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Sarfraz Z, Sarfraz A, Mehak O, Akhund R, Bano S, Aftab H. Racial and socioeconomic disparities in triple-negative breast cancer treatment. Expert Rev Anticancer Ther 2024; 24:107-116. [PMID: 38436305 DOI: 10.1080/14737140.2024.2326575] [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: 08/09/2023] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Triple-negative breast cancer (TNBC) continues to be a significant concern, especially among minority populations, where treatment disparities are notably pronounced. Addressing these disparities, especially among African American women and other minorities, is crucial for ensuring equitable healthcare. AREAS COVERED This review delves into the continuum of TNBC treatment, noting that the standard of care, previously restricted to chemotherapy, has now expanded due to emerging clinical trial results. With advances like PARP inhibitors, immunotherapy, and antibody-drug conjugates, a more personalized treatment approach is on the horizon. The review highlights innovative interventions tailored for minorities, such as utilizing technology like text messaging, smartphone apps, and targeted radio programming, coupled with church-based behavioral interventions. EXPERT OPINION Addressing TNBC treatment disparities demands a multifaceted approach, blending advanced medical treatments with culturally sensitive community outreach. The potential of technology, especially in the realm of promoting health awareness, is yet to be fully harnessed. As the field progresses, understanding and integrating the socio-economic, biological, and access-related challenges faced by minorities will be pivotal for achieving health equity in TNBC care.
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Affiliation(s)
- Zouina Sarfraz
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Azza Sarfraz
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan
| | - Onaiza Mehak
- Department of Medicine, Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan
| | - Ramsha Akhund
- Department of Surgery, University of Alabama at Birmingham, Tuscaloosa, AL, USA
| | - Shehar Bano
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Hinna Aftab
- Department of Medicine, CMH Lahore Medical College, Lahore, Pakistan
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Martínez-Nava GA, Urbina-Jara LK, Lira-Albarrán S, Gómez HL, Ruiz-García E, Nieto-Coronel MT, Ortiz-Lopez R, Martínez Villalba KN, Muñoz-Sánchez M, Aguilar D, Gómez-Flores-Ramos L, Cabrera-Nieto SA, Mohar A, Cruz-Ramos M. Somatic Mutations in Latin American Breast Cancer Patients: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:287. [PMID: 38337803 PMCID: PMC10855727 DOI: 10.3390/diagnostics14030287] [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: 11/30/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Somatic mutations may be connected to the exposome, potentially playing a role in breast cancer's development and clinical outcomes. There needs to be information regarding Latin American women specifically, as they are underrepresented in clinical trials and have limited access to somatic analysis in their countries. This study aims to systematically investigate somatic mutations in breast cancer patients from Latin America to gain a better understanding of tumor biology in the region. (2) Methods: We realize a systematic review of studies on breast cancer in 21 Latin American countries using various databases such as PubMed, Google Scholar, Web of Science, RedAlyc, Dianlet, and Biblioteca Virtual en Salud. Of 392 articles that fit the criteria, 10 studies have clinical data which can be used to create a database containing clinical and genetic information. We compared mutation frequencies across different breast cancer subtypes using statistical analyses and meta-analyses of proportions. Furthermore, we identified overexpressed biological processes and canonical pathways through functional enrichment analysis. (3) Results: 342 mutations were found in six Latin American countries, with the TP53 and PIK3CA genes being the most studied mutations. The most common PIK3CA mutation was H1047R. Functional analysis provided insights into tumor biology and potential therapies. (4) Conclusion: evaluating specific somatic mutations in the Latin American population is crucial for understanding tumor biology and determining appropriate treatment options. Combining targeted therapies may improve clinical outcomes in breast cancer. Moreover, implementing healthy lifestyle strategies in Latin America could enhance therapy effectiveness and clinical outcomes.
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Affiliation(s)
- Gabriela A. Martínez-Nava
- Laboratorio de Gerociencias, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Calz. México-Xochimilco 289, Tlalpan, Mexico City 14389, Mexico;
| | - Laura Keren Urbina-Jara
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 64710, Mexico; (L.K.U.-J.); (R.O.-L.)
| | - Saúl Lira-Albarrán
- Departamento de Gestión Académica e Investigación, Hospital Escuela, Tegucigalpa 11101, Honduras;
| | - Henry L. Gómez
- Departmento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 15023, Peru;
| | - Erika Ruiz-García
- Laboratorio de Medicina Traslacional, Instituto Nacional de Cancerologia, Mexico City 14080, Mexico;
| | - María Tereza Nieto-Coronel
- Departamento de Medicina Oncológica, Centro Oncopalia, Universidad Mayor de San Andrés, La Paz P.O. Box 8635, Bolivia;
| | - Rocio Ortiz-Lopez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 64710, Mexico; (L.K.U.-J.); (R.O.-L.)
- Tecnologico de Monterrey, Institute for Obesity Research, Monterrey 64849, Mexico
| | - Kenia Nadiezhda Martínez Villalba
- Unidad de Epidemiología e Investigación Biomédica en Cáncer, Instituto de Investigaciones Biomédicas, UNAM-Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (K.N.M.V.); (A.M.)
| | - Mariana Muñoz-Sánchez
- Facultad de Ciencias de la Salud, Universidad Anáhuac México, Mexico City 52786, Mexico; (M.M.-S.); (S.A.C.-N.)
| | - Dione Aguilar
- Tecnologico de Monterrey, Centro de Cáncer de Mama, Hospital Zambrano Hellion, San Pedro Garza García 66278, Mexico;
| | - Liliana Gómez-Flores-Ramos
- CONAHCYT/Center for Population Health Research, National Institute of Public Health, Universidad No. 655, Cuernavaca 62100, Mexico;
| | - Sara Aileen Cabrera-Nieto
- Facultad de Ciencias de la Salud, Universidad Anáhuac México, Mexico City 52786, Mexico; (M.M.-S.); (S.A.C.-N.)
| | - Alejandro Mohar
- Unidad de Epidemiología e Investigación Biomédica en Cáncer, Instituto de Investigaciones Biomédicas, UNAM-Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (K.N.M.V.); (A.M.)
| | - Marlid Cruz-Ramos
- Programa Joven y Fuerte/CONAHCYT, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Sección 16, Tlalpan, Mexico City 14080, Mexico
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Tiscoski KA, Giacomazzi J, Rocha MS, Gössling G, Werutsky G. Real-world data on triple-negative breast cancer in Latin America and the Caribbean. Ecancermedicalscience 2023; 17:1635. [PMID: 38414969 PMCID: PMC10898885 DOI: 10.3332/ecancer.2023.1635] [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: 04/28/2023] [Indexed: 02/29/2024] Open
Abstract
Breast cancer (BC) is the most prevalent cancer in women in Latin America and the Caribbean. We compiled real-world data (RWD) on the epidemiology, diagnosis, treatment, and patient outcomes of triple-negative breast cancer (TNBC), addressing the main barriers to optimal care in Latin America. The prevalence of TNBC varies between 11% and 38.5% of all BC cases diagnosed in the region, and TNBC primarily affects young patients. Delays in BC diagnosis, with consequent advanced disease stages and barriers to access efficient therapies, particularly due to high costs, negatively impact patient outcomes. Cancer clinical trials are an opportunity to access standard and novel therapies for patients with this aggressive BC subtype and thus must be prioritised. Finally, generating RWD and cost-effectiveness studies in a region with limited resources is critical for decision-makers to define the incorporation of new technologies for the treatment of BC.
