title: Primary tumor size, not race, determines outcomes in women with hormone-responsive breast cancer.
abstract: BACKGROUND
  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).
  
  
  CONCLUSIONS
  African Americans present with larger tumors than Caucasians; treatment is similar. Tumor size, not race, affects disease-specific outcomes in patients with breast cancer.
authors: Department of Surgery, Yale University, New Haven, CT 06510, USA. anees.chagpar@yale.edu
authors: Anees B
authors: AB
authors: Chagpar
authors: Clifford R
authors: CR
authors: Crutcher
authors: Laura B
authors: LB
authors: Cornwell
authors: Kelly M
authors: KM
authors: McMasters
mesh_terms: D001741:Black or African American; D001943:Breast Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007629:Kentucky / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009376:Neoplasms, Hormone-Dependent / Q000378:metabolism / Q000401:mortality* / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012042:Registries; D044465:White People
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone