Within-stage racial disparities in tumor size and number of positive nodes in women with breast cancer

Department of Epidemiology, Mailman School of Public Health, New York, New York, USA.
Cancer (Impact Factor: 4.89). 09/2007; 110(6):1201-8. DOI: 10.1002/cncr.22884
Source: PubMed


Black women have higher breast cancer mortality rates, are more likely to be diagnosed at an advanced stage of disease, and have worse stage-for-stage survival than white women. It was hypothesized that differences in the tumor size and number of positive lymph nodes within each disease stage contribute to the survival disparity.
In the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, black and white women diagnosed with a first primary tumor (TNM stage I-IIIA breast cancer) between 1988 and 2003 were identified. The demographic and clinical characteristics were compared by race. Logistic regression models of the association between race and tumor size and lymph node status were developed. Cox proportional hazards models of the association between mortality and race, tumor size, lymph node status, and other covariates were also examined.
Among 256,174 SEER cases (21,861 black and 234,313 white women), more black than white women with lymph node-negative breast cancer had tumors measuring >or=2.0 cm. Adjusted for tumor size, more black than white women had >or=1 positive lymph nodes (odds ratio [OR], 1.24; 95% confidence interval [95% CI], 1.20-1.28). The age-adjusted and TNM stage-adjusted mortality rate ratio for blacks versus whites was 1.56 (95% CI, 1.51-1.61). Adjustment for within-stage differences in tumor size and lymph node involvement were found to have a negligible effect. With adjustment for additional covariates, the rate ratio was 1.39 (95% CI, 1.35-1.44). In addition, the rate ratio reflecting racial disparity increased as the stage of disease increased. CONCLUSIONS.: Adjusting for within-stage differences in tumor size and lymph node status did not appear to reduce the racial disparity. The finding that disparities increased with higher stage of disease suggests that interventions aimed at reducing these differences should target women with more advanced disease.