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Affiliation(s)
- Katsuki Arima Tiscoski
- Santa Casa de Misericórdia de Porto Alegre, Rua Professor Annes Dias, Porto Alegre 90020-090, Brazil
- https://orcid.org/0000-0003-0074-4272
| | - Juliana Giacomazzi
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
- https://orcid.org/0000-0001-5811-5140
| | - Matheus Soares Rocha
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
- https://orcid.org/0000-0001-8972-7449
| | - Gustavo Gössling
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
- https://orcid.org/0000-0002-4361-2889
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
- https://orcid.org/0000-0001-6271-105X
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Andrade DAP, Veneziani AC, Paiva CE, dos Reis R, Filho CAF, Sanches AON, Barroso AWA, Paz ACMC, Kons GCDM, Preto DD, Budib MCB, Safro MA, Pinto GSF, Bilibio JP, Souza CDP. Discrepancies in breast cancer's oncological outcomes between public and private institutions in the southeast region of Brazil: a retrospective cohort study. Front Oncol 2023; 13:1169982. [PMID: 37441430 PMCID: PMC10333566 DOI: 10.3389/fonc.2023.1169982] [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: 02/20/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
Background Brazil is a middle-income country with inequalities in its healthcare system. The disparities between public and private services affect the diagnosis and treatment of patients with breast cancer. The aim of this study is to assess whether disease-free survival (DFS) and overall survival (OS) are different in public and private specialized centers. Patient and methods A retrospective cohort study with 1,545 breast cancer patients diagnosed from 2003 to 2011 at Barretos Cancer Hospital-BCH (public group, N = 1,408) and InORP Oncoclinicas (private group, N = 137) was conducted. A 1:1 propensity score matching (PSM) analysis was used to adjust the differences between the groups' characteristics (n = 137 in each group). Results The median age at diagnosis was 54.4 years. Estimated DFS rates at 1, 5, and 10 years were 96.0%, 71.8%, and 59.6%, respectively, at BCH and 97.8%, 86.9%, and 78%, respectively, at InORP (HR: 2.09; 95% confidence interval [CI], 1.41-3.10; p < 0.0001). Estimated OS rates at 1, 5, and 10 years were 98.1%, 78.5%, and 65.4%, respectively, at BCH and 99.3%, 94.5%, and 91.9%, respectively, at InORP (HR: 3.84; 95% CI, 2.16-6.82; p < 0.0001). After adjustment by PSM, DFS and OS results in 1, 3, and 5 years remained worse in the public service compared to the private service. Conclusion Patients treated in a public center have worse DFS and OS after a follow-up period of more than 5 years. These results were corroborated after carrying out the PSM.
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Affiliation(s)
- Diocésio Alves Pinto Andrade
- Clinical Oncology Department, InORP Oncoclínicas Group, Oncology Institute of Ribeirão Preto, Ribeirão Preto, Brazil
| | | | - Carlos Eduardo Paiva
- Clinical Oncology Department, Division of Breast and Gynecologic, Barretos Cancer Hospital, Barretos, Brazil
| | - Ricardo dos Reis
- Gynecologic Oncology Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Carlos Alberto Fruet Filho
- Clinical Oncology Department, InORP Oncoclínicas Group, Oncology Institute of Ribeirão Preto, Ribeirão Preto, Brazil
| | | | | | | | | | - Daniel D’Almeida Preto
- Clinical Oncology Department, Division of Urology, Barretos Cancer Hospital, Barretos, Brazil
| | | | | | | | | | - Cristiano de Pádua Souza
- Clinical Oncology Department, Division of Breast and Gynecologic, Barretos Cancer Hospital, Barretos, Brazil
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Chavez-MacGregor M, Lei X, Malinowski C, Zhao H, Shih YC, Giordano SH. Medicaid expansion, chemotherapy delays, and racial disparities among women with early-stage breast cancer. J Natl Cancer Inst 2023; 115:644-651. [PMID: 36794921 PMCID: PMC10248833 DOI: 10.1093/jnci/djad033] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/19/2022] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Medicaid expansion under the Affordable Care Act extends eligibility for participating states and has been associated with improved outcomes by facilitating access to care. Delayed initiation of adjuvant chemotherapy is associated with worse outcomes among patients with early-stage breast cancer (BC). The impact of Medicaid expansion in narrowing delays by race and ethnicity has not been studied, to our knowledge. METHODS This was a population-based study using the National Cancer Database. Patients diagnosed with primary early-stage BC between 2007 and 2017 residing in states that underwent Medicaid expansion in January 2014 were included. Time to chemotherapy initiation and proportion of patients experiencing chemotherapy delays (>60 days) were evaluated using difference-in-difference and Cox proportional hazards models in preexpansion and postexpansion periods according to race and ethnicity. RESULTS A total 100 643 patients were included (63 313 preexpansion and 37 330 postexpansion). After Medicaid expansion, the proportion of patients experiencing chemotherapy initiation delay decreased from 23.4% to 19.4%. The absolute decrease was 3.2, 5.3, 6.4, and 4.8 percentage points (ppt) for Black, Hispanic, White, and Other patients. Compared with White patients, statistically significant adjusted difference-in-differences were observed for Black (-2.1 ppt, 95% confidence interval [CI] = -3.7% to -0.5%) and Hispanic patients (-3.2 ppt, 95% CI = -5.6% to -0.9%). Statistically significant reductions in time to chemotherapy between expansion periods were observed among White patients (adjusted hazard ratio = .11, 95% CI = 1.09 to 1.12) and those belonging to racialized groups (adjusted hazard ratio = 1.14, 95% CI = 1.11 to 1.17). CONCLUSIONS Among patients with early-stage BC, Medicaid expansion was associated with a reduction in racial disparities by decreasing the gap in the proportion of Black and Hispanic patients experiencing delays in adjuvant chemotherapy initiation.
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Affiliation(s)
- Mariana Chavez-MacGregor
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Breast Cancer Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiudong Lei
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Catalina Malinowski
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hui Zhao
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ya-Chen Shih
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Breast Cancer Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Rey-Vargas L, Bejarano-Rivera LM, Mejia-Henao JC, Sua LF, Bastidas-Andrade JF, Ossa CA, Gutiérrez-Castañeda LD, Fejerman L, Sanabria-Salas MC, Serrano-Gómez SJ. Association of genetic ancestry with HER2, GRB7 AND estrogen receptor expression among Colombian women with breast cancer. Front Oncol 2022; 12:989761. [PMID: 36620598 PMCID: PMC9815522 DOI: 10.3389/fonc.2022.989761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Our previous study reported higher mRNA levels of the human epidermal growth factor receptor 2 (HER2)-amplicon genes ERBB2 and GRB7 in estrogen receptor (ER)-positive breast cancer patients with relatively high Indigenous American (IA) ancestry from Colombia. Even though the protein expression of HER2 and GRB7 is highly correlated, they may also express independently, an event that could change the patients' prognosis. In this study, we aimed to explore the differences in ER, HER2 and GRB7 protein expression according to genetic ancestry, to further assess the clinical implications of this association. Methods We estimated genetic ancestry from non-tumoral breast tissue DNA and assessed tumoral protein expression of ER, HER2, and GRB7 by immunohistochemistry in a cohort of Colombian patients from different health institutions. We used binomial and multinomial logistic regression models to test the association between genetic ancestry and protein expression. Kaplan-Meier and log-rank tests were used to evaluate the effect of HER2/GRB7 co-expression on patients' survival. Results Our results show that patients with higher IA ancestry have higher odds of having HER2+/GRB7- breast tumors, compared to the HER2-/GRB7- subtype, and this association seems to be stronger among ER-positive tumors (ER+/HER2+/GRB7-: OR=3.04, 95% CI, 1.47-6.37, p<0.05). However, in the multivariate model this association was attenuated (OR=1.80, 95% CI, 0.72-4.44, p=0.19). On the other hand, it was observed that having a higher European ancestry patients presented lower odds of ER+/HER2+/GRB7- breast tumors, this association remained significant in the multivariate model (OR=0.36, 95% CI, 0.13 - 0.93, p= 0.0395). The survival analysis according to HER2/GRB7 co-expression did not show statistically significant differences in the overall survival and recurrence-free survival. Conclusions Our results suggest that Colombian patients with higher IA ancestry and a lower European fraction have higher odds of ER+/HER2+/GRB7- tumors compared to ER+/HER2-/GRB7- disease. However, this association does not seem to be associated with patients' overall or recurrence-free survival.
