Abstract IA29: Race, ethnicity, and outcomes in breast cancer

The racial divide in breast cancer outcomes is well known. Breast cancer is the most common cause of cancer in women in the United States, and the second leading cause of cancer death.1 Black race is associated with a worse prognosis in operable breast cancer2 and in other hormone dependent cancers such as uterine and prostate cancer, but generally not other cancer types.3,4 Black women are more likely to present with advanced stage disease5, have triple negative breast cancer (TNBC), exhibit greater non-adherence and poorer tolerance to chemotherapy6 and endocrine therapy7, and have more comorbidities8 and experience more disparities in care.9-11 Black race has also been associated with worse outcome in male breast cancer.12 Although breast cancer incidence and mortality have declined by about 35% in the United States since 1990, mortality rates have declined less in black women, contributing to a widening of the racial gap which has contributed to about a 35% higher mortality rate for black women compared with others.13 However, a widening racial gap has also been observed for women in the U.S. Department of Defense healthcare system, suggesting that factors other than disparities in care may be playing a role. 14 With regard to ethnicity, Hispanic women also exhibit higher rates of TNBC, but otherwise experience similar outcomes as non-Hispanic women. There is emerging evidence that differences in outcomes may be due in part due to factors other than disparities in care. In this review, we explore some of the biological factors that may be contributing to the racial divide in breast cancer. References: 1. Jemal A, Siegel R, Ward E, et al: Cancer statistics, 2009. CA Cancer J Clin 59:225-49, 2009 2. Newman LA, Mason J, Cote D, et al: African-American ethnicity, socioeconomic status, and breast cancer survival: a meta-analysis of 14 studies involving over 10,000 African-American and 40,000 White American patients with carcinoma of the breast. Cancer 94:2844-54, 2002 3. Albain KS, Unger JM, Crowley JJ, et al: Racial disparities in cancer survival among randomized clinical trials patients of the Southwest Oncology Group. J Natl Cancer Inst 101:984-92, 2009 4. Bach PB, Schrag D, Brawley OW, et al: Survival of blacks and whites after a cancer diagnosis. Jama 287:2106-13, 2002 5. Joslyn SA, West MM: Racial differences in breast carcinoma survival. Cancer 88:114-23, 2000 6. Hershman D, McBride R, Jacobson JS, et al: Racial disparities in treatment and survival among women with early-stage breast cancer. J Clin Oncol 23:6639-46, 2005 7. Partridge AH, Wang PS, Winer EP, et al: Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol 21:602-6, 2003 8. Tammemagi CM, Nerenz D, Neslund-Dudas C, et al: Comorbidity and survival disparities among black and white patients with breast cancer. Jama 294:1765-72, 2005 9. Bhargava A, Du XL: Racial and socioeconomic disparities in adjuvant chemotherapy for older women with lymph node-positive, operable breast cancer. Cancer 115:2999-3008, 2009 10. Schneider EC, Zaslavsky AM, Epstein AM: Racial disparities in the quality of care for enrollees in medicare managed care. Jama 287:1288-94, 2002 11. Shavers VL, Brown ML: Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst 94:334-57, 2002 12. Crew KD, Neugut AI, Wang X, et al: Racial disparities in treatment and survival of male breast cancer. J Clin Oncol 25:1089-98, 2007 13. Menashe I, Anderson WF, Jatoi I, et al: Underlying causes of the black-white racial disparity in breast cancer mortality: a population-based analysis. J Natl Cancer Inst 101:993-1000, 2009 14. Jatoi I, Becher H, Leake CR: Widening disparity in survival between white and African-American patients with breast carcinoma treated in the U. S. Department of Defense Healthcare system. Cancer 98:894-9, 2003 Citation Format: Joseph Sparano. Race, ethnicity, and outcomes in breast cancer. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr IA29.