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Wang J, Luo T, Xiang ZZ, He MM, Zeng YY, Yang T, Wei XY, Yu S, Dai ZL, Xu NY, Tan CF, Liu L. Survival and Trends in Annualized Hazard Function by Age at Diagnosis Among Chinese Breast Cancer Patients Aged ≤40 Years: Case Analysis Study. JMIR Public Health Surveill 2023; 9:e47110. [PMID: 37463020 PMCID: PMC10394600 DOI: 10.2196/47110] [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: 03/10/2023] [Revised: 04/19/2023] [Accepted: 06/15/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Young breast cancer patients are more likely to develop aggressive tumor characteristics and a worse prognosis than older women, and different races and ethnicities have distinct epidemiologies and prognoses. However, few studies have evaluated the clinical biological features and relapse patterns in different age strata of young women in Asia. OBJECTIVE We aimed to explore survival differences and the hazard function in young Chinese patients with breast cancer (BC) by age. METHODS The patients were enrolled from West China Hospital, Sichuan University. The chi-squared test, a Kaplan-Meier analysis, a log-rank test, a Cox multivariate hazards regression model, and a hazard function were applied for data analysis. Locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), breast cancer-specific survival (BCSS), and overall survival (OS) were defined as end points. RESULTS We included 1928 young BC patients diagnosed between 2008 and 2019. Patients aged 18 to 25, 26 to 30, 31 to 35, and 36 to 40 years accounted for 2.7% (n=53), 11.8% (n=228), 27.7% (n=535), and 57.7% (n=1112) of the patients, respectively. The diagnosis of young BC significantly increased from 2008 to 2019. Five-year LRFS, DMFS, BCSS, and OS for the entire population were 98.3%, 93.4%, 94.4%, and 94%, respectively. Patients aged 18 to 25 years had significantly poorer 5-year LRFS (P<.001), 5-year DMFS (P<.001), 5-year BCSS (P=.04), and 5-year OS (P=.04) than those aged 31 to 35, 26 to 30, and 36 to 40 years. The hazard curves for recurrence and metastasis for the whole cohort continuously increased over the years, while the BC mortality risk peaked at 2 to 3 years and then slowly decreased. When stratified by age, the annualized hazard function for recurrence, metastasis, and BC mortality in different age strata showed significantly different trends, especially for BC mortality. CONCLUSIONS The annual diagnosis of young BC seemed to increase in Chinese patients, and the distinct age strata of young BC patients did not differ in survival outcome or failure pattern. Our results might provide strategies for personalized management of young BC.
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Affiliation(s)
- Jun Wang
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Luo
- Breast Disease Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhong-Zheng Xiang
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming-Min He
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan-Yuan Zeng
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Tian Yang
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Yuan Wei
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Siting Yu
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Ze-Lei Dai
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Ning-Yue Xu
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Chen-Feng Tan
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
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Zeng Y, Wang J, Zhong X, Xiang Z, Yang T, Yu S, Dai Z, Xu N, Liu L. The disparities in prognostic prediction and annualized hazard function in different molecular subtypes between young Chinese and White American women with breast cancer. Front Oncol 2023; 13:1199492. [PMID: 37492473 PMCID: PMC10364598 DOI: 10.3389/fonc.2023.1199492] [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: 04/03/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
Background and objectives The prognostic disparities in different molecular subtypes between young Chinese and White American breast cancer patients remain unclear. The goal of this study was to explore the prognostic differences in different molecular subtypes between Chinese and White American patients aged ≤ 40 years. Methods We included Chinese and White female breast cancer patients at or under the age of 40 from the Surveillance, Epidemiology, and End Results database (SEER) and the West China Hospital of Sichuan University. The chi-square test, log-rank test, and Cox proportional hazards model were employed to evaluate the distribution and survival disparities in the two racial/ethnic cohorts and different molecular subtypes. An annualized hazard function was used to calculate the annual failure rate among different molecular subtypes. Results This study included 20,859 female breast cancer patients at or under the age of 40, of whom 18,400 were White women and 2,459 were Chinese women. With a median follow-up time of 47 months, the 5-year breast cancer-specific survival (BCSS) rates for young Chinese and White women were 93.9% and 90.0%, respectively (P< 0.001). Molecular subtype was found to be a significant predictor in both young Chinese and White patients (P< 0.001), but different trends were observed in the two racial/ethnic cohorts when exploring the association between BCSS and molecular subtypes. Among young White patients, the hormone receptor (HoR) (+)/epidermal growth factor receptor 2 (HER2) (+) subtype had the best 5-year BCSS rate, while in young Chinese patients, the HoR (+)/HER2 (+) and HoR (+)/HER2 (-) showed comparable survival curves and both showed superior 5-year BCSS than other subtypes. Stratification by molecular subtypes, young Chinese patients demonstrated a superior 5-year BCSS in HoR (+)/HER2 (-) (96.3% vs 92.9%, P< 0.001) and triple-negative subtypes (88% vs 81.7%, P= 0.006) compared to young White American patients, while no significant differences were found in HoR (+)/HER2 (+) and HER2 enriched tumors. The annual hazard function for BCSS showed that there were significantly different trends in the HoR (+)/HER2 (-) and HoR (+)/HER2 (+) subtypes between young Chinese and White patients. Conclusions There are disparities in prognosis and annualized hazard function between young Chinese and White females with breast cancer in different molecular subtypes.
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Affiliation(s)
- Yuanyuan Zeng
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Wang
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaorong Zhong
- Breast Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongzheng Xiang
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tian Yang
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Siting Yu
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zelei Dai
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ningyue Xu
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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3
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Angajala A, Raymond H, Muhammad A, Uddin Ahmed MS, Haleema S, Haque M, Wang H, Campbell M, Martini R, Karanam B, Kahn AG, Bedi D, Davis M, Tan M, Dean-Colomb W, Yates C. MicroRNAs within the Basal-like signature of Quadruple Negative Breast Cancer impact overall survival in African Americans. Sci Rep 2022; 12:22178. [PMID: 36550153 PMCID: PMC9780260 DOI: 10.1038/s41598-022-26000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
We previously found that QNBC tumors are more frequent in African Americans compared to TNBC tumors. To characterize this subtype further, we sought to determine the miRNA-mRNA profile in QNBC patients based on race. Both miRNA and mRNA expression data were analyzed from TCGA and validated using datasets from the METABRIC, TCGA proteomic, and survival analysis by KMPLOT. miRNA-mRNAs which include FOXA1 and MYC (mir-17/20a targets); GATA3 and CCNG2 (mir-135b targets); CDKN2A, CDK6, and B7-H3 (mir-29c targets); and RUNX3, KLF5, IL1-β, and CTNNB1 (mir-375 targets) were correlated with basal-like and immune subtypes in QNBC patients and associated with a worse survival. Thus, QNBC tumors have an altered gene signature implicated in racial disparity and poor survival.
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Affiliation(s)
- Anusha Angajala
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, 36088, USA
- Department of Pathology, University of South Alabama, Mobile, AL, 36604, USA
| | - Hughley Raymond
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, 36088, USA
| | - Aliyu Muhammad
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, 36088, USA
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, 810107, Kaduna State, Nigeria
| | - Md Shakir Uddin Ahmed
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, 36088, USA
- Bangladesh Council of Scientific and Industrial Research (BCSIR), Dhaka, Bangladesh
| | - Saadia Haleema
- Department of Pathology, University of South Alabama, Mobile, AL, 36604, USA
| | - Monira Haque
- Department of Pathology, University of South Alabama, Mobile, AL, 36604, USA
| | - Honghe Wang
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, 36088, USA
| | - Moray Campbell
- Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, OH, 43210, USA
| | - Rachel Martini
- Department of Surgery, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Balasubramanian Karanam
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, 36088, USA
| | - Andrea G Kahn
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, 35249-7331, USA
| | - Deepa Bedi
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, 36088, USA
| | - Melissa Davis
- Department of Surgery, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Ming Tan
- Graduate Institute of Biomedical Sciences and Research Center for Cancer Biology, China Medical University, Taichung, 406040, Taiwan
| | - Windy Dean-Colomb
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, 36088, USA
- Department of Hematology/Oncology, Piedmont Hospital, Newnan, GA, 30265, USA
| | - Clayton Yates
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, 36088, USA.
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, 21218, USA.
- Cancer Genetics and Epigenetics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, The Bunting-Blaustein Cancer Research Building 1, 1650 Orleans Street - Room 1M44, Baltimore, MD, 21287-0013, USA.
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, 21218, USA.
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4
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McDonald JT, Ricks-Santi LJ. Hereditary variants of unknown significance in African American women with breast cancer. PLoS One 2022; 17:e0273835. [PMID: 36315513 PMCID: PMC9621418 DOI: 10.1371/journal.pone.0273835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022] Open
Abstract
Expanded implementation of genetic sequencing has precipitously increased the discovery of germline and somatic variants. The direct benefit of identifying variants in actionable genes may lead to risk reduction strategies such as increased surveillance, prophylactic surgery, as well as lifestyle modifications to reduce morbidity and mortality. However, patients with African ancestry are more likely to receive inconclusive genetic testing results due to an increased number of variants of unknown significance decreasing the utility and impact on disease management and prevention. This study examines whole exome sequencing results from germline DNA samples in African American women with a family history of cancer including 37 cases that were diagnosed with breast cancer and 51 family members. Self-identified ancestry was validated and compared to the 1000 genomes population. The analysis of sequencing results was limited to 85 genes from three clinically available common genetic screening platforms. This target region had a total of 993 variants of which 6 (<1%) were pathogenic or likely pathogenic, 736 (74.1%) were benign, and 170 (17.1%) were classified as a variant of unknown significance. There was an average of 3.4±1.8 variants with an unknown significance per individual and 85 of 88 individuals (96.6%) harbored at least one of these in the targeted genes. Pathogenic or likely pathogenic variants were only found in 6 individuals for the BRCA1 (p.R1726fs, rs80357867), BRCA2 (p.K589fs, rs397507606 & p.L2805fs, rs397507402), RAD50 (p.E995fs, rs587780154), ATM (p.V2424G, rs28904921), or MUTYH (p.G396D, rs36053993) genes. Strategies to functionally validate the remaining variants of unknown significance, especially in understudied and hereditary cancer populations, are greatly needed to increase the clinical utility and utilization of clinical genetic screening platforms to reduce cancer incidence and mortality.
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Affiliation(s)
- J. Tyson McDonald
- Department of Radiation Medicine, Georgetown University School of Medicine, Washington, DC, United States of America
| | - Luisel J. Ricks-Santi
- Cancer Research Center, Hampton University, Hampton, VA, United States of America
- Department of Pharmacotherapy and Translational Research, College of Medicine, University of Florida, Gainesville, FL, United States of America
- * E-mail:
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Hamel KM, Liimatta KQ, Belgodere JA, Bunnell BA, Gimble JM, Martin EC. Adipose-Derived Stromal/Stem Cell Response to Tumors and Wounds: Evaluation of Patient Age. Stem Cells Dev 2022; 31:579-592. [PMID: 35262397 PMCID: PMC9836707 DOI: 10.1089/scd.2021.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/05/2022] [Indexed: 01/22/2023] Open
Abstract
Tumors were characterized as nonhealing wounds by Virchow in 1858 and Dvorak in 1986. Since then, researchers have analyzed tumors from a new perspective. The parallels between tumorigenesis and physiological wound healing can provide a new framework for developing antitumor therapeutics. One commonality between tumors and wounds is the involvement of the stromal environment, particularly adipose stromal/stem cells (ASCs). ASCs exhibit dual functions, in which they stimulate tumor progression and assist in tissue repair and regeneration. Numerous studies have focused on the role of ASCs in cancer and wound healing, but none to date has linked age, cancer, and wound healing. Furthermore, very few studies have focused on the role of donor-specific characteristics of ASCs, such as age and their role in facilitating ASC behavior in cancer and wound healing. This review article is designed to provide important insights into the impact of donor age on ASC tumor and wound response and their role in facilitating ASC behavior in cancer and wound healing.
