title: HER2 status and disparities in luminal breast cancers.
abstract: National Comprehensive Care Network guidelines for adjuvant treatment of invasive breast cancer are based on HER2 and hormone receptor (HR) status, where HR+ disease encompasses all estrogen receptor (ER)+ and/or progesterone receptor (PR)+ tumors. We sought to explore clinical and demographic differences among patients with HR+ breast cancer subtypes, and the role of HER2 status, age, race/ethnicity, and socioeconomic status (SES) in disease risk. We evaluated breast cancer subtype distribution, defined by HR and HER2 status, using patient clinical, demographic, and socioeconomic characteristics. Differences in HR categories by demographic and tumor characteristics were examined using chi-squared tests. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) to quantify associations between breast cancer HR status and demographic factors. We found that differences in HR+ (ER-/PR+ vs. ER+/PR- or ER+/PR+) tumor biology are likely clinically significant and may play a role in breast cancer, regardless of HER2 status. While clinical and patient characteristics differed within each luminal subtype, we found disparities in SES only among Luminal A (HR+/HER2-) tumors. Among HR+/HER2- cases, we observed that ER-/PR+ patients tend to live in areas of higher poverty (OR = 1.20, 95% CI = 1.03-1.40) and are 70% more likely to be aged 50 years or older. However, this pattern was not found in women with Luminal B (HR+/HER2+) disease (Poverty OR = 0.98, 95% CI = 0.76-1.27; Age OR = 1.01, 95% CI = 0.81-1.26). Racial/ethnic disparities among non-Hispanic black and Hispanic women persisted across HR+/HER2- cases compared to non-Hispanic white women. Our findings suggest that while race/ethnicity and SES are correlated, each plays an independent role in contributing to disease among Luminal A tumors. Further study is needed to investigate how tumor biology, race/ethnicity, and socioeconomic disparities among HR+/HER2- cases may contribute to poorer patient prognosis.
authors.affiliation: Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.|Population Studies and Disparities Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan.
authors.forename: Andreana N
authors.identifier: 0000-0001-8001-8793
authors.initials: AN
authors.lastname: Holowatyj
authors.affiliation: Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Ruterbusch
authors.affiliation: Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.|Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan.
authors.forename: Manohar
authors.initials: M
authors.lastname: Ratnam
authors.affiliation: Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.|Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan.|Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: David H
authors.initials: DH
authors.lastname: Gorski
authors.affiliation: Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.|Population Studies and Disparities Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Cote
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000378:metabolism* / Q000473:pathology; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D018426:SEER Program; D012959:Socioeconomic Factors; D047368:Tumor Burden; D014481:United States / Q000453:epidemiology / Q000208:ethnology
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases
keywords: Breast cancer; HER2; SEER; disparities; hormone receptor; luminal