Recent breast cancer trends among Asian/Pacific Islander, Hispanic, and African-American women in the US: changes by tumor subtype

Prevalence of Breast Cancer Subtypes Among Different Ethnicities and Bangladeshi Women: Demographic, Clinicopathological, and Integrated Cancer Informatics Analysis

Background

The molecular subtyping of breast cancer is related to estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). The present study aimed to systematically analyze the expression, function, and prognostic value of ER, PR, HER2, and their prevalence in different ethnic groups and among Bangladeshi breast cancer (BC) patients.

Method

This study included 25 BC patients and 25 healthy controls, aged between 25 and 70 years. The study characteristics were compared using the ANOVA and Chi-square tests. Also, the multi-Omics dataset of 775 BC patients from TCGA was analyzed for ER, PR, and HER2 in breast cancer subtypes and compared among different ethnicities.

Results

For most BD breast cancer cases, the age at diagnosis was ⩾40 years, had only a histopathological diagnosis (P-value .004), and no history of mammography or other pathological tests. For treatment, had only chemotherapy (P-value .004) and no hormone therapy (P-value <.001). The majority of patients (>60%) were of stage-II cancer and TNBC (40%) subtype. The BC ethnicity-stratified data of ER, PR, and HER2 indicated a strong correlation across all ethnicities (P-value 4.99e-35; P-value 3.79e-18). The subtypes stratified data indicated a higher percentage of Luminal A (58.3%) in Caucasians whereas Luminal B (24.3%) and HER2 (25.2%) subtypes were found higher in Asians and TNBC (36.0%) were found in Africans. However, a significantly higher frequency of TNBC (52.2%) compared to Asians (14.8%) was found in BD patients (P-value <.001). The overall survival analysis of BC subtypes demonstrated that Luminal B (P-value .005) and HER2 enriched (P-value .015) were significantly more aggressive and were dominant in the Asian population.

Conclusion

A significant association was found between BC subtypes with different ethnicities and Bangladeshi women and these findings might aid in the prevention, management, and raising of awareness against risk factors in the near future.

Breast cancer incidence trends in Asian women aged 20 or older as compared to other ethnic women in the United States from 2000 to 2018 by time period, age and tumor stage

BACKGROUND

After new cancer data are released in April 2021, it is important to update the incidence trend in breast cancer from 2000 to 2018 and focus on ethnic disparities in the risk of developing breast cancer.

METHODS

We identified 1129,564 women who were diagnosed with incident breast cancer at age ≥ 20 in 2000-2018 from 18 SEER (Surveillance, Epidemiology, and End Results) registries. We utilized the SEER*Stat software to calculate age-adjusted incidence rates.

RESULTS

Overall age-adjusted incidence rate of breast cancer was the highest in non-Hispanic white (NHW) women (190.4 cases per 100,000 women), followed by NH-black (NHB) (178.4), Asian/Pacific-Islanders (API) (141.3), Hispanic (133.3) and American-Indians/Alaska-Native (AIAN) women (128.8). Annual percentage change (APC) from 2000 to 2018 showed that annual increase was statistically significant for API (APC: 1.0, 95% CI: 0.8-1.3), NHB (APC: 0.5, 0.2-0.7), AIAN (1.6, 1.1-2.2), and Hispanic women (0.4, 0.2-0.7), but annual percentage of incidence did not significantly decrease for NHW (-0.1, -0.4 to -0.1). Incidence rates of hormone-receptor positive breast cancer increased from 2000 to 2018 in all ethnic women, while incidence rates of hormone-receptor negative breast cancer decreased. NHW and NHB women had a significantly higher risk of having breast cancer than API women. In 2012-2018, the risks of having local stage and distant stage breast cancer for NHW (1.31, 1.29-1.33 and 1.19, 1.16-1.21) and NHB (1.09, 1.07-1.11 and 1.31, 1.28-1.35) women were significantly higher than that of API women.

CONCLUSIONS

The incidence of hormone-receptor positive breast cancer increased in all ethnic women from 2000 to 2018 while the incidence of hormone-receptor negative breast cancer decreased. There were still substantial racial disparities in breast cancer incidences.

Incidence of breast cancer subtypes in immigrant and non-immigrant women in Norway

BACKGROUND

Breast cancer incidence differs between non-immigrants and immigrants from low- and middle-income countries. This study investigates whether immigrants also have different subtype-specific incidences.

METHODS

We used national health registries in Norway and calculated subtype-specific incidence rate ratios (IRRs) for invasive breast cancer among women aged 20-75 and 20-49 years between 2005 and 2015. Immigrant groups were classified by country of birth broadly defined based on WHO regional groupings. Subtype was defined using estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 (HER2) status as luminal A-like (ER+ PR+ HER2-), luminal B-like/HER2- (ER+ PR- HER2-), luminal B-like/HER2+ (ER+ PR any HER2+), HER2+ (ER-PR-HER2+) and triple-negative breast cancer (TNBC) (ER-PR-HER2-).

RESULTS

Compared to non-immigrants, incidence of the luminal A-like subtype was lower in immigrants from Sub-Saharan Africa (IRR 0.43 95% CI 0.28-0.66), South East Asia (IRR 0.63 95% CI 0.51-0.79), South Asia (IRR 0.67 95% CI 0.52-0.86) and Eastern Europe (IRR 0.86 95% CI 0.76-0.99). Immigrants from South Asia had higher rates of HER2 + tumors (IRR 2.02 95% CI 1.26-3.23). The rates of TNBC tended to be similar regardless of region of birth, except that women from South East Asia had an IRR of 0.54 (95% CI 0.32-0.91).

CONCLUSIONS

Women from Eastern Europe, Sub-Saharan Africa and Asia had different subtype-specific incidences compared to women from high-income countries (including non-immigrants). These differences in tumor characteristics between immigrant groups should be taken into consideration when planning preventive or screening strategies.

Racial and Ethnic Disparities in Breast Cancer: A Collaboration Between the American College of Radiology Commissions on Women and Diversity and Breast Imaging

Since the 1980s, the mortality rate from breast cancer in the United States has dropped almost 40%. The quality of life and survival gains from early detection and improved treatment have not been shared equally by all ethnic groups, however. Many factors, including social determinants of health, unequal access to screening and oncologic care, and differences in incidence, tumor biology, and risk factors, have contributed to these unequal breast cancer outcomes. As breast radiologists approach their own patients, they must be aware that minority women are disproportionately affected by breast cancer at earlier ages and that non-Hispanic Black and Hispanic women are impacted by greater severity of disease than non-Hispanic White women. Guidelines that do not include women younger than 50 and/or have longer intervals between examinations could have a disproportionately negative impact on minority women. In addition, the COVID-19 pandemic could worsen existing disparities in breast cancer mortality. Increased awareness and targeted efforts to identify and mitigate all of the underlying causes of breast cancer disparities will be necessary to realize the maximum benefit of screening, diagnosis, and treatment and to optimize quality of life and mortality gains for all women. Breast radiologists, as leaders in breast cancer care, have the opportunity to address and reduce some of these disparities for their patients and communities.

Changing trends in liver cancer incidence by race/ethnicity and sex in the US: 1992-2016

PURPOSE

Liver cancer incidence continues to increase while incidence of most other cancers is decreasing. We analyze recent and long-term trends of US liver cancer incidence by race/ethnicity and sex to best understand where to focus preventive efforts.

METHODS

Liver cancer incidence rates from 1992 to 2016 were obtained from the Surveillance, Epidemiology, and End Results registry. Delay-adjusted age-standardized incidence trends by race/ethnicity and sex were analyzed using joinpoint regression. Age-specific incidence was analyzed using age-period-cohort models. Hepatitis C seroprevalence by cohort was calculated using National Health and Nutrition Examination Survey data.

RESULTS

Liver cancer incidence has peaked in males and Asian or Pacific Islanders. Hispanic males, a high-incidence population, are experiencing a decrease in incidence, although not yet statistically significant. In contrast, incidence continues to increase in females, although at lower rates than in the 1990s, and American Indian/Alaska Natives (AI/ANs). Liver cancer incidence continues to be higher in males. Non-Hispanic Whites have the lowest incidence among racial/ethnic groups. Trends largely reflect differences in incidence by birth-cohort, which increased considerably, particularly in males, for those born around the 1950s, and continues to increase in females and AI/ANs. The patterns in males are likely driven by cohort variations in Hepatitis C infection.

CONCLUSIONS

Liver cancer incidence appears to have peaked among males. However, important differences in liver cancer trends by race/ethnicity and sex remain, highlighting the need for monitoring trends across different groups. Preventive interventions should focus on existing liver cancer disparities, targeting AI/ANs, females, and high-incidence groups.

