title: Distinctions in Breast Tumor Recurrence Patterns Post-Therapy among Racially Distinct Populations.
abstract: BACKGROUND
  Clinical studies have revealed a higher risk of breast tumor recurrence in African-American (AA) patients compared to European-American (EA) patients, contributing to the alarming inequality in clinical outcomes among the ethnic groups. However, distinctions in recurrence patterns upon receiving hormone, radiation, and/or chemotherapy between the races remain poorly characterized.
  
  
  METHODS
  We compared patterns and rates (per 1000 cancer patients per 1 year) of recurrence following each form of treatment between AA (n = 1850) and EA breast cancer patients (n = 7931) from a cohort of patients (n = 10504) treated between 2005-2015 at Northside Hospital in Atlanta, GA.
  
  
  RESULTS
  Among patients who received any combination of adjuvant therapy, AA displayed higher overall rates of recurrence than EA (p = 0.015; HR: 1.699; CI: 1.108-2.606). Furthermore, recurrence rates were higher in AA than EA among stage I (p = 0.031; HR: 1.736; CI: 1.052-2.864) and T1 classified patients (p = 0.003; HR: 2.009; CI: 1.263-3.197). Interestingly, among patients who received neoadjuvant chemotherapy, AA displayed higher rates of local recurrence than EA (p = 0.024; HR: 7.134; CI: 1.295-39.313).
  
  
  CONCLUSIONS
  Our analysis revealed higher incidence rates of recurrence in AA compared to EA among patients that received any combination of adjuvant therapy. Moreover, our data demonstrates an increased risk of tumor recurrence in AA than EA among patients diagnosed with minimally invasive disease. This is the first clinical study to suggest that neoadjuvant chemotherapy improves breast cancer recurrence rates and patterns in AA.
authors.affiliation: Department of Biology, Georgia State University, Atlanta, Georgia, United States of America.
authors.forename: Nikita
authors.initials: N
authors.lastname: Wright
authors.affiliation: Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia, United States of America.
authors.forename: Jun
authors.initials: J
authors.lastname: Xia
authors.affiliation: Department of Gynecologic Oncology, Northside Hospital Cancer Institute, Atlanta, Georgia, United States of America.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Cantuaria
authors.affiliation: Department of Biology, Georgia State University, Atlanta, Georgia, United States of America.
authors.forename: Sergey
authors.initials: S
authors.lastname: Klimov
authors.affiliation: Department of Pathology Oncology Analytics, Northside Hospital Cancer Institute, Atlanta, GA, United States of America.
authors.forename: Mildred
authors.initials: M
authors.lastname: Jones
authors.affiliation: Department of Biology, Georgia State University, Atlanta, Georgia, United States of America.
authors.forename: Pranay
authors.initials: P
authors.lastname: Neema
authors.affiliation: School of Public Health, Georgia State University, Atlanta, Georgia, United States of America.
authors.forename: Dora
authors.initials: D
authors.lastname: Il'yasova
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Uma
authors.initials: U
authors.lastname: Krishnamurti
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Xiaoxian
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Reid
authors.affiliation: Clinical Pathology and Anatomic Pathology, West Georgia Hospitals, LaGrange, Georgia, United States of America.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Biology, Georgia State University, Atlanta, Georgia, United States of America.
authors.forename: Padmashree C G
authors.initials: PC
authors.lastname: Rida
authors.affiliation: Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia, United States of America.
authors.forename: Remus
authors.initials: R
authors.lastname: Osan
authors.affiliation: Department of Biology, Georgia State University, Atlanta, Georgia, United States of America.
authors.forename: Ritu
authors.initials: R
authors.lastname: Aneja
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000208:ethnology* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data*