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Tambvekar SE, Balsarkar G. "Modernizing Cervical Cytology Screening with Liquid-Based Methods at Community-Level Hospitals: A Much-Needed Breakthrough for India". J Obstet Gynaecol India 2024; 74:371-377. [PMID: 39280206 PMCID: PMC11399528 DOI: 10.1007/s13224-024-02051-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 08/08/2024] [Indexed: 09/18/2024] Open
Abstract
Introduction Cervical cancer still ranks highest causing cancer-related morbidity and mortality in women in India. It is prudent to emphasise and implement cervical cancer screening strategies in the population efficiently and with regular intervals. Conventionally, PAP smear cytology is obtained by wooden spatula-Ayre's spatula. To improve sensitivity and specificity of the procedure and detection rate, better techniques of cells retrieval are available mainly liquid-based cytology (LBC), with help of cyto-brush. Literature has consistently proven efficiency of the technique and also reduced the proportion of inadequate sampling. We conduct this study to compare both the techniques and efficiency in a community hospital from data over 6 years, to asses its role and benefits among Indian women. Aims and Objectives To compare conventional PAP smear and liquid-based cytology techniques analysing detection rates of positive lesions (CIN and also includes ASCUS and malignant), incidence of inadequate sampling, efficiency and cost-effectiveness. Methods This is retrospective study at tertiary care obstetric hospital affiliated to government-run medical college in a metropolitan city of Mumbai. Data are retrieved from the Pathology Department, Medical Records Department, laboratory books and OPD registers. Pap's smear sampling was done mainly from OPD with all indications including routine tests as a part of gynaecological evaluation and screening, as well as for suspicious lesions on inspection. Group A consists women who had conventional PAP smear test for 3 years (Dec 2015-Nov 2018) and Group B had women who benefited by LBC method for 3 years (Dec 2018-Nov 2021). COVID-19 pandemic majorly affected the routine gynaecological OPD practice during 2021 as hospital was COVID facility hospital. Results Demographic parameters and presentations were comparable and similar. LBC methods have higher detection rate for positive reports, including ASCUS. But results were comparable in both groups and not statistically different. Importantly, incidences of inadequate sampling are reduced significantly with the LBC method. Unsatisfactory smears war high in Group A (7.752%) compared to Group B (3.712%) p-value 0.005, stating the increased rate of requirement of sending repeat smears, which involves higher engagement of time, resources and active participation from healthcare personnel. Conclusion Good detection rates and significantly low rates of unsatisfactory smears make LBC rational and cost-effective. These are the times to switch to liquid-based cytology techniques, especially at the community level hospitals; in order to detect more women with cervical premalignant as well as malignant neoplastic lesions and to save lives. This can be made possible by emphasising the policy makers to incorporate these services through quality resources.
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Affiliation(s)
- Sunil E Tambvekar
- Deptartment of Obstetrics and Gynaecology, Nowrosjee Wadia Maternity Hospital, Seth GS Medical College, Mumbai, India
| | - Geetha Balsarkar
- Deptartment of Obstetrics and Gynaecology, Nowrosjee Wadia Maternity Hospital, Seth GS Medical College, Mumbai, India
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Santaliz-Casiano A, Mehta D, Danciu OC, Patel H, Banks L, Zaidi A, Buckley J, Rauscher GH, Schulte L, Weller LR, Taiym D, Liko-Hazizi E, Pulliam N, Friedewald SM, Khan S, Kim JJ, Gradishar W, Hegerty S, Frasor J, Hoskins KF, Madak-Erdogan Z. Identification of metabolic pathways contributing to ER + breast cancer disparities using a machine-learning pipeline. Sci Rep 2023; 13:12136. [PMID: 37495653 PMCID: PMC10372029 DOI: 10.1038/s41598-023-39215-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023] Open
Abstract
African American (AA) women in the United States have a 40% higher breast cancer mortality rate than Non-Hispanic White (NHW) women. The survival disparity is particularly striking among (estrogen receptor positive) ER+ breast cancer cases. The purpose of this study is to examine whether there are racial differences in metabolic pathways typically activated in patients with ER+ breast cancer. We collected pretreatment plasma from AA and NHW ER+ breast cancer cases (AA n = 48, NHW n = 54) and cancer-free controls (AA n = 100, NHW n = 48) to conduct an untargeted metabolomics analysis using gas chromatography mass spectrometry (GC-MS) to identify metabolites that may be altered in the different racial groups. Unpaired t-test combined with multiple feature selection and prediction models were employed to identify race-specific altered metabolic signatures. This was followed by the identification of altered metabolic pathways with a focus in AA patients with breast cancer. The clinical relevance of the identified pathways was further examined in PanCancer Atlas breast cancer data set from The Cancer Genome Atlas Program (TCGA). We identified differential metabolic signatures between NHW and AA patients. In AA patients, we observed decreased circulating levels of amino acids compared to healthy controls, while fatty acids were significantly higher in NHW patients. By mapping these metabolites to potential epigenetic regulatory mechanisms, this study identified significant associations with regulators of metabolism such as methionine adenosyltransferase 1A (MAT1A), DNA Methyltransferases and Histone methyltransferases for AA individuals, and Fatty acid Synthase (FASN) and Monoacylglycerol lipase (MGL) for NHW individuals. Specific gene Negative Elongation Factor Complex E (NELFE) with histone methyltransferase activity, was associated with poor survival exclusively for AA individuals. We employed a comprehensive and novel approach that integrates multiple machine learning and statistical methods, coupled with human functional pathway analyses. The metabolic profile of plasma samples identified may help elucidate underlying molecular drivers of disproportionately aggressive ER+ tumor biology in AA women. It may ultimately lead to the identification of novel therapeutic targets. To our knowledge, this is a novel finding that describes a link between metabolic alterations and epigenetic regulation in AA breast cancer and underscores the need for detailed investigations into the biological underpinnings of breast cancer health disparities.
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Affiliation(s)
| | - Dhruv Mehta
- Food Science and Human Nutrition Department, University of Illinois, Urbana-Champaign, Urbana, IL, USA
| | - Oana C Danciu
- Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Hariyali Patel
- Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Landan Banks
- Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Ayesha Zaidi
- Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Jermya Buckley
- Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Garth H Rauscher
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Lauren Schulte
- Robert H. Lurie Cancer Center of Northwestern University, Chicago, IL, USA
| | - Lauren Ro Weller
- Robert H. Lurie Cancer Center of Northwestern University, Chicago, IL, USA
| | - Deanna Taiym
- Robert H. Lurie Cancer Center of Northwestern University, Chicago, IL, USA
| | | | - Natalie Pulliam
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Seema Khan
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J Julie Kim
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - William Gradishar
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Jonna Frasor
- Department Physiology and Biophysics, University of Illinois at Chicago, Chicago, IL, USA
| | - Kent F Hoskins
- Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Zeynep Madak-Erdogan
- Division of Nutritional Sciences, University of Illinois, Urbana-Champaign, Urbana, IL, USA.
- Food Science and Human Nutrition Department, University of Illinois, Urbana-Champaign, Urbana, IL, USA.
- Department of Biomedical and Translational Sciences, Carle Illinois College of Medicine, Urbana, IL, USA.
- Carl R. Woese Institute for Genomic Biology, University of Illinois, Urbana-Champaign, Urbana, IL, USA.
- Cancer Center at Illinois, 1201 W Gregory Dr, Urbana, IL, 61801, USA.
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Fang HA, Irfan A, Vickers SM, Gbolahan O, Williams GR, Outlaw D, Wang TNT, Dudeja V, Rose JB, Reddy S. Are Lymph Node Metastases Associated With Survival in Black Patients With Pancreatic Cancer? J Surg Res 2023; 284:143-150. [PMID: 36571869 DOI: 10.1016/j.jss.2022.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/12/2022] [Accepted: 11/16/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Despite aggressive surgical care and systemic therapy, patients with pancreatic ductal adenocarcinoma (PDAC) have a poor prognosis. Recent studies show that racial disparities in outcome also exist. We sought to investigate the association lymph node (LN) metastases had with survival between Black and White patients with PDAC after resection. METHODS Retrospective analysis of 226 PDAC patients who underwent resection at a single institution from 2010 to 2018 was performed with attention to LN metastasis and patient race. The number of patients who received chemotherapy was also evaluated. RESULTS One Hundred Seventy Five (77.4%) PDAC patients were White and 51 (22.6%) were Black. 130 (59.3%) patients had LN metastasis (LN+). LN+ and LN- groups were similar in race (P = 0.93), sex (P = 0.10) and age at the time of diagnosis (P = 0.45). Patients with LN + disease were more likely to present with larger tumors (3.4 versus 2.8 cm, P = 0.02) and higher T status (P = 0.001). White and Black patients had similar rates of LN metastasis (59% versus 58.8%, P = 1.0). The median survival for LN- Black and White patients were similar (43.2 versus 30.2 mo, P = 0.82). LN + Black patients trended towards receiving more systemic therapy than White LN + patients (55% versus 42%, P = 0.10). The median survival for LN + Black patients was significantly less than LN + White patients (17.5 versus 24.6 mo, P = 0.04). CONCLUSIONS Black LN + PDAC patients have an inferior survival rate after resection when compared to their White counterparts. Our disparity in outcome cannot be solely explained by a difference in systemic treatment. Further investigation is warranted to determine racial differences in tumor biology or response to chemotherapy.
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Affiliation(s)
- Hua Amanda Fang
- School of Medicine, University of Alabama in Birmingham, Birmingham, Alabama; Department of Surgery, Birmingham, University of Alabama in Birmingham, Alabama
| | - Ahmer Irfan
- Department of Surgery, Birmingham, University of Alabama in Birmingham, Alabama
| | - Selwyn M Vickers
- Department of Surgery, Birmingham, University of Alabama in Birmingham, Alabama
| | - Olumide Gbolahan
- Department of Surgery, Birmingham, University of Alabama in Birmingham, Alabama; Department of Hematology and Oncology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Grant R Williams
- Department of Hematology and Oncology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Darryl Outlaw
- Department of Hematology and Oncology, University of Alabama in Birmingham, Birmingham, Alabama
| | | | - Vikas Dudeja
- Department of Surgery, Birmingham, University of Alabama in Birmingham, Alabama
| | - J Bart Rose
- Department of Surgery, Birmingham, University of Alabama in Birmingham, Alabama
| | - Sushanth Reddy
- Department of Surgery, Birmingham, University of Alabama in Birmingham, Alabama.
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Darmon S, Lovejoy LA, Shriver CD, Zhu K, Ellsworth RE. Nondisparate Survival of Non-Hispanic Black Women With Breast Cancer Despite Less Favorable Pathology: Effect of Access to and Provision of Care Within a Military Health Care System. Health Equity 2023; 7:178-184. [PMID: 36942312 PMCID: PMC10024578 DOI: 10.1089/heq.2022.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 03/12/2023] Open
Abstract
Introduction Breast cancer mortality rates are 40% higher in non-Hispanic Blacks (NHBs) than in non-Hispanic White (NHWs) in the United States. All women treated within the Murtha Cancer Center at Walter Reed National Military Medical Center (MCC/WRNMMC) have health insurance and are provided multidisciplinary health care. Pathological factors and outcomes of NHBs and NHWs treated within the MCC/WRNMMC were evaluated to determine whether equal-access health care reduces disparate phenotypes and survival between the racial groups. Methods Between 2001 and 2018, 368 NHB and 819 NHW women were diagnosed with breast cancer at MCC/WRNMMC. Differences between NHBs and NHWs in epidemiological and pathological characteristics were evaluated. Overall and breast cancer-specific 5- and 10-year survival rates were compared between races. Results Compared with NHWs, NHBs were significantly more likely to have a body mass index ≥30 kg/m2, to be unmarried, to have tumors of higher grade, later stage, with lymph node metastases, and to be hormone receptor negative (HR-)/human epidermal growth factor receptor 2 positive (HER2+) or triple negative. After adjustment for demographic factors, NHBs remained significantly more likely to have tumors diagnosed at a higher grade and later stage, and to be HR-/HER2+ or triple negative. Neither 5- nor 10-year overall or breast cancer-specific survival differed significantly between the racial groups after adjusting for demographic and pathological variables. Discussion Despite having tumors with less favorable pathological characteristics, overall and disease-free survival disparities were not observed for NHBs treated at MCC/WRNMMC. These data suggest that survival disparities of NHBs with breast cancer can be diminished with provision of quality care.
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Affiliation(s)
- Sarah Darmon
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Leann A. Lovejoy
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, Pennsylvania, USA
| | - Craig D. Shriver
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kangmin Zhu
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Rachel E. Ellsworth
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- Address correspondence to: Rachel E. Ellsworth, PhD, Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 620 Seventh Street, Windber, PA 15963, USA,
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de Oliveira Andrade F, Verma V, Hilakivi-Clarke L. Maternal obesity and resistance to breast cancer treatments among offspring: Link to gut dysbiosis. Cancer Rep (Hoboken) 2022; 5:e1752. [PMID: 36411524 PMCID: PMC9780430 DOI: 10.1002/cnr2.1752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/22/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND About 50 000 new cases of cancer in the United States are attributed to obesity. The adverse effects of obesity on breast cancer may be most profound when affecting the early development; that is, in the womb of a pregnant obese mother. Maternal obesity has several long-lasting adverse health effects on the offspring, including increasing offspring's breast cancer risk and mortality. Gut microbiota is a player in obesity as well as may impact breast carcinogenesis. Gut microbiota is established early in life and the microbial composition of an infant's gut becomes permanently dysregulated because of maternal obesity. Metabolites from the microbiota, especially short chain fatty acids (SCFAs), play a critical role in mediating the effect of gut bacteria on multiple biological functions, such as immune system, including tumor immune responses. RECENT FINDINGS Maternal obesity can pre-program daughter's breast cancer to be more aggressive, less responsive to treatments and consequently more likely to cause breast cancer related death. Maternal obesity may also induce poor response to immune checkpoint inhibitor (ICB) therapy through increased abundance of inflammation associated microbiome and decreased abundance of bacteria that are linked to production of SCFAs. Dietary interventions that increase the abundance of bacteria producing SCFAs potentially reverses offspring's resistance to breast cancer therapy. CONCLUSION Since immunotherapies have emerged as highly effective treatments for many cancers, albeit there is an urgent need to enlarge the patient population who will be responsive to these treatments. One of the factors which may cause ICB refractoriness could be maternal obesity, based on its effects on the microbiota markers of ICB therapy response among the offspring. Since about 40% of children are born to obese mothers in the Western societies, it is important to determine if maternal obesity impairs offspring's response to cancer immunotherapies.