Gene expression profiling in prognosis of distant recurrence in HR-positive and HER2-negative breast cancer patients

There had been several studies using gene-expression profiling in predicting distant recurrence in breast cancer. In this study, we developed an 18-gene classifier (18-GC) to predict distant recurrence of breast cancer and compared it with the 21-gene panel (Oncotype DX^®, ODx) in performance. Included were 224 breast cancer patients with positive hormonal receptor (HR+) and negative human epidermal growth factor receptor 2 (HER2-). We compared the demographic, clinical, and survival information of the patients, and further compared the prediction of recurrence risk obtained by using the 18-GC with that by ODx. To have the best combined sensitivity and specificity, receiver operating characteristics (ROC) curve analysis was performed to determine the cutoff values for several breakpoint scores. For the new 18-GC, a breakpoint score of 21 was adopted to produce a combined highest sensitivity (95%) and specificity (39%) in detecting distant recurrence. At this breakpoint score, 164 of the 224 patients were classified by the 18-GC in the same risk level as by ODx, giving a concordance rate of 73%. Along with patient age and tumor stage, this 18-GC was found to be an independent significant prognostic factor of distant metastasis of breast cancer. We have thus created a new gene panel assay for prediction of distant recurrence in HR+ and HER2- breast cancer patients. With a high concordance rate with ODx, this new assay may serve as a good tool for individual breast cancer patients to make an informed decision on whether adjuvant chemotherapy should be performed post-surgery.

Genetics, tumor features and treatment response of breast cancer in Latinas

Breast cancer is a heterogeneous and genetic disease that has variability according to ethnicity and race with respect to incidence, clinical characteristics and prognosis. The incidence of breast cancer is lower but mortality is higher in Latinas than Caucasians in the US series. Risk factors appear to have different prevalence and impact in Latinas. Breast cancer in Latinas has particular clinic-pathological features including younger age, higher rates of triple-negative subtype and advanced stages. Molecular studies find that Latinas from every region have a specific BRCA incidence and a recurrent mutation, as well as differences in activity of molecular pathways. Treatment response rates and toxicity have also been compared, and no difference was found between Latinas and other ethnic groups.

Black-White Disparities in Breast Cancer Subtype: The Intersection of Socially Patterned Stress and Genetic Expression

Hormone receptor negative (HR-) breast cancer subtypes are etiologically distinct from the more common, less aggressive, and more treatable form of estrogen receptor positive (ER+) breast cancer. Numerous population-based studies have found that, in the United States, Black women are 2 to 3 times more likely to develop HR- breast cancer than White women. Much of the existing research on racial disparities in breast cancer subtype has focused on identifying predisposing genetic factors associated with African ancestry. This approach fails to acknowledge that racial stratification shapes a wide range of environmental and social exposures over the life course. Human stress genomics considers the role of individual stress perceptions on gene expression. Yet, the role of structurally rooted biopsychosocial processes that may be activated by the social patterning of stressors in an historically unequal society, whether perceived by individual black women or not, could also impact cellular physiology and gene expression patterns relevant to HR- breast cancer etiology. Using the weathering hypothesis as our conceptual framework, we develop a structural perspective for examining racial disparities in breast cancer subtypes, integrating important findings from the stress biology, breast cancer epidemiology, and health disparities literatures. After integrating key findings from these largely independent literatures, we develop a theoretically and empirically guided framework for assessing potential multilevel factors relevant to the development of HR- breast cancer disproportionately among Black women in the US. We hypothesize that a dynamic interplay among socially patterned psychosocial stressors, physiological & behavioral responses, and genomic pathways contribute to the increased risk of HR- breast cancer among Black women. This work provides a basis for exploring potential alternative pathways linking the lived experience of race to the risk of HR- breast cancer, and suggests new avenues for research and public health action.

Analysis of Tumor Biology to Advance Cancer Health Disparity Research

Cancer mortality rates in the United States continue to decline. Reductions in tobacco use, uptake of preventive measures, adoption of early detection methods, and better treatments have resulted in improved cancer outcomes for men and women. Despite this progress, some population groups continue to experience an excessive cancer burden when compared with other population groups. One of the most prominent cancer health disparities exists in prostate cancer. Prostate cancer mortality rates are highest among men of African ancestry when compared with other men, both in the United States and globally. This disparity and other cancer health disparities are largely explained by differences in access to health care, diet, lifestyle, cultural barriers, and disparate exposures to carcinogens and pathogens. Dietary and lifestyle factors, pathogens, and ancestry-related factors can modify tumor biology and induce a more aggressive disease. There are numerous examples of how environmental exposures, like tobacco, chronic stress, or dietary factors, induce an adverse tumor biology, leading to a more aggressive disease and decreased patient survival. Because of population differences in the exposure to these risk factors, they can be the cause of cancer disparities. In this review, we will summarize recent advances in our understanding of prostate and breast cancer disparities in the United States and discuss how the analysis of tumor biology can advance health disparity research.

Genomic Disparities in Breast Cancer Among Latinas

BACKGROUND

Breast cancer is the most common cancer diagnosed among Latinas in the United States and the leading cause of cancer-related death among this population. Latinas tend to be diagnosed at a later stage and have worse prognostic features than their non-Hispanic white counterparts. Genetic and genomic factors may contribute to observed breast cancer health disparities in Latinas.

METHODS

We provide a landscape of our current understanding and the existing gaps that need to be filled across the cancer prevention and control continuum.

RESULTS

We summarize available data on mutations in high and moderate penetrance genes for inherited risk of breast cancer and the associated literature on disparities in awareness of and uptake of genetic counseling and testing in Latina populations. We also discuss common genetic polymorphisms and risk of breast cancer in Latinas. In the treatment setting, we examine tumor genomics and pharmacogenomics in Latina patients with breast cancer.

CONCLUSIONS

As the US population continues to diversify, extending genetic and genomic research into this underserved and understudied population is critical. By understanding the risk of breast cancer among ethnically diverse populations, we will be better positioned to make treatment advancements for earlier stages of cancer, identify more effective and ideally less toxic treatment regimens, and increase rates of survival.

Racial and socio-economic disparities in breast cancer hospitalization outcomes by insurance status

BACKGROUND

Breast cancer remains a major cause of morbidity and mortality among women in the US, and despite numerous studies documenting racial disparities in outcomes, the survival difference between Black and White women diagnosed with breast cancer continues to widen. Few studies have assessed whether observed racial disparities in outcomes vary by insurance type e.g. Medicare/Medicaid versus private insurance. Differences in coverage, availability of networked physicians, or cost-sharing policies may influence choice of treatment and treatment outcomes, even after patients have been hospitalized, effects of which may be differential by race.

PURPOSE

The aim of this analysis was to examine hospitalization outcomes among patients with a primary diagnosis of breast cancer and assess whether differences in outcome exist by insurance status after adjusting for age, race/ethnicity and socio-economic status.

METHODS

We obtained data on over 67,000 breast cancer patients with a primary diagnosis of breast cancer for this cross-sectional study from the 2007-2011 Healthcare Cost and Utilization project Nationwide Inpatient Sample (HCUP-NIS), and examined breast cancer surgery type (mastectomy vs. breast conserving surgery or BCS), post-surgical complications and in-hospital mortality. Multivariable regression models were used to compute estimates, odds ratios and 95% confidence intervals.

RESULTS

Black patients were less likely to receive mastectomies compared with White women (OR: 0.80, 95% CI: 0.71-0.90), regardless of whether they had Medicare/Medicaid or Private insurance. Black patients were also more likely to experience post-surgical complications (OR: 1.41, 95% CI: 1.12-1.78) and higher in-hospital mortality (OR: 1.57, 95%: 1.21-2.03) compared with White patients, associations that were strongest among women with Private insurance. Women residing outside of large metropolitan areas were significantly more likely to receive mastectomies (OR: 1.89, 95% CI: 1.54-2.31) and experience higher in-hospital mortality (OR: 1.74, 95% CI: 1.40-2.16) compared with those in metropolitan areas, regardless of insurance type.

CONCLUSION

Among hospitalized patients with breast cancer, racial differences in hospitalization outcomes existed and worse outcomes were observed among Black women with private insurance. Future studies are needed to determine factors associated with poor outcomes in this group of women, as well as to examine contributors to low BCS adoption in non-metropolitan areas.

Characterisation of the triple negative breast cancer phenotype associated with the development of central nervous system metastases

Aims

Breast cancer (BC) is the most frequent tumour in women, representing 20–30% of all malignancies, and continues to be the leading cause of cancer deaths among European women. Triple-negative (TN) BC biological aggressiveness is associated with a higher dissemination rate, with central nervous system (CNS) metastases common. This study aims to elucidate the association between gene expression profiles of PTGS2, HBEGF and ST6GALNAC5 and the development of CNS metastases in TNBC.

