Distinctions in Breast Tumor Recurrence Patterns Post-Therapy among Racially Distinct Populations.

Nikita Wright,Guilherme Cantuaria,Ritu Aneja,Jun Xia,Padmashree C G Rida,Dora Il’Yasova,Michelle D Reid,Meenakshi Gupta,Mildred Jones,Xiaoxian Li,Remus Osan,Sergey Klimov,Uma Krishnamurti,Pranay Neema,William B Coleman

doi:10.1371/journal.pone.0170095

Nikita Wright, Guilherme Cantuaria + Show 13 more

Open Access

https://doi.org/10.1371/journal.pone.0170095

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Abstract

BackgroundClinical 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.MethodsWe 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.ResultsAmong 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).ConclusionOur 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.

Highlights

The significant divide in breast cancer mortality between African-American (AA) and European-American (EA) patients remains a challenge for clinicians
Our analysis revealed higher incidence rates of recurrence in AA compared to EA among patients that received any combination of adjuvant therapy
Our data demonstrates an increased risk of tumor recurrence in AA than EA among patients diagnosed with minimally invasive disease

Summary

Introduction

The significant divide in breast cancer mortality between African-American (AA) and European-American (EA) patients remains a challenge for clinicians. Clinical studies have revealed a higher risk of recurrence in AA compared to EA, presumably contributing to the inequality in clinical outcomes among the ethnic groups [1] This statistic has provided an impetus for clinicians to devise and implement robust prognosticative measures to preclude the tumor returning in AA breast cancer patients. We conducted a large institutional study based in Atlanta, Georgia, in which we analyzed rates and patterns of tumor recurrence post hormone, radiation, and chemotherapy among AA and EA breast cancer patients This retrospective clinical study uncovered previously unrecognized distinctions in recurrence patterns following each conventional form of treatment among racially distinct breast populations and may impart valuable clinical insight into preclusive measures for mitigating the ethnic disparity in breast tumor recurrence. Distinctions in recurrence patterns upon receiving hormone, radiation, and/or chemotherapy between the races remain poorly characterized.

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