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Affiliation(s)
| | - Vivek Verma
- The Hormel Institute, University of Minnesota, Austin, Minnesota, USA
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Hardy D, Du DY. Socioeconomic and Racial Disparities in Cancer Stage at Diagnosis, Tumor Size, and Clinical Outcomes in a Large Cohort of Women with Breast Cancer, 2007-2016. J Racial Ethn Health Disparities 2021; 8:990-1001. [PMID: 32914344 DOI: 10.1007/s40615-020-00855-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Socioeconomic and treatment factors contribute to diagnosis of early-stage (local-stage) breast cancer, as well as excess deaths among African American women. OBJECTIVES We evaluated socioeconomic and treatment predictive factors for early-stage breast cancer among African American women compared to Caucasian women. A secondary aim evaluated predictors and overall risks associated with all-cause and breast cancer-specific mortality. METHODS We used retrospective cohort population-based study data from the Surveillance, Epidemiology, and End Results (SEER) Program on 547,703 women aged ≥ 20 years diagnosed with breast cancer primary tumors from 2007 to 2016. Statistical analysis used logistic regression to assess predictors of early-stage breast cancer and Cox proportional hazards regression for mortality risks. RESULTS African American women were more likely to be diagnosed at advanced-stage, had larger tumor size at diagnosis, and received less cancer-directed surgery, but more chemotherapy than Caucasian women. Insured women (> 50%) were more likely to be diagnosed at early-stage and to have smaller tumors (p < 0.05). Education level, poverty level, and household income had no impact on racial disparities or socioeconomic disparities in women diagnosed at early stage. We found increased risks for all-cause mortality (hazard ratio = 1.18; 95% confidence interval, 1.16-1.21) and breast cancer-specific mortality (HR = 1.22; 95% CI, 1.19-1.25) among African American women compared to Caucasian women after adjusting for demographic, socioeconomic, and treatment factors. CONCLUSIONS In this population-based study using the most recent SEER data, African American women with breast cancer continued to exhibit higher all-cause mortality and breast cancer-specific mortality compared to Caucasian women.
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Affiliation(s)
- Dale Hardy
- Department of Internal Medicine, Morehouse School of Medicine, Research Wing, Rm 339, 720 Westview Drive, Atlanta, GA, 30310, USA.
| | - Daniel Y Du
- Department of Natural Sciences, University of Houston, Houston, TX, 77030, USA
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Albain KS, Gray RJ, Makower DF, Faghih A, Hayes DF, Geyer CE, Dees EC, Goetz MP, Olson JA, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Wood WC, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge GW, Sparano JA. Race, Ethnicity, and Clinical Outcomes in Hormone Receptor-Positive, HER2-Negative, Node-Negative Breast Cancer in the Randomized TAILORx Trial. J Natl Cancer Inst 2021; 113:390-399. [PMID: 32986828 PMCID: PMC8599918 DOI: 10.1093/jnci/djaa148] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/22/2020] [Accepted: 09/09/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Black race is associated with worse outcomes in early breast cancer. We evaluated clinicopathologic characteristics, the 21-gene recurrence score (RS), treatment delivered, and clinical outcomes by race and ethnicity among women who participated in the Trial Assigning Individualized Options for Treatment. METHODS The association between clinical outcomes and race (White, Black, Asian, other or unknown) and ethnicity (Hispanic vs non-Hispanic) was examined using proportional hazards models. All P values are 2-sided. RESULTS Of 9719 eligible women with hormone receptor-positive, HER2-negative, node-negative breast cancer, there were 8189 (84.3%) Whites, 693 (7.1%) Blacks, 405 (4.2%) Asians, and 432 (4.4%) with other or unknown race. Regarding ethnicity, 889 (9.1%) were Hispanic. There were no substantial differences in RS or ESR1, PGR, or HER2 RNA expression by race or ethnicity. After adjustment for other covariates, compared with White race, Black race was associated with higher distant recurrence rates (hazard ratio [HR] = 1.60, 95% confidence intervals [CI] = 1.07 to 2.41) and worse overall survival in the RS 11-25 cohort (HR = 1.51, 95% CI = 1.06 to 2.15) and entire population (HR = 1.41, 95% CI = 1.05 to 1.90). Hispanic ethnicity and Asian race were associated with better outcomes. There was no evidence of chemotherapy benefit for any racial or ethnic group in those with a RS of 11-25. CONCLUSIONS Black women had worse clinical outcomes despite similar 21-gene assay RS results and comparable systemic therapy in the Trial Assigning Individualized Options for Treatment. Similar to Whites, Black women did not benefit from adjuvant chemotherapy if the 21-gene RS was 11-25. Further research is required to elucidate the basis for this racial disparity in prognosis.
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Affiliation(s)
- Kathy S Albain
- Loyola University Chicago Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | | | - Della F Makower
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amir Faghih
- Thunder Bay Regional Health Science Centre, Thunder Bay, Ontario, Canada
| | | | | | | | | | - John A Olson
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tracy Lively
- National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - Sunil S Badve
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Lynne I Wagner
- Wake Forest University Health Service, Winston Salem, NC, USA
| | | | | | | | | | - Henry L Gomez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | | | | | | | | | | | | | - Jeffrey Abrams
- National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | | | - Joseph A Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Babatunde OA, Eberth JM, Felder T, Moran R, Truman S, Hebert JR, Zhang J, Adams SA. Social Determinants of Racial Disparities in Breast Cancer Mortality Among Black and White Women. J Racial Ethn Health Disparities 2021; 8:147-156. [PMID: 32385849 PMCID: PMC7648729 DOI: 10.1007/s40615-020-00766-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/09/2020] [Accepted: 04/22/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Mortality from breast cancer among Black women is 60% greater than that of White women in South Carolina (SC). The aim of this study was to assess racial differences in mortality among Black and White breast cancer patients based on variations in social determinants and access to state-based early detection programs. METHODS We obtained a retrospective record for breast cancer patients diagnosed between 2002 and 2010 from the SC Central Cancer Registry. Mortality was the main outcome while race-stratified Cox proportional hazard models were performed to assess disparities in mortality. We assessed effect modification, and we used an automated backward elimination process to obtain the best fitting models. RESULTS There were 3286 patients of which the majority were White women (2186, 66.52%). Compared with married White women, the adjusted hazard ratio (aHR) for mortality was greatest among Black unmarried women (aHR 2.31, CI 1.83, 2.91). Compared with White women who lived in the Low Country region mortality was greatest among Black women who lived in the Midland (aHR 2.17 CI 1.47, 3.21) and Upstate (aHR 2.96 CI 1.96, 2.49). Mortality was higher among Black women that were not receiving services in the Best Chance Network (BCN) program (aHR 1.70, CI 1.40, 2.04) compared with White women. CONCLUSIONS To reduce the racial disparity gap in survival in SC, Black breast cancer patients who live in the Upstate, are unmarried, and those that are not enrolled in the BCN program may benefit from more intense navigation efforts directed at early detection and linkage to breast cancer treatments.
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Affiliation(s)
- Oluwole Adeyemi Babatunde
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.
| | - Jan M Eberth
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Tisha Felder
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
| | - Robert Moran
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Samantha Truman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - James R Hebert
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
- Connecting Health Innovations LLC, 1417 Gregg Street, Columbia, SC, 29201, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Swann Arp Adams
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
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Emerson MA, Golightly YM, Aiello AE, Reeder-Hayes KE, Tan X, Maduekwe U, Johnson-Thompson M, Olshan AF, Troester MA. Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women. Cancer 2020; 126:4957-4966. [PMID: 32954493 DOI: 10.1002/cncr.33121] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/10/2020] [Accepted: 07/06/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Breast cancer mortality is higher for Black and younger women. This study evaluated 2 possible contributors to disparities-time to treatment and treatment duration-by race and age. METHODS Among 2841 participants with stage I-III disease in the Carolina Breast Cancer Study, we identified groups of women with similar patterns of socioeconomic status (SES), access to care, and tumor characteristics using latent class analysis. We then evaluated latent classes in association with treatment delay (initiation >60 days after diagnosis) and treatment duration (in quartiles by treatment modality). RESULTS Thirty-two percent of younger Black women were in the highest quartile of treatment duration (versus 22% of younger White women). Black women experienced a higher frequency of delayed treatment (adjusted relative frequency difference [RFD], 5.5% [95% CI, 3.2%-7.8%]) and prolonged treatment duration (RFD, 8.8% [95% CI, 5.7%-12.0%]). Low SES was significantly associated with treatment delay among White women (RFD, 3.5% [95% CI, 1.1%-5.9%]), but treatment delay was high at all levels of SES in Black women (eg, 11.7% in high SES Black women compared with 10.6% and 6.7% among low and high SES White women, respectively). Neither SES nor access to care classes were significantly associated with delayed initiation among Black women, but both low SES and more barriers were associated with treatment duration across both groups. CONCLUSIONS Factors that influence treatment timeliness persist throughout the care continuum, with prolonged treatment duration being a sensitive indicator of differences by race, SES, and care barriers.
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Affiliation(s)
- Marc A Emerson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yvonne M Golightly
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Xianming Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ugwuji Maduekwe
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Melissa A Troester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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10
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Hill HE, Schiemann WP, Varadan V. Understanding breast cancer disparities-a multi-scale challenge. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:906. [PMID: 32793750 DOI: 10.21037/atm.2020.04.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite convergence of overall breast cancer incidence rates between European American (EA) and African American (AA) women, disparities in mortality persist. The factors contributing to differences in mortality rates across population groups remain controversial and range from population genetics to sociodemographic influences. This review explores the complex multi-factorial nature of tumor-intrinsic and -extrinsic factors that impact the biology and clinical outcomes of breast cancer patients. In addition to summarizing the current state of breast cancer disparities research, we also motivate the development of integrative multi-scale approaches involving interdisciplinary teams to tackle this complex clinical challenge.
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Affiliation(s)
- Hannah E Hill
- Department of Pharmacology, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - William P Schiemann
- Department of Pharmacology, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of General Medical Sciences-Oncology, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Vinay Varadan
- Department of Pharmacology, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of General Medical Sciences-Oncology, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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11
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Kim G, Pastoriza JM, Condeelis JS, Sparano JA, Filippou PS, Karagiannis GS, Oktay MH. The Contribution of Race to Breast Tumor Microenvironment Composition and Disease Progression. Front Oncol 2020; 10:1022. [PMID: 32714862 PMCID: PMC7344193 DOI: 10.3389/fonc.2020.01022] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022] Open
Abstract
Breast cancer is the second most commonly diagnosed cancer in American women following skin cancer. Despite overall decrease in breast cancer mortality due to advances in treatment and earlier screening, black patients continue to have 40% higher risk of breast cancer related death compared to white patients. This disparity in outcome persists even when controlled for access to care and stage at presentation and has been attributed to differences in tumor subtypes or gene expression profiles. There is emerging evidence that the tumor microenvironment (TME) may contribute to the racial disparities in outcome as well. Here, we provide a comprehensive review of current literature available regarding race-dependent differences in the TME. Notably, black patients tend to have a higher density of pro-tumorigenic immune cells (e.g., M2 macrophages, regulatory T cells) and microvasculature. Although immune cells are classically thought to be anti-tumorigenic, increase in M2 macrophages and angiogenesis may lead to a paradoxical increase in metastasis by forming doorways of tumor cell intravasation called tumor microenvironment of metastasis (TMEM). Furthermore, black patients also have higher serum levels of inflammatory cytokines, which provide a positive feedback loop in creating a pro-metastatic TME. Lastly, we propose that the higher density of immune cells and angiogenesis observed in the TME of black patients may be a result of evolutionary selection for a more robust immune response in patients of African geographic ancestry. Better understanding of race-dependent differences in the TME will aid in overcoming the racial disparity in breast cancer mortality.
