To estimate the odds of breast cancer subtypes in minority populations versus non-Hispanic (NH) whites stratified by socioeconomic status (SES) [a composite of individual-level SES (insurance status) and area-level SES (median household income quartile from 2000 U.S. Census data)] using a large nationwide cancer database. We used the National Cancer Data Base to identify breast cancer cases diagnosed in 2010 and 2011, the only 2 years since U.S. cancer registries uniformly began collecting HER2 results. Breast cancer cases were classified into five subtypes based on hormone receptor (HR) and HER2 status: HR+/HER2−, HR+/HER2+, HR−/HER2+ (HER2-overexpressing), HR−/HER2− (TN), and unknown. A polytomous logistic regression was used to estimate odds ratios (ORs) comparing the odds of non-HR+/HER2-subtypes to HR+/HER2− for racial/ethnic groups controlling for and stratifying by SES, using a composite of insurance status and area-level income. Compared with NH whites, NH blacks and Hispanics were 84 % (OR = 1.84; 95 % CI 1.77–1.92) and 17 % (OR = 1.17; 95 % CI 1.11–1.24) more likely to have TN subtype versus HR+/HER2−, respectively. Asian/Pacific Islanders (API) had 1.45 times greater odds of being diagnosed with HER2-overexpressing subtype versus HR+/HER2− compared with NH whites (OR = 1.45; 95 % CI 1.31–1.61). We found similar ORs for race in high and low strata of SES. In a large nationwide hospital-based dataset, we found higher odds of having TN breast cancer in black women and of HER2-overexpressing in API compared with white women in every level of SES.
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Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB et al (2009) Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Cancer Netw 7:122–192
Sotiriou C, Neo S-Y, McShane LM, Korn EL, Long PM et al (2003) Breast cancer classification and prognosis based on gene expression profiles from a population-based study. Proc Natl Acad Sci USA 100:10393–10398
Onitilo AA, Engel JM, Greenlee RT, Mukesh BN (2009) Breast cancer subtypes based onER/PR and Her2 expression: comparison of clinicopathologic features and survival. Clin Med Res 7:4–13
Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D et al (2006) Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA 295:2492–2502
Haque R, Ahmed SA, Inzhakova G, Shi J, Avila C et al (2012) Impact of breast cancer subtypes and treatment on survival: an analysis spanning two decades. Cancer Epidemiol Biomark Prev 21:1848–1855
O’Brien KM, Cole SR, Tse C-K, Perou CM, Carey LA et al (2010) Intrinsic breast tumor subtypes, race, and long-term survival in the Carolina Breast Cancer Study. Clin Cancer Res 16:6100–6110
Joslyn SA (2002) Hormone receptors in breast cancer: racial differences in distribution and survival. Breast Cancer Res Treat 73:45–59
Anders CK, Deal AM, Miller CR, Khorram C, Meng H et al (2011) The prognostic contribution of clinical breast cancer subtype, age, and race among patients with breast cancer brain metastases. Cancer 117:1602–1611
Puig-Vives M, Sanchez MJ, Sanchez-Cantalejo J, Torrella-Ramos A, Martos C et al (2013) Distribution and prognosis of molecular breast cancer subtypes defined by immunohistochemical biomarkers in a Spanish population-based study. Gynecol Oncol 130:609–614
O’Brien KM, Cole SR, Engel LS, Bensen JT, Poole CL et al (2013) Breast cancer subtypes and previously established genetic risk factors: a Bayesian approach. Cancer Epidemiol Biomark Prev 23(1):84–97
Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S et al (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 98:10869–10874
Parise CA, Bauer KR, Brown MM, Caggiano V (2009) Breast cancer subtypes as defined by the estrogen receptor (ER), progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER2) among women with invasive breast cancer in California, 1999–2004. Breast J 15:593–602
Brown M, Tsodikov A, Bauer KR, Parise CA, Caggiano V (2008) The role of human epidermal growth factor receptor 2 in the survival of women with estrogen and progesterone receptor-negative, invasive breast cancer: the California Cancer Registry, 1999–2004. Cancer 112:737–747
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. Cancer 109:1721–1728
Cheang MC, Voduc D, Bajdik C, Leung S, McKinney S et al (2008) Basal-like breast cancer defined by five biomarkers has superior prognostic value than triple-negative phenotype. Clin Cancer Res 14:1368–1376
American College of Surgeons (2013) All Edits in the NCDB Metafile for 2012 Submissions Using Layout 12.1: NCDB_22_v121_12012011.rmf. http://www.facsorg/cancer/ncdb/edits_22_v121pdf. Accessed on 13 Nov 2013
Simon MS, Severson RK (1997) Racial differences in breast cancer survival: the interaction of socioeconomic status and tumor biology. Am J Obstet Gynecol 176:S233–S239
Clarke CA, Keegan TH, Yang J, Press DJ, Kurian AW et al (2012) Age-specific incidence of breast cancer subtypes: understanding the black–white crossover. J Natl Cancer Inst 104:1094–1101
Ferguson NL, Bell J, Heidel R, Lee S, Vanmeter S et al (2013) Prognostic value of breast cancer subtypes, Ki-67 proliferation index, age, and pathologic tumor characteristics on breast cancer survival in Caucasian women. Breast J 19:22–30
Morris GJ, Naidu S, Topham AK, Guiles F, Xu Y et al (2007) Differences in breast carcinoma characteristics in newly diagnosed African-American and Caucasian patients. Cancer 110:876–884