Methods

This is a case-controlled retrospective study comparing patients (pts) with CNS metastases versus patients without them after adjuvant treatment. The selection of the samples was performed including 30 samples in both case and control groups. Formalin-fixed, paraffin-embedded samples were retrieved from the Hospital 12 de Octubre Biobank. Five 10 µm sections from each FFPE sample were deparaffinised with xylene and washed with ethanol, and the RNA was then extracted with the RecoverAll Kit (Ambion). Gene expression was assessed using TaqMan assays.

Results

A total of 53 patients were included in the study. The average age was 55 years (range 25–85). About 47 patients (88.67%) had ductal histology and presented high grade (III) tumours (40 patients; 75.47%). Eight women in the case group presented first distant recurrence in the CNS (34.80%), local recurrence (three patients, 13.04%), lungs (two patients; 8.7%), bone (one patient; 4.34%) and other locations (seven patients; 30.38%). In the control group, first distant recurrence occurred locally (six patients; 46.1%), in bone (two patients; 15.4%), lungs (one patient; 7.7%) and other sites (four patients; 23.1%). RNA was successfully obtained from 53 out of 60 samples. PTGS2, HBEGF, and ST6GALNAC5 expression values were not related to metastasis location.

Conclusion

TN tumours frequently metastasise to the visceral organs, particularly lungs and brain, and are less common in bone. The literature suggests that expression of the three genes of interest (PTGS2, HBEGF, and ST6GALNAC5) could be different in TNBC patients with CNS metastasis when compared to patients without it. We did not find a differential expression pattern in PTGS2, HBEGF, and ST6GALNAC5 genes in primary TNBC showing CNS metastases. Further studies are needed to clarify the role of these genes in CNS metastases in TNBC patients.

Histological Features and Tissue Microarray Taxonomy of Nigerian Breast Cancer Reveal Predominance of the High-Grade Triple-Negative Phenotype

INTRODUCTION

Little is known about the biology, molecular profile and hence optimal treatment of African Nigerian breast cancer. The aim of this work, therefore, was to characterize the histology and molecular profile of Nigerian breast cancer.

METHODS

Breast carcinomas from women at 6 centres of similar tribal origin in Nigeria were reviewed and assembled into tissue microarrays (TMAs), and sections were stained for hormone receptors, i.e. estrogen receptor (ER)α, ERβ1, ERβ progesterone receptor (PR) and androgen receptor, cyclin D, HER2, Ki67 and cytokeratins (CKs), i.e. CK5/6 and CK14 (basal) and CK18 and 19 (luminal).

RESULTS

A total of 835 tumours were analysed. The mean age at diagnosis was 48.62 ± 12.41 years. The most common histological subtype was ductal NST (no-special-type) carcinoma (87.3%). Over 90% of the tumours were grade 2 or 3. The predominant molecular phenotype was the non-basal, triple-negative type (47.65%) followed by the HER2-positive group (19.6%). The percentage of ER-, PR- and HER2-positive tumours was 22.4, 18.9 and 18.8%, respectively.

CONCLUSION

Nigerian breast cancer predominantly has a high-grade, triple-negative profile. It occurs at a younger age and bears similarities at the molecular level to pre-menopausal breast cancer in white women, with remarkably lower levels of ERβ expression. The early presentation and histological and molecular phenotype may explain the poor prognosis, and tailoring treatment strategies to target this unique profile are required.

Sleep duration and breast cancer risk among black and white women

BACKGROUND

Sleep has been suggested to influence breast cancer risk; however, the evidence is mixed. Black women have a higher prevalence of both short (<6 h) and long (≥9 h) sleep duration and are more likely to develop more aggressive, hormone receptor-negative breast cancer. No study has examined the relationship between sleep and breast cancer in blacks. We focused on race-specific associations among the blacks.

METHODS

In the Southern Community Cohort Study (SCCS), a prospective study of which two-thirds of the population were black, we prospectively investigated self-reported sleep duration in relation to overall breast cancer risk by estrogen (ER) and progesterone receptor (PR) status in all women and in black women alone.

RESULTS

Sleep duration was not associated with risk of total or hormone receptor-positive breast cancer. However, we found an inverse relationship between sleep duration and risk of ER- and PR- breast cancer among all women and in black women alone. Compared to the reference group (8 h), black women who reported shorter sleep duration had an increased risk of ER- PR- breast cancer (odds ratios; ORs (95% confidence intervals; CIs): 2.13 (1.15, 3.93), 1.66 (0.92, 3.02), and 2.22 (1.19, 4.12) for <6, 6, and 7 h, respectively, (p for trend, 0.04).

CONCLUSIONS

Short sleep duration may be a risk factor for hormone receptor-negative breast cancer among black women.

Survival Improvement in Korean Breast Cancer Patients Due to Increases in Early-Stage Cancers and Hormone Receptor Positive/HER2 Negative Subtypes: A Nationwide Registry-Based Study

Purpose

The aim of this study was to investigate whether the observed changes over time in the survival rates vary according to the intrinsic subtypes of breast cancer diagnosed.

Methods

Data from 46,320 breast cancer patients in the Korean Breast Cancer Registry who underwent surgery between 1999 and 2006 were reviewed. Among them, results from 25,887 patients with available data about the status of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) were analyzed. Patients were classified into two cohorts according to the year in which they underwent surgery: 1999-2002 and 2003-2006.

Results

The patients treated in the latter time period showed significantly better overall survival (OS) compared with those in the former period when adjusted for follow-up duration. The proportion of hormone receptor+/HER2-subtype and stage I breast cancer were significantly higher in the latter period (47.4% vs. 54.6%, p<0.001; 31.0% vs. 39.6%, p<0.001, respectively). Improvement in OS between the former and latter periods was seen in all subtypes of breast cancer, including triple-negative cancers (all p-values <0.001 in univariate and multivariate analyses).

Conclusion

Improvement in survival in Korean breast cancer patients over the study years is being observed in all subtypes of breast cancer, implying that increases in both early-stage detection and the proportion of less aggressive cancers contribute to this improvement.

Molecular portrait of breast cancer in China reveals comprehensive transcriptomic likeness to Caucasian breast cancer and low prevalence of luminal A subtype

The recent dramatic increase in breast cancer incidence across China with progressive urbanization and economic development has signaled the urgent need for molecular and clinical detailing of breast cancer in the Chinese population. Our analyses of a unique transethnic collection of breast cancer frozen specimens from Shanghai Fudan Cancer Center (Chinese Han) profiled simultaneously with an analogous Caucasian Italian series revealed consistent transcriptomic data lacking in batch effects. The prevalence of Luminal A subtype was significantly lower in Chinese series, impacting the overall prevalence of estrogen receptor (ER)-positive disease in a large cohort of Chinese/Caucasian patients. Unsupervised and supervised comparison of gene and microRNA (miRNA) profiles of Chinese and Caucasian samples revealed extensive similarity in the comprehensive taxonomy of transcriptional elements regulating breast cancer biology. Partition of gene expression data using gene lists relevant to breast cancer as "intrinsic" and "extracellular matrix" genes identified Chinese and Caucasian subgroups with equivalent global gene and miRNA profiles. These findings indicate that in the Chinese and Caucasian groups, breast neoplasia and the surrounding stromal characteristics undergo the same differentiation and molecular processes. Transcriptional similarity across transethnic cohorts may simplify translational medicine approaches and clinical management of breast cancer patients worldwide.

Application of joinpoint regression in determining breast cancer incidence rate change points by age and tumor characteristics in women aged 30-69 (years) and in Isfahan city from 2001 to 2010

BACKGROUND AND OBJECTIVES

Breast cancer is a major threat to women's health. Evaluation of the changes in trend of the incidence rate provides valuable information for the assessment and planning of development indicators of each country. The aim of the present study was to apply the JoinPoint regression model for determining changes in the trend of the breast cancer incidence rate in Isfahan.

MATERIALS AND METHODS

In this cross-sectional study, 3640 women with breast cancer referring to oncology and radiotherapy departments of Seyed-al-Shohada and Milad cancer treatment centers of Isfahan during 2001-2010 were studied and sampling was not done. Joinpoint regression model was used to investigate the pattern of breast cancer incidence rate. Response and independent variables were the natural logarithm of the age-standardized incidence rates and year of diagnosis of breast cancer, respectively, in which various levels of cancer tumor characteristics (P < 0.05) were analyzed.

RESULTS

The incidence rates increased annually in the age groups of 40-44 years (6.2%), 45-49 years (5.3%), and 55-59 years (5.3%). The trend of incidence rates in women with tumor size ≤2 cm (18.2%), well (moderately) differentiated tumor grade [8% (10.2%)], positive estrogen (progesterone) hormone receptor status [10.5% (6.9%)], and the proportion of positive lymph node to surgery node ≤25% (nonsignificant) was upward.