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Affiliation(s)
- Laura Rey-Vargas
- Cancer Biology Research Group, National Cancer Institute of Colombia, Bogotá, Colombia,Doctoral Program in Biological Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Juan Carlos Mejia-Henao
- Oncological Pathology Research Group, National Cancer Institute of Colombia, Bogotá, Colombia
| | - Luz F. Sua
- Department of Pathology and Laboratory Medicine, Fundación Valle del Lili, and Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | | | | | - Luz Dary Gutiérrez-Castañeda
- Research Institute, Group of Basic Sciences in Health (CBS), Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
| | - Laura Fejerman
- Department of Public Health Sciences and Comprehensive Cancer Center, University of California Davis, Davis, CA, United States
| | | | - Silvia J. Serrano-Gómez
- Cancer Biology Research Group, National Cancer Institute of Colombia, Bogotá, Colombia,Research support and follow-up group, National Cancer Institute of Colombia, Bogotá, Colombia,*Correspondence: Silvia J. Serrano-Gómez,
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Vazquez ED, Fang X, Levesque LA, Huynh M, Venegas C, Lu N, Salazar N. Chemokine receptors differentially expressed by race category and molecular subtype in the breast cancer TCGA cohort. Sci Rep 2022; 12:10825. [PMID: 35754051 PMCID: PMC9234040 DOI: 10.1038/s41598-022-14734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/13/2022] [Indexed: 11/22/2022] Open
Abstract
Racial disparities in mortality due to metastasis remain significant among breast cancer patients. Chemokine receptors contribute to breast tumors and metastatic outcome. We explored for significant differences in chemokine receptor expression in breast tumors from Black, Asian, and White patients in The Cancer Genome Atlas. We show that despite sharing the same molecular subtype, expression of the chemokine receptors ACKR1, CCR3, CCR6, CCRL1, CCRL2, CXCR1, CXCR2, CXCR4, CXCR6, and CXC3CR1 was significantly different depending on racial group. For patients with triple negative breast cancer, CCR3 was higher in Black versus White and CCRL2 was higher in Asian versus White. In luminal A tumors, ACKR1 was lower in Asian versus White, CCR3 was higher in Black versus White, and CCR6 and CXC3CR1 were lower in Black versus White. In luminal B tumors, CCRL2 was lower in Black versus White, CXCR1 and CXC3CR1 were lower in Asian versus White, and CXCR2 was lower in Black and Asian versus White. In HER2 enriched tumors, CCR3 was higher in Black versus White and CXCR4 lower in Asian versus White. CCR3, CCR6, and CXCR6 associated with worse patient survival. These findings can inform improved treatment strategies to decrease racial disparities in breast cancer burden.
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Affiliation(s)
- Elissa D Vazquez
- Department of Biology, San Francisco State University, San Francisco, CA, 94132, USA
| | - Xiangyi Fang
- Department of Biology, San Francisco State University, San Francisco, CA, 94132, USA
| | - Lauren A Levesque
- Department of Biology, San Francisco State University, San Francisco, CA, 94132, USA
| | - Mike Huynh
- Department of Biology, San Francisco State University, San Francisco, CA, 94132, USA
| | - Citlali Venegas
- Department of Biology, San Francisco State University, San Francisco, CA, 94132, USA
| | - Nhien Lu
- Department of Biology, San Francisco State University, San Francisco, CA, 94132, USA
| | - Nicole Salazar
- Department of Biology, San Francisco State University, San Francisco, CA, 94132, USA.
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Fejerman L, Ramirez AG, Nápoles AM, Gomez SL, Stern MC. Cancer Epidemiology in Hispanic Populations: What Have We Learned and Where Do We Need to Make Progress? Cancer Epidemiol Biomarkers Prev 2022; 31:932-941. [PMID: 35247883 DOI: 10.1158/1055-9965.epi-21-1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/09/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
The Hispanic/Latino(x) population (H/L) in the United States of America is heterogeneous and fast growing. Cancer is the number one cause of death among H/Ls, accounting for 21% of deaths. Whereas for the most common cancers, incidence rates are lower in H/Ls compared with non-H/L White (NHW) individuals, H/Ls have a higher incidence of liver, stomach, cervical, penile, and gallbladder cancers. H/L patients tend to be diagnosed at more advanced stages for breast, colorectal, prostate, and lung cancers, and melanoma compared with NHW individuals. Etiologic and cancer outcomes research among H/Ls lags other populations. In this review, we provide a summary of challenges, opportunities, and research priorities related to cancer etiology, cancer outcomes, and survivorship to make progress in addressing scientific gaps. Briefly, we prioritize the need for more research on determinants of obesity, nonalcoholic fatty liver disease and its progression to liver cancer, stomach and gallbladder cancers, and pediatric acute lymphoblastic leukemia. We emphasize the need to improve cancer screening, early detection of cancer, and survivorship care. We highlight critical resources needed to make progress in cancer epidemiologic studies among H/L populations, including the importance of training the next generation of cancer epidemiologists conducting research in H/Ls.
