title: Breast cancer presentation and therapy in migrant versus native German patients: contrasting and convergent data of a retrospective monocentric study.
abstract: The aim of this study was to identify differences between breast cancer patients with and without migrant background in Germany, especially differences concerning patient characteristics, tumor biology, diagnostics, therapy, and oncological outcome.
  
  
  
  In 99 breast cancer patients (composed of 50 native, randomly selected Germans and 49 consecutively selected immigrants of Anatolian origin) who were operated due to breast cancer at the Heidelberg University Hospital between the years 2009-2012, relevant information was retrospectively reviewed.
  
  
  
  Patients with migrant background were significantly younger at the time of receiving the diagnosis of breast cancer than native German patients with an average age difference of nine years (p < 0.001). Moreover, immigrants needed a second operation for re-excision more frequently than native Germans (45 vs. 20 %, p = 0.01). The medication used for hormone therapy was significantly different between the two cohorts (p = 0.049). Although statistically not significant, a tendency towards difference was observed in six characteristics examined: Premenopausal status, estrogen receptor-positive tumors, multifocal or bilateral tumors, BRCA-1 mutations, and an accompanying carcinoma in situ were more common in patients with migrant background. On the other hand, correspondence was found between both patient groups relating to tumor staging, grading and metastasis as well as surgical, drug, and radiologic therapies employed. Oncologic outcome data were not different either.
  
  
  
  A difference in age between breast cancer patients of diverse ethnic groups has already been described previously. The difference in the frequency of surgical re-excision might be explained by several factors like a young age at first diagnosis, premenopausal status, multifocal tumors and an accompanying carcinoma in situ which were more common in the migrant patients of this study and are known to increase the risk of re-excision. The medication used for hormonal therapy was also different between migrants and native Germans, which might be interpreted by the difference in patients' age and menopausal status. Of note, however, in the present study, the overall breast cancer outcome did not show any substantial disparity between the different ethnic patient groups investigated.
authors.affiliation: Department of Gynecology and Obstetrics, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: von Au
authors.affiliation: Department of Gynecology and Obstetrics, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Weiler
authors.affiliation: Department of Gynecology and Obstetrics, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stefanovic
authors.affiliation: Department of Gynecology and Obstetrics, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Wallwiener
authors.affiliation: Department of Gynecology and Obstetrics, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Heil
authors.affiliation: Department of Gynecology and Obstetrics, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Golatta
authors.affiliation: Department of Gynecology and Obstetrics, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Rom
authors.affiliation: Department of Gynecology and Obstetrics, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Sohn
authors.affiliation: Department of Gynecology and Obstetrics, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schneeweiss
authors.affiliation: Department of Gynecology and Obstetrics, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Schuetz
authors.affiliation: Department of Gynecology and Obstetrics, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany. christoph.domschke@med.uni-heidelberg.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Domschke
mesh_terms: D000328:Adult; D000367:Age Factors; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000208:ethnology / Q000473:pathology* / Q000628:therapy*; D002278:Carcinoma in Situ / Q000208:ethnology / Q000473:pathology* / Q000628:therapy*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D017697:Premenopause; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012189:Retrospective Studies; D014171:Transients and Migrants
chemical_list: D018931:Antineoplastic Agents, Hormonal; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
keywords: Breast cancer; Epidemiology; Incidence; Migrants; Treatment standards