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Affiliation(s)
- Katie M. Hamel
- Department of Biological Engineering, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Kara Q. Liimatta
- Department of Biological Engineering, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Jorge A. Belgodere
- Department of Biological Engineering, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Bruce A. Bunnell
- University of North Texas Health Sciences Center, Fort Worth, Texas, USA
| | | | - Elizabeth C. Martin
- Department of Biological Engineering, Louisiana State University, Baton Rouge, Louisiana, USA
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6
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Champion CD, Thomas SM, Plichta JK, Parrilla Castellar E, Rosenberger LH, Greenup RA, Hyslop T, Hwang ES, Fayanju OM. Disparities at the Intersection of Race and Ethnicity: Examining Trends and Outcomes in Hispanic Women With Breast Cancer. JCO Oncol Pract 2022; 18:e827-e838. [PMID: 33026950 PMCID: PMC9797230 DOI: 10.1200/op.20.00381] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE We sought to examine tumor subtype, stage at diagnosis, time to surgery (TTS), and overall survival (OS) among Hispanic patients of different races and among Hispanic and non-Hispanic (NH) women of the same race. METHODS Women 18 years of age or older who had been diagnosed with stage 0-IV breast cancer and who had undergone lumpectomy or mastectomy were identified in the National Cancer Database (2004-2014). Tumor subtype and stage at diagnosis were compared by race/ethnicity. Multivariable linear regression and Cox proportional hazards modeling were used to estimate associations between race/ethnicity and adjusted TTS and OS, respectively. RESULTS A total of 44,374 Hispanic (American Indian [AI]: 79 [0.2%]; Black: 1,011 [2.3%]; White: 41,126 [92.7%]; Other: 2,158 [4.9%]) and 858,634 NH women (AI: 2,319 [0.3%]; Black: 97,206 [11.3%]; White: 727,270 [84.7%]; Other: 31,839 [3.7%]) were included. Hispanic Black women had lower rates of triple-negative disease (16.2%) than did NH Black women (23.5%) but higher rates than did Hispanic White women (13.9%; P < .001). Hispanic White women had higher rates of node-positive disease (23.2%) versus NH White women (14.4%) but slightly lower rates than Hispanic (24.6%) and NH Black women (24.5%; P < .001). Hispanic White women had longer TTS versus NH White women regardless of treatment sequence (adjusted means: adjuvant chemotherapy, 42.71 v 38.60 days; neoadjuvant chemotherapy, 208.55 v 201.14 days; both P < .001), but there were no significant racial differences in TTS among Hispanic patients. After adjustment, Hispanic White women (hazard ratio, 0.77 [95% CI, 0.74 to 0.81]) and Black women (hazard ratio, 0.75 [95% CI, 0.58 to 0.96]) had improved OS versus NH White women (reference) and Black women (hazard ratio, 1.15 [95% CI, 1.12 to 1.18]; all P < .05). CONCLUSION Hispanic women had improved OS versus NH women, but racial differences in tumor subtype and nodal stage among Hispanic women highlight the importance of disaggregating racial/ethnic data in breast cancer research.
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Affiliation(s)
- Cosette D. Champion
- Department of Medicine, Washington University School of Medicine, St Louis, MO,Oluwadamilola M. Fayanju, MD, MA, MPHS, DUMC 3513, Durham, NC 27710; e-mail:
| | - Samantha M. Thomas
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Jennifer K. Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC,Women’s Cancer Program, Duke Cancer Institute, Durham, NC
| | - Edgardo Parrilla Castellar
- Women’s Cancer Program, Duke Cancer Institute, Durham, NC,Department of Pathology, Duke University Medical Center, Durham, NC
| | - Laura H. Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC,Women’s Cancer Program, Duke Cancer Institute, Durham, NC
| | - Rachel A. Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC,Women’s Cancer Program, Duke Cancer Institute, Durham, NC,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Terry Hyslop
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - E. Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC,Women’s Cancer Program, Duke Cancer Institute, Durham, NC
| | - Oluwadamilola M. Fayanju
- Department of Surgery, Duke University Medical Center, Durham, NC,Women’s Cancer Program, Duke Cancer Institute, Durham, NC,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC,Duke Forge, Duke University, Durham, NC,Department of Surgery, Durham VA Medical Center, Durham, NC,Oluwadamilola M. Fayanju, MD, MA, MPHS, DUMC 3513, Durham, NC 27710; e-mail:
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7
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Abou-Fadel J, Bhalli M, Grajeda B, Zhang J. CmP Signaling Network Leads to Identification of Prognostic Biomarkers for Triple-Negative Breast Cancer in Caucasian Women. Genet Test Mol Biomarkers 2022; 26:198-219. [PMID: 35481969 DOI: 10.1089/gtmb.2021.0221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: Triple-negative breast cancer (TNBC) constitutes ∼15% of all diagnosed invasive breast cancer cases with limited options for treatment since immunotherapies that target ER, PR, and HER2 receptors are ineffective. Progesterone (PRG) can induce its effects through either classic, nonclassic, or combined responses by binding to classic nuclear PRG receptors (nPRs) or nonclassic membrane PRG receptors (mPRs). Under PRG-induced actions, we previously demonstrated that the CCM signaling complex (CSC) can couple both nPRs and mPRs into a CmPn signaling network, which plays an important role during nPR(+) breast cancer tumorigenesis. We recently defined the novel CmP signaling network in African American women (AAW)-derived TNBC cells, which overlapped with our previously defined CmPn network in nPR(+) breast cancer cells. Methods: Under mPR-specific steroid actions, we measured alterations to key tumorigenic pathways in Caucasian American women (CAW)- derived TNBC cells, with RNAseq/proteomic and systems biology approaches. Exemption from ethics approval from IRB: This study only utilized cultured NBC cell lines with publicly available TNBC clinical data sets. Results: Our results demonstrated that TNBCs in CAW share similar altered signaling pathways, as TNBCs in AAW, under mPR-specific steroid actions, demonstrating the overall aggressive nature of TNBCs, regardless of racial differences. Furthermore, in this report, we have deconvoluted the CmP signalosome, using systems biology approaches and CAW-TNBC clinical data, to identify 21 new CAW-TNBC-specific prognostic biomarkers that reinforce the definitive role of CSC and mPR signaling during CAW-TNBC tumorigenesis. Conclusion: This new set of potential prognostic biomarkers may revolutionize molecular mechanisms and currently known concepts of tumorigenesis in CAW-TNBCs, leading to hopeful new therapeutic strategies.
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Affiliation(s)
- Johnathan Abou-Fadel
- Department of Molecular and Translational Medicine (MTM), Texas Tech University Health Science Center El Paso, El Paso, Texas, USA
| | - Muaz Bhalli
- Department of Molecular and Translational Medicine (MTM), Texas Tech University Health Science Center El Paso, El Paso, Texas, USA
| | - Brian Grajeda
- Department of Biological Sciences, University of Texas at El Paso, El Paso, Texas, USA
| | - Jun Zhang
- Department of Molecular and Translational Medicine (MTM), Texas Tech University Health Science Center El Paso, El Paso, Texas, USA
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8
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Williams SD, Sakwe AM. Reduced Expression of Annexin A6 Induces Metabolic Reprogramming That Favors Rapid Fatty Acid Oxidation in Triple-Negative Breast Cancer Cells. Cancers (Basel) 2022; 14:1108. [PMID: 35267416 PMCID: PMC8909273 DOI: 10.3390/cancers14051108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 12/01/2022] Open
Abstract
The ability of cancer cells to alter their metabolism is one of the major mechanisms underlying rapid tumor progression and/or therapeutic resistance in solid tumors, including the hard-to-treat triple-negative breast cancer (TNBC) subtype. Here, we assessed the contribution of the tumor suppressor, Annexin A6 (AnxA6), in the metabolic adaptation of basal-like (AnxA6-low) versus mesenchymal-like (AnxA6-high), as well as in lapatinib-resistant TNBC cells. Using model basal-like and mesenchymal-like TNBC cell lines, we show that TNBC cells also exhibit metabolic heterogeneity. The downregulation of AnxA6 in TNBC cells generally attenuated mitochondrial respiration, glycolytic flux, and cellular ATP production capacity resulting in a quiescent metabolic phenotype. We also show that AnxA6 depletion in mesenchymal-like TNBC cells was associated with a rapid uptake and mitochondrial fatty acid oxidation and diminished lipid droplet accumulation and altered the lipogenic metabolic phenotype of these cells to a lypolytic metabolic phenotype. The overexpression or chronic lapatinib-induced upregulation of AnxA6 in AnxA6-low TNBC cells reversed the quiescent/lypolytic phenotype to a more lipogenic/glycolytic phenotype with gluconeogenic precursors as additional metabolites. Collectively, these data suggest that the expression status of AnxA6 in TNBC cells underlies distinct metabolic adaptations of basal-like and mesenchymal-like TNBC subsets in response to cellular stress and/or therapeutic intervention and suggest AnxA6 as a biomarker for metabolic subtyping of TNBC subsets.
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Affiliation(s)
| | - Amos M. Sakwe
- Department of Biochemistry, Cancer Biology, Neuroscience and Pharmacology, School of Graduate Studies and Research, Meharry Medical College, Nashville, TN 37208, USA;
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9
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Ashing KT, Jones V, Bedell F, Phillips T, Erhunmwunsee L. Calling Attention to the Role of Race-Driven Societal Determinants of Health on Aggressive Tumor Biology: A Focus on Black Americans. JCO Oncol Pract 2022; 18:15-22. [PMID: 34255546 PMCID: PMC8758120 DOI: 10.1200/op.21.00297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Blacks have the highest incidence and mortality from most cancers. The reasons for these disparities remain unclear. Blacks are exposed to adverse social determinants because of historic and contemporary racist polices; however, how these determinants affect the disparities that Blacks experience is understudied. As a result of discriminatory community policies, like redlining, Blacks have higher exposure to air pollution and neighborhood deprivation. Studies investigating how these factors affect tumor biology are emerging. We highlight the literature that connects racism-related community exposure to the tumor biology in breast, lung, prostate, and colorectal cancer. Further investigations that clarify the link between adverse social determinants that result from systemic racism and aggressive tumor biology are required if health equity is to be achieved. Without recognition that racism is a public health risk with carcinogenic impact, health care delivery and cancer care will never achieve excellence. In response, health systems ought to establish corrective actions to improve Black population health and bring medical justice to marginalized racialized groups.