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Affiliation(s)
- Laura Fejerman
- Department of Public Health Sciences, UC Davis Comprehensive Cancer Center, University of California Davis, Davis, California
| | - Amelie G Ramirez
- Department of Population Health Sciences, School of Medicine, Mays Cancer Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Mariana C Stern
- Department of Population and Public Health Sciences, Department of Urology, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
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Llera AS, Abdelhay ESFW, Artagaveytia N, Daneri-Navarro A, Müller B, Velazquez C, Alcoba EB, Alonso I, Alves da Quinta DB, Binato R, Bravo AI, Camejo N, Carraro DM, Castro M, Castro-Cervantes JM, Cataldi S, Cayota A, Cerda M, Colombo A, Crocamo S, Del Toro-Arreola A, Delgadillo-Cisterna R, Delgado L, Dreyer-Breitenbach M, Fejerman L, Fernández EA, Fernández J, Fernández W, Franco-Topete RA, Gabay C, Gaete F, Garibay-Escobar A, Gómez J, Greif G, Gross TG, Guerrero M, Henderson MK, Lopez-Muñoz ME, Lopez-Vazquez A, Maldonado S, Morán-Mendoza AJ, Nagai MA, Oceguera-Villanueva A, Ortiz-Martínez MA, Quintero J, Quintero-Ramos A, Reis RM, Retamales J, Rivera-Claisse E, Rocha D, Rodríguez R, Rosales C, Salas-González E, Sanchotena V, Segovia L, Sendoya JM, Silva-García AA, Trinchero A, Valenzuela O, Vedham V, Zagame L, Podhajcer OL. The Transcriptomic Portrait of Locally Advanced Breast Cancer and Its Prognostic Value in a Multi-Country Cohort of Latin American Patients. Front Oncol 2022; 12:835626. [PMID: 35433488 PMCID: PMC9007037 DOI: 10.3389/fonc.2022.835626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purposes Most molecular-based published studies on breast cancer do not adequately represent the unique and diverse genetic admixture of the Latin American population. Searching for similarities and differences in molecular pathways associated with these tumors and evaluating its impact on prognosis may help to select better therapeutic approaches. Patients and Methods We collected clinical, pathological, and transcriptomic data of a multi-country Latin American cohort of 1,071 stage II-III breast cancer patients of the Molecular Profile of Breast Cancer Study (MPBCS) cohort. The 5-year prognostic ability of intrinsic (transcriptomic-based) PAM50 and immunohistochemical classifications, both at the cancer-specific (OSC) and disease-free survival (DFS) stages, was compared. Pathway analyses (GSEA, GSVA and MetaCore) were performed to explore differences among intrinsic subtypes. Results PAM50 classification of the MPBCS cohort defined 42·6% of tumors as LumA, 21·3% as LumB, 13·3% as HER2E and 16·6% as Basal. Both OSC and DFS for LumA tumors were significantly better than for other subtypes, while Basal tumors had the worst prognosis. While the prognostic power of traditional subtypes calculated with hormone receptors (HR), HER2 and Ki67 determinations showed an acceptable performance, PAM50-derived risk of recurrence best discriminated low, intermediate and high-risk groups. Transcriptomic pathway analysis showed high proliferation (i.e. cell cycle control and DNA damage repair) associated with LumB, HER2E and Basal tumors, and a strong dependency on the estrogen pathway for LumA. Terms related to both innate and adaptive immune responses were seen predominantly upregulated in Basal tumors, and, to a lesser extent, in HER2E, with respect to LumA and B tumors. Conclusions This is the first study that assesses molecular features at the transcriptomic level in a multicountry Latin American breast cancer patient cohort. Hormone-related and proliferation pathways that predominate in PAM50 and other breast cancer molecular classifications are also the main tumor-driving mechanisms in this cohort and have prognostic power. The immune-related features seen in the most aggressive subtypes may pave the way for therapeutic approaches not yet disseminated in Latin America. Clinical Trial Registration ClinicalTrials.gov (Identifier: NCT02326857).
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Affiliation(s)
- Andrea Sabina Llera
- Molecular and Cellular Therapy Laboratory, Fundación Instituto Leloir-CONICET, Buenos Aires, Argentina
| | | | - Nora Artagaveytia
- Hospital de Clínicas Manuel Quintela, Universidad de la República, Montevideo, Uruguay
| | | | | | | | - Elsa B Alcoba
- Hospital Municipal de Oncología María Curie, Buenos Aires, Argentina
| | - Isabel Alonso
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Daniela B Alves da Quinta
- Molecular and Cellular Therapy Laboratory, Fundación Instituto Leloir-CONICET, Buenos Aires, Argentina.,Universidad Argentina de la Empresa (UADE), Instituto de Tecnología (INTEC), Buenos Aires, Argentina
| | - Renata Binato
- Bone Marrow Transplantation Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | | | - Natalia Camejo
- Hospital de Clínicas Manuel Quintela, Universidad de la República, Montevideo, Uruguay
| | - Dirce Maria Carraro
- Laboratory of Genomics and Molecular Biology/Centro Internacional de Pesquisa (CIPE), AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Mónica Castro
- Instituto de Oncología Angel Roffo, Buenos Aires, Argentina
| | | | | | | | - Mauricio Cerda
- Integrative Biology Program, Instituto de Ciencias Biomédicas (ICBM), Centro de Informática Médica y Telemedicina, Facultad de Medicina, Instituto de Neurociencias Biomédicas, Universidad de Chile, Santiago, Chile
| | - Alicia Colombo
- Department of Pathology, Facultad de Medicina y Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Susanne Crocamo
- Oncology Department, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | | | | | - Lucía Delgado
- Hospital de Clínicas Manuel Quintela, Universidad de la República, Montevideo, Uruguay
| | - Marisa Dreyer-Breitenbach
- Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Laura Fejerman
- Department of Public Health Sciences and Comprehensive Cancer Center, University of California Davis, Davis, CA, United States
| | - Elmer A Fernández
- Centro de Investigación y Desarrollo en Inmunología y Enfermedades Infecciosas [Centro de Investigación y Desarrollo en Inmunología y Enfermedades Infecciosas (CIDIE) CONICET/Universidad Católica de Córdoba], Córdoba, Argentina.,Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | | | - Ramón A Franco-Topete
- Organismo Público Descentralizado (OPD), Hospital Civil de Guadalajara, Universidad de Guadalajara, Guadalajara, Mexico
| | - Carolina Gabay
- Instituto de Oncología Angel Roffo, Buenos Aires, Argentina
| | | | | | - Jorge Gómez
- Texas A&M University, Houston, TX, United States
| | | | - Thomas G Gross
- Center for Global Health, National Cancer Institute, Rockville, MD, United States
| | | | - Marianne K Henderson
- Center for Global Health, National Cancer Institute, Rockville, MD, United States
| | | | | | | | | | - Maria Aparecida Nagai
- Center for Translational Research in Oncology, Cancer Institute of São Paulo (ICESP), Sao Paulo University Medical School, Sao Paulo, Brazil
| | | | | | | | | | - Rui M Reis
- Molecular Oncology Research Center, Hospital de Câncer de Barretos, Barretos, Brazil
| | - Javier Retamales
- Grupo Oncológico Cooperativo Chileno de Investigación, Santiago, Chile
| | | | - Darío Rocha
- Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | - Cristina Rosales
- Hospital Municipal de Oncología María Curie, Buenos Aires, Argentina
| | | | | | | | - Juan Martín Sendoya
- Molecular and Cellular Therapy Laboratory, Fundación Instituto Leloir-CONICET, Buenos Aires, Argentina
| | - Aida A Silva-García
- Organismo Público Descentralizado (OPD), Hospital Civil de Guadalajara, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | - Vidya Vedham
- Center for Global Health, National Cancer Institute, Rockville, MD, United States
| | - Livia Zagame
- Instituto Jalisciense de Cancerologia, Guadalajara, Mexico
| | | | - Osvaldo L Podhajcer
- Molecular and Cellular Therapy Laboratory, Fundación Instituto Leloir-CONICET, Buenos Aires, Argentina
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10
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Melo-Uribe MA, Serrano-Gómez SJ, Abaunza Chagin MC. Androgen receptor expression and prognosis in Hispanic/Latino women with triple negative breast cancer. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2022; 55:96-104. [PMID: 35483775 DOI: 10.1016/j.patol.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVE Triple-negative breast cancer (TNBC) is an aggressive subtype that has no available molecular targets. It occurs most often in premenopausal African-American and Hispanic/Latino women. In Colombia, its prevalence has been reported to be 20.6%. Androgen receptor (AR) belongs to the steroid nuclear receptor family and has been recently considered a potential biomarker for breast cancer. Considering the high prevalence of TNBC in Colombian women and the lack of knowledge of AR expression, our aim was to determine the frequency of AR expression and its association with pathological variables. MATERIALS AND METHODS 149 women diagnosed with TNBC between 2011 and 2014 were included. Clinical and pathological data were obtained from medical and pathology reports. Information on hormone receptor status, Ki67 expression and HER2 was reevaluated by a pathologist. AR expression was considered positive when it exceeded 1% of nuclear staining in tumor cells. RESULTS AR expression was detected in 41.6% of the samples. Although we did not find statistically significant differences in clinic-pathological variables according to AR expression, patients with AR expression over 50% were younger (53.92 years vs. 60.78 years, p=0.027) and presented higher Ki67 expression (64.06% vs. 47.32%, p=0.05), compared to patients with a low AR expression. The median overall survival in our sample of TNBC patients was 2.45 years. CONCLUSIONS The expression of AR in our sample was similar to the expression in populations of European descent. We found statistically significant differences in age at diagnosis and Ki67 expression according to AR expression.
