Abstract
Some studies suggest that Hispanic women are more likely to have ER− and triple-negative (ER−/PR−/HER2−) tumors and subsequently poorer prognosis than non-Hispanic white (NHW) women. In addition, only a handful of studies have examined period-specific effects of tumor phenotype and ethnicity on breast cancer survival, leaving the time-varying effects of hormonal status and ethnicity on breast cancer survival poorly defined. This study describes short and long-term breast cancer survival by ethnicity at 0–5 years and 5+ years post-diagnosis using data from the New Mexico Health, Eating, Activity, and Lifestyle cohort of Hispanic and NHW women ages 29–88 years newly diagnosed with stages I–IIIA breast cancer. The survival rate for Hispanics at 0–5 years was 82.2 % versus 94.3 % for NHW. Hispanics were more likely to have larger tumors, more advanced stage, and ER− phenotypes compared to NHW women. There was a significantly higher risk of breast cancer mortality in Hispanics over 5 years of follow-up compared to NHW (HR = 2.78, 95 % CI 1.39–5.56), adjusting for age, tumor phenotype, stage, and tumor size. This ethnic difference in survival, however, was attenuated and no longer statistically significant when additional adjustment was made for education, although a >1.5-fold increase in mortality was observed. In contrast, there was no difference between ethnic groups for survival after 5 years (HR = 1.08, 95 % CI 0.36–3.24). Our results indicate that the difference in survival between Hispanic and NHW women with breast cancer occurs in the first few years following diagnosis and is jointly associated with tumor phenotype and socio-demographic factors related to education.
Similar content being viewed by others
References
Howlader N et al (2012) SEER cancer statistics review, 1975–2009. National Cancer Institute, Bethesda
Li CI, Malone KE, Daling JR (2003) Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 163:49–56
Li R et al (2002) Hormone replacement therapy and breast carcinoma risk in Hispanic and non-Hispanic women. Cancer 95(5):960–968
Shavers VL, Harlan LC, Stevens JL (2003) Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer 97(1):134–147
Martinez ME et al (2007) Breast cancer among Hispanic and non-Hispanic White women in Arizona. J Health Care Poor Underserved 18(4 Suppl):130–145
Abdel-Maksoud MF et al (2012) Behavioral risk factors and their relationship to tumor characteristics in Hispanic and non-Hispanic white long-term breast cancer survivors. Breast Cancer Res Treat 131(1):169–176
Bauer KR et al (2007) Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer Registry. Cancer 109(9):1721–1728
Carey LA et al (2006) Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA 295(21):2492–2502
Hines LM et al (2011) Ethnic disparities in breast tumor phenotypic subtypes in Hispanic and non-Hispanic white women. J Womens Health (Larchmt) 20(10):1543–1550
Kwan ML et al (2009) Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors. Breast Cancer Res 11(3):R31
Li CI, Malone KE, Daling JR (2002) Differences in breast cancer hormone receptor status and histology by race and ethnicity among women 50 years of age and older. Cancer Epidemiol Biomarkers Prev 11:601–607
Lund MJ et al (2009) Race and triple negative threats to breast cancer survival: a population-based study in Atlanta, GA. Breast Cancer Res Treat 113(2):357–370
Parise CA, Bauer KR, Caggiano V (2010) Variation in breast cancer subtypes with age and race/ethnicity. Crit Rev Oncol Hematol 76(1):44–52
Trivers KF et al (2009) The epidemiology of triple-negative breast cancer, including race. Cancer Causes Control 20(7):1071–1082
O’Brien KM et al (2010) Intrinsic breast tumor subtypes, race, and long-term survival in the Carolina Breast Cancer Study. Clin Cancer Res 16(24):6100–6110
Dent R et al (2009) Time to disease recurrence in basal-type breast cancers: effects of tumor size and lymph node status. Cancer 115(21):4917–4923
Tischkowitz M et al (2007) Use of immunohistochemical markers can refine prognosis in triple negative breast cancer. BMC Cancer 7:134
Grann VR et al (2005) Hormone receptor status and survival in a population-based cohort of patients with breast carcinoma. Cancer 103(11):2241–2251
Hill DA et al (2010) Method of detection and breast cancer survival disparities in Hispanic women. Cancer Epidemiol Biomarkers Prev 19(10):2453–2460
Curtis E et al (2008) Racial and ethnic differences in breast cancer survival: how much is explained by screening, tumor severity, biology, treatment, comorbidities, and demographics? Cancer 112(1):171–180
Ooi SL, Martinez ME, Li CI (2011) Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Res Treat 127(3):729–738
O’Malley CD et al (2003) Socioeconomic status and breast carcinoma survival in four racial/ethnic groups: a population-based study. Cancer 97(5):1303–1311
Lara-Medina F et al (2011) Triple-negative breast cancer in Hispanic patients: high prevalence, poor prognosis, and association with menopausal status, body mass index, and parity. Cancer 117(16):3658–3669
Livaudais JC et al (2012) Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer. Breast Cancer Res Treat 131(2):607–617
Patel TA et al (2010) Breast cancer in Latinas: gene expression, differential response to treatments, and differential toxicities in Latinas compared with other population groups. Oncologist 15(5):466–475
Lantz PM et al (2006) The influence of race, ethnicity, and individual socioeconomic factors on breast cancer stage at diagnosis. Am J Public Health 96(12):2173–2178
Miller BA, Hankey BF, Thomas TL (2002) Impact of sociodemographic factors, hormone receptor status, and tumor grade on ethnic differences in tumor stage and size for breast cancer in US women. Am J Epidemiol 155(6):534–545
