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Risk factors for breast cancer subtypes among Black women undergoing screening mammography

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

Abstract

Purpose

Black women are more likely than non-Hispanic White women to be diagnosed with triple negative breast cancer (TNBC), an aggressive subtype with limited treatment options. The study objective was to evaluate the associations of known breast cancer risk factors, including breast density, with TNBC among Black women.

Methods

This study included Black women who underwent screening mammography between the ages of 40–84 years at a University of Pennsylvania Health System between 2010 and 2015. Cox proportional hazard models using multiple imputation with chained equations were used to estimate hazard ratios and 95% confidence intervals for risk factors for ER/PR+/HER2− and TNBC.

Results

Among 25,013 Black women, there were 330 incident breast cancers (1.3%) during a mean follow-up of 5.8 years; 218 (66.1%) ER/PR+ HER− and 61 (18.1%) TNBC. Having dense breasts (heterogeneously dense or extremely dense) vs. non-dense breasts (almost entirely fatty or scattered areas of fibroglandular density) increased risk of ER/PR+/HER2− breast cancer almost 80% (HR 1.79, 95% CI 1.32–2.43) and TNBC more than twofold (HR 2.53, 1.45–4.44). Older age was associated with an increased risk for ER/PR+/HER2− (HR 1.04, 1.03–1.06) and TNBC (HR 1.03, 1.00–1.05). Having a BMI of > 30 kg/m2 was associated with an increased risk (HR 2.77, 1.05–7.30) for TNBC and an increased risk of ERPR+/HER2− breast cancer in postmenopausal but not pre-menopausal women (p-interaction = 0.016).

Conclusion

Our results suggest that breast density and obesity are strong risk factors for TNBC among Black women. Understanding breast cancer subtype specific risk factors among Black women can help improve risk assessment.

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Data availability

The data underlying this article cannot be shared publicly in order to protect patient privacy. The data may be shared in a de-identified format on reasonable request to the corresponding author.

Code availability

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Funding

This work was supported by the American Cancer Society: 131052-MRSG-17-144-01-CCE and the Susan G. Komen Foundation®: CCR17480662.

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Authors and Affiliations

  1. Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA

    Tara M. Friebel-Klingner, Sarah Ehsan, Emily F. Conant, Despina Kontos, Susan M. Domchek & Anne Marie McCarthy

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  1. Tara M. Friebel-Klingner
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  2. Sarah Ehsan
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  3. Emily F. Conant
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  5. Susan M. Domchek
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Contributions

TMF-K: Conceptualization, Formal Analysis, Methodology, Writing-original draft, Writing-review and editing; SE: Data Curation, Writing-review and editing; EC: Conceptualization, Writing-review and editing, Resources; DK: Conceptualization, Writing-review and editing, Resources; SD: Conceptualization, Writing-review and editing; AMM: Conceptualization, Data curation, Funding acquisition, Methodology, Writing-review and editing.

Corresponding author

Correspondence to Tara M. Friebel-Klingner.

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Conflict of interest

Emily Conant has grants and is on the Advisory Board for iCAD, Inc. and for Hologic, Inc. The remaining authors have no conflicts to disclose.

Ethical approval

This observational study was deemed exempt from review by the University of Pennsylvania Institutional Review Board.

Informed consent

The need for informed consent by human subjects was waived by the University of Pennsylvania Institutional Review Board.

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Appendix

Appendix

See Table 3, 4, 5 and 6.

Table 3 Risk factors for breast cancer subtypes among 25,013 Black women undergoing screening mammography in multivariable adjusted models using missing data
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Table 4 Risk factors breast cancer subtypes among 25,013 Black women undergoing screening mammography using missing data
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Table 5 Risk factors for breast cancer subtypes among 25,013 Black women undergoing screening mammography using missing data
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Table 6 Interactions of menopause status with BMI and menopause status with breast density
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Friebel-Klingner, T.M., Ehsan, S., Conant, E.F. et al. Risk factors for breast cancer subtypes among Black women undergoing screening mammography. Breast Cancer Res Treat 189, 827–835 (2021). https://doi.org/10.1007/s10549-021-06340-2

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