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Affiliation(s)
- Mario Alexander Melo-Uribe
- Department of Pathology, Universidad de La Sabana, Colombia; Department of Oncology-Pathology, Instituto Nacional de Cancerología, Colombia.
| | - Silvia J Serrano-Gómez
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología, Colombia
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11
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Hirko KA, Rocque G, Reasor E, Taye A, Daly A, Cutress RI, Copson ER, Lee DW, Lee KH, Im SA, Park YH. The impact of race and ethnicity in breast cancer-disparities and implications for precision oncology. BMC Med 2022; 20:72. [PMID: 35151316 PMCID: PMC8841090 DOI: 10.1186/s12916-022-02260-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 12/14/2022] Open
Abstract
Breast cancer is the most commonly diagnosed cancer worldwide and is one of the leading causes of cancer death. The incidence, pathological features, and clinical outcomes in breast cancer differ by geographical distribution and across racial and ethnic populations. Importantly, racial and ethnic diversity in breast cancer clinical trials is lacking, with both Blacks and Hispanics underrepresented. In this forum article, breast cancer researchers from across the globe discuss the factors contributing to racial and ethnic breast cancer disparities and highlight specific implications of precision oncology approaches for equitable provision of breast cancer care to improve outcomes and address disparities.
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Affiliation(s)
- Kelly A Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, 48824, USA.
| | - Gabrielle Rocque
- Department of Internal Medicine, Division of Hematology Oncology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erica Reasor
- Department of Internal Medicine, Division of Hematology Oncology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ammanuel Taye
- Department of Internal Medicine, Division of Hematology Oncology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alex Daly
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Ramsey I Cutress
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Ellen R Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Dae-Won Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeon Hee Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, Korea
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12
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Winters S, Alomari A, Shokar G, Martin C, Dwivedi A, Shokar NK. Breast cancer screening outcomes among Mexican-origin Hispanic women participating in a breast cancer screening program. Prev Med Rep 2021; 24:101561. [PMID: 34987953 PMCID: PMC8693837 DOI: 10.1016/j.pmedr.2021.101561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 11/24/2022] Open
Abstract
We observed a higher recall rate for diagnostic
testing in this population. Breast density distribution was different to both
Hispanic and other populations. We did not observe lower biopsy rates compared to
other populations. Age, health status, and years in the US were
associated with breast density.
Breast cancer is the commonest occurring cancer and the
leading cause of cancer death among Hispanic women in the USA. Although their
overall breast cancer incidence and mortality is lower, incidence rates are
rising faster and mortality declines are lower than other groups. It is expected
that the breast cancer burden will rise as this population ages and becomes more
acculturated. It is therefore important to better characterize their screening
outcomes. This is an observational study of socioeconomically disadvantaged
Hispanic women participating in a community-based breast cancer screening
program that offered no-cost testing and navigation services in two US-Mexico
border counties. Outcomes include results of screening mammograms, diagnostic
tests and breast findings. Of 1,966 eligible women, 1,675 (85%) completed a
screening mammogram and were included in this analysis. Mean age was 56 years
(SD: 6.8 years, range 50 to 75.6 years); 99% were Hispanic and 83.6% had less
than high school education. 19.3% of the initial mammogram results were abnormal
(BIRADS 0, 3, 4, or 5); a diagnostic mammogram was indicated in 12.2% (n = 205),
a diagnostic ultrasound in 26.4% (n = 443), and biopsies in 3.0% (n = 51) of the
total. Eleven women (0.66%) had breast cancer diagnosed. Mexican-origin Hispanic
women had higher recall rates, but similar biopsy and cancer rates to general
screening populations despite their overall lower incidence and mortality in the
USA. This suggests that the expected rise in future breast cancer burden among
US Hispanics due to aging and acculturation could occur sooner than
expected.
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Affiliation(s)
- Stella Winters
- UPMC St. Margaret Family Medicine Residency Program, 815 Freeport Road,
Pittsburg, PA 15215-3301, USA
| | - Adam Alomari
- Department of Family and Community Medicine, Texas Texas TX Tech
University Health Sciences Ctr., El Paso, 9849 Kenworthy Street, El Paso, TX
79924, USA
| | - Gurjeet Shokar
- Department of Family and Community Medicine, Texas Texas TX Tech
University Health Sciences Ctr., El Paso, 9849 Kenworthy Street, El Paso, TX
79924, USA
| | - Charmaine Martin
- Department of Family and Community Medicine, Texas Texas TX Tech
University Health Sciences Ctr., El Paso, 9849 Kenworthy Street, El Paso, TX
79924, USA
| | - Alok Dwivedi
- Department of Molecular and Translational Medicine, Texas Texas TX Tech
University Health Sciences Ctr., El Paso, 5001 El Paso Drive, Texas 79905,
USA
| | - Navkiran K. Shokar
- Department of Population, Dell Medical School at the University of Austin
Texas, DMS Health Discovery Building, #4.702, 1601 Trinity St., BLDG B STOP
Z0500 Austin, TX 78712-1872, USA
- Corresponding author.
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13
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Buki LP, Rivera-Ramos ZA, Kanagui-Muñoz M, Heppner PP, Ojeda L, Lehardy EN, Weiterschan KA. "I never heard anything about it": Knowledge and psychosocial needs of Latina breast cancer survivors with lymphedema. ACTA ACUST UNITED AC 2021; 17:17455065211002488. [PMID: 33764235 PMCID: PMC8010798 DOI: 10.1177/17455065211002488] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: Breast cancer is the most commonly diagnosed form of cancer and the leading cause of cancer-related death among Latina women in the United States. One aspect of recovery that has been underrepresented in the English-language literature is the recovery of Latina women who have developed lymphedema, a debilitating condition characterized by persistent swelling of the arm, hand, chest, and/or breast. To fill this research gap, a study was conducted to examine the lived experiences of Latina women with breast cancer-related lymphedema. Methods: Given the limited scholarship on this topic, qualitative methods were used to obtain a foundational and nuanced understanding of Latina women’s experiences. Semi-structured interviews were conducted with a sample of 10 Latina survivors with breast cancer-related lymphedema. Data were analyzed through thematic analysis and constant comparison methodology. Results: The data analysis yielded three major themes: knowledge of lymphedema, impact of lymphedema diagnosis, and coping with lymphedema. Participants had limited knowledge of lymphedema and its risk factors upon diagnosis, in addition to barriers accessing quality care. They also noted psychological distress related to a significant financial burden as well as social anxiety related to interacting with others while wearing compression gloves or sleeves. A major coping strategy was receiving social support from friends, family, peers in structured support groups, and spiritual/religious groups or practices. Conclusions: Our findings bring to light contextual factors that may place Latina breast cancer survivors at increased risk for lymphedema and for experiencing a high burden managing their condition. Recommendations are provided for primary, secondary, and tertiary prevention.