CONCLUSION

The trend of incidence rates with tumor size ≤2 cm, well-differentiated tumor grade, moderately differentiated tumor grade, and positive estrogen and progesterone hormone receptors was upward. The pattern of breast cancer can help in cancer prevention and prognosis, and in selecting the best type of surgery.

Factors which affect use of breast conservation and mastectomy in an underinsured Hispanic population

BACKGROUND

Despite no difference in overall survival between breast conservation and mastectomy, significant variation exists between institutions and within populations. Less data exists about racial and ethnic minority populations. The current study was performed to evaluate variables that affect use of breast conservation and mastectomy in an underinsured Hispanic population.

METHODS

A retrospective review was performed of all patients who self-identified as of Hispanic ethnicity and underwent breast cancer operations from July 2001 to February 2011 at a safety net hospital. Sociodemographic, clinical, and treatment variables were evaluated. All patients with documented contraindications to breast conservation were excluded. Univariate analysis and multivariate analysis were performed to identify variables which were associated with type of operation.

RESULTS

The average age of the 219 patients included was 50 years. Most of the patients (93%) were insured with Medicaid or uninsured and 59% presented with clinical stage 2A/B cancers. Mastectomy was performed in 33% of patients and 67% had breast conservation. In adjusted multivariate analysis higher pathologic stage (p=0.01) and English speakers (p=0.03) were associated with mastectomy. By contrast, higher BMI (p=0.03) and use of preoperative chemotherapy (p=0.01) were associated with breast conservation.

CONCLUSIONS

In this underinsured Hispanic population, patients with higher pathologic stage and English speaking patients were more likely to undergo mastectomy. Patients who underwent preoperative chemotherapy and who had higher BMI were more likely to undergo breast conservation.

The burden of rare cancer in Japan: application of the RARECARE definition

BACKGROUND

Despite the fact that rare cancer is a new target of cancer control in Japan, the incidence of rare cancers is unknown and there is no generally accepted definition of rare cancers in this country. With the aim of calculating incidences of rare cancers in Japan, we therefore adopted a definition and classification of rare cancers that had been published in the European Union (EU) in 2011.

METHODS

Using incidence data between 1998 and 2007 submitted by 12 of population based cancer registries in Japan that met our quality criteria and drawing on the EU definition (incidence <6 per 100,000 per year), we estimated the incidences of 845 combinations of tumor sites and histological groups and thus identified the cancers that are rare in Japan.

RESULTS

After identifying 193 combinations of tumor sites and histological groups that fit our criteria for rare cancers, we estimated their incidence to be about 75 per 100,000, which corresponds to about 94,800 new diagnoses in 2012 or approximately 15% of all cancer diagnoses. The categorization of rare and common cancers was almost the same in Japan as in EU.

CONCLUSIONS

The present study provides an indication of the size of the rare cancer burden in Japan and epidemiological information to explore this. We are expecting further discussion based on our results with stakeholders in order to construct a Japanese definition of rare cancers.

Trends in breast cancer incidence rates by age and tumor characteristics of women in the city of Isfahan for the period 2001-2010: An application of joinpoint analysis

BACKGROUND

Cancer incidence trends use by health officials in order to program evaluations and development of cancer control strategies. The trends of cancer incidence have used to evaluate programs and develop the cancer control strategies. The aim of this study is to analyze changes of breast cancer incidence trends in Isfahan city using joinpoint regression models.

MATERIALS AND METHODS

The study was based on all cases of breast cancer reported among women residing in the city of Isfahan for the period 2001-2010. Age-standardized rates were calculated for each tumor characteristics, using the direct method. Joinpoint regression was used to provide estimated annual percentage change.

RESULTS

A plot of the age-specific rates of breast cancer showed an increase in all age groups from 30 to 69 years and sharp increase in the incidence of breast cancer confined to estrogen receptor-positive and progesterone receptor-positive tumors and the significant change (2003) by progesterone receptor(-) tumors. The analysis by tumor size and grade, incidence rates decreased for tumors >5 cm by 10.6% since 2006.7 and for poorly differentiated tumor by 26.1% since 2007.8. No decrease in incidence was observed for group of proportion of positive lymph nodes to lymph node surgery ≥25%. The proportion of positive lymph node to surgery node ≤25% (nonsignificant) was upward.

CONCLUSION

The trend of incidence rates with tumor size ≤2, well-differentiated tumor grade, moderately differentiated tumor grade, positive estrogen and progesterone hormone receptors was upward. The pattern of breast cancer can help to cancer prevention and prognosis, selecting the best type of surgery.

Quality of cancer follow-up care: a focus on Latina breast cancer survivors

INTRODUCTION

Receiving quality cancer follow-up care influences survivorship outcomes. Among Latinas, breast cancer is the number one cause of cancer death; yet Latinas do not receive adequate follow-up care. This study examined quality of cancer follow-up care among Latina breast cancer survivors (BCS) and whether it differs by participant language and healthcare system variables (provider specialty, and medical setting).

METHODS

Two hundred thirty-two (95 English-speaking Latina and 137 Spanish-speaking) Latina BCS were recruited from the California Cancer Registry, hospital cancer registries, and community agencies.

RESULTS

English-speaking Latina BCS were more likely to report receiving cancer follow-up care at a doctor's office (p < 0.001). BCS without a regular place for cancer follow-up care were more likely to report not seeing a primary care provider (p < 0.05) or cancer specialist (p < 0.001) in the past 12 months. English-speaking Latina BCS (p < 0.001), BCS who saw a cancer specialist in the past 12 months (p < 0.001), and received follow-up care at a doctor's office (p < 0.05) reported higher quality of care. Speaking English, having seen a cancer specialist, and receiving follow-up care at a doctor's office were independently associated with higher quality of care, explaining 44 % of the variance.

CONCLUSIONS

Our study findings suggest that examining the influence of ethnic and linguistic factors on quality of cancer follow-up care is necessary to address health disparities. Improved access to cancer follow-up care for Spanish-speaking Latina BCS is of particular concern.

IMPLICATION OF CANCER SURVIVORS

Identifying follow-up care needs of Latina BCS may contribute to providing high-quality care and improved survivorship outcomes.

The risk of developing invasive breast cancer in Hispanic women : a look across Hispanic subgroups

BACKGROUND

Current evidence on breast cancer among US Hispanic women indicates a significant public health threat, although few studies have assessed the heterogeneity in breast cancer risk among Hispanics of different origin.

METHODS

The 2000 and 2005 National Health Interview Survey Cancer Control Modules were used to examine the Breast Cancer Risk Assessment Tool (BCRAT) 5-year risk and lifetime risk of invasive breast cancer among Mexican/Mexican American, Puerto Rican, Cuban/Cuban American, Dominican (Republic), Central/South American, Other Hispanic, and non-Hispanic white (NHW) women ages 35 to 84 years. Multiple linear regression models were used to compare the BCRAT 5-year and lifetime breast cancer risk between 1) Hispanics and NHWs and 2) Hispanic subgroups.

RESULTS

Hispanic women had significantly lower mean BCRAT 5-year and lifetime breast cancer risk compared with NHW women (P < .001). Among Hispanic subgroups, Cuban/Cuban Americans had a higher BCRAT 5-year risk (P < .05), whereas Dominicans had a higher lifetime risk (P < .001) compared with Mexican/Mexican Americans. Approximately 2.6% of Hispanic women were at high risk for breast cancer (BCRAT 5-year risk ≥1.67%), ranging from 1% of Central/South Americans to 3.7% of Puerto Ricans; few Hispanics (0.2%) had a lifetime risk ≥20%.

CONCLUSIONS

The current findings indicate that Hispanic women have a significantly lower risk of breast cancer compared with NHW women, although the risk according to BCRAT differed significantly between specific Hispanic subgroups. We provide estimates of the number of US Hispanic women from six subgroups who may be eligible for prophylactic breast cancer chemoprevention. The authors concluded that future studies should further investigate the heterogeneity in breast cancer risk and risk factors between Hispanic women of different origins.

Individual and neighborhood socioeconomic status and healthcare resources in relation to black-white breast cancer survival disparities

Background. Breast cancer survival has improved significantly in the US in the past 10–15 years. However, disparities exist in breast cancer survival between black and white women. Purpose. To investigate the effect of county healthcare resources and SES as well as individual SES status on breast cancer survival disparities between black and white women. Methods. Data from 1,796 breast cancer cases were obtained from the Surveillance Epidemiology and End Results and the National Longitudinal Mortality Study dataset. Cox Proportional Hazards models were constructed accounting for clustering within counties. Three sequential Cox models were fit for each outcome including demographic variables; demographic and clinical variables; and finally demographic, clinical, and county-level variables. Results. In unadjusted analysis, black women had a 53% higher likelihood of dying of breast cancer and 32% higher likelihood of dying of any cause (P < 0.05) compared with white women. Adjusting for demographic variables explained away the effect of race on breast cancer survival (HR, 1.40; 95% CI, 0.99–1.97), but not on all-cause mortality. The racial difference in all-cause survival disappeared only after adjusting for county-level variables (HR, 1.27; CI, 0.95–1.71). Conclusions. Improving equitable access to healthcare for all women in the US may help eliminate survival disparities between racial and socioeconomic groups.

