Breast Cancer Receptor Status: Do Results from a Centralized Pathology Laboratory Agree with SEER Registry Reports?

Huiyan Ma; Yaping Wang; Jane Sullivan-Halley; Linda Weiss; Ronald T. Burkman; Michael S. Simon; Kathleen E. Malone; Brian L. Strom; Giske Ursin; Polly A. Marchbanks; Jill A. McDonald; Robert Spirtas; Michael F. Press; Leslie Bernstein

doi:10.1158/1055-9965.EPI-09-0301

DOI: 10.1158/1055-9965.EPI-09-0301 Published August 2009

Article Figures & Data

Tables

Table 1.

ER and PR status from different data sources among women ages 35 to 64 y with invasive breast cancer in the Women's CARE Study

Receptor status from a centralized pathology laboratory	Receptor status from SEER registries
ER status	ER−	ER+
ER−	316 (92%)	122 (17%)
ER+	28 (8%)	582 (83%)
κ (95% CI)	0.70 (0.65-0.74)
PR status	PR−	PR+
PR−	296 (83%)	121 (21%)
PR+	60 (17%)	449 (79%)
κ (95% CI)	0.60 (0.55-0.65)
Joint ER/PR status	ER−/PR−	ER+/PR+	ER+/PR−	ER−/PR+
ER−/PR−	240 (90%)	48 (9%)	18 (20%)	36 (69%)
ER+/PR+	8 (3%)	392 (76%)	38 (43%)	8 (15%)
ER+/PR−	8 (3%)	35 (7%)	29 (33%)	2 (4%)
ER−/PR+	10 (4%)	38 (8%)	3 (3%)	6 (12%)
Overall κ (95% CI)	0.55 (0.51-0.59)
ER−/PR− κ (95% CI)	0.69 (0.64-0.74)
ER+/PR+ κ (95% CI)	0.62 (0.57-0.67)
ER+/PR− κ (95% CI)	0.30 (0.20-0.40)
ER−/PR+ κ (95% CI)	0.05 (−0.03 to 0.14)

Table 2.

κ Statistics for agreement of ER and PR status from different data sources by study site, tumor characteristics, and cases' demographic characteristics

	ER		PR		Overall ER/PR
	No. of cases	κ (95% CI)	No. of cases	κ (95% CI)	No. of cases	κ (95% CI)
Study site
Detroit	286	0.68 (0.59-0.76)	261	0.64 (0.55-0.73)	257	0.56 (0.48-0.64)
Los Angeles	762	0.70 (0.65-0.76)	665	0.58 (0.52-0.65)	662	0.55 (0.49-0.60)
P^*		0.62		0.32		0.71
Calendar year of diagnosis
1994	143	0.54 (0.41-0.67)	137	0.39 (0.24-0.54)	136	0.35 (0.24-0.46)
1995	179	0.66 (0.55-0.77)	166	0.59 (0.47-0.71)	166	0.52 (0.42-0.62)
1996	325	0.78 (0.71-0.85)	268	0.65 (0.56-0.74)	265	0.62 (0.55-0.70)
1997	302	0.72 (0.64-0.80)	268	0.65 (0.56-0.74)	266	0.60 (0.53-0.68)
1998	99	0.66 (0.51-0.82)	87	0.67 (0.51-0.83)	86	0.56 (0.42-0.69)
P^*		0.02		0.04		0.001
Tumor size (source, SEER), cm
<2	472	0.64 (0.57-0.72)	408	0.57 (0.49-0.66)	404	0.53 (0.46-0.60)
2-4.9	445	0.75 (0.69-0.81)	396	0.61 (0.54-0.69)	394	0.57 (0.51-0.63)
≥5	88	0.57 (0.41-0.74)	84	0.53 (0.36-0.70)	83	0.45 (0.31-0.59)
Diffuse	14		13		13
Unknown	29		25		25
P^*		0.03		0.62		0.26
Tumor stage (source, SEER)
Localized disease	615	0.70 (0.65-0.76)	535	0.59 (0.52-0.66)	531	0.56 (0.50-0.61)
Regional disease (extension to lymph nodes)	409	0.68 (0.60-0.75)	370	0.63 (0.55-0.71)	367	0.54 (0.48-0.61)
Distant metastases	23	0.82 (0.60-1.00)	20	0.38 (−0.02 to 0.78)	20	0.51 (0.25-0.76)
Unknown	1		1		1
P^*		0.45		0.42		0.91
Age at diagnosis
<40	200	0.74 (0.65-0.83)	188	0.62 (0.51-0.73)	186	0.59 (0.50-0.68)
40-44	182	0.63 (0.53-0.74)	168	0.62 (0.50-0.74)	167	0.51 (0.42-0.61)
45-49	164	0.70 (0.59-0.81)	142	0.66 (0.54-0.79)	141	0.58 (0.48-0.69)
50-54	187	0.72 (0.61-0.83)	163	0.71 (0.60-0.82)	161	0.62 (0.52-0.72)
55-59	153	0.70 (0.58-0.82)	129	0.54 (0.40-0.69)	128	0.51 (0.39-0.63)
60-64	162	0.62 (0.48-0.76)	136	0.36 (0.20-0.53)	136	0.41 (0.29-0.53)
P^*		0.60		0.02		0.10
Race
White	614	0.66 (0.60-0.72)	544	0.60 (0.53-0.67)	542	0.53 (0.48-0.59)
African American	434	0.73 (0.67-0.79)	382	0.59 (0.52-0.67)	377	0.56 (0.50-0.63)
P^*		0.11		0.98		0.51

