Skip to main content

Advertisement

SpringerLink
Log in

Racial differences in the incidence of breast cancer subtypes defined by combined histologic grade and hormone receptor status

  • Original paper
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Breast cancer encompasses several distinct clinical entities of very different characteristics and behaviors, a fact which likely contributes to the higher breast cancer mortality in African-Americans (AA) despite the higher incidence in European-Americans (EA). We are interested in how incidence variability in cancer subtypes defined by combined estrogen receptor (ER) and grade contributes to racial mortality disparities. As an initial step, we compared age-specific and age-adjusted incidence rates for each ER/Grade subtype in South Carolina (SC—a southern state) with Ohio (a northern mid-western state), using state registry data for 1996–2004. Each ER/Grade subtype had a distinct incidence pattern and rate, with three striking racial/geographic differences. First, the racial incidence disparity in ER negative (ER−) cancers was mostly within the ER−/G3 subtype, of which AAs had ~65% higher incidence than did EAs; ER−/G2 was much less common, but of significantly higher incidence in AAs. Second, the racial disparity in ER positive (ER+) cancers was in the ER+/lower-grade cancers, with a marked EA excess in both states. Third, AA incidence of the ER+/lower-grade subtypes was ~26% higher in Ohio than in SC. The other subtypes (ER−/G1 and ER+/G3) varied minimally by race and state, and the latter showed a strong association with age. Age adjustment halved the racial difference in mean age at diagnosis to about 2 years younger in AAs, compared to 4 years younger in case comparisons. Use of age-adjusted and age-specific rates of breast cancer subtypes may improve understanding of racial incidence and mortality disparities over time and geography. This approach also may aid in estimating the race-specific incidence rates of triple-negative breast cancer.

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
Fig. 3

Similar content being viewed by others

Abbreviations

AA:

African-American

ACoS:

American College of Surgeons

CDC:

Centers for Disease Control and Prevention

dk:

Not known or unavailable

EA:

European-American

ER:

Estrogen receptor

ER+:

Positive ER expression status

ER+/G1:

ER positive and Grade 1

ER+/G1, 2:

ER positive and either Grade 1 or Grade 2

ER−:

Negative ER expression status

HER-2/neu:

Human epidermal growth factor receptor-2 also called HER-2

NAACCR:

North American Association of Central Cancer Registries

NPCR:

National Program of Cancer Registries

PR:

Progesterone receptor

SC:

South Carolina

SCCCR:

South Carolina Central Cancer Registry

SEER:

Surveillance, Epidemiology and End Results (program of the NCI)

T-stage:

Tumor stage, based upon size of invasive primary tumor

vs:

Versus

References

  1. Henson DE, Chu K, Levine PH (2003) Histologic grade, stage, and survival in breast carcinoma. Comparison of African American and Caucasian women. Cancer 98:908–917

    Article  PubMed  Google Scholar 

  2. 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 112:171–180

    Article  PubMed  Google Scholar 

  3. American Cancer Society (2007) Breast cancer facts & figures 2007–2008. American Cancer Society, Inc, Atlanta p. 3

    Google Scholar 

  4. Fitzgibbons PL, Page DL, Weaver D, Thor AD, Allred DC, Clark GM, Ruby SG et al (2000) Prognostic factors in breast cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 124:966–978

    CAS  PubMed  Google Scholar 

  5. Greene F, Page DL, Fleming ID, Fritz A, Balch DM, Haller DG, Morrow M (eds) (2002) AJCC cancer staging manual. Springer-Verlag, New York

    Google Scholar 

  6. Volpi A, Bacci F, Paradiso A, Saragoni L, Scarpi E, Ricci M et al (2004) Prognostic relevance of histologic grade and its components in node-negative breast cancer patients. Mod Pathol 17:1038–1044

    Article  PubMed  Google Scholar 

  7. Pinder SE, Murray S, Ellis IO, Trihia H, Elston CW, Gelber RD et al (1998) The importance of the histologic grade of invasive breast carcinoma and response to chemotherapy. Cancer 83:1529–1539

    Article  CAS  PubMed  Google Scholar 

  8. Page DL, Gray R, Allred DC, Dressler LG, Hatfield AK, Martino S et al (2001) Prediction of node-negative breast cancer outcome by histologic grading and S-phase analysis by flow cytometry: an Eastern Cooperative Oncology Group Study. Am J Clin Oncol 24:10–18

    Article  CAS  PubMed  Google Scholar 

  9. Sohib LH, Wittekind C (2002) TNM classification of malignant tumours: International Union Against Cancer

  10. Cunningham JE, Butler WM (2004) Racial disparities in female breast cancer in South Carolina: clinical evidence for a biological basis even in small tumors. Breast Cancer Res Treat 88:161–176

    Article  PubMed  Google Scholar 

  11. Carey LA, Perou C, Livasy CA, Dressler LG, Cowan D, Conway K et al (2006) Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA 295:2492–2502

