.

Methods

Using data collected from a population-based cohort of breast cancer patients from Chicago, IL, Kaplan–Meier survival curves and hazard functions were generated and proportional hazards models were estimated to determine the black/white disparity in time to death from breast cancer while adjusting for age at diagnosis, patient characteristics, treatment-related variables, and tumor grade and stage.

Results

In regression models, hazard of breast cancer death among ER/PR-positive patients was at least 4 times higher for black than for white patients in all models tested. Notably, even after adjusting for stage at diagnosis, tumor grade, and treatment variables (including initiation of systemic adjuvant therapies), the hazard ratio for death from ER/PR-positive breast cancer between black and white women was 4.39 (95% CI 1.76, 10.9, p = 0.001).

Conclusions

We observed a racial disparity in breast cancer survival for patients diagnosed with ER/PR-positive tumors that did not appear to be due to differences in tumor stage, grade, or therapy initiation in black patients, suggesting that there may be racial differences in the molecular characteristics of hormone receptor-positive tumors, such that ER/PR-positive tumors in black patients may be less responsive to standard treatments.
Literature
1.
Ansell D, Whitman S, Lipton R, Cooper R (1993) Race, income, and survival from breast cancer at two public hospitals. Cancer 72:2974–2978CrossRefPubMed
2.
Baquet CR, Mishra SI, Commiskey P, Ellison GL, DeShields M (2008) Breast cancer epidemiology in blacks and whites: disparities in incidence, mortality, survival rates and histology. J Natl Med Assoc 100:480–488CrossRefPubMedPubMedCentral
3.
Curtis E, Quale C, Haggstrom D, Smith-Bindman R (2008) Racial and ethnic differences in breast cancer survival: how much is explained by screening, tumor severity, biology, treatment, comorbidities, and demographics? Cancer 112:171–180CrossRefPubMedPubMedCentral
4.
Whitman S, Orsi J, Hurlbert M (2012) The racial disparity in breast cancer mortality in the 25 largest cities in the United States. Cancer Epidemiol 36:e147–e151CrossRefPubMed
5.
Whitman S, Ansell D, Orsi J, Francois T (2011) The racial disparity in breast cancer mortality. J Commun Health 36:588–596CrossRef
6.
Gerend MA, Pai M (2008) Social determinants of Black-White disparities in breast cancer mortality: a review. Cancer Epidemiol Biomark Prev 17:2913–2923CrossRef
7.
Freedman RA, Virgo KS, He Y, Pavluck AL, Winer EP, Ward EM et al (2011) The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care. Cancer 117:180–189CrossRefPubMed
8.
Roberts MC, Wheeler SB, Reeder-Hayes K (2015) Racial/ethnic and socioeconomic disparities in endocrine therapy adherence in breast cancer: a systematic review. Am J Public Health 105(Suppl 3):e4–e15CrossRefPubMedPubMedCentral
9.
Molina Y, Silva A, Rauscher GH (2015) Racial/ethnic disparities in time to a breast cancer diagnosis: the mediating effects of health care facility factors. Med Care 53:872–878CrossRefPubMedPubMedCentral
10.
Mortel M, Rauscher GH, Murphy AM, Hoskins K, Warnecke RB (2015) Racial and ethnic disparity in symptomatic breast cancer awareness despite a recent screen: the role of tumor biology and mammography facility characteristics. Cancer Epidemiol Biomark Prev 24:1599–1606CrossRef
11.
Rauscher GH, Allgood KL, Whitman S, Conant E (2012) Disparities in screening mammography services by race/ethnicity and health insurance. J Women Health 21:154–160CrossRef
12.
Rauscher GH, Conant EF, Khan JA, Berbaum ML (2013) Mammogram image quality as a potential contributor to disparities in breast cancer stage at diagnosis: an observational study. BMC Cancer 13:208CrossRefPubMedPubMedCentral
13.
Rauscher GH, Khan JA, Berbaum ML, Conant EF (2013) Potentially missed detection with screening mammography: does the quality of radiologist’s interpretation vary by patient socioeconomic advantage/disadvantage? Ann Epidemiol 23:210–214CrossRefPubMedPubMedCentral
14.
Taplin SH, Yabroff KR, Zapka J (2012) A multilevel research perspective on cancer care delivery: the example of follow-up to an abnormal mammogram. Cancer Epidemiol Biomarkers Prev 21:1709–1715CrossRefPubMedPubMedCentral
15.