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Affiliation(s)
- Lydia P Buki
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, FL, USA.,University of Illinois, Champaign, IL, USA
| | - Zully A Rivera-Ramos
- Department of Educational Psychology, University of Illinois, Champaign, IL, USA.,Counseling & Wellness Center, University of Florida, Gainesville, FL, USA
| | - Marlen Kanagui-Muñoz
- Department of Educational, School & Counseling Psychology, University of Missouri, Columbia, MO, USA.,Department of Psychiatry, Kaiser Permanente Medical Center, Richmond, CA, USA
| | - Puncky P Heppner
- Department of Educational, School & Counseling Psychology, University of Missouri, Columbia, MO, USA
| | - Lizette Ojeda
- Department of Educational, School & Counseling Psychology, University of Missouri, Columbia, MO, USA.,Department of Education and Human Development, Texas A&M University, College Station, TX, USA
| | - Emaan N Lehardy
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, FL, USA.,Department of Behavioral Health, University of Nebraska Medicine, Omaha, NE, USA
| | - Kari A Weiterschan
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, FL, USA.,Rush University Medical Center, Chicago, IL, USA
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14
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Buki LP, Schwartz JR, McInerney EEW. Creating community: Expanding access to psychosocial programs for Latina breast cancer survivors. Psychooncology 2021. [PMID: 33555106 DOI: 10.1002/pon.5646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/29/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Breast cancer survivors often derive benefits from psychosocial interventions, but less is known about Latina women's experiences. Given the disproportionately high disease burden faced by Latina survivors, it is critical to examine ways to enhance access for this population. Thus, the present study aimed to (a) examine women's perceptions of factors associated with effective delivery of a psychosocial program designed for Spanish speaking women with limited access to care, and (b) identify the mechanisms by which the program enhanced women's psychological well-being. METHODS In a qualitative study, in-depth interviews were conducted with 15 immigrant Latina breast cancer survivors who previously received psychosocial services at a community-based organization. Grounded theory was used to analyze the data. RESULTS Through open, axial, and selective coding, we arrived at the core category achieving a sense of community. The psychosocial program promoted access and enhanced women's psychological well-being by creating a sense of community among participants. This was facilitated by three primary aspects of service provision: access factors, a holistic approach to health, and therapeutic factors imparted through a biweekly support group. CONCLUSIONS Psychosocial services promoted a sense of community among Latina breast cancer survivors while reflecting their cultural values and unique psychosocial needs. Findings may guide the development of interventions to increase access to care, enhance health outcomes, and create and maintain a sense of community among medically underserved populations.
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Affiliation(s)
- Lydia P Buki
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, Florida, USA
| | - Jessica R Schwartz
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, Florida, USA
| | - Elizabeth E W McInerney
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, Florida, USA
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15
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Sly JR, Miller SJ, Thelemaque L, Yazdanie F, Sperling R, Sasan F, Howell EA, Loudon H, Jandorf L. Knowledge of the Relationship Between Breastfeeding and Breast Cancer Risk Among Racial and Ethnic Minority Women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:1193-1196. [PMID: 31338810 PMCID: PMC6980917 DOI: 10.1007/s13187-019-01580-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research indicates breastfeeding can reduce the risk of breast cancer in women. Black and Hispanic women are more likely to die from breast cancer than non-Hispanic white women and are least likely to breastfeed. The current study was designed to evaluate women's knowledge of the link between breastfeeding and decreased breast cancer risk among a racially diverse cohort of pregnant women. Pregnant women 18 and older (N = 89; 48.4% black; 28% Hispanic) were recruited during a prenatal visit to complete a survey. Women indicated limited understanding of the association between breastfeeding and breast cancer risk reduction; less than 40% of black and white women indicated knowledge, while 64.7% of Hispanic women were aware of the association. These findings underscore the need for interventions to educate women about the protective benefits of breastfeeding as a strategy to reduce their breast cancer incidence and mortality.
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Affiliation(s)
- Jamilia R Sly
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.
| | - Sarah J Miller
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - Linda Thelemaque
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - Fahd Yazdanie
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - Rhoda Sperling
- Department of Obstetrics, Gynecology and Reproductive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fahimeh Sasan
- Department of Obstetrics, Gynecology and Reproductive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth A Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Holly Loudon
- Department of Obstetrics, Gynecology and Reproductive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lina Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
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16
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Philipovskiy A, Dwivedi AK, Gamez R, McCallum R, Mukherjee D, Nahleh Z, Aguilera RJ, Gaur S. Association between tumor mutation profile and clinical outcomes among Hispanic Latina women with triple-negative breast cancer. PLoS One 2020; 15:e0238262. [PMID: 32886682 PMCID: PMC7473586 DOI: 10.1371/journal.pone.0238262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
Triple-negative breast cancer (TNBC) represents 15%-20% of all breast cancer types. It is more common among African American (AA) and Hispanic-Latina (HL) women. The biology of TNBC in HL women has been poorly characterized, but some data suggest that the molecular drivers of breast cancer might differ. There are no clinical tools to aid medical oncologists with decisions regarding appropriate individualized therapy, and no way to predict long-term outcomes. The aim of this study was to characterize individual patient gene mutation profiles and to identify the relationship with clinical outcomes. We collected formalin-fixed paraffin-embedded tumors (FFPE) from women with TNBC. We analyzed the gene mutation profiles of the collected tumors and compared the results with individual patient's clinical histories and outcomes. Of 25 patients with TNBC, 24 (96%) identified as HL. Twenty-one (84%) had stage III-IV disease. The most commonly mutated genes were TP53, NOTCH1, NOTCH2, NOTCH3, AKT, MEP3K, PIK3CA, and EGFR. Compared with other international cancer databases, our study demonstrated statistically significant higher frequencies of these genes among HL women. Additionally, a worse clinical course was observed among patients whose tumors had mutations in NOTCH genes and PIK3CA. This study is the first to identify the most common genetic alterations among HL women with TNBC. Our data strongly support the notion that molecular drivers of breast cancer could differ in HL women compared with other ethnic backgrounds. Therefore, a deeper understanding of the biological mechanisms behind NOTCH gene and PIK3CA mutations may lead to a new treatment approach.
