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Cancer Causes & Control

, Volume 30, Issue 11, pp 1171–1182 | Cite as

Do breast quadrants explain racial disparities in breast cancer outcomes?

  • Yunan Han
  • Justin Xavier Moore
  • Marvin Langston
  • Lindsay Fuzzell
  • Saira Khan
  • Marquita W. Lewis
  • Graham A. Colditz
  • Ying LiuEmail author
Original Paper
First Online:
  • 126 Downloads

Abstract

Purpose

Tumors of the inner quadrants of the breast are associated with poorer survival than those of the upper-outer quadrant. It is unknown whether racial differences in breast cancer outcomes are modified by breast quadrant, in addition to comparisons among Asian subgroups.

Methods

Using the Surveillance, Epidemiology, and End Results database, we analyzed data among women diagnosed with non-metastatic invasive breast cancer between 1990 and 2014. We performed Cox proportional hazards regression models to assess the associations of race with breast cancer-specific survival and overall survival, stratified by breast quadrants. The models were adjusted for age, year of the diagnosis, tumor size, grade, histological type, tumor laterality, lymph node, estrogen receptor, progesterone receptor, and treatments.

Results

Among 454,154 patients (73.0% White, 10.0% Black, 7.8% Asian/PI, and 9.2% Hispanic), 54.3% had tumors diagnosed in the upper-outer quadrant of the breast. Asian/PI women were more likely than White to have tumors diagnosed in the nipple/central portion of the breast and were less likely to have diagnosed in the upper-outer quadrant (P < 0.001), despite a similar distribution of breast quadrant between Black, Hispanic, and White women. Compared with White women, the multivariable-adjusted hazard ratios of breast cancer-specific mortality were 1.41 (95% CI 1.37–1.44) in Black women, 0.82 (95% CI 0.79–0.85) in Asian women, and 1.05 (95% CI 1.02–1.09) in Hispanic women. Among Asian subgroups, Japanese American women had a lower risk of breast cancer-specific mortality (HR = 0.68, 95% CI 0.62–0.74) compared with White women. Overall survival was similar to breast cancer-specific survival in each race group. The race-associated risks did not vary significantly by breast quadrants for breast cancer-specific mortality and all-cause mortality.

Conclusions

Differences in breast cancer survival by race could not be attributed to tumor locations. Understanding the cultural, biological, and lifestyle factors that vary between White, African American, and ethnic subgroups of Asian American women may help explain these survival differences.

Keywords

Breast cancer Race Breast quadrant Primary tumor site Survival 

Abbreviations

BCS

Breast-conserving surgery

BCSM

Breast cancer-specific mortality

BCSS

Breast cancer-specific survival

CI

Confidence interval

ER

Estrogen receptor

HR

Hazard ratio

NOS

Not otherwise specified

OS

Overall survival

PI

Pacific Islander

PR

Progesterone receptor

SEER

Surveillance, Epidemiology, and End Results

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Notes

Funding

Dr. Han was supported by foundations from Barnes-Jewish Hospital and Breast Cancer Research Foundation (award ID: BCRF-17-028). Dr. Colditz is supported by the Breast Cancer Research Foundation. Drs. Moore, Langston, Fuzzell, Khan, and Lewis were supported by the Washington University School of Medicine, Public Health Sciences Division Postdoctoral Training in Cancer Prevention and Control, and a training grant from the National Cancer Institute of the National Institutes of Health under award number T32CA190194. YL is supported by an American Cancer Society—Denim Days Research Scholar Grant (RSG-18-116-01-CPHPS) and the National Cancer Institute (R01CA215418). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

As this study is based on a publicly available database without identifying patient information, informed consent was not needed.

Supplementary material

10552_2019_1222_MOESM1_ESM.doc (338 kb)
Supplementary file1 (DOC 338 kb)

