title: Disparities in the risk of the ER/PR/HER2 breast cancer subtypes among Asian Americans in California.
abstract: BACKGROUND
  Population-based studies of breast cancer often aggregate all Asians into a single category termed Asian/Pacific Islander (API).
  
  
  OBJECTIVE
  (1) Describe the demographic and clinicopathologic features of early breast cancer utilizing all eight ER/PR/HER2 subtypes among white, black, Hispanic, American Indian, seven Asian ethnicities, and the aggregate API category; (2) ascertain the risk of the ER+/PR+/HER2+, ER-/PR-/HER2-, and ER-/PR-/HER2+ subtypes when compared with the ER+/PR+/HER2- subtype, among seven Asian ethnicities versus non-Hispanic white women and (3) contrast the results with the risk of these same subtypes when using the aggregate API category.
  
  
  METHODS
  Using the California Cancer Registry, we identified 225,441 cases of stages 1-4 first primary female invasive breast cancer. Logistic regression was used to assess the association of race with the ER+/PR+/HER2+, ER-/PR-/HER2- (triple-negative), and the ER-/PR-/HER2+ subtypes versus the ER+/PR+/HER2- when adjusted for stage, age, tumor grade, and socioeconomic status. Models were fit separately for each subtype. Odds ratios for the seven Asian ethnicities and the aggregate API category using non-Hispanic white women as the reference category were computed.
  
  
  RESULTS
  There was an increased risk of the ER+/PR+/HER2+ subtype for the combined API category (OR=1.16; 95% CI=1.09-1.23). But only Southeast Asians (OR=1.17; 95% CI=1.04-1.31), Filipino (OR=1.23; 95% CI=1.12-1.36), and Korean (OR=1.63; 95% CI=1.38-1.99) women had an increased risk of this subtype. The reduced risk of the triple-negative subtype seen in APIs (OR=0.84; 95% CI=0.79-0.90) was only noted in Chinese (OR=0.80; 95% CI=0.70-0.91) and Filipino (OR=0.65; 95% CI=0.58-0.73) women whereas Indian Continent (OR=1.25; 95% CI=1.01-1.53) women had an increased risk of the triple-negative subtype. The race×stage interaction was statistically significant for the ER-/PR-/HER2+ subtype (p<0.05). When stratified by stage, there was no statistically significant association of race with subtype in stages 3 and 4. APIs had an increased risk of the ER-/PR-/HER2+ subtype in stage 1 (OR=1.59; 95% CI=1.37-1.75) and stage 2 (OR=1.42; 95% CI=1.28-1.58) but this risk was not seen in Pacific Islander, Indian Continent, and Japanese women for either stage.
  
  
  CONCLUSIONS
  Among the Asian ethnicities, there is marked variability in the demographic and clinicopathologic features of breast cancer. Use of the ER/PR/HER2 subtypes reveals that the risk of the ER-/PR-/HER2-, ER+/PR+/HER2+, and ER-/PR-/HER2+ subtypes varies among the Asian population. The API category, is sometimes, but not always reflective of all Asian women.
authors.affiliation: Sutter Institute for Medical Research, 2801 Capitol Ave Suite 400, Sacramento, CA 95816, United States. Electronic address: parisec@sutterhealth.org.
authors.forename: Carol
authors.initials: C
authors.lastname: Parise
authors.affiliation: Sutter Institute for Medical Research, 2801 Capitol Ave Suite 400, Sacramento, CA 95816, United States.
authors.forename: Vincent
authors.initials: V
authors.lastname: Caggiano
mesh_terms: D000328:Adult; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000473:pathology; D002140:California / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data*; D009367:Neoplasm Staging; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012042:Registries; D064726:Triple Negative Breast Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000473:pathology
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
keywords: Asian Americans; Breast cancer subtypes; Disparities; HER2-positive; Triple-negative