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Affiliation(s)
- Kimlin T. Ashing
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA,African-Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA,Kimlin T. Ashing, PhD, CCARE—Department of Population Sciences, City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte, CA 91010-3000; e-mail:
| | - Veronica Jones
- African-Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA
| | - Fornati Bedell
- Division of Urology and Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Tanyanika Phillips
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Loretta Erhunmwunsee
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA,Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA
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10
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Intrinsic subtypes in Ethiopian breast cancer patient. Breast Cancer Res Treat 2022; 196:495-504. [PMID: 36282363 PMCID: PMC9633534 DOI: 10.1007/s10549-022-06769-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/06/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE The recent development of multi-gene assays for gene expression profiling has contributed significantly to the understanding of the clinically and biologically heterogeneous breast cancer (BC) disease. PAM50 is one of these assays used to stratify BC patients and individualize treatment. The present study was conducted to characterize PAM50-based intrinsic subtypes among Ethiopian BC patients. PATIENTS AND METHODS Formalin-fixed paraffin-embedded tissues were collected from 334 BC patients who attended five different Ethiopian health facilities. All samples were assessed using the PAM50 algorithm for intrinsic subtyping. RESULTS The tumor samples were classified into PAM50 intrinsic subtypes as follows: 104 samples (31.1%) were luminal A, 91 samples (27.2%) were luminal B, 62 samples (18.6%) were HER2-enriched and 77 samples (23.1%) were basal-like. The intrinsic subtypes were found to be associated with clinical and histopathological parameters such as steroid hormone receptor status, HER2 status, Ki-67 proliferation index and tumor differentiation, but not with age, tumor size or histological type. An immunohistochemistry-based classification of tumors (IHC groups) was found to correlate with intrinsic subtypes. CONCLUSION The distribution of the intrinsic subtypes confirms previous immunohistochemistry-based studies from Ethiopia showing potentially endocrine-sensitive tumors in more than half of the patients. Health workers in primary or secondary level health care facilities can be trained to offer endocrine therapy to improve breast cancer care. Additionally, the findings indicate that PAM50-based classification offers a robust method for the molecular classification of tumors in the Ethiopian context.
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11
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Skaar DA, Dietze EC, Alva-Ornelas JA, Ann D, Schones DE, Hyslop T, Sistrunk C, Zalles C, Ambrose A, Kennedy K, Idassi O, Miranda Carboni G, Gould MN, Jirtle RL, Seewaldt VL. Epigenetic Dysregulation of KCNK9 Imprinting and Triple-Negative Breast Cancer. Cancers (Basel) 2021; 13:6031. [PMID: 34885139 PMCID: PMC8656495 DOI: 10.3390/cancers13236031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/26/2021] [Indexed: 12/02/2022] Open
Abstract
Genomic imprinting is an inherited form of parent-of-origin specific epigenetic gene regulation that is dysregulated by poor prenatal nutrition and environmental toxins. KCNK9 encodes for TASK3, a pH-regulated potassium channel membrane protein that is overexpressed in 40% of breast cancer. However, KCNK9 gene amplification accounts for increased expression in <10% of these breast cancers. Here, we showed that KCNK9 is imprinted in breast tissue and identified a differentially methylated region (DMR) controlling its imprint status. Hypomethylation at the DMR, coupled with biallelic expression of KCNK9, occurred in 63% of triple-negative breast cancers (TNBC). The association between hypomethylation and TNBC status was highly significant in African-Americans (p = 0.006), but not in Caucasians (p = 0.70). KCNK9 hypomethylation was also found in non-cancerous tissue from 77% of women at high-risk of developing breast cancer. Functional studies demonstrated that the KCNK9 gene product, TASK3, regulates mitochondrial membrane potential and apoptosis-sensitivity. In TNBC cells and non-cancerous mammary epithelial cells from high-risk women, hypomethylation of the KCNK9 DMR predicts for increased TASK3 expression and mitochondrial membrane potential (p < 0.001). This is the first identification of the KCNK9 DMR in mammary epithelial cells and demonstration that its hypomethylation in breast cancer is associated with increases in both mitochondrial membrane potential and apoptosis resistance. The high frequency of hypomethylation of the KCNK9 DMR in TNBC and non-cancerous breast tissue from high-risk women provides evidence that hypomethylation of the KNCK9 DMR/TASK3 overexpression may serve as a marker of risk and a target for prevention of TNBC, particularly in African American women.
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Affiliation(s)
- David A. Skaar
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA;
| | - Eric C. Dietze
- Beckman Research Institute, Department of Population Sciences, City of Hope, Duarte, CA 91010, USA; (E.C.D.); (J.A.A.-O.); (D.A.); (D.E.S.); (C.S.); (A.A.); (K.K.); (O.I.)
| | - Jackelyn A. Alva-Ornelas
- Beckman Research Institute, Department of Population Sciences, City of Hope, Duarte, CA 91010, USA; (E.C.D.); (J.A.A.-O.); (D.A.); (D.E.S.); (C.S.); (A.A.); (K.K.); (O.I.)
| | - David Ann
- Beckman Research Institute, Department of Population Sciences, City of Hope, Duarte, CA 91010, USA; (E.C.D.); (J.A.A.-O.); (D.A.); (D.E.S.); (C.S.); (A.A.); (K.K.); (O.I.)
| | - Dustin E. Schones
- Beckman Research Institute, Department of Population Sciences, City of Hope, Duarte, CA 91010, USA; (E.C.D.); (J.A.A.-O.); (D.A.); (D.E.S.); (C.S.); (A.A.); (K.K.); (O.I.)
| | - Terry Hyslop
- Department of Biostatistics, School of Medicine, Duke University, Durham, NC 27710, USA;
| | - Christopher Sistrunk
- Beckman Research Institute, Department of Population Sciences, City of Hope, Duarte, CA 91010, USA; (E.C.D.); (J.A.A.-O.); (D.A.); (D.E.S.); (C.S.); (A.A.); (K.K.); (O.I.)
| | - Carola Zalles
- Department of Pathology, Mercy Hospital, Miami, FL 33133, USA;
| | - Adrian Ambrose
- Beckman Research Institute, Department of Population Sciences, City of Hope, Duarte, CA 91010, USA; (E.C.D.); (J.A.A.-O.); (D.A.); (D.E.S.); (C.S.); (A.A.); (K.K.); (O.I.)
| | - Kendall Kennedy
- Beckman Research Institute, Department of Population Sciences, City of Hope, Duarte, CA 91010, USA; (E.C.D.); (J.A.A.-O.); (D.A.); (D.E.S.); (C.S.); (A.A.); (K.K.); (O.I.)
| | - Ombeni Idassi
- Beckman Research Institute, Department of Population Sciences, City of Hope, Duarte, CA 91010, USA; (E.C.D.); (J.A.A.-O.); (D.A.); (D.E.S.); (C.S.); (A.A.); (K.K.); (O.I.)
| | - Gustavo Miranda Carboni
- Laboratory of Oncology, Department of Oncology, School of Medicine, University of Tennessee Health Science, Memphis, TN 38163, USA;
| | - Michael N. Gould
- McArdle Laboratory for Cancer Research, University of Wisconsin-Madison, Madison, WI 53706, USA;
| | - Randy L. Jirtle
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA;
| | - Victoria L. Seewaldt
- Beckman Research Institute, Department of Population Sciences, City of Hope, Duarte, CA 91010, USA; (E.C.D.); (J.A.A.-O.); (D.A.); (D.E.S.); (C.S.); (A.A.); (K.K.); (O.I.)
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12
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Poteat T, Adams MA, Malone J, Geffen S, Greene N, Nodzenski M, Lockhart A, Su IH, Dean LT. Delays in breast cancer care by race and sexual orientation: Results from a national survey with diverse women in the United States. Cancer 2021; 127:3514-3522. [PMID: 34287838 PMCID: PMC8684596 DOI: 10.1002/cncr.33629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/19/2020] [Accepted: 01/19/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Despite known differences in breast cancer by both race and sexual orientation, data on the intersectional experiences of Black sexual minority women (BSMW) along the care continuum are scant. This study sought to understand delays in breast cancer care by examining the intersection of race and sexual orientation. METHODS This online, cross-sectional survey enrolled racially and sexually diverse women aged ≥ 35 years who had been diagnosed with breast cancer within the prior 10 years or had an abnormal screening in the prior 24 months. The authors calculated summary statistics by race/sexual orientation categories, and they conducted univariate and multivariable modeling by using multiple imputation for missing data. RESULTS BSMW (n = 101) had the highest prevalence of care delays with 5.17-fold increased odds of a care delay in comparison with White heterosexual women (n = 298) in multivariable models. BSMW reported higher intersectional stigma and lower social support than all other groups. In models adjusted for race, sexual orientation, and income, intersectional stigma was associated with a 2.43-fold increase in care delays, and social support was associated with a 32% decrease in the odds of a care delay. CONCLUSIONS Intersectional stigma may be an important driver of breast cancer inequities for BSMW. Reducing stigma and ensuring access to appropriate social support that addresses known barriers can be an important approach to reducing inequities in the breast cancer care continuum.
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Affiliation(s)
- Tonia Poteat
- University of North Carolina Chapel Hill, Department of Social Medicine, CB #7240, Chapel Hill, NC 27599
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21205
| | | | - Jowanna Malone
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21205
| | - Sophia Geffen
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21205
| | - Naomi Greene
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 North Broadway Street, Baltimore, MD 21205
| | - Michael Nodzenski
- University of North Carolina Chapel Hill, Department of Biostatistics, CB #7420, Chapel Hill, NC 27599
| | - Alex Lockhart
- University of North Carolina Chapel Hill, Department of Biostatistics, CB #7420, Chapel Hill, NC 27599
| | - I-Hsuan Su
- University of North Carolina Chapel Hill, Department of Biostatistics, CB #7420, Chapel Hill, NC 27599
| | - Lorraine T. Dean
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21205
- Johns Hopkins School of Medicine, Department of Oncology, 720 Rutland Ave, Baltimore, MD 21205
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13
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Hormone receptor-positive breast cancer and black race: does sex matter? Breast Cancer Res Treat 2021; 190:111-119. [PMID: 34383180 DOI: 10.1007/s10549-021-06359-5] [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: 06/29/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Black breast cancer patients have worse clinical outcomes than their White counterparts. There are few studies comparing clinical outcomes between Black male breast cancer (MBC) and female breast cancer (FBC) patients. The objective of this study is to examine differences in presentation, treatment, and mortality between Black MBC and FBC. METHODS The National Cancer Database was queried for all Black MBC and FBC patients, ages 18-90, with hormone receptor-positive breast cancer diagnosed between 2010 and 2016. Hormone receptor positivity was defined as estrogen receptor-positive, progesterone-positive and HER 2-negative cancer. Sociodemographic and clinical variables were compared between MBC and FBC patients on bivariable analysis. After propensity score matching, overall survival was evaluated using the log-rank test and Cox proportional hazards. RESULTS Compared to FBC patients, MBC patients had higher rates of metastatic disease (stage 4, MBC 4.4% vs. FBC 2.6%, p < 0.001), larger tumors (tumor size < 2 cm, MBC 32.1 vs. FBC 49.1%, p < 0.001) and a higher percentage of poorly differentiated tumors (grade 3, MBC 28.5% vs. FBC 21.4%, p < 0.001). MBC patients had lower rates of hormone therapy (MBC 66.4% vs. FBC 80.7%, p < 0.001) and neoadjuvant chemotherapy (MBC 5.8% vs. FBC 7.5%, p = 0.05) than FBC. On propensity score matched analysis, Black MBC patients had a higher overall mortality (p25 of 60 months vs. 74 months) compared to FBC patients (p = 0.0260). CONCLUSION Among hormone receptor-positive Black MBC and FBC patients, there are sex-based disparities in stage, hormone therapy use and overall survival.
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14
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Kantor O, Wang ML, Bertrand K, Pierce L, Freedman RA, Chavez-MacGregor M, King TA, Mittendorf EA. Racial and Socioeconomic Disparities in Breast Cancer Outcomes within the AJCC Pathologic Prognostic Staging System. Ann Surg Oncol 2021; 29:686-696. [PMID: 34331158 DOI: 10.1245/s10434-021-10527-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Non-Hispanic black (NHB) women and those of lower socioeconomic status (SES) have inferior breast cancer outcomes compared with non-Hispanic white (NHW) women and those of higher SES. We examined racial and SES disparities in breast cancer survival within the AJCC 8th edition pathologic prognostic staging system. METHODS Using the Surveillance, Epidemiology and End Results Program, we identified patients diagnosed with invasive breast cancer from 2010 to 2015, with follow-up through 2016. Census tract-level SES (cSES) data were available as a composite index and analyzed in quintiles. Cox proportional-hazards survival analyses adjusted for age, race, cSES, insurance, marital status, histology, pathologic prognostic stage, and treatment were used to estimate disease-specific survival (DSS). RESULTS A total of 259,852 patients were included: 176,369 (67.9%) NHW; 28,510 (11.0%) NHB; 29,737 (11.4%) Hispanic; and 22,887 (8.8%) Asian. NHB race and lower cSES were associated with increased incidence of triple-negative disease compared with NHW (p < 0.01). NHB race, lower cSES, public insurance, lower education, and increased poverty were associated with lower DSS. Survival analyses adjusting for cSES, tumor, and treatment characteristics demonstrated that NHB patients had inferior DSS within each AJCC pathologic prognostic stage (hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.20-1.30) compared with NHW patients. Fully adjusted models also showed patients residing in lower SES counties had inferior DSS. CONCLUSIONS Racial and cSES disparities in breast cancer-specific mortality were evident across all stages, even within the pathologic prognostic staging system which incorporates tumor biology. Future efforts should assess the biological, behavioral, social, and environmental determinants that underlie racial and SES inequities in outcomes.
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Affiliation(s)
- Olga Kantor
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Monica L Wang
- Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kimberly Bertrand
- Slone Epidemiology Center, Boston University, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Lori Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Rachel A Freedman
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mariana Chavez-MacGregor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. .,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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15
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Gupta A, Oyekunle T, Salako O, Daramola A, Alatise O, Ogun G, Adeniyi A, Deveaux A, Saraiya V, Hall A, Ayandipo O, Olajide T, Olasehinde O, Arowolo O, Adisa A, Afuwape O, Olusanya A, Adegoke A, Tollefsbol TO, Arnett D, Muehlbauer MJ, Newgard CB, Akinyemiju T. Association of high-sensitivity C-reactive protein and odds of breast cancer by molecular subtype: analysis of the MEND study. Oncotarget 2021; 12:1230-1242. [PMID: 34194621 PMCID: PMC8238238 DOI: 10.18632/oncotarget.27991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022] Open
Abstract
Breast cancer (BC) in Nigeria is characterized by disproportionately aggressive molecular subtypes. C-reactive protein (CRP) is associated with risk and aggressiveness for several types of cancer. We examined the association of high-sensitivity CRP (hsCRP) with odds of BC by molecular subtype among Nigerian women. Among 296 newly diagnosed BC cases and 259 healthy controls, multivariable logistic regression models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association between hsCRP and odds of BC overall and by molecular subtype (luminal A, luminal B, HER2-enriched and triple-negative or TNBC). High hsCRP (> 3 mg/L) was observed in 57% of cases and 31% of controls and was associated with 4 times the odds of BC (aOR: 4.43; 95% CI: 2.56, 7.66) after adjusting for socio-demographic, reproductive, and clinical variables. This association persisted regardless of menopausal status and body mass index (BMI) category. High hsCRP was associated with increased odds of TNBC (aOR: 3.32; 95% CI: 1.07, 10.35), luminal A BC (aOR: 4.03; 95% CI: 1.29, 12.64), and HER2-enriched BC (aOR: 6.27; 95% CI: 1.69, 23.25). Future studies are necessary in this population to further evaluate a potential role for CRP as a predictive biomarker for BC.
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Affiliation(s)
- Anjali Gupta
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Taofik Oyekunle
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Omolola Salako
- College of Medicine & Lagos University Teaching Hospital, University of Lagos, Lagos State, Nigeria
| | - Adetola Daramola
- College of Medicine & Lagos University Teaching Hospital, University of Lagos, Lagos State, Nigeria
| | - Olusegun Alatise
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Gabriel Ogun
- University College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | | | - April Deveaux
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Veeral Saraiya
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Allison Hall
- Department of Pathology, School of Medicine, Duke University, Durham, NC, USA
| | - Omobolaji Ayandipo
- University College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Thomas Olajide
- College of Medicine & Lagos University Teaching Hospital, University of Lagos, Lagos State, Nigeria
| | | | - Olukayode Arowolo
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Adewale Adisa
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Oludolapo Afuwape
- University College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Aralola Olusanya
- University College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Aderemi Adegoke
- Our Lady of Apostle Catholic Hospital, Ibadan, Oyo State, Nigeria
| | - Trygve O. Tollefsbol
- Department of Biology, College of Arts and Sciences, University of Alabama at Birmingham, AL, USA
| | - Donna Arnett
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | | | | | | | - Tomi Akinyemiju
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
- Duke Cancer Institute, School of Medicine, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
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16
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Romanoff A, Olasehinde O, Goldman DA, Alatise OI, Constable J, Monu N, Knapp GC, Odujoko O, Onabanjo E, Adisa AO, Arowolo AO, Omisore AD, Famurewa OC, Anderson BO, Gemignani ML, Kingham TP. Opportunities for Improvement in the Administration of Neoadjuvant Chemotherapy for T4 Breast Cancer: A Comparison of the U.S. and Nigeria. Oncologist 2021; 26:e1589-e1598. [PMID: 33955123 DOI: 10.1002/onco.13814] [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: 10/22/2020] [Accepted: 04/08/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is an integral component of T4 breast cancer (BCa) treatment. We compared response to NAC for T4 BCa in the U.S. and Nigeria to direct future interventions. MATERIALS AND METHODS Cross-sectional retrospective analysis included all patients with non-metastatic T4 BCa treated from 2010 to 2016 at Memorial Sloan Kettering Cancer Center (New York, New York) and Obafemi Awolowo University Teaching Hospitals Complex (Ile Ife, Nigeria). Pathologic complete response (pCR) and survival were compared and factors contributing to disparities evaluated. RESULTS Three hundred and eight patients met inclusion criteria: 157 (51%) in the U.S. and 151 (49%) in Nigeria. All U.S. patients received NAC and surgery compared with 93 (62%) Nigerian patients. Fifty-six out of ninety-three (60%) Nigerian patients completed their prescribed course of NAC. In Nigeria, older age and higher socioeconomic status were associated with treatment receipt. Fewer patients in Nigeria had immunohistochemistry performed (100% U.S. vs. 18% Nigeria). Of those with available receptor subtype, 18% (28/157) of U.S. patients were triple negative versus 39% (9/23) of Nigerian patients. Overall pCR was seen in 27% (42/155) of U.S. patients and 5% (4/76) of Nigerian patients. Five-year survival was significantly shorter in Nigeria versus the U.S. (61% vs. 72%). However, among the subset of patients who received multimodality therapy, including NAC and surgery with curative intent, 5-year survival (67% vs. 72%) and 5-year recurrence-free survival (48% vs. 61%) did not significantly differ between countries. CONCLUSION Addressing health system, socioeconomic, and psychosocial barriers is necessary for administration of complete NAC to improve BCa outcomes in Nigeria. IMPLICATIONS FOR PRACTICE This cross-sectional retrospective analysis of patients with T4 breast cancer in Nigeria and the U.S. found a significant difference in pathologic complete response to neoadjuvant chemotherapy (5% Nigeria vs. 27% U.S.). Five-year survival was shorter in Nigeria, but in patients receiving multimodality treatment, including neoadjuvant chemotherapy and surgery with curative intent, 5-year overall and recurrence-free survival did not differ between countries. Capacity-building efforts in Nigeria should focus on access to pathology services to direct systemic therapy and promoting receipt of complete chemotherapy to improve outcomes.
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Affiliation(s)
- Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Surgery, Global Cancer Disparities Initiatives, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Debra A Goldman
- Department of Epidemiology and Biostatics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Olusegun I Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Jeremy Constable
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ngozi Monu
- Weill Cornell School of Medicine, New York, New York, USA
| | - Gregory C Knapp
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Oluwole Odujoko
- Department of Pathology, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Emmanuella Onabanjo
- African Research Group for Oncology, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Adewale O Adisa
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Adeolu O Arowolo
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Adeleye D Omisore
- Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Olusola C Famurewa
- Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Benjamin O Anderson
- Departments of Surgery and Global Health, University of Washington, Seattle, Washington, USA.,Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Mary L Gemignani
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - T Peter Kingham
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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17
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Greene N, Malone J, Adams MA, Dean LT, Poteat T. "This is some mess right here": Exploring interactions between Black sexual minority women and health care providers for breast cancer screening and care. Cancer 2021; 127:74-81. [PMID: 32990978 PMCID: PMC7865953 DOI: 10.1002/cncr.33219] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/13/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Few studies have explored how the intersection of race and sexual identity contribute to breast cancer disparities for Black sexual minority women (SMW). Issues within patient-provider relationships, including bias, contribute to health disparities for minority groups. The authors used constructs from self-determination theory (SDT) to explore the nature of health care provider interactions in breast cancer screening and care among Black SMW. METHODS Participants were sampled nationally through social media, targeted emails, and referrals. Qualitative, in-depth interviews were conducted with 15 Black cisgender SMW, ages 38 to 64 years, who had a breast cancer diagnosis or recent abnormal mammogram. Interviews were conducted face-to-face or online, audio-recorded, and transcribed verbatim. Two analysts coded the interviews. Codes were analyzed across interviews to identify themes salient to SDT. RESULTS Themes aligned with the SDT constructs of relatedness and autonomy. Some participants discussed feeling most understood by Black and/or female providers who shared at least 1 of their identities. Feeling understood through shared identity contributed to participants feeling seen and heard by their providers. Participants who discussed negative experiences with providers believed that the provider made negative assumptions about them based on their race and/or sexual orientation. CONCLUSIONS When interacting with health care providers for breast cancer screening and care, Black SMW face specific challenges related to their multiply marginalized social position. Reducing health care provider bias toward Black SMW may improve patients' desires to continue in care. Providing equitable care while acknowledging and respecting women with multiply marginalized identities may improve the nature of these interactions.
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Affiliation(s)
- Naomi Greene
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society
| | - Jowanna Malone
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology
| | - Mary Anne Adams
- ZAMI NOBLA: National Organization of Black Lesbians on Aging
| | - Lorraine T. Dean
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology
- Sidney Kimmel Cancer Center, Department of Oncology
| | - Tonia Poteat
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology
- University of North Carolina Chapel Hill School of Medicine, Department of Social Medicine
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Breast cancer stem cells: A fallow research ground in Africa. Pathol Res Pract 2020; 216:153118. [PMID: 32853953 DOI: 10.1016/j.prp.2020.153118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022]
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Malone J, Snguon S, Dean LT, Adams MA, Poteat T. Breast Cancer Screening and Care Among Black Sexual Minority Women: A Scoping Review of the Literature from 1990 to 2017. J Womens Health (Larchmt) 2019; 28:1650-1660. [PMID: 30882262 PMCID: PMC6919240 DOI: 10.1089/jwh.2018.7127] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Black women are more likely to be diagnosed at later stages of breast cancer compared with White women due to lower frequency of screening and lack of timely follow-up after abnormal screening results. Disparities in breast cancer screening, risk, and mortality are present within both Black women and sexual minority communities; however, there exists limited research concerning breast cancer care among Black sexual minority women. Materials and Methods: This scoping review examines the literature from 1990 to 2017 of the breast cancer care continuum among Black sexual minority women, including behavioral risk factors, screening, treatment, and survivorship. A total of 91 articles were identified through PubMed, PsycINFO, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. Fifteen articles were selected for data extraction, which met the criteria for including Black/African American women, discussing breast cancer care among both racial and sexual minorities, and being a peer-reviewed article. Results: The 15 articles were primarily within urban contexts, and defined sexual minorities as lesbian or bisexual women. Across all the studies, Black sexual minority women were highly under-represented, and key conclusions are not fully applicable to Black sexual minority women. Sexual minority women had a higher prevalence of breast cancer risk factors (i.e., nulliparity, fewer mammograms, higher alcohol intake, and lower oral contraceptive use). Furthermore, some studies noted homophobia from health providers as potential barriers to engagement in care for sexual minority women. Conclusions: The lack of studies concerning Black sexual minority women in breast cancer care indicates the invisibility of a group that experiences multiple marginalized identities. More research is needed to capture the dynamics of the breast cancer care continuum for Black sexual minority women.
