Differences in breast cancer outcomes amongst Black US-born and Caribbean-born immigrants

  • Priscila Barreto-Coelho
  • Danielle Cerbon
  • Matthew Schlumbrecht
  • Carlos M. Parra
  • Judith Hurley
  • Sophia H. L. GeorgeEmail author



There are few studies that directly investigate disparities in outcome within the African diaspora in the US. We investigated the association between nativity of Black women diagnosed with breast cancer (Caribbean or USA place of birth) and ethnicity, age at diagnosis, treatment, tumor characteristics and outcome.


The data were obtained from the University of Miami Health System, and Jackson Health System. Individual-level data from 1132 cases was used to estimate hazard rations (HRs) of women born in the Caribbean (Caribbean Blacks, CB) or in the USA (US Black, USB) using Cox proportional hazards regression analysis for overall survival.


The cohort contains data from 624 (54.9%) USB women and 507 (45%) CB women diagnosed with breast cancer between 2006 and 2017. Compared to CB patients, USB patients had more Estrogen Receptor negative (31.4% vs. 39.1%, P = 0.018) and triple negative breast cancers (19.6% vs. 27.9%, P = 0.003). CB women presented at more advanced stages III/IV (44.2% vs. 35.2%; P = 0.016). CB patients showed a better overall survival (hazard ratio, HR = 0.75; 95% CI 0.59–0.96; P = 0.024). Overall Black Hispanic patients had a better overall survival (HR = 0.51; 95% CI 0.28–0.93; P = 0.028) compared to non-Hispanic Black patients.


In conclusion the study found that CB immigrants diagnosed with breast cancer have an improved overall survival when compared with USB patients. This finding suggests that within the African diaspora in the USA, additional factors beyond race contribute to worse outcomes in African Americans.


Breast cancer Caribbean-born Black US-born Black Health disparities 


Author contributions

SHLG had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: SHLG, JH, PB-C. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: SHLG, PB-C, JH. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: MS, SHLG, DC. Obtained funding: SHLG, JH. Administrative, technical, or material support: SHLG, JH. Supervision: SHLG, JH.


Research reported in this publication was supported by funds from Sylvester Comprehensive Cancer Center. SG is supported by DOD OCRP W81XWH1810072.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest.

Research involving human and animal participants

This study did not involve animals.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

This was a retrospective study; informed consent was not sought.

Supplementary material

10549_2019_5403_MOESM1_ESM.docx (898 kb)
Supplementary material 1 (DOCX 897 kb)


