Breast Cancer Outcomes in a Racially and Ethnically Diverse Cohort of Insured Women

In: Ethnicity & disease: an international journal on population differences in health and disease patterns, Band 28, Heft 4, S. 565-574

Abstract

Background: It is unknown how subse­quent breast cancer outcomes vary by bio­logic subtype and race/ethnicity in a diverse cohort of breast cancer survivors.Methods: We conducted a prospective cohort study of 6,154 insured breast cancer survivors (AJCC TNM stages 0–IV) diagnosed between 1996-2007 and followed them through 1/1/2010 for subsequent breast cancer events (recurrence, contralateral breast cancer, metastasis, mortality). We compared subsequent breast cancer rates by race/ethnicity groups and biologic subtype (luminal A, luminal B, HER2-enriched, and triple negative). We calculated hazard ratios (HRs) with 95% CIs using multivariable Cox proportional hazards models, adjusted for sociodemographics, cancer treatments, and tumor characteristics.Results: The cohort was diverse: 62.4% non-Hispanic White, 13.2% Hispanic, 14.9% African American, and 9.5% Asian. We identified 1,456 subsequent breast cancer events over 22,830 person-years. Although certain Asian women had higher crude subsequent breast cancer rates com­pared with Whites, within each biologic subtype category, these disparities disap­peared in the multivariable analyses. After accounting for race/ethnicity, compared with women with luminal A tumors (refer­ence), women with luminal B (adjusted HR=3.65, 95% CI: 3.08-4.32), HER2- enriched (adjusted HR=2.81, 95% CI: 2.25-3.51) and triple negative (adjusted HR=1.25, 95% CI: 1.01-1.54) tumors had statistically increased risks of subsequent breast cancer. Factors that were statistically significantly associated with increased risk included higher stage, larger tumor size, positive lymph nodes, and no adjuvant endocrine or chemotherapy (all P<.025).Discussion: Our data suggest that dispari­ties in subsequent breast cancer outcomes were more strongly associated with tumor characteristics and non-use of adjuvant treatments than race/ethnicity. Ethn Dis. 2018;28(4):565-574; doi:10.18865/ed.28.4.565.