Do breast quadrants explain racial disparities in breast cancer outcomes?

Yunan Han, Justin Xavier Moore, Marvin Langston, Lindsay Fuzzell, Saira Khan, Marquita W. Lewis, Graham A. Colditz, Ying Liu

Research output: Contribution to journalArticle

Abstract

Purpose: Tumors of the inner quadrants of the breast are associated with poorer survival than those of the upper-outer quadrant. It is unknown whether racial differences in breast cancer outcomes are modified by breast quadrant, in addition to comparisons among Asian subgroups. Methods: Using the Surveillance, Epidemiology, and End Results database, we analyzed data among women diagnosed with non-metastatic invasive breast cancer between 1990 and 2014. We performed Cox proportional hazards regression models to assess the associations of race with breast cancer-specific survival and overall survival, stratified by breast quadrants. The models were adjusted for age, year of the diagnosis, tumor size, grade, histological type, tumor laterality, lymph node, estrogen receptor, progesterone receptor, and treatments. Results: Among 454,154 patients (73.0% White, 10.0% Black, 7.8% Asian/PI, and 9.2% Hispanic), 54.3% had tumors diagnosed in the upper-outer quadrant of the breast. Asian/PI women were more likely than White to have tumors diagnosed in the nipple/central portion of the breast and were less likely to have diagnosed in the upper-outer quadrant (P < 0.001), despite a similar distribution of breast quadrant between Black, Hispanic, and White women. Compared with White women, the multivariable-adjusted hazard ratios of breast cancer-specific mortality were 1.41 (95% CI 1.37–1.44) in Black women, 0.82 (95% CI 0.79–0.85) in Asian women, and 1.05 (95% CI 1.02–1.09) in Hispanic women. Among Asian subgroups, Japanese American women had a lower risk of breast cancer-specific mortality (HR = 0.68, 95% CI 0.62–0.74) compared with White women. Overall survival was similar to breast cancer-specific survival in each race group. The race-associated risks did not vary significantly by breast quadrants for breast cancer-specific mortality and all-cause mortality. Conclusions: Differences in breast cancer survival by race could not be attributed to tumor locations. Understanding the cultural, biological, and lifestyle factors that vary between White, African American, and ethnic subgroups of Asian American women may help explain these survival differences.

Original languageEnglish (US)
Pages (from-to)1171-1182
Number of pages12
JournalCancer Causes and Control
Volume30
Issue number11
DOIs
StatePublished - Nov 1 2019

Fingerprint

Breast
Breast Neoplasms
Survival
Hispanic Americans
Neoplasms
Asian Americans
Mortality
Nipples
Biological Factors
Progesterone Receptors
Proportional Hazards Models
Estrogen Receptors
African Americans
Life Style
Epidemiology
Lymph Nodes
Databases

Keywords

  • Breast cancer
  • Breast quadrant
  • Primary tumor site
  • Race
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Han, Y., Moore, J. X., Langston, M., Fuzzell, L., Khan, S., Lewis, M. W., ... Liu, Y. (2019). Do breast quadrants explain racial disparities in breast cancer outcomes? Cancer Causes and Control, 30(11), 1171-1182. https://doi.org/10.1007/s10552-019-01222-x

Do breast quadrants explain racial disparities in breast cancer outcomes? / Han, Yunan; Moore, Justin Xavier; Langston, Marvin; Fuzzell, Lindsay; Khan, Saira; Lewis, Marquita W.; Colditz, Graham A.; Liu, Ying.

In: Cancer Causes and Control, Vol. 30, No. 11, 01.11.2019, p. 1171-1182.

Research output: Contribution to journalArticle

Han, Y, Moore, JX, Langston, M, Fuzzell, L, Khan, S, Lewis, MW, Colditz, GA & Liu, Y 2019, 'Do breast quadrants explain racial disparities in breast cancer outcomes?', Cancer Causes and Control, vol. 30, no. 11, pp. 1171-1182. https://doi.org/10.1007/s10552-019-01222-x
Han Y, Moore JX, Langston M, Fuzzell L, Khan S, Lewis MW et al. Do breast quadrants explain racial disparities in breast cancer outcomes? Cancer Causes and Control. 2019 Nov 1;30(11):1171-1182. https://doi.org/10.1007/s10552-019-01222-x
Han, Yunan ; Moore, Justin Xavier ; Langston, Marvin ; Fuzzell, Lindsay ; Khan, Saira ; Lewis, Marquita W. ; Colditz, Graham A. ; Liu, Ying. / Do breast quadrants explain racial disparities in breast cancer outcomes?. In: Cancer Causes and Control. 2019 ; Vol. 30, No. 11. pp. 1171-1182.
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abstract = "Purpose: Tumors of the inner quadrants of the breast are associated with poorer survival than those of the upper-outer quadrant. It is unknown whether racial differences in breast cancer outcomes are modified by breast quadrant, in addition to comparisons among Asian subgroups. Methods: Using the Surveillance, Epidemiology, and End Results database, we analyzed data among women diagnosed with non-metastatic invasive breast cancer between 1990 and 2014. We performed Cox proportional hazards regression models to assess the associations of race with breast cancer-specific survival and overall survival, stratified by breast quadrants. The models were adjusted for age, year of the diagnosