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Racial disparities in survival outcomes among breast cancer patients by molecular subtypes

Abstract

Purpose

Differences in tumor biology, genomic architecture, and health care delivery patterns contribute to the breast cancer mortality gap between White and Black patients in the US. Although this gap has been well documented in previous literature, it remains uncertain how large the actual effect size of race is for different survival outcomes and the four breast cancer subtypes.

Methods

We established a breast cancer patient cohort at the University of Chicago Comprehensive Cancer Center. We chose five major survival outcomes to study: overall survival, recurrence-free survival, breast-cancer-specific survival, time-to-recurrence and post-recurrence survival. Cox proportional hazards models were used to estimate the hazard ratios between Black and White patients, adjusting for selected patient, tumor, and treatment characteristics, and also stratified by the four breast cancer subtypes.

Results

The study included 2795 stage I–III breast cancer patients (54% White and 38% Black). After adjusting for selected patient, tumor and treatment characteristics, Black patients still did worse than White patients in all five survival outcomes. The racial difference was highest within the HR−/HER2+ subgroup, in both overall survival (hazard ratio = 4.00, 95% CI 1.47–10.86) and recurrence-free survival (hazard ratio = 3.00, 95% CI 1.36–6.60), adjusting for age at diagnosis, cancer stage, and comorbidities. There was also a significant racial disparity within the HR+/HER2− group in both overall survival and recurrence-free survival.

Conclusions

Our study confirmed that racial disparity existed between White and Black breast cancer patients in terms of both survival and recurrence, and found that this disparity was largest among HR−/HER2+ and HR+/HER2− patients.

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Acknowledgements

This project was supported by the National Cancer Institute (P20 CA233307), the Breast Cancer Research Foundation, and Susan G. Komen for the Cure (SAC110026). The authors are grateful to the participants of the ChiMEC study.

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Correspondence to Dezheng Huo.

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Conflict of interest

Olufunmilayo I. Olopade is a cofounder at CancerIQ and serves on the Scientific Advisory Board for Tempus. The other authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by Intuitional Review Board of the University of Chicago. All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Zhao, F., Copley, B., Niu, Q. et al. Racial disparities in survival outcomes among breast cancer patients by molecular subtypes. Breast Cancer Res Treat 185, 841–849 (2021). https://doi.org/10.1007/s10549-020-05984-w

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  • DOI: https://doi.org/10.1007/s10549-020-05984-w

Keywords

  • Breast cancer
  • Racial disparity
  • Subtype
  • Survival
  • Recurrence