Race and Hormone Receptor-Positive Breast Cancer Outcomes in a Randomized Chemotherapy Trial

Albert Einstein College of Medicine, Montefiore Medical Center-Weiler Division, 1825 Eastchester Rd, 2S-Rm 47, Bronx, NY 10461, USA.
Journal of the National Cancer Institute (Impact Factor: 12.58). 03/2012; 104(5):406-14. DOI: 10.1093/jnci/djr543
Source: PubMed


The association between black race and worse outcomes in operable breast cancer reported in previous studies has been attributed to a higher incidence of more aggressive triple-negative disease, disparities in care, and comorbidities. We evaluated associations between black race and outcomes, by tumor hormone receptor and HER2 expression, in patients who were treated with contemporary adjuvant therapy.
The effect of black race on disease-free and overall survival was evaluated using Cox proportional hazards models adjusted for multiple covariates in a clinical trial population that was treated with anthracycline- and taxane-containing chemotherapy. Categorical variables were compared using the Fisher exact test. All P values are two-sided.
Of 4817 eligible patients, 405 (8.4%) were black. Compared with nonblack patients, black patients had a higher rate of triple-negative disease (31.9% vs 17.2%; P < .001) and a higher body mass index (median: 31.7 vs 27.4 kg/m(2); P < .001). Black race was statistically significantly associated with worse disease-free survival (5-year disease-free survival, black vs nonblack: 76.7% vs 84.5%; hazard ratio of recurrence or death = 1.58, 95% confidence interval = 1.19 to 2.10, P = .0015) and overall survival (5-year overall survival, black vs nonblack: 87.6% vs 91.9%; hazard ratio of death = 1.49, 95% confidence interval = 1.05 to 2.12, P = .025) in patients with hormone receptor-positive HER2-negative disease but not in patients with triple-negative or HER2-positive disease. In a model that included black race, hormone receptor-positive HER2-negative disease vs other subtypes, and their interaction, the interaction term was statistically significant for disease-free survival (P = .027) but not for overall survival (P = .086).
Factors other than disparities in care or aggressive disease contribute to increased recurrence in black women with hormone receptor-positive breast cancer.

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    • "Furthermore, the percentage of obese patients was lower in our study (16.6 versus 36.6% respectively) and we did not include black patients. This is relevant because the ECOG 1199 has shown a significant association between black race, increased frequency of obesity and a worse prognosis in ER-positive patients [28]. "
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