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Affiliation(s)
- Gina Kim
- Department of Anatomy and Structural Biology, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Integrated Imaging Program, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Department of Surgery, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States
| | - Jessica M Pastoriza
- Department of Surgery, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States
| | - John S Condeelis
- Department of Anatomy and Structural Biology, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Integrated Imaging Program, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Department of Surgery, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Gruss-Lipper Biophotonics Center, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States
| | - Joseph A Sparano
- Integrated Imaging Program, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Department of Medicine (Oncology), Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States
| | - Panagiota S Filippou
- School of Health & Life Sciences, Teesside University, Middlesbrough, United Kingdom.,National Horizons Centre, Teesside University, Darlington, United Kingdom
| | - George S Karagiannis
- Department of Anatomy and Structural Biology, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Integrated Imaging Program, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Gruss-Lipper Biophotonics Center, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States
| | - Maja H Oktay
- Department of Anatomy and Structural Biology, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Integrated Imaging Program, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Gruss-Lipper Biophotonics Center, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.,Department of Pathology, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States
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12
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Steele SR, Bilchik A, Johnson EK, Nissan A, Peoples GE, Eberhardt JS, Kalina P, Petersen B, BrüCher B, Protic M, Avital I, Stojadinovic A. Time-dependent Estimates of Recurrence and Survival in Colon Cancer: Clinical Decision Support System Tool Development for Adjuvant Therapy and Oncological Outcome Assessment. Am Surg 2020. [DOI: 10.1177/000313481408000514] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Unanswered questions remain in determining which high-risk node-negative colon cancer (CC) cohorts benefit from adjuvant therapy and how it may differ in an equal access population. Machine-learned Bayesian Belief Networks (ml-BBNs) accurately estimate outcomes in CC, providing clinicians with Clinical Decision Support System (CDSS) tools to facilitate treatment planning. We evaluated ml-BBNs ability to estimate survival and recurrence in CC. We performed a retrospective analysis of registry data of patients with CC to train–test–crossvalidate ml-BBNs using the Department of Defense Automated Central Tumor Registry (January 1993 to December 2004). Cases with events or follow-up that passed quality control were stratified into 1-, 2-, 3-, and 5-year survival cohorts. ml-BBNs were trained using machine-learning algorithms and k-fold crossvalidation and receiver operating characteristic curve analysis used for validation. BBNs were comprised of 5301 patients and areas under the curve ranged from 0.85 to 0.90. Positive predictive values for recurrence and mortality ranged from 78 to 84 per cent and negative predictive values from 74 to 90 per cent by survival cohort. In the 12-month model alone, 1,132,462,080 unique rule sets allow physicians to predict individual recurrence/mortality estimates. Patients with Stage II (N0M0) CC benefit from chemotherapy at different rates. At one year, all patients older than 73 years of age with T2–4 tumors and abnormal carcinoembryonic antigen levels benefited, whereas at five years, all had relative reduction in mortality with the largest benefit amongst elderly, highest T-stage patients. ml-BBN can readily predict which high-risk patients benefit from adjuvant therapy. CDSS tools yield individualized, clinically relevant estimates of outcomes to assist clinicians in treatment planning.
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Affiliation(s)
- Scott R. Steele
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the
- Department of Surgery, Madigan Army Medical Center, Tacoma, Washington; the
| | - Anton Bilchik
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- John Wayne Cancer Institute, Santa Monica, California, and the California Oncology Research Institute, Los Angeles, California; the
- INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy, Munich, Germany; the
| | - Eric K. Johnson
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- Department of Surgery, Madigan Army Medical Center, Tacoma, Washington; the
| | - Aviram Nissan
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; the
- INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy, Munich, Germany; the
| | - George E. Peoples
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- Department of Surgery, Brooke Army Medical Center, San Antonio, Texas
| | | | | | | | - BjöRn BrüCher
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- Bon Secours Cancer Institute, Richmond, Virginia
- INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy, Munich, Germany; the
| | - Mladjan Protic
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy, Munich, Germany; the
- Clinic of Abdominal, Endocrine, and Transplantation Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia
- University of Novi Sad–Medical Faculty, Novi Sad, Serbia
| | - Itzhak Avital
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- Bon Secours Cancer Institute, Richmond, Virginia
- INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy, Munich, Germany; the
| | - Alexander Stojadinovic
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the
- U.S. Military Cancer Institute, Clinical Trials Group, Washington, DC; the
- Department of Surgery, Division of Surgical Oncology, Walter Reed Army Medical Center, Washington, DC; the
- INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy, Munich, Germany; the
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13
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Wieder R, Shafiq B, Adam N. Greater Survival Improvement in African American vs. Caucasian Women with Hormone Negative Breast Cancer. J Cancer 2020; 11:2808-2820. [PMID: 32226499 PMCID: PMC7086262 DOI: 10.7150/jca.39091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/30/2019] [Indexed: 01/01/2023] Open
Abstract
Background: African American women have not benefited equally from recently improved breast cancer survival. We investigated if this was true for all subsets. Methods: We identified 395,170 patients with breast adenocarcinoma from the SEER database from 1990 to 2011 with designated race, age, stage, grade, ER and PR status, marital status and laterality, as control. We grouped patients into two time periods, 1990-2000 and 2001-2011, three age categories, under 40, 40-69 and ≥ 70 years and two stage categories, I-III and IV. We used the Kaplan-Meier and logrank tests to compare survival curves. We stratified data by patient- and tumor-associated variables to determine co-variation among confounding factors using the Pearson Chi-square test and Cox proportional hazards regression to determine hazard ratios (HR) to compare survival. Results: Stage I-III patients of both races ≥ 70 years old, African American widowed patients and Caucasians with ER- and PR- tumors had worse improvements in survival in 2001-2011 than younger, married or hormone receptor positive patients, respectively. In contrast, African Americans with ER- (Cox HR 0.70 [95% CI 0.65-0.76]) and PR- (Cox HR 0.67 [95% CI 0.62-0.72]) had greater improvement in survival in 2001-2011 than Caucasians with ER- (Cox HR 0.81 [95% CI 0.78-0.84]) and PR- disease (Cox HR 0.75 [95% CI 0.73-0.78]). This was not associated with changes in distribution of tumor or patient attributes. Conclusions: African American women with stage I-III ER- and PR- breast cancer had greater improvement in survival than Caucasians in 2001-2011. This is the first report of an improvement in racial disparities in survival from breast cancer in a subset of patients.
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Affiliation(s)
- Robert Wieder
- Department of Medicine, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences.,The Cancer Institute of New Jersey, Rutgers Biomedical and Health Sciences
| | - Basit Shafiq
- Institute of Data Science, Learning, and Applications (I-DSLA), Rutgers University Newark.,Department of Computer Science, Lahore University of Management Sciences (LUMS)
| | - Nabil Adam
- Department of Medicine, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences.,Institute of Data Science, Learning, and Applications (I-DSLA), Rutgers University Newark.,Department of Management Science and Information Systems, Rutgers Business School
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14
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Eaglehouse YL, Georg MW, Shriver CD, Zhu K. Racial Differences in Time to Breast Cancer Surgery and Overall Survival in the US Military Health System. JAMA Surg 2019; 154:e185113. [PMID: 30673075 DOI: 10.1001/jamasurg.2018.5113] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Racial disparities in time to surgery (TTS) after a breast cancer diagnosis and whether these differences account for disparities in overall survival have been understudied in the US population. Objectives To compare TTS in non-Hispanic black (NHB) and non-Hispanic white (NHW) women with breast cancer and to examine whether racial differences in TTS may explain possible racial disparities in overall survival in a universal health care system. Design, Setting, and Participants Retrospective cohort identified from the Department of Defense Central Cancer Registry and Military Health System Data Repository linked databases containing records between January 1, 1998, and December 31, 2008, of 998 NHB women and 3899 NHW women who received a diagnosis of stages I to III breast cancer and underwent breast-conserving surgery (BCS) or mastectomy in the US Military Health System during the study period. Data analyses were conducted from July 5, 2017, to December 29, 2017. Main Outcomes and Measures The main outcome was time to breast cancer surgery. Non-Hispanic black and NHW women were compared at the 25th, 50th (median), 75th, and 90th percentiles of TTS by using multivariable quantile regression. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for all-cause death in NHB compared with NHW women after controlling for potential confounders first without and then with TTS. Results Among the 4887 NHB and NHW women in the cohort, the mean (SD) age was 50.0 (9.4) years. The median TTS was 21 days (95% CI, 20.6-21.4 days) among NHW women and 22 days (95% CI, 20.6-23.4 days) among NHB women. Non-Hispanic black women had a significantly greater estimated TTS at the 75th (3.6 days; 95% CI, 1.6-5.5 days) and 90th (8.9 days; 95% CI, 5.1-12.6 days) percentiles than NHW women in multivariable models. The estimated differences were similar by surgery type. Non-Hispanic black women had a higher adjusted risk for death (HR, 1.45; 95% CI, 1.06-2.01) compared with NHW women among patients receiving breast-conserving surgery. The risks were similar between races among those receiving mastectomy (HR, 1.06; 95% CI, 0.76-1.48). The HRs remained similar after adding TTS to the Cox proportional hazards regression models. Conclusions and Relevance This study's results indicate that time to breast cancer surgery was delayed for NHB compared with NHW women in the Military Health System. However, the racial differences in TTS did not explain the observed racial differences in overall survival among women who received breast-conserving surgery.
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Affiliation(s)
- Yvonne L Eaglehouse
- John P. Murtha Cancer Center, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
| | - Matthew W Georg
- John P. Murtha Cancer Center, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Craig D Shriver
- John P. Murtha Cancer Center, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
| | - Kangmin Zhu
- John P. Murtha Cancer Center, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
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15
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Chang CS, Kitamura E, Johnson J, Bollag R, Hawthorn L. Genomic analysis of racial differences in triple negative breast cancer. Genomics 2018; 111:1529-1542. [PMID: 30366040 DOI: 10.1016/j.ygeno.2018.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/09/2018] [Accepted: 10/17/2018] [Indexed: 01/26/2023]
Abstract
Triple negative breast cancer (TNBC) is more prevalent in African Americans (AAs), has a more aggressive clinical course including a higher mortality rate and an increased occurrence of metastases. This study was designed to determine if racial differences at the molecular level might explain the more aggressive phenotype in AAs. Mutation profiling, was performed on 51 AA and 77 CA tumor/ normal pairs. Transcript expression analysis was performed on 35AA and 37CA. Genes with high frequency mutation rates such as MUC4 and TP53 were common to both racial populations, however genes that were less frequently mutated differed between the races suggesting that those cause the more aggressive nature of TNBC in AA women. JAK-Stat and HER2 signaling were unique to the AA and PTEN and mTOR were unique to the CA profiles. Many pathways identified by the mutational profiles were predicted to be down-regulated by the transcript expression profiles.
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Affiliation(s)
| | - Eiko Kitamura
- Georgia Cancer Center at Augusta University, Augusta, GA, USA
| | - Joan Johnson
- Georgia Cancer Center at Augusta University, Augusta, GA, USA
| | - Roni Bollag
- Georgia Cancer Center at Augusta University, Augusta, GA, USA
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16
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Purwaha P, Gu F, Piyarathna DWB, Rajendiran T, Ravindran A, Omilian AR, Jiralerspong S, Das G, Morrison C, Ambrosone C, Coarfa C, Putluri N, Sreekumar A. Unbiased Lipidomic Profiling of Triple-Negative Breast Cancer Tissues Reveals the Association of Sphingomyelin Levels with Patient Disease-Free Survival. Metabolites 2018; 8:metabo8030041. [PMID: 30011843 PMCID: PMC6161031 DOI: 10.3390/metabo8030041] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 12/26/2022] Open
Abstract
The reprogramming of lipid metabolism is a hallmark of many cancers that has been shown to promote breast cancer progression. While several lipid signatures associated with breast cancer aggressiveness have been identified, a comprehensive lipidomic analysis specifically targeting the triple-negative subtype of breast cancer (TNBC) may be required to identify novel biomarkers and therapeutic targets for this most aggressive subtype of breast cancer that still lacks effective therapies. In this current study, our global LC-MS-based lipidomics platform was able to measure 684 named lipids across 15 lipid classes in 70 TNBC tumors. Multivariate survival analysis found that higher levels of sphingomyelins were significantly associated with better disease-free survival in TNBC patients. Furthermore, analysis of publicly available gene expression datasets identified that decreased production of ceramides and increased accumulation of sphingoid base intermediates by metabolic enzymes were associated with better survival outcomes in TNBC patients. Our LC-MS lipidomics profiling of TNBC tumors has, for the first time, identified sphingomyelins as a potential prognostic marker and implicated enzymes involved in sphingolipid metabolism as candidate therapeutic targets that warrant further investigation.
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Affiliation(s)
- Preeti Purwaha
- Alkek Center for Molecular Discovery and Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Franklin Gu
- Alkek Center for Molecular Discovery and Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX 77030, USA.
- Verna and Mars McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX 77030, USA.
| | | | | | - Anindita Ravindran
- Alkek Center for Molecular Discovery and Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Angela R Omilian
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Sao Jiralerspong
- Alkek Center for Molecular Discovery and Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Gokul Das
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Carl Morrison
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | | | - Cristian Coarfa
- Alkek Center for Molecular Discovery and Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Nagireddy Putluri
- Alkek Center for Molecular Discovery and Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Arun Sreekumar
- Alkek Center for Molecular Discovery and Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX 77030, USA.
- Verna and Mars McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX 77030, USA.
