Abstract P6-10-06: Racial differences in the characteristics and outcomes of young breast cancer patients: A national population-based study

Background:

Disparity in demographic characteristics as it relates to breast cancer outcomes is well-studied. However, studies evaluating racial differences exclusively among young patients are more limited. We sought to examine socioeconomic and clinical factors and their impact on outcomes in young patients, as well as to determine whether variation in outcomes changed over the 22-year study period.

Methods:

Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified female patients aged 20-35 with invasive breast cancer diagnosed from 1990-2012. We performed univariate, multivariate and survival analysis. Variables included patient age, race, stage, receptor status, surgery type and year of diagnosis

Results:

A total of 18,999 women were identified and analyzed. Mean age was 31.7 years. 31.2% were diagnosed between 1990-2000 while 68.7% were diagnosed between 2001-2012. 80.8% (15,364) of patients were white and 19.1% (3,635) were black. A higher percentage of blacks had stage III/IV disease (34% v 27%) and ≥ 4 positive nodes (19% v 16%) compared to whites. 54% of whites were ER receptor positive while 46% of blacks were ER receptor positive (p<0.0001). White patents were more likely to live in counties where ≤15% of households were below the poverty line (64% v 45%) and where ≤15% of the population had less than a high school education (35% v 28%) compared to blacks.

The overall 5-year disease specific survival (DSS) for the entire cohort was 82.5%. 5-year DSS was 84.4% for all white patients and 74.2% for all black patients (p<0.0001). 5-year DSS was 79.1% among all patients diagnosed from 1990-2000 and 84.2% among patients diagnosed from 2001-2012 (p<0.0001). While the 5-year DSS for white patients improved from 80.9% in 1990-2000 to 86.3% in 2001-2012 (p<0.0001), the 5-year DSS improvement for black patients from 1990-2000 to 2001-2012 did not reach statistical significance (71.3% vs 75.7 %, p=0.24).

Discussion:

Racial disparity among breast cancer patients is also an issue in young females, as young white patients have superior disease-specific survival compared to African-Americans collectively and in each time-period studied. Absolute disease-specific survival has improved from 1990-2000 to 2001-2012 for both races. However, the statistically significant difference in improvement of disease-specific survival seen among white patients was not demonstrated in African-American patients. Continued attention to racial disparity in breast cancer outcomes is needed with additional studies examining potential differences in treatment, disease characteristics and biology, and accessibility to health care, with a particular focus on young cancer patients. With continued research, hopefully new treatment approaches will be developed to reduce this disparity.

5-Year Disease Specific SurvivalTime Period5 year DSSp value WhiteBlack 1990-200080.9%71.3%0.00012001-201286.3%75.7%0.0001p value0.00010.24 

Survival by stage 5 yr DSS  WhiteBlackp valueStage I96.2%94.9%<0.001Stage II89.0%83.5%<0.0001Stage III69.4%57.4%<0.0001Stage IV34.6%16.9%<0.0001

Citation Format: McClain JT, Mosquera C, Muzaffar M. Racial differences in the characteristics and outcomes of young breast cancer patients: A national population-based study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-10-06.

Abstract P6-09-26: Effect of race on triple negative breast cancer outcomes

Background: African American (AA) women and patients with Triple Negative Breast Cancer (TNBC) have poor outcomes. It is unclear whether these worse outcomes in AA women are due to a higher frequency of TNBC in AA women. The purpose of our study was to determine difference in outcomes between AA and Caucasian (CA) female with TNBC.

Methods: A retrospective study of women diagnosed with ER, PR and HER2 (1+) negative breast cancer between January 1/2001 and December 31/2013 at Vidant Medical Center (East Carolina University) in Greenville, North Carolina was undertaken. Patient demographics and tumor characteristics were analyzed to determine impact on overall survival.

Results: In our institution, 4,434 women were diagnosed with breast cancer in this study period, of which 378 had TNBC. Our TNBC population was predominantly AA (53%). AA patients were younger (54.1 years vs 58.7 years, p=0.005), less often postmenopausal (62.6% vs 74.5%, p=0.013), more likely to have Medicaid (24.3% vs 7.9%, p <0.001), and to have received chemotherapy (80% vs 69%, p=0.017) compared to CA women. There was no difference in stage at diagnosis between AA and CA patients (p=0.12). By univariate analysis, improved survival in TNBC was associated with non-Medicaid status (p=0.01), early stage at diagnosis (p=0.001), N stage (<0.001), and tumor grade (p<0.001). A Cox regression analysis demonstrated that only insurance status (p=0.007) and N Stage (p=0.01) predicted outcomes in TNBC. Survival in TNBC was not affected by race (p=0.7).

Conclusions: Poorer outcomes in AA women cannot be attributed to the higher frequency of TNBC. Improved access to healthcare, with broader insurance coverage, may help minimize disparities in outcome by diagnosing TNBC at an earlier stage.Background: African American (AA) women and patients with Triple Negative Breast Cancer (TNBC) have poor outcomes. It is unclear whether these worse outcomes in AA women are due to a higher frequency of TNBC in AA women. The purpose of our study was to determine difference in outcomes between AA and Caucasian (CA) female with TNBC.

Methods: A retrospective study of women diagnosed with ER, PR and HER2 (1+) negative breast cancer between January 1/2001 and December 31/2013 at Vidant Medical Center (East Carolina University) in Greenville, North Carolina was undertaken. Patient demographics and tumor characteristics were analyzed to determine impact on overall survival.

Results: In our institution, 4,434 women were diagnosed with breast cancer in this study period, of which 378 had TNBC. Our TNBC population was predominantly AA (53%). AA patients were younger (54.1 years vs 58.7 years, p=0.005), less often postmenopausal (62.6% vs 74.5%, p=0.013), more likely to have Medicaid (24.3% vs 7.9%, p <0.001), and to have received chemotherapy (80% vs 69%, p=0.017) compared to CA women. There was no difference in stage at diagnosis between AA and CA patients (p=0.12). By univariate analysis, improved survival in TNBC was associated with non-Medicaid status (p=0.01), early stage at diagnosis (p=0.001), N stage (<0.001), and tumor grade (p<0.001). A Cox regression analysis demonstrated that only insurance status (p=0.007) and N Stage (p=0.01) predicted outcomes in TNBC. Survival in TNBC was not affected by race (p=0.7).

Conclusions: Poorer outcomes in AA women cannot be attributed to the higher frequency of TNBC. Improved access to healthcare, with broader insurance coverage, may help minimize disparities in outcome by diagnosing TNBC at an earlier stage.

Citation Format: Mosquera C, Amin R, Wong JH. Effect of race on triple negative breast cancer outcomes [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-26.

Localized high-grade gastroenteropancreatic neuroendocrine tumors: Defining prognostic and therapeutic factors for a disease of increasing clinical significance

BACKGROUND

Due to the limited sample size in the existing series, the natural history and management of high-grade gastroenteropancreatic neuroendocrine tumors (GEP-NET) is poorly understood. In order to better understand high-grade GEP-NET, a large cohort study was undertaken.

OBJECTIVE

To determine the prognostic factors associated with high-grade GEP-NET.

METHODS

Patients diagnosed with non-metastatic high-grade GEP-NET from 1988 to 2010 were identified in SEER.

RESULTS

Incidence of high-grade GEP-NETs increased from 0.03 to 0.19/100,000 over the study period. The median age was 65 years, and the majority of the patients were white and females. The most common primary site was colorectal, and the most frequent T classification was T3. Surgical resection was performed in 89% of patients that varied by site (p < 0.0001). Nodal involvement was frequent and varied by site (p = 0.0002). The 5-year disease-specific survival was 63.3% and was the greatest for small bowel (p = 0.0003). Survival was associated with age, node status and surgery (p < 0.05). On multivariate analysis, the node status, surgery, and site continued to be associated with survival (p < 0.05); however, age (p = 0.08) no longer influenced the patient's survival.

