Does Race Affect Outcomes in Triple Negative Breast Cancer?

Abstract

Background: There is discordance among studies assessing the impact of race on outcome of patients with Triple Negative Breast Cancer (TNBC). We assessed survival outcomes for African American (AA) versus Caucasian (CA) women with TNBC treated at an urban cancer center in Memphis, TN with a predominant AA patient population. Methods: Patients with Stage I-III TNBC were identified from our breast database. Event free survival (EFS) and Breast cancer specific survival (BCSS) were the primary outcome measures. Cox proportional hazards models were fitted for EFS and BCSS. Results: Of the 124 patients, 71% were AA. No significant association between race and stage (P = 0.21) or menopausal status (P = 0.15) was observed. Median age at diagnosis was significantly lower for AA versus CA women (49.5 vs. 55 years, P = 0.024). 92% of the patients received standard neo/adjuvant chemotherapy, with no significant difference in duration and type of chemotherapy between the races. With a median follow up of 23 months, 28% of AA vs. 19% of CA women had an event (P = 0.37). 3 year EFS and BCSS trended favorably towards CA race (77% vs. 64%, log rank P = 0.20 and 92% vs. 76%, P = 0.13 respectively) with a similar trend noted on multiple variable modeling (EFS: HR 0.62, P = 0.29; BCSS: HR 0.36, P = 0.18). AA women $50 years at diagnosis had a significantly worse BCSS than the CA women in that age group (P = 0.012). Conclusion: Older AA women with TNBC have a significantly worse breast cancer specific survival than their CA counterparts. Overall, there is a trend towards lower survival for AA women compared to Caucasians despite uniformity of tumor phenotype and treatment. The high early event rate, irrespective of race, underscores the need for effective therapies for women with TNBC.

Associations Between Mammography and Ultrasound Imaging Features and Molecular Characteristics of Triple-negative Breast Cancer

“…The reason might be due to the diversity of race, menopausal status or weight in different regions. (Sachdev et al, 2010;Li et al, 2013;Somali et al, 2013) Similar to other studies (Crook et al, 1997;Noguchi et al, 1999;Claus et al, 2005;Yang et al, 2008), DCIS was rare among our TNBCs lacking mammographic calcifications. As we all know, calcifications were regarded as the specific pictures of DCIS.…”

Racial/ethnic differences in breast cancer survival by inflammatory status and hormonal receptor status: an analysis of the Surveillance, Epidemiology, and End Results data

“…For example, black patients may be more likely to have tumors with negative status of human epidermal growth factor-like receptor 2 (HER2) (43, 44) or P53 mutation (45), which are related to survival (43, 46–48). Although inconsistent (43, 47, 48), some studies on triple negative breast cancer, which included HER2- in addition to ER+/PR+, have found no racial differences in survival (49–51), suggesting a minimal potential impact of HER2 on racial differences . Therefore, there is a possibility that biomarkers of breast cancer other than inflammatory histology and ER/PR status may be associated with racial/ethnic disparities in survival in addition to the access to and use of medical care.…”

Breast Cancer Mortality in African-American and Non-Hispanic White Women by Molecular Subtype and Stage at Diagnosis: A Population-Based Study

“…In particular, African-American women are more likely than white women to be diagnosed with triple-negative breast cancer, which, because of its lack of expression for the three molecular markers, does not currently have targeted treatment options (7, 15-17). A few studies have measured the contribution of molecular subtype to racial/ethnic disparities in breast cancer survival (18-20), but the findings were inconsistent when comparing survival in African-American patients with whites. One study found mortality risk difference between African-American and white women occurs only among older women diagnosed with luminal A/p53- but not with triple-negative breast cancer (18), whereas another two studies suggested higher overall mortality (19) and breast cancer specific mortality (20) in African-American than white patients with the triple-negative subtype.…”

“…A few studies have measured the contribution of molecular subtype to racial/ethnic disparities in breast cancer survival (18-20), but the findings were inconsistent when comparing survival in African-American patients with whites. One study found mortality risk difference between African-American and white women occurs only among older women diagnosed with luminal A/p53- but not with triple-negative breast cancer (18), whereas another two studies suggested higher overall mortality (19) and breast cancer specific mortality (20) in African-American than white patients with the triple-negative subtype. To date, there have been no datasets large enough to examine racial/ethnic mortality disparities by tumor molecular subtypes and stage at diagnosis, the two important prognostic determinants of survival, to further isolate the subgroups with the worst disparities.…”