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Affiliation(s)
- Jowanna Malone
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Sevly Snguon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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20
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Distinct microbial communities that differ by race, stage, or breast-tumor subtype in breast tissues of non-Hispanic Black and non-Hispanic White women. Sci Rep 2019; 9:11940. [PMID: 31420578 PMCID: PMC6697683 DOI: 10.1038/s41598-019-48348-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/29/2019] [Indexed: 01/03/2023] Open
Abstract
Growing evidence highlights an association between an imbalance in the composition and abundance of bacteria in the breast tissue (referred as microbial dysbiosis) and breast cancer in women. However, studies on the breast tissue microbiome have not been conducted in non-Hispanic Black (NHB) women. We investigated normal and breast cancer tissue microbiota from NHB and non-Hispanic White (NHW) women to identify distinct microbial signatures by race, stage, or tumor subtype. Using 16S rRNA gene sequencing, we observed that phylum Proteobacteria was most abundant in normal (n = 8), normal adjacent to tumor (normal pairs, n = 11), and breast tumors from NHB and NHW women (n = 64), with fewer Firmicutes, Bacteroidetes, and Actinobacteria. Breast tissues from NHB women had a higher abundance of genus Ralstonia compared to NHW tumors, which could explain a portion of the breast cancer racial disparities. Analysis of tumor subtype revealed enrichment of family Streptococcaceae in TNBC. A higher abundance of genus Bosea (phylum Proteobacteria) increased with stage. This is the first study to identify racial differences in the breast tissue microbiota between NHB and NHW women. Further studies on the breast cancer microbiome are necessary to help us understand risk, underlying mechanisms, and identify potential microbial targets.
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Smith A, Vidal GA, Pritchard E, Blue R, Martin MY, Rice LJ, Brown G, Starlard-Davenport A. Sistas Taking a Stand for Breast Cancer Research (STAR) Study: A Community-Based Participatory Genetic Research Study to Enhance Participation and Breast Cancer Equity among African American Women in Memphis, TN. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122899. [PMID: 30567326 PMCID: PMC6313663 DOI: 10.3390/ijerph15122899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/11/2018] [Accepted: 12/14/2018] [Indexed: 01/14/2023]
Abstract
African American women are substantially underrepresented in breast cancer genetic research studies and clinical trials, yet they are more likely to die from breast cancer. Lack of trust in the medical community is a major barrier preventing the successful recruitment of African Americans into research studies. When considering the city of Memphis, TN, where the percentage of African Americans is significantly higher than the national average and it has a high rate of breast cancer mortality inequities among African American women, we evaluated the feasibility of utilizing a community-based participatory (CBPR) approach for recruiting African American women into a breast cancer genetic study, called the Sistas Taking A Stand for Breast Cancer Research (STAR) study. From June 2016 and December 2017, African American women age 18 and above were recruited to provide a 2 mL saliva specimen and complete a health questionnaire. A total of 364 African American women provided a saliva sample and completed the health questionnaire. Greater than 85% agreed to be contacted for future studies. Educational workshops on the importance of participating in cancer genetic research studies, followed by question and answer sessions, were most successful in recruitment. Overall, the participants expressed a strong interest and a willingness to participate in the STAR study. Our findings highlight the importance of implementing a CBPR approach that provides an educational component detailing the importance of participating in cancer genetic research studies and that includes prominent community advocates to build trust within the community.
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Affiliation(s)
- Alana Smith
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - Gregory A Vidal
- Department of Medicine, The University of Tennessee West Cancer Center, Memphis, TN 38163, USA.
- Division of Hematology and Oncology, Department of Medicine, University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Memphis, TN 38138, USA.
| | - Elizabeth Pritchard
- Department of Medicine, The University of Tennessee West Cancer Center, Memphis, TN 38163, USA.
| | - Ryan Blue
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - Michelle Y Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - LaShanta J Rice
- School of Health Sciences, Online Learning, Stratford University, 3201 Jermantown Road, Ste 500, Fairfax, VA 22030, USA.
| | - Gwendolynn Brown
- Carin and Sharin Breast Cancer Support Group, Memphis, TN 38613, USA.
| | - Athena Starlard-Davenport
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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22
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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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23
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Samiian L, Sharma P, Botty Van Den Bruele A, Smotherman C, Vincent M, Crandall M. The Effect of Insurance and Race on Breast Cancer Tumor Biology and Short-Term Outcomes. Am Surg 2018. [DOI: 10.1177/000313481808400743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
To determine whether low-income status as demonstrated by insurance type has any association with aggressive tumor biology and breast cancer outcomes. Retrospective review of 535 women with new diagnosis of breast cancer from January 2009 to March 2013 was performed. There was no significant association between race and stage at diagnosis. Women with Medicaid/Charity coverage were diagnosed at more advanced stages, more likely to have triple-negative breast cancer (TNBC), and had longer time to treatment. Rate of TNBC was higher in black women and younger patients. There was no significant difference in breast cancer recurrence or survival by race, insurance type, age, or tumor biology. In multivariable analysis, only black race (P = 0.003) and Medicaid/Charity Insurance (P = 0.0008) were the most significant predictors of TNBC. Presentation of aggressive tumor biology and advanced stage is strongly associated with socio-economic factors as reflected by Medicaid funding and lack of insurance.
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Affiliation(s)
- Laila Samiian
- Department of Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida and
| | - Priya Sharma
- Department of Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida and
| | | | - Carmen Smotherman
- Center for Health Equity and Quality Research (CHEQR), University of Florida, Jacksonville, Florida
| | - Mia Vincent
- Department of Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida and
| | - Marie Crandall
- Department of Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida and
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Martei YM, Vanderpuye V, Jones BA. Fear of Mastectomy Associated with Delayed Breast Cancer Presentation Among Ghanaian Women. Oncologist 2018; 23:1446-1452. [PMID: 29959283 DOI: 10.1634/theoncologist.2017-0409] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/17/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Breast cancer is the leading cause of cancer mortality among women globally. Most women in Ghana present with advanced stage disease. The aim of this study is to characterize sociocultural factors associated with delayed presentation. MATERIALS AND METHODS Qualitative study (grounded theory, constant comparative method) using individual in-depth interviews with breast cancer patients seen at the Korle Bu Teaching Hospital in Accra, Ghana. Interviews were conducted in English and three local languages. We achieved theoretical saturation with 31 participants. RESULTS The mean length of delay reported by patients was approximately 1 year. Five recurrent themes were related to delayed presentation: (a) Women with a confirmed breast cancer diagnosis delay treatment because of the fear of mastectomy due to self and societal stigma; (b) role of the church as a social support system given the societal stigma associated with breast cancer; (c) study participants expressed some awareness of breast cancer, but with varying depths of breast cancer knowledge encompassing both myths and misconceptions about breast cancer; (d) most patients present late because they do not associate a "painless" breast lump with possible breast malignancy; and (e) delayed presentation linked to significant financial burden associated with breast cancer treatment. CONCLUSION Despite current efforts to increase breast cancer awareness, the fear of mastectomy remains one of the main reasons for delayed presentation. Successful breast cancer education programs will need to be framed within the broader sociocultural dimensions of femininity that address some of the stigma associated with mastectomy reported in the Ghanaian context. IMPLICATIONS FOR PRACTICE Most women in Ghana present with advanced-stage disease. The aim of this study was to characterize sociocultural factors associated with delayed presentation. Although several quantitative studies have been conducted on delays in presentation in sub-Saharan Africa (SSA), this study is one of the few to identify fear of mastectomy as a reason for delayed presentation. Anecdotal data from current clinical experiences in SSA suggest that this is still an issue that has not been adequately reported and addressed in most SSA countries. The research results presented here will hopefully guide health providers and national organizations in designing breast cancer education programs in Ghana and other parts of SSA.
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Affiliation(s)
- Yehoda M Martei
- Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Verna Vanderpuye
- National Center for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Beth A Jones
- Yale School of Public Health, Yale Comprehensive Cancer Center, New Haven, Connecticut, USA
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25
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Shoemaker ML, White MC, Wu M, Weir HK, Romieu I. Differences in breast cancer incidence among young women aged 20-49 years by stage and tumor characteristics, age, race, and ethnicity, 2004-2013. Breast Cancer Res Treat 2018; 169:595-606. [PMID: 29445940 PMCID: PMC5955792 DOI: 10.1007/s10549-018-4699-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/29/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Younger women diagnosed with breast cancer have poorer prognoses and higher mortality compared to older women. Young black women have higher incidence rates of breast cancer and more aggressive subtypes than women of other races/ethnicities. In this study, we examined recent trends and variations in breast cancer incidence among young women in the United States. METHODS Using 2004-2013 National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program data, we calculated breast cancer incidence rates and trends and examined variations in stage, grade, and tumor subtype by age and race/ethnicity among young women aged 20-49 years. RESULTS The majority of breast cancer cases occurred in women aged 40-44 and 45-49 years (77.3%). Among women aged < 45 years, breast cancer incidence was highest among black women. Incidence trends increased from 2004 to 2013 for Asian or Pacific Islander (API) women and white women aged 20-34 years. Black, American Indian or Alaska Native, and Hispanic women had higher proportions of cases diagnosed at later stages than white and API women. Black women had a higher proportion of grade III-IV tumors than other racial/ethnic groups. Across all age groups, incidence rates for triple-negative breast cancer were significantly higher in black women than women of other races/ethnicities, and this disparity increased with age. CONCLUSIONS Breast cancer among young women is a highly heterogeneous disease. Differences in tumor characteristics by age and race/ethnicity suggest opportunities for further research into personal and cultural factors that may influence breast cancer risk among younger women.
