Mortality risk of black women and white women with invasive breast cancer by hormone receptors, HER2, and p53 status

Huiyan Ma, Yani Lu, Kathleen E. Malone, Polly A. Marchbanks, Dennis M. Deapen, Robert Spirtas, Ronald T. Burkman, Brian Strom, Jill A. McDonald, Suzanne G. Folger, Michael S. Simon, Jane Sullivan-Halley, Michael F. Press, Leslie Bernstein

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Abstract

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.

Original languageEnglish (US)
Article number225
JournalBMC cancer
Volume13
DOIs
StatePublished - May 4 2013

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Hormones
Breast Neoplasms
Estrogen Receptors
Mortality
Progesterone Receptors
hydroquinone
human ERBB2 protein
Proportional Hazards Models
Paraffin
Biomarkers
Immunohistochemistry
Confidence Intervals
Neoplasms
Proteins

All Science Journal Classification (ASJC) codes

  • Oncology
  • Genetics
  • Cancer Research

Cite this

Ma, H., Lu, Y., Malone, K. E., Marchbanks, P. A., Deapen, D. M., Spirtas, R., ... Bernstein, L. (2013). Mortality risk of black women and white women with invasive breast cancer by hormone receptors, HER2, and p53 status. BMC cancer, 13, [225]. https://doi.org/10.1186/1471-2407-13-225
Ma, Huiyan ; Lu, Yani ; Malone, Kathleen E. ; Marchbanks, Polly A. ; Deapen, Dennis M. ; Spirtas, Robert ; Burkman, Ronald T. ; Strom, Brian ; McDonald, Jill A. ; Folger, Suzanne G. ; Simon, Michael S. ; Sullivan-Halley, Jane ; Press, Michael F. ; Bernstein, Leslie. / Mortality risk of black women and white women with invasive breast cancer by hormone receptors, HER2, and p53 status. In: BMC cancer. 2013 ; Vol. 13.
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title = "Mortality risk of black women and white women with invasive breast cancer by hormone receptors, HER2, and p53 status",
abstract = "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.",
author = "Huiyan Ma and Yani Lu and Malone, {Kathleen E.} and Marchbanks, {Polly A.} and Deapen, {Dennis M.} and Robert Spirtas and Burkman, {Ronald T.} and Brian Strom and McDonald, {Jill A.} and Folger, {Suzanne G.} and Simon, {Michael S.} and Jane Sullivan-Halley and Press, {Michael F.} and Leslie Bernstein",
year = "2013",
month = "5",
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doi = "10.1186/1471-2407-13-225",
language = "English (US)",
volume = "13",
journal = "BMC Cancer",
issn = "1471-2407",
publisher = "BioMed Central",

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Ma, H, Lu, Y, Malone, KE, Marchbanks, PA, Deapen, DM, Spirtas, R, Burkman, RT, Strom, B, McDonald, JA, Folger, SG, Simon, MS, Sullivan-Halley, J, Press, MF & Bernstein, L 2013, 'Mortality risk of black women and white women with invasive breast cancer by hormone receptors, HER2, and p53 status', BMC cancer, vol. 13, 225. https://doi.org/10.1186/1471-2407-13-225

Mortality risk of black women and white women with invasive breast cancer by hormone receptors, HER2, and p53 status. / Ma, Huiyan; Lu, Yani; Malone, Kathleen E.; Marchbanks, Polly A.; Deapen, Dennis M.; Spirtas, Robert; Burkman, Ronald T.; Strom, Brian; McDonald, Jill A.; Folger, Suzanne G.; Simon, Michael S.; Sullivan-Halley, Jane; Press, Michael F.; Bernstein, Leslie.

In: BMC cancer, Vol. 13, 225, 04.05.2013.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Mortality risk of black women and white women with invasive breast cancer by hormone receptors, HER2, and p53 status

AU - Ma, Huiyan

AU - Lu, Yani

AU - Malone, Kathleen E.

AU - Marchbanks, Polly A.

AU - Deapen, Dennis M.

AU - Spirtas, Robert

AU - Burkman, Ronald T.

AU - Strom, Brian

AU - McDonald, Jill A.

AU - Folger, Suzanne G.

AU - Simon, Michael S.

AU - Sullivan-Halley, Jane

AU - Press, Michael F.

AU - Bernstein, Leslie

PY - 2013/5/4

Y1 - 2013/5/4

N2 - 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.

AB - 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.

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DO - 10.1186/1471-2407-13-225

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