Racial/ethnic differences in sex hormone levels among postmenopausal women in the diabetes prevention program

CONTEXT

Sex hormones may differ by race/ethnicity in postmenopausal women. Whether racial/ethnic differences also exist among those who are overweight and glucose intolerant is not clear.

OBJECTIVES

The objective of the study was to compare sex hormones by race/ethnicity [non-Hispanic white (NHW), Hispanic, African-American (AA)] in overweight, glucose-intolerant, postmenopausal women.

DESIGN

This was a secondary analysis of a randomized controlled trial.

PARTICIPANTS

Participants included postmenopausal glucose-intolerant women participating in the Diabetes Prevention Program.

INTERVENTIONS

Interventions included intensive lifestyle modification (consisting of diet and physical activity) or metformin 850 mg twice a day vs. placebo.

MAIN OUTCOME MEASURES

Baseline levels and 1-yr intervention-related changes in SHBG, total and bioavailable estradiol (E2), total and bioavailable testosterone, and dehydroepiandrosterone were measured.

RESULTS

At baseline, among women not using estrogen (n = 370), NHW had higher total and bioavailable E2 and testosterone levels than Hispanics independent of age, type of menopause, waist circumference, alcohol intake, and current smoking. NHW also had higher levels of bioavailable E2 and lower levels of SHBG than AA. At baseline, among estrogen users (n = 310), NHW had higher total and bioavailable E2 than Hispanics and higher levels of SHBG than AA after adjustment. At 1 yr, among women not using estrogen, NHW had larger declines in total E2 and bioavailable E2 levels than AA after adjustment for the above covariates, changes in waist circumference, and randomization arm. At 1 yr, among estrogen users, sex hormone changes did not differ by race/ethnicity.

CONCLUSIONS

Among postmenopausal women, there were significant race/ethnicity differences in baseline sex hormones and changes in sex hormones.

Disease burden and treatment outcomes in second-line therapy of patients with estrogen receptor-positive (ER+) advanced breast cancer: a review of the literature

OBJECTIVE

To determine the variable burden of disease of patients with advanced estrogen receptor-positive (ER+) breast cancer and assess the current treatment landscape after failure of first-line endocrine therapy.

METHODS

A comprehensive literature review was performed (2000-2011) by searching Medline via PubMed, and Embase and Cochrane databases, to assess disease burden (i.e. societal, humanistic, and/or economic burden) and treatment landscape for second-line therapy of ER+ advanced breast cancer in postmenopausal women.

RESULTS

Only 1 study was identified that evaluated burden of disease based on ER status (ER+, ER-negative, or ER-unknown); this study was a subgroup analysis assessing the impact of breast cancer recurrence over 10 years. The investigators reported that only minor differences in survival and medical costs were noted based on ER status in relapsing patients. Regardless of ER status, patients with breast cancer recurrence consumed more healthcare resources and were associated with more costly care than those without recurrence. A total of 7 studies were identified related to treatment outcomes of second-line therapy in ER+ patients. A combined international population totaled >3800 patients who had progressed on prior hormonal therapy, including tamoxifen and aromatase inhibitors. Three trials performed a comparative efficacy/safety assessment of an ER antagonist vs. aromatase inhibitor, 1 trial compared an aromatase inhibitor to megestrol acetate, and 1 trial compared 2 aromatase inhibitors. Among each of the studies evaluated, no significant differences were observed in the primary efficacy endpoint, and the safety profiles were similar. Two additional studies demonstrated a similar or better efficacy and safety profile based on different dosing evaluations.

CONCLUSIONS

Currently, there is insufficient evidence on the economic and humanistic burden associated with ER status, and this gap warrants further research. With increasing drug resistance and greater economic burden associated with breast cancer recurrence, there is an unmet medical need for improved treatment in this patient population.

Comparative analysis of clinicopathologic features, treatment, and survival of Asian women with a breast cancer diagnosis residing in the United States

BACKGROUND

It has been established that disparities by ethnicity in the rates of breast cancer diagnoses and disease-specific survival (DSS) exist in the United States. However, few studies have assessed differences specifically between Asians and other ethnic groups or among Asian subgroups.

METHODS

The authors used the Surveillance, Epidemiology, and End Results database to identify patients who were diagnosed with invasive breast cancer between 1988 and 2008. Clinicopathologic features, treatment, and DSS rates were compared among broad ethnic groups and among Asian subgroups.

RESULTS

In total, there were 658,691 patients in the study, including 511,701 non-Hispanic white (NHW) women (77.7%), 57,890 black women (8.8%), 45,461 Hispanic white (HW) women (6.9%), and 43,639 Asian women (6.6%). The Asian cohort was divided into the following subgroups: Filipino, Chinese, Japanese, Indian/Pakistani, Korean, Vietnamese, Hawaiian/Pacific Islander, and other. Patients in all the Asian subgroups, except Japanese, were younger at diagnosis than NHW patients. After adjustment for disease stage, Japanese patients diagnosed with stage I through III disease had better DSS rates than patients in the NHW group or in the other Asian subgroups. Hawaiian/Pacific Islander patients with stage III or IV disease had worse DSS rates than NHW patients and patients in the other Asian subgroups. All other Asian subgroups had DSS rates similar to the DSS rate in the NHW group. [Formula: see text]

CONCLUSIONS

The current results indicated that disparities exist for Asian women with breast cancer who reside in the United States compared with NHW groups and among Asian subgroups. Differences in presenting clinicopathologic features may affect DSS rates, suggesting that further investigation of these disparities is warranted to increase early detection and treatment for specific subgroups.

Cancer screening behaviors among Latina women: the role of the Latino male

The purpose of this article is to determine, through a community-based breast and cervical cancer intervention program, the impact Latino males may have on Latinas and their cancer screening behaviors. This report includes data collected from 163 Latino males recruited throughout rural Arkansas and four New York City boroughs for the Esperanza y Vida program, designed to evaluate cancer screening outcomes among Latinas and address their health care needs and cancer control challenges. Basic demographics and identical pre- and post-program knowledge surveys were collected and analyzed using SPSS 15.0 and SAS 9.2. Results from this study suggest Latino men have little knowledge about breast or cervical cancer screening and are unfamiliar with their partners' screening histories. Male participants were also less likely to complete program assessment forms (pre, post, demographic questionnaires) and more likely to commit response errors (i.e. multiple answers, illegible responses). These findings suggest that including males in education programs for Latinas may be a crucial component in decreasing cancers among this segment of the population. The further development of programs such as Esperanza y Vida, that empowers Latino males, will be important in reducing the unequal burden of breast and cervical cancers for Latinas. It is important to continue including Latino men in these types of studies because the impact of their role on Latina's health remains understudied, unknown, and misunderstood.

Breast feeding, parity and breast cancer subtypes in a Spanish cohort

BACKGROUND

Differences in the incidence and outcome of breast cancer among Hispanic women compared with white women are well documented and are likely explained by ethnic differences in genetic composition, lifestyle, or environmental exposures. METHODOLGY/PRINCIPAL FINDINGS: A population-based study was conducted in Galicia, Spain. A total of 510 women diagnosed with operable invasive breast cancer between 1997 and 2010 participated in the study. Data on demographics, breast cancer risk factors, and clinico-pathological characteristics were collected. The different breast cancer tumor subtypes were compared on their clinico-pathological characteristics and risk factor profiles, particularly reproductive variables and breastfeeding. Among the 501 breast cancer patients (with known ER and PR receptors), 85% were ER+/PR+ and 15% were ER-&PR-. Among the 405 breast cancer with known ER, PR and HER2 status, 71% were ER+/PR+/HER2- (luminal A), 14% were ER+/PR+/HER2+ (luminal B), 10% were ER-/PR-/HER2- (triple negative breast cancer, TNBC), and 5% were ER-/PR-/HER2+ (non-luminal). A lifetime breastfeeding period equal to or longer than 7 months was less frequent in case patients with TNBC (OR = 0.25, 95% CI = 0.08-0.68) compared to luminal A breast cancers. Both a low (2 or fewer pregnancies) and a high (3-4 pregnancies) number of pregnancies combined with a long breastfeeding period were associated with reduced odds of TNBC compared with luminal A breast cancer, although the association seemed to be slightly more pronounced among women with a low number of pregnancies (OR = 0.09, 95% CI = 0.005-0.54).