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Affiliation(s)
- Meredith L Shoemaker
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Bldg. 107, F-76, 4770 Buford Highway, NE, Atlanta, GA, 30341, USA.
| | - Mary C White
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Bldg. 107, F-76, 4770 Buford Highway, NE, Atlanta, GA, 30341, USA
| | - Manxia Wu
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Bldg. 107, F-76, 4770 Buford Highway, NE, Atlanta, GA, 30341, USA
| | - Hannah K Weir
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Bldg. 107, F-76, 4770 Buford Highway, NE, Atlanta, GA, 30341, USA
| | - Isabelle Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
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26
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How advanced is breast cancer in Africa? LANCET GLOBAL HEALTH 2018; 4:e875-e876. [PMID: 27855857 DOI: 10.1016/s2214-109x(16)30283-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/30/2016] [Indexed: 11/21/2022]
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27
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Fernandes GC, Michelli RAD, Galvão HCR, Paula AE, Pereira R, Andrade CE, Felicio PS, Souza CP, Mendes DRP, Volc S, Berardinelli GN, Grasel RS, Sabato CS, Viana DV, Mauad EC, Scapulatempo-Neto C, Arun B, Reis RM, Palmero EI. Prevalence of BRCA1/BRCA2 mutations in a Brazilian population sample at-risk for hereditary breast cancer and characterization of its genetic ancestry. Oncotarget 2018; 7:80465-80481. [PMID: 27741520 PMCID: PMC5348334 DOI: 10.18632/oncotarget.12610] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 10/01/2016] [Indexed: 11/25/2022] Open
Abstract
Background There are very few data about the mutational profile of families at-risk for hereditary breast and ovarian cancer (HBOC) from Latin America (LA) and especially from Brazil, the largest and most populated country in LA. Results Of the 349 probands analyzed, 21.5% were BRCA1/BRCA2 mutated, 65.3% at BRCA1 and 34.7% at BRCA2 gene. The mutation c.5266dupC (former 5382insC) was the most frequent alteration, representing 36.7% of the BRCA1 mutations and 24.0% of all mutations identified. Together with the BRCA1 c.3331_3334delCAAG mutation, these mutations constitutes about 35% of the identified mutations and more than 50% of the BRCA1 pathogenic mutations. Interestingly, six new mutations were identified. Additionally, 39 out of the 44 pathogenic mutations identified were not previously reported in the Brazilian population. Besides, 36 different variants of unknown significance (VUS) were identified. Regarding ancestry, average ancestry proportions were 70.6% European, 14.5% African, 8.0% Native American and 6.8% East Asian. Materials and methods This study characterized 349 Brazilian families at-risk for HBOC regarding their germline BRCA1/BRCA2 status and genetic ancestry. Conclusions This is the largest report of BRCA1/BRCA2 assessment in an at-risk HBOC Brazilian population. We identified 21.5% of patients harboring BRCA1/BRCA2 mutations and characterized the genetic ancestry of a sample group at-risk for hereditary breast cancer showing once again how admixed is the Brazilian population. No association was found between genetic ancestry and mutational status. The knowledge of the mutational profile in a population can contribute to the definition of more cost-effective strategies for the identification of HBOC families.
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Affiliation(s)
- Gabriela C Fernandes
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | - Henrique C R Galvão
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - André E Paula
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Rui Pereira
- Institute of Research and Innovation in Health, University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology at the University of Porto (IPATIMUP), Porto, Portugal
| | - Carlos E Andrade
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Paula S Felicio
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Cristiano P Souza
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Deise R P Mendes
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Sahlua Volc
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | - Rebeca S Grasel
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Cristina S Sabato
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Danilo V Viana
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Edmundo C Mauad
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Prevention Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Cristovam Scapulatempo-Neto
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Pathology Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Banu Arun
- MD Anderson Cancer Center, Houston, Texas, USA
| | - Rui M Reis
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Edenir I Palmero
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Barretos School of Health Sciences, Dr. Paulo Prata-FACISB, São Paulo, Brazil
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Hadgu E, Seifu D, Tigneh W, Bokretsion Y, Bekele A, Abebe M, Sollie T, Merajver SD, Karlsson C, Karlsson MG. Breast cancer in Ethiopia: evidence for geographic difference in the distribution of molecular subtypes in Africa. BMC WOMENS HEALTH 2018; 18:40. [PMID: 29444670 PMCID: PMC5813361 DOI: 10.1186/s12905-018-0531-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 02/07/2018] [Indexed: 01/03/2023]
Abstract
Background Breast cancer is a heterogeneous disease with several morphological and molecular subtypes. Widely accepted molecular classification system uses assessment of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and proliferation marker Ki67. Few studies have been conducted on the incidence and molecular types of breast cancer in Sub-Saharan Africa. Previous studies mainly from Western and Central Africa, showed breast cancer to occur at younger ages and to present with aggressive features, such as high-grade, advanced stage and triple-negative phenotype (negative for ER, PR and HER2). Limited data from East Africa including Ethiopia however shows hormone receptor negative tumors to account for a lower proportion of all breast cancers than has been reported from elsewhere in Africa. Methods In this study from Tikur Anbessa Specialized Hospital, 114 breast cancer patients diagnosed between 2012 and 2015 were enrolled. ER, PR, Ki67 and HER2 receptor status were assessed using immunohistochemistry from tissue microarrays. FISH was used for assessment of gene amplification in all equivocal tumor samples and for confirmation in HER2-enriched cases. Results The distribution of molecular subtypes was: Luminal A: 40%; Luminal B: 26%; HER2-enriched: 10%; TNBC: 23%. ER were positive in 65% of all tumors and 43% the cases were positive for PR. There was statistically significant difference in median age at diagnosis between the molecular subtypes (P < 0.05). There was a bimodal distribution of molecular subtypes in different age ranges with Luminal B subtype being more common at younger ages (median = 36) and Luminal A subtype more prevalent at older ages (median = 42). There were no statistically significant differences in tumor grade, histology, and stage between the molecular subtypes of breast cancer. Conclusion The present study detected Luminal A breast cancer to be the most common subtype and reveals a relatively low rate of hormone receptor negative and TNBC. Our findings and results from other East African studies suggest geographic variability in the distribution of the molecular subtypes of breast cancer in Africa and hence have important clinical and policy implications for breast cancer control and treatment in Ethiopia.
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Affiliation(s)
- Endale Hadgu
- Department of Biochemistry, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Daniel Seifu
- Department of Biochemistry, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondemagegnhu Tigneh
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yonas Bokretsion
- Department of Pathology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Bekele
- Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Markos Abebe
- Armauer Hansen research Institute (AHRI), Addis Ababa, Ethiopia
| | - Thomas Sollie
- Dept of Laboratory Medicine, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Sofia D Merajver
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | | | - Mats G Karlsson
- Dept of Laboratory Medicine, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
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29
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Joffe M, Ayeni O, Norris SA, McCormack VA, Ruff P, Das I, Neugut AI, Jacobson JS, Cubasch H. Barriers to early presentation of breast cancer among women in Soweto, South Africa. PLoS One 2018; 13:e0192071. [PMID: 29394271 PMCID: PMC5796726 DOI: 10.1371/journal.pone.0192071] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/16/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Reported breast cancer incidence is rising in South Africa, where some women are diagnosed late and have poor outcomes. We studied patient and provider factors associated with clinical stage at diagnosis among women diagnosed at the Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg in 2015-2016. METHODS From face-to-face interviewer-administered questionnaires we compared self-reported socioeconomics, demographics, comorbidities, risk factors, personal and health system barriers, and from patient clinical records, clinical staging, receptor subtype, and tumor grade among 499 consecutive women newly diagnosed with advanced stage (III/IV) breast cancer versus those diagnosed early (stage 0/I/II). Logistic regression models were used to identify factors associated with advanced stage at diagnosis. RESULTS Among the women, 243 (49%) were diagnosed at early and 256 (51%) at advanced stages. In the multiple logistic regression adjusted model, completion of high school or beyond (odds ratio (OR) 0.59, and greater breast cancer knowledge and awareness (OR 0.86) were associated with lower stage of breast cancer at presentation. Advanced stage was associated with Luminal B (OR 2.25) and triple-negative subtypes (OR 3.17) compared to luminal A, with delays >3 months from first breast symptoms to accessing the health system (OR 2.79) and with having more than 1 visit within the referral health system (OR 3.19) for 2 visits; OR 2.73 for ≥3 visits). CONCLUSIONS Limited patient education, breast cancer knowledge and awareness, and health system inefficiencies were associated with advanced stage at diagnosis. Sustained community and healthcare worker education may down-stage disease and improve cancer outcomes.
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Affiliation(s)
- Maureen Joffe
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- MRC Developmental Pathways to Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Oluwatosin Ayeni
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
| | - Shane Anthony Norris
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- MRC Developmental Pathways to Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Valerie Ann McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Paul Ruff
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- Division of Medical Oncology, Department Internal Medicine, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Ishani Das
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, United States of America
| | - Alfred I. Neugut
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, United States of America
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Judith S. Jacobson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Herbert Cubasch
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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30
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Adekeye OA, Adesuyi BF, Takon JG. Barriers to Healthcare among African Immigrants in Georgia, USA. J Immigr Minor Health 2018; 20:188-193. [PMID: 28213691 DOI: 10.1007/s10903-017-0549-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
African-born immigrants are among the fastest growing immigrant groups in the US, yet they are underrepresented in healthcare research, particularly, cancer research and tend to be categorized as African American or Black, obscuring any cultural nuances that exist. A survey designed to provide insight on the barriers to healthcare, knowledge of common cancers, and cancer risks was utilized during a health fair. Data analyses included descriptive statistics to examine participant demographics and other study variables of interest. Most of the participants reported African origin (approximately 97%), were males (59%), were aged 18-40 years (49%), had a minimum of some college education (78%), a household income of >$50,000 (35%) and were mostly uninsured (45%). The cost of medical treatment 19 (45.2%) was reported as a major barrier to healthcare access. The Health Fair presented the opportunity to provide free health screenings, education/awareness, and referral to follow-up resources. The findings are evidence of the importance and impact of health fairs in communities of greatest need.
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Affiliation(s)
- Oluwatoyosi A Adekeye
- Department of Community Health and Preventive Medicine, Satcher Health Leadership Institute, NCPC A-216C, Morehouse School of Medicine, 720 Westview Drive S.W., Atlanta, GA, 30310, USA.
| | - Bola F Adesuyi
- Redeemer's Medical Center, 5875 Peachtree Industrial Blvd #370, Norcross, GA, 30092, USA
| | - Joseph G Takon
- Redeemer's Medical Center, 5875 Peachtree Industrial Blvd #370, Norcross, GA, 30092, USA
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31
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Linnenbringer E, Gehlert S, Geronimus AT. Black-White Disparities in Breast Cancer Subtype: The Intersection of Socially Patterned Stress and Genetic Expression. AIMS Public Health 2017; 4:526-556. [PMID: 29333472 PMCID: PMC5764177 DOI: 10.3934/publichealth.2017.5.526] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Hormone receptor negative (HR-) breast cancer subtypes are etiologically distinct from the more common, less aggressive, and more treatable form of estrogen receptor positive (ER+) breast cancer. Numerous population-based studies have found that, in the United States, Black women are 2 to 3 times more likely to develop HR- breast cancer than White women. Much of the existing research on racial disparities in breast cancer subtype has focused on identifying predisposing genetic factors associated with African ancestry. This approach fails to acknowledge that racial stratification shapes a wide range of environmental and social exposures over the life course. Human stress genomics considers the role of individual stress perceptions on gene expression. Yet, the role of structurally rooted biopsychosocial processes that may be activated by the social patterning of stressors in an historically unequal society, whether perceived by individual black women or not, could also impact cellular physiology and gene expression patterns relevant to HR- breast cancer etiology. Using the weathering hypothesis as our conceptual framework, we develop a structural perspective for examining racial disparities in breast cancer subtypes, integrating important findings from the stress biology, breast cancer epidemiology, and health disparities literatures. After integrating key findings from these largely independent literatures, we develop a theoretically and empirically guided framework for assessing potential multilevel factors relevant to the development of HR- breast cancer disproportionately among Black women in the US. We hypothesize that a dynamic interplay among socially patterned psychosocial stressors, physiological & behavioral responses, and genomic pathways contribute to the increased risk of HR- breast cancer among Black women. This work provides a basis for exploring potential alternative pathways linking the lived experience of race to the risk of HR- breast cancer, and suggests new avenues for research and public health action.
