Elsevier

Surgery

Volume 150, Issue 4, October 2011, Pages 796-801
Surgery

Central Surgical Association
Primary tumor size, not race, determines outcomes in women with hormone-responsive breast cancer

Presented at the Central Surgical Association Meeting held in Detroit, Michigan, March 17–19, 2011.
https://doi.org/10.1016/j.surg.2011.07.066Get rights and content

Introduction

We sought to determine if there was a difference in outcomes in African-American compared with Caucasian women with hormone-responsive breast cancer, and whether this was related to race or other tumor and treatment variables.

Methods

We included 1,205 patients with hormone-responsive breast cancer were identified in the Kentucky Cancer Registry (1996–2007). The effect of race on survival was evaluated using Kaplan–Meier and Cox regression methodologies.

Results

In this cohort, 76.9% were Caucasian and 21.7% were African American. Compared with Caucasians, African-American women were older (57 vs 55 years; P = .032) and more likely to have larger tumors (19 vs 17 mm; P = .009). No significant racial differences in grade, operative, or systemic treatment were noted. Univariate analysis found no significant differences in disease-specific overall survival (DSS) or disease-free survival (DFS) between Caucasians and African Americans (5-year actuarial DSS, 93.6% vs 90.7%, respectively; P = .205; 5-year actuarial DFS, 91.5% vs 90.4%, respectively; P = .829). On multivariate analysis, only tumor size remained an independent predictor of DSS (odds ratio [OR], 1.021; 95% confidence interval [CI], 1.013–1.028; P < .001). Controlling for age, tumor size, and insurance status, race did not influence DSS or DFS (P = .913 and P = .857).

Conclusion

African Americans present with larger tumors than Caucasians; treatment is similar. Tumor size, not race, affects disease-specific outcomes in patients with breast cancer.

Section snippets

Methods

Between 1996 and 2007, 1903 patients with breast cancer were recorded in the Kentucky Cancer Registry (KCR). The KCR is the population-based central cancer registry for Kentucky, and all acute care hospitals and their outpatient facilities are mandated to report every case of cancer to this registry. Hospitals diagnosing more than 100 cases of cancer annually are mandated to have their own cancer registrar, each of whom must attend extensive formal training before abstracting cases for KCR.

Results

Of the total 1903 breast cancer cases identified, 1415 (74.4%) were Caucasian and 469 (24.6%) were African American. Of these, 1205 (63.3%) patients were hormone-receptor positive: 1175 (97.5%) were ER-positive, 1019 (84.6%) were PR-positive, and 989 (82.1%) were positive for both ER and PR. The majority of these patients had invasive ductal carcinoma (n = 916; 76.0%); 100 (8.3%) had invasive lobular carcinoma, 80 (6.6%) had invasive carcinoma of other histologic types, and 100 (8.3%) had in

Discussion

Although it has been well-elucidated that African-American women tend to have a lesser incidence of breast cancer and a greater mortality rate,1 the etiology of these differences has remained elusive.9 Indeed, a number of authors have found varying results in terms of the effect of race on survival in breast cancer patients. Some investigators, similar to our study, found no difference in DSS and DFS between racial groups,7, 8, 10, 11, 12, 13 whereas others found that African-American women

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