CONCLUSION

High-grade GEP-NETs are neoplasms with exponentially increasing in incidence. Tumor location and nodal status are predictors of survival. Surgery is associated with a survival advantage and could be considered for localized disease.

Seroprevalence of and risk factors for HIV-1 infection among female commercial sex workers in South America

OBJECTIVE

Assessment of HIV prevalence and associated risk behaviours among female commercial sex workers (FCSW) across major cities in South America.

METHODS

Seroepidemiological, cross sectional studies of 13 600 FCSW were conducted in nine countries of South America during the years 1999-2002. Participants were recruited in brothels, massage parlours, hotels, and streets where anonymous questionnaires and blood samples were collected. HIV infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot confirmatory tests.

RESULTS

The overall HIV seroprevalence was 1.2% (range 0.0%-4.5%). The highest HIV seroprevalences were reported in Argentina (4.5%) and Paraguay (2.6%); no HIV infected FCSW were detected in Venezuela and Chile. Consistent predictors of HIV seropositivity were: (1) a previous history of sexually transmitted infections (STI, AORs = 3.8-8.3), and (2) 10 years or more in commercial sex work (AORs = 2.2-24.8). In addition, multiple (> or =3) sexual contacts (AOR = 5.0), sex with foreigners (AOR = 6.9), use of illegal drugs (AOR = 3.2), and marijuana use (AOR = 8.2) were associated with HIV seropositivity in Southern Cone countries.

CONCLUSIONS

Consistently low HIV seroprevalences were detected among FCSW in South America, particularly in the Andean region. Predictors of HIV infection across the continent were STI and length of commercial sex work; however, use of illegal drugs, especially marijuana, and sexual contacts with foreigners were also found to be associated risk factors in the Southern Cone region. Interventions for the control of HIV and other STI need to be region and country specific; drug use appears to have an ever increasing role in the spread of HIV among heterosexually active populations.

Prenatal diagnosis of severe structural congenital malformations in Europe

OBJECTIVES

To assess at a population-based level the frequency with which severe structural congenital malformations are detected prenatally in Europe and the gestational age at detection, and to describe regional variation in these indicators.

METHODS

In the period 1995-1999, data were obtained from 17 European population-based registries of congenital malformations (EUROCAT). Included were all live births, fetal deaths and terminations of pregnancy diagnosed with one or more of the following malformations: anencephalus, encephalocele, spina bifida, hydrocephalus, transposition of great arteries, hypoplastic left heart, limb reduction defect, bilateral renal agenesis, diaphragmatic hernia, omphalocele and gastroschisis.

RESULTS

The 17 registries reported 4366 cases diagnosed with the 11 severe structural malformations and of these 2300 were live births (53%), 181 were fetal deaths (4%) and 1863 were terminations of pregnancy (43%); in 22 cases pregnancy outcome was unknown. The overall prenatal detection rate was 64% (range, 25-88% across regions). The proportion of terminations of pregnancy varied between regions from 15% to 59% of all cases. Gestational age at discovery for prenatally diagnosed cases was less than 24 weeks for 68% (range, 36-88%) of cases. There was a significant relationship between high prenatal detection rate and early diagnosis (P < 0.0001). For individual malformations, the prenatal detection rate was highest for anencephalus (469/498, 94%) and lowest for transposition of the great arteries (89/324, 27%). Termination of pregnancy was performed in more than half of the prenatally diagnosed cases, except for those with transposition of the great arteries, diaphragmatic hernia and gastroschisis, in which 30-40% of the pregnancies with a prenatal diagnosis were terminated.

CONCLUSION

European countries currently vary widely in the provision and uptake of prenatal screening and its quality, as well as the "culture" in terms of decision to continue the pregnancy. This inevitably contributes to variation between countries in perinatal and infant mortality and in childhood prevalence and cost to health services of congenital anomalies.