Zapka J, Taplin SH, Ganz P, Grunfeld E, Sterba K (2012) Multilevel factors affecting quality: examples from the cancer care continuum. J Natl Cancer Inst Monogr 2012:11–19CrossRefPubMedPubMedCentral
16.
Jones BA, Kasl SV, Howe CL, Lachman M, Dubrow R, Curnen MM et al (2004) African-American/White differences in breast carcinoma: p53 alterations and other tumor characteristics. Cancer 101:1293–1301CrossRefPubMed
17.
Chlebowski RT, Chen Z, Anderson GL, Rohan T, Aragaki A, Lane D et al (2005) Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst 97:439–448CrossRefPubMed
18.
Elledge RM, Clark GM, Chamness GC, Osborne CK (1994) Tumor biologic factors and breast cancer prognosis among white, Hispanic, and black women in the United States. J Natl Cancer Inst 86:705–712CrossRefPubMed
19.
Miller BA, Hankey BF, Thomas TL (2002) Impact of sociodemographic factors, hormone receptor status, and tumor grade on ethnic differences in tumor stage and size for breast cancer in US women. Am J Epidemiol 155:534–545CrossRefPubMed
20.
Rauscher GH, Campbell RT, Wiley EL, Hoskins K, Stolley M, Warnecke RB (2015) Socioeconomic position and reproductive factors mediate racial and ethnic disparities in estrogen/progesterone receptor negative breast cancer. Am J Epidemiol 183:884–893CrossRef
21.
Dietze EC, Sistrunk C, Miranda-Carboni G, O’Regan R, Seewaldt VL (2015) Triple-negative breast cancer in African-American women: disparities versus biology. Nat Rev Cancer 15:248–254CrossRefPubMed
22.
Althuis MD, Fergenbaum JH, Garcia-Closas M, Brinton LA, Madigan MP, Sherman ME (2004) Etiology of hormone receptor-defined breast cancer: a systematic review of the literature. Cancer Epidemiol Biomark Prev 13:1558–1568
23.
Ballard-Barbash R, Griffin MR, Fisher LD, Covalciuc MA, Jiang NS (1986) Estrogen receptors in breast cancer. Association with epidemiologic risk factors. Am J Epidemiol 124:77–84CrossRefPubMed
24.
25.
Simon MS, Severson RK (1997) Racial differences in breast cancer survival: the interaction of socioeconomic status and tumor biology. Am J Obstet Gynecol 176:S233–S239CrossRefPubMed
26.
Early Breast Cancer Clinical Trialists’ Collaborative Group (2011) Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet 378:771–784CrossRef
27.
DeSantis C, Ma J, Bryan L, Jemal A (2014) Breast cancer statistics, 2013. CA Cancer J Clin 64:52–62CrossRefPubMed
28.
Silva A, Rauscher GH, Hoskins K et al (2013) Assessing racial/ethnic disparities in chemotherapy treatment among breast cancer patients in context of changing treatment guidelines. Breast Cancer Res Treat 142:667–672CrossRefPubMedPubMedCentral
29.
Silva A, Rauscher GH, Ferrans CE et al (2014) Assessing the quality of race/ethnicity, tumor, and breast cancer treatment information in a non-SEER state registry. J Regist Manag 41:24–30
30.
Dookeran KA, Silva A, Warnecke RB, Rauscher GH (2015) Race/Ethnicity and disparities in mastectomy practice in the breast cancer care in chicago study. Ann Surg Oncol 22:66–74CrossRefPubMed
31.
Iqbal J, Ginsburg O, Rochon PA, Sun P, Narod SA (2015) Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. JAMA 313(2):165–173CrossRefPubMed
32.
O’Brien KM, Cole SR, Tse CK, Perou CM, Carey LA, Foulkes WD et al (2010) Intrinsic breast tumor subtypes, race, and long-term survival in the Carolina Breast Cancer Study. Clin Cancer Res 16:6100–6110CrossRefPubMedPubMedCentral
33.
Ma H, Lu Y, Malone KE, Marchbanks PA, Deapen DM, Spirtas R, Burkman RT, Strom BL, McDonald JA, Folger SG, Simon MS, Sullivan-Halley J, Press MF, Bernstein L (2013) Mortality risk of black women and white women with invasive breast cancer by hormone receptors, HER2, and p53 status. BMC Cancer 13:225CrossRefPubMedPubMedCentral
34.
Warner ET, Tamimi RM, Hughes ME, Ottesen RA, Wong YN, Edge SB et al (2015) Racial and ethnic differences in breast cancer survival: mediating effect of tumor characteristics and sociodemographic and treatment factors. J Clin Oncol 33:2254–2261CrossRefPubMedPubMedCentral
35.
Rauscher GH, Johnson TP, Cho YI, Walk JA (2008) Accuracy of self-reported cancer-screening histories: a meta-analysis. Cancer Epidemiol Biomark Prev 17:748–757CrossRef
36.
Wu X, Richardson LC, Kahn AR, Fulton JP, Cress RD, Shen T et al (2008) Survival difference between non-Hispanic black and non-Hispanic white women with localized breast cancer: the impact of guideline-concordant therapy. J Natl Med Assoc 2008(100):490–498 [Erratum appears in J Natl Med Assoc, 2008 Jun;100(6):659] CrossRef
