Differences in biology and outcome of breast cancer in African American versus Caucasian women are not due to socioeconomic factors alone.
Field LA, Ellsworth RE, Hooke JA, Bronfman L, Gutchell V, Love B, Weyandt J, Shriver CD.
Windber Research Institute, Windber, PA; Walter Reed Army Medical Center, Washington, DC; Invitrogen Informatics, Carlsbad, CA
Background: Studies have shown that breast cancers that develop in African American women (AAW) are more aggressive and deadly than those in Caucasian women (CW). Breast cancer in AAW occurs more often in younger women, is diagnosed at a more advanced stage, and is characterized by higher rates of lymph node involvement, negative ER status, a BRCA1-like phenotype, and higher mortality rates from disease than the breast cancers that develop in CW.
Various theories have been promulgated for the worse biologic behavior of these cancers, including disparities in education, income, health care access, and social belief systems, all leading to potentially suboptimal diagnosis and treatment.
Methods: The Clinical Breast Care Project (CBCP) at Walter Reed Army Medical Center has an extensive database and tissue repository on Department of Defense employees and beneficiaries with breast cancer who are diagnosed within an equal-access healthcare system.
Epidemiologic and pathologic data was analyzed using chi-square analysis and t-tests and a value of P<0.05 was used to measure significance.
Results: Of the 2,420 patients enrolled in the CBCP, 24% were African-American.
Education and income levels were similar between AAW and CW. Both AAW and CW had high (>90%) utilization rates of screening MMG, and more AAW reported performing monthly SBE than CW (70% vs. 64%). A higher proportion of AAW had BMI > 25; AAW also had a higher average fat intake than CW (28.47 vs. 27.02).
AAW had earlier age at menarche, younger age at first parity, fewer children, and were less likely to have breastfed compared to CW. With regards to breast tumors, 1,254 (51%) patients had surgical biopsy procedures.
Overall, CW had a higher percentage of invasive breast cancer vs. AAW, but in women under 40 years old, more AAW had invasive cancer vs. CW (14% vs. 5%); 50% of AAW with invasive cancer were younger than 50 years old compared to 27% of CW.
AAW had higher stage breast cancers (beyond Stage I) at diagnosis than CW and were more likely to be ER(-), PR(-) and “triple negative” than CW.
Conclusions: In an equal access, equal utilization healthcare environment, which minimizes disparities in socioeconomic status, the breast cancers that developed in AAW were more aggressive, occurred at a younger age, and were associated with poor prognostic features.
This study suggests that disparities in disease outcomes should not be solely attributed to socioeconomic or other non-tumor-related factors. Molecular studies by the CBCP are beginning to show that these cancers in AAW may represent a different, more aggressive type of breast cancer, and the associated molecular and biological factors demand further elucidation.
San Antonio Breast Cancer Symposium, 12/06
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