Patient Involvement in Surgery Treatment Decisions for Breast Cancer

Purpose High rates of mastectomy and marked regional variations have motivated lingering concerns about overtreatment and failure to involve women in treatment decisions. We examined the relationship between patient involvement in decision making and type of surgical treatment for women with breast cancer. Methods All women with ductal carcinoma-in-situ and a 20% random sample of women with invasive breast cancer aged 79 years and younger who were diagnosed in 2002 and reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries were identified and surveyed shortly after receipt of surgical treatment (response rate, 77.4%; n = 1,844). Results Mean age was 60.1 years; 70.2% of the women were white, 18.0% were African American, and 11.8% were from other ethnic groups. Overall, 30.2% of women received mastectomy as initial treatment. Most women reported that they made the surgical decision (41.0%) or that the decision was shared (37.1%); 21.9% of patients reported that their surgeon made the decision with or without their input. Among white women, only 5.3% of patients whose surgeon made the decision received mastectomy compared with 16.8% of women who shared the decision and 27.0% of women who made the decision (P < .001, adjusted for clinical factors, predisposing factors, and number of surgeons visited). However, this association was not observed for African American women (Wald test 10.0, P = .041). Conclusion Most women reported that they made or shared the decision about surgical treatment. More patient involvement in decision making was associated with greater use of mastectomy. Racial differences in the association of involvement with receipt of treatment suggest that the decision-making process varies by racial groups.

Download Full-text

Race-Specific Association of Caesarean-Section Delivery with Body Size at Age 2 Years

Ethnicity & Disease ◽

10.18865/ed.26.1.61 ◽

2016 ◽

Vol 26 (1) ◽

pp. 61 ◽

Cited By ~ 1

Author(s):

Andrea E Cassidy-Bushrow ◽

Ganesa Wegienka ◽

Suzanne Havstad ◽

Albert M. Levin ◽

Susan V. Lynch ◽

...

Keyword(s):

African American ◽

Caesarean Section ◽

African American Women ◽

Birth Cohort ◽

Racial Differences ◽

White Women ◽

Specific Effect ◽

Delivery Mode ◽

Font Size ◽

African American Mothers

Objectives: African American children are at higher risk of obesity than White children and African American women are more likely to undergo caesarean-section (CS) delivery than White women. CS is associated with childhood obesity, however, little is known whether this relationship varies by race.We examined if the association of CS with obesity at age 2 years varied by race. Design: Longitudinal birth cohort.Setting: Birth cohort conducted in a health care system in metropolitan Detroit, Michigan with follow-up at age 2 years.Participants: 639 birth cohort participants; 367 children (57.4%) were born to African American mothers and 230 (36.0%) children were born via CS.Main Outcome Measure: Obesity defined as body mass index ≥95th percentile at age 2 years.Results: Slightly more children of African American (n=37; 10.1%) than non-African American mothers (n=18; 6.6%) were obese (P=.12). There was evidence of effect modification between race and delivery mode with obesity at age 2 years (interaction P=.020). In children of African-American mothers, CS compared to vaginal birth was associated with a significantly higher odds of obesity (aOR=2.35 (95% CI: 1.16, 4.77), P=.017). In contrast, delivery mode was not associated with obesity at age 2 years in children of non-African-American mothers (aOR=.47 (95% CI: .13, 1.71), P=.25). Conclusions: There is evidence for a race-specific effect of CS on obesity at age 2 years; potential underlying mechanisms may be racial differences in the developing gut microbiome or in epigenetic programming. Future research is needed to determine if this racial difference persists into later childhood. Ethn Dis. 2016;26(1):61-68; doi:10.18865/ed.26.1.61

Download Full-text

Inflammatory Cytokine Levels and Breast Cancer Risk Factors: Racial Differences of Healthy Caucasian and African American Women

Oncology Nursing Forum ◽

10.1188/13.onf.40-05ap ◽

2013 ◽

Vol 40 (5) ◽

pp. 490-500 ◽

Cited By ~ 20

Author(s):

Na-Jin Park ◽

Duck-Hee Kang

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

African American ◽

Breast Cancer Risk ◽

African American Women ◽

Racial Differences ◽

Inflammatory Cytokine ◽

Cancer Risk Factors ◽

Cytokine Levels ◽

Breast Cancer Risk Factors

Download Full-text

Body mass index at age 18 years and recent body mass index in relation to risk of breast cancer overall and ER/PR/HER2-defined subtypes in white women and African-American women: a pooled analysis

Breast Cancer Research ◽

10.1186/s13058-017-0931-5 ◽

2018 ◽

Vol 20 (1) ◽

Cited By ~ 11

Author(s):

Huiyan Ma ◽

Giske Ursin ◽

Xinxin Xu ◽

Eunjung Lee ◽

Kayo Togawa ◽

...

Keyword(s):

Breast Cancer ◽

Body Mass Index ◽

African American ◽

African American Women ◽

Body Mass ◽

White Women ◽

Pooled Analysis ◽

American Women

Download Full-text

Differences in Treatment and Outcome Between African-American and White Women With Endometrial Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2003.01.218 ◽

2003 ◽

Vol 21 (22) ◽

pp. 4200-4206 ◽

Cited By ~ 77

Author(s):

Thomas C. Randall ◽

Katrina Armstrong

Keyword(s):

African American ◽

Endometrial Cancer ◽

African American Women ◽

Racial Differences ◽

White Women ◽

Sociodemographic Characteristics ◽

Histologic Type ◽

American Women ◽

Epithelial Cancers ◽

Primary Surgery

Purpose: To investigate disparities in treatment and outcomes between African-American and white women with endometrial cancer. Patients and Methods: We analyzed 1992 to 1998 Surveillance, Epidemiology, and End Results data for 21,561 women with epithelial cancers of the endometrium. Sequential Cox proportional hazard models were used to determine the association between tumor characteristics (stage, grade, and histologic type), sociodemographic characteristics (age and marital status), and treatment (surgery and radiation therapy) and the racial difference in mortality. Results: The unadjusted hazard ratio (HR) for death from endometrial cancer for African-American women compared with white women was 2.57. However, African-American women were significantly more likely to present with advanced-stage disease and have poorly differentiated tumors or tumors with an unfavorable histologic type and were significantly less likely to undergo definitive surgery at all stages of disease. Adjusting for tumor and sociodemographic characteristics lowered the HR for African-American women to 1.80. Further adjustment for the use of surgery reduced the HR to 1.51. The association between surgery and survival was stronger among white women (HR, 0.26) than among African-American women (HR, 0.44). Conclusion: African-American women with endometrial cancer are significantly less likely to undergo primary surgery and have significantly shorter survival than white women with endometrial cancer. Racial differences in treatment are associated with racial differences in survival. The association between use of surgery and survival is weaker among African-American than white women, raising questions about potential racial differences in the effectiveness of surgery.

Download Full-text

Breast Cancer Surgery Decision-Making and African-American Women

Journal of Cancer Education ◽

10.1007/s13187-014-0725-8 ◽

2014 ◽

Vol 30 (3) ◽

pp. 497-502 ◽

Cited By ~ 1

Author(s):

Jane R. Schubart ◽

Michelle A. Farnan ◽

Rena B. Kass

Keyword(s):

Breast Cancer ◽

Decision Making ◽

African American ◽

African American Women ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

American Women

Download Full-text

ZDHHC3 as a Risk and Mortality Marker for Breast Cancer in African American Women

Cancer Informatics ◽

10.1177/1176935117746644 ◽

2017 ◽

Vol 16 ◽

pp. 117693511774664 ◽

Cited By ~ 6

Author(s):

Nick Kinney ◽

Robin T Varghese ◽

Ramu Anandakrishnan ◽

Harold R “Skip” Garner

Keyword(s):

Breast Cancer ◽

African American ◽

African American Women ◽

Messenger Rna ◽

White Women ◽

African American Woman ◽

Breast Cancer Mortality ◽

American Woman ◽

Ribosomal Gene ◽

American 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.

Download Full-text

The incidence of BRCA1 and BRCA2 variants of unknown significance varies in different ethnic populations

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10002 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10002-10002 ◽

Cited By ~ 1

Author(s):

D. M. Opatt ◽

M. Morrow ◽

M. Daly

Keyword(s):

Breast Cancer ◽

African American ◽

Genetic Testing ◽

African American Women ◽

White Women ◽

Personal History ◽

Brca1 And Brca2 ◽

Variants Of Unknown Significance ◽

Unknown Significance ◽

History Of

10002 Background: BRCA1 and BRCA2 mutations in the general population are rare. Women with these mutations have a significantly increased risk of invasive breast and ovarian cancer (65–85% and 15–65% cumulative lifetime risk, respectively). Variants of unknown significance (VUS), which are of uncertain clinical importance, account for up to 50% of all identified BRCA1 and BRCA2 sequence alterations1. Methods: Pooled data from all patients presenting to Fox Chase Cancer Center for genetic counseling was examined. Patients underwent genetic testing after detailed genetic counseling. Clinical data, including gender, ethnic background, and personal history of cancer, and total number of patients tested were collected. Results: A total of 1,765 women and 236 men underwent genetic testing. The distribution of ethnicity was: <1% Asian, 2.7% African American, <1% Hispanic, 2.4% other or of more than one ethnicity, 83% White, and 11% unknown. Mutations of BRCA1 and BRCA2 were seen in 13% of the women and 2.7% of the men. VUS were seen in 6.2% of the women and .15% of the men. Of the women positive for a VUS, 2.4% were Asian, 18.1% were African American, 5.5% were Hispanic, 4.7% were more than one ethnicity, 66.9% were White, and 2.4% were Unknown ethnicity. Only .15% of the men tested were positive for a VUS, all of whom were White. Of the 51 African American women tested, 45.1% were positive for a VUS while only 5.5% of the 1,503 White women tested were positive (p<0.0001). Of the females testing positive for a VUS, a personal history of breast cancer was seen in 66.7% of Asians, 78.3% of African Americans, 100% of Hispanics, 83.3% of those more than one race, 61% of Whites, and none of the people of unknown ethnic origin. One of three men testing positive for a VUS reported a history of breast cancer. Conclusions: Identification of VUS occurred disproportionately in African Americans, occurring ten times more often in African American women than White women in our study. Studies to improve classification of VUS as deleterious or neutral are needed to enhance the utility of genetic testing for women at risk, particularly those of African American ethnicity. 1Goldman, DE et al. Am. J. Hum. Genet., 2004. No significant financial relationships to disclose.

Download Full-text

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.

Download Full-text