Henry Ford Health System/Henry Ford Cancer Institute, Detroit, MI, USA.
Weill Cornell Medicine, New York, NY, USA.
Breast J. 2021 Jul;27(7):573-580. doi: 10.1111/tbj.14225. Epub 2021 Mar 18.
Breast cancer mortality rates are 39% higher in the African-American (AA) women compared to White-American (WA) women despite the advances in overall breast cancer screening and treatments. Several studies have undertaken to identify the factors leading to this disparity in United States with possible effects of lower socioeconomic status and underlying aggressive biology.
A retrospective analysis was done using a prospectively maintained database of a metropolitan health system. Patients were selected based on diagnosis of early-stage breast cancer between 10/1998 and 02/2017, and included women over age of 18 with clinically node-negative disease. Patients were then stratified by phenotype confirmed by pathology and patient-identified race.
A total of 2,298 women were identified in the cohort with 39% AA and 61% WA women. The overall mean age at the time of diagnosis for AA women was slightly younger at 60 years compared to 62 years for WA women (p = 0.003). Follow-up time was longer for the WA women at 95 months vs. 86 months in AA women. The overall 5-year survival was analyzed for the entire cohort, with the lowest survival occurring in patients with triple-negative breast cancer (TNBC). Phenotype distribution revealed a higher incidence of TNBC in AA women compared to WA women (AA 16% vs. WA 10%; p < 0.0001). AA women also had higher incidence of HER2 positive cancers (AA 16.8% vs. WA 15.3%; p < 0.0001). WA women had a significantly higher distribution of Non-TNBC/HER2-negative phenotype (AA 55% vs. WA 65%; p < 0.0001). Furthermore, a subgroup analysis was done for a sentinel lymph node (SLN) negative cohort that showed higher rates of grade 3 tumors in AA (AA 35% vs. WA 23%; p < 0.0001); and higher rates of grade 1 and grade 2 tumors in WA (30% vs. 21% and 44% vs. 40%). Despite higher grade tumors in AA women, five-year overall survival outcomes in SLN-negative cohort did not differ between AA and WA women when stratifying based on tumor subtype.
Breast cancer survival disparities in AA and WA women with SLN-negative breast cancer are diminished when evaluated at early-stage cancers defined by SLN-negative tumors. Our evaluation suggests that when diagnosed early, phenotype does not contribute to racial survival outcomes. The lower survival rate in AA women with breast cancer may be attributed to later stage biology between the two races, or underlying socioeconomic disparities.
尽管在整体乳腺癌筛查和治疗方面取得了进展，但非裔美国（AA）女性的乳腺癌死亡率比白种美国（WA）女性高 39%。多项研究已经着手确定导致这一差异的因素，这些因素可能与较低的社会经济地位和潜在的侵袭性生物学有关。
本研究使用一个大都市健康系统的前瞻性维护数据库进行回顾性分析。根据 1998 年 10 月至 2017 年 2 月期间早期乳腺癌的诊断，选择患者，包括年龄在 18 岁以上且临床淋巴结阴性的女性。然后根据病理和患者确定的种族证实的表型将患者分层。
在队列中，共有 2298 名女性被确定，其中 39%为 AA 女性，61%为 WA 女性。AA 女性在诊断时的平均年龄稍年轻，为 60 岁，而 WA 女性为 62 岁（p=0.003）。WA 女性的随访时间更长，为 95 个月，而 AA 女性为 86 个月。对整个队列进行了 5 年总生存率分析，总生存率最低的是三阴性乳腺癌（TNBC）患者。表型分布显示 AA 女性 TNBC 的发生率高于 WA 女性（AA 16% vs. WA 10%；p<0.0001）。AA 女性 HER2 阳性癌症的发生率也较高（AA 16.8% vs. WA 15.3%；p<0.0001）。WA 女性非 TNBC/HER2-阴性表型的分布明显较高（AA 55% vs. WA 65%；p<0.0001）。此外，还对前哨淋巴结（SLN）阴性队列进行了亚组分析，结果显示 AA 组中 3 级肿瘤的比例较高（AA 35% vs. WA 23%；p<0.0001）；WA 组中 1 级和 2 级肿瘤的比例较高（30% vs. 21%和 44% vs. 40%）。尽管 AA 女性的肿瘤分级较高，但在根据 SLN 阴性肿瘤定义的早期癌症中，SLN 阴性乳腺癌的 AA 和 WA 女性的 5 年总生存率结果没有差异。我们的评估表明，当早期诊断时，表型不会影响种族的生存结果。AA 女性乳腺癌的生存率较低可能归因于两种种族之间晚期生物学的差异，或潜在的社会经济差异。