    Article  CAS  PubMed  Google Scholar 

  12. Bauer KR, Brown M, Cress RD et al (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 109:1721–1728

    Article  PubMed  Google Scholar 

  13. United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS) (2008) Bridged-race population estimates, United States July 1st resident population by state, county, age, sex, bridged-race, and Hispanic origin, on CDC WONDER On-line Database. Vintage 2006: years 2000–2006, September 2007 online database, based on the August 16, 2007 data release. http://wonder.cdc.gov/bridged-race-v2006.html

  14. National Center for Health Statistics (NCHS) (2008) http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm

  15. National Cancer Institute Surveillance Research Program (2008) http://seer.cancer.gov/stdpopulations

  16. North American Association of Central Cancer Registries (2008) http://www.cancer-rates.info/naaccr/

  17. Jensen OM, Parkin DM, MacLennan R, Muir CS, Skeet RG (eds) (1991) Cancer registration: principles and methods. Scientific Publication No. 95. International Agency for Research on Cancer. Lyon, France, p 138 (Equations 11.11 and 11.12)

  18. Sørlie T, Perou C, Tibshirani R, Aas T, Geisler S, Johnsen H et al (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 98:10869–10874

    Article  PubMed  Google Scholar 

  19. Sørlie T, Wang Y, Xiao C, Johnsen H, Naume B, Samaha RR, Børresen-Dale AL (2006) Distinct molecular mechanisms underlying clinically relevant subtypes of breast cancer: gene expression analyses across three different platforms. BMC Genomics 7:127

    Article  PubMed  CAS  Google Scholar 

  20. Reis-Filho JS, Tutt A (2008) Triple negative tumours: a critical review. Histopathology 52:108–118

    Article  CAS  PubMed  Google Scholar 

  21. Rakha EA, Ellis IO (2009) Triple-negative/basal-like breast cancer: review. Pathology 41(1):40–47

    Article  PubMed  Google Scholar 

  22. Asselin-Labat ML, Shackleton M, Stingl J, Vaillant F, Forrest NC, Eaves CJ et al (2006) Steroid hormone receptor status of mouse mammary stem cells. J Natl Cancer Inst 98:1011–1014

    CAS  PubMed  Google Scholar 

  23. Sims AH, Howell A, Howell SJ, Clarke RB (2007) Origins of breast cancer subtypes and therapeutic implications. Nat Clin Pract Oncol 4:516–525

    Article  CAS  PubMed  Google Scholar 

  24. Melchor L, Benitz J (2008) An integrative hypothesis about the origin and development of sporadic and familial breast cancer subtypes. Carcinogenesis 29(8):1475–1482

    Article  CAS  PubMed  Google Scholar 

  25. Bloushtain-Qimron N, Yao J, Shipitsin M, Maruyama R, Polyak K (2009) Epigenetic patterns of embryonic and adult stem cells. Cell Cycle 8(6):806–817

    Google Scholar 

  26. Abdel-Fatah TMA, Powell D, Hodi Z, Reis-Filho JS, Lee AHS, Ellis IO (2008) Morphologic and molecular evolutionary pathways of low nuclear grade invasive breast cancers and their putative precursor lesions: further evidence to support the concept of low nuclear grade breast neoplasia family. Am J Surg Pathol 32(4):513–523

    Google Scholar 

  27. Tlsty TD, Coussens LM (2006) Tumor stroma and regulation of cancer development. Ann Rev Pathol 1:119–150

    Article  CAS  Google Scholar 

  28. Hunter KW, Crawford NP (2006) Germline polymorphism in metastatic progression. Cancer Res 66:1251–1254

    Article  CAS  PubMed  Google Scholar 

  29. Crawford NPS, Hunter K (2006) New perspectives on hereditary influences in metastatic progression. Trends Genet 22:555–561

    Article  CAS  PubMed  Google Scholar 

  30. Potter J, Cerhan JR, Sellers TA, McGovern PG, Drinkard C, Kushi LR, Folsom AR (1995) Progesterone and estrogen receptors and mammary neoplasia in the Iowa Women’s Health Study: how many types of breast cancer are there? Cancer Epidemiol Biomark Prev 4:319–326

    CAS  Google Scholar 

  31. Li CI, Malone K, Porter PL, Weiss NS, Tang M-TC, Daling JR (2003) The relationship between alcohol use and risk of breast cancer by histology and hormone receptor status among women 65–79 years of age. Cancer Epidemiol Biomark Prev 12:1061–1066

    CAS  Google Scholar 

  32. Smigal C, Jemal A, Ward E, Cokkinides V, Smith R, Howe HL, Thun M (2006) Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin 56:168–183

    Article  PubMed  Google Scholar 

  33. Chen WY, Colditz G (2007) Risk factors and hormone-receptor status: epidemiology, risk-prediction models and treatment implications for breast cancer. Nat Clin Pract Oncol 4:415–423

