Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA 91010, USA.
BMC Cancer. 2013 May 4;13:225. doi: 10.1186/1471-2407-13-225.
BACKGROUND: Black women are more likely than white women to have an aggressive subtype of breast cancer that is associated with higher mortality and this may contribute to the observed black-white difference in mortality. However, few studies have investigated the black-white disparity in mortality risk stratified by breast cancer subtype, defined by estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status. Furthermore, it is not known whether additional consideration of p53 protein status influences black-white differences in mortality risk observed when considering subtypes defined by ER, PR and HER2 status. METHODS: Four biomarkers were assessed by immunohistochemistry in paraffin-embedded breast tumor tissue from 1,204 (523 black, 681 white) women with invasive breast cancer, aged 35-64 years at diagnosis, who accrued a median of 10 years' follow-up. Multivariable Cox proportional hazards regression models were fit to assess subtype-specific black-white differences in mortality risk. RESULTS: No black-white differences in mortality risk were observed for women with triple negative (ER-negative [ER-], PR-, and HER2-) subtype. However, older (50-64 years) black women had greater overall mortality risk than older white women if they had been diagnosed with luminal A (ER-positive [ER+] or PR+ plus HER2-) breast cancer (all-cause hazard ratio, HR, 1.88; 95% confidence interval, CI, 1.18 to 2.99; breast cancer-specific HR, 1.51; 95% CI, 0.83 to 2.74). This black-white difference among older women was further confined to those with luminal A/p53- tumors (all-cause HR, 2.22; 95% CI, 1.30 to 3.79; breast cancer-specific HR, 1.89; 95% CI, 0.93 to 3.86). Tests for homogeneity of race-specific HRs comparing luminal A to triple negative subtype and luminal A/p53- to luminal A/p53+ subtype did not achieve statistical significance, although statistical power was limited. CONCLUSIONS: Our findings suggest that the subtype-specific black-white difference in mortality risk occurs mainly among older women diagnosed with luminal A/p53- breast cancer, which is most likely treatable. These results further suggest that factors other than subtype may be relatively more important in explaining the increased mortality risk seen in older black women.
背景：黑人女性比白人女性更有可能患有侵袭性更强的乳腺癌亚型，这种亚型与更高的死亡率相关，这可能导致观察到的黑人和白人死亡率之间的差异。然而，很少有研究调查过根据雌激素受体 (ER)、孕激素受体 (PR) 和人表皮生长因子受体 2 (HER2) 状态定义的乳腺癌亚型分层后的黑人和白人死亡率风险的差异。此外，当考虑到 ER、PR 和 HER2 状态定义的亚型时，是否还需要考虑 p53 蛋白状态，这是否会影响观察到的黑人和白人死亡率风险的差异尚不清楚。 方法：对 1204 名（523 名黑人，681 名白人）年龄在 35-64 岁诊断时患有浸润性乳腺癌的女性的石蜡包埋乳腺癌组织中的 4 种生物标志物进行免疫组织化学评估，这些女性在中位随访 10 年后发生死亡。多变量 Cox 比例风险回归模型用于评估特定亚型的黑人和白人死亡率风险差异。 结果：对于三阴性（ER-、PR-和 HER2-）亚型的女性，未观察到黑人和白人死亡率风险的差异。然而，如果诊断为 luminal A（ER+或 PR+加 HER2+）乳腺癌，年龄较大（50-64 岁）的黑人女性的总体死亡率风险高于年龄较大的白人女性（全因危险比，HR，1.88；95%置信区间，CI，1.18 至 2.99；乳腺癌特异性 HR，1.51；95%CI，0.83 至 2.74）。这种老年女性的黑人和白人之间的差异进一步局限于 luminal A/p53-肿瘤的女性（全因 HR，2.22；95%CI，1.30 至 3.79；乳腺癌特异性 HR，1.89；95%CI，0.93 至 3.86）。比较 luminal A 与三阴性亚型以及 luminal A/p53-与 luminal A/p53+亚型的种族特异性 HR 同质性检验未达到统计学意义，尽管统计效力有限。 结论：我们的研究结果表明，死亡率风险的亚型特异性黑人和白人差异主要发生在诊断为 luminal A/p53-乳腺癌的老年女性中，这种亚型很可能是可治疗的。这些结果进一步表明，在解释老年黑人女性死亡率风险增加时，可能还有其他因素比亚型更为重要。
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