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Available from: Russell B McBride, Oct 23, 2014
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    • "Elevated microvessel area quantified by AQUA was shown to be a marker of node positivity and reduced 20 year survival [20]. Although differences in overall survival were not observed between EA and AA patients in this cohort, this finding is consistent with higher frequencies of lymph node metastases in AA patients observed in this cohort and elsewhere [3] and may advocate the utility of antiangiogenic drugs for African American patients with triple negative breast cancer. "
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    ABSTRACT: Triple negative breast cancer (TNBC) is characterized by high proliferation, poor differentiation and a poor prognosis due to high rates of recurrence. Despite lower overall incidence African American (AA) patients suffer from higher breast cancer mortality in part due to the higher proportion of TNBC cases among AA patients compared to European Americans (EA). It was recently shown that the clinical heterogeneity of TNBC is reflected by distinct transcriptional programs with distinct drug response profiles in preclinical models. In this study, gene expression profiling and immunohistochemistry were used to elucidate potential differences between TNBC tumors of EA and AA patients on a molecular level. In a retrospective cohort of 136 TNBC patients, a major transcriptional signature of proliferation was found to be significantly upregulated in samples of AA ethnicity. Furthermore, transcriptional profiles of AA tumors showed differential activation of insulin-like growth factor 1 (IGF1) and a signature of BRCA1 deficiency in this cohort. Using signatures derived from the meta-analysis of TNBC gene expression carried out by Lehmann et al., tumors from AA patients were more likely of basal-like subtypes whereas transcriptional features of many EA samples corresponded to mesenchymal-like or luminal androgen receptor driven subtypes. These results were validated in The Cancer Genome Atlas mRNA and protein expression data, again showing enrichment of a basal-like phenotype in AA tumors and mesenchymal subtypes in EA tumors. In addition, increased expression of VEGF-activated genes together with elevated microvessel area determined by the AQUA method suggest that AA patients exhibit higher tumor vascularization. This study confirms the existence of distinct transcriptional programs in triple negative breast cancer in two separate cohorts and that these programs differ by racial group. Differences in TNBC subtypes and levels of tumor angiogenesis in AA versus EA patients suggest that targeted therapy choices should be considered in the context of race.
    PLoS ONE 11/2013; 8(11):e71915. DOI:10.1371/journal.pone.0071915 · 3.23 Impact Factor
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    • "Studies of ethnic differences in BC pathological features are limited, except for those between African American women, and Caucasian American women. African American women are known to have aggressive BC compared with Caucasian American women [26,27]. "
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    ABSTRACT: Background We evaluated the relationship of the apoptotic activity index (AI) and the standardized mitotic-apoptotic ratio (SMI/AI) with clinicopathological features and prognosis in Libyan female breast cancer (BC) patients. We then compared our results with corresponding results in Finnish and Nigerian female BC patients. Methods Histological samples of breast carcinoma from 130 patients were retrospectively studied: an estimation of the apoptotic activity per square millimeter (expressed as apoptotic activity index (AI)), and standardized mitotic-apoptotic ratio (SMI/AI) was made, and the results compared with the clinicopathological features and the patient’s survival. Results There was a statistically significant correlation between the AI and most of the clinicopathological features; the strongest association was observed for clinical stage lymph node (LN) status (P = 0.005). There were also correlations between AI and histological grade (P = 0.035), large tumor size (P = 0.011) and the clinical stage (P = 0.009). There were, however, prominent AI differences between Libyan, Nigerian and Finnish populations. The mean values of AI and SMI/AI in Libyan BC patients were 12.8 apoptotic figures per square millimeter and 2.8, respectively. The Libyan AI is slightly higher than in Nigeria, but much higher than in Finland. The differences between countries are seen throughout the samples as well as being present in certain subgroups. The survival analysis indicated that short survival time was associated with high apoptotic indices values and so can identify aggressive tumors and provide significant prognostic support. The cutoff (4 and 18 apoptosis/mm2) of AI might be applied as a quantitative criterion for Libyan BC to separate the patients into good, moderate and bad prognosis groups. Conclusions The results indicated that the differences in AI among the three countries may be due to the known variation in the distribution of genetic markers in these populations. Improvement in health care and introduction of screening programs, however, could be very helpful in the Libyan population.
    World Journal of Surgical Oncology 06/2012; 10(1):102. DOI:10.1186/1477-7819-10-102 · 1.41 Impact Factor
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    ABSTRACT: To compare the distribution of stage at breast cancer diagnosis between First Nations (FN) and non-FN women, and to investigate factors associated with later diagnosis in FN women. A case-case design was employed to compare FN women (N = 287) to a frequency-matched random sample of women (N = 671) from the general population diagnosed with breast cancer in the Ontario Cancer Registry. Women were matched (2:1) on period of diagnosis (1995-1999, 2000-2004), age at diagnosis (< 50 vs. > or = 50), and Regional Cancer Centre (RCC). Stage and data relevant to the determinants of stage were collected from medical charts at the RCCs. The association between stage (stage II + vs. I) and FN status was modeled using logistic regression analyses; for FN women, the association between risk factors and stage was examined. FN women (66%) were diagnosed with a later stage significantly more often than non-FN women (56%). FN women with a non-screened cancer (OR 5.03, 95% CI 2.48-10.21) and those who were overweight or obese (OR 2.98, 95% CI 1.27-6.98 and OR 4.46, 95% CI 1.95-10.21, respectively) were significantly more likely to be diagnosed at a later stage. Having a comorbidity reduced the odds of a later stage (OR 0.51, 95% CI 0.27-0.96) in FN women. This study demonstrates the need for FN women, in particular those who are not accessing the health care system, to participate in breast screening programs aimed at detecting breast cancers earlier with a better prognosis. These findings suggest that the cancer care system in Ontario should better target this population through increasing awareness and access to screening.
    Canadian journal of public health. Revue canadienne de santé publique 01/2010; 101(1):101-5. · 1.02 Impact Factor
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