Telli ML, Chang ET, Kurian AW, Keegan TH, McClure LA et al (2011) Asian ethnicity and breast cancer subtypes: a study from the California Cancer Registry. Breast Cancer Res Treat 127:471–478
Setiawan VW, Monroe KR, Wilkens LR, Kolonel LN, Pike MC et al (2009) Breast cancer risk factors defined by estrogen and progesterone receptor status: the multiethnic cohort study. Am J Epidemiol 169:1251–1259
Kwan ML, Kushi LH, Weltzien E, Maring B, Kutner SE et al (2009) Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors. Breast Cancer Res 11:R31
Lund MJB, Butler EN, Bumpers HL, Okoli J, Rizzo M et al (2008) High prevalence of triple-negative tumors in an urban cancer center. Cancer 113:608–615
Millikan RC, Newman B, Tse C-K, Moorman PG, Conway K et al (2008) Epidemiology of basal-like breast cancer. Breast Cancer Res Treat 109:123–139
Gordon NH (2003) Socioeconomic factors and breast cancer in black and white Americans. Cancer Metastasis Rev 22:55–65
DeSantis C, Jemal A, Ward E (2010) Disparities in breast cancer prognostic factors by race, insurance status, and education. Cancer Causes Control 21:1445–1450
Andaya AA, Enewold L, Horner M-J, Jatoi I, Shriver CD et al (2012) Socioeconomic disparities and breast cancer hormone receptor status. Cancer Causes Control 23:951–958
American College of Surgeons (2013) National Cancer Data Base. http://www.facsorg/cancer/ncdb/. Accessed 29 Oct 2013
Lerro CC, Robbins AS, Phillips JL, Stewart AK (2013) Comparison of cases captured in the national cancer data base with those in population-based central cancer registries. Ann of Surg Oncol 20:1759–1765
Facility Oncology Registry Data Standards Manual (2013) http://www.facsorg/cancer/coc/fords/FORDS_for_2010d_05012010pdf. Accessed 29 Oct 2013
Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619
Yost K, Perkins C, Cohen R, Morris C, Wright W (2001) Socioeconomic status and breast cancer incidence in California for different race/ethnic groups. Cancer Causes Control 12:703–711
American College of Surgeons (2013) Collaborative stage. Site-specific factor 7. http://web2.facs.org/cstage/breast/Breast_saa.html. Accessed 30 Oct 2013
Hahn KM, Bondy ML, Selvan M, Lund MJ, Liff JM et al (2007) Factors associated with advanced disease stage at diagnosis in a population-based study of patients with newly diagnosed breast cancer. Am J of Epidemiol 166:1035–1044
Hammond MEH, Hayes DF, Dowsett M, Allred DC, Hagerty KL et al (2010) American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version). Arch Path Lab Med 134:e48–e72
Wolff AC, Hammond MEH, Schwartz JN, Hagerty KL, Allred DC et al (2007) American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. Arch Pathol Lab Med 131:18–43
Brawley OW (2010) Toward a better understanding of race and cancer. Clin Cancer Res 16:5920–5922
Taylor A, Cheng K (2003) Social deprivation and breast cancer. J Public Health 25:228–233
Dunn BK, Agurs-Collins T, Browne D, Lubet R, Johnson KA (2010) Health disparities in breast cancer: biology meets socioeconomic status. Breast Cancer Res Treat 121:281–292
Lund MJ, Butler EN, Hair BY, Ward KC, Andrews JH et al (2010) Age/race differences in HER2 testing and in incidence rates for breast cancer triple subtypes. Cancer 116:2549–2559
Palmer JR, Ruiz-Narvaez EA, Rotimi CN, Cupples LA, Cozier YC et al (2013) Genetic susceptibility loci for subtypes of breast cancer in an African American population. Cancer Epidemiol Biomark Prev 22:127–134
Kagawa-Singer M (2001) From genes to social science. Cancer 91:226–232
Kagawa-Singer M, Valdez Dadia A, Yu MC, Surbone A (2010) Cancer, culture, and health disparities: time to chart a new course? Cancer J Clin 60:12–39
Keegan TH, Gomez SL, Clarke CA, Chan JK, Glaser SL (2007) Recent trends in breast cancer incidence among 6 Asian groups in the Greater Bay Area of Northern California. Int J Cancer 120:1324–1329
Gomez SL, Quach T, Horn-Ross PL, Pham JT, Cockburn M et al (2010) Hidden breast cancer disparities in Asian women: disaggregating incidence rates by ethnicity and migrant status. Am J Public Health 100:S125
Anders CK, Hsu DS, Broadwater G, Acharya CR, Foekens JA et al (2008) Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol 26:3324–3330
Fedewa SA, Ward EM, Stewart AK, Edge SB (2010) Delays in adjuvant chemotherapy treatment among patients with breast cancer are more likely in African American and Hispanic populations: a national cohort study 2004–2006. J Clin Oncol 28:4135–4141
Dowsett M, Hanna WM, Kockx M, Penault-Llorca F, Rüschoff J et al (2007) Standardization of HER2 testing: results of an international proficiency-testing ring study. Mod Path 20:584–591
Reichman ME, Altekruse S, Li CI, Chen VW, Deapen D et al (2010) Feasibility study for collection of HER2 data by National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program central cancer registries. Cancer Epidemiol Biomark Prev 19:144–147
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Sineshaw, H.M., Gaudet, M., Ward, E.M. et al. Association of race/ethnicity, socioeconomic status, and breast cancer subtypes in the National Cancer Data Base (2010–2011). Breast Cancer Res Treat 145, 753–763 (2014). https://doi.org/10.1007/s10549-014-2976-9
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