    Article  PubMed  Google Scholar 

  34. Yang XR, Sherman ME, Rimm DL, Lissowska J, Brinton LA, Peplonska B, Hewitt SM, Anderson WF, Szeszenia-Dabrowska N, Bardin-Mikolajczak A, Zatonski W, Cartun R, Mandich D, Rymkiewicz G, Ligaj M, Lukaszek S, Kordek R, Garcia-Closas M (2007) Differences in risk factors for breast cancer molecular subtypes in a population-based study. Cancer Epidemiol Biomarkers Prev 16(3):439–443

    Article  CAS  PubMed  Google Scholar 

  35. Setiawan VW, Monroe KR, Wilkens LR, Kolonel LN, Pike MC, Henderson BE (2009) Breast cancer risk factors defined by estrogen and progesterone receptor status: the multiethnic cohort study. AJE Adv Access

  36. Stead L, Lash TL, Sobieraj J, Chi D, Westrup J, Charlot M, Blanchard R, Lee JC, King T, Rosenberg CL (2009) Triple negative breast cancers are increased in black women regardless of age or body mass index. Breast Cancer Res 11(2):R18 [Epub ahead of print.]

    Article  PubMed  Google Scholar 

  37. Karp SE, Tonin PN, Begin LR, Martinez JJ, Zhang JC, Pollak MN, Foulkes WD (1997) Influence of BRCA1 mutations on nuclear grade and estrogen receptor status of breast carcinoma in Ashkenazi Jewish women. Cancer 80:435–441

    Article  CAS  PubMed  Google Scholar 

  38. Anderson WF, Chen B, Brinton LA, Devesa SS (2007) Qualitative age interactions (or effect modification) suggest different cancer pathways for early-onset and late-onset breast cancers. Cancer Causes Control 18:1187–1198

    Article  PubMed  Google Scholar 

  39. Anderson WF, Matsuno R (2006) Breast cancer heterogeneity: a mixture of at least two main types? J Natl Cancer Inst 98:948–951

    Article  CAS  PubMed  Google Scholar 

  40. Krieger N, Chen JT, Ware JH, Kaddour A (2008) Race/ethnicity and breast cancer estrogen receptor status: impact of class, missing data and modeling assumptions. Cancer Causes Control doi: 10.1007/s10552-008-9202-1

  41. Robert SA, Strombom I, Trentham-Dietz A et al (2004) Socioeconomic risk factors for breast cancer: distinguishing individual- and community-level effects. Epidemiology 15:442–450

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the following people from the South Carolina Central Cancer Registry for providing the South Carolina data: Susan Bollick-Aldrich, MSPH, CTR (director), Catishia Moseley, MSPH, and Deborah Hurley, MSPH. Special thanks are also due to Mike Byrd, PhD, MPH, LMSW, director of the Chronic Diseases Branch of the South Carolina Department of Health and Environmental Control, for his unflagging encouragement of this analysis, and to Dr. Anthony Alberg of the Medical University of South Carolina for his editorial assistance. Ohio cancer incidence data were obtained from the Ohio Cancer Incidence Surveillance System (OCISS), Ohio Department of Health (ODH), a registry participating in the National Program of Cancer Registries of the Centers for Disease Control and Prevention (CDC). Use of these data does not imply ODH or CDC either agrees or disagrees with any presentations, analyses, interpretations, or conclusions. Information about the OCISS can be obtained at: http://www.odh.ohio.gov/odhPrograms/svio/ci_surv/ci_surv1.aspx.

Author information

Authors and Affiliations

  1. Division of Biostatistics and Epidemiology, and Hollings Cancer Center, Medical University of South Carolina, 135 Cannon St., Suite 302, Charleston, SC, 29425, USA

    Joan E. Cunningham

  2. Division of Hematology/Oncology, University of Miami Sylvester Cancer Center, Miami, FL, USA

    Alberto J. Montero

  3. Division of Biostatistics and Epidemiology, and Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., Suite 118G, Charleston, SC, 29425, USA

    Elizabeth Garrett-Mayer

  4. ABC Consulting, Dayton, OH, USA

    Hans J. Berkel

  5. Department of Biological Sciences, University of South Carolina, Columbia, SC, USA

    Bert Ely

Authors
  1. Joan E. Cunningham
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alberto J. Montero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth Garrett-Mayer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hans J. Berkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bert Ely
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joan E. Cunningham.

Additional information

This work was performed at Division of Biostatistics and Epidemiology, Department of Medicine, Medical University of South Carolina, Charleston SC, AND at the University of South Carolina, Columbia, SC.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cunningham, J.E., Montero, A.J., Garrett-Mayer, E. et al. Racial differences in the incidence of breast cancer subtypes defined by combined histologic grade and hormone receptor status. Cancer Causes Control 21, 399–409 (2010). https://doi.org/10.1007/s10552-009-9472-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-009-9472-2

Keywords

Search

Navigation