Stead, L. A. et al. Triple-negative breast cancers are increased in black women regardless of age or body mass index. Breast Cancer Res. 11, R18

Department of Medicine, Boston University Medical Center, Boston, MA 02118, USA.
Breast cancer research: BCR (Impact Factor: 5.49). 04/2009; 11(2):R18. DOI: 10.1186/bcr2242
Source: PubMed


We investigated clinical and pathologic features of breast cancers (BC) in an unselected series of patients diagnosed in a tertiary care hospital serving a diverse population. We focused on triple-negative (Tneg) tumours (oestrogen receptor (ER), progesterone receptor (PR) and HER2 negative), which are associated with poor prognosis.
We identified female patients with invasive BC diagnosed between 1998 and 2006, with data available on tumor grade, stage, ER, PR and HER2 status, and patient age, body mass index (BMI) and self-identified racial/ethnic group. We determined associations between patient and tumour characteristics using contingency tables and multivariate logistic regression.
415 cases were identified. Patients were racially and ethnically diverse (born in 44 countries, 36% white, 43% black, 10% Hispanic and 11% other). 47% were obese (BMI > 30 kg/m2). 72% of tumours were ER+ and/or PR+, 20% were Tneg and 13% were HER2+. The odds of having a Tneg tumour were 3-fold higher (95% CI 1.6, 5.5; p = 0.0001) in black compared with white women. Tneg tumours were equally common in black women diagnosed before and after age 50 (31% vs 29%; p = NS), and who were obese and non-obese (29% vs 31%; p = NS). Considering all patients, as BMI increased, the proportion of Tneg tumours decreased (p = 0.08).
Black women of diverse background have 3-fold more Tneg tumours than non-black women, regardless of age and BMI. Other factors must determine tumour subtype. The higher prevalence of Tneg tumours in black women in all age and weight categories likely contributes to black women's unfavorable breast cancer prognosis.