  1. 1.
    DeSantis CE et al (2016) Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin 66(1):31–42CrossRefGoogle Scholar
  2. 2.
    DeSantis CE et al (2016) Cancer statistics for African Americans, 2016: progress and opportunities in reducing racial disparities. CA Cancer J Clin 66(4):290–308CrossRefGoogle Scholar
  3. 3.
    Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30CrossRefGoogle Scholar
  4. 4.
    Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69:7–34CrossRefGoogle Scholar
  5. 5.
    Pew Research Center (2015) Modern immigration wave brings 59 million to U.S., driving population growth and change through 2065: views of immigration’s impact on U.S. society mixed. Pew Research Center, Washington, DCGoogle Scholar
  6. 6.
    Anderson M, Lopez G (2018) Key facts about black immigrants in the U.S. Pew Research Center 1:1–5Google Scholar
  7. 7.
    Zong J, Batalova J (2016) Caribbean immigrants in the United States. Migration Policy Institute.
  8. 8.
    US Census Bureau (2010) US Census Bureau 2010.
  9. 9.
    Pinheiro PS et al (2016) Black heterogeneity in cancer mortality: US-Blacks, Haitians, and Jamaicans. Cancer Control 23(4):347–358CrossRefGoogle Scholar
  10. 10.
    Singh GK, Siahpush M (2001) All-cause and cause-specific mortality of immigrants and native born in the United States. Am J Public Health 91(3):392–399CrossRefGoogle Scholar
  11. 11.
    Camacho-Rivera M et al (2015) Breast cancer clinical characteristics and outcomes in Trinidad and Tobago. J Immigr Minor Health 17(3):765–772CrossRefGoogle Scholar
  12. 12.
    Taioli E et al (2010) Breast cancer survival in women of African descent living in the US and in the Caribbean: effect of place of birth. Breast Cancer Res Treat 122(2):515–520CrossRefGoogle Scholar
  13. 13.
    DeGennaro V Jr et al (2016) Development of a breast cancer treatment program in Port-au-Prince, Haiti: experiences from the field. J Glob Oncol 2(1):9–14CrossRefGoogle Scholar
  14. 14.
    Gomez A et al (2017) Presentation, treatment, and outcomes of Haitian women with breast cancer in Miami and Haiti: disparities in breast cancer—a retrospective cohort study. J Glob Oncol 3(4):389–399CrossRefGoogle Scholar
  15. 15.
    Ragin C et al (2018) Breast cancer research in the Caribbean: analysis of reports from 1975 to 2017. J Glob Oncol 4:1–21CrossRefGoogle Scholar
  16. 16.
    Schlumbrecht M et al (2019) Endometrial cancer outcomes among non-Hispanic US born and Caribbean born black women. Int J Gynecol Cancer 29:897–903CrossRefGoogle Scholar
  17. 17.
    Pertschuk LP et al (1990) Immunocytochemical estrogen and progestin receptor assays in breast cancer with monoclonal antibodies. Histopathologic, demographic, and biochemical correlations and relationship to endocrine response and survival. Cancer 66(8):1663–1670CrossRefGoogle Scholar
  18. 18.
    Consedine NS et al (2015) Beyond the black box: a systematic review of breast, prostate, colorectal, and cervical screening among native and immigrant African-descent Caribbean populations. J Immigr Minor Health 17(3):905–924CrossRefGoogle Scholar
  19. 19.
    Donenberg T et al (2011) A high prevalence of BRCA1 mutations among breast cancer patients from the Bahamas. Breast Cancer Res Treat 125(2):591–596CrossRefGoogle Scholar
  20. 20.
    Akbari MR et al (2014) The spectrum of BRCA1 and BRCA2 mutations in breast cancer patients in the Bahamas. Clin Genet 85(1):64–67CrossRefGoogle Scholar
  21. 21.
    Donenberg T et al (2016) A survey of BRCA1, BRCA2, and PALB2 mutations in women with breast cancer in Trinidad and Tobago. Breast Cancer Res Treat 159(1):131–138CrossRefGoogle Scholar
  22. 22.
    Donenberg T et al (2018) A clinically structured and partnered approach to genetic testing in Trinidadian women with breast cancer and their families. Breast Cancer Res Treat 174(2):469–477. CrossRefPubMedGoogle Scholar
  23. 23.
    Pal T et al (2015) A high frequency of BRCA mutations in young black women with breast cancer residing in Florida. Cancer 121(23):4173–4180CrossRefGoogle Scholar
  24. 24.
    Greenup R et al (2013) Prevalence of BRCA mutations among women with triple-negative breast cancer (TNBC) in a genetic counseling cohort. Ann Surg Oncol 20(10):3254–3258CrossRefGoogle Scholar
  25. 25.
    Miller KD et al (2018) Cancer statistics for Hispanics/Latinos, 2018. CA Cancer J Clin 68(6):425–445CrossRefGoogle Scholar
  26. 26.
    Khan HM et al (2014) Inferential statistics from Black Hispanic breast cancer survival data. Sci World J 2014:604581Google Scholar
  27. 27.
    Banegas MP, Li CI (2012) Breast cancer characteristics and outcomes among Hispanic Black and Hispanic White women. Breast Cancer Res Treat 134(3):1297–1304CrossRefGoogle Scholar
  28. 28.
    Trapido EJ et al (1994) Cancer in south Florida Hispanic women. A 9-year assessment. Arch Intern Med 154(10):1083–1088CrossRefGoogle Scholar
  29. 29.
    McCoy CB et al (2004) A community-based breast cancer screening program for medically underserved women: its effect on disease stage at diagnosis and on hazard of death. Rev Panam Salud Publica 15(3):160–167CrossRefGoogle Scholar
  30. 30.
    Medhanie GA et al (2017) Cancer incidence profile in sub-Saharan African-born blacks in the United States: similarities and differences with US-born non-Hispanic blacks. Cancer 123(16):3116–3124CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineUniversity of Miami/Jackson Memorial HospitalMiamiUSA
  2. 2.Sylvester Comprehensive Cancer CenterMiamiUSA
  3. 3.Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Miller School of MedicineUniversity of MiamiMiamiUSA
  4. 4.Miller School of MedicineUniversity of MiamiMiamiUSA
  5. 5.Division of Medical Oncology, Department of Medicine, Miller School of MedicineUniversity of MiamiMiamiUSA

Personalised recommendations