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Are There Differences in Treatment and Outcomes for African American and White Women With Triple-Negative Breast Cancer?


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In a study using Henry Ford Health System data reported in a research letter in JAMA Surgery, Chen et al found little difference in treatment and outcomes between African American and white women with nonmetastatic triple-negative breast cancer. Screen detection of disease was associated with better survival.

Study Details

The study included data from 106 African American and 87 white women with triple-negative breast cancer diagnosed between January 2011 and December 2015.  The median follow-up was 50.3 months for African American patients and 47.5 months for white patients.

Key Findings

There were no significant differences between African American and white patients in mean age (61.3 vs 61.0 years), tumor size (mean = 2.2 vs 2.7 cm), or nodal status (75.5% vs 78.2%: node-negative). African American patients had higher mean body mass index (P = .001). Family histories were similar for African American and white patients. Overall, 95.8% of African American patients and 88.6% of white patients had some form of nonpublic insurance, including Medicare.

KEY POINTS

  • On univariate analysis, factors significantly associated with improved overall survival were screen-detected disease, non-T1 disease, and node-positive disease; factors associated with significantly worse survival were high-grade disease, lymphovascular invasion, and receipt of adjuvant/neoadjuvant chemotherapy.
  • Race/ethnicity, age, histology, body mass index, insurance status, and parity were not associated with survival.
  • On multivariate analysis, screen detection and high-grade pathology remained significant factors associated with better survival.

Disease consisted of invasive ductal tumors in 84.0% of African American patients vs 77.0% of white patients; lymphovascular invasion was present in 10.4% vs 17.2%; and high-grade pathology was present in 79.2% vs 72.4%. None of these differences were deemed as statistically significant.

Lumpectomy was performed in 55.7% of the African American patients vs 59.8% of the white patients; 57.5% vs 60.9% received postoperative chemotherapy; and 22.6% vs 19.5% received neoadjuvant chemotherapy. African American patients were less likely to have contralateral prophylactic mastectomy (1.9% vs 11.5%, P = .01).

Disease was detected by mammography screening in 58.5% of African American patients vs 44.8% of white patients. Among all patients, compared with non–screen-detected cases, more screen-detected cases were T1 (79.2% vs 37.1%, P < .001) and node-negative (91.1% vs 59.6%, P < .001) and more resulted in lumpectomy (68.3% vs 46.1%); these patterns did not differ between African American and white patients.

Rates of local recurrence and distant relapse did not significantly differ between groups. Detection of disease via screening vs nonscreening detection was associated with significantly improved 4-year overall survival among African American patients (93.2% vs 59.1%, P < .001), with a nonsignificant improvement observed among white patients (87.5% vs 74.8%).

On univariate analysis, factors significantly associated with improved overall survival were screen-detected disease, non-T1 disease, and node-positive disease; factors associated with significantly worse survival were high-grade disease, lymphovascular invasion, and receipt of adjuvant/neoadjuvant chemotherapy. Race/ethnicity, age, histology, body mass index, insurance status, and parity were not associated with survival.

On multivariate analysis, screen detection and high-grade pathology remained significant factors associated with better survival. Hazard ratios for any-cause mortality were 0.21 (P < .001) for screen-detected vs non–screen-detected disease and 3.37 (95% confidence interval = 1.17–9.66) for high-grade vs non–high-grade pathology.

The investigators concluded, “We report equal outcomes among equitably treated African American patients and white American patients with triple-negative breast cancer. Screening mammography successfully detected early-stage triple-negative breast cancer, improving outcomes for both African American and white American patients. Screening mammography is therefore an important strategy for reducing race/ethnicity–associated breast cancer disparities by optimizing overall survival for both population subsets.”

Lisa A. Newman, MD, MPH, of the Department of Surgery, Weill Cornell Medicine, New York, is the corresponding author for the JAMA Surgery article.

Disclosure: The study was supported by the Susan G. Komen Breast Cancer Foundation and Fashion Footwear Association of New York. For full disclosures of the study authors, visit jamanetwork.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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