Skip to main content

Advertisement

SpringerLink
Log in

Racial differences in outcomes of triple-negative breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

African American (AA) women have a higher incidence of triple-negative breast cancer (TNBC: negative for the expression of estrogen receptor, progesterone receptor, and HER2 gene amplification) than Caucasian (CA) women, explaining in part their higher breast cancer mortality. However, there have been inconsistent data in the literature regarding survival outcomes of TNBC in AA versus CA women. We performed a retrospective chart review on 493 patients with TNBC first seen at the Washington University Breast Oncology Clinic (WUBOC) between January 2006 and December 2010. Analysis was done on 490 women (30 % AA) for whom follow-up data was available. The median age at diagnosis was 53 (23–98) years and follow-up time was 27.2 months. There was no significant difference between AA and CA women in the age of diagnosis, median time from abnormal imaging to breast biopsy and from biopsy diagnosis to surgery, duration of follow-up, tumor stage, grade, and frequency of receiving neoadjuvant or adjuvant chemotherapy and pathologic complete response rate to neoadjuvant chemotherapy. There was no difference in disease free survival (DFS) and overall survival (OS) between AA and CA groups by either univariate or multivariate analysis that included age, race, and stage. The hazard ratio for AA women was 1.19 (CI 0.80–1.78, p = 0.39) and 0.91 (CI 0.62–1.35, p = 0.64) for OS and DFS, respectively. Among the 158 patients who developed recurrence or presented with stage IV disease (AA: n = 36, CA: n = 122), no racial differences in OS were observed. We conclude that race did not significantly affect the clinical presentation and outcome of TNBC in this single center study where patients received similar therapy and follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Chlebowski RT, Chen Z, Anderson GL, Rohan T, Aragaki A, Lane D, Dolan NC, Paskett ED, McTiernan A, Hubbell FA et al (2005) Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst 97(6):439–448

    Article  PubMed  Google Scholar 

  2. Joslyn SA, West MM (2000) Racial differences in breast carcinoma survival. Cancer 88(1):114–123

    Article  PubMed  CAS  Google Scholar 

  3. Parker SL, Davis KJ, Wingo PA, Ries LA, Heath CW Jr (1998) Cancer statistics by race and ethnicity. CA Cancer J Clin 48(1):31–48

    Article  PubMed  CAS  Google Scholar 

  4. Siegel R, Naishadham D, Jemal A (2012) Cancer statistics. CA Cancer J Clin 62(1):10–29

    Article  PubMed  Google Scholar 

  5. Ayanian JZ, Kohler BA, Abe T, Epstein AM (1993) The relation between health insurance coverage and clinical outcomes among women with breast cancer. NEJM 329(5):326–331

    Article  PubMed  CAS  Google Scholar 

  6. Bradley CJ, Given CW, Roberts C (2002) Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst 94(7):490–496

    Article  PubMed  Google Scholar 

  7. Moskowitz MA, Ash A, Shwartz M, Marwill SL, Freund KM, McCarthy EP, Burns RB (1996) Black women receive less mammography even with similar use of primary care. Ann Intern Med 125(3):173–182

    PubMed  Google Scholar 

  8. 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(9):705–712

    Article  PubMed  CAS  Google Scholar 

  9. Furberg H, Millikan R, Dressler L, Newman B, Geradts J (2001) Tumor characteristics in African American and white women. Breast Cancer Res Treat 68(1):33–43

    Article  PubMed  CAS  Google Scholar 

  10. Gwyn K, Bondy ML, Cohen DS, Lund MJ, Liff JM, Flagg EW, Brinton LA, Eley JW, Coates RJ (2004) Racial differences in diagnosis, treatment, and clinical delays in a population-based study of patients with newly diagnosed breast carcinoma. Cancer 100(8):1595–1604

    Article  PubMed  Google Scholar 

  11. Hershman D, McBride R, Jacobson JS, Lamerato L, Roberts K, Grann VR, Neugut AI (2005) Racial disparities in treatment and survival among women with early-stage breast cancer. J Clin Oncol 23(27):6639–6646

    Article  PubMed  Google Scholar 

  12. Lannin DR, Mathews HF, Mitchell J, Swanson MS, Swanson FH, Edwards MS (1998) Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA 279(22):1801–1807

    Article  PubMed  CAS  Google Scholar 

  13. McWhorter WP, Mayer WJ (1987) Black/white differences in type of initial breast cancer treatment and implications for survival. Am J Public Health 77(12):1515–1517

    Article  PubMed  CAS  Google Scholar 

  14. Morris GJ, Naidu S, Topham AK, Guiles F, Xu Y, McCue P, Schwartz GF, Park PK, Rosenberg AL, Brill K et al (2007) Differences in breast carcinoma characteristics in newly diagnosed African-American and Caucasian patients: a single-institution compilation compared with the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. Cancer 110(4):876–884

    Article  PubMed  Google Scholar 

  15. Newman LA, Griffith KA, Jatoi I, Simon MS, Crowe JP, Colditz GA (2006) Meta-analysis of survival in African American and white American patients with breast cancer: ethnicity compared with socioeconomic status. J Clin Oncol 24(9):1342–1349

    Article  PubMed  Google Scholar 

  16. Partridge AH, Wang PS, Winer EP, Avorn J (2003) Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol 21(4):602–606

    Article  PubMed  CAS  Google Scholar 

  17. Smith-Bindman R, Miglioretti DL, Lurie N, Abraham L, Barbash RB, Strzelczyk J, Dignan M, Barlow WE, Beasley CM, Kerlikowske K (2006) Does utilization of screening mammography explain racial and ethnic differences in breast cancer? Ann Intern Med 144(8):541–553