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17
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Hill DA, Friend S, Lomo L, Wiggins C, Barry M, Prossnitz E, Royce M. Breast cancer survival, survival disparities, and guideline-based treatment. Breast Cancer Res Treat 2018; 170:405-414. [PMID: 29569018 PMCID: PMC6002943 DOI: 10.1007/s10549-018-4761-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/16/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE The role of appropriate therapy in breast cancer survival and survival disparities by race/ethnicity has not been fully elucidated. We investigated whether lack of guideline-recommended therapy contributed to survival differences overall and among Hispanics relative to non-Hispanic white (NHW) women in a case-cohort study. METHODS The study included a 15% random sample of female invasive breast cancer patients diagnosed from 1997 to 2009 in 6 New Mexico counties and all deaths due to breast cancer-related causes. Information was obtained from comprehensive medical chart reviews. National Comprehensive Cancer Network (NCCN®) guideline-recommended treatment was assessed among white women aged < 70 who were free of contraindications for recommended therapy, had stage I-III tumors, and survived ≥ 12 months. Hazard ratios (HRs) and 95% confidence intervals (CIs) for breast cancer death were estimated using Cox proportional hazards models. RESULTS Included women represented 4635 patients and 449 breast cancer deaths. Women who did not receive radiotherapy (HR 2.3; 95% CI 1.2-4.4) or endocrine therapy (HR 2.0; 95% CI 1.0-4.0) as recommended by guidelines had an increased risk of breast cancer death, relative to those treated appropriately. Receipt of guideline-recommended therapy did not differ between Hispanic and NHW women for chemotherapy (84.2% vs. 81.3%, respectively), radiotherapy (89.2% vs. 91.1%), or endocrine therapy (89.2% vs. 85.8%), thus did not influence Hispanic survival disparities. CONCLUSIONS Lack of guideline-recommended radiotherapy or endocrine therapy contributed to survival as strongly as other established prognostic indicators. Hispanic survival disparities in this population do not appear to be attributable to treatment differences.
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Affiliation(s)
- Deirdre A Hill
- Internal Medicine Department, University of New Mexico School of Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA.
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA.
| | - Sarah Friend
- Department of Hematology/Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Lesley Lomo
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Charles Wiggins
- Internal Medicine Department, University of New Mexico School of Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Marc Barry
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Eric Prossnitz
- Internal Medicine Department, University of New Mexico School of Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Melanie Royce
- Internal Medicine Department, University of New Mexico School of Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
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18
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19
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The continuum of breast cancer care and outcomes in the U.S. Military Health System: an analysis by benefit type and care source. J Cancer Surviv 2018; 12:407-416. [PMID: 29455447 DOI: 10.1007/s11764-018-0680-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/07/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE This study investigates transition rates between breast cancer diagnosis, recurrence, and death by insurance benefit type and care source in U.S. Military Health System (MHS). METHODS The MHS data repository and central cancer registry linked data were used to identify women aged 40-64 with histologically confirmed breast cancer between 2003 and 2007. Three-state continuous time Markov models were used to estimate transition rates and transition rate ratios (TRRs) by TRICARE benefit type (Prime or non-Prime) and care source (direct, purchased, or both), adjusted for demographic, tumor, and treatment variables. RESULTS Analyses included 2668 women with transitions from diagnosis to recurrence (n = 832), recurrence to death (n = 79), and diagnosis to death without recurrence (n = 91). Compared to women with Prime within each care source, women with non-Prime using both care sources had higher transition rates (TRR 1.47, 95% CI 1.03, 2.10). Compared to those using direct care within each benefit type, women utilizing both care sources with non-Prime had higher transition rates (TRR 1.86, 95% CI 1.11, 3.13), while women with Prime utilizing purchased care had lower transition rates (TRR 0.82, 95% CI 0.68, 0.98). CONCLUSIONS In the MHS, women with non-Prime benefit plans compared to Prime had higher transition rates along the breast cancer continuum among both care source users. Purchased care users had lower transition rates than direct care users among Prime beneficiaries. IMPLICATIONS FOR CANCER SURVIVORS Benefit plan and care source may be associated with breast cancer progression. Further research is needed to demonstrate differences in survivorship.
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20
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Smith CJ, Minas TZ, Ambs S. Analysis of Tumor Biology to Advance Cancer Health Disparity Research. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 188:304-316. [PMID: 29137948 DOI: 10.1016/j.ajpath.2017.06.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/24/2017] [Accepted: 06/29/2017] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Cheryl J Smith
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Tsion Z Minas
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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21
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Jiagge E, Oppong JK, Bensenhaver J, Aitpillah F, Gyan K, Kyei I, Osei-Bonsu E, Adjei E, Ohene-Yeboah M, Toy K, Jackson KE, Akpaloo M, Acheampong D, Antwi B, Agyeman FO, Alhassan Z, Fondjo LA, Owusu-Afriyie O, Brewer RN, Gyamfuah A, Salem B, Johnson T, Wicha M, Merajver S, Kleer C, Pang J, Amankwaa-Frempong E, Stark A, Abantanga F, Newman L, Awuah B. Breast Cancer and African Ancestry: Lessons Learned at the 10-Year Anniversary of the Ghana-Michigan Research Partnership and International Breast Registry. J Glob Oncol 2016; 2:302-310. [PMID: 28717716 PMCID: PMC5493263 DOI: 10.1200/jgo.2015.002881] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Women with African ancestry in western, sub-Saharan Africa and in the United States represent a population subset facing an increased risk of being diagnosed with biologically aggressive phenotypes of breast cancer that are negative for the estrogen receptor, the progesterone receptor, and the HER2/neu marker. These tumors are commonly referred to as triple-negative breast cancer. Disparities in breast cancer incidence and outcome related to racial or ethnic identity motivated the establishment of the International Breast Registry, on the basis of partnerships between the Komfo Anokye Teaching Hospital in Kumasi, Ghana, the University of Michigan Comprehensive Cancer Center in Ann Arbor, Michigan, and the Henry Ford Health System in Detroit, Michigan. This research collaborative has featured educational training programs as well as scientific investigations related to the comparative biology of breast cancer in Ghanaian African, African American, and white/European American patients. Currently, the International Breast Registry has expanded to include African American patients throughout the United States by partnering with the Sisters Network (a national African American breast cancer survivors' organization) and additional sites in Ghana (representing West Africa) as well as Ethiopia (representing East Africa). Its activities are now coordinated through the Henry Ford Health System International Center for the Study of Breast Cancer Subtypes. Herein, we review the history and results of this international program at its 10-year anniversary.
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Affiliation(s)
- Evelyn Jiagge
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Joseph Kwaku Oppong
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Jessica Bensenhaver
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Francis Aitpillah
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Kofi Gyan
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Ishmael Kyei
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Ernest Osei-Bonsu
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Ernest Adjei
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Michael Ohene-Yeboah
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Kathy Toy
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Karen Eubanks Jackson
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Marian Akpaloo
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Dorcas Acheampong
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Beatrice Antwi
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Faustina Obeng Agyeman
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Zainab Alhassan
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Linda Ahenkorah Fondjo
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Osei Owusu-Afriyie
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Robert Newman Brewer
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Amma Gyamfuah
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Barbara Salem
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Timothy Johnson
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Max Wicha
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Sofia Merajver
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Celina Kleer
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Judy Pang
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Emmanuel Amankwaa-Frempong
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Azadeh Stark
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Francis Abantanga
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Lisa Newman
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Baffour Awuah
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
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22
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Killelea BK, Chagpar AB, Horowitz NR, Lannin DR. Characteristics and treatment of human epidermal growth factor receptor 2 positive breast cancer: 43,485 cases from the National Cancer Database treated in 2010 and 2011. Am J Surg 2016; 213:426-432. [PMID: 27769548 DOI: 10.1016/j.amjsurg.2016.05.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/05/2016] [Accepted: 05/16/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although identification of human epidermal growth factor receptor 2 (Her2) positive breast cancer represents one of the greatest advances over the past 3 decades, it has not been studied extensively on a national level. METHODS The National Cancer Database is a joint project of the American Cancer Society and the American College of Surgeons and contains data on about 70% of the cancer cases in the United States. Data on Her2 have been collected since 2010 and was used for this study. RESULTS Of 298,937 cases of invasive breast cancer with known Her2 status diagnosed in 2010 and 2011, 43,485 (14.5%) were Her2 positive. Her2 positivity was greatest in Asian/Pacific Islanders and least in non-Hispanic Whites and was markedly more common in younger women. The incidence of Her2 positive tumors ranged from a low of 13.9% in the Mountain West region to a high of 16.0% in the West South Central region (P < .001). Compared with Her2 negative tumors, Her2 positive tumors were larger (2.6 vs 2.2 cm, P < .001), more likely to have positive nodes (39% vs 31% P < .001), have lymphovascular invasion (30% vs 20%, P < .001), and be high grade (56% vs 29%, P < .001). There were also differences by histology: invasive ductal 16.4%, invasive lobular 5.5%, tubular 2.3%, inflammatory 36%, and Paget's with invasion 59%. When adjusted for age, race, tumor size, and nodal status Her2 positive tumors were much more likely to receive chemotherapy (odds ratio = 5.5, confidence interval = 5.2 to 6.0) and somewhat less likely to undergo breast preservation (odds ratio = .78, confidence interval = .76 to .80). CONCLUSIONS Her2 positive tumors have distinct epidemiologic, clinical, and treatment characteristics.
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Affiliation(s)
- Brigid K Killelea
- Department of Surgery, Yale University School of Medicine, The Breast Center, Smilow Cancer Hospital at Yale-New Haven, 20 York Street North Pavilion, First Floor, New Haven, CT 06510, USA.
| | - Anees B Chagpar
- Department of Surgery, Yale University School of Medicine, The Breast Center, Smilow Cancer Hospital at Yale-New Haven, 20 York Street North Pavilion, First Floor, New Haven, CT 06510, USA
| | - Nina R Horowitz
- Department of Surgery, Yale University School of Medicine, The Breast Center, Smilow Cancer Hospital at Yale-New Haven, 20 York Street North Pavilion, First Floor, New Haven, CT 06510, USA
| | - Donald R Lannin
- Department of Surgery, Yale University School of Medicine, The Breast Center, Smilow Cancer Hospital at Yale-New Haven, 20 York Street North Pavilion, First Floor, New Haven, CT 06510, USA
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23
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Sposto R, Keegan THM, Vigen C, Kwan ML, Bernstein L, John EM, Cheng I, Yang J, Koo J, Kurian AW, Caan BJ, Lu Y, Monroe KR, Shariff-Marco S, Gomez SL, Wu AH. The Effect of Patient and Contextual Characteristics on Racial/Ethnic Disparity in Breast Cancer Mortality. Cancer Epidemiol Biomarkers Prev 2016; 25:1064-72. [PMID: 27197297 PMCID: PMC4930680 DOI: 10.1158/1055-9965.epi-15-1326] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/29/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Racial/ethnic disparity in breast cancer-specific mortality in the United States is well documented. We examined whether accounting for racial/ethnic differences in the prevalence of clinical, patient, and lifestyle and contextual factors that are associated with breast cancer-specific mortality can explain this disparity. METHODS The California Breast Cancer Survivorship Consortium combined interview data from six California-based breast cancer studies with cancer registry data to create a large, racially diverse cohort of women with primary invasive breast cancer. We examined the contribution of variables in a previously reported Cox regression baseline model plus additional contextual, physical activity, body size, and comorbidity variables to the racial/ethnic disparity in breast cancer-specific mortality. RESULTS The cohort comprised 12,098 women. Fifty-four percent were non-Latina Whites, 17% African Americans, 17% Latinas, and 12% Asian Americans. In a model adjusting only for age and study, breast cancer-specific HRs relative to Whites were 1.69 (95% CI, 1.46-1.96), 1.00 (0.84-1.19), and 0.52 (0.33-0.85) for African Americans, Latinas, and Asian Americans, respectively. Adjusting for baseline-model variables decreased disparity primarily by reducing the HR for African Americans to 1.13 (0.96-1.33). The most influential variables were related to disease characteristics, neighborhood socioeconomic status, and smoking status at diagnosis. Other variables had negligible impact on disparity. CONCLUSIONS Although contextual, physical activity, body size, and comorbidity variables may influence breast cancer-specific mortality, they do not explain racial/ethnic mortality disparity. IMPACT Other factors besides those investigated here may explain the existing racial/ethnic disparity in mortality. Cancer Epidemiol Biomarkers Prev; 25(7); 1064-72. ©2016 AACR.
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Affiliation(s)
- Richard Sposto
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California. Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California.
| | - Theresa H M Keegan
- Division of Hematology and Oncology, Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, California
| | - Cheryl Vigen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Esther M John
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California
| | - Iona Cheng
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California
| | - Juan Yang
- Cancer Prevention Institute of California, Fremont, California
| | - Jocelyn Koo
- Cancer Prevention Institute of California, Fremont, California
| | - Allison W Kurian
- Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California
| | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Yani Lu
- City of Hope, Duarte, California
| | - Kristine R Monroe
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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24
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Koru-Sengul T, Santander AM, Miao F, Sanchez LG, Jorda M, Glück S, Ince TA, Nadji M, Chen Z, Penichet ML, Cleary MP, Torroella-Kouri M. Breast cancers from black women exhibit higher numbers of immunosuppressive macrophages with proliferative activity and of crown-like structures associated with lower survival compared to non-black Latinas and Caucasians. Breast Cancer Res Treat 2016; 158:113-126. [PMID: 27283835 DOI: 10.1007/s10549-016-3847-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/27/2016] [Indexed: 12/16/2022]
Abstract
Racial disparities in breast cancer incidence and outcome are a major health care challenge. Patients in the black race group more likely present with an early onset and more aggressive disease. The occurrence of high numbers of macrophages is associated with tumor progression and poor prognosis in solid malignancies. Macrophages are observed in adipose tissues surrounding dead adipocytes in "crown-like structures" (CLS). Here we investigated whether the numbers of CD163+ tumor-associated macrophages (TAMs) and/or CD163+ CLS are associated with patient survival and whether there are significant differences across blacks, non-black Latinas, and Caucasians. Our findings confirm that race is statistically significantly associated with the numbers of TAMs and CLS in breast cancer, and demonstrate that the highest numbers of CD163+ TAM/CLS are found in black breast cancer patients. Our results reveal that the density of CD206 (M2) macrophages is a significant predictor of progression-free survival univariately and is also significant after adjusting for race and for HER2, respectively. We examined whether the high numbers of TAMs detected in tumors from black women were associated with macrophage proliferation, using the Ki-67 nuclear proliferation marker. Our results reveal that TAMs actively divide when in contact with tumor cells. There is a higher ratio of proliferating macrophages in tumors from black patients. These findings suggest that interventions based on targeting TAMs may not only benefit breast cancer patients in general but also serve as an approach to remedy racial disparity resulting in better prognosis patients from minority racial groups.
