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Race, response to chemotherapy, and outcome within clinical breast cancer subtypes

  • Epidemiology
  • Published:
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Abstract

The effect of race on breast cancer outcome is confounded by tumor and treatment heterogeneity. We examined a cohort of women with stage II–III breast cancer treated uniformly with neoadjuvant chemotherapy to identify factors associated with racial differences in chemotherapeutic response and long-term survival. Using a prospective database, we identified women with stage II-III breast cancer treated with neoadjuvant chemotherapy from 1998 to 2011. Race was categorized as African-American (AA) or non-AA. Preplanned subtype analyses were stratified by hormone receptor (HR) and HER2. Pathologic response to chemotherapy (pCR), time to recurrence (TTR), and overall survival (OS) were assessed using logistic regression, Kaplan–Meier method, and Cox proportional hazards regression analyses. Of 349 women identified, 102 (29 %) were AA, who were younger (p = 0.03), more obese (p < 0.001), and less likely to have HR+/HER2− tumors (p = 0.01). No significant differences in pCR rate by race were found. At median follow-up of 6.5 years, AA had worse TTR (hazard ratio 1.51, 95 % CI 1.02–2.24), which was attenuated in multivariable modeling, and there was no significant difference in OS. When stratified by HR, worse outcomes were limited to HR+AA (TTR hazard ratio 1.85, 95 % CI 1.09–3.14; OS hazard ratio 2.42 95 % CI 1.37–4.28), which remained significant in multivariable analysis including pCR rate and BMI. With long-term follow-up, racial disparity in outcome was limited to HR+ breast cancer, with no apparent contribution of chemotherapy sensitivity. This suggests that disparity root causes may be driven by HR+ factors such as unmeasured molecular differences, endocrine therapy sensitivity, or adherence.

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Acknowledgments

This work was supported by Breast Cancer Research Foundation (13295 to LAC); National Research Service Award T32, Academic Training in Oncology at the University of North Carolina at Chapel Hill (5T32CA128590-05 to JRT).

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Hematology/Oncology, University of North Carolina, 170 Manning Drive, Campus Box 7305; 3119 Physician’s Office Building, Chapel Hill, NC, 27599, USA

    J. R. Tichy, C. K. Anders, K. Reeder-Hayes & L. A. Carey

  2. University of North Carolina-Lineberger Comprehensive Cancer Center, 450 West Drive, Campus Box 7295, Chapel Hill, NC, 27599, USA

    J. R. Tichy, A. M. Deal, C. K. Anders, K. Reeder-Hayes & L. A. Carey

  3. Biostatistics Core Facility, University of North Carolina, 450 West Drive, Campus Box 7295, Chapel Hill, NC, 27599, USA

    A. M. Deal

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  1. J. R. Tichy
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Correspondence to L. A. Carey.

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Tichy, J.R., Deal, A.M., Anders, C.K. et al. Race, response to chemotherapy, and outcome within clinical breast cancer subtypes. Breast Cancer Res Treat 150, 667–674 (2015). https://doi.org/10.1007/s10549-015-3350-2

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  • DOI: https://doi.org/10.1007/s10549-015-3350-2

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