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Affiliation(s)
- Erin Linnenbringer
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110-1093, USA
| | - Sarah Gehlert
- College of Social Work, University of South Carolina, Columbia, SC 29208, USA
| | - Arline T Geronimus
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48106-1248, USA
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32
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Hashim D, Manczuk M, Holcombe R, Lucchini R, Boffetta P. Cancer mortality disparities among New York City's Upper Manhattan neighborhoods. Eur J Cancer Prev 2017; 26:453-460. [PMID: 27104595 PMCID: PMC5074912 DOI: 10.1097/cej.0000000000000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The East Harlem (EH), Central Harlem (CH), and Upper East Side (UES) neighborhoods of New York City are geographically contiguous to tertiary medical care, but are characterized by cancer mortality rate disparities. This ecological study aims to disentangle the effects of race and neighborhood on cancer deaths. Mortality-to-incidence ratios were determined using neighborhood-specific data from the New York State Cancer Registry and Vital Records Office (2007-2011). Ecological data on modifiable cancer risk factors from the New York City Community Health Survey (2002-2006) were stratified by sex, age group, race/ethnicity, and neighborhood and modeled against stratified mortality rates to disentangle race/ethnicity and neighborhood using logistic regression. Significant gaps in mortality rates were observed between the UES and both CH and EH across all cancers, favoring UES. Mortality-to-incidence ratios of both CH and EH were similarly elevated in the range of 0.41-0.44 compared with UES (0.26-0.30). After covariate and multivariable adjustment, black race (odds ratio=1.68; 95% confidence interval: 1.46-1.93) and EH residence (odds ratio=1.20; 95% confidence interval: 1.07-1.35) remained significant risk factors in all cancers' combined mortality. Mortality disparities remain among EH, CH, and UES neighborhoods. Both neighborhood and race are significantly associated with cancer mortality, independent of each other. Multivariable adjusted models that include Community Health Survey risk factors show that this mortality gap may be avoidable through community-based public health interventions.
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Affiliation(s)
- Dana Hashim
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marta Manczuk
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Cancer Epidemiology, Maria Skłodowska-Curie Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Randall Holcombe
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roberto Lucchini
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Occupational Medicine, University of Brescia, Italy
| | - Paolo Boffetta
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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33
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Newman LA, Stark A, Chitale D, Pepe M, Longton G, Worsham MJ, Nathanson SD, Miller P, Bensenhaver JM, Proctor E, Swain M, Patriotis C, Engstrom PF. Association Between Benign Breast Disease in African American and White American Women and Subsequent Triple-Negative Breast Cancer. JAMA Oncol 2017; 3:1102-1106. [PMID: 28006062 DOI: 10.1001/jamaoncol.2016.5598] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Compared with white American (WA) women, African American (AA) women have a 2-fold higher incidence of breast cancers that are negative for estrogen receptor, progesterone receptor, and ERBB2 (triple-negative breast cancer [TNBC]). Triple-negative breast cancer, compared with non-TNBC, likely arises from different pathogenetic pathways, and benign breast disease (BBD) predicts future non-TNBC. Objective To determine whether AA identity remains associated with TNBC for women with a prior diagnosis of BBD. Design, Setting, and Participants This study is a retrospective analysis of data of a cohort of 2588 AA and 3566 WA women aged between 40 and 70 years with a biopsy-proven BBD diagnosis. The data-obtained from the Pathology Information System of Henry Ford Health System (HFHS), an integrated multihospital and multispecialty health care system headquartered in Detroit, Michigan-include specimens of biopsies performed between January 1, 1994, and December 31, 2005. Data analysis was performed from November 1, 2015, to June 15, 2016. Main Outcomes and Measures Subsequent breast cancer was stratified on the basis of combinations of hormone receptor and ERBB2 expression. Results Case management, follow-up, and outcomes received or obtained by our cohort of 2588 AA and 3566 WA patients were similar, demonstrating that HFHS delivered care equitably. Subsequent breast cancers developed in 103 (4.1%) of AA patients (mean follow-up interval of 6.8 years) and 143 (4.0%) of WA patients (mean follow-up interval of 6.1 years). More than three-quarters of subsequent breast cancers in each subset were ductal carcinoma in situ or stage I. The 10-year probability estimate for developing TNBC was 0.56% (95% CI, 0.32%-1.0%) for AA patients and 0.25% (95% CI, 0.12%-0.53%) for WA patients. Among the 66 AA patients who developed subsequent invasive breast cancer, 16 (24.2%) developed TNBC compared with 7 (7.4%) of the 94 WA patients who developed subsequent invasive breast cancers and had complete biomarker data (P = .01). Conclusions and Relevance This study is the largest analysis to date of TNBC in the context of racial/ethnic identity and BBD as risk factors. The study found that AA identity persisted as a significant risk factor for TNBC. This finding suggests that AA identity is associated with inherent susceptibility for TNBC pathogenetic pathways.
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Affiliation(s)
- Lisa A Newman
- Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan
| | - Azadeh Stark
- Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan.,Breast Oncology Program, Department of Pathology, Henry Ford Health System, Detroit, Michigan
| | - Dhanajay Chitale
- Breast Oncology Program, Department of Pathology, Henry Ford Health System, Detroit, Michigan
| | - Margaret Pepe
- Department of Biostatistics and Biomathematics, Fred Hutchinson Comprehensive Cancer Center, Seattle, Washington
| | - Gary Longton
- Department of Biostatistics and Biomathematics, Fred Hutchinson Comprehensive Cancer Center, Seattle, Washington
| | - Maria J Worsham
- Breast Oncology Program, Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan
| | - S David Nathanson
- Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan
| | - Patricia Miller
- Breast Oncology Program, Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Jessica M Bensenhaver
- Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan
| | - Erica Proctor
- Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan
| | - Monique Swain
- Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan
| | - Christos Patriotis
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
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Ogden A, Rida PCG, Aneja R. Centrosome amplification: a suspect in breast cancer and racial disparities. Endocr Relat Cancer 2017; 24:T47-T64. [PMID: 28515047 PMCID: PMC5837860 DOI: 10.1530/erc-17-0072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/17/2017] [Indexed: 12/31/2022]
Abstract
The multifaceted involvement of centrosome amplification (CA) in tumorigenesis is coming into focus following years of meticulous experimentation, which have elucidated the powerful abilities of CA to promote cellular invasion, disrupt stem cell division, drive chromosomal instability (CIN) and perturb tissue architecture, activities that can accelerate tumor progression. Integration of the extant in vitro, in vivo and clinical data suggests that in some tissues CA may be a tumor-initiating event, in others a consequential 'hit' in multistep tumorigenesis, and in some others, non-tumorigenic. However, in vivo data are limited and primarily focus on PLK4 (which has CA-independent mechanisms by which it promotes aggressive cellular phenotypes). In vitro breast cancer models suggest that CA can promote tumorigenesis in breast cancer cells in the setting of p53 loss or mutation, which can both trigger CA and promote cellular tolerance to its tendency to slow proliferation and induce aneuploidy. It is thus our perspective that CA is likely an early hit in multistep breast tumorigenesis that may sometimes be lost to preserve aggressive karyotypes acquired through centrosome clustering-mediated CIN, both numerical and structural. We also envision that the robust link between p53 and CA may underlie, to a considerable degree, racial health disparity in breast cancer outcomes. This question is clinically significant because, if it is true, then analysis of centrosomal profiles and administration of centrosome declustering drugs could prove highly efficacious in risk stratifying breast cancers and treating African American (AA) women with breast cancer.
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Affiliation(s)
- Angela Ogden
- Department of BiologyGeorgia State University, Atlanta, Georgia, USA
| | | | - Ritu Aneja
- Department of BiologyGeorgia State University, Atlanta, Georgia, USA
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35
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Vidal G, Bursac Z, Miranda-Carboni G, White-Means S, Starlard-Davenport A. Racial disparities in survival outcomes by breast tumor subtype among African American women in Memphis, Tennessee. Cancer Med 2017; 6:1776-1786. [PMID: 28612435 PMCID: PMC5504313 DOI: 10.1002/cam4.1117] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/13/2017] [Accepted: 05/07/2017] [Indexed: 01/09/2023] Open
Abstract
Racial disparities in survival among African American (AA) women in the United States have been well documented. Breast cancer mortality rates among AA women is higher in Memphis, Tennessee as compared to 49 of the largest US cities. In this study, we investigated the extent to which racial/ethnic disparities in survival outcomes among Memphis women are attributed to differences in breast tumor subtype and treatment outcomes. A total of 3527 patients diagnosed with stage I-IV breast cancer between January 2002 and April 2015 at Methodist Health hospitals and West Cancer Center in Memphis, TN were included in the analysis. Kaplan-Meier survival curves were generated and Cox proportional hazards regression were used to compare survival outcomes among 1342 (38.0%) AA and 2185 (62.0%) non-Hispanic White breast cancer patients by race and breast tumor subtype. Over a mean follow-up time of 29.9 months, AA women displayed increased mortality risk [adjusted hazard ratio (HR), 1.65; 95% confidence interval (CI), 1.35-2.03] and were more likely to be diagnosed at advanced stages of disease. AA women with triple-negative breast cancer (TNBC) had the highest death rate at 26.7% compared to non-Hispanic White women at 16.5%. AA women with TNBC and luminal B/HER2- breast tumors had the highest risk of mortality. Regardless of race, patients who did not have surgery had over five times higher risk of dying compared to those who had surgery. These findings provide additional evidence of the breast cancer disparity gap between AA and non-Hispanic White women and highlight the need for targeted interventions and policies to eliminate breast cancer disparities in AA populations, particularly in Memphis, TN.
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Affiliation(s)
- Gregory Vidal
- Division of Hematology/Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, 38133.,The University of Tennessee West Cancer Center, Germantown, Tennessee
| | - Zoran Bursac
- Division of Biostatistics and Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gustavo Miranda-Carboni
- Division of Hematology/Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, 38133
| | - Shelley White-Means
- Department of Clinical Pharmacy, Consortium on Health Education, Economic Empowerment and Research (CHEER), University of Tennessee Health Science Center, Memphis, Tennessee, 38163
| | - Athena Starlard-Davenport
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, Tennessee, 38133
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36
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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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Williams DR, Mohammed SA, Shields AE. Understanding and effectively addressing breast cancer in African American women: Unpacking the social context. Cancer 2016; 122:2138-49. [PMID: 26930024 PMCID: PMC5588632 DOI: 10.1002/cncr.29935] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 12/12/2022]
Abstract
Black women have a higher incidence of breast cancer before the age of 40 years, more severe disease at all ages, and an elevated mortality risk in comparison with white women. There is limited understanding of the contribution of social factors to these patterns. Elucidating the role of the social determinants of health in breast cancer disparities requires greater attention to how risk factors for breast cancer unfold over the lifecourse and to the complex ways in which socioeconomic status and racism shape exposure to psychosocial, physical, chemical, and other individual and community-level assaults that increase the risk of breast cancer. Research that takes seriously the social context in which black women live is also needed to maximize the opportunities to prevent breast cancer in this underserved group. Cancer 2016;122:2138-49. © 2016 American Cancer Society.