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Affiliation(s)
- Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ana M Santander
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, 1600 NW 10th Avenue Rosenstiel Medical School Building Suite 3123A, P.O. Box 016960 (R-138), Miami, FL, 33101, USA
| | - Feng Miao
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lidia G Sanchez
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, 1600 NW 10th Avenue Rosenstiel Medical School Building Suite 3123A, P.O. Box 016960 (R-138), Miami, FL, 33101, USA
| | - Merce Jorda
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stefan Glück
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.,Celgene Corporation, Summit, NJ, USA
| | - Tan A Ince
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mehrad Nadji
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zhibin Chen
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, 1600 NW 10th Avenue Rosenstiel Medical School Building Suite 3123A, P.O. Box 016960 (R-138), Miami, FL, 33101, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Manuel L Penichet
- Division of Surgical Oncology, Department of Surgery, UCLA, Los Angeles, CA, USA.,Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine at UCLA, UCLA, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA.,UCLA AIDS Institute, UCLA, Los Angeles, CA, USA.,The Molecular Biology Institute, UCLA, Los Angeles, CA, USA
| | - Margot P Cleary
- Hormel Institute, University of Minnesota, Austin, MN, 55912, USA
| | - Marta Torroella-Kouri
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA. .,Department of Microbiology and Immunology, University of Miami Miller School of Medicine, 1600 NW 10th Avenue Rosenstiel Medical School Building Suite 3123A, P.O. Box 016960 (R-138), Miami, FL, 33101, USA. .,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
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Moses KA, Orom H, Brasel A, Gaddy J, Underwood W. Racial/ethnic differences in the relative risk of receipt of specific treatment among men with prostate cancer. Urol Oncol 2016; 34:415.e7-415.e12. [PMID: 27161898 DOI: 10.1016/j.urolonc.2016.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/21/2016] [Accepted: 04/05/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE African-American (AA) men have excess mortality from prostate cancer compared with White men, which has remained unchanged over several decades. The purpose of this study is to determine if race/ethnicity is an independent predictor of receipt of any definitive treatment vs. watchful waiting/active surveillance (WW/AS). METHODS AND MATERIALS Men diagnosed with prostate cancer from 2004 to 2011 were identified from the Surveillance, Epidemiology, and End-Results program. Multinomial logistic regression analysis was performed to determine the relative risk ratio (RRR) of receipt of radical prostatectomy (RP), external beam radiation therapy (RT), brachytherapy, cryotherapy, or combination therapy vs. WW/AS. RESULTS Compared with White men, AA men were significantly less likely to receive RP (RRR = 0.53, P<0.001), brachytherapy (RRR = 0.72, P<0.001), cryotherapy (RRR = 0.84, P = 0.001), and combination therapy (RRR = 0.70, P<0.001), and more likely to receive RT (RRR = 1.03, P = 0.041) vs. AS/WW. Hispanic men were significantly less likely to receive RP (RRR = 0.84, P<0.001) and brachytherapy (RRR = 0.77, P<0.001), and more likely to receive RT (RRR = 1.08, P<0.001), and cryotherapy (RRR = 1.19, P = 0.005) vs. AS/WW compared with White men. CONCLUSIONS The disparate risk of receiving definitive treatment among AA and Hispanic men represents a significant public health issue that requires efforts to improve physician education, increase cultural competency, and ensure equitable access.
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Affiliation(s)
- Kelvin A Moses
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Alicia Brasel
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Jacquelyne Gaddy
- Loyola University Chicago Stritch School of Medicine, Chicago, IL
| | - Willie Underwood
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY; Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
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Mbah O, Ford JG, Qiu M, Wenzel J, Bone L, Bowie J, Elmi A, Slade JL, Towson M, Dobs AS. Mobilizing social support networks to improve cancer screening: the COACH randomized controlled trial study design. BMC Cancer 2015; 15:907. [PMID: 26573809 PMCID: PMC4647280 DOI: 10.1186/s12885-015-1920-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disadvantaged populations face many barriers to cancer care, including limited support in navigating through the complexities of the healthcare system. Family members play an integral role in caring for patients and provide valuable care coordination; however, the effect of family navigators on adherence to cancer screening has not previously been evaluated. Training and evaluating trusted family members and other support persons may improve cancer outcomes for vulnerable patients. METHODS Guided by principles of community based participatory research (CBPR), "Evaluating Coaches of Older Adults for Cancer Care and Healthy Behaviors (COACH)" is a community-based randomized controlled trial to assess the effectiveness of a trained participant-designated coach (support person or care giver) in navigating cancer-screening for older African American adults, 50-74 years old. Participants are randomly assigned as dyads (participant+coach pair) to receiving either printed educational materials only (PEM--control group) or educational materials plus coach training (COACH--intervention group). We defined a coach as family member, friend, or other lay support person designated by the older adult. The coach training is designed as a one-time, 35- to 40-minute training consisting of: 1) a didactic session that covers the role of the coach, basic facts about colorectal, breast and cervical cancers (including risk factors, signs and symptoms and screening modalities), engaging the healthcare provider in cancer screening, insurance coverage for screening, and related healthcare issues, 2) three video skits addressing misconceptions about and planning for cancer screening, and 3) an interactive role-play session with the trainer to reinforce and practice strategies for encouraging the participant to get screened. The primary study outcome is the difference in the proportion of participants completing at least one of the recommended screenings (for breast, cervix or colorectal cancer) between the control and intervention groups. DISCUSSION Building on trusted patient contacts to encourage cancer screening, COACH is a highly sustainable intervention in a high-risk population. It has the potential to minimize the effect of mistrust of the medical establishment on screening behaviors by mobilizing participants' existing support networks. If effective, the intervention could have a high impact on health care disparities research across multiple diseases. TRIAL REGISTRATION ClinicalTrials.gov ( NCT01613430 ). Registered June 5, 2012.
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Affiliation(s)
- Olive Mbah
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Jean G Ford
- Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, USA.
| | - Miaozhen Qiu
- Medical Oncology Department, Cancer Center of Sun Yat-sen University, Guangzhou, China.
| | - Jennifer Wenzel
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA.
| | - Lee Bone
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Janice Bowie
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ahmed Elmi
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Jimmie L Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA.
| | | | - Adrian S Dobs
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Aggarwal H, Callahan CM, Miller KD, Tu W, Loehrer PJ. Are There Differences in Treatment and Survival Between Poor, Older Black and White Women with Breast Cancer? J Am Geriatr Soc 2015; 63:2008-13. [PMID: 26456765 DOI: 10.1111/jgs.13669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore differences in treatment and survival outcome between poor, older black and white women with breast cancer. DESIGN Retrospective cohort study. SETTING Public safety net hospital. PARTICIPANTS Women aged 65 and older diagnosed with breast cancer from 1999 to 2008 (n = 1,000). MEASUREMENTS Breast cancer treatments that black and white women sought were compared using the Pearson chi-square test. All-cause mortality of black and white women was compared using hazard ratios derived from a multivariate Cox proportional hazards model. RESULTS There was no significant difference between older black and white women in surgical treatment, radiation therapy, chemotherapy, or hormone therapy over the study period. Race was not a significant predictor of survival in the Cox proportional hazards model that controlled for stage of cancer, age at diagnosis, dual-eligibility status, comorbid conditions, body mass index, smoking history, mammogram screening, and treatment for breast cancer. CONCLUSION Race did not appear to affect treatment or mortality in a cohort of older women with low socioeconomic status. This may be associated with similar healthcare delivery and equivalent access to health care for the older black and white women in this study.
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Affiliation(s)
- Himani Aggarwal
- Health Services Research, Indianapolis, Indiana
- Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Christopher M Callahan
- Regenstrief Institute, Inc., Indianapolis, Indiana
- Center for Aging Research, Indianapolis, Indiana
- Department of Medicine, Simon Cancer Center Indiana University, Indianapolis, Indiana
| | - Kathy D Miller
- Regenstrief Institute, Inc., Indianapolis, Indiana
- Indiana University Melvin and Bren, Simon Cancer Center, Indianapolis, Indiana
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University, School of Medicine, Simon Cancer Center Indiana University, Indianapolis, Indiana
| | - Patrick J Loehrer
- Regenstrief Institute, Inc., Indianapolis, Indiana
- Indiana University Melvin and Bren, Simon Cancer Center, Indianapolis, Indiana
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Race/ethnicity and socio-economic differences in breast cancer surgery outcomes. Cancer Epidemiol 2015; 39:745-51. [PMID: 26231096 DOI: 10.1016/j.canep.2015.07.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/04/2015] [Accepted: 07/21/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The purpose of this study is to evaluate racial and socio-economic differences in breast cancer surgery treatment, post-surgical complications, hospital length of stay and mortality among hospitalized breast cancer patients. METHODS We examined the association between race/ethnicity and socio-economic status with treatment and outcomes after surgery among 71,156 women hospitalized with a primary diagnosis of breast cancer using the Nationwide Inpatient Sample database from 2007 to 2011. Multivariable regression models were used to compute estimates, odds ratios and 95% confidence intervals adjusting for age, comorbidities, stage at diagnosis, insurance, and residential region. RESULTS Black women were more likely to receive breast conserving surgery but less likely to receive mastectomies compared with white women. They also experienced significantly longer hospital stays (β=0.31, 95% CI: 0.24, 0.39), post-surgical complications (OR=1.21, 95% CI: 1.04-1.42) and in-hospital mortality (OR=1.26, 95% CI: 1.07-1.50) compared with Whites, after adjusting for other factors including the number of comorbidities and treatment type. CONCLUSION Among patients hospitalized for breast cancer, there were racial differences observed in treatment and outcomes. Further studies are needed to fully characterize whether these differences are due to individual, provider level or hospital level factors, and to highlight areas for targeted approaches to eliminate these disparities.
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Sun SX, Leung AN, Dillon PW, Hollenbeak CS. Length of Stay and Readmissions in Mastectomy Patients. Breast J 2015; 21:526-32. [DOI: 10.1111/tbj.12442] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Susie X. Sun
- Department of Surgery; Penn State Milton S. Hershey Medical Center; Hershey Pennsylvania
| | - Anna N. Leung
- Section of Surgical Oncology; Penn State Milton S. Hershey Medical Center; Hershey Pennsylvania
| | - Peter W. Dillon
- Department of Surgery; Penn State Milton S. Hershey Medical Center; Hershey Pennsylvania
| | - Christopher S. Hollenbeak
- Division of Outcomes Research and Quality; Penn State Milton S. Hershey Medical Center; Hershey Pennsylvania
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Rizzo JA, Sherman WE, Arciero CA. Racial disparity in survival from early breast cancer in the department of defense healthcare system. J Surg Oncol 2015; 111:819-23. [PMID: 25711959 DOI: 10.1002/jso.23884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 12/15/2014] [Indexed: 07/13/2024]
Abstract
BACKGROUND Racial disparity is often identified as a factor in survival from breast cancer in the United States. Current data regarding survival in patients treated in the Department of Defense Military Healthcare System is lacking. METHODS The Department of Defense Automated Central Tumor Registry (ACTUR) was queried for all women diagnosed with Stage I or II breast cancer from January 1, 1996 through December 31, 2008. Statistical analyses evaluated demographics, surgical treatment, tumor stage, and survival rates. RESULTS There were 8,890 patients meeting inclusion criteria. Patients who were younger, Asian American (versus white or black), lower T and/or N stage had significantly improved survival rates. Interestingly, white and black patients demonstrated similar survival in this study. Patients with a longer period of time between diagnosis and treatment had no decrement in survival. As would be expected, patients with a longer recurrence free period enjoyed longer survival. CONCLUSIONS Survival from early stage breast cancer is equivalent between white and black patients in the Department of Defense Healthcare System. This finding is contrary to reports from our civilian counterparts and may be indicative of improved access to care and overall improved cancer surveillance.
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Affiliation(s)
- Julie A Rizzo
- U.S. Institute of Surgical Research, Fort Sam Houston, Texas
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Race, response to chemotherapy, and outcome within clinical breast cancer subtypes. Breast Cancer Res Treat 2015; 150:667-74. [PMID: 25814053 DOI: 10.1007/s10549-015-3350-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
The effect of race on breast cancer outcome is confounded by tumor and treatment heterogeneity. We examined a cohort of women with stage II-III breast cancer treated uniformly with neoadjuvant chemotherapy to identify factors associated with racial differences in chemotherapeutic response and long-term survival. Using a prospective database, we identified women with stage II-III breast cancer treated with neoadjuvant chemotherapy from 1998 to 2011. Race was categorized as African-American (AA) or non-AA. Preplanned subtype analyses were stratified by hormone receptor (HR) and HER2. Pathologic response to chemotherapy (pCR), time to recurrence (TTR), and overall survival (OS) were assessed using logistic regression, Kaplan-Meier method, and Cox proportional hazards regression analyses. Of 349 women identified, 102 (29 %) were AA, who were younger (p = 0.03), more obese (p < 0.001), and less likely to have HR+/HER2- tumors (p = 0.01). No significant differences in pCR rate by race were found. At median follow-up of 6.5 years, AA had worse TTR (hazard ratio 1.51, 95 % CI 1.02-2.24), which was attenuated in multivariable modeling, and there was no significant difference in OS. When stratified by HR, worse outcomes were limited to HR+AA (TTR hazard ratio 1.85, 95 % CI 1.09-3.14; OS hazard ratio 2.42 95 % CI 1.37-4.28), which remained significant in multivariable analysis including pCR rate and BMI. With long-term follow-up, racial disparity in outcome was limited to HR+ breast cancer, with no apparent contribution of chemotherapy sensitivity. This suggests that disparity root causes may be driven by HR+ factors such as unmeasured molecular differences, endocrine therapy sensitivity, or adherence.
