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Racial differences in the incidence of breast cancer subtypes defined by combined histologic grade and hormone receptor status

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Abstract

Breast cancer encompasses several distinct clinical entities of very different characteristics and behaviors, a fact which likely contributes to the higher breast cancer mortality in African-Americans (AA) despite the higher incidence in European-Americans (EA). We are interested in how incidence variability in cancer subtypes defined by combined estrogen receptor (ER) and grade contributes to racial mortality disparities. As an initial step, we compared age-specific and age-adjusted incidence rates for each ER/Grade subtype in South Carolina (SC—a southern state) with Ohio (a northern mid-western state), using state registry data for 1996–2004. Each ER/Grade subtype had a distinct incidence pattern and rate, with three striking racial/geographic differences. First, the racial incidence disparity in ER negative (ER−) cancers was mostly within the ER−/G3 subtype, of which AAs had ~65% higher incidence than did EAs; ER−/G2 was much less common, but of significantly higher incidence in AAs. Second, the racial disparity in ER positive (ER+) cancers was in the ER+/lower-grade cancers, with a marked EA excess in both states. Third, AA incidence of the ER+/lower-grade subtypes was ~26% higher in Ohio than in SC. The other subtypes (ER−/G1 and ER+/G3) varied minimally by race and state, and the latter showed a strong association with age. Age adjustment halved the racial difference in mean age at diagnosis to about 2 years younger in AAs, compared to 4 years younger in case comparisons. Use of age-adjusted and age-specific rates of breast cancer subtypes may improve understanding of racial incidence and mortality disparities over time and geography. This approach also may aid in estimating the race-specific incidence rates of triple-negative breast cancer.

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Abbreviations

AA:

African-American

ACoS:

American College of Surgeons

CDC:

Centers for Disease Control and Prevention

dk:

Not known or unavailable

EA:

European-American

ER:

Estrogen receptor

ER+:

Positive ER expression status

ER+/G1:

ER positive and Grade 1

ER+/G1, 2:

ER positive and either Grade 1 or Grade 2

ER−:

Negative ER expression status

HER-2/neu:

Human epidermal growth factor receptor-2 also called HER-2

NAACCR:

North American Association of Central Cancer Registries

NPCR:

National Program of Cancer Registries

PR:

Progesterone receptor

SC:

South Carolina

SCCCR:

South Carolina Central Cancer Registry

SEER:

Surveillance, Epidemiology and End Results (program of the NCI)

T-stage:

Tumor stage, based upon size of invasive primary tumor

vs:

Versus

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Acknowledgments

We thank the following people from the South Carolina Central Cancer Registry for providing the South Carolina data: Susan Bollick-Aldrich, MSPH, CTR (director), Catishia Moseley, MSPH, and Deborah Hurley, MSPH. Special thanks are also due to Mike Byrd, PhD, MPH, LMSW, director of the Chronic Diseases Branch of the South Carolina Department of Health and Environmental Control, for his unflagging encouragement of this analysis, and to Dr. Anthony Alberg of the Medical University of South Carolina for his editorial assistance. Ohio cancer incidence data were obtained from the Ohio Cancer Incidence Surveillance System (OCISS), Ohio Department of Health (ODH), a registry participating in the National Program of Cancer Registries of the Centers for Disease Control and Prevention (CDC). Use of these data does not imply ODH or CDC either agrees or disagrees with any presentations, analyses, interpretations, or conclusions. Information about the OCISS can be obtained at: http://www.odh.ohio.gov/odhPrograms/svio/ci_surv/ci_surv1.aspx.

Author information

Authors and Affiliations

  1. Division of Biostatistics and Epidemiology, and Hollings Cancer Center, Medical University of South Carolina, 135 Cannon St., Suite 302, Charleston, SC, 29425, USA

    Joan E. Cunningham

  2. Division of Hematology/Oncology, University of Miami Sylvester Cancer Center, Miami, FL, USA

    Alberto J. Montero

  3. Division of Biostatistics and Epidemiology, and Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., Suite 118G, Charleston, SC, 29425, USA

    Elizabeth Garrett-Mayer

  4. ABC Consulting, Dayton, OH, USA

    Hans J. Berkel

  5. Department of Biological Sciences, University of South Carolina, Columbia, SC, USA

    Bert Ely

Authors
  1. Joan E. Cunningham
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  2. Alberto J. Montero
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  3. Elizabeth Garrett-Mayer
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Corresponding author

Correspondence to Joan E. Cunningham.

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This work was performed at Division of Biostatistics and Epidemiology, Department of Medicine, Medical University of South Carolina, Charleston SC, AND at the University of South Carolina, Columbia, SC.

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Cunningham, J.E., Montero, A.J., Garrett-Mayer, E. et al. Racial differences in the incidence of breast cancer subtypes defined by combined histologic grade and hormone receptor status. Cancer Causes Control 21, 399–409 (2010). https://doi.org/10.1007/s10552-009-9472-2

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  • DOI: https://doi.org/10.1007/s10552-009-9472-2

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