Circulating recombinant form CRF02_AG in South America

With the objective of monitoring the distribution of HIV-1 subtypes and circulating recombinant forms (CRFs)in South America, population-based surveillance studies were performed in seven countries. Peripheral blood mononuclear cell, filter paper, fresh blood, and cocultivation samples were collected from HIV-positive patients from Colombia, Ecuador, Peru, Bolivia, Chile, Argentina, and Uruguay, during a 7-year period(1995-2001). DNA was prepared and HIV envelope subtypes were determined by heteroduplex mobility as-say and DNA sequencing from 1289 HIV-positive samples. While subtypes B and F were the most commonly observed subtypes, two CRF02_AG strains were detected, in Ecuador. This is the first report of the existence of this CRF in South America.

Legal abortion in Asturias (Spain) after the 1985 law: sociodemographic characteristics of women applying for abortion

STUDY OBJECTIVE

To describe the use of induced abortion (IA) in Asturias after its legalisation as well as the socio-demographic characteristics of women applying for abortion.

DESIGN AND SETTING

Descriptive study, population-based, using data collected by the regional abortion surveillance system for the period 1988 1994.

MAIN RESULTS

The number of IA and the abortion rate (AR) (10 per 1000 women aged 15-49) have been stable in Asturias during the study period. The highest ARs were found for women in the age group 20-34, for divorced/separated, for women with a higher educational level and for women with only one child. The proportion of pregnancies which ended in abortion was one in four; for teenagers and women over 34 years it was one in two. This proportion was also higher for women not married, students and women with two or more children. Ninety-eight percent of all abortions took place in private clinics, the woman's physical/mental health being the medical indication for these abortions. Abortion was most often performed within eight weeks of gestation (65%). Late abortion ocurred more frequently among teenagers and women of low educational level. Eighteen percent of women had repeated abortions. A high proportion (61%) of women applying for abortion had not used the Family Planning (FP) services in the previous two years; adolescents and women of low educational level had the lowest frequencies of FP use.

CONCLUSIONS

Compared with that of other European countries, the AR in Asturias was intermediate. The results regarding adolescents show the need for evaluation and promotion of sex education and contraceptive programmes. The lower and later use of abortion by women of low educational level shows inequalities that call for specific action.

Diagnostic accuracy of the cytologic diagnosis of anal human papillomavirus infection compared with DNA hybridization studies

During the years 1990 to 1991, smears taken from the anal canal of 45 randomly selected homosexual males were studied. Several cytological criteria were used to study infection by human papillomavirus (HPV). The cytological study and an anoscopy was performed and a swab was taken for HPV-DNA hybridization, using labelled RNA probes for HPV-DNA: 6,11,16,18,31,33, and 35. In our study we observed the existence of a high proportion (9.5%) of inadequate smears that did not contain glandular cells and/or metaplasia. A sensitivity of 78% and a specificity of 72% was obtained. Sensitivity and specificity were 68% and 91%, respectively, when these criteria were restricted to the presence of koilocytes and/or dyskeratocytes. The high rate of occult infections obtained in our study lead us to suggest the simultaneous use of cytology, molecular hybridization, and anoscopy for suitable care of those patients with a high risk of contracting HPV infections of the anal canal.

[Preventing the recurrence of febrile seizures: intermittent prevention with rectal diazepam compared with continuous treatment with sodium valproate]

Sixty nine children suffering from a first febrile seizure without evidence of neurologic disorder or associated risk factors were randomly assigned to one of three groups: no treatment; intermittent rectal diazepam; or continuous oral sodium valproate. All patients were followed for two years. Periodical controls were performed every three months in order to record febrile episodes, recurrent seizures, and treatment side affects. Rate of recurrent febrile seizures was 16% in control group, and 5.5% in diazepam group. Sodium valproate group showed no recurrences in the follow-up period. The low relapsing rate in control group suggests that prophylaxis should not be established even if it is requested by certain parental attitudes.