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Yakoub D, Avisar E, Koru-Sengul T, Miao F, Tannenbaum SL, Byrne MM, Moffat F, Livingstone A, Franceschi D. Factors associated with contralateral preventive mastectomy. BREAST CANCER-TARGETS AND THERAPY 2015; 7:1-8. [PMID: 25609997 PMCID: PMC4293214 DOI: 10.2147/bctt.s72737] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Contralateral prophylactic mastectomy (CPM) is an option for women who wish to reduce their risk of breast cancer or its local recurrence. There is limited data on demographic differences among patients who choose to undergo this procedure. METHODS The population-based Florida cancer registry, Florida's Agency for Health Care Administration data, and US census data were linked and queried for patients diagnosed with invasive breast cancer from 1996 to 2009. The main outcome variable was the rate of CPM. Primary predictors were race, ethnicity, socioeconomic status (SES), marital status and insurance status. RESULTS Our population was 91.1% White and 7.5% Black; 89.1% non-Hispanic and 10.9% Hispanic. Out of 21,608 patients with a single unilateral invasive breast cancer lesion, 837 (3.9%) underwent CPM. Significantly more White than Black (3.9% vs 2.8%; P<0.001) and more Hispanic than non-Hispanic (4.5% vs 3.8%; P=0.0909) underwent CPM. Those in the highest SES category had higher rates of CPM compared to the lowest SES category (5.3% vs 2.9%; P<0.001). In multivariate analyses, Blacks compared to Whites (OR =0.59, 95% CI =0.42-0.83, P=0.002) and uninsured patients compared to privately insured (OR =0.60, 95% CI =0.36-0.98, P=0.043) had significantly less CPM. CONCLUSION CPM rates were significantly different among patients of different race, socio-economic class, and insurance coverage. This observation is not accounted for by population distribution, incidence or disease stage. More in-depth study of the causes of these disparities in health care choice and delivery is critically needed.
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Affiliation(s)
- Danny Yakoub
- Division of Surgical Oncology at Department of Surgery, University of Miami - Miller School of Medicine, Miami, FL, USA ; Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Eli Avisar
- Division of Surgical Oncology at Department of Surgery, University of Miami - Miller School of Medicine, Miami, FL, USA ; Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Tulay Koru-Sengul
- Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA ; Department of Public Health Sciences, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Feng Miao
- Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Stacey L Tannenbaum
- Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Margaret M Byrne
- Division of Surgical Oncology at Department of Surgery, University of Miami - Miller School of Medicine, Miami, FL, USA ; Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA ; Department of Public Health Sciences, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Frederick Moffat
- Division of Surgical Oncology at Department of Surgery, University of Miami - Miller School of Medicine, Miami, FL, USA ; Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Alan Livingstone
- Division of Surgical Oncology at Department of Surgery, University of Miami - Miller School of Medicine, Miami, FL, USA ; Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Dido Franceschi
- Division of Surgical Oncology at Department of Surgery, University of Miami - Miller School of Medicine, Miami, FL, USA ; Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
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Hershman DL, Ganz PA. Quality of Care, Including Survivorship Care Plans. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:255-69. [PMID: 26059941 DOI: 10.1007/978-3-319-16366-6_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
With the expectation of prolonged survival in the vast majority of women diagnosed with breast cancer, making initial treatment decisions that minimize or prevent late complications, and maximize the quality as well as quantity of life, is absolutely critical. Unfortunately, such care is not uniformly delivered. Patient, provider, and system barriers contribute to delays in cancer care, lower quality of care, and poorer outcomes in vulnerable populations, including low income, underinsured, and racial/ethnic minority populations. Covering the costs of cancer care is a major concern for many cancer survivors, and as a result, a major challenge will be to provide cost-effective follow-up care by reducing overuse of unnecessary tests and procedures so that access to effective medications can be preserved. One of the recently promoted means of improving the coordination of care for breast cancer survivors has been the use of survivorship care planning, as coordination of care will be absolutely essential to deliver high-quality care. Patient navigation is another approach to help overcome healthcare system barriers and facilitate timely access to quality medical care. Understanding the challenges and opportunities in delivering high-quality cancer care is one of the most critical issues of the day. With the large numbers of breast cancer patients and the tremendous advances in our understanding of the disease and treatments (leading to large numbers of survivors), breast cancer will likely be the focus of new models for the delivery of better and more efficient cancer care.
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Affiliation(s)
- Dawn L Hershman
- Medicine and Epidemiology, Herbert Irving Comprehensive Cancer Center Columbia University, 161 Fort Washington, 1068, New York, NY, 10032, USA,
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Pierre-Louis BJ, Moore AD, Hamilton JB. The Military Health Care System May Have the Potential to Prevent Health Care Disparities. J Racial Ethn Health Disparities 2014; 2:280-9. [DOI: 10.1007/s40615-014-0067-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/11/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
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Oseni TO, Soballe PW. Breast cancer screening patterns among military beneficiaries: racial variations in screening eliminated in an equal-access model. Ann Surg Oncol 2014; 21:3336-41. [PMID: 25092162 DOI: 10.1245/s10434-014-3961-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND African American women present with more aggressive breast tumors and at later stages than white women. Many factors have been proposed to explain these findings, including socioeconomic status, cultural beliefs, and access to medical care. The purpose of this project was to determine if stage at presentation would be equivalent in a system providing equal access to care and if screening was equivalent. METHODS The Naval Medical Center San Diego (NMCSD) tumor registry from 2007 to 2012 was queried for this cross-sectional study. Eligible women included all those diagnosed and treated for breast cancer at NMCSD. Distribution of tumor stage (early vs. advanced) between racial groups was compared by age, treatment, and receptor status. RESULTS A total of 624 women were eligible; 88 % were early stage (0-II) and 12 % presented with advanced stage (III or IV). Racial differences in distribution were significant among African American and Hispanic women for early versus advanced presentation (p = 0.011). No racial disparity was seen in screening patterns among women. CONCLUSIONS In a military health system with equal access to care and standard screening recommendations, screening patterns did not vary with race but did vary with stage and active duty status. African American women present with breast cancer at later stages and with more hormone-receptor negative tumors, suggesting that biology rather than socioeconomic or access factors may be the most important determinant of stage at presentation of breast cancer for African American women.
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Affiliation(s)
- Tawakalitu O Oseni
- Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, 92134, USA,
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The impact of age on colorectal cancer incidence, treatment, and outcomes in an equal-access health care system. Dis Colon Rectum 2014; 57:303-10. [PMID: 24509451 DOI: 10.1097/dcr.0b013e3182a586e7] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inferior outcomes in younger patients with colorectal cancer may be associated with multiple factors, including tumor biology, delayed diagnosis, disparities such as access to care, and/or treatment differences. OBJECTIVE This study aims to examine age-based colorectal cancer outcomes in an equal-access health care system. DESIGN This study is a retrospective large multi-institutional database analysis. PATIENTS Patients with colorectal cancer included in the Department of Defense Automated Central Tumor Registry (January 1993 to December 2008) were stratified by age <40, 40 to 49, 50 to 79, and ≥80 years to determine the effect of age on incidence, treatment, and outcomes. MAIN OUTCOME MEASURES The primary outcomes measured were the stage at presentation, adjuvant therapy use, 3- and 5-year disease-free survival, and overall survival. RESULTS Some 7948 patients were identified; most (77%) patients were in the 50- to 79-year age group. Overall, 25% presented with stage III disease. Compared with patients aged 50 to 79 and ≥80 years, patients aged <40 and 40 to 49 years presented more frequently with advanced disease (stage III (35% and 35% vs 28% and 26%) and stage IV (24% and 21% vs 18% and 15%); all p < 0.001). Adjuvant chemotherapy use in stage III patients was 62%; those patients ≥80 and 50 to 79 years had decreased use (p < 0.001). Overall recurrence was 8.1% at 3 years and 9.7% at 5 years, with the highest rates in patients <40 years (11.8%; p = 0.007). Overall survival was worse in patients ≥80 years, whereas the remaining cohorts were similar. For stage III disease, patients 40 to 49 years had the highest survival among all cohorts (p < 0.001). LIMITATIONS This study was limited by the lack of specific comorbid information and the limitations inherent to large database reviews. CONCLUSIONS In an equal-access system, young age at presentation (<50 years) was associated with advanced stage and higher recurrence of colorectal cancer, but similar survival in comparison with older patients. Although increased adjuvant therapy use in younger patients may partially account for stage-specific increases in survival, the relative decreased chemotherapy use overall requires further evaluation.
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Sturtz LA, Melley J, Mamula K, Shriver CD, Ellsworth RE. Outcome disparities in African American women with triple negative breast cancer: a comparison of epidemiological and molecular factors between African American and Caucasian women with triple negative breast cancer. BMC Cancer 2014; 14:62. [PMID: 24495414 PMCID: PMC3916697 DOI: 10.1186/1471-2407-14-62] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 02/02/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although diagnosed less often, breast cancer in African American women (AAW) displays different characteristics compared to breast cancer in Caucasian women (CW), including earlier onset, less favorable clinical outcome, and an aggressive tumor phenotype. These disparities may be attributed to differences in socioeconomic factors such as access to health care, lifestyle, including increased frequency of obesity in AAW, and tumor biology, especially the higher frequency of triple negative breast cancer (TNBC) in young AAW. Improved understanding of the etiology and molecular characteristics of TNBC in AAW is critical to determining whether and how TNBC contributes to survival disparities in AAW. METHODS Demographic, pathological and survival data from AAW (n = 62) and CW (n = 98) with TNBC were analyzed using chi-square analysis, Student's t-tests, and log-rank tests. Frozen tumor specimens were available from 57 of the TNBC patients (n = 23 AAW; n = 34 CW); RNA was isolated after laser microdissection of tumor cells and was hybridized to HG U133A 2.0 microarrays. Data were analyzed using ANOVA with FDR <0.05, >2-fold difference defining significance. RESULTS The frequency of TNBC compared to all BC was significantly higher in AAW (28%) compared to CW (12%), however, significant survival and pathological differences were not detected between populations. Gene expression analysis revealed the tumors were more similar than different at the molecular level, with only CRYBB2P1, a pseudogene, differentially expressed between populations. Among demographic characteristics, AAW consumed significantly lower amounts of caffeine and alcohol, were less likely to breastfeed and more likely to be obese. CONCLUSIONS These data suggest that TNBC in AAW is not a unique disease compared to TNBC in CW. Rather, higher frequency of TNBC in AAW may, in part, be attributable to the effects of lifestyle choices. Because these risk factors are modifiable, they provide new opportunities for the development of risk reduction strategies that may decrease mortality by preventing the development of TNBC in AAW.
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Affiliation(s)
| | | | | | | | - Rachel E Ellsworth
- Clinical Breast Care Project, Henry M, Jackson Foundation for the Advancement of Military Medicine, Windber, PA, USA.
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Copson E, Maishman T, Gerty S, Eccles B, Stanton L, Cutress RI, Altman DG, Durcan L, Simmonds P, Jones L, Tapper W, Eccles D. Ethnicity and outcome of young breast cancer patients in the United Kingdom: the POSH study. Br J Cancer 2014; 110:230-41. [PMID: 24149174 PMCID: PMC3887284 DOI: 10.1038/bjc.2013.650] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/23/2013] [Accepted: 10/01/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Black ethnic groups have a higher breast cancer mortality than Whites. American studies have identified variations in tumour biology and unequal health-care access as causative factors. We compared tumour pathology, treatment and outcomes in three ethnic groups in young breast cancer patients treated in the United Kingdom. METHODS Women aged ≤ 40 years at breast cancer diagnosis were recruited to the POSH national cohort study (MREC: 00/06/69). Personal characteristics, tumour pathology and treatment data were collected at diagnosis. Follow-up data were collected annually. Overall survival (OS) and distant relapse-free survival (DRFS) were assessed using Kaplan-Meier curves, and multivariate analyses were performed using Cox regression. RESULTS Ethnicity data were available for 2915 patients including 2690 (91.0%) Whites, 118 (4.0%) Blacks and 87 (2.9%) Asians. Median tumour diameter at presentation was greater in Blacks than Whites (26.0 mm vs 22.0 mm, P=0.0103), and multifocal tumours were more frequent in both Blacks (43.4%) and Asians (37.0%) than Whites (28.9%). ER/PR/HER2-negative tumours were significantly more frequent in Blacks (26.1%) than Whites (18.6%, P=0.043). Use of chemotherapy was similarly high in all ethnic groups (89% B vs 88.6% W vs 89.7% A). A 5-year DRFS was significantly lower in Blacks than Asians (62.8% B vs 77.0% A, P=0.0473) or Whites (62.8 B% vs 77.0% W, P=0.0053) and a 5-year OS for Black patients, 71.1% (95% CI: 61.0-79.1%), was significantly lower than that of Whites (82.4%, 95% CI: 80.8-83.9%, W vs B: P=0.0160). In multivariate analysis, Black ethnicity had an effect on DRFS in oestrogen receptor (ER)-positive patients that is independent of body mass index, tumour size, grade or nodal status, HR: 1.60 (95% CI: 1.03-2.47, P=0.035). CONCLUSION Despite equal access to health care, young Black women in the United Kingdom have a significantly poorer outcome than White patients. Black ethnicity is an independent risk factor for reduced DRFS particularly in ER-positive patients.
