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Outcomes of Hormone-Receptor Positive, HER2-Negative Breast Cancers by Race and Tumor Biological Features

Citation

Benefield, Halei C.; Reeder-Hayes, Katherine E.; Nichols, Hazel B.; Calhoun, Benjamin C.; Love, Michael I.; Kirk, Erin L.; Geradts, Joseph; Hoadley, Katherine A.; Cole, Stephen R.; & Earp, H. Shelton, et al. (2021). Outcomes of Hormone-Receptor Positive, HER2-Negative Breast Cancers by Race and Tumor Biological Features. JNCI Cancer Spectrum, 5(1), pkaa072. PMCID: PMC7791616

Abstract

Background: Black women have higher hormone receptor positive (HR+) breast cancer mortality than White women. Early recurrence rates differ by race, but little is known about genomic predictors of early recurrence among HR+ women.
Methods: Using data from the Carolina Breast Cancer Study (phase III, 2008-2013), we estimated associations between race and recurrence among nonmetastatic HR+/HER2-negative tumors, overall and by PAM50 Risk of Recurrence score, PAM50 intrinsic subtype, and tumor grade using survival curves and Cox models standardized for age and stage. Relative frequency differences (RFD) were estimated using multivariable linear regression. To assess intervention opportunities, we evaluated treatment patterns by race among patients with high-risk disease.
Results: Black women had higher recurrence risk relative to White women (crude hazard ratio = 1.81, 95% confidence interval [CI] = 1.34 to 2.46), which remained elevated after standardizing for clinical covariates (hazard ratio = 1.42, 95% CI = 1.05 to 1.93). Racial disparities were most pronounced among those with high PAM50 Risk of Recurrence score (5-year standardized recurrence risk = 18.9%, 95% CI = 8.6% to 29.1% in Black women vs 12.5%, 95% CI = 2.0% to 23.0% in White women) and high grade (5-year standardized recurrence risk = 16.6%, 95% CI = 11.7% to 21.5% in Black women vs 12.0%, 95% CI = 7.3% to 16.7% in White women). However, Black women with high-grade tumors were statistically significantly less likely to initiate endocrine therapy (RFD = −8.3%, 95% CI = −15.9% to −0.6%) and experienced treatment delay more often than White women (RFD = +9.0%, 95% CI = 0.3% to 17.8%).
Conclusions: Differences in recurrence by race appear greatest among women with aggressive tumors and may be influenced by treatment differences. Efforts to identify causes of variation in cancer treatment are critical to reducing outcome disparities.

URL

https://doi.org/10.1093/jncics/pkaa072

Reference Type

Journal Article

Article Type

Regular

Year Published

2021

Journal Title

JNCI Cancer Spectrum

Author(s)

Benefield, Halei C.
Reeder-Hayes, Katherine E.
Nichols, Hazel B.
Calhoun, Benjamin C.
Love, Michael I.
Kirk, Erin L.
Geradts, Joseph
Hoadley, Katherine A.
Cole, Stephen R.
Earp, H. Shelton
Olshan, Andrew F.
Carey, Lisa A.
Perou, Charles M.
Troester, Melissa A.

PMCID

PMC7791616

Data Set/Study

Carolina Breast Cancer Study

Continent/Country

United States of America

State

Nonspecific

Race/Ethnicity

Black