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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Racial/Ethnic Disparities in Survival after Breast Cancer Diagnosis by Estrogen and Progesterone Receptor Status: A Pooled Analysis

Esther M. John, Valerie McGuire, Allison W. Kurian, Jocelyn Koo, Salma Shariff-Marco, Scarlett Lin Gomez, Iona Cheng, Theresa H.M. Keegan, Marilyn L. Kwan, Leslie Bernstein, Cheryl Vigen and Anna H. Wu
Esther M. John
1Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California.
2Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, California.
3Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California.
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  • ORCID record for Esther M. John
  • For correspondence: emjohn@stanford.edu
Valerie McGuire
1Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California.
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Allison W. Kurian
1Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California.
2Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, California.
3Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California.
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Jocelyn Koo
3Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California.
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Salma Shariff-Marco
4Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.
5Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
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Scarlett Lin Gomez
4Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.
5Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
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Iona Cheng
4Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.
5Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
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Theresa H.M. Keegan
6Division of Hematology and Oncology, UC Davis Comprehensive Cancer Center, University of California, Davis, California.
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Marilyn L. Kwan
7Division of Research, Kaiser Permanente Northern California, Oakland, California.
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Leslie Bernstein
8Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California.
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Cheryl Vigen
9Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
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Anna H. Wu
9Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
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DOI: 10.1158/1055-9965.EPI-20-1291 Published February 2021
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Abstract

Background: Limited studies have investigated racial/ethnic survival disparities for breast cancer defined by estrogen receptor (ER) and progesterone receptor (PR) status in a multiethnic population.

Methods: Using multivariable Cox proportional hazards models, we assessed associations of race/ethnicity with ER/PR-specific breast cancer mortality in 10,366 California women diagnosed with breast cancer from 1993 to 2009. We evaluated joint associations of race/ethnicity, health care, sociodemographic, and lifestyle factors with mortality.

Results: Among women with ER/PR+ breast cancer, breast cancer–specific mortality was similar among Hispanic and Asian American women, but higher among African American women [HR, 1.31; 95% confidence interval (CI), 1.05–1.63] compared with non-Hispanic White (NHW) women. Breast cancer–specific mortality was modified by surgery type, hospital type, education, neighborhood socioeconomic status (SES), smoking history, and alcohol consumption. Among African American women, breast cancer–specific mortality was higher among those treated at nonaccredited hospitals (HR, 1.57; 95% CI, 1.21–2.04) and those from lower SES neighborhoods (HR, 1.48; 95% CI, 1.16–1.88) compared with NHW women without these characteristics. Breast cancer–specific mortality was higher among African American women with at least some college education (HR, 1.42; 95% CI, 1.11–1.82) compared with NHW women with similar education. For ER−/PR− disease, breast cancer–specific mortality did not differ by race/ethnicity and associations of race/ethnicity with breast cancer–specific mortality varied only by neighborhood SES among African American women.

Conclusions: Racial/ethnic survival disparities are more striking for ER/PR+ than ER−/PR− breast cancer. Social determinants and lifestyle factors may explain some of the survival disparities for ER/PR+ breast cancer.

Impact: Addressing these factors may help reduce the higher mortality of African American women with ER/PR+ breast cancer.

This article is featured in Highlights of This Issue, p. 243

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Cancer Epidemiol Biomarkers Prev 2021;30:351–63

  • Received September 1, 2020.
  • Revision received October 28, 2020.
  • Accepted November 19, 2020.
  • Published first December 18, 2020.
  • ©2020 American Association for Cancer Research.
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Cancer Epidemiology Biomarkers & Prevention: 30 (2)
February 2021
Volume 30, Issue 2
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Racial/Ethnic Disparities in Survival after Breast Cancer Diagnosis by Estrogen and Progesterone Receptor Status: A Pooled Analysis
Esther M. John, Valerie McGuire, Allison W. Kurian, Jocelyn Koo, Salma Shariff-Marco, Scarlett Lin Gomez, Iona Cheng, Theresa H.M. Keegan, Marilyn L. Kwan, Leslie Bernstein, Cheryl Vigen and Anna H. Wu
Cancer Epidemiol Biomarkers Prev February 1 2021 (30) (2) 351-363; DOI: 10.1158/1055-9965.EPI-20-1291

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Racial/Ethnic Disparities in Survival after Breast Cancer Diagnosis by Estrogen and Progesterone Receptor Status: A Pooled Analysis
Esther M. John, Valerie McGuire, Allison W. Kurian, Jocelyn Koo, Salma Shariff-Marco, Scarlett Lin Gomez, Iona Cheng, Theresa H.M. Keegan, Marilyn L. Kwan, Leslie Bernstein, Cheryl Vigen and Anna H. Wu
Cancer Epidemiol Biomarkers Prev February 1 2021 (30) (2) 351-363; DOI: 10.1158/1055-9965.EPI-20-1291
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