↵*P value from the κ homogeneity χ² test of Fleiss.

Table 3.

The association between reproductive factors and invasive breast cancer risk by the source of data on ER and PR status among women ages 35 to 64 y in the Women's CARE Study

	No. of controls	No. of cases				Multivariable adjusted^* odds ratio (95% CI)
	No. of controls	ER−/PR−	ER+/PR+	ER+/PR−	ER−/PR+	ER−/PR−	ER+/PR+	ER+/PR−	ER−/PR+
Number of full-term pregnancies^*
ER/PR measured in a centralized pathology laboratory
Never pregnant	178	26	59	10	8	Reference	Reference	Reference	Reference
1	315	64	78	16	11	1.25 (0.76-2.07)	0.85 (0.57-1.27)	0.87 (0.38-2.01)	0.77 (0.30-1.99)
2	576	112	120	19	22	1.28 (0.80-2.04)	0.69 (0.48-1.00)	0.58 (0.26-1.30)	0.87 (0.37-2.03)
3	396	57	80	12	6	1.00 (0.60-1.67)	0.69 (0.47-1.03)	0.53 (0.22-1.28)	0.35 (0.12-1.05)
≥4	405	58	71	13	7	0.99 (0.59-1.68)	0.60 (0.39-0.92)	0.55 (0.22-1.34)	0.44 (0.15-1.31)
P_trend						0.38	0.008	0.09	0.05
Pregnant but no full-term pregnancy	159	25	38	4	3	0.92 (0.50-1.67)	0.74 (0.46-1.19)	0.44 (0.13-1.44)	0.38 (0.10-1.46)
ER/PR from SEER registries
Never pregnant	178	19	68	8	8	Reference	Reference	Reference	Reference
1	315	46	92	15	16	1.20 (0.68-2.13)	0.85 (0.58-1.24)	1.15 (0.47-2.81)	1.07 (0.44-2.61)
2	576	82	149	30	12	1.23 (0.72-2.10)	0.75 (0.53-1.05)	1.23 (0.54-2.76)	0.47 (0.19-1.19)
3	396	56	85	9	5	1.29 (0.74-2.28)	0.64 (0.44-0.94)	0.49 (0.18-1.32)	0.31 (0.10-0.99)
≥4	405	47	76	18	8	1.04 (0.57-1.87)	0.57 (0.38-0.85)	0.89 (0.36-2.20)	0.53 (0.18-1.54)
P_trend						0.98	0.002	0.20	0.02
Pregnant but no full-term pregnancy	159	16	43	8	3	0.77 (0.38-1.57)	0.71 (0.45-1.11)	1.30 (0.47-3.61)	0.38 (0.10-1.47)
ER/PR status consistently ascertained by both sources
Never pregnant	178	16	54	—	—	Reference	Reference	—	—
1	315	38	69	—	—	1.19 (0.64-2.23)	0.83 (0.55-1.26)	—	—
2	576	78	106	—	—	1.40 (0.79-2.49)	0.69 (0.47-1.01)	—	—
3	396	48	69	—	—	1.33 (0.72-2.44)	0.67 (0.45-1.02)	—	—
≥4	405	44	62	—	—	1.15 (0.61-2.17)	0.59 (0.38-0.92)	—	—
P_trend						0.75	0.01	—	—
Pregnant but no full-term pregnancy	159	16	32			0.94 (0.45-1.96)	0.67 (0.41-1.11)	—	—
Age at first full-term pregnancy,^† y
ER/PR measured in a centralized laboratory
≤19	586	96	87	22	10	Reference	Reference	Reference	Reference
20-24	618	101	134	17	16	1.06 (0.77-1.46)	1.38 (1.01-1.89)	0.60 (0.31-1.19)	1.47 (0.64-3.38)
25-29	282	53	85	15	15	1.19 (0.79-1.80)	1.90 (1.29-2.78)	1.15 (0.53-2.51)	2.80 (1.12-7.02)
≥30	206	41	43	6	5	1.25 (0.76-2.05)	1.26 (0.77-2.06)	0.58 (0.20-1.72)	1.14 (0.32-4.03)
P_trend						0.31	0.05	0.63	0.29
ER/PR from SEER registries
≤19	586	81	99	24	11	Reference	Reference	Reference	Reference
20-24	618	80	155	21	12	1.01 (0.71-1.43)	1.39 (1.03-1.87)	0.71 (0.37-1.35)	0.98 (0.41-2.35)
25-29	282	45	99	16	8	1.26 (0.81-1.97)	1.82 (1.27-2.61)	1.28 (0.60-2.72)	1.38 (0.49-3.92)
≥30	206	25	49	11	10	1.02 (0.57-1.82)	1.14 (0.72-1.81)	1.37 (0.56-3.37)	1.94 (0.63-5.93)
P_trend						0.61	0.11	0.35	0.20
ER/PR status consistently ascertained by both sources
≤19	586	74	77	—	—	Reference	Reference	—	—
20-24	618	73	122	—	—	1.04 (0.72-1.51)	1.47 (1.06-2.05)	—	—
25-29	282	38	73	—	—	1.22 (0.76-1.96)	1.83 (1.22-2.75)	—	—
≥30	206	23	34	—	—	1.10 (0.60-2.00)	1.09 (0.64-1.85)	—	—
P_trend						0.57	0.18	—	—
Duration of breastfeeding,^† mo
ER/PR measured in a centralized laboratory
Never	715	135	152	32	25	Reference	Reference	Reference	Reference
<1	203	37	52	9	3	0.99 (0.66-1.48)	1.11 (0.77-1.60)	0.98 (0.45-2.13)	0.37 (0.11-1.28)
1-6	336	55	65	9	10	0.79 (0.55-1.13)	0.75 (0.54-1.06)	0.51 (0.23-1.12)	0.58 (0.26-1.28)
7-23	304	44	62	8	6	0.70 (0.47-1.03)	0.79 (0.55-1.12)	0.52 (0.23-1.20)	0.40 (0.15-1.05)
≥24	134	20	18	2	2	0.77 (0.45-1.32)	0.55 (0.31-0.96)	0.32 (0.07-1.43)	0.31 (0.07-1.47)
P_trend						0.05	0.02	0.02	0.03
ER/PR from SEER registries
Never	715	111	173	39	21	Reference		Reference	Reference
<1	203	29	60	7	5	0.93 (0.59-1.45)	1.16 (0.82-1.64)	0.60 (0.26-1.38)	0.76 (0.28-2.10)
1-6	336	40	79	13	7	0.70 (0.47-1.06)	0.80 (0.58-1.10)	0.61 (0.31-1.19)	0.55 (0.22-1.37)
7-23	304	34	70	9	7	0.64 (0.41-0.98)	0.78 (0.56-1.10)	0.50 (0.23-1.08)	0.65 (0.26-1.67)
≥24	134	17	20	4	1	0.74 (0.41-1.34)	0.55 (0.32-0.93)	0.56 (0.19-1.68)	0.24 (0.03-1.89)
P_trend						0.03	0.01	0.05	0.10
ER/PR status consistently ascertained by both sources
Never	715	96	130	—	—	Reference	Reference	—	—
<1	203	29	46	—	—	1.08 (0.68-1.70)	1.15 (0.78-1.70)	—	—
1-6	336	37	60	—	—	0.79 (0.52-1.20)	0.84 (0.59-1.19)	—	—
7-23	304	31	54	—	—	0.69 (0.44-1.09)	0.83 (0.57-1.20)	—	—
≥24	134	15	16	—	—	0.77 (0.41-1.42)	0.58 (0.32-1.05)	—	—
P_trend						0.09	0.06	—	—

↵*Adjusted for categorical variables of age, race, family history of breast cancer, age at menarche, education and study site.
↵^†Additionally adjusted for number of full-term-pregnancies and mutually adjusted for age at first full-term pregnancy and duration of breastfeeding.