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Affiliation(s)
- David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health
- Department of African and African American Studies, Harvard University
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Selina A. Mohammed
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA
| | - Alexandra E. Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital
- Department of Medicine, Harvard Medical School
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Racial disparities in individual breast cancer outcomes by hormone-receptor subtype, area-level socio-economic status and healthcare resources. Breast Cancer Res Treat 2016; 157:575-86. [PMID: 27255533 DOI: 10.1007/s10549-016-3840-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/21/2016] [Indexed: 01/22/2023]
Abstract
The aim of the study is to determine the influence of area-level socio-economic status and healthcare access in addition to tumor hormone-receptor subtype on individual breast cancer stage, treatment, and mortality among Non-Hispanic (NH)-Black, NH-White, and Hispanic US adults. Analysis was based on 456,217 breast cancer patients in the SEER database from 2000 to 2010. Multilevel and multivariable-adjusted logistic and Cox proportional hazards regression analysis was conducted to account for clustering by SEER registry of diagnosis. NH-Black women had greater area-level access to healthcare resources compared with women of other races. For instance, the average numbers of oncology hospitals per million population in counties with NH-Black, NH-White, and Hispanic women were 8.1, 7.7, and 5.0 respectively; average numbers of medical doctors per million in counties with NH-Black, NH-White, and Hispanic women were 100.7, 854.0, and 866.3 respectively; and average number of Ob/Gyn in counties with NH-Black, NH-White, and Hispanic women was 155.6, 127.4, and 127.3, respectively (all p values <0.001). Regardless, NH-Black women (HR 1.39, 95 % CI 1.36-1.43) and Hispanic women (HR 1.05, 95 % CI 1.03-1.08) had significantly higher breast cancer mortality compared with NH-White women even after adjusting for hormone-receptor subtype, area-level socio-economic status, and area-level healthcare access. In addition, lower county-level socio-economic status and healthcare access measures were significantly and independently associated with stage at presentation, surgery, and radiation treatment as well as mortality after adjusting for age, race/ethnicity, and HR subtype. Although breast cancer HR subtype is a strong, important, and consistent predictor of breast cancer outcomes, we still observed significant and independent influences of area-level SES and HCA on breast cancer outcomes that deserve further study and may be critical to eliminating breast cancer outcome disparities.
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Kantelhardt EJ, Muluken G, Sefonias G, Wondimu A, Gebert HC, Unverzagt S, Addissie A. A Review on Breast Cancer Care in Africa. Breast Care (Basel) 2015; 10:364-70. [PMID: 26989354 DOI: 10.1159/000443156] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The global incidence of breast cancer (BC) is rising, especially in low- and middle-income countries. The purpose of this review is to summarize existing publications on BC care in Africa. PATIENTS AND METHODS A systematic search in MEDLINE and smaller databases was carried out to identify African studies on BC treatment, and an additional PubMed search was performed for relevant topics on BC care. RESULTS A total of 219 publications, mainly from North and West Africa, were found by systematic search. We also selected articles on BC epidemiology, risk factors, clinical presentation, and cancer control in Africa. CONCLUSIONS Publications on BC treatment are mostly from hospital case series. Evidence on treatment from prospective randomized trials that address the specific characteristics of African patients is lacking. The epidemiologic data shows rising incidences in Africa. The prevalence of risk factors is changing by age group, geographic region, and over time. The clinical picture of BC differs from that of Western countries due to the high proportion of young patients (on account of the African population with a high proportion of young people) and late presentation. Global collaborative efforts are needed to address the rising need for improved BC care in Africa.
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Affiliation(s)
- Eva J Kantelhardt
- Department of Gynecology, Martin-Luther-University, Halle (Saale), Germany
| | - Gizaw Muluken
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getachew Sefonias
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ayele Wondimu
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Susanne Unverzagt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle (Saale), Germany
| | - Adamu Addissie
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Langa BC, Oliveira MMC, Pereira SRF, Lupicki K, Marian C, Govender D, Panieri E, Hiss D, Cavalli IJ, Abdul-Rasool S, Cavalli LR. Copy Number Analysis of the DLX4 and ERBB2 Genes in South African Breast Cancer Patients. Cytogenet Genome Res 2015; 146:195-203. [PMID: 26524685 DOI: 10.1159/000439155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Indexed: 11/19/2022] Open
Abstract
Breast cancer is one of the main causes of cancer death among South African women. Although several risk factors can be attributed to the observed high mortality rate, the biology of the tumors is not extensively investigated. Copy number gain of the DLX4 homeobox gene has been observed in breast cancer in association with poor prognosis and specific racial groups. Therefore, we aimed to assess the copy number and prognostic role of DLX4 in breast cancer from South African patients. Due to the co-location of ERBB2 and DLX4 in the 17q21 region, its copy number was also evaluated. Our results in the analysis of 66 cases demonstrated copy number gains of DLX4 and ERBB2 in 24.1 and 29.7% of the cases, respectively. Linear regression analysis showed no dependency between the copy number alterations in these genes. Although not significant, patients with DLX4 and ERBB2 gains presented a higher frequency of advanced-grade tumors. In addition, copy number alterations of these genes were not significantly differently observed in the 3 main racial groups of the Western Cape population: Colored, White, and Black. These findings indicate that gains of DLX4 and ERBB2 occur in South African breast cancer patients irrespectively of their race and factors known to influence prognosis.
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Sebastião E, Chodzko-Zajko W, Schwingel A. The need to modify physical activity messages to better speak to older African American women: a pilot study. BMC Public Health 2015; 15:962. [PMID: 26403196 PMCID: PMC4582709 DOI: 10.1186/s12889-015-2317-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combating the physical inactivity crisis and improving health and quality of life is a challenge and a public health priority, especially in underserved populations. A key role of public health consists of informing, educating, and empowering individuals and communities about health issues. Researchers have found that mass communication messages often have limited effectiveness in reaching and impacting the health of underserved populations. The present pilot study was designed to explore perceptions of older African American women (AAW) in response to widely disseminated public information pertaining to physical activity (PA) and aging. METHODS A total of 10 older AAW aged 60 years and over participated in this study. Participants were evenly assigned in one of the 2 focus groups (i.e. active, n = 5; and inactive, n = 5) based on their PA level. The focus group approach was employed to gather information about widely available public information materials related to PA that target the adult and older adult population. The three guides used were: (1) Exercise and Physical Activity: Your Everyday Guide; (2) The Physical Activity Guidelines for Older Adults; and (3) Be Active Your Way: A Guide for Adults. NVIVO 10 software was used to help in the qualitative data analysis. Descriptive thematic analysis was employed in identifying, analyzing and reporting patterns/themes within the data. RESULTS Older AAW in the present study identified some shortcomings in current public health materials. Participants from both focus groups raised concerns regarding language and the types of activities used as examples in the materials. After analysis, two themes emerged: "We may have trouble in reading it" and "It does not reflect us". Participants' evaluation was found to be similar between the active and inactive focus groups. CONCLUSIONS Older AAW's perceptions of the materials suggest that materials intended to educate and motivate the general public towards PA need to be modified to better speak to older African American women, especially to those who are sedentary and have difficulty in building PA into their daily lives.
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Affiliation(s)
- Emerson Sebastião
- Aging and Diversity Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Huff Hall, 1206S. Fourth St, Champaign, IL, 61820, USA.
| | - Wojtek Chodzko-Zajko
- Aging and Diversity Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Huff Hall, 1206S. Fourth St, Champaign, IL, 61820, USA.
| | - Andiara Schwingel
- Aging and Diversity Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Huff Hall, 1206S. Fourth St, Champaign, IL, 61820, USA.
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Breast cancer survival in African-American women by hormone receptor subtypes. Breast Cancer Res Treat 2015; 153:211-8. [PMID: 26250393 DOI: 10.1007/s10549-015-3528-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/01/2015] [Indexed: 12/31/2022]
Abstract
Breast cancer accounts for over 200,000 annual cases among women in the United States, and is the second leading cause of cancer-related deaths. However, few studies have investigated the association between breast cancer subtype and survival among African-American women. We analyzed cancer-related deaths among African-American women using data obtained from the SEER database linked to the 2000 U.S. census data. We examined distribution of baseline socio-demographic and clinical characteristics by breast cancer subtypes and used Cox proportional hazard models to determine associations between breast cancer subtypes and cancer-related mortality, adjusting for age, socio-economic status, stage at diagnosis, and treatment. Among 19,836 female breast cancer cases, 54.4% were diagnosed with the HER2-/HR+ subtype, with the majority of those cases occurring among women ages 55 and older. However, after adjusting for age, stage, and treatment type (surgery, radiation, or no radiation and/or cancer-directed surgery), TNBC (HR 2.34; 95% CI 1.95-2.81) and HER2+/HR- (HR 1.39, 95% CI 1.08-1.79) cases had significantly higher hazards of cancer-related deaths compared with HER2+/HR+ cases. Adjusting for socio-economic status did not significantly alter these associations. African-American women with TNBC were more likely to have a cancer-related death than African-American women with other breast cancer subtypes. This association remained after adjustments for age, stage, treatment, and socio-economic status. Further studies are needed to identify subtype-specific risk and prognostic factors aimed at better informing prevention efforts for all women.
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Abstract
Recognition of breast cancer disparities between African-American and White American women has generated exciting research opportunities investigating the biologic and hereditary factors that contribute to the observed outcome differences, leading to international studies of breast cancer in Africa. The study of breast cancer in women with African ancestry has opened the door to unique investigations regarding breast cancer subtypes and the genetics of this disease. International research efforts can advance our understanding of race/ethnicity-associated breast cancer disparities within the USA; the pathogenesis of triple negative breast cancer; and hereditary susceptibility for breast cancer.
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Affiliation(s)
- Lisa A Newman
- Department of Surgery, Breast Care Center, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
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Boufettal H, Samouh N. [Synchronous bilateral breast cancer in Morocco: epidemiological and clinical characteristics]. Pan Afr Med J 2015; 20:118. [PMID: 26090066 PMCID: PMC4458310 DOI: 10.11604/pamj.2015.20.118.6136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/06/2015] [Indexed: 12/28/2022] Open
Abstract
Préciser la fréquence, les facteurs de risque et le pronostic du cancer du sein bilatéral, à partir d'une étude rétrospective de 22 cas de cancer du sein bilatéral synchrone dans un pays du Maghreb. De 2002 à 2010, 625 patientes étaient prises en charge pour cancer du sein au service de Gynécologie-Obstétrique «C» du centre hospitalier universitaire de Casablanca. 22 cas de cancer bilatéral synchrone étaient diagnostiqués. Nos résultats sont comparés avec ceux de la littérature. La fréquence de la bilatéralité du cancer du sein synchrone était de 3,52% (22/625). L'intervalle de temps moyen entre les deux cancers est de 4 mois (0 à 6 mois). Les patientes âgées de moins de 40 ans lors du premier cancer avaient six fois plus de risque de développer un cancer au niveau du sein controlatéral que les femmes âgées de plus de 40 ans. Les patientes atteintes d'une tumeur T3 ou T4 avaient un risque neuf fois plus élevé que les autres. 90,9% (2/22) des cas des premiers cancers sont des adénocarcinomes infiltrants. Les types histologiques du premier et du douzième cancer étaient identiques dans 86,4% (19/22) des cas. Quant au pronostic, il dépend à la fois du stade du premier et du deuxième cancer et le traitement de ce dernier doit obéir aux mêmes règles du traitement du premier cancer. L'incidence du cancer bilatéral synchrone du sein est de 3,52% dans notre série. Le cancer du sein unilatéral constitue un facteur de risque de développement d'un cancer du sein controlatéral. Une surveillance à vie est nécessaire au cours d'un cancer du sein pour détecter un cancer controlatéral.
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Affiliation(s)
- Houssine Boufettal
- Service de Gynécologie - Obstétrique «C», Centre Hospitalier Universitaire Ibn Rochd, Faculté de Médecine et de Pharmacie, Université Hassan 2, Casablanca, Maroc
| | - Naïma Samouh
- Service de Gynécologie - Obstétrique «C», Centre Hospitalier Universitaire Ibn Rochd, Faculté de Médecine et de Pharmacie, Université Hassan 2, Casablanca, Maroc
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Jiagge E, Bensenhaver JM, Oppong JK, Awuah B, Newman LA. Global Surgical Oncology Disease Burden: Addressing Disparities Via Global Surgery Initiatives: The University of Michigan International Breast Cancer Registry. Ann Surg Oncol 2015; 22:734-40. [DOI: 10.1245/s10434-014-4345-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Indexed: 01/21/2023]
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