Survival Differences in Chinese Versus White Women With Breast Cancer in the United States: A SEER-Based Analysis

Abstract

PURPOSE The affect of race on breast cancer prognosis is not well understood. We compared crude and adjusted breast cancer survival rates of Chinese women versus White women in the United States. METHODS We conducted a cohort study of Chinese and White women with breast cancer diagnosed between 2004 to 2015 in the SEER 18 registries database. We abstracted information on age at diagnosis, tumor size, grade, lymph node status, receptor status, surgical treatment, receipt of radiotherapy and chemotherapy, and death. We compared crude breast cancer–specific mortality between the two ethnic groups. We calculated adjusted hazard ratios (HRs) in a propensity-matched design using the Cox proportional hazards model. P < .05 was considered statistically significant. RESULTS There were 7,553 Chinese women (1.8%) and 414,618 White women (98.2%) with stage I-IV breast cancer in the SEER database. There were small differences in demographics, nodal burden, and clinical stage between Chinese and White women. Ten-year breast cancer–specific survival was 88.8% for Chinese women and 85.6% for White women (HR, 0.73; 95% CI, 0.67 to 0.80; P < .0001). In a propensity-matched analysis among women with stage I–IIIC breast cancer, the HR was 0.71 (95% CI, 0.62 to 0.81; P < .0001). Annual mortality rates in White women exceeded those in Chinese women for the first 9 years after diagnosis. CONCLUSION Chinese women in the United States have superior breast cancer–specific survival compared with White women. The reason for the observed difference is not clear. Differences in demographic and tumor features between Chinese and White women with breast cancer may contribute to the disparity, as may the possibility of intrinsic biologic differences.

Distribution, Chemotherapy Use, and Outcome of the 21-Gene Recurrence Score Between Chinese and White breast Cancer in the United States

“…In the present study, the race was not the predictor associated with high RS. In addition, our study showed similar BCSS between Chinese and WA BC, which was contrary to the results from the previous SEER studies [10,11]. Therefore, differences in demographic and tumor features between Chinese and WA BC may contribute to the disparity between our study and the previous SEER studies.…”

“…Two previous SEER studies have shown that Chinese women in the US have better BCSS compared to WA women [10,11]. However, in our study, we did not found that Chinese BC patients had lower risks of breast cancer-specific mortality than WA patients.…”

“…Although population-based incidence rates of HER2-positive BC are higher in Chinese women in the United States (US) compared to White American (WA), comparable incidence rates of hormone receptor-positive BC were found between Chinese and WA [10,11]. However, Chinese women in the US have better breast cancer-specific survival (BCSS) than the WA women [10,11], and mortality differences persist among BC patients with stage I-II, N0, and ER-positive diseases [10]. The reason for the observed difference remains unclear.…”

Prognostic significance of receptor expression discordance between primary and recurrent breast cancers: a meta-analysis

“…In cases wherein clinicopathological characteristics are different among studies, a random-effects model results could be more appropriate than a fixed-effects model. Lim et al have reported that the clinicopathological staging and survival outcomes are different between Asian and European groups [ 52 ]. Therefore, a random-effects model results would be more recommended in the subgroup analysis according to the study area.…”

Proteomic Analysis Revealed Underlying Biological Pathways Associated with Hormetic Response of Hormone Positive Breast Cancer Cell Line Exposed to Low-Dose Flavonoid Mixture

“…Thus, the differences of dietary habits, regarding the flavonoid consumption tendencies among populations can be suggested as a factor for this phenomenon. Furthermore, the breast cancer prevalence increase, among Asian women who migrate to western countries, may also be considered as evidence for the protective effect of flavonoids against breast cancer (6).…”