Abstract
BackgroundVariation in tumor biology in African-American (AA) and Caucasian (CAU) women with breast cancer is poorly defined. Activated leukocyte cell adhesion molecule (ALCAM) is a bad prognostic factor of breast cancer yet it has never being studied in the AA population. We tested the hypothesis that ALCAM expression would be markedly lower in cases of AA breast cancer when compared to CAU.MethodsCases of breast cancer among AA (n = 78) and CAU (n = 95) women were studied. Immunohistochemical staining was used to semi-quantitatively score ALCAM expression in tumor and adjacent non-tumor breast tissues. Clinico-pathological characteristics including histological type, histological grade, tumor size, lymph node metastasis, estrogen receptor (ER), progesterone receptor (PR), and HER2-neu status were abstracted, and their association with ALCAM expression tested.ResultsUnivariate analysis revealed that the level of ALCAM expression at intercellular junctions of primary tumors correlates with histological grade (AA; p = 0.04, CUA; p = 0.02), ER status (AA; p = 0.0004, CAU; p = 0.0015), PR status (AA; p = 0.002, CUA p = 0.034) and triple-negative tumor status (AA; p = 0.0002, CAU; p = 0.0006,) in both ethnic groups. Multivariate analysis demonstrated that ethnicity contribute significantly to ALCAM expression after accounting for basal-like subtype, age, histological grade, tumor size, and lymph node status. Compared to CAU tumors, the AA are 4 times more likely to have low ALCAM expression (p = 0.003).ConclusionsMarkedly low expression of ALCAM at sites of cell-cell contact in primary breast cancer tumors regardless of differentiation, size and lymph node involvement may contribute to the more aggressive phenotype of breast cancer among AA women.
Highlights
Variation in tumor biology in African-American (AA) and Caucasian (CAU) women with breast cancer is poorly defined
The predominant histological type was ductal adenocarcinoma (CAU 77.8% vs. AA 97.4%; p = 0.003), and there was no statistical difference in histological grade between the two ethnic groups (p = 0.069)
The major findings are that Activated leukocyte cell adhesion molecule (ALCAM) expression at the critically important intercellular junctions of primary breast cancer tumors is markedly lower in AA women compared to CAU women, regardless of age, histological grade, tumor size and lymph node involvement, estrogen receptor (ER)/progesterone receptor (PR) and Human epidermal growth receptor 2 (HER2)-neu status
Summary
Variation in tumor biology in African-American (AA) and Caucasian (CAU) women with breast cancer is poorly defined. Breast cancer affects African-American (AA) women at a lower frequency than Caucasian (CAU) women, yet progression of the tumor and mortality from the disease is higher among AA [1]. This difference persists even after taking into account access to care, tumor characteristics, and treatments [2,3]. The discovery of molecular markers that influence prognostic or treatment outcome may help to understand the ethnic disparity in breast cancer in the US [7,8]. In support of this idea low ALCAM mRNA correlates with the development of skeletal metastasis [24]
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