Underinsured African-American Women Have Worse Breast Cancer Outcomes Than Underinsured White Women

African American woman are 43% more likely to die from breast cancer than white women and have increased the risk of tumor recurrence despite lower incidence. We investigate variations in microsatellite genomic regions—a type of repetitive DNA—and possible links to the breast cancer mortality gap. We screen 33 854 microsatellites in germline DNA of African American women with and without breast cancer: 4 are statistically significant. These are located in the 3′ UTR (untranslated region) of gene ZDHHC3, an intron of transcribed pseudogene INTS4L1, an intron of ribosomal gene RNA5-8S5, and an intergenic region of chromosome 16. The marker in ZDHHC3 is interesting for 3 reasons: (a) the ZDHHC3 gene is located in region 3p21 which has already been linked to early invasive breast cancer, (b) the Kaplan-Meier estimator demonstrates that ZDHHC3 alterations are associated with poor breast cancer survival in all racial/ethnic groups combined, and (c) data from cBioPortal suggest that ZDHHC3 messenger RNA expression is significantly lower in African Americans compared with whites. These independent lines of evidence make ZDHHC3 a candidate for further investigation.

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Triple negative breast cancer in African American women: Disparity between women in New Orleans versus Louisiana.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e12501 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e12501-e12501 ◽

Cited By ~ 1

Author(s):

Michelle Marie Loch ◽

John Estrada ◽

Thomas Reske ◽

Xiangrong Li ◽

Vivien Chen ◽

...

Keyword(s):

Breast Cancer ◽

African American ◽

African American Women ◽

New Orleans ◽

White Women ◽

Triple Negative ◽

Her2 Status ◽

Tumor Characteristics ◽

Empirical Observation ◽

American Women

e12501 Background: For years clinicians have made the empirical observation that there is an unusually high number of African American women (AAW) with triple-negative (Tneg) breast cancer (BC) in New Orleans (NO). Knowing the rate of Tneg BC in AAW is higher than white women (WW), we explored the hypothesis that AAW in NO have a higher rate of Tneg BC when compared to AAW in the rest of Louisiana (LA). Methods: We analyzed data from the Louisiana Tumor Registry, one of the NCI funded SEER registries, for the tumor characteristics of invasive female BC diagnosed in 2010, focusing on racial disparities; HER2 status was not available for prior to 2010 diagnosis. We explored the association of HER2 status with age, race, ER, PR, HER2, T, N, M to determine crude and adjusted odds ratios and rate distribution of subtypes using SEER*Stat and SAS programs. Results: Overall age-adjusted incidence rate of Tneg BC in AAW was 30 per 100,000 in NO, which was 24% higher than that in AAW in the rest of LA and two-fold the rate in WW of both NO and LA. The highest rate of Tneg BC was seen in AAW aged 65-69 in NO (184.97 per 100,000) compared with 81.5 per 100,000 in AAW aged 55-59 in LA. AAW with Tneg BC in NO were more likely to have more aggressive BC. Young age, black race, large tumor size, higher grade and TNM stage were significantly associated with the high risk of Tneg BC. After adjusting for age, geographic area, and other tumor characteristics, the higher risk of Tneg BC in AAW remained in NO compared with the rest of LA (OR=1.4; 95% CI: 1.01-1.87). Conclusions: AAW in NO are more likely to have poorly differentiated and Tneg BC compared to AAW in the rest of LA. This disparity remains when comparing our data to previously published literature in other parts of the US. We plan to continue our data analysis and compare NO data to the national average as the HER2 data become available in the SEER Program to better characterize the disparity. This newly identified disparity in the AAW population in NO has clinical implications and translational research potential as it enables us to broaden the understanding and treatment of this aggressive disease.

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Benefits and Costs of Interventions to Improve Breast Cancer Outcomes in African American Women

Journal of Clinical Oncology ◽

10.1200/jco.2004.05.009 ◽

2004 ◽

Vol 22 (13) ◽

pp. 2554-2566 ◽

Cited By ~ 42

Author(s):

Jeanne S. Mandelblatt ◽

Clyde B. Schechter ◽

K. Robin Yabroff ◽

William Lawrence ◽

James Dignam ◽

...

Keyword(s):

Breast Cancer ◽

African American ◽

African American Women ◽

White Women ◽

Breast Cancer Mortality ◽

Status Quo ◽

Intensive Treatment ◽

Baseline Risk ◽

American Women ◽

Use Of Resources

Purpose Historically, African American women have experienced higher breast cancer mortality than white women, despite lower incidence. Our objective was to evaluate whether costs of increasing rates of screening or application of intensive treatment will be off-set by survival benefits for African American women. Methods We use a stochastic simulation model of the natural history of breast cancer to evaluate the incremental societal costs and benefits of status quo versus targeted biennial screening or treatment improvements among African Americans 40 years of age and older. Main outcome measures were number of mammograms, stage, all-cause mortality, and discounted costs per life year saved (LYS). Results At the current screening rate of 76%, there is little incremental benefit associated with further increasing screening, and the costs are high: $124,053 and $124,217 per LYS for lay health worker and patient reminder interventions, respectively, compared with the status quo. Using reminders would cost $51,537 per LYS if targeted to virtually unscreened women or $78,130 per LYS if targeted to women with a two-fold increase in baseline risk. If all patients received the most intensive treatment recommended, costs increase but deaths decrease, for a cost of $52,678 per LYS. Investments of up to $6,000 per breast cancer patient could be used to enhance treatment and still yield cost-effectiveness ratios of less than $75,000 per LYS. Conclusion Except in pockets of unscreened or high-risk women, further investments in interventions to increase screening are unlikely to be an efficient use of resources. Ensuring that African American women receive intensive treatment seems to be the most cost-effective approach to decreasing the disproportionate mortality experienced by this population.

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Reproductive factors and the risk of triple-negative breast cancer in white women and African-American women: a pooled analysis

Breast Cancer Research ◽

10.1186/s13058-016-0799-9 ◽

2017 ◽

Vol 19 (1) ◽

Cited By ~ 25

Author(s):

Huiyan Ma ◽

Giske Ursin ◽

Xinxin Xu ◽

Eunjung Lee ◽

Kayo Togawa ◽

...

Keyword(s):

Breast Cancer ◽

African American ◽

African American Women ◽

Triple Negative Breast Cancer ◽

White Women ◽

Triple Negative ◽

Reproductive Factors ◽

Pooled Analysis ◽

American Women

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Increased Uptake of BRCA1/2 Genetic Testing Among African American Women With a Recent Diagnosis of Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.10.6377 ◽

2008 ◽

Vol 26 (1) ◽

pp. 32-36 ◽

Cited By ~ 43

Author(s):

Lisa R. Susswein ◽

Cécile Skrzynia ◽

Leslie A. Lange ◽

Jessica K. Booker ◽

Mark L. Graham ◽

...

Keyword(s):

Breast Cancer ◽

African American ◽

Genetic Testing ◽

African American Women ◽

White Women ◽

Breast Cancer Diagnosis ◽

American Women ◽

Logistic Regression Models ◽

Testing Uptake ◽

Recent Diagnosis

Purpose Studies suggest that African American women are less likely to pursue BRCA1/2 genetic testing than white women. However, such studies are often confounded by unequal access to care. Methods Data from 132 African American and 636 white women, obtained from a clinical database at the University of North Carolina (Chapel Hill, NC) between 1998 and 2005, were analyzed to assess BRCA1/2 genetic testing uptake. Importantly, the clinical setting minimized barriers of both cost and access. Race and time of new breast cancer diagnosis (recent v > 1 year before genetic evaluation) were assessed for association with BRCA1/2 testing uptake using multivariable logistic regression models. Results Both race (P = .0082) and a recent diagnosis of breast cancer (P = .014) were independently associated with testing uptake. African American women had a lower estimated odds of pursuing testing than white women (odds ratio [OR], 0.54; 95%CI, 0.34 to 0.85), and women with a recent diagnosis had a higher OR than those with a remote diagnosis (OR, 1.58; 95% CI, 1.10 to 2.29). In a race-stratified analysis, there was no statistical evidence for association between recent status and testing uptake in the larger white stratum (OR, 1.38, P = .13) while there was for the smaller African American sample (OR, 2.77, P = .018). The test of interaction between race and remote status was not significant (P = .15). Conclusion African American race was associated with an overall decreased uptake of BRCA1/2 genetic testing, even when barriers of ascertainment and cost were minimized. However, among African American women, a recent diagnosis of breast cancer was associated with substantially increased uptake of testing.

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