The epidemiology of triple-negative breast cancer, including race

Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
Cancer Causes and Control (Impact Factor: 2.74). 05/2009; 20(7):1071-82. DOI: 10.1007/s10552-009-9331-1
Source: PubMed


Predictors of intrinsic breast cancer subtypes, including the triple-negative (TN) subtype, are largely unknown. We evaluated whether anthropometrics, demographics, and reproductive history were associated with distinct breast cancer subtypes.
Invasive breast tumors from a population-based case-control study of 476 (116 black and 360 white) Atlanta women aged 20-54, diagnosed between 1990 and 1992, were centrally reviewed and immunohistochemically analyzed for estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2); then grouped [TN (ER-PR-HER2-); ER-PR-HER2+; ER/PR+HER2+; ER/PR+HER2- (case-only reference group)]. Data were from interviews and anthropometric measurements; adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression, including both case-only and case-control comparisons.
From the case-only analyses and compared with the ER/PR+HER2- subtype, women with TN tumors were more likely to be obese than normal/underweight [OR = 1.89 (95% CI = 1.22, 2.92)]. Regardless of HER2 status, ER-PR- tumors were associated with black race, young age at first birth, having a recent birth, and being overweight.
Distinct breast cancer subtypes have unique sociodemographic, anthropometric and reproductive characteristics and possibly different pathways for development.

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    • "Their data revealed that hormone receptor negative breast cancers were associated with black race and young age at first birth. They also affirmed that history of recent birth and obesity as being risk factors for these cancers [18]. Phipps AL et al. suggested nulliparity as a protective factor for triple negative breast cancer, although they didn’t find a significant association with breast feeding and oral contraceptive usage [19]. "
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    ABSTRACT: Young age breast cancers are quite prevalent in our setup, a significant number of which exhibit triple negative phenotype. These cancers behave in an aggressive fashion and unresponsive to targeted adjuvant therapy. We aimed to evaluate clinical and histopathologic features of triple negative cancers in our population. We retrospectively evaluated 1104 cases of primary breast cancers. Immunohistochemical studies for ER, PR and Her2neu followed by Her2neu gene amplification by FISH testing were done to identify 205 (18.6%) cases of triple negative breast cancers. Mean age for triple negative breast cancer patients was 48.4 years (+/-12.3) and 60% of patients were diagnosed at less than 50 years of age. Although ductal carcinoma was the most frequent histologic type, a meaningful number of cases exhibited metaplastic and medullary like features (10.7% and 5.9% respectively). Similarly geographic necrosis involving more than 40% of tumor and extensive lymphocytic infiltration was a considerable finding. Mean Ki67 index was 45.2% (+/-25.2) and as a reflection of tumor grade, a significantly higher proportion of cases (66.3%) were under high risk Ki67 category (>30%). Triple negative breast cancers typify high grade breast cancers with a higher frequency of atypical medullary and metaplastic histologies. Their prevailing occurrence at a younger age raises question of under lying BRCA mutations in our population. Therefore, we suggest that risk factors including BRCA 1 mutations should be uncovered in reproductive age group breast cancers especially those disclosing basal like phenotype.Virtual slides: The virtual slide(s) for this article can be found here:
    Full-text · Article · Feb 2014 · Diagnostic Pathology
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    • "Obesity, which is more prevalent in women with low income and educational levels [18], has been related to more advanced breast cancer at the time of diagnosis and a poor prognosis in both premenopausal and postmenopausal women [1]. It is also associated with the triple-negative phenotype [13, 19]. Several studies found that obese women were at an increased risk for breast cancer metastasis to distant sites (reviewed in [3]), and Dawood et al. [20] have reported that overweight and obese women with locally advanced breast cancer, regardless of their menopausal status, are at a greater risk for visceral metastases than their lean counterparts. "
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    ABSTRACT: Breast cancer patients in rural Appalachia have a high prevalence of obesity and poverty, together with more triple-negative phenotypes. We reviewed clinical records for tumor receptor status and time to distant metastasis. Body mass index, tumor size, grade, nodal status, and receptor status were related to metastatic patterns. For 687 patients, 13.8% developed metastases to bone (n = 42) or visceral sites (n = 53). Metastases to viscera occurred within five years, a latent period which was shorter than that for bone (P = 0.042). More women with visceral metastasis presented with grade 3 tumors compared with the bone and nonmetastatic groups (P = 0.0002). There were 135/574 women (23.5%) with triple-negative breast cancer, who presented with lymph node involvement and visceral metastases (68.2% versus 24.3%; P = 0.033). Triple-negative tumors that metastasized to visceral sites were larger (P = 0.007). Developing a visceral metastasis within 10 years was higher among women with triple-negative tumors. Across all breast cancer receptor subtypes, the probability of remaining distant metastasis-free was greater for brain and liver than for lung. The excess risk of metastatic spread to visceral organs in triple-negative breast cancers, even in the absence of positive nodes, was combined with the burden of larger and more advanced tumors.
    Full-text · Article · Jan 2014 · Journal of Cancer Epidemiology
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    • "Results of numerous epidemiological studies about the relationship between cigarette smoking and breast cancer risk are inconsistent (International Agency for Research on Cancer, 2004; Braithwaite et al., 2012). The majority of studies have shown a weak positive association (Reynolds et al., 2004; Cui et al., 2006; Rollison et al., 2008; Slattery et al., 2008; Young et al., 2009) or absence of any association (Prescott et al., 2007; Roddam et al., 2007; Lin et al., 2008; Trivers et al., 2009). "
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    ABSTRACT: Background: Despite the fact that breast cancer is the most common female cancer worldwide, more than half of the breast cancer risk factors remained unexplained. The aim of this study was to investigate the association of cigarette smoking with risk of breast cancer. Materials and methods: A case-control study was conducted in the Clinical Centre of Kragujevac, Serbia, covering 382 participants (191 cases and 191 controls). In the analysis of data logistic regression was used. Results: Breast cancer risk was significantly increased in those who quit smoking at ≤ 50 years of age (OR=2.72; 95% confidence interval - 95%CI=1.02-7.27) and in those who quit smoking less than 5 years before diagnosis of the disease (OR=4.36; 95%CI=1.12-16.88). When smokers were compared with nonsmokers without passive exposure to smoking, former smoking significantly increased breast cancer risk (OR=2.37; 95%CI=1.07-5.24). Risk for breast cancer was significantly increased in those who quit smoking at ≤ 50 years of age (OR=3.29; 95%CI=1.17-9.27) and in those who quit smoking less than 5 years before diagnosis of the disease (OR=5.46; 95%CI=1.34-22.28). Conclusions: These data suggest that cigarette smoking is associated with an elevated risk of breast cancer among former smokers in Serbia.
    Full-text · Article · Nov 2013 · Asian Pacific journal of cancer prevention: APJCP
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