37.
Li CI, Malone KE, Daling JR (2003) Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 163:49–56CrossRefPubMed
38.
Albain KS, Unger JM, Crowley JJ, Coltman CA Jr, Hershman DL (2009) Racial disparities in cancer survival among randomized clinical trials patients of the Southwest Oncology Group. J Natl Cancer Inst 101:984–992CrossRefPubMedPubMedCentral
39.
Sparano JA, Wang M, Zhao F, Stearns V, Martino S, Ligibel JA et al (2012) Race and hormone receptor-positive breast cancer outcomes in a randomized chemotherapy trial. J Natl Cancer Inst 104:406–414CrossRefPubMedPubMedCentral
40.
Neugut AI, Subar M, Wilde ET, Stratton S, Brouse CH, Hillyer GC et al (2011) Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer. J Clin Oncol 29:2534–2542CrossRefPubMedPubMedCentral
41.
Friese CR, Pini TM, Li Y, Abrahamse PH, Graff JJ, Hamilton AS et al (2013) Adjuvant endocrine therapy initiation and persistence in a diverse sample of patients with breast cancer. Breast Cancer Res Treat 138:931–939CrossRefPubMedPubMedCentral
42.
Lund MJ, Mosunjac M, Davis KM, Gabram-Mendola S, Rizzo M, Bumpers HL et al (2012) 21-Gene recurrence scores: racial differences in testing, scores, treatment, and outcome. Cancer 118:788–796CrossRefPubMed
43.
Robinson DR, Wu YM, Vats P, Su F, Lonigro RJ, Cao X et al (2013) Activating ESR1 mutations in hormone-resistant metastatic breast cancer. Nat Genet 45:1446–1451CrossRefPubMedPubMedCentral
44.
Fribbens C, O’Leary B, Kilburn L, Hrebien S, Garcia-Murillas I, Beaney M et al (2016) Plasma esr1 mutations and the treatment of estrogen receptor-positive advanced breast cancer. J Clin Oncol 34:2961–2968CrossRefPubMed
45.
Larsen SL, Yde CW, Laenkholm AV, Rasmussen BB, Duun-Henriksen AK, Bak M et al (2015) Aurora kinase B is important for antiestrogen resistant cell growth and a potential biomarker for tamoxifen resistant breast cancer. BMC Cancer 15:239CrossRefPubMedPubMedCentral
46.
Stewart PA, Luks J, Roycik MD, Sang QX, Zhang J (2013) Differentially expressed transcripts and dysregulated signaling pathways and networks in African American breast cancer. PLoS ONE 8:e82460CrossRefPubMedPubMedCentral
47.
D’Arcy M, Fleming J, Robinson WR, Kirk EL, Perou CM, Troester MA (2015) Race-associated biological differences among Luminal A breast tumors. Breast Cancer Res Treat 152:437–448CrossRefPubMedPubMedCentral
48.
Field LA, Love B, Deyarmin B, Hooke JA, Shriver CD, Ellsworth RE (2012) Identification of differentially expressed genes in breast tumors from African American compared with Caucasian women. Cancer 118:1334–1344CrossRefPubMed
49.
Gao Q, Patani N, Dunbier AK, Ghazoui Z, Zvelebil M, Martin LA et al (2014) Effect of aromatase inhibition on functional gene modules in estrogen receptor-positive breast cancer and their relationship with antiproliferative response. Clin Cancer Res 20:2485–2494CrossRefPubMed
50.
Nelson ER, Wardell SE, Jasper JS, Park S, Suchindran S, Howe MK, Carver NJ, Pillai RV et al (2013) 27-Hydroxycholesterol links hypercholesterolemia and breast cancer pathophysiology. Science 342(6162):1094–1098CrossRefPubMedPubMedCentral
51.
Network CGA (2012) Comprehensive molecular portraits of human breast tumours. Nature 490:61–70CrossRef
52.
Lee JJ, Lee HJ, Son BH, Kim SB, Ahn JH, Ahn SD et al (2016) Expression of FOXM1 and related proteins in breast cancer molecular subtypes. Int J Exp Pathol 97:170–177CrossRefPubMedPubMedCentral
53.
Ahn H, Sim J, Abdul R, Chung MS, Paik SS, Oh YH et al (2015) Increased expression of forkhead box M1 is associated with aggressive phenotype and poor prognosis in estrogen receptor-positive breast cancer. J Korean Med Sci 30:390–397CrossRefPubMedPubMedCentral
Metadata
Title
Racial disparity in survival from estrogen and progesterone receptor-positive breast cancer: implications for reducing breast cancer mortality disparities
Authors
Garth H. Rauscher
Abigail Silva
Heather Pauls
Jonna Frasor
Marcelo G. Bonini
Kent Hoskins
Publication date
01-06-2017
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 2/2017
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-017-4166-z

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