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African-American race is associated with a poorer overall survival rate for breast cancer patients treated with mastectomy and doxorubicin-based chemotherapy†

  1. Wendy A. Woodward MD, PhD1,
  2. Eugene H. Huang MD1,
  3. Marsha D. McNeese MD1,
  4. George H. Perkins MD1,
  5. Susan L. Tucker MD2,
  6. Eric A. Strom MD1,
  7. Lavinia Middleton MD3,
  8. Karin Hahn MD4,
  9. Gabriel N. Hortobagyi MD4,
  10. Thomas A. Buchholz MD1,‡,*

Article first published online: 23 OCT 2006

DOI: 10.1002/cncr.22281

Issue

Cancer

Cancer

Volume 107, Issue 11, pages 2662–2668, 1 December 2006

Additional Information

How to Cite

Woodward, W. A., Huang, E. H., McNeese, M. D., Perkins, G. H., Tucker, S. L., Strom, E. A., Middleton, L., Hahn, K., Hortobagyi, G. N. and Buchholz, T. A. (2006), African-American race is associated with a poorer overall survival rate for breast cancer patients treated with mastectomy and doxorubicin-based chemotherapy. Cancer, 107: 2662–2668. doi: 10.1002/cncr.22281

Author Information

  1. 1

    Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas

  2. 2

    Department of Biomathematics, University of Texas M. D. Anderson Cancer Center, Houston, Texas

  3. 3

    Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas

  4. 4

    Department of Breast Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas

  1. ‡

    Fax: (713) 794-5579

*Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcolmbe Blvd., Unit 97, Houston, TX 77030

  1. †

    Presented at the San Antonio Breast Cancer Symposium annual meeting, San Antonio, TX, December 3ndash;6, 2003.

Publication History

  1. Issue published online: 17 NOV 2006
  2. Article first published online: 23 OCT 2006
  3. Manuscript Accepted: 30 AUG 2006
  4. Manuscript Revised: 22 AUG 2006
  5. Manuscript Received: 3 MAY 2006

Funded by

  • National Cancer Institute. Grant Numbers: CA16672, T32CA77050
  • Nellie B. Connally Breast Cancer Research Fund
  • Arlette and William Colmen Foundation
  • Stanford and Joan Alexander Foundation, Houston, Texas

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Keywords:

  • race;
  • African-American;
  • Hispanic;
  • breast cancer;
  • mastectomy

Records from 2 independent cohorts of breast cancer patients treated on institutional protocols with mastectomy and adjuvant (n = 1456) or neoadjuvant (n = 684) doxorubicin-based chemotherapy were reviewed. African-American race is associated with poorer overall survival and less favorable biological tumor features, such as an increased likelihood of estrogen receptor-negative disease, than those found in Caucasian and Hispanic patients.

Abstract

BACKGROUND.

African-American (AA) race has been associated with a worse outcome in breast cancer. It is unclear whether this is due to biological factors, socioeconomic factors, or both.

METHODS.

The records from 2 independent cohorts of breast cancer patients treated on institutional protocols with mastectomy and adjuvant (n = 1456) or neoadjuvant (n = 684) doxorubicin-based chemotherapy were retrospectively reviewed.

RESULTS.

The adjuvant (Adj) chemotherapy cohort included 1142 Caucasian (CA), 186 Hispanic (HI), and 128 (AA) patients. The neoadjuvant (Neo) chemotherapy protocols included 448 CA, 114 HI, and 122 AA patients. In both groups, AA patients had later-stage tumors (Adj P = .017; Neo P = .051), a higher rate of estrogen receptor (ER)-negative disease (Adj P = .054; Neo P = .039), and a worse 10-year actuarial overall survival rate than CA or HI patients (Adj, 52%, 62%, and 62%, respectively, P = .009; Neo, 40%, 50%, and 56%, respectively, P = .015). In multivariate analyses, AA race remained independently associated with a poorer overall survival rate in both cohorts (Adj, hazard ratio = 1.39, P = .018; Neo, hazard ratio = 1.37, P = .02).

CONCLUSIONS.

The data suggest that AA race is associated with less favorable biological tumor features, such as an increased likelihood of ER-negative disease, than those found in CA and HI patients. Such differences in tumor biology, as well as previously described socioeconomic factors, likely contribute to the lower rate of survival in the AA breast cancer population. Cancer 2006. © 2006 American Cancer Society.

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