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Breast Cancer Research and Treatment

, Volume 113, Issue 2, pp 357–370 | Cite as

Race and triple negative threats to breast cancer survival: a population-based study in Atlanta, GA

  • Mary Jo Lund
  • Katrina F. Trivers
  • Peggy L. Porter
  • Ralph J. Coates
  • Brian Leyland-Jones
  • Otis W. Brawley
  • Elaine W. Flagg
  • Ruth M. O’Regan
  • Sheryl G. A. Gabram
  • J. William Eley
Epidemiology

Abstract

Background Breast cancers with a triple negative tumor (TNT) subtype (as defined by lacking protein expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)) preclude the use of available targeted therapies and may contribute to poor outcome and to the historically poorest survival observed among African–American (AA) women. This study examines association of the ER/PR/HER2 subtypes with race and breast cancer survival. Methods Breast tumors from a population-based cohort of 116 AA and 360 white Atlanta women aged 20–54, diagnosed from 1990 to 1992 were centrally reviewed and tested by immunohistochemistry. Multivariate survival analyses within subtypes (TNT, ER−PR−HER2+, ER+/PR+HER2+, ER+/PR+HER2−) were conducted using weighted Cox regression and included socio-demographic, prognostic, and treatment factors. Results TNTs were more prevalent among young women and particularly among AA women (Odds Ratio [OR] = 1.9, 95% Confidence Interval [CI] 1.2–2.9), adjusting for age, stage, grade, and poverty index. Overall mortality was higher for AA women (Hazard Ratio [HR] = 1.9, 95% CI, 1.5–2.5) and differed by subtypes (P < 0.001). Within the TNT subtype, racial differences in survival persisted, after additional adjustment for treatment and comorbidities (HR = 2.0, 95% CI 1.0–3.7). TNTs were uniquely associated with high expression of p16, p53, and Cyclin E; and low Bcl-2 and Cyclin D1 expression. Conclusions The high prevalence of TNTs among younger women and particularly younger AA women, along with unique protein expression patterns and poorer survival, suggests varying gene–environment etiologies with respect to age and race/ethnicity and a need for effective therapies.

Keywords

African–American Breast cancer Race Survival Triple negative Tumor subtypes 

Notes

Acknowledgements

Supported in part by awards RO1CA64292 (R.J.C., E.W.F., J.W.E., M.J.L.), RO1CA71735 (P.L.P.), the Avon Foundation (M.J.L., P.L.P.), the Glenn Foundation (M.J.L.), the Sindab Endowment (M.J.L., R.M.O.) and the Oak Ridge Institute for Science & Education Research Participation Program/CDC (M.J.L., K.F.T). The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Mary Jo Lund
    • 1
    • 2
    • 3
    • 4
  • Katrina F. Trivers
    • 5
  • Peggy L. Porter
    • 6
  • Ralph J. Coates
    • 5
  • Brian Leyland-Jones
    • 2
    • 3
  • Otis W. Brawley
    • 1
    • 2
    • 3
    • 4
  • Elaine W. Flagg
    • 7
  • Ruth M. O’Regan
    • 2
    • 3
  • Sheryl G. A. Gabram
    • 3
    • 4
  • J. William Eley
    • 2
    • 3
  1. 1.Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaUSA
  2. 2.Hematology and OncologyEmory University School of MedicineAtlantaUSA
  3. 3.Winship Cancer InstituteEmory University School of MedicineAtlantaUSA
  4. 4.Georgia Cancer Center for Excellence at GradyEmory UniversityAtlantaUSA
  5. 5.Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaUSA
  6. 6.Division of Human BiologyFred Hutchinson Cancer Research CenterSeattleUSA
  7. 7.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaUSA

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