Race and risk of subsequent aggressive breast cancer following ductal carcinoma in situ

Abstract

Background General populations of black women have a higher risk of developing breast cancer negative for both estrogen receptor (ER) and progesterone receptor (PR) in comparison with white counterparts. Racial differences remain unknown in the risk of developing aggressive invasive breast cancer (IBC) that is characterized by negativity for both ER and PR (ER–PR–) or higher 21‐gene recurrence scores after ductal carcinoma in situ (DCIS). Methods This study identified 163,892 women (10.5% black, 9.8% Asian, and 8.6% Hispanic) with incident DCIS between 1990 and 2015 from the Surveillance, Epidemiology, and End Results data sets. Cox proportional hazards regression was used to estimate hazards ratios (HRs) of subsequent IBC classified by the hormone receptor status and 21‐gene recurrence scores. Results During a median follow‐up of 90 months, 8333 women developed IBC. In comparison with white women, the adjusted HR of subsequent ER–PR– breast cancer was 1.86 (95% confidence interval [CI], 1.57‐2.20) for black women (absolute 10‐year difference, 2.2%) and 1.40 (95% CI, 1.14‐1.71) for Asian women (absolute 10‐year difference, 0.4%); this was stronger than the associations for ER+ and/or PR+ subtypes (Pheterogeneity = .0004). The 21‐gene recurrence scores of subsequent early‐stage, ER+ IBCs varied by race/ethnicity (Pheterogeneity = .057); black women were more likely than white women to have a recurrence score of 26 or higher (HR, 1.38; 95% CI, 1.00‐1.92). No significant difference was observed in the risks of subsequent IBC subtypes for Hispanic women. Conclusions Black and Asian women with DCIS had higher risks of developing biologically aggressive IBC than white counterparts. This should be considered in treatment decisions for black and Asian patients with DCIS.

Transition to invasive breast cancer is associated with progressive changes in the structure and composition of tumor stroma

“…Although the performance was impressive, certain caveats should be taken into account when considering how generalized this model might be. Given the complexity of breast cancer subtypes and the impact of patient demographics on outcome (Alaeikhanehshir et al, 2020;Liu et al, 2019), the sample size in this study may not have been sufficient to fully account for the confounding effects of these variables. Lastly, since all patients in the RAHBT cohort received one or more therapeutic interventions, the features leveraged by this model to identify non-progressors might not be valid when applied to patient populations where therapy is omitted.…”

Associations of race and ethnicity with risk of developing invasive breast cancer after lobular carcinoma in situ

“…In a nationally representative population of DCIS patients diagnosed between 1990 and 2015, we demonstrated that compared with white women, the risk of developing ER−PR− invasive breast cancer was significantly increased by 86% (HR = 1.86, 95% CI 1.57–2.20) in black women and by 40% in Asian women (HR = 1.40, 95% CI 1.14–1.71). The associations for ER−/PR− invasive cancer were stronger than the associations for ER+/PR+ subtypes (HR = 1.31, 95% CI 1.21–1.43 in blacks; HR = 1.01, 95% CI 0.92–1.11 in Asians; H eterogeneity = 0.0004) [24]. Thus, the magnitude of the associations between black race and risk of invasive breast cancer subtypes following LCIS and DCIS was similar.…”

Disease characteristics and mortality among Asian women with breast cancer

“…Racial differences in breast cancer diagnosis, prognosis, and survival are well documented 4‐10 . However, these studies typically aggregate women from geographically diverse countries in East Asia, Southeast Asia, and the Indian subcontinent into a single Asian racial group.…”