J Cancer 2020; 11(10):2808-2820. doi:10.7150/jca.39091 This issue

Research Paper

Greater Survival Improvement in African American vs. Caucasian Women with Hormone Negative Breast Cancer

Robert Wieder1,2✉, Basit Shafiq3,4, Nabil Adam1,3,5

1. Department of Medicine, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences
2. The Cancer Institute of New Jersey, Rutgers Biomedical and Health Sciences
3. Institute of Data Science, Learning, and Applications (I-DSLA), Rutgers University Newark
4. Department of Computer Science, Lahore University of Management Sciences (LUMS)
5. Department of Management Science and Information Systems, Rutgers Business School

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Wieder R, Shafiq B, Adam N. Greater Survival Improvement in African American vs. Caucasian Women with Hormone Negative Breast Cancer. J Cancer 2020; 11(10):2808-2820. doi:10.7150/jca.39091. Available from https://www.jcancer.org/v11p2808.htm

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Background: African American women have not benefited equally from recently improved breast cancer survival. We investigated if this was true for all subsets.

Methods: We identified 395,170 patients with breast adenocarcinoma from the SEER database from 1990 to 2011 with designated race, age, stage, grade, ER and PR status, marital status and laterality, as control. We grouped patients into two time periods, 1990-2000 and 2001-2011, three age categories, under 40, 40-69 and ≥ 70 years and two stage categories, I-III and IV. We used the Kaplan-Meier and logrank tests to compare survival curves. We stratified data by patient- and tumor-associated variables to determine co-variation among confounding factors using the Pearson Chi-square test and Cox proportional hazards regression to determine hazard ratios (HR) to compare survival.

Results: Stage I-III patients of both races ≥ 70 years old, African American widowed patients and Caucasians with ER- and PR- tumors had worse improvements in survival in 2001-2011 than younger, married or hormone receptor positive patients, respectively. In contrast, African Americans with ER- (Cox HR 0.70 [95% CI 0.65-0.76]) and PR- (Cox HR 0.67 [95% CI 0.62-0.72]) had greater improvement in survival in 2001-2011 than Caucasians with ER- (Cox HR 0.81 [95% CI 0.78-0.84]) and PR- disease (Cox HR 0.75 [95% CI 0.73-0.78]). This was not associated with changes in distribution of tumor or patient attributes.

Conclusions: African American women with stage I-III ER- and PR- breast cancer had greater improvement in survival than Caucasians in 2001-2011. This is the first report of an improvement in racial disparities in survival from breast cancer in a subset of patients.

Keywords: breast cancer, African Americans, risk factor, survival