Brigid K Killelea1, Vicky Q Yang2, Shi-Yi Wang2, Brandon Hayse2, Sarah Mougalian2, Nina R Horowitz2, Anees B Chagpar2, Lajos Pusztai2, Donald R Lannin2. 1. Brigid K. Killelea, Brandon Hayse, Sarah Mougalian, Nina R. Horowitz, Anees B. Chagpar, Lajos Pusztai, and Donald R. Lannin, Yale University School of Medicine; Brigid K. Killelea, Sarah Mougalian, Nina R. Horowitz, Anees B. Chagpar, Lajos Pusztai, and Donald R. Lannin, Yale Comprehensive Cancer Center; and Vicky Q. Yang and Shi-Yi Wang, Yale University School of Public Health, New Haven, CT. brigid.killelea@yale.edu. 2. Brigid K. Killelea, Brandon Hayse, Sarah Mougalian, Nina R. Horowitz, Anees B. Chagpar, Lajos Pusztai, and Donald R. Lannin, Yale University School of Medicine; Brigid K. Killelea, Sarah Mougalian, Nina R. Horowitz, Anees B. Chagpar, Lajos Pusztai, and Donald R. Lannin, Yale Comprehensive Cancer Center; and Vicky Q. Yang and Shi-Yi Wang, Yale University School of Public Health, New Haven, CT.
Abstract
PURPOSE: To explore racial differences in the use and outcome of neoadjuvant chemotherapy for breast cancer. METHODS: The National Cancer Data Base was queried to identify women with stage 1 to 3 breast cancer diagnosed in 2010 and 2011. Chemotherapy use and rate of pathologic complete response (pCR) was determined for various racial/ethnic groups. RESULTS: Of 278,815 patients with known race and ethnicity, 127,417 (46%) received chemotherapy, and of 121,446 where the timing of chemotherapy was known, 27,300 (23%) received neoadjuvant chemotherapy. Chemotherapy, and neoadjuvant chemotherapy in particular, was given more frequently to black, Hispanic, and Asian women than to white women (P < 0.001). This difference was largely explained by more advanced stage, higher grade tumors, and a greater proportion of triple-negative and human epidermal growth factor receptor 2 (HER2)-positive tumors in these women. Of 17,970 patients with known outcome, 5,944 (33%) had a pCR. No differences in response rate for estrogen receptor (ER)/progesterone receptor (PR)-positive tumors were found, but compared with white women, black but not Hispanic or Asian women had a lower rate of pCR for ER/PR-negative, HER2-positive (43% v 54%, P = 0.001) and triple-negative tumors (37% v 43%, P < 0.001). This difference persisted when adjusted for age, clinical T stage, clinical N stage, histology, grade, comorbidity index, facility type, geographic region, insurance status, and census-derived median income and education for the patient's zip code (odds ratio, 0.84; 95% CI, 0.77 to 0.93). CONCLUSION: Neoadjuvant chemotherapy is given more frequently to black, Hispanic, and Asian women than to white women. Black women have a lower likelihood of pCR for triple-negative and HER2-positive breast cancer. Whether this is due to biologic differences in chemosensitivity or to treatment or socioeconomic differences that could not be adjusted for is unknown.
PURPOSE: To explore racial differences in the use and outcome of neoadjuvant chemotherapy for breast cancer. METHODS: The National Cancer Data Base was queried to identify women with stage 1 to 3 breast cancer diagnosed in 2010 and 2011. Chemotherapy use and rate of pathologic complete response (pCR) was determined for various racial/ethnic groups. RESULTS: Of 278,815 patients with known race and ethnicity, 127,417 (46%) received chemotherapy, and of 121,446 where the timing of chemotherapy was known, 27,300 (23%) received neoadjuvant chemotherapy. Chemotherapy, and neoadjuvant chemotherapy in particular, was given more frequently to black, Hispanic, and Asian women than to white women (P < 0.001). This difference was largely explained by more advanced stage, higher grade tumors, and a greater proportion of triple-negative and humanepidermal growth factor receptor 2 (HER2)-positive tumors in these women. Of 17,970 patients with known outcome, 5,944 (33%) had a pCR. No differences in response rate for estrogen receptor (ER)/progesterone receptor (PR)-positive tumors were found, but compared with white women, black but not Hispanic or Asian women had a lower rate of pCR for ER/PR-negative, HER2-positive (43% v 54%, P = 0.001) and triple-negative tumors (37% v 43%, P < 0.001). This difference persisted when adjusted for age, clinical T stage, clinical N stage, histology, grade, comorbidity index, facility type, geographic region, insurance status, and census-derived median income and education for the patient's zip code (odds ratio, 0.84; 95% CI, 0.77 to 0.93). CONCLUSION: Neoadjuvant chemotherapy is given more frequently to black, Hispanic, and Asian women than to white women. Black women have a lower likelihood of pCR for triple-negative and HER2-positive breast cancer. Whether this is due to biologic differences in chemosensitivity or to treatment or socioeconomic differences that could not be adjusted for is unknown.
Authors: Tess O'Meara; Anton Safonov; David Casadevall; Tao Qing; Andrea Silber; Brigid Killelea; Christos Hatzis; Lajos Pusztai Journal: Breast Cancer Res Treat Date: 2019-02-06 Impact factor: 4.872
Authors: Jessica M Pastoriza; George S Karagiannis; Juan Lin; Sonali Lanjewar; David Entenberg; John S Condeelis; Joseph A Sparano; Xiaonan Xue; Thomas E Rohan; Maja H Oktay Journal: Clin Exp Metastasis Date: 2018-08-22 Impact factor: 5.150
Authors: Lu Zhang; Jessica King; Xiao-Cheng Wu; Mei-Chin Hsieh; Vivien W Chen; Qingzhao Yu; Elizabeth Fontham; Michelle Loch; Lori A Pollack; Tekeda Ferguson Journal: Cancer Epidemiol Date: 2018-11-08 Impact factor: 2.984
Authors: Erica T Warner; Karla V Ballman; Carrie Strand; Judy C Boughey; Aman U Buzdar; Lisa A Carey; William M Sikov; Ann H Partridge Journal: Breast Cancer Res Treat Date: 2016-07-22 Impact factor: 4.872
Authors: Larissa A Korde; Mark R Somerfield; Lisa A Carey; Jennie R Crews; Neelima Denduluri; E Shelley Hwang; Seema A Khan; Sibylle Loibl; Elizabeth A Morris; Alejandra Perez; Meredith M Regan; Patricia A Spears; Preeti K Sudheendra; W Fraser Symmans; Rachel L Yung; Brittany E Harvey; Dawn L Hershman Journal: J Clin Oncol Date: 2021-01-28 Impact factor: 44.544
Authors: Bryan P Schneider; Fei Shen; Guanglong Jiang; Anne O'Neill; Milan Radovich; Lang Li; Laura Gardner; Dongbing Lai; Tatiana Foroud; Joseph A Sparano; George W Sledge; Kathy D Miller Journal: JCO Precis Oncol Date: 2017-08-21
Authors: Irene L Wapnir; Allison W Kurian; Daphne Y Lichtensztajn; Christina A Clarke; Scarlett L Gomez Journal: Ann Surg Date: 2017-08 Impact factor: 13.787