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Newman LA , Stark A , Chitale D , Pepe M , Longton G , Worsham MJ , Nathanson SD , Miller P , Bensenhaver JM , Proctor E , Swain M , Patriotis C , Engstrom PF
Association Between Benign Breast Disease in African American and White American Women and Subsequent Triple-Negative Breast Cancer
JAMA Oncol. 2017 Aug 01;3(8) :1102-1106
PMID: 28006062    PMCID: PMC5796807    URL: https://www.ncbi.nlm.nih.gov/pubmed/28006062
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Importance: Compared with white American (WA) women, African American (AA) women have a 2-fold higher incidence of breast cancers that are negative for estrogen receptor, progesterone receptor, and ERBB2 (triple-negative breast cancer [TNBC]). Triple-negative breast cancer, compared with non-TNBC, likely arises from different pathogenetic pathways, and benign breast disease (BBD) predicts future non-TNBC. Objective: To determine whether AA identity remains associated with TNBC for women with a prior diagnosis of BBD. Design, Setting, and Participants: This study is a retrospective analysis of data of a cohort of 2588 AA and 3566 WA women aged between 40 and 70 years with a biopsy-proven BBD diagnosis. The data-obtained from the Pathology Information System of Henry Ford Health System (HFHS), an integrated multihospital and multispecialty health care system headquartered in Detroit, Michigan-include specimens of biopsies performed between January 1, 1994, and December 31, 2005. Data analysis was performed from November 1, 2015, to June 15, 2016. Main Outcomes and Measures: Subsequent breast cancer was stratified on the basis of combinations of hormone receptor and ERBB2 expression. Results: Case management, follow-up, and outcomes received or obtained by our cohort of 2588 AA and 3566 WA patients were similar, demonstrating that HFHS delivered care equitably. Subsequent breast cancers developed in 103 (4.1%) of AA patients (mean follow-up interval of 6.8 years) and 143 (4.0%) of WA patients (mean follow-up interval of 6.1 years). More than three-quarters of subsequent breast cancers in each subset were ductal carcinoma in situ or stage I. The 10-year probability estimate for developing TNBC was 0.56% (95% CI, 0.32%-1.0%) for AA patients and 0.25% (95% CI, 0.12%-0.53%) for WA patients. Among the 66 AA patients who developed subsequent invasive breast cancer, 16 (24.2%) developed TNBC compared with 7 (7.4%) of the 94 WA patients who developed subsequent invasive breast cancers and had complete biomarker data (P = .01). Conclusions and Relevance: This study is the largest analysis to date of TNBC in the context of racial/ethnic identity and BBD as risk factors. The study found that AA identity persisted as a significant risk factor for TNBC. This finding suggests that AA identity is associated with inherent susceptibility for TNBC pathogenetic pathways.
Newman, Lisa A Stark, Azadeh Chitale, Dhanajay Pepe, Margaret Longton, Gary Worsham, Maria J Nathanson, S David Miller, Patricia Bensenhaver, Jessica M Proctor, Erica Swain, Monique Patriotis, Christos Engstrom, Paul F eng JAMA Oncol. 2017 Aug 1;3(8):1102-1106. doi: 10.1001/jamaoncol.2016.5598.