References

  1. 1.
    Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin. 69:7–34CrossRefPubMedGoogle Scholar
  2. 2.
    Smith RA, Andrews KS, Brooks D et al (2017) Cancer screening in the United States, 2017: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 67:100–121CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A (2016) Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin. 66:31–42CrossRefPubMedGoogle Scholar
  4. 4.
    Lohrisch C, Jackson J, Jones A, Mates D, Olivotto IA (2000) Relationship between tumor location and relapse in 6,781 women with early invasive breast cancer. J Clin Oncol 18:2828–2835CrossRefPubMedGoogle Scholar
  5. 5.
    Zucali R, Mariani L, Marubini E et al (1998) Early breast cancer: evaluation of the prognostic role of the site of the primary tumor. J Clin Oncol 16:1363–1366CrossRefPubMedGoogle Scholar
  6. 6.
    Gaffney DK, Tsodikov A, Wiggins CL (2003) Diminished survival in patients with inner versus outer quadrant breast cancers. J Clin Oncol 21:467–472CrossRefPubMedGoogle Scholar
  7. 7.
    Siotos C, McColl M, Psoter K et al (2018) Tumor site and breast cancer prognosis. Clinical Breast Cancer 18:e1045–e1052CrossRefPubMedGoogle Scholar
  8. 8.
    Perkins CI, Hotes J, Kohler BA, Howe HL (2004) Association between breast cancer laterality and tumor location, United States, 1994–1998. Cancer Causes Control: CCC 15:637–645CrossRefPubMedGoogle Scholar
  9. 9.
    Lee AH (2005) Why is carcinoma of the breast more frequent in the upper outer quadrant? A case series based on needle core biopsy diagnoses. Breast (Edinburgh, Scotland) 14:151–152CrossRefGoogle Scholar
  10. 10.
    Bao J, Yu KD, Jiang YZ, Shao ZM, Di GH (2014) The effect of laterality and primary tumor site on cancer-specific mortality in breast cancer: a SEER population-based study. PLoS ONE 9:e94815CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Colleoni M, Zahrieh D, Gelber RD et al (2005) Site of primary tumor has a prognostic role in operable breast cancer: the international breast cancer study group experience. J Clin Oncol 23:1390–1400CrossRefPubMedGoogle Scholar
  12. 12.
    Sohn VY, Arthurs ZM, Sebesta JA, Brown TA (2008) Primary tumor location impacts breast cancer survival. Am J Surg 195:641–644CrossRefPubMedGoogle Scholar
  13. 13.
    Giess CS, Keating DM, Osborne MP, Ng YY, Rosenblatt R (1998) Retroareolar breast carcinoma: clinical, imaging, and histopathologic features. Radiology 207:669–673CrossRefPubMedGoogle Scholar
  14. 14.
    Nicholson BT, Harvey JA, Cohen MA (2009) Nipple-areolar complex: normal anatomy and benign and malignant processes. Radiographics 29:509–523CrossRefPubMedGoogle Scholar
  15. 15.
    Turner-Warwick RT (1959) The lymphatics of the breast. Br J Surg 46:574–582CrossRefPubMedGoogle Scholar
  16. 16.
    Savaridas SL, Spratt JD, Cox J (2015) Incidence and potential significance of internal mammary lymphadenopathy on computed tomography in patients with a diagnosis of primary breast cancer. Breast Cancer: Basic Clin Res 9:59–65Google Scholar
  17. 17.
    Gou ZC, Liu XY, Xiao Y, Zhao S, Jiang YZ, Shao ZM (2018) Decreased survival in patients with carcinoma of axillary tail versus upper outer quadrant breast cancers: a SEER population-based study. Cancer Manage Res 10:1133–1141CrossRefGoogle Scholar
  18. 18.
    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 313:165–173CrossRefPubMedGoogle Scholar
  19. 19.
    National Cancer Institute. Surveillance, Epidemiology, and End Results program. SEER incidence data, 1973-2015.Google Scholar
  20. 20.
    National Cancer Institute. Surveillance, Epidemiology, and End Results program. Quadrants of the Breast.Google Scholar
  21. 21.
    Park JJ, Humble S, Sommers BD, Colditz GA, Epstein AM, Koh HK (2018) Health Insurance for Asian Americans, Native Hawaiians, and Pacific Islanders Under the Affordable Care Act. JAMA Intern Med 178:1128–1129CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Gomez SL, Von Behren J, McKinley M et al (2017) Breast cancer in Asian Americans in California, 1988–2013: increasing incidence trends and recent data on breast cancer subtypes. Breast Cancer Res Treat 164:139–147CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    VanderWeele TJ (2009) On the distinction between interaction and effect modification. Epidemiology (Cambridge, Mass.). 20:863–871CrossRefGoogle Scholar
  24. 24.
    Shahar KH, Buchholz TA, Delpassand E et al (2005) Lower and central tumor location correlates with lymphoscintigraphy drainage to the internal mammary lymph nodes in breast carcinoma. Cancer 103:1323–1329CrossRefPubMedGoogle Scholar
  25. 25.
    Warner ET, Tamimi RM, Hughes ME et al (2015) Racial and ethnic differences in breast cancer survival: mediating effect of tumor characteristics and sociodemographic and treatment factors. J Clin Oncol 33:2254–2261CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Sakamoto G, Sugano H (1991) Pathology of breast cancer: present and prospect in Japan. Breast Cancer Res Treat 18(Suppl 1):S81–S83CrossRefPubMedGoogle Scholar
  27. 27.
    Stemmermann GN (1991) The pathology of breast cancer in Japanese women compared to other ethnic groups: a review. Breast Cancer Res Treat 18(Suppl 1):S67–S72CrossRefPubMedGoogle Scholar
  28. 28.
    Shoemaker ML, White MC, Wu M, Weir HK, Romieu I (2018) Differences in breast cancer incidence among young women aged 20-49 years by stage and tumor characteristics, age, race, and ethnicity, 2004-2013. Breast Cancer Res Treat 169:595–606CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Lamb EP, Pritchard FE, Nouer SS et al (2018) Understanding disparities in breast cancer care in Memphis. Tennessee Am Surg 84:620–627PubMedGoogle Scholar
  30. 30.
    Parkes A, Warneke CL, Clifton K et al (2018) Prognostic factors in patients with metastatic breast cancer with bone-only metastases. Oncologist 23:1282–1288CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    DeSantis CE, Siegel RL, Sauer AG et al (2016) Cancer statistics for African Americans, 2016: progress and opportunities in reducing racial disparities. CA Cancer J Clin. 66:290–308CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    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 109:1721–1728CrossRefPubMedGoogle Scholar
  33. 33.
    Akinyemiju T, Moore JX, Altekruse SF (2015) Breast cancer survival in African-American women by hormone receptor subtypes. Breast Cancer Res Treat 153:211–218CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    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 24:1342–1349CrossRefPubMedGoogle Scholar
  35. 35.
    Kwan ML, John EM, Caan BJ et al (2014) Obesity and mortality after breast cancer by race/ethnicity: The California Breast Cancer Survivorship Consortium. Am J Epidemiol 179:95–111CrossRefPubMedGoogle Scholar
  36. 36.
    Nahleh Z, Otoukesh S, Mirshahidi HR et al (2018) Disparities in breast cancer: a multi-institutional comparative analysis focusing on American Hispanics. Cancer Med 7:2710–2717CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Liu N, Johnson KJ, Ma CX (2018) Male breast cancer: an updated surveillance, epidemiology, and end results data analysis. Clin Breast Cancer 18:e997–e1002CrossRefPubMedGoogle Scholar
  38. 38.
    Haji-Jama S, Gorey KM, Luginaah IN, Balagurusamy MK, Hamm C (2013) Health insurance mediation of the Mexican American non-Hispanic white disparity on early breast cancer diagnosis. SpringerPlus 2:285CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Wheeler SB, Reeder-Hayes KE, Carey LA (2013) Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research. Oncologist 18:986–993CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Stevenson JKR, Cheung MC, Earle CC et al (2018) Chinese and South Asian ethnicity, immigration status, and clinical cancer outcomes in the Ontario Cancer System. Cancer 124:1473–1482CrossRefPubMedGoogle Scholar
  41. 41.
    Gomez SL, Glaser SL (2006) Misclassification of race/ethnicity in a population-based cancer registry (United States). Cancer Causes Control: CCC 17:771–781CrossRefPubMedGoogle Scholar
  42. 42.
    Swallen KC, Glaser SL, Stewart SL, West DW, Jenkins CN, McPhee SJ (1998) Accuracy of racial classification of Vietnamese patients in a population-based cancer registry. Ethn Dis 8:218–227PubMedGoogle Scholar
  43. 43.
    Duggan MA, Anderson WF, Altekruse S, Penberthy L, Sherman ME (2016) The Surveillance, Epidemiology, and End Results (SEER) Program and Pathology: toward strengthening the critical relationship. Am J Surg Pathol 40:e94–e102CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Sogaard M, Thomsen RW, Bossen KS, Sorensen HT, Norgaard M (2013) The impact of comorbidity on cancer survival: a review. Clin Epidemiol 5:3–29CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Yunan Han
    • 1
    • 2
  • Justin Xavier Moore
    • 1
    • 3
  • Marvin Langston
    • 1
    • 4
  • Lindsay Fuzzell
    • 1
    • 5
  • Saira Khan
    • 1
    • 6
  • Marquita W. Lewis
    • 1
  • Graham A. Colditz
    • 1
    • 7
  • Ying Liu
    • 1
    • 7
    Email author
  1. 1.Division of Public Health Sciences, Department of SurgeryWashington University School of MedicineSt. LouisUSA
  2. 2.Department of Breast SurgeryFirst Hospital of China Medical UniversityShenyangChina
  3. 3.Division of Epidemiology, Department of Population Health SciencesAugusta UniversityAugustaUSA
  4. 4.Division of ResearchKaiser PermanenteOaklandUSA
  5. 5.Department of Health Outcomes & BehaviorH. Lee Moffitt Cancer CenterTampaUSA
  6. 6.Epidemiology Program, College of Health SciencesUniversity of DelawareNewarkUSA
  7. 7.Alvin J. Siteman Cancer CenterBarnes-Jewish Hospital and Washington University School of MedicineSt. LouisUSA

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