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Affiliation(s)
- E Copson
- Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
| | - T Maishman
- Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
| | - S Gerty
- Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
| | - B Eccles
- Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
| | - L Stanton
- Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
| | - R I Cutress
- Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
| | - D G Altman
- Centre for Statistics in Medicine, Wolfson College Annexe, Oxford OX2 6UD, UK
| | - L Durcan
- Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
| | - P Simmonds
- Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
| | - L Jones
- Tumour Biology Department, Institute of Cancer, Barts & The London School of Medicine & Dentistry, Charterhouse Square, London, EC1M 6BQ, UK
| | - W Tapper
- Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
| | - POSH study steering group4
- Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
- Centre for Statistics in Medicine, Wolfson College Annexe, Oxford OX2 6UD, UK
- Tumour Biology Department, Institute of Cancer, Barts & The London School of Medicine & Dentistry, Charterhouse Square, London, EC1M 6BQ, UK
| | - Diana Eccles
- Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
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Salai S, Rohrer JE, Peoples GE, Stoodt G, Danawi H. Comparing Stage at Diagnosis Among Patients With Breast Cancer Served by Military and Civilian Medical Care Systems. Health Serv Res Manag Epidemiol 2014; 1:2333392814533660. [PMID: 28462242 PMCID: PMC5278822 DOI: 10.1177/2333392814533660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Breast cancer (BC) remains one of the top causes of cancer-related deaths in women in the United States, and little is known about the differences in access to health care between military and civilians. This study compared the differences in access to health care between military and civilian female patients with BC. In particular, this study examined whether patients with BC, in an equal access health care system such as the military, are diagnosed at an earlier stage of disease process in comparison to the patients with BC in the civilian health care system. Methods: Independent variables included military versus civilian care and demographic variables. Dependent variable was the stage of cancer at diagnosis. This cross-sectional study of 2 groups included data from 2198 women with BC (439 military and 1759 civilian) for years 2004 through 2008. Multiple logistic regression was used to analyze the data. Results: There was no difference in the early BC stage (0, I, and II) diagnosis prevalence rate between the military and the civilian groups (95% confidence interval [CI], P = .15). The logistic regression analysis indicated that both the health systems had equal performance with respect to the stage at diagnosis indicator but found that black patients had higher odds of being in the late stage (III and IV) BC group at diagnosis (1.62 OR, 1.14-2.30 CI, P = .0068) than white patients. Conclusions: Although no difference was found between the performance of the 2 health systems in the early (0, I, and II) versus late stage (III and IV) at diagnosis indicator, this study further confirms the existence of racial disparities in late-stage BC regardless of whether the patient was diagnosed in the civilian or military health system. More research is needed to further investigate the potential explanations of racial disparities other than just differences in access to health care.
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Affiliation(s)
| | - James E Rohrer
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
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Stewart PA, Luks J, Roycik MD, Sang QXA, Zhang J. Differentially expressed transcripts and dysregulated signaling pathways and networks in African American breast cancer. PLoS One 2013; 8:e82460. [PMID: 24324792 PMCID: PMC3853650 DOI: 10.1371/journal.pone.0082460] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/23/2013] [Indexed: 12/24/2022] Open
Abstract
African Americans (AAs) have higher mortality rate from breast cancer than that of Caucasian Americans (CAs) even when socioeconomic factors are accounted for. To better understand the driving biological factors of this health disparity, we performed a comprehensive differential gene expression analysis, including subtype- and stage-specific analysis, using the breast cancer data in the Cancer Genome Atlas (TCGA). In total, 674 unique genes and other transcripts were found differentially expressed between these two populations. The numbers of differentially expressed genes between AA and CA patients increased in each stage of tumor progression: there were 26 in stage I, 161 in stage II, and 223 in stage III. Resistin, a gene that is linked to obesity, insulin resistance, and breast cancer, was expressed more than four times higher in AA tumors. An uncharacterized, long, non-coding RNA, LOC90784, was down-regulated in AA tumors, and its expression was inversely related to cancer stage and was the lowest in triple negative AA breast tumors. Network analysis showed increased expression of a majority of components in p53 and BRCA1 subnetworks in AA breast tumor samples, and members of the aurora B and polo-like kinase signaling pathways were also highly expressed. Higher gene expression diversity was observed in more advanced stage breast tumors suggesting increased genomic instability during tumor progression. Amplified resistin expression may indicate insulin-resistant type II diabetes and obesity are associated with AA breast cancer. Expression of LOC90784 may have a protective effect on breast cancer patients, and its loss, particularly in triple negative breast cancer, could be having detrimental effects. This work helps elucidate molecular mechanisms of breast cancer health disparity and identifies putative biomarkers and therapeutic targets such as resistin, and the aurora B and polo-like kinase signaling pathways for treating AA breast cancer patients.
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Affiliation(s)
- Paul A. Stewart
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, Florida, United States of America
| | - Jennifer Luks
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, Florida, United States of America
| | - Mark D. Roycik
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, Florida, United States of America
| | - Qing-Xiang Amy Sang
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, Florida, United States of America
- Institute of Molecular Biophysics, Florida State University, Tallahassee, Florida, United States of America
- * E-mail: (QXS); (JZ)
| | - Jinfeng Zhang
- Department of Statistics, Florida State University, Tallahassee, Florida, United States of America
- * E-mail: (QXS); (JZ)
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Tariq K, Rana F. TNBC vs. Non-TNBC: A Five-Year Retrospective Review of Differences in Mean Age, Family History, Smoking History and Stage at Diagnosis at an Inner City University Program. World J Oncol 2013; 4:241-247. [PMID: 29147364 PMCID: PMC5649849 DOI: 10.4021/wjon738w] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In recent years, breast cancer has been classified on the basis of estrogen or progesterone receptor (ER/PR) status and whether the human epidermal growth factor 2 receptor (HER2/neu) protein is overexpressed. Based on this system, breast cancer is broadly divided into the triple negative breast cancer (TNBC) and the non-TNBC subtypes. TNBC is a subtype of breast cancer, notable for its propensity to metastasize early and display a comparatively more aggressive course than its non-TNBC counterpart. Certain clinico-pathologic and demographic risk factors have been associated with breast cancer. In this study, we aim to compare mean age, ethnicity, family history, tobacco use and stage at presentation between TNBC and non-TNBC subtypes at our inner city university program. METHODS We reviewed data in our tumor registry between January 2000 and December 2005 with particular attention to mean age, race, family history, tobacco use and stage at presentation. We found a total of 445 patients with various subtypes of breast cancers. We included only those patients in whom the status of both ER/PR and the status of Her2/neu protein overexpression were recorded. Our strict selection criteria lead to an exclusion of about 103 patients. Out of the remaining 342 patients, 39 were TNBC and 303 were non-TNBC. RESULTS Mean age of onset for TNBC vs. non-TNBC patients was 59.87 ± 15.67 years vs. 60.09 ± 13.98 years respectively (P = 0.9272). In terms of ethnicity, TNBC vs. non-TNBC patients had the following racial backgrounds: black, 58.97% vs. 39.27%; white, 35.90% vs. 57.76%; Chinese, 2.56% vs. 0.99%; others, 2.57% vs. 1.98% respectively (P = 0.004, OR = 2.755). Comparisons with respect to a history of tobacco abuse for TNBC vs. non-TNBC patients revealed a positive smoking history in 20.51% vs. 27.72% whereas there was no former or current smoking history in 71.79% vs. 61.72% respectively (P = 0.4385). Comparison of family history of a breast cancer in TNBC vs. non-TNBC patients showed that positive family history of breast cancer was seen in 30.77% vs. 33.33%, no family history of cancer was seen in 51.28% vs. 51.82% and unknown 17.95% vs. 14.85% (P = 0.8384). Pathologic stage at the time of diagnosis for TNBC vs. non-TNBC patients was as follows: stage 0, 15.79% vs. 11.37% (P = 0.4332); stage 1, 34.21% vs. 30.98% (P = 0.6890); stage 2, 28.98% vs. 37.25% (P = 0.3205); stage 3, 18.42% vs. 17.25% (P = 0.0.8591); and stage 4, 3.63% vs. 3.14% (P = 0.8651). Analysis using Chi-square test revealed χ2 value of 0.855. CONCLUSION Our results add to the growing body of evidence pertaining to the association of certain demographic and clinico-pathologic characteristics in women with breast cancer. We found that in our patient population, there is a significant ethnic predisposition for the two types of breast cancers that we studied. African Americans were more likely to have TNBC compared to the higher frequency of non-TNBC in white females. We did not find a significant difference in mean age, cigarette smoking, family history and stage at diagnosis between the TNBC and non-TNBC breast cancer patients. These findings are all consistent with the previously published research studies.
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Affiliation(s)
- Khurram Tariq
- Department of Internal Medicine, College of Medicine, University of Florida, Jacksonville, FL 32209, USA
| | - Fauzia Rana
- Division of Hematology & Medical Oncology, College of Medicine, University of Florida, Jacksonville, FL 32209, USA
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Potter BK, Hwang PF, Forsberg JA, Hampton CB, Graybill JC, Peoples GE, Stojadinovic A. Impact of margin status and local recurrence on soft-tissue sarcoma outcomes. J Bone Joint Surg Am 2013; 95:e151. [PMID: 24132366 DOI: 10.2106/jbjs.l.01149] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The impact of local recurrence and surgical resection margin status on survival in extremity soft-tissue sarcomas remains to be clearly defined. Our aim was to conduct a retrospective analysis of prospectively collected data to determine the prognostic relevance of positive resection margins and local recurrence for extremity soft-tissue sarcomas for survival. METHODS Three hundred and sixty-three patients who underwent resection of localized primary extremity soft-tissue sarcomas with curative intent were selected from the United States Department of Defense Automated Central Tumor Registry. Outcomes for local recurrence, distant recurrence, disease-specific survival, and overall survival were analyzed according to clinical, pathological, and treatment variables with use of the Kaplan-Meier method (log-rank test) and the multivariate Cox regression model. RESULTS Positive margins (hazard ratio, 1.99 [95% confidence interval, 1.15 to 3.45]), local recurrence (hazard ratio, 2.93 [95% confidence interval, 1.38 to 6.23]), and distant recurrence (hazard ratio, 12.13 [95% confidence interval, 5.97 to 24.65]) were significantly associated with overall survival on multivariate Cox regression analysis. However, for disease-specific survival, local recurrence was not significant and tumor size of >10 cm (hazard ratio, 2.83 [95% confidence interval, 1.15 to 6.95]), positive margins (hazard ratio, 1.95 [95% confidence interval, 1.05 to 3.63]), and distant recurrence (hazard ratio, 9.46 [95% confidence interval, 4.37 to 20.47]) were independent adverse prognostic factors. The disease-specific survival rate for patients with localized soft-tissue sarcomas was 89% (95% confidence interval, 85% to 92%) for five years and 75% (95% confidence interval, 70% to 81%) for ten years. CONCLUSIONS Positive surgical margins are consistently associated with adverse survival-related outcomes in localized soft-tissue sarcomas of the extremity. Local recurrence had a significant impact on overall survival, but not on disease-specific survival.
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Affiliation(s)
- Benjamin K Potter
- Departments of Orthopaedics (B.K.P., C.B.H., and J.A.F) and Surgery (P.F.H. and J.C.G.), Walter Reed National Military Medical Center, 8901 Rockville Pike, America Building (Building 19), 2nd Floor, Orthopaedics, Bethesda, MD 20889. E-mail address for B.K. Potter:
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Ma H, Lu Y, Malone KE, Marchbanks PA, Deapen DM, Spirtas R, Burkman RT, Strom BL, McDonald JA, Folger SG, Simon MS, Sullivan-Halley J, Press MF, Bernstein L. Mortality risk of black women and white women with invasive breast cancer by hormone receptors, HER2, and p53 status. BMC Cancer 2013; 13:225. [PMID: 23642215 PMCID: PMC3648503 DOI: 10.1186/1471-2407-13-225] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 05/01/2013] [Indexed: 12/26/2022] Open
Abstract
Background Black women are more likely than white women to have an aggressive subtype of breast cancer that is associated with higher mortality and this may contribute to the observed black-white difference in mortality. However, few studies have investigated the black-white disparity in mortality risk stratified by breast cancer subtype, defined by estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status. Furthermore, it is not known whether additional consideration of p53 protein status influences black-white differences in mortality risk observed when considering subtypes defined by ER, PR and HER2 status. Methods Four biomarkers were assessed by immunohistochemistry in paraffin-embedded breast tumor tissue from 1,204 (523 black, 681 white) women with invasive breast cancer, aged 35–64 years at diagnosis, who accrued a median of 10 years’ follow-up. Multivariable Cox proportional hazards regression models were fit to assess subtype-specific black-white differences in mortality risk. Results No black-white differences in mortality risk were observed for women with triple negative (ER-negative [ER-], PR-, and HER2-) subtype. However, older (50–64 years) black women had greater overall mortality risk than older white women if they had been diagnosed with luminal A (ER-positive [ER+] or PR+ plus HER2-) breast cancer (all-cause hazard ratio, HR, 1.88; 95% confidence interval, CI, 1.18 to 2.99; breast cancer-specific HR, 1.51; 95% CI, 0.83 to 2.74). This black-white difference among older women was further confined to those with luminal A/p53- tumors (all-cause HR, 2.22; 95% CI, 1.30 to 3.79; breast cancer-specific HR, 1.89; 95% CI, 0.93 to 3.86). Tests for homogeneity of race-specific HRs comparing luminal A to triple negative subtype and luminal A/p53- to luminal A/p53+ subtype did not achieve statistical significance, although statistical power was limited. Conclusions Our findings suggest that the subtype-specific black-white difference in mortality risk occurs mainly among older women diagnosed with luminal A/p53- breast cancer, which is most likely treatable. These results further suggest that factors other than subtype may be relatively more important in explaining the increased mortality risk seen in older black women.
