Main Article Content
Hispanic ethnicity, Breast cancer, Disparities , State versus SEER
Background: While stage and grade of breast cancer determines prognosis and outcome, race also impacts survival. While Black and White women have been studied, data for Hispanic women is sparse.
Methods: Age-matched Hispanic, Black and White women diagnosed/treated with breast cancer at a single institution were retrospectively evaluated regarding prevalence, treatments and outcomes.
Results: Overall, 120 women were included in the study (40 per race). No demographic/histologic variables were significantly different among races. ER+/PR+ tumors were less frequent in Hispanics than Whites, but higher than Blacks. Prevalence of triple negative breast cancers in Hispanic women was between the Black and White cohorts (p=0.025 and p=0.011, respectively). Stage II and III diagnoses (p=0.025) were more frequent in Hispanics and they opted for chemotherapy more often (p=0.034); however, there were no significant differences in outcomes and mortality among groups. When compared to the State tumor registry, our population had more LCIS diagnoses (p=0.01), earlier stages (I p=0.02; II p=0.006), received more treatment overall (radiation p=0.02, chemotherapy p=0.0001) and experienced better survival (p=0.004). In comparing the study population to the SEER database, higher rates of LCIS and IDC and lower rates of ILC and mixed histology in the study population were noted. LCIS and IDC were more prevalent in our cohort than SEER data (p=0.005, p=0.05, respectively), although we noted less ILC and mixed histology (p=0.03 and p=0.04).
Conclusion: These data are the first reported for Hispanics in our state and highlight the need for larger studies to better serve this growing demographic.
2. Cronin KA LA, Scott S, Sherman RL, Noone AM, Howlader N, et al. Annual Report to the Nation on the Status of Cancer, part I: National cancer statistics. Cancer. 2018;124:2785-800.
3. Yang XR SM, Rimm DL, Lissowska J, Brinton LA, Peplonska B, et al. Differences in risk factors for breast cancer molecular subtypes in a population-based study. Cancer Epidemiol Biomarkers Prev. 2007;16:439-43.
4. Ma H BL, Pike MC, Ursin G. Reproductive factors and breast cancer risk according to joint estrogen and progesterone receptor status: a meta-analysis of epidemiological studies. Breast Cancer Res. 2006;8:R43.
5. Shoemaker ML WM, Wu M, Weir HK, Romieu I. Differences in breast cancer incidence among young women aged 20-49 years by stage and tumor characteristics, age, race, and ethnicity, 2004-2013. Breast Cancer Res Treat. 2018;169: 595-606.
6. Iqbal J GO, Rochon PA, Sun P, Narod SA.Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. JAMA. 2015; 313:165-73.
7. Power EJ CM, Haq MM. Breast Cancer Incidence and Risk Reduction in the Hispanic Population. Cureus. 2018;10:e2235.
8. Rauscher GH CR, Wiley EL, Hoskins K, Stolley MR, Warnecke RB. Mediation of Racial and Ethnic Disparities in Estrogen/Progesterone Receptor-Negative Breast Cancer by Socioeconomic Position and Reproductive Factors. Am J Epidemiol. 2016;183:884-93.
9. Chlebowski RT CZ, Anderson GL, Rohan T, Aragaki A, Lane D, et al. Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst. 2005;97:439-48.
10. Krieger N CJ, Waterman PD. Decline in US breast cancer rates after the Women's Health Initiative: socioeconomic and racial/ethnic differentials. Am J Public Health. 2010;100: 5132-9.
11.Society AC. ancer Facts & Figures for Hispanics/Latinos: 2018-2020. Atlanta, GA: American Cancer Society, 2018 2018 [Available from: https://www.cancer.org/ content/dam/ cancer-org/research/cancer-facts-and-statistics/ cancer-facts-and-figures-for-hispanics-and-latinos/cancer-facts-and-figures-for-hispanics-and-latinos-2018-2020.pdf.
12. Society AC. Cancer Facts & Figures for African Americans: 2016-2018. Atlanta, GA: American Cancer Society, 2016 2016 [Available from: https://www.cancer.org/research/cancer-facts-statistics/cancer-facts-figures-for-african-americans.html.
13. Warner ET TR, Boggs DA, Rosner B, Rosenberg L, Colditz GA, Palmer JR. Estrogen receptor positive tumors: do reproductive factors explain differences in incidence between black and white women? Cancer Causes Control. 2013;24:731-9.
14. Haiman CA PM, Bernstein L, Jaque SV, Stanczyk FZ, Afghani A, Peters RK, et al. Ethnic differences in ovulatory function in nulliparous women. Br J Cancer. 2002;86:367-71.
15. Hoppe EJ HL, Grannan KJ, Dunki-Jacobs EM, Lee DY, Wexelman BA. Racial disparities in breast cancer persist despite early detection: analysis of treatment of stage 1 breast cancer and effect of insurance status on disparities. Breast Cancer Res. 2019;173:597-602.
16. Williams DR MS, Shields AE. Understanding and effectively addressing breast cancer in African American women: Unpacking the social context. Cancer. 2016;122:2138-49.
17. Yedjou CG SJ, Miele L, Noubissi F, Lowe, Fonseca DD, Alo RA, et al. . Health and Racial Disparity in Breast Cancer. : Springer; 2019.
18.Vona-Davis L RD. The Influence of Socioeconomic Disparities on Breast Cancer Tumor Biology and Prognosis: A Review. J Women’s Health. 2009;18:883-93.
19. Plasilova ML HB, Killelea BK, Horowitz NR, Chagpar AB, Lannin DR. Features of triple-negative breast cancer: Analysis of 38,813 cases from the national cancer database. Medicine (Baltimore). 2016;95:e4614.
