Long-term outcomes and clinicopathologic differences of African-American versus white patients treated with breast conservation therapy for early-stage breast cancer

Authors

  • Meena S. Moran MD,

    Corresponding author
    1. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
    • Department of Therapeutic Radiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208040, New Haven, CT 06520-8040===

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    • Fax: (203) 785-4622

  • Qifeng Yang MD, PhD,

    1. Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, People's Republic of China
    2. Department of Radiation Oncology, UMDNJ-Robert Wood Johnson School of Medicine, the Cancer Institute of New Jersey, New Brunswick, New Jersey
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  • Lyndsay N. Harris MD,

    1. Department of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut
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  • Beth Jones PhD, MPH,

    1. Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
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  • David P. Tuck MD,

    1. Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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  • Bruce G. Haffty MD

    1. Department of Radiation Oncology, UMDNJ-Robert Wood Johnson School of Medicine, the Cancer Institute of New Jersey, New Brunswick, New Jersey
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Abstract

BACKGROUND.

African–American (AA) and white patients with early–stage disease who were treated with breast conservation therapy (BCT) were examined to detect differences in clinicopathologic features and outcomes as a function of race.

METHODS.

Clinical data from the charts of 2164 white and 207 AA patients treated with BCT, and p53 expression status on 444 patients (from an existing tissue database), were analyzed to detect differences between the 2 cohorts.

RESULTS.

The median follow-up was 7 years. There were no differences in the method of tumor detection, lymph nodes excised, surgical margin status, or chemotherapy/radiotherapy delivered, reflecting similar screening and treatment policies for AA women in the study community. Despite this, AA patient presented at a younger age, with higher T and N classifications, and more estrogen and progesterone negative and “triple negative” tumors (all P values <.016). Tumors in AA patients were p53 positive more often than tumors in white patients (P = .0003). At 10 years, AA patients had a higher rate of distant metastasis (20% vs 17%; P = .042), lymph node recurrence (6% vs 2%; P = .004), and breast recurrence (17% vs 13%; P = .036). There was no difference in overall survival between the 2 groups. On multivariate analysis, only lymph node recurrence (risk ratio of 3.140; 95% confidence interval, 1.396-7.063 [P = .0057]) remained significantly higher among AA women.

CONCLUSIONS.

In this cohort of uniformly treated patients, the authors found the expected clinicopathologic differences, but race was not found to be an independent predictor of local recurrence for AA patients when other confounding variables were taken into account in the multivariate model. These findings suggest that BCT is a reasonable option for appropriately selected AA patients. To the authors' knowledge, this is the largest study addressing outcomes after BCT for AA women published to date. Cancer 2008. © 2008 American Cancer Society.

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