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Affiliation(s)
- Alexander Philipovskiy
- Division of Hematology-Oncology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States of America
| | - Alok K. Dwivedi
- Division of Biostatistics & Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States of America
| | - Roberto Gamez
- Department of Pathology, University Medical Center, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States of America
| | - Richard McCallum
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States of America
| | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States of America
| | - Zeina Nahleh
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic, Florida, Weston, Florida, United States of America
| | - Renato J. Aguilera
- Border Biomedical Research Center, The University of Texas at El Paso, El Paso, Texas, United States of America
| | - Sumit Gaur
- Division of Hematology-Oncology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States of America
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17
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The impact of sociodemographic factors and health insurance coverage in the diagnosis and clinicopathological characteristics of breast cancer in Brazil: AMAZONA III study (GBECAM 0115). Breast Cancer Res Treat 2020; 183:749-757. [PMID: 32728860 DOI: 10.1007/s10549-020-05831-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/21/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE In Brazil, the available cancer registries are deficient in number and quality and, hence, little information is known regarding sociodemographic, clinicopathological characteristics, treatment patterns, and outcomes of breast cancer (BC) patients. We performed the AMAZONA III/ GBECAM 0115 study and in this analysis, we describe patients' characteristics at diagnosis and their association with health insurance type. METHODS This is a prospective cohort study developed in 23 sites in Brazil including women with newly diagnosed invasive BC from January 2016 to March 2018. In order to compare healthcare insurance type, we considered patients who were treated under the Brazilian public health system as publicly insured, and women who had private insurance or paid for their treatment as privately insured. RESULTS A total of 2950 patients were included in the study. Median age at diagnosis was 53.9 years; 63.1% were publicly insured. The majority of patients (68.6%) had stage II-III breast cancer and ductal carcinoma histology (80.9%). The most common breast cancer subtype was luminal A-like (48.0%) followed by luminal B-HER2 positive-like (17.0%) and triple-negative (15.6%). Luminal A was more frequent in private (53.7% vs. 44.2%, p < .0001) than public, whereas Luminal B HER2-positive (19.2% vs. 14.2%, p = 0.0012) and HER2-positive (8.8% vs. 5.1%, p = 0.0009) were more common in patients with public health system coverage. Only 34% of patients were diagnosed by screening exams. Privately insured patients were more frequently diagnosed with stage I disease when compared to publicly insured patients; publicly insured patients had more stage III (33.5% vs. 14.7%; p-value < 0.0001) disease than privately insured ones. Breast cancer was detected by symptoms more frequently in publicly than in privately insured patients (74.2% vs 25.8%, respectively; p-value < 0.0001). CONCLUSIONS Patients with public health coverage were diagnosed with symptomatic disease, later stages and more aggressive subtypes when compared to privately insured patients.
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18
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Abstract
Purpose of the review Breast cancer incidence and mortality rates are lower in some Hispanic/Latino subpopulations compared to Non-Hispanic White women. However, studies suggest that the risk of breast cancer-specific mortality is higher in US Hispanics/Latinas. In this review we summarized current knowledge on factors associated with breast cancer incidence and risk of mortality in women of Hispanic/Latino origin. Recent findings Associative studies have proposed a multiplicity of factors likely contributing to differences in breast cancer incidence and survival between population groups, including socioeconomic/sociodemographic factors, lifestyle choices as well as access to and quality of care. Reports of association between global genetic ancestry overall as well as subtype-specific breast cancer risk among Hispanic/Latinas suggest that incidence and subtype distribution could result from differential exposure to environmental and lifestyle related factors correlated with genetic ancestry as well as germline genetic variation. Summary Hispanic/Latino in the United States have been largely underrepresented in cancer research. It is important to implement inclusive programs that facilitate the access of this population to health services and that also include education programs for the community on the importance of screening. In addition, it is important to continue promoting the inclusion of Hispanics/Latinos in genomic studies that allow understanding the biological behavior of this disease in the context of all human genetic diversity.
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Marker KM, Zavala VA, Vidaurre T, Lott PC, Vásquez JN, Casavilca-Zambrano S, Calderón M, Abugattas JE, Gómez HL, Fuentes HA, Picoaga RL, Cotrina JM, Neciosup SP, Castañeda CA, Morante Z, Valencia F, Torres J, Echeverry M, Bohórquez ME, Polanco-Echeverry G, Estrada-Florez AP, Serrano-Gómez SJ, Carmona-Valencia JA, Alvarado-Cabrero I, Sanabria-Salas MC, Velez A, Donado J, Song S, Cherry D, Tamayo LI, Huntsman S, Hu D, Ruiz-Cordero R, Balassanian R, Ziv E, Zabaleta J, Carvajal-Carmona L, Fejerman L. Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Is Associated with Indigenous American Ancestry in Latin American Women. Cancer Res 2020; 80:1893-1901. [PMID: 32245796 PMCID: PMC7202960 DOI: 10.1158/0008-5472.can-19-3659] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/11/2020] [Accepted: 02/26/2020] [Indexed: 12/18/2022]
Abstract
Women of Latin American origin in the United States are more likely to be diagnosed with advanced breast cancer and have a higher risk of mortality than non-Hispanic White women. Studies in U.S. Latinas and Latin American women have reported a high incidence of HER2 positive (+) tumors; however, the factors contributing to this observation are unknown. Genome-wide genotype data for 1,312 patients from the Peruvian Genetics and Genomics of Breast Cancer Study (PEGEN-BC) were used to estimate genetic ancestry. We tested the association between HER2 status and genetic ancestry using logistic and multinomial logistic regression models. Findings were replicated in 616 samples from Mexico and Colombia. Average Indigenous American (IA) ancestry differed by subtype. In multivariate models, the odds of having an HER2+ tumor increased by a factor of 1.20 with every 10% increase in IA ancestry proportion (95% CI, 1.07-1.35; P = 0.001). The association between HER2 status and IA ancestry was independently replicated in samples from Mexico and Colombia. Results suggest that the high prevalence of HER2+ tumors in Latinas could be due in part to the presence of population-specific genetic variant(s) affecting HER2 expression in breast cancer. SIGNIFICANCE: The positive association between Indigenous American genetic ancestry and HER2+ breast cancer suggests that the high incidence of HER2+ subtypes in Latinas might be due to population and subtype-specific genetic risk variants.
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Affiliation(s)
- Katie M Marker
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California
| | - Valentina A Zavala
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | | | - Paul C Lott
- UC Davis Genome Center, University of California, Davis, Davis, California
| | | | | | | | | | - Henry L Gómez
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Hugo A Fuentes
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | - Jose M Cotrina
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | | | - Zaida Morante
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | - Javier Torres
- Unidad de Investigación en Enfermedades Infecciosas, Instituto Mexicano del Seguro Social; México City, México
| | - Magdalena Echeverry
- Grupo de Citogenética, Filogenia y Evolución de Poblaciones, Facultades de Ciencias y Facultad de Ciencias de la Salud, Universidad del Tolima, Ibagué, Colombia
| | - Mabel E Bohórquez
- Grupo de Citogenética, Filogenia y Evolución de Poblaciones, Facultades de Ciencias y Facultad de Ciencias de la Salud, Universidad del Tolima, Ibagué, Colombia
| | | | - Ana P Estrada-Florez
- UC Davis Genome Center, University of California, Davis, Davis, California
- Grupo de Citogenética, Filogenia y Evolución de Poblaciones, Facultades de Ciencias y Facultad de Ciencias de la Salud, Universidad del Tolima, Ibagué, Colombia
| | - Silvia J Serrano-Gómez
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | | | | | - Alejandro Velez
- Dinamica IPS, Medellín, Colombia
- Hospital Pablo Tobon Uribe, Medellín, Colombia
| | | | - Sikai Song
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Daniel Cherry
- Department of Medicine, University of California San Diego, San Diego, California
| | - Lizeth I Tamayo
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Scott Huntsman
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Donglei Hu
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | | | - Ronald Balassanian
- Department of Pathology, University of California, San Francisco, California
| | - Elad Ziv
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Jovanny Zabaleta
- Stanley S. Scott Cancer Center, LSUHSC, New Orleans, Louisiana
- Department of Pediatrics, LSUHSC, New Orleans, Louisiana
| | | | - Laura Fejerman
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California.
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
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20
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Philipovskiy A, Corral J, Dwivedi KA, Heydarian R, Gaur S. Efficacy of Neoadjuvant Versus Adjuvant Chemotherapy in Hispanic/Latino (H/L) Women With Local or Locally Advanced Triple-negative Breast Cancer (TNBC). In Vivo 2019; 33:1227-1234. [PMID: 31280213 DOI: 10.21873/invivo.11594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/23/2019] [Accepted: 05/31/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM The aim of the study was to investigate the efficacy of neoadjuvant and chemotherapy (NACT) and adjuvant chemotherapy (ACT) in Hispanic/Latino (H/L) women with TNBC. PATIENTS AND METHODS We reviewed the charts of patients with TNBC, stages I-III, treated at TTUHSC from 2006 to 2016. Overall survival (OS) and recurrence-free survival (RFS) were estimated and compared between the treatment groups. Kaplan-Meier curve and Cox proportional hazards regression analyses were conducted to estimate unadjusted and adjusted effects of NACT compared to ACT. RESULTS A total of 104 patients with TNBC, 30 (29%) received NACT and 74 (71%) ACT. Women undergoing NACT were younger, with a mean age of 50.8 years. Of the 30 patients who received NACT, 12 (40%) had pathologically complete response (pCR). Women who achieved pCR had an excellent RFS (HR=0.5, p=0.001). Women with residual cancer after NACT had worse outcome compared to patients who received ACT (HR=1.7, p=0.005). CONCLUSION pCR to NACT is a powerful surrogate for OS in H/L women with TNBC.
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Affiliation(s)
- Alexander Philipovskiy
- Department of Internal Medicine, Division of Hematology-Oncology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, U.S.A.
| | - Javier Corral
- Department of Internal Medicine, Division of Hematology-Oncology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, U.S.A
| | - Kumar Alok Dwivedi
- Department of Molecular and Translational Medicine, Division of Biostatistics & Epidemiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, U.S.A
| | - Rosalinda Heydarian
- Department of Internal Medicine, Division of Hematology-Oncology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, U.S.A
| | - Sumit Gaur
- Department of Internal Medicine, Division of Hematology-Oncology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, U.S.A
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21
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Sugita BM, Pereira SR, de Almeida RC, Gill M, Mahajan A, Duttargi A, Kirolikar S, Fadda P, de Lima RS, Urban CA, Makambi K, Madhavan S, Boca SM, Gusev Y, Cavalli IJ, Ribeiro EMSF, Cavalli LR. Integrated copy number and miRNA expression analysis in triple negative breast cancer of Latin American patients. Oncotarget 2019; 10:6184-6203. [PMID: 31692930 PMCID: PMC6817452 DOI: 10.18632/oncotarget.27250] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/16/2019] [Indexed: 12/18/2022] Open
Abstract
Triple negative breast cancer (TNBC), a clinically aggressive breast cancer subtype, affects 15–35% of women from Latin America. Using an approach of direct integration of copy number and global miRNA profiling data, performed simultaneously in the same tumor specimens, we identified a panel of 17 miRNAs specifically associated with TNBC of ancestrally characterized patients from Latin America, Brazil. This panel was differentially expressed between the TNBC and non-TNBC subtypes studied (p ≤ 0.05, FDR ≤ 0.25), with their expression levels concordant with the patterns of copy number alterations (CNAs), present mostly frequent at 8q21.3-q24.3, 3q24-29, 6p25.3-p12.2, 1q21.1-q44, 5q11.1-q22.1, 11p13-p11.2, 13q12.11-q14.3, 17q24.2-q25.3 and Xp22.33-p11.21. The combined 17 miRNAs presented a high power (AUC = 0.953 (0.78–0.99);95% CI) in discriminating between the TNBC and non-TNBC subtypes of the patients studied. In addition, the expression of 14 and 15 of the 17miRNAs was significantly associated with tumor subtype when adjusted for tumor stage and grade, respectively. In conclusion, the panel of miRNAs identified demonstrated the impact of CNAs in miRNA expression levels and identified miRNA target genes potentially affected by both CNAs and miRNA deregulation. These targets, involved in critical signaling pathways and biological functions associated specifically with the TNBC transcriptome of Latina patients, can provide biological insights into the observed differences in the TNBC clinical outcome among racial/ethnic groups, taking into consideration their genetic ancestry.
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Affiliation(s)
- Bruna M Sugita
- Department of Genetics, Federal University of Paraná, Curitiba, PR, Brazil.,Faculdades Pequeno Príncipe, Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil
| | - Silma R Pereira
- Department of Biology, Federal University of Maranhão, São Luis, MA, Brazil
| | - Rodrigo C de Almeida
- Department of Biomedical Data Sciences, Section Molecular Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mandeep Gill
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
| | - Akanksha Mahajan
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
| | - Anju Duttargi
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
| | - Saurabh Kirolikar
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
| | - Paolo Fadda
- Genomics Shared Resource, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Rubens S de Lima
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - Cicero A Urban
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - Kepher Makambi
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington DC, USA
| | - Subha Madhavan
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA.,Innovation Center for Biomedical Informatics (ICBI), Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
| | - Simina M Boca
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA.,Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington DC, USA.,Innovation Center for Biomedical Informatics (ICBI), Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
| | - Yuriy Gusev
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA.,Innovation Center for Biomedical Informatics (ICBI), Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
| | - Iglenir J Cavalli
- Department of Genetics, Federal University of Paraná, Curitiba, PR, Brazil
| | | | - Luciane R Cavalli
- Faculdades Pequeno Príncipe, Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil.,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
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22
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Rey-Vargas L, Sanabria-Salas MC, Fejerman L, Serrano-Gómez SJ. Risk Factors for Triple-Negative Breast Cancer among Latina Women. Cancer Epidemiol Biomarkers Prev 2019; 28:1771-1783. [DOI: 10.1158/1055-9965.epi-19-0035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/15/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022] Open
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23
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Breast cancer subtype and survival among Indigenous American women in Peru. PLoS One 2018; 13:e0201287. [PMID: 30183706 PMCID: PMC6124707 DOI: 10.1371/journal.pone.0201287] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/12/2018] [Indexed: 01/09/2023] Open
Abstract
Latina women in the U.S. have relatively low breast cancer incidence compared to Non-Latina White (NLW) or African American women but are more likely to be diagnosed with the more aggressive “triple negative” breast cancer (TNBC). Latinos in the U.S. are a heterogeneous group originating from different countries with different cultural and ancestral backgrounds. Little is known about the distribution of tumor subtypes in Latin American regions. Clinical records of 303 female Peruvian patients, from the Peruvian National Cancer Institute, were analyzed. Participants were diagnosed with invasive breast cancer between 2010 and 2015 and were identified as residing in either the Selva or Sierra region. We used Fisher’s exact test for proportions and multivariable Cox Proportional Hazards Models to compare overall survival between regions. Women from the Selva region were more likely to be diagnosed with TNBC than women from the Sierra region (31% vs. 14%, p = 0.01). In the unadjusted Cox model, the hazard of mortality was 1.7 times higher in women from the Selva than the Sierra (p = 0.025); this survival difference appeared to be largely explained by differences in the prevalence of TNBC. Our results suggest that the distribution of breast cancer subtypes differs between highly Indigenous American women from two regions of Peru. Disentangling the factors that contribute to this difference will add valuable information to better target prevention and treatment efforts in Peru and improve our understanding of TNBC among all women. This study demonstrates the need for larger datasets of Latin American patients to address differences between Latino subpopulations and optimize targeted prevention and treatment.
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