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Available from: Jerome Sobieraj, May 10, 2015
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    • "This leads to the hypothesis that breast cancer is more aggressive in those patients. In studies undertaken in Western countries, breast cancer has proven to be more aggressive in Native Africans patients [15,25]. TN tumours tend to occur at a relatively young age with a more aggressive behaviour in African patients compared to Caucasians, presenting as large tumours, with a high proliferation rate and a high mortality [26]. "
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    ABSTRACT: Background Breast cancer is the second leading cancer worldwide. In Tanzania, though it ranks as the second leading cancer in women after cervical cancer, hormonal receptor status is not carried out routinely in patients. Adjuvant hormonal therapy is given without prior knowledge of hormonal receptors status and patients can incur unnecessary costs and side effects. This study was performed to investigate the expression of hormonal receptors, epidermal growth factor receptors (HER-2) and proliferation index of the breast cancer by Ki-67 in a few selected patients with breast cancer at referral hospital in North-Western Tanzania. The study classified breast cancer subtypes based on hormonal receptors status and the expression of epidermal growth factor receptors. Results A total of 52 cases of breast cancer were investigated. Patients’ mean age at diagnosis was 49 years. The majority of the tumors was invasive ductal carcinoma 47 (90.4%) and 40 (76.9%) were of histological grade III. Thirty-eight (73.1%) of the patient had lymph node metastasis at the time of diagnosis and 36 (69.2%) were at clinical stage III. Only 3 (5.8%) patients were in clinical stage I. There was a tendency of a low level of expression of the receptors, whereby Estrogen Receptor (ER) positive tumors were 17 (32.7%), progesterone receptor (PR) positive tumors were 22 (42.3%), and HER-2 positive tumors were 12 (23.1%). Triple negative tumors constituted 20 (38.4%) of the patients. Most of the tumors (75%) showed high proliferation by Ki-67. Lymph node metastasis was more common in Triple Negative and HER enriched tumors. Conclusion This study showed a tendency for a low level of expression of hormonal receptors. There was a significant proportion of Triple Negative breast cancers. Routine testing for hormonal receptors in breast cancer is recommended before the initiation of adjuvant hormonal therapy.
    Full-text · Article · Jun 2014 · BMC Research Notes
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    • ") and that many established breast cancer risk factors are more strongly associated with hormone receptor-positive (ER þ and/or PR þ ) cancers; for example, high parity, earlier age at first birth, and later age at menarche have been associated with reduced risk of ER þ and/or PR þ cancers (Althuis et al, 2004; Nichols et al, 2005; Ursin et al, 2005; Ma et al, 2006a, b, 2010a; Lord et al, 2008; Setiawan et al, 2009; Bao et al, 2011; Palmer et al, 2011; Yang et al, 2011), and postmenopausal hormone therapy use has been associated with an increased risk of ER þ and/or PR þ cancer (Althuis et al, 2004; Rosenberg et al, 2008; Setiawan et al, 2009; Slanger et al, 2009; Bao et al, 2011). In contrast, ER-and PR-negative breast cancer (ER À PR À ), which is associated with a higher tumour grade and poorer prognosis, and is more prevalent in women of African-American race, and in younger age groups (Britton et al, 2002; Carey et al, 2006; Bauer et al, 2007; Brinton et al, 2008; Stead et al, 2009; Clarke et al, 2012), is not associated with reproductive and hormonal risk factors in the same way as hormone receptorpositive cancers. For example, age at first birth appears to be unrelated to ER À PR À cancer, and high parity has been associated with increased, rather than decreased risk (Rusiecki et al, 2005; Ma et al, 2006a, b; Rosenberg et al, 2006; Millikan et al, 2007; Kwan et al, 2009; Setiawan et al, 2009; Bao et al, 2011; Palmer et al, 2011; Yang et al, 2011). "
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    ABSTRACT: Background: Oestrogen receptor (ER)- and progesterone receptor (PR)-negative (ER−PR−) breast cancer is associated with poorer prognosis compared with other breast cancer subtypes. High parity has been associated with an increased risk of ER−PR− cancer, but emerging evidence suggests that breastfeeding may reduce this risk. Whether this potential breastfeeding benefit extends to women at high risk of breast cancer remains critical to understand for prevention. Methods: Using population-based ascertained cases (n=4011) and controls (2997) from the Breast Cancer Family Registry, we examined reproductive risk factors in relation to ER and PR status. Results: High parity (⩾3 live births) without breastfeeding was positively associated only with ER−PR− tumours (odds ratio (OR)=1.57, 95% confidence interval (CI), 1.10–2.24); there was no association with parity in women who breastfed (OR=0.93, 95% CI 0.71–1.22). Across all race/ethnicities, associations for ER−PR− cancer were higher among women who did not breastfeed than among women who did. Oral contraceptive (OC) use before 1975 was associated with an increased risk of ER−PR− cancer only (OR=1.32, 95% CI 1.04–1.67). For women who began OC use in 1975 or later there was no increased risk. Conclusions: Our findings support that there are modifiable factors for ER−PR− breast cancer and that breastfeeding in particular may mitigate the increased risk of ER−PR− cancers seen from multiparity.
    Full-text · Article · Feb 2014 · British Journal of Cancer
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    • "Multivariate Cox regression models were used to generate hazard ratios (HRs) and 95 % confidence intervals (CIs) to assess the effect of race (black vs. white) on survival outcomes, while adjusting for clinically significant baseline treatment and prognostic factors. Multivariate models were adjusted for baseline factors including age at enrollment, BMI, Eastern Cooperative Oncology Group (ECOG) performance status, serum albumin level, tumor ER/PR status, site of metastatic disease (adjusted using a hierarchical approach, i.e., [1] central nervous system [CNS], [2] bone only or bone plus breast, [3] visceral/other, and [4] node/local), number of metastatic sites, stage of disease at initial diagnosis, history of underlying CVD, and history of other underlying noncardiac comorbid conditions. The final multivariate models further adjusted for first-line treatment variables among patients, including receipt of trastuzumab, taxanes, and hormonal therapy. "
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    ABSTRACT: Data characterizing demographics, treatment patterns, and clinical outcomes in black patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) are limited. registHER is a large, observational cohort study of patients (n = 1,001) with HER2-positive MBC diagnosed ≤6 months of enrollment and followed until death, disenrollment, or June 2009 (median follow-up of 27 months). Demographics, treatment patterns, and clinical outcomes were described for black (n = 126) and white patients (n = 793). Progression-free survival (PFS) following first-line therapy and overall survival (OS) were examined. Multivariate analyses adjusted for baseline and treatment factors. Black patients were more likely than white patients to be obese (body mass index ≥30), to have diabetes, and to have a history of cardiovascular disease; they were also less likely to have estrogen receptor or progesterone receptor positive disease. In patients treated with trastuzumab, the incidence of cardiac safety events (grade ≥3) was higher in black patients (10.9 %) than in white patients (7.9 %). Unadjusted median OS and PFS (months) were significantly lower in black patients than in white patients (OS: black: 27.1, 95 % confidence interval [CI] 21.3-32.1; white: 37.3, 95 % CI 34.6-41.1; PFS: black: 7.0, 95 % CI 5.7-8.2; white: 10.2, 95 % CI 9.3-11.2). The adjusted OS hazard ratio (HR) for black patients compared with white patients was 1.29 (95 % CI 1.00-1.65); adjusted PFS HR was 1.29 (95 % CI 1.05-1.59). This real-world evaluation of a large cohort of patients with HER2-positive MBC shows poorer prognostic factors and independently worse clinical outcomes in black versus white patients. Further research is needed to identify potential biologic differences that could have predictive impact for black patients or that could explain these differences.
    Full-text · Article · Sep 2013 · Breast Cancer Research and Treatment
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