Vona-Davis L, Rose DP (2009) The influence of socioeconomic disparities on breast cancer tumor biology and prognosis: a review. J Womens Health (Larchmt) 18(6):883–893
Anderson WF (2005) Distinct breast cancer incidence and prognostic patterns in the NCI’s SEER program: suggesting a possible link between etiology and outcome. Breast Cancer Res Treat 90:127–137
Blows FM et al (2010) Subtyping of breast cancer by immunohistochemistry to investigate a relationship between subtype and short and long term survival: a collaborative analysis of data for 10,159 cases from 12 studies. PLoS Med 7(5):e1000279
Costa SD et al (2002) Factors influencing the prognostic role of oestrogen and progesterone receptor levels in breast cancer—results of the analysis of 670 patients with 11 years of follow-up. Eur J Cancer 38(10):1329–1334
Irwin ML et al (2003) Physical activity levels before and after a diagnosis of breast carcinoma: the health, eating, activity, and lifestyle (HEAL) study. Cancer 97(7):1746–1757
McTiernan A et al (2003) Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol 21(10):1961–1966
Baumgartner KB et al (2004) Association of body composition and weight history with breast cancer prognostic markers: divergent pattern for Hispanic and non-Hispanic White women. Am J Epidemiol 160(11):1087–1097
Hammond ME et al (2010) American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version). Arch Pathol Lab Med 134(7):e48–e72
McGuire WL et al (1975) Estrogen receptors in human breast cancer. In: McGuire WL, Carbone P, Vollmer E (eds) Estrogen receptors in human breast cancer. Raven Press, New York
Raghav KP et al (2012) Impact of low estrogen/progesterone receptor expression on survival outcomes in breast cancers previously classified as triple negative breast cancers. Cancer 118(6):1498–1506
Li C (2010) Breast cancer epidemiology. Springer, New York, NY
American Cancer Society (2011) Breast Cancer Facts & Figures 2011–2012. American Cancer Society, Inc., Atlanta
Cheang MC et al (2008) Basal-like breast cancer defined by five biomarkers has superior prognostic value than triple-negative phenotype. Clin Cancer Res 14(5):1368–1376
Pierce BL et al (2009) Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients. J Clin Oncol 27(21):3437–3444
WHO (1992) International statistical classification of diseases and related health problems (10th Revision). World Health Organization, Geneva
Therneau T, Grambsch P (2000) Modeling survival data: extending the Cox model. Statistics for biology and health. Springer, New York, NY
Ghali WA et al (2001) Comparison of 2 methods for calculating adjusted survival curves from proportional hazards models. JAMA 286(12):1494–1497
Kleinbaum D, Klein M (2005) Evaluating the proportional hazards assumption. Survival analysis, a self-learning text. Springer, New York, NY, pp 131–171
Baumgartner KB et al (2004) Hispanic ethnicity is associated with increased recurrence and death in women with breast cancer in New Mexico: The Health, Eating, Activity and Lifestyle Study. In: 27th annual san antonio breast cancer conference. December 8–11, 2004. San Antonio, TX: Breast Cancer Research and Treatment 88(Supplement 1): S98–S99
Siegel R, Naishadham D, Jemal A (2012) Cancer statistics for Hispanics/Latinos, 2012. CA Cancer J Clin 62(5):283–298
Ennis S, Rios-Vargas M, Albert N (2011) The Hispanic population: 2010: 2010 census briefs. United States Census Bureau, Washington
Sweeney C et al (2007) Genetic admixture among Hispanics and candidate gene polymorphisms: potential for confounding in a breast cancer study? Cancer Epidemiol Biomarkers Prev 16(1):142–150
Frost F et al (1996) Breast cancer survival among New Mexico Hispanic, American Indian, and non-Hispanic white women (1973–1992). Cancer Epidemiol Biomarkers Prev 5(11):861–866
Watlington AT et al (2007) Does having insurance affect differences in clinical presentation between Hispanic and non-Hispanic white women with breast cancer? Cancer 109(10):2093–2099
Fedewa SA et al (2010) Delays in adjuvant chemotherapy treatment among patients with breast cancer are more likely in African American and Hispanic populations: a national cohort study 2004–2006. J Clin Oncol 28(27):4135–4141
Freedman RA et al (2011) The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care. Cancer 117(1):180–189
Tian N et al (2012) Identifying risk factors for disparities in breast cancer mortality among African-American and Hispanic women. Womens Health Issues 22(3):e267–e276
Gore S, Pocock S, Kerr G (1984) Regression models and non-proportional hazards in the analysis of breast cancer survival. Appl Stat 33:176–195
Martinussen T, Scheike T (2006) Dynamic regression models for survival data. Statistics for Biology and Health. Springer, New York, NY
Acknowledgments
Preliminary results using this data were presented at the 36th Annual CTRC-AACR San Antonio Breast Cancer Symposium, 6–10 December 2011. This research was supported by the National Cancer Institute research contract for the “Health Eating Activity and Lifestyle” (HEAL) study (N01-PC-67010) and by the Susan G. Komen for the cure: Breast Cancer Disparities Epidemiology Research Training Program (KG090926).
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Boone, S.D., Baumgartner, K.B., Joste, N.E. et al. The joint contribution of tumor phenotype and education to breast cancer survival disparity between Hispanic and non-Hispanic white women. Cancer Causes Control 25, 273–282 (2014). https://doi.org/10.1007/s10552-013-0329-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-013-0329-3