Louisiana Health Sciences Center, School of Medicine, New Orleans, LA, United States.
Department of Public Health and Preventive Medicine, St. George's University, True Blue, Grenada.
Front Public Health. 2020 Dec 22;8:576964. doi: 10.3389/fpubh.2020.576964. eCollection 2020.
Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer that lacks expression of the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (HER2). TNBC constitutes about 15-30 percent of all diagnosed invasive breast cancer cases in the United States. African-American (AA) women have high prevalence of TNBC with worse clinical outcomes than European-American (EA) women. The contributing factors underlying racial disparities have been divided into two major categories based on whether they are related to lifestyle (non-biologic) or unrelated to lifestyle (biologic). Our objective in the present review article was to understand the potential interactions by which these risk factors intersect to drive the initiation and development of the disparities resulting in the aggressive TNBC subtypes in AA women more likely than in EA women. To reach our goal, we conducted literature searches using MEDLINE/PubMed to identify relevant articles published from 2005 to 2019 addressing breast cancer disparities primarily among AA and EA women in the United States. We found that disparities in TNBC may be attributed to racial differences in biological factors, such as tumor heterogeneity, population genetics, somatic genomic mutations, and increased expression of genes in AA breast tumors which have direct link to breast cancer. In addition, a large number of non-biologic factors, including socioeconomic deprivation adversities associated with poverty, social stress, unsafe neighborhoods, lack of healthcare access and pattern of reproductive factors, can promote comorbid diseases such as obesity and diabetes which may adversely contribute to the aggression of TNBC biology in AA women. Further, the biological risk factors directly linked to TNBC in AA women may potentially interact with non-biologic factors to promote a higher prevalence of TNBC, more aggressive biology, and poor survival. The relative contributions of the biologic and non-biologic factors and their potential interactions is essential to our understanding of disproportionately high burden and poor survival rates of AA women with TNBC.
三阴性乳腺癌（TNBC）是一种侵袭性乳腺癌亚型，缺乏雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体 2（HER2）的表达。TNBC 约占美国所有诊断为浸润性乳腺癌病例的 15-30%。非裔美国（AA）女性 TNBC 发病率较高，临床结局较欧洲裔美国（EA）女性差。造成这种种族差异的因素可分为与生活方式（非生物学）有关或与生活方式无关（生物学）两大类。本综述文章的目的是了解这些风险因素相互作用的潜在机制，这些风险因素相互作用导致了 AA 女性中 TNBC 亚型的起始和发展，使 AA 女性比 EA 女性更有可能出现侵袭性 TNBC 亚型。为了达到我们的目标，我们使用 MEDLINE/PubMed 进行文献检索，以确定从 2005 年到 2019 年发表的主要针对美国 AA 和 EA 女性乳腺癌差异的相关文章。我们发现，TNBC 差异可能归因于生物学因素的种族差异，如肿瘤异质性、群体遗传学、体细胞基因组突变以及 AA 乳腺癌中基因表达增加，这些因素与乳腺癌直接相关。此外，大量非生物学因素，包括与贫困相关的社会经济剥夺逆境、社会压力、不安全的社区、缺乏医疗保健机会和生殖因素模式，可促进肥胖和糖尿病等共病的发生，这可能对 AA 女性 TNBC 生物学的侵袭性产生不利影响。此外，与 AA 女性 TNBC 直接相关的生物学风险因素可能与非生物学因素相互作用，从而导致 TNBC 的更高发生率、更具侵袭性的生物学和较差的生存。了解 AA 女性 TNBC 负担过重和生存率低的相对生物学和非生物学因素及其潜在相互作用至关重要。