    PubMed  Google Scholar 

  18. Tammemagi CM, Nerenz D, Neslund-Dudas C, Feldkamp C, Nathanson D (2005) Comorbidity and survival disparities among black and white patients with breast cancer. JAMA 294(14):1765–1772

    Article  PubMed  CAS  Google Scholar 

  19. Trock B, Rimer BK, King E, Balshem A, Cristinzio CS, Engstrom PF (1993) Impact of an HMO-based intervention to increase mammography utilization. Cancer Epidemiol Biomarkers Prev 2(2):151–156

    PubMed  CAS  Google Scholar 

  20. Ward E, Jemal A, Cokkinides V, Singh GK, Cardinez C, Ghafoor A, Thun M (2004) Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 54(2):78–93

    Article  PubMed  Google Scholar 

  21. Lund MJ, Trivers KF, Porter PL, Coates RJ, Leyland-Jones B, Brawley OW, Flagg EW, O’Regan RM, Gabram SG, Eley JW (2009) Race and triple negative threats to breast cancer survival: a population-based study in Atlanta, GA. Breast Cancer Res Treat 113(2):357–370

    Article  PubMed  Google Scholar 

  22. Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V (2007) Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer Registry. Cancer 109(9):1721–1728

    Article  PubMed  Google Scholar 

  23. Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, Karaca G, Troester MA, Tse CK, Edmiston S et al (2006) Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA 295(21):2492–2502

    Article  PubMed  CAS  Google Scholar 

  24. Sachdev JC, Ahmed S, Mirza MM, Farooq A, Kronish L, Jahanzeb M (2010) Does race affect outcomes in triple negative breast cancer? Breast Cancer (Auckl) 4:23–33

    Google Scholar 

  25. Dent R, Hanna WM, Trudeau M, Rawlinson E, Sun P, Narod SA (2009) Pattern of metastatic spread in triple-negative breast cancer. Breast Cancer Res Treat 115(2):423–428

    Article  PubMed  Google Scholar 

  26. Dent R, Trudeau M, Pritchard KI, Hanna WM, Kahn HK, Sawka CA, Lickley LA, Rawlinson E, Sun P, Narod SA (2007) Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res 13(15 Pt 1):4429–4434

    Article  PubMed  Google Scholar 

  27. Peddi PF, Ellis MJ, Ma C (2012) Molecular basis of triple negative breast cancer and implications for therapy. Int J Breast Cancer 2012:217185

    PubMed  Google Scholar 

  28. Dawood S, Broglio K, Kau SW, Green MC, Giordano SH, Meric-Bernstam F, Buchholz TA, Albarracin C, Yang WT, Hennessy BT et al (2009) Triple receptor-negative breast cancer: the effect of race on response to primary systemic treatment and survival outcomes. J Clin Oncol 27(2):220–226

    Article  PubMed  CAS  Google Scholar 

  29. O’Brien KM, Cole SR, Tse CK, Perou CM, Carey LA, Foulkes WD, Dressler LG, Geradts J, Millikan RC (2010) Intrinsic breast tumor subtypes, race, and long-term survival in the Carolina Breast Cancer Study. Clin Cancer Res 16(24):6100–6110

    Article  PubMed  Google Scholar 

  30. Sparano JA, Wang M, Zhao F, Stearns V, Martino S, Ligibel JA, Perez EA, Saphner T, Wolff AC, Sledge GW Jr et al (2012) Race and hormone receptor-positive breast cancer outcomes in a randomized chemotherapy trial. J Natl Cancer Inst 104(5):406–414

    Article  PubMed  CAS  Google Scholar 

  31. Mallol N, Desandes E, Lesur-Schwander A, Guillemin F (2006) Disease-specific and event-free survival in breast cancer patients: a hospital-based study between 1990 and 2001. Rev Epidemiol Sante Publique 54(4):313–325

    Article  PubMed  CAS  Google Scholar 

  32. Schootman M, Jeffe D, Reschke A, Aft R (2004) The full potential of breast cancer screening use to reduce mortality has not yet been realized in the United States. Breast Cancer Res Treat 85(3):219–222

    Article  PubMed  Google Scholar 

  33. Lin NU, Vanderplas A, Hughes ME, Theriault RL, Edge SB, Wong Y-N, Blayney DW, Niland JC, Winer EP, Weeks JC (2012) Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network. Cancer 118(22):5463–5472

    Article  PubMed  Google Scholar 

  34. Fisher CS, Ma CX, Gillanders WE, Aft RL, Eberlein TJ, Gao F, Margenthaler JA (2011) Neoadjuvant chemotherapy is associated with improved survival compared with adjuvant chemotherapy in patients with triple-negative breast cancer only after complete pathologic response. Ann Surg Oncol 19(1):253–258

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank patients who participated in this study and physicians, nurses, and research coordinators at Washington University Breast Cancer Oncology Clinic for their care of these patients. The authors also wish to acknowledge the support of the Biostatistics Core, Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842.

Conflict of interest

All authors disclose no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Jose M. Pacheco

  2. Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA

    Feng Gao

  3. Section of Breast Oncology, Division of Oncology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, P.O. Box 8056, St. Louis, MO, 63110, USA

    Caroline Bumb, Matthew J. Ellis & Cynthia X. Ma

  4. Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA

    Matthew J. Ellis & Cynthia X. Ma

Authors
  1. Jose M. Pacheco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Feng Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Caroline Bumb
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew J. Ellis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cynthia X. Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cynthia X. Ma.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pacheco, J.M., Gao, F., Bumb, C. et al. Racial differences in outcomes of triple-negative breast cancer. Breast Cancer Res Treat 138, 281–289 (2013). https://doi.org/10.1007/s10549-012-2397-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-012-2397-6

Keywords

Search

Navigation