CONCLUSIONS/SIGNIFICANCE

In case-case analyses with the luminal A cases as the reference group, we observed a lower proportion of TNBC among women who breastfed 7 or more months. The combination of longer breastfeeding duration and lower parity seemed to further reduce the odds of having a TNBC compared to a luminal A breast cancer.

Breast cancer characteristics and outcomes among Hispanic Black and Hispanic White women

Evaluating breast cancer outcomes specific to Hispanics of different race (e.g. Hispanic Black, Hispanic White) may further explain variations in the burden of breast cancer among Hispanic women. Using data from the SEER 17 population-based registries, we evaluated the association between race/ethnicity and tumor stage, hormone receptor status, and breast cancer-specific mortality. The study cohort of 441,742 women, aged 20-79, who were diagnosed with primary invasive breast cancer between January 1, 1992 and December 31, 2008, included 44,246 Hispanic whites, 622 Hispanic Blacks, 44,797 non-Hispanic Blacks and 352,077 non-Hispanic whites. Hispanic black, Hispanic white and non-Hispanic black women had a 1.5-2.5 fold greater risk of presenting with stage IV breast cancer compared to non-Hispanic whites. All groups were significantly more likely than non-Hispanic whites to be diagnosed with ER+/PR- (1.1-1.5 fold increase) or ER-/PR- (1.4-2.2 fold increase) breast cancer. Hispanic black, Hispanic white and non-Hispanic black women had a 10-50 % greater risk of breast cancer-specific mortality compared to non-Hispanic whites. Our findings underscore the breast cancer disparities that continue to exist for Hispanic and black women, overall, as well as between Hispanic women of different race. These disparities highlight the factors that may lead to the poor outcomes observed among Hispanic and black women diagnosed with breast cancer, and for which targeted strategies aimed at reducing breast cancer disparities could be developed.

Age-specific incidence of breast cancer subtypes: understanding the black-white crossover

BACKGROUND

Breast cancer incidence is higher among black women than white women before age 40 years, but higher among white women than black women after age 40 years (black-white crossover). We used newly available population-based data to examine whether the age-specific incidences of breast cancer subtypes vary by race and ethnicity.

METHODS

We classified 91908 invasive breast cancers diagnosed in California between January 1, 2006, and December 31, 2009, by subtype based on tumor expression of estrogen receptor (ER) and progesterone receptor (PR)-together referred to as hormone receptor (HR)-and human epidermal growth factor receptor 2 (HER2). Breast cancer subtypes were classified as ER or PR positive and HER2 negative (HR(+)/HER2(-)), ER or PR positive and HER2 positive (HR(+)/HER2(+)), ER and PR negative and HER2 positive (HR(-)/HER2(+)), and ER, PR, and HER2 negative (triple-negative). We calculated and compared age-specific incidence rates, incidence rate ratios, and 95% confidence intervals by subtype and race (black, white, Hispanic, and Asian). All P values are two-sided.

RESULTS

We did not observe an age-related black-white crossover in incidence for any molecular subtype of breast cancer. Compared with white women, black women had statistically significantly higher rates of triple-negative breast cancer at all ages but statistically significantly lower rates of HR(+)/HER2(-) breast cancers after age 35 years (all P < .05). The age-specific incidence of HR(+)/HER2(+) and HR(-)/HER2(+) subtypes did not vary markedly between white and black women.

CONCLUSIONS

The black-white crossover in breast cancer incidence occurs only when all breast cancer subtypes are combined and relates largely to higher rates of triple-negative breast cancers and lower rates of HR(+)/HER2(-) breast cancers in black vs white women.

The pathologic characteristics of breast cancer in China and its shift during 1999-2008: a national-wide multicenter cross-sectional image over 10 years

In China, breast cancer is currently the most common malignancy and the sixth leading cause of cancer death in women. But, the characteristics of breast cancer in the whole population are not determined. The aim of this study was to perform a detailed study on pathologic characteristics of breast cancer representing the whole population in China during 1999-2008 and to compare the difference in invasive breast cancer between the Western and Chinese. We randomly collected 4,211 inpatient at seven hospitals in representative geographical regions of China during 1999-2008. All the hospitals had the ability of comprehensive cancer treatment. The pathologic characters including estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status were surveyed. The shift of pathologic characters was evaluated and the data from China were also compared with those of the Western, both using Chi-square test. We found as follow. (i) The median age of the patients was 48 years and showed the similar characters of Asia. (ii) Breast cancer in China showed more invasive ductal carcinoma with larger tumor size, later stage, lower ER and PR expression and higher HER2 overexpression than those in the Western (p < 0.001). (iii) Both tumor size and stage at diagnosis decreased year by year (p < 0.001). Breast cancer in China showed more aggressive behavior than those in western countries, although tumor size and stage at diagnosis decreased by year during 1999-2008. We addressed the urgent needs for employ race-specific breast cancer screen, diagnosis methods, and therapeutic models in China.

Phyllodes tumors: race-related differences

BACKGROUND

Phyllodes tumors (PT) are rare breast malignancies accounting for 0.5% to 1% of all breast tumors. PT have unpredictable behavior, with recurrence rates as high as 40%. A dearth of information exists about racial differences; elucidation of these differences is the objective of this study.

STUDY DESIGN

A retrospective review of patients treated for PT at either Moffitt Cancer Center or University of Texas Health Science Center San Antonio from 1999 to 2010.

RESULTS

Of the 124 patients, 71 (57%) were treated at Moffitt Cancer Center and 53 (42%) at University of Texas Health Science Center San Antonio. Mean age at diagnosis was 44 years (15 to 70 years). Thirty-three patients required mastectomy. Combining both cohorts, 42% of the patients were Caucasian, 43% were Hispanic, and 12% were black. Tumors were benign in 49% patients, borderline in 35%, and malignant in 16%, with a higher percentage of borderline and malignant tumors in Hispanic patients (p < 0.01). Hispanic patients tended to have larger tumors and higher mitotic rates (p = 0.01; p = 0.03). At a median follow-up time of 13 months, the local recurrence rate (6.4%) was associated with tumor size, tumor grade, mitotic rate, and close margin status (<2 mm) (p <0.01; p = 0.01; p = 0.01; p = 0.04). However, these findings did not translate into a survival difference by race.

CONCLUSIONS

In this multi-institutional review of PT we found substantial pathologic differences by race with higher-grade tumors present more often in Hispanic patients. These differences did not substantially affect outcomes at short-term follow-up. Further investigation into additional molecular, biologic factors, geographic impact, and socioeconomic factors is needed to more clearly delineate this finding.

Ethnic disparities in breast tumor phenotypic subtypes in Hispanic and non-Hispanic white women

AIMS

Hispanic women are at a lower risk of getting breast cancer than non-Hispanic white (NHW) women, yet they experience a higher risk of mortality after diagnosis. There is some evidence to suggest differences in tumor pathology; however, very limited research has been published on Hispanic women. This represents one of the first studies to evaluate the prevalence of tumor markers and phenotypic subtypes that are associated with poorer prognosis (human epidermal growth factor receptor 2 [HER2], triple negative and basal-like tumors) among Hispanic women.

METHODS

We reviewed pathology reports, obtained paraffin blocks of breast cancer tissue, and established tissue microarrays from NHW (n=119) and Hispanic women (n=69) who were Colorado participants in the 4-Corners Breast Cancer Study. We evaluated ethnic differences in the prevalence of tumor markers and phenotypic subtypes and assessed the contribution of risk factors in explaining the observed differences.

RESULTS

Consistent with other studies, Hispanic women had a higher prevalence of estrogen receptor-negative tumors compared with NHWs (36.2% vs. 22.7%, p=0.05). Hispanics also had an unexpectedly higher proportion of HER2-positive tumors compared with NHWs (31.9% vs. 14.3%, p<0.01). Independent of other prognostic factors, Hispanics were 2.8 times more likely to have a HER2-positive tumor (95% confidence interval [CI] 0.98-7.86). Hispanics were less likely to have the more favorable luminal A subtype, but no significant differences were observed for the less favorable basal-like or triple negative subtypes. However, there were suggestive differences when considering menopausal status.

CONCLUSIONS

These findings provide evidence that breast cancers among Hispanic women comprise a distinct spectrum of tumor subtypes when compared with NHW women.

