title: Racial disparity in estrogen receptor positive breast cancer patients receiving trimodality therapy.
abstract: BACKGROUND
  We assessed racial differences in progression-free survival (PFS) and overall survival (OS) in relation to subtype in uniformly treated stage II-III breast cancer patients.
  
  
  METHODS
  We reviewed records of 582 patients receiving post-mastectomy radiation (PMRT) between 1/1999 and 12/2009 and evaluated the effect of demographic, tumor, and treatment characteristics on PFS and OS.
  
  
  RESULTS
  Median follow up was 44.7 months. 24% of patients were black and 76% white. All had mastectomy and PMRT; 98% had chemotherapy; Estrogen receptor (ER)+ patients received endocrine therapy. Black patients were more likely to have ER- (56% vs. 38%, p=0.0001), progesterone receptor (PR)- (69% vs. 54%, p = 0.002), and triple negative (TN) (46% vs. 24%, p < 0.0001) tumors. Overall, black patients had worse PFS (60.6% vs. 78.3%, p = 0.001) and OS (72.8% vs. 87.7%, p < 0.0001). There was no racial difference in PFS (p = 0.229 and 0.273 respectively) or OS (p = 0.113 and 0.097 respectively) among ER- or TN. Among ER+, black patients had worse PFS (55% vs. 81%, p < 0.001) and OS (73% vs. 91%, p < 0.0001). The difference in PFS was seen in the ER+/PR+/HER2- subgroup (p = 0.002) but not ER+/PR-/HER2- (p = 0.129), and in the post-menopausal ER+/HER2- subgroup (p = 0.004) but not pre/peri-menopausal ER+/HER2- (p = 0.150).
  
  
  CONCLUSIONS
  Black women had worse survival outcomes in this cohort. This disparity was driven by (1) a higher proportion of ER- and TN tumors in black women and (2) worse outcome of similarly treated black women with ER+ breast cancer. The underlying causes of racial disparity within hormone receptor categories must be further examined.
authors.affiliation: Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA. jwright3@med.miami.edu
authors.forename: J L
authors.initials: JL
authors.lastname: Wright
authors.forename: I M
authors.initials: IM
authors.lastname: Reis
authors.forename: W
authors.initials: W
authors.lastname: Zhao
authors.forename: J E
authors.initials: JE
authors.lastname: Panoff
authors.forename: C
authors.initials: C
authors.lastname: Takita
authors.forename: V
authors.initials: V
authors.lastname: Sujoy
authors.forename: C R
authors.initials: CR
authors.lastname: Gomez
authors.forename: M
authors.initials: M
authors.lastname: Jorda
authors.forename: D
authors.initials: D
authors.lastname: Franceschi
authors.forename: J
authors.initials: J
authors.lastname: Hurley
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000208:ethnology* / Q000378:metabolism / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009376:Neoplasms, Hormone-Dependent / Q000209:etiology* / Q000378:metabolism / Q000628:therapy*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone