Triple-negative early-stage breast cancer in African American women: A fuel to the fire

Abstract

11039 Background: Previous studies have described triple negative (TN) breast cancer (ER/PR/ HER2/neu negative) as an aggressive and poor prognostic phenotype with higher relapse rate (RR) and shorter survival. The incidence of TN breast cancer has reportedly been higher (30–35%) in African American (AA) women compared to the general population (15%) but the patterns of RR have not been well defined. The objective of this study was to determine the prevalence and impact of triple negative status in AA women with breast cancer. Methods: We retrospectively reviewed tumor registry data from a large academic medical center serving an inner city population. A total of 282 AA women with invasive breast cancer were identified from 1994–2006. Characteristics evaluated include patient (pt) age, TNM disease stage at diagnosis, ER, PR, Her2/neu, tumor grade, and sites of relapse. RR, disease free survival (DFS) and overall survival (OS) were determined for TN vs. non-triple negative (NTN) pts. Results: The prevalence of TN disease in AA women was 30% (82/282). Median age (57 yrs) was the same in both TN and NTN group. A higher proportion of pts presented with later stage disease (III/IV) in the TN vs. the NTN group (32% vs. 20%, p<0.01). With a median follow-up of 5.5 years, the RR was significantly higher in the TN vs. NTN group for stages I and II (p<0.05) but not for stage III (see table). Compared to the NTN group, TN pts demonstrated a higher overall RR, lower DFS and OS in the earlier stages (see table). Conclusion: This study represents one of the largest reported series of AA women with breast cancer. The incidence of TN breast cancer is higher in AA women with a higher frequency of advanced stage of disease. TN status emerged as a strong adverse prognostic factor especially in the early stages (I/II) of disease with higher overall RR and lower survival. Alternative forms of treatment for early stage TN breast cancer should be explored in this high risk category of breast cancer in AA women. Stage Specific Patterns of Relapse and Survival in TN vs. NTN Groups Stage Triple- Negative Non-Triple Negative P-Value Relapse Rate (RR) I 6/24 (25%) 10/97 (10%) 0.04 II 10/32 (31%) 8/63 (13%) 0.02 III 5/14 (36%) 6/17 (35%) NS DFS I 4.7 yrs 8.7 yrs 0.04 II 3.5 yrs 7.8 yrs NS III 2.4 yrs 1.3 yrs NS OS I 4.7 yrs 8.4 yrs NS II 2.8 yrs 7 yrs 0.01 ns=not significant No significant financial relationships to disclose.