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Affiliation(s)
- Huiyan Ma
- Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA 91010, USA.
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Ibrahim NI, Dahlui M, Aina EN, Al-Sadat N. Who are the breast cancer survivors in Malaysia? Asian Pac J Cancer Prev 2013; 13:2213-8. [PMID: 22901196 DOI: 10.7314/apjcp.2012.13.5.2213] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Worldwide, breast cancer is the commonest cause of cancer death in women. However, the survival rate varies across regions at averages of 73%and 57% in the developed and developing countries, respectively. OBJECTIVE This study aimed to determine the survival rate of breast cancer among the women of Malaysia and characteristics of the survivors. METHOD A retrospective cohort study was conducted on secondary data obtained from the Breast Cancer Registry and medical records of breast cancer patients admitted to Hospital Kuala Lumpur from 2005 to 2009. Survival data were validated with National Birth and Death Registry. Statistical analysis applied logistic regression, the Cox proportional hazard model, the Kaplan-Meier method and log rank test. RESULTS A total of 868 women were diagnosed with breast cancer between January 2005 and December 2009, comprising 58%, 25% and 17% Malays, Chinese and Indians, respectively. The overall survival rate was 43.5% (CI 0.573-0.597), with Chinese, Indians and Malays having 5 year survival rates of 48.2% (CI 0.444-0.520), 47.2% (CI 0.432-0.512) and 39.7% (CI 0.373-0.421), respectively (p<0.05). The survival rate was lower as the stages increased, with the late stages were mostly seen among the Malays (46%), followed by Chinese (36%) and Indians (34%). Size of tumor>3.0cm; lymph node involvement, ERPR, and HER 2 status, delayed presentation and involvement of both breasts were among other factors that were associated with poor survival. CONCLUSIONS The overall survival rate of Malaysian women with breast cancer was lower than the western figures with Malays having the lowest because they presented at late stage, after a long duration of symptoms, had larger tumor size, and had more lymph nodes affected. There is an urgent need to conduct studies on why there is delay in diagnosis and treatment of breast cancer women in Malaysia.
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Agboola AJ, Musa AA, Wanangwa N, Abdel-Fatah T, Nolan CC, Ayoade BA, Oyebadejo TY, Banjo AA, Deji-Agboola AM, Rakha EA, Green AR, Ellis IO. Molecular characteristics and prognostic features of breast cancer in Nigerian compared with UK women. Breast Cancer Res Treat 2012; 135:555-69. [PMID: 22842985 DOI: 10.1007/s10549-012-2173-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 07/16/2012] [Indexed: 01/19/2023]
Abstract
Although breast cancer (BC) incidence is lower in African-American women compared with White-American, in African countries such as Nigeria, BC is a common disease. Nigerian women have a higher risk for early-onset, with a high mortality rate from BC, prompting speculation that risk factors could be genetic and the molecular portrait of these tumours are different to those of western women. In this study, 308 BC samples from Nigerian women with complete clinical history and tumour characteristics were included and compared with a large series of BC from the UK as a control group. Immunoprofile of these tumours was characterised using a panel of 11 biomarkers of known relevance to BC. The immunoprofile and patients' outcome were compared with tumour grade-matched UK control group. Nigerian women presenting with BC were more frequently premenopausal, and their tumours were characterised by large primary tumour size, high tumour grade, advanced lymph node stage, and a higher rate of vascular invasion compared with UK women. In the grade-matched groups, Nigerian BC showed over representation of triple-negative and basal phenotypes and BRCA1 deficiency BC compared with UK women, but no difference was found regarding HER2 expression between the two series. Nigerian women showed significantly poorer outcome after development of BC compared with UK women. This study demonstrates that there are possible genetic and molecular differences between an indigenous Black population and a UK-based series. The basal-like, triple negative and BRCA1 dysfunction groups of tumours identified in this study may have implications in the development of screening programs and therapies for African patients and families that are likely to have a BRCA1 dysfunction, basal like and triple negative.
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Affiliation(s)
- A J Agboola
- Division of Pathology, School of Molecular Medical Sciences, University Hospitals and University of Nottingham, Nottingham, UK.
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Grunda JM, Steg AD, He Q, Steciuk MR, Byan-Parker S, Johnson MR, Grizzle WE. Differential expression of breast cancer-associated genes between stage- and age-matched tumor specimens from African- and Caucasian-American Women diagnosed with breast cancer. BMC Res Notes 2012; 5:248. [PMID: 22616718 PMCID: PMC3476447 DOI: 10.1186/1756-0500-5-248] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 04/25/2012] [Indexed: 11/24/2022] Open
Abstract
Background Recent studies suggest that the poorer breast cancer outcome observed in African-American women (AAW) may, in part, result from underlying molecular factors. The purpose of this study was to investigate gene expression differences between Caucasian-American women (CAW) and AAW that may contribute to this poorer prognosis. Methods The expression of 84 genes involved in breast carcinoma prognosis, response to therapy, estrogen signaling, and tumor aggressiveness was assessed in age- and stage-matched CAW and AAW paraffin-embedded breast cancer specimens. The Wilcoxon–Mann–Whitney Test was used to identify genes with a significant difference in expression between CAW and AAW. To determine if the differentially expressed genes could segregate between the CAW and AAW, we performed semi-supervised principal component analysis (SSPCA). Results Twenty genes were differentially expressed between AAW and CAW. SSPCA incorporating these 20 genes segregated AAW and CAW into two distinct groups. AAW were significantly (p < 0.05) more likely to display aberrations in G1/S cell-cycle regulatory genes, decreased expression of cell-adhesion genes, and low to no expression of ESR1, PGR, ERBB2 and estrogen pathway targets. Conclusions The gene expression differences identified between AAW and CAW may contribute to more aggressive disease, resistance to therapy, enhanced metastatic potential and poor clinical outcome. These findings support the hypothesis that breast cancer specimens collected from AAW display distinct gene expression differences compared to similar tissues obtained from CAW. Additional population-based studies are necessary to determine if these gene expression variations contribute to the highly aggressive and treatment-resistant breast cancer phenotype frequently observed in AAW.
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Affiliation(s)
- Jessica M Grunda
- Department of Medicine, Division of Endocrinology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Abstract
The theory presented in this article proposes an alternative view of access to care on the basis of an African American woman's perception of the necessity, availability, and appropriateness of breast health care. The theory of perceived access to breast health care in African American women may also be useful in framing future research studies exploring the relationship between access to care and utilization of primary, secondary, and tertiary clinical preventive services related to breast health care.
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Sparano JA, Wang M, Zhao F, Stearns V, Martino S, Ligibel JA, Perez EA, Saphner T, Wolff AC, Sledge GW, Wood WC, Davidson NE. Race and hormone receptor-positive breast cancer outcomes in a randomized chemotherapy trial. J Natl Cancer Inst 2012; 104:406-14. [PMID: 22250182 DOI: 10.1093/jnci/djr543] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The association between black race and worse outcomes in operable breast cancer reported in previous studies has been attributed to a higher incidence of more aggressive triple-negative disease, disparities in care, and comorbidities. We evaluated associations between black race and outcomes, by tumor hormone receptor and HER2 expression, in patients who were treated with contemporary adjuvant therapy. METHODS The effect of black race on disease-free and overall survival was evaluated using Cox proportional hazards models adjusted for multiple covariates in a clinical trial population that was treated with anthracycline- and taxane-containing chemotherapy. Categorical variables were compared using the Fisher exact test. All P values are two-sided. RESULTS Of 4817 eligible patients, 405 (8.4%) were black. Compared with nonblack patients, black patients had a higher rate of triple-negative disease (31.9% vs 17.2%; P < .001) and a higher body mass index (median: 31.7 vs 27.4 kg/m(2); P < .001). Black race was statistically significantly associated with worse disease-free survival (5-year disease-free survival, black vs nonblack: 76.7% vs 84.5%; hazard ratio of recurrence or death = 1.58, 95% confidence interval = 1.19 to 2.10, P = .0015) and overall survival (5-year overall survival, black vs nonblack: 87.6% vs 91.9%; hazard ratio of death = 1.49, 95% confidence interval = 1.05 to 2.12, P = .025) in patients with hormone receptor-positive HER2-negative disease but not in patients with triple-negative or HER2-positive disease. In a model that included black race, hormone receptor-positive HER2-negative disease vs other subtypes, and their interaction, the interaction term was statistically significant for disease-free survival (P = .027) but not for overall survival (P = .086). CONCLUSION Factors other than disparities in care or aggressive disease contribute to increased recurrence in black women with hormone receptor-positive breast cancer.
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Affiliation(s)
- Joseph A Sparano
- Albert Einstein College of Medicine, Montefiore Medical Center-Weiler Division, 1825 Eastchester Rd, 2S-Rm 47, Bronx, NY 10461, USA.
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Morehead-Gee AJ, Pfalzer L, Levy E, McGarvey C, Springer B, Soballe P, Gerber L, Stout NL. Racial disparities in physical and functional domains in women with breast cancer. Support Care Cancer 2011; 20:1839-47. [PMID: 21979903 DOI: 10.1007/s00520-011-1285-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 09/26/2011] [Indexed: 01/22/2023]
Abstract
INTRODUCTION African-American women are more likely than white women to have functional impairments after breast cancer (BC) surgery; however, no differences were found in self-reported health status surveys at 12+ months postsurgery. PURPOSE This analysis compared white and African-American BC survivors' (BCS) health status, health-related quality of life, and the occurrence of physical impairments after BC treatment. METHODS One hundred sixty-six women (130 white, 28 African-American, 8 other) were assessed for impairments preoperatively and at 1, 3, 6, 9, and 12+ months postsurgery. Health status was assessed at 12+ months using the Short Form Health Survey (SF36v2™). Analysis of variance estimated differences between groups for health status and impairment occurrence. RESULTS No differences were found between groups for BC type, stage, grade, or tumor size; surgery type; or number of lymph nodes sampled. African-American BCS had more estrogen/progesterone receptor-negative tumors (p < 0.001; p = 0.036) and received radiation more frequently (p = 0.03). More African-American BCS were employed (p = 0.022) and reported higher rates of social activities (p = 0.011) but less recreational activities (p = 0.020) than white BCS. African-American BCS had higher rates of cording (p = 0.013) and lymphedema (p = 0.011) postoperatively. No differences were found in self-reported health status. CONCLUSION In a military healthcare system, where access to care is ubiquitous, there were no significant differences in many BC characteristics commonly attributed to race. African-American women had more ER/PR-negative tumors; however, no other BC characteristics differed between racial groups. African-American women exhibited more physical impairments, although their BC treatment only differed regarding radiation therapy. This suggests that African-American BCS may be at higher risk for physical impairments and should be monitored prospectively for early identification and treatment.
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Affiliation(s)
- Alicia J Morehead-Gee
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Enewold L, Zhou J, McGlynn KA, Devesa SS, Shriver CD, Potter JF, Zahm SH, Zhu K. Racial variation in tumor stage at diagnosis among Department of Defense beneficiaries. Cancer 2011; 118:1397-403. [PMID: 21837685 DOI: 10.1002/cncr.26208] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 03/30/2011] [Accepted: 03/30/2011] [Indexed: 01/11/2023]
Abstract
BACKGROUND Tumor stage at diagnosis often varies by racial/ethnic group, possibly because of inequitable health care access. Within the Department of Defense (DoD) Military Health System, beneficiaries have equal health care access. The objective of this study was to determine whether tumor stage differed between whites and blacks with breast, cervical, colorectal, and prostate cancers, which have effective screening regimens, based on data from the DoD Automated Cancer Tumor Registry from 1990 to 2003. METHODS Distributions of tumor stage (localized vs nonlocalized) between whites and blacks in the military were compared stratified by sex, active duty status, and age at diagnosis. Logistic regression was used to further adjust for age, marital status, year of diagnosis, geographic region, military service branch, and tumor grade. Distributions of tumor stage were then compared between the military and general populations. RESULTS Racial differences in the distribution of stage were significant only among nonactive duty beneficiaries. After adjusting for covariates, earlier stages of breast cancer after age 49 years and prostate cancer after age 64 years were significantly more common among white than black nonactive duty beneficiaries (P < .05), although the absolute difference was minimal for prostate cancer. Racial differences in stage for cervical and colorectal cancers were not significant after adjustment. Compared with the general population, racial differences in the military were similar or were slightly attenuated. CONCLUSIONS Racial disparities in stage at diagnosis were apparent in the DoD equal-access health care system among older nonactive duty beneficiaries. Socioeconomic status, supplemental insurance, cultural beliefs, and biologic factors may be related to these results.
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Affiliation(s)
- Lindsey Enewold
- United States Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC 20306-6000, USA.
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