Importance
African American (AA) women have a two-fold higher incidence of breast cancers that are negative for estrogen receptor, progesterone receptor and HER2/neu (triple negative breast cancer, TNBC) compared with White/Caucasian Americans (WA). TNBC likely arises from different pathogenetic pathways compared to non-TNBC, and benign breast disease (BBD) predicts for future non-TNBC.
Objective
To determine whether AA identity remained associated with TNBC among women with a prior diagnosis of BBD.
Design
Retrospective analysis; January 1, 1994-December 31, 2005; mean follow-up 10.2 years.
Setting
Henry Ford Health System in metropolitan Detroit, Michigan; an integrated multihospital, multispecialty health care system.
Participants
2,588 AA and 3,566 WA patients age 40-70 years with biopsy-proven BBD diagnosed 1/1/1994 to 12/31/2005.
Main Outcome Measures
Subsequent breast cancer, stratified by phenotype.
Results
BBD detection and management were similar for the AA and WA patients. Subsequent breast cancers developed in approximately 4% of AA patients (mean 6.8 years following BBD diagnosis) and WA patients (mean 6.1 years). More than three-quarters of subsequent cancers in each subset were DCIS or Stage I. The 10-year probability estimate for developing TNBC was 0.56% (95% confidence interval 0.32-1.0) for AA versus 0.25% for WA (95% confidence interval 0.12-0.53). Among the 73 AA patients that developed subsequent invasive breast cancer, 24.2% were TNBC compared to 7.4% of the 111 subsequent invasive BC cases (p=0.0125) among the WA patients.
Conclusion and Relevance
AA identity persisted as a significant risk factor for TNBC in our study, the largest analysis to date of BBD and subsequent breast cancer phenotypes in a diverse patient population managed equitably. This suggests that AA identity is associated with inherent susceptibility for TNBC pathogenetic pathways.
The utility and effectiveness of screening mammography in diagnosing breast cancer at earlier stages and reducing disease-specific mortality remain controversial especially as to when to start and stop routine mammographic screening, and whether mammograms should be performed annually or biennially in average-risk women. This manuscript will analyze the available moderate and high-quality data to analyze both the benefits (lives saved and life-years saved) and inconveniences/harms (additional views, extra biopsies/overdiagnosis, and overtreatment of ductal carcinoma in situ) of different mammography screening guidelines to assist the practitioner in counseling their patients in clinical practice.
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