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Influence of clinical, societal, and treatment variables on racial differences in ER−/PR− breast cancer survival

  • Epidemiology
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Breast Cancer Research and Treatment Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 10 July 2017

Abstract

Background

African American (AA) women with breast cancer have persistently higher mortality compared to whites. We evaluated racial disparities in mortality among women with estrogen receptor (ER)/progesterone receptor (PR)-negative breast cancer.

Methods

The study population included 542 women (45% AA) diagnosed with ER/PR-negative Stage I through III breast cancer treated at the Henry Ford Health System (HFHS) between 1996 and 2005. Linked datasets from HFHS, Metropolitan Detroit Cancer Surveillance System, and the U.S. Census Bureau were used to obtain demographic, socioeconomic, and clinical information. Economic deprivation was categorized using a previously validated deprivation index, which included 5 categories based on the quintile of census tract socioeconomic deprivation. Cox proportional hazards models were used to assess the relationship between race and mortality.

Results

AA women were more likely to have larger tumors, have higher Charlson Comorbidity Indices (CCI), and to reside in economically deprived areas. In an unadjusted analysis, AA women demonstrated a significantly higher risk of death compared to whites [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.09–2.00]. Following adjustment for clinical factors (age, stage, CCI) and treatment (radiation and chemotherapy), AA race continued to have a significant impact on mortality (HR 1.51, CI 1.10–2.08 and HR 1.63, CI 1.20–2.21). Only after adjusting for deprivation was race no longer significant (HR 1.26, CI 0.84–1.87).

Conclusions

Social determinants of health play a large role in explaining racial disparities in breast cancer outcomes, especially among women with aggressive subtypes.

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Acknowledgements

This study was funded in part by National Cancer Institute, N01-PC- 35145 (addendum 12) and the Wayne State University Clinical and Translational Science Pilot Program.

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Authors and Affiliations

  1. Wayne State University School of Medicine, Detroit, MI, USA

    M. E. Roseland

  2. Department of Family Medicine & Public Health Sciences, Wayne State University, Detroit, MI, USA

    K. Schwartz & J. Booza

  3. Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, 4100 John R HW4HO, Detroit, MI, 48201, USA

    K. Schwartz, J. J. Ruterbusch & Michael S. Simon

  4. Department of Public Health Sciences, Henry Ford Health Systems, Detroit, MI, USA

    L. Lamerato & R. Krajenta

  5. Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA

    Michael S. Simon

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  1. M. E. Roseland
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Correspondence to Michael S. Simon.

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Roseland, M.E., Schwartz, K., Ruterbusch, J.J. et al. Influence of clinical, societal, and treatment variables on racial differences in ER−/PR− breast cancer survival. Breast Cancer Res Treat 165, 163–168 (2017). https://doi.org/10.1007/s10549-017-4300-y

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