Differences in breast cancer hormone receptor status in ethnic groups: A London population

doi:10.1016/j.ejca.2012.09.012

European Journal of Cancer

Volume 49, Issue 3, February 2013, Pages 696-702

https://doi.org/10.1016/j.ejca.2012.09.012 Get rights and content

Abstract

Background

Triple negative breast cancer (TNBC) is associated with different ethnic groups in the United States (US), however this has not previously been examined in a population-based study within the United Kingdom (UK).

Methods

Electronic pathology reports from the North East London Cancer Network (NELCN) on women diagnosed with breast cancer between 2005 and 2007 were collated. The statuses of oestrogen receptor, progesterone receptor and HER-2 were extracted. Women were classified as having TNBC if all three receptor statuses were negative, and as not having TNBC if at least one receptor was positive or borderline. Logistic regression was used to quantify the association between TNBC and ethnicity, adjusting for age, year of diagnosis and socioeconomic deprivation. Overall survival in different ethnic groups was examined using Cox regression, adjusting as appropriate for age, stage of disease, triple negative status, year of diagnosis, socioeconomic deprivation and recorded treatment.

Results

There were 2417 women resident in NELCN diagnosed with breast cancer between 2005 and 2007, and TNBC status was determined for 1228 (51%) women. Overall, of women who had their TNBC status determined, 128 (10%) were diagnosed with TNBC. Compared with White women, Black (odds ratio [OR] = 2.81, p < 0.001) and South Asian (OR = 1.80, p = 0.044) women with breast cancer were more likely to have TNBC. Black women had a worse age-adjusted survival than White women (hazard ratio [HR] = 2.05, p < 0.001). This was attenuated by further adjustment for stage of disease (1.52, p = 0.032) and triple negative status (1.31, p = 0.175).

Conclusion

Better methods of early detection may need to be developed in addition to more effective systemic treatment in order to improve outcomes for women with TNBC.

Introduction

Although breast cancer is the most commonly diagnosed cancer in England,¹ different subtypes require different treatments and vary in terms of survival outcomes.2, 3, 4, 5 Triple negative breast cancer (TNBC) is diagnosed when a tumour tests negative for oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) expression, and is associated with a poor prognosis.5, 6, 7 Studies in the United States (US) have shown that among breast cancer patients a higher proportion of Black women than White women are diagnosed with TNBC.8, 9, 10, 11 In the United Kingdom (UK), one hospital-based study in North East London found that among breast cancer patients aged under 60, Black women were more likely to have TNBC than White women, but this was of borderline statistical significance, possibly due to the small numbers of patients analysed.¹²

Variation in the survival of breast cancer patients between ethnic groups has been identified in the US13, 14, 15 and the UK.16, 17 In US work these differences remain after adjusting for breast cancer subtype.13, 14 In the UK, studies have not been able to examine the combined effect of these variables on survival as data on receptor status and ethnicity have historically not been routinely recorded.

The age-specific incidence of breast cancer in ethnic groups in this South East England population has been reported separately.17, 18 This study uses new electronic pathology data obtained in recent improvements of routine cancer registration processes to study women with breast cancer in more detail. Its objectives were to determine whether there is any variation in the proportion of women with TNBC among breast cancer patients from different ethnic groups, and to examine survival in these patients.

Section snippets

Material and methods

In the UK, cancer registries record the occurrence of cancer in their resident populations. In the area covered by the Thames Cancer Registry (TCR), registration is initiated by clinical and pathological information received from hospitals and by information about deaths provided by the National Health Service Central Register through the Office for National Statistics. Trained cancer registration officers then extract further information on demographic details, disease stage and treatment in

Results

There were 2417 women resident in NELCN diagnosed with breast cancer between 2005 and 2007. Pathology reports were found and matched for 1538 (64%) women, and the TNBC status was determined for 1228 (51%) women. Of the patients who had a matching pathology report but their TNBC status could not be determined, the majority (266/310, 86%) had no ER, PR or HER-2 status information contained in the pathology report. Of those who did have a matching pathology report, HER-2 status was more likely to

Discussion

This study of a population of London women with breast cancer found that TNBC makes up a higher proportion in Black women, and is also more common in South Asian than White women. The worse survival in Black women is partially explained by TNBC status, but is also due to differences in stage of disease at diagnosis.

These results replicate the findings in the US that TNBC is more common in Black breast cancer patients than in White patients.8, 9, 10, 11 A study in California also examined the

Conflict of interest statement

None declared.

Acknowledgements

This work was carried out by the Thames Cancer Registry, King’s College London, which receives funding from the Department of Health. The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St. Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

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Differences in breast cancer hormone receptor status in ethnic groups: A London population

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Material and methods

Results

Discussion

Conflict of interest statement

Acknowledgements

Eur J Cancer

Lancet Oncol

Ann Oncol

Eur J Cancer

J Surg Res

Soc Sci Med

Ann Oncol

Lancet

Cancer statistics registrations. Registrations of cancer diagnosed in 2009

Breast cancer subtypes as defined by the estrogen receptor (ER), progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER2) among women with invasive breast cancer in California, 1999–2004

Breast J

Triple-negative breast cancer: clinical features and patterns of recurrence

Clin Cancer Res

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

Triple-negative breast cancers are increased in black women regardless of age or body mass index

Breast Cancer Res

Age/race differences in HER2 testing and in incidence rates for breast cancer triple subtypes: a population-based study and first report

Cancer