title: Association Between Benign Breast Disease in African American and White American Women and Subsequent Triple-Negative Breast Cancer.
abstract: OBJECTIVE
  Compared with white American (WA) women, African American (AA) women have a 2-fold higher incidence of breast cancers that are negative for estrogen receptor, progesterone receptor, and ERBB2 (triple-negative breast cancer [TNBC]). Triple-negative breast cancer, compared with non-TNBC, likely arises from different pathogenetic pathways, and benign breast disease (BBD) predicts future non-TNBC.
  
  
  OBJECTIVE
  To determine whether AA identity remains associated with TNBC for women with a prior diagnosis of BBD.
  
  
  METHODS
  This study is a retrospective analysis of data of a cohort of 2588 AA and 3566 WA women aged between 40 and 70 years with a biopsy-proven BBD diagnosis. The data-obtained from the Pathology Information System of Henry Ford Health System (HFHS), an integrated multihospital and multispecialty health care system headquartered in Detroit, Michigan-include specimens of biopsies performed between January 1, 1994, and December 31, 2005. Data analysis was performed from November 1, 2015, to June 15, 2016.
  
  
  METHODS
  Subsequent breast cancer was stratified on the basis of combinations of hormone receptor and ERBB2 expression.
  
  
  RESULTS
  Case management, follow-up, and outcomes received or obtained by our cohort of 2588 AA and 3566 WA patients were similar, demonstrating that HFHS delivered care equitably. Subsequent breast cancers developed in 103 (4.1%) of AA patients (mean follow-up interval of 6.8 years) and 143 (4.0%) of WA patients (mean follow-up interval of 6.1 years). More than three-quarters of subsequent breast cancers in each subset were ductal carcinoma in situ or stage I. The 10-year probability estimate for developing TNBC was 0.56% (95% CI, 0.32%-1.0%) for AA patients and 0.25% (95% CI, 0.12%-0.53%) for WA patients. Among the 66 AA patients who developed subsequent invasive breast cancer, 16 (24.2%) developed TNBC compared with 7 (7.4%) of the 94 WA patients who developed subsequent invasive breast cancers and had complete biomarker data (P = .01).
  
  
  CONCLUSIONS
  This study is the largest analysis to date of TNBC in the context of racial/ethnic identity and BBD as risk factors. The study found that AA identity persisted as a significant risk factor for TNBC. This finding suggests that AA identity is associated with inherent susceptibility for TNBC pathogenetic pathways.
authors.affiliation: Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Newman
authors.affiliation: Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan.|Breast Oncology Program, Department of Pathology, Henry Ford Health System, Detroit, Michigan.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Stark
authors.affiliation: Breast Oncology Program, Department of Pathology, Henry Ford Health System, Detroit, Michigan.
authors.forename: Dhanajay
authors.initials: D
authors.lastname: Chitale
authors.affiliation: Department of Biostatistics and Biomathematics, Fred Hutchinson Comprehensive Cancer Center, Seattle, Washington.
authors.forename: Margaret
authors.initials: M
authors.lastname: Pepe
authors.affiliation: Department of Biostatistics and Biomathematics, Fred Hutchinson Comprehensive Cancer Center, Seattle, Washington.
authors.forename: Gary
authors.initials: G
authors.lastname: Longton
authors.affiliation: Breast Oncology Program, Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Worsham
authors.affiliation: Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan.
authors.forename: S David
authors.initials: SD
authors.lastname: Nathanson
authors.affiliation: Breast Oncology Program, Department of Radiology, Henry Ford Health System, Detroit, Michigan.
authors.forename: Patricia
authors.initials: P
authors.lastname: Miller
authors.affiliation: Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Bensenhaver
authors.affiliation: Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan.
authors.forename: Erica
authors.initials: E
authors.lastname: Proctor
authors.affiliation: Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan.
authors.forename: Monique
authors.initials: M
authors.lastname: Swain
authors.affiliation: Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland.
authors.forename: Christos
authors.initials: C
authors.lastname: Patriotis
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Engstrom
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001706:Biopsy; D001941:Breast Diseases / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data