title: Correlates of Triple Negative Breast Cancer and Chemotherapy Patterns in Black and White Women With Breast Cancer.
abstract: Triple negative breast cancer (TNBC) tumors are estrogen receptor-negative, progesterone receptor-negative, and human epidermal growth factor-negative. TNBC is responsive to chemotherapy, but chemotherapy might be underused in some patient subgroups. The goal of the present study was to characterize the patterns of chemotherapy use (uptake and completion) in TNBC patients.
  
  
  
  Women with primary invasive, nonmetastatic breast cancer were recruited in Washington, DC, and Detroit. Data were collected using a standardized telephone survey that captured sociocultural and health care process factors. Clinical data were abstracted from the medical records. We used χ2tests to access the association between the receipt of chemotherapy use (initiation and completion) and categorical variables, and t tests were used for continuous variables. Logistic regression models were used to evaluate the factors associated with chemotherapy uptake.
  
  
  
  Women with TNBC (16% of sample) were more likely to be black than white (68% vs. 32%; P < .05). Among women with TNBC, 60% underwent chemotherapy. Chemotherapy uptake was greater for black than for white women (48.3% vs. 11.7%; P = .01) and in women without (vs. with) healthcare discrimination (35% vs. 25%; P = .04). In multivariable models, only race was associated with the receipt of chemotherapy. Black women were more likely to receive chemotherapy than were white women. The odds ratio of receiving chemotherapy by race was 4.1 (95% confidence interval, 1.3-13.1). Each 1-year increase in age was associated with a lower likelihood of chemotherapy completion (odds ratio, 0.9; 95% confidence interval, 0.826-0.981; P = .02). Women with at least some college were less likely to complete chemotherapy than were those with other education levels (P = .02).
  
  
  
  A substantial number of TNBC patients failed to receive and/or complete chemotherapy. Differences in chemotherapy uptake by race and sociocultural factors diminished in multivariable models but age and stage remained significant. Suboptimal treatment among women with TNBC could contribute to adverse outcomes. Future investigations are necessary to assess whether the noninitiation and/or noncompletion of chemotherapy is clinically warranted.
authors.affiliation: Georgetown University Medical Center, Washington, DC. Electronic address: vls3@georgetown.edu.
authors.forename: Vanessa B
authors.initials: VB
authors.lastname: Sheppard
authors.affiliation: Georgetown University Medical Center, Washington, DC.
authors.forename: Luciane R
authors.initials: LR
authors.lastname: Cavalli
authors.affiliation: Georgetown University Medical Center, Washington, DC.
authors.forename: Chiranjeev
authors.initials: C
authors.lastname: Dash
authors.affiliation: Department of Microbiology, Howard University College of Medicine, Washington, DC.
authors.forename: Yasmine M
authors.initials: YM
authors.lastname: Kanaan
authors.affiliation: Georgetown University Medical Center, Washington, DC.
authors.forename: Asma A
authors.initials: AA
authors.lastname: Dilawari
authors.affiliation: Howard University Hospital, Washington, DC.
authors.forename: Sara
authors.initials: S
authors.lastname: Horton
authors.affiliation: Georgetown University Medical Center, Washington, DC.
authors.forename: Kepher H
authors.initials: KH
authors.lastname: Makambi
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D015996:Survival Rate; D064726:Triple Negative Breast Neoplasms / Q000188:drug therapy / Q000208:ethnology* / Q000378:metabolism / Q000473:pathology; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: Discontinuation; Disparities; Noninitiation; Race; TNBC