Disparities exist between African-American and EuropeanAmerican women in the incidence and nature of breast cancer. African-American women are more often diagnosed with breast cancer at an earlier age and with more aggressive disease, characterized by higher grade and negative estrogen and progesterone receptor status. Recent findings reveal specific gene expression patterns associated with the more aggressive breast cancers observed in African-American women. An overview of the current literature about racial differences in breast cancer prompts questions for future research to elucidate causes for the apparent disparities in tumor biology. (Cancer Res 2006; 66(17): 8327-30) EpidemiologyBreast cancer is the most common cancer diagnosed among women in the United States, with >130,000 cases diagnosed yearly. The Surveillance, Epidemiology, and End Results (SEER) database, a large population-based database, has shown that breast cancer incidence and mortality rates have differed between AfricanAmerican and European-American women over the past 2 decades (1). Between 1998 and 2002, European-American women had higher age-adjusted breast cancer incidence rates compared with African-American women (143 per 100,000 versus 119 per 100,00; ref. 1). Among women ages z50 years, European Americans were at a greater risk for developing the disease compared with AfricanAmerican women (397 per 100,000 versus 323 per 100,000), but the pattern was reversed among women ages <35 years. For each age group <35 years, incidence rates were higher among African-American women. Furthermore, compared with EuropeanAmerican women, African-American women have the highest age-adjusted mortality rates from the disease. Between 1995 and 2001, the 5-year survival rate from breast cancer was 75.9% for African-American women and 89.5% for European-American women, with age-specific breast cancer mortality rates among younger African-American women approximately twice that of younger European-American women (1).It has been suggested that higher mortality and lower survival rates among African-American women are due to factors associated with lower socioeconomic status and later stage at diagnosis (2-5). However, in several studies, racial differences in survival remained after adjustment for stage at diagnosis, access to health care, treatment, comorbid illness, marital status, and other pathologic and sociodemographic variables (4, 6-9). These data point to possible differences in the nature of the disease itself, supported by the observation that breast cancer in AfricanAmerican women is more aggressive at presentation, characterized by an increased prevalence of high-grade, hormone receptornegative tumors as shown in Table 1. In this article, we review the current literature about breast cancer in African-American women, with a focus on tumor biology, particularly in comparison with breast cancer in European-American women. Tumor BiologyTumor grade. African-American women are more likely to be diagnosed with high-grade disease compar...

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Breast cancer in African-American (AA) women occurs at an earlier age than in European-American (EA) women and is more likely to have aggressive features associated with poorer prognosis, such as high-grade and negative estrogen receptor (ER) status. The mechanisms underlying these differences are unknown. To address this, we conducted a case-control study to evaluate risk factors for high-grade ER- disease in both AA and EA women. With the onset of the Health Insurance Portability and Accountability Act of 1996, creative measures were needed to adapt case ascertainment and contact procedures to this new environment of patient privacy. In this paper, we report on our approach to establishing a multicenter study of breast cancer in New York and New Jersey, provide preliminary distributions of demographic and pathologic characteristics among case and control participants by race, and contrast participation rates by approaches to case ascertainment, with discussion of strengths and weaknesses.

In this large population-based investigation of PML with thorough case finding and a known source population, the IR of medical record-confirmed PML was rare in non-HIV patient cohorts.