Activation of Src and transformation by an RPTPα splice mutant found in human tumours

Receptor protein tyrosine phosphatase α (RPTPα)-mediated Src activation is required for survival of tested human colon and oestrogen receptor-negative breast cancer cell lines. To explore whether mutated RPTPα participates in human carcinogenesis, we sequenced RPTPα cDNAs from five types of human tumours and found splice mutants in ∼30% of colon, breast, and liver tumours. RPTPα245, a mutant expressed in all three tumour types, was studied further. Although it lacks any catalytic domain, RPTPα245 expression in the tumours correlated with Src tyrosine dephosphorylation, and its expression in rodent fibroblasts activated Src by a novel mechanism. This involved RPTPα245 binding to endogenous RPTPα (eRPTPα), which decreased eRPTPα-Grb2 binding and increased eRPTPα dephosphorylation of Src without increasing non-specific eRPTPα activity. RPTPα245-eRPTPα binding was blocked by Pro210 → Leu/Pro211 → Leu mutation, consistent with the involvement of the structural 'wedge' that contributes to eRPTPα homodimerization. RPTPα245-induced fibroblast transformation was blocked by either Src or eRPTPα RNAi, indicating that this required the dephosphorylation of Src by eRPTPα. The transformed cells were tumourigenic in nude mice, suggesting that RPTPα245-induced activation of Src in the human tumours may have contributed to carcinogenesis.

A review of body size and breast cancer risk in Hispanic and African American women

Obesity is an epidemic in the United States, especially among Hispanics and African Americans. Studies of obesity and breast cancer risk have been conducted primarily in non-Hispanic whites. There have been few studies of the association between body mass index (BMI) or weight gain and the risk of breast cancer in minorities, and the results have been inconsistent. Because most studies are conducted primarily in non-Hispanic whites, the etiology of breast cancer in minorities is not well understood. The authors of the current report reviewed the literature on the association between obesity, weight, and weight gain and breast cancer in minorities using a combination of the Medical Subject Heading (MeSH) terms "obesity," "body mass index," "weight," "weight gain," "Hispanic," and "African American." Only publications in English and with both risk estimates and 95% confidence intervals were considered. Forty-five studies of body size and breast cancer risk in non-Hispanic whites were identified. After an exhaustive search of the literature, only 3 studies of body size and breast cancer were conducted in Hispanic women were identified, and only 8 such studies in African American women were identified. The results were inconsistent in both race/ethnicity groups, with studies reporting positive, inverse, and null results. Thus, as obesity rates among Hispanics and African Americans continue to rise, there is an urgent need to identify the roles that both obesity and adult weight gain play in the development of breast cancer in these minorities. Additional studies are needed to provide more understanding of the etiology of this disease and to explain some of the disparities in incidence and mortality.

Interactions among genes, tumor biology and the environment in cancer health disparities: examining the evidence on a national and global scale

Cancer incidence and mortality rates show great variations across nations and between population groups. These variations are largely explained by differences in age distribution, diet and lifestyle, access to health care, cultural barriers and exposure to carcinogens and pathogens. Cancers caused by infections are significantly more common in developing than developed countries, and they overproportionally affect immigrant populations in the USA and other countries. The global pattern of cancer is not stagnant. Instead, it is dynamic because of fluctuations in the age distribution of populations, improvements in cancer prevention and early detection in affluent countries and rapid changes in diet and lifestyle in parts of the world. For example, increased smoking rates have caused tobacco-induced cancers to rise in various Asian countries, whereas reduced smoking rates have caused these cancers to plateau or even begin to decline in Western Europe and North America. Some population groups experience a disproportionally high cancer burden. In the USA and the Caribbean, cancer incidence and mortality rates are excessively high in populations of African ancestry when compared with other population groups. The causes of this disparity are multifaceted and may include tumor biological and genetic factors and their interaction with the environment. In this review, we will discuss the magnitude and causes of global cancer health disparities and will, with a focus on African-Americans and selected cancer sites, evaluate the evidence that genetic and tumor biological factors contribute to existing cancer incidence and outcome differences among population groups in the USA.

Power of tests for comparing trend curves with application to national immunization survey (NIS)

To develop statistical tests for comparing trend curves of study outcomes between two socio-demographic strata across consecutive time points, and compare statistical power of the proposed tests under different trend curves data, three statistical tests were proposed. For large sample size with independent normal assumption among strata and across consecutive time points, the Z and Chi-square test statistics were developed, which are functions of outcome estimates and the standard errors at each of the study time points for the two strata. For small sample size with independent normal assumption, the F-test statistic was generated, which is a function of sample size of the two strata and estimated parameters across study period. If two trend curves are approximately parallel, the power of Z-test is consistently higher than that of both Chi-square and F-test. If two trend curves cross at low interaction, the power of Z-test is higher than or equal to the power of both Chi-square and F-test; however, at high interaction, the powers of Chi-square and F-test are higher than that of Z-test. The measurement of interaction of two trend curves was defined. These tests were applied to the comparison of trend curves of vaccination coverage estimates of standard vaccine series with National Immunization Survey (NIS) 2000-2007 data.

Breast cancers in U.S. residing Indian-Pakistani versus non-Hispanic White women: comparative analysis of clinical-pathologic features, treatment, and survival

South Asians from India and Pakistan represent one of the fastest growing immigrant populations in the US, yet there are limited data assessing breast cancers for this distinct ethnic sub-group. The aim of this study was to analyze clinical-pathologic, treatment and outcome characteristics of U.S.-residing Indian-Pakistani (IP) versus non-Hispanic white (NHW) female breast cancer patients to assess if any differences/disparities exist. The study cohort consisted of 2,393 IP and 555,832 NHW women (diagnosed 1988-2006) in the SEER database. Differences between the two populations were analyzed using chi-squared and multivariate regression analysis. Age-adjusted incidence, mortality, and relative survival rates were calculated for the two groups. Significant differences in the characteristics of the IP cohort's invasive disease included: younger median age at presentation; larger tumor size; higher stage, higher grade, more involved lymph-nodes, and more hormone receptor negative disease (all P < 0.01). The age-adjusted incidence and breast cancer mortality were lower in IP women. The relative survival at 5 years was statistically significant at 84% for IP versus 89% for NHW women, but was not significantly different on multivariate analysis (P > 0.05). Within each stage (Tis, I, II), there were no disparities in the rate of breast conservation surgery (BCS) or in the percentage of patients receiving adjuvant radiation after BCS for the 2 cohorts. Post-mastectomy radiation was delivered significantly more often in stage I/II IP patients undergoing mastectomy. In conclusion, this analysis suggests that while there appear to be significant differences in the features of breast cancers of US-residing IP women, no disparities were noted in the rates of breast conserving surgery or adjuvant radiation, as seen in some other ethnicities. The more aggressive clinical-pathologic features stage-for-stage in IP women may partially explain the more frequent use of post-mastectomy RT in this patient population. These findings warrant further investigation.

Global cancer statistics

The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of the total cancer cases and 14% of the cancer deaths. Lung cancer is the leading cancer site in males, comprising 17% of the total new cancer cases and 23% of the total cancer deaths. Breast cancer is now also the leading cause of cancer death among females in economically developing countries, a shift from the previous decade during which the most common cause of cancer death was cervical cancer. Further, the mortality burden for lung cancer among females in developing countries is as high as the burden for cervical cancer, with each accounting for 11% of the total female cancer deaths. Although overall cancer incidence rates in the developing world are half those seen in the developed world in both sexes, the overall cancer mortality rates are generally similar. Cancer survival tends to be poorer in developing countries, most likely because of a combination of a late stage at diagnosis and limited access to timely and standard treatment. A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake. Clinicians, public health professionals, and policy makers can play an active role in accelerating the application of such interventions globally.

Advanced breast cancer incidence following population-based mammographic screening

BACKGROUND

Breast cancer mortality is declining in many Western countries. If mammography screening contributed to decreases in mortality, then decreases in advanced breast cancer incidence should also be noticeable.

PATIENTS AND METHODS

We assessed incidence trends of advanced breast cancer in areas where mammography screening is practiced for at least 7 years with 60% minimum participation and where population-based registration of advanced breast cancer existed. Through a systematic Medline search, we identified relevant published data for Australia, Italy, Norway, Switzerland, The Netherlands, U.K. and the U.S.A. Data from cancer registries in Northern Ireland, Scotland, the U.S.A. (Surveillance, Epidemiology and End Results (SEER), and Connecticut), and Tasmania (Australia) were available for the study. Criterion for advanced cancer was the tumour size, and if not available, spread to regional/distant sites.

RESULTS

Age-adjusted annual percent changes (APCs) were stable or increasing in ten areas (APCs of -0.5% to 1.7%). In four areas (Firenze, the Netherlands, SEER and Connecticut) there were transient downward trends followed by increases back to pre-screening rates.

CONCLUSIONS

In areas with widespread sustained mammographic screening, trends in advanced breast cancer incidence do not support a substantial role for screening in the decrease in mortality.

