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Race and triple negative threats to breast cancer survival: a population-based study in Atlanta, GA.
Breast Cancer Res Treat. 2009 Jan; 113(2):357-70.BC

Abstract

BACKGROUND

Breast cancers with a triple negative tumor (TNT) subtype (as defined by lacking protein expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)) preclude the use of available targeted therapies and may contribute to poor outcome and to the historically poorest survival observed among African-American (AA) women. This study examines association of the ER/PR/HER2 subtypes with race and breast cancer survival.

METHODS

Breast tumors from a population-based cohort of 116 AA and 360 white Atlanta women aged 20-54, diagnosed from 1990 to 1992 were centrally reviewed and tested by immunohistochemistry. Multivariate survival analyses within subtypes (TNT, ER-PR-HER2+, ER+/PR+HER2+, ER+/PR+HER2-) were conducted using weighted Cox regression and included socio-demographic, prognostic, and treatment factors.

RESULTS

TNTs were more prevalent among young women and particularly among AA women (Odds Ratio [OR] = 1.9, 95% Confidence Interval [CI] 1.2-2.9), adjusting for age, stage, grade, and poverty index. Overall mortality was higher for AA women (Hazard Ratio [HR] = 1.9, 95% CI, 1.5-2.5) and differed by subtypes (P < 0.001). Within the TNT subtype, racial differences in survival persisted, after additional adjustment for treatment and comorbidities (HR = 2.0, 95% CI 1.0-3.7). TNTs were uniquely associated with high expression of p16, p53, and Cyclin E; and low Bcl-2 and Cyclin D1 expression.

CONCLUSIONS

The high prevalence of TNTs among younger women and particularly younger AA women, along with unique protein expression patterns and poorer survival, suggests varying gene-environment etiologies with respect to age and race/ethnicity and a need for effective therapies.

Authors+Show Affiliations

Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA. mlund@sph.emory.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18324472

Citation

Lund, Mary Jo, et al. "Race and Triple Negative Threats to Breast Cancer Survival: a Population-based Study in Atlanta, GA." Breast Cancer Research and Treatment, vol. 113, no. 2, 2009, pp. 357-70.
Lund MJ, Trivers KF, Porter PL, et al. Race and triple negative threats to breast cancer survival: a population-based study in Atlanta, GA. Breast Cancer Res Treat. 2009;113(2):357-70.
Lund, M. J., Trivers, K. F., Porter, P. L., Coates, R. J., Leyland-Jones, B., Brawley, O. W., Flagg, E. W., O'Regan, R. M., Gabram, S. G., & Eley, J. W. (2009). Race and triple negative threats to breast cancer survival: a population-based study in Atlanta, GA. Breast Cancer Research and Treatment, 113(2), 357-70. https://doi.org/10.1007/s10549-008-9926-3
Lund MJ, et al. Race and Triple Negative Threats to Breast Cancer Survival: a Population-based Study in Atlanta, GA. Breast Cancer Res Treat. 2009;113(2):357-70. PubMed PMID: 18324472.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Race and triple negative threats to breast cancer survival: a population-based study in Atlanta, GA. AU - Lund,Mary Jo, AU - Trivers,Katrina F, AU - Porter,Peggy L, AU - Coates,Ralph J, AU - Leyland-Jones,Brian, AU - Brawley,Otis W, AU - Flagg,Elaine W, AU - O'Regan,Ruth M, AU - Gabram,Sheryl G A, AU - Eley,J William, Y1 - 2008/03/07/ PY - 2008/01/24/received PY - 2008/01/28/accepted PY - 2008/3/8/pubmed PY - 2009/2/7/medline PY - 2008/3/8/entrez SP - 357 EP - 70 JF - Breast cancer research and treatment JO - Breast Cancer Res Treat VL - 113 IS - 2 N2 - BACKGROUND: Breast cancers with a triple negative tumor (TNT) subtype (as defined by lacking protein expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)) preclude the use of available targeted therapies and may contribute to poor outcome and to the historically poorest survival observed among African-American (AA) women. This study examines association of the ER/PR/HER2 subtypes with race and breast cancer survival. METHODS: Breast tumors from a population-based cohort of 116 AA and 360 white Atlanta women aged 20-54, diagnosed from 1990 to 1992 were centrally reviewed and tested by immunohistochemistry. Multivariate survival analyses within subtypes (TNT, ER-PR-HER2+, ER+/PR+HER2+, ER+/PR+HER2-) were conducted using weighted Cox regression and included socio-demographic, prognostic, and treatment factors. RESULTS: TNTs were more prevalent among young women and particularly among AA women (Odds Ratio [OR] = 1.9, 95% Confidence Interval [CI] 1.2-2.9), adjusting for age, stage, grade, and poverty index. Overall mortality was higher for AA women (Hazard Ratio [HR] = 1.9, 95% CI, 1.5-2.5) and differed by subtypes (P < 0.001). Within the TNT subtype, racial differences in survival persisted, after additional adjustment for treatment and comorbidities (HR = 2.0, 95% CI 1.0-3.7). TNTs were uniquely associated with high expression of p16, p53, and Cyclin E; and low Bcl-2 and Cyclin D1 expression. CONCLUSIONS: The high prevalence of TNTs among younger women and particularly younger AA women, along with unique protein expression patterns and poorer survival, suggests varying gene-environment etiologies with respect to age and race/ethnicity and a need for effective therapies. SN - 1573-7217 UR - https://www.unboundmedicine.com/medline/citation/18324472/Race_and_triple_negative_threats_to_breast_cancer_survival:_a_population_based_study_in_Atlanta_GA_ L2 - https://doi.org/10.1007/s10549-008-9926-3 DB - PRIME DP - Unbound Medicine ER -