20. Newman LA R-FJ, Morrow M, Carey LA, King TA. The 2014 Society of Surgical Oncology Susan G. Komen for the Cure Symposium: triple-negative breast cancer. . Ann Surg Oncol. 2015;22:874-82.
21. Lin NU VA, Hughes ME, Theriault RL, Edge SB, Wong YN, Blayney DW et al. Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network. Cancer. 2012;118:5463-72.
22. Chen L LC, Tang MT, Porter P, Hill DA, Wiggins CL, Cook LS. Reproductive Factors and Risk of Luminal, HER2-Overexpressing, and Triple-Negative Breast Cancer Among Multiethnic Women. Cancer Epidemiol Biomarkers Prev. 2016;25:1297-304.
23. Hines LM SR, Byers T, John EM, Fejerman L, Stern MC, Baumgartner KB, et al. The Interaction between Genetic Ancestry and Breast Cancer Risk Factors among Hispanic Women: The Breast Cancer Health Disparities Study. Cancer Epidemiol Biomarkers Prev. 2017;26:692-701.
24. Ambrosone CB ZG, Ruszczyk M, Shankar J, Hong CC, Mcllwain D, Roberts M, et al. Parity and breastfeeding among African-American women: differential effects on breast cancer risk by estrogen receptor status in the Women’s Circle of Health Study. . Cancer Causes Control. 2014;25:259-65.
25. Castaneda CA. CM, Villarreal-Garza C, Rabanal C, Dunstan J, Caleron G, De La Cruz M et al. Genetics, tumor features and treatment response of breast cancer in Latinas. Breast Cancer Management. Breast Cancer Management. 2018;7:BMT01.
26. Brown A LM. Mapping the Latino population, by state, county and city Pew Hispanic Center, 20142014 [Available from: https://www. pewresearch.org/hispanic/states.
27. Noe-Bustamante L LM, Krogstad JM. . U.S. Hispanic population reached new high in 2018, but growth has slowed Pew Hispanic Center2018 [Available from: ttps://www.pewresearch.org/ fact-tank/2019/07/08/u-s-hispanic-population-reached-new-high-in-2018-but-growth-has-slowed.
28. Wolff AC HM, Hicks DG, Dowsett M, McShane LM, Allison KH, Allred DC, et al. . American Society of Clinical Oncology; College of American Pathologists. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. . J Clin Oncol. 2013;31:3997-4013.
29. [Available from: https://factfinder.census.gov/ faces/nav/jsf/pages/community_facts.xhtml.
30. J M. Diversity of Breast Carcinoma: Histological Subtypes and Clinical Relevance Clin Med Insights Pathol 2015;8:23-31.
31. Howell A AA, Clarke RB, Duffy SW, Evans DG, Garcia-Closas M, Gescher AJ, et al. Risk determination and prevention of breast cancer. Breast Cancer Res. 2014;16:446.
32. Chen L LC. Racial disparities in breast cancer diagnosis and treatment by hormone receptor and HER2 status. Cancer Epidemiol Biomarkers Prev. 2015;24:1666-72.
33. Amirikia KC MP, Bush J, Newman LA. Higher population-based incidence rates of triple-negative breast cancer among young African-American women: Implications for breast cancer screening recommendations. Cancer. 2011;117:2747-53.
34. Wheeler SB R-HK, Carey LA. Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research. Oncologist. 2013;18: 986-93.
35. Martínez ME GS, Tao L, Cress R, Rodriguez D, Unkart J, Schwab R, et al. Contribution of clinical and socioeconomic factors to differences in breast cancer subtype and mortality between Hispanic and non-Hispanic white women. Breast Cancer Res Treat. 2017;166:185-93.
36. Franzoi MA SG, de Azevedo SJ, Geib G, Zaffaroni F, Liedke PER. Differences in Breast Cancer Stage at Diagnosis by Ethnicity, Insurance Status, and Family Income in Young Women in the USA. J Racial Ethn Health Disparities. 2019;6:909-16.
37. Miller KD GSA, Ortiz AP, Fedewa SA, Pinheiro PS, Tortolero-Luna G, Martinez-Tyson D, et al. Cancer Statistics for Hispanics/Latinos, 2018. CA Cancer J Clin. 2018;68:425-45.
38. Stuver SO ZJ, Simchowitz B, Hassett MJ, Shulman LN, Weingart SN. Identifying women at risk of delayed breast cancer diagnosis. J Comm J Qual Patient Saf. 2011;37:568-75.
39. Miranda PY TW, González P, Johnson-Jennings M, González HM. Breast cancer screening trends in the United States and ethnicity. Cancer Epidemiol Biomarkers Prev. 2012;21:351-7.
40. [Available from: https://www.nccn.org/patients/ guidelines/content/PDF/stage_0_breast-patient.pdf.
41. Tian N GP, Zhan FB, Chow TE, Wilson JG. Identifying risk factors for disparities in breast cancer mortality among African-American and Hispanic women. Womens Health Issues. 2012;22:e267-e76.
42. Vargas Bustamante A FH, Garza J, Carter-Pokras O, Wallace SP, Rizzo JA, Ortega AN. Variations in healthcare access and utilization among Mexican immigrants: the role of documentation status. J Immigr Minor Health. 2012;14:146-55.
43. Freedman RA VK, He Y, Pavluck AL, Winer EP, Ward EM, Keating NL. The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care. Cancer. 2011;117: 180-9.
44. Walker GV GS, Guadagnolo BA, Hoffman KE, Smith BD, Koshy M, Allen P, et al. Disparities in stage at diagnosis, treatment, and survival in nonelderly adult patients with cancer according to insurance status. J Clin Oncol. 2014;32:3118-25.