Ethnic and socioeconomic trends in breast cancer incidence in New Zealand

BACKGROUND

Breast cancer incidence varies between social groups, but differences have not been thoroughly examined in New Zealand. The objectives of this study are to determine whether trends in breast cancer incidence varied by ethnicity and socioeconomic position between 1981 and 2004 in New Zealand, and to assess possible risk factor explanations.

METHODS

Five cohorts of the entire New Zealand population for 1981-86, 1986-1991, 1991-1996, 1996-2001, and 2001-2004 were created, and probabilistically linked to cancer registry records, allowing direct determination of ethnic and socioeconomic trends in breast cancer incidence.

RESULTS

Breast cancer rates increased across all ethnic and socioeconomic groups between 1981 and 2004. Māori women consistently had the highest age standardised rates, and the difference between Māori and European/Other women increased from 7% in 1981-6 to 24% in 2001-4. Pacific and Asian women had consistently lower rates of breast cancer than European/Other women over the time period studied (12% and 28% lower respectively when pooled over time), although young Pacific women had slightly higher incidence rates than young European/other women. A gradient between high and low income women was evident, with high income women having breast cancer rates approximately 10% higher and this difference did not change significantly over time.

CONCLUSIONS

Differences in breast cancer incidence between European and Pacific women and between socioeconomic groups are explicable in terms of known risk factors. However no straightforward explanation for the relatively high incidence amongst Māori is apparent. Further research to explore high Māori breast cancer rates may contribute to reducing the burden of breast cancer amongst Māori women, as well as improving our understanding of the aetiology of breast cancer.

Higher parity and shorter breastfeeding duration: association with triple-negative phenotype of breast cancer

BACKGROUND

The combination of increased parity and shorter breastfeeding duration might increase the odds of the least differentiated triple-negative breast cancer (BC) phenotype, theoretically because an expanded progenitor cell population from each pregnancy would incompletely differentiate postpartum.

METHODS

Subjects consisted of a consecutive case series of 2473 women treated for invasive breast cancer between 2001 and 2006. Breast cancer phenotype (triple-negative BC, vs non-triple-negative BC) was compared with reproductive and demographic information. Odds ratios (OR) with 95% confidence intervals (CIs) for the association of breastfeeding duration (months per child) and parity with triple-negative BC were calculated after adjusting for ethnicity, age at menarche, family history, and age at diagnosis.

RESULTS

Compared with non-triple-negative BC, triple-negative BC was associated with shorter duration of breastfeeding per child (OR, 0.93; 95% CI, 0.90-0.97) and with higher parity (OR, 1.12; 95% CI, 1.06-1.20). By using multivariate logistic regression, triple-negative BC was independently associated with higher parity (OR, 2.76 [95% CI, 1.86-4.08] if ≥3 live births; OR, 1.89 [95% CI, 1.30-2.74] if ≤2 live births vs nulliparae), breastfeeding duration (OR, 0.55 [95% CI, 0.41-0.74] if >2 mo/child and OR, 0.58 [95% CI, 0.42-0.82] if ≤2 mo/child vs none), African American ethnicity (OR, 2.10; 95% CI, 1.52-2.92), and younger age at diagnosis (OR, 3.02 [95% CI, 2.03-4.47] if ≤40 years vs >60 years).

CONCLUSIONS

Among women with invasive breast cancer, higher parity and the absence or short duration of breastfeeding were independently associated with triple-negative BC. Any duration of breastfeeding was found to be associated with lower probability of triple-negative BC, and the odds of this phenotype decreased with increasing duration of breastfeeding.

Pathologic complete response in breast cancer patients receiving anthracycline- and taxane-based neoadjuvant chemotherapy: evaluating the effect of race/ethnicity

BACKGROUND

The current study was conducted to evaluate the influence of race/ethnicity and tumor subtype in pathologic complete response (pCR) following treatment with neoadjuvant chemotherapy.

METHODS

A total of 2074 patients diagnosed with breast cancer between 1994 and 2008 who were treated with neoadjuvant anthracycline- and taxane-based chemotherapy were included. pCR was defined as no residual invasive cancer in the breast and axilla. The Kaplan-Meier product-limit was used to calculate survival outcomes. Cox proportional hazards models were fitted to determine the relationship of patient and tumor variables with outcome.

RESULTS

The median patient age was 50 years; 14.6% of patients were black, were 15.2% Hispanic, 64.3% were white, and 5.9% were of other race. There were no differences in pCR rates among race/ethnicity (12.3% in black, 14.2% in Hispanics, 12.3% in whites, and 11.5% in others, P = .788). Lack of pCR, breast cancer subtype, grade 3 tumors, and lymphovascular invasion were associated with worse recurrence-free survival (RFS) and overall survival (OS) (P </= .0001). Differences in RFS by race/ethnicity were noted in the patients with hormone receptor-positive disease (P = .007). On multivariate analysis, Hispanics had improved RFS (hazard ratio [HR], 0.69; 95% confidence interval [95% CI], 0.49-0.97) and OS (HR, 0.63; 95% CI, 0.41-0.97); blacks had a trend toward worse outcomes (RFS: HR, 1.28 [95% CI, 0.97-1.68] and OS: HR, 1.32 [95% CI, 0.97-1.81]) when compared with whites.

CONCLUSIONS

In this cohort of patients, race/ethnicity was not found to be significantly associated with pCR rates. On a multivariate analysis, improved outcomes were observed in Hispanics and a trend toward worse outcomes in black patients, when compared with white patients. Further research was needed to explore the potential differences in biology and outcomes.

Disparities in breast cancer characteristics and outcomes by race/ethnicity

Disparities in breast cancer stage and mortality by race/ethnicity in the United States are persistent and well known. However, few studies have assessed differences across racial/ethnic subgroups of women broadly defined as Hispanic, Asian, or Pacific Islander, particularly using more recent data. Using data from 17 population-based cancer registries in the Surveillance, Epidemiology, and End Results (SEER) program, we evaluated the relationships between race/ethnicity and breast cancer stage, hormone receptor status, treatment, and mortality. The cohort consisted of 229,594 women 40-79 years of age diagnosed with invasive breast carcinoma between January 2000 and December 2006, including 176,094 non-Hispanic whites, 20,486 Blacks, 15,835 Hispanic whites, 14,951 Asians, 1,224 Pacific Islanders, and 1,004 American Indians/Alaska Natives. With respect to statistically significant findings, American Indian/Alaska Native, Asian Indian/Pakistani, Black, Filipino, Hawaiian, Mexican, Puerto Rican, and Samoan women had 1.3-7.1-fold higher odds of presenting with stage IV breast cancer compared to non-Hispanic white women. Almost all groups were more likely to be diagnosed with estrogen receptor-negative/progesterone receptor-negative (ER-/PR-) disease with Black and Puerto Rican women having the highest odds ratios (2.4 and 1.9-fold increases, respectively) compared to non-Hispanic whites. Lastly, Black, Hawaiian, Puerto Rican, and Samoan patients had 1.5-1.8-fold elevated risks of breast cancer-specific mortality. Breast cancer disparities persist by race/ethnicity, though there is substantial variation within subgroups of women broadly defined as Hispanic or Asian. Targeted, multi-pronged interventions that are culturally appropriate may be important means of reducing the magnitudes of these disparities.

Is the decrease in breast cancer incidence related to a decrease in postmenopausal hormone therapy?

Following the Women's Health Initiative (WHI) publication in mid 2002, a drastic decrease in hormone therapy for postmenopausal women has been observed worldwide. Since 2007, the reported incidence in breast cancer has declined. Most authors have linked this decline to the reduction in hormone treatment. In this paper we discuss why these ecological observations are not fully convincing and focus on the importance of screening and variations in other risk factors to interpret this decline in breast cancer.

A model building exercise of mortality risk for Taiwanese women with breast cancer

BACKGROUND

The accurate estimation of outcome in patients with malignant disease is an essential component of the optimal treatment, decision-making and patient counseling processes. The prognosis and disease outcome of breast cancer patients can differ according to geographic and ethnic factors. To our knowledge, to date these factors have never been validated in a homogenous loco-regional patient population, with the aim of achieving accurate predictions of outcome for individual patients. To clarify this topic, we created a new comprehensive prognostic and predictive model for Taiwanese breast cancer patients based on a range of patient-related and various clinical and pathological-related variables.

METHODS

Demographic, clinical, and pathological data were analyzed from 1 137 patients with breast cancer who underwent surgical intervention. A survival prediction model was used to allow analysis of the optimal combination of variables.

RESULTS

The area under the receiver operating characteristic (ROC) curve, as applied to an independent validation data set, was used as the measure of accuracy. Results were compared by comparing the area under the ROC curve.

CONCLUSIONS

our model building exercise of mortality risk was able to predict disease outcome for individual patients with breast cancer. This model could represent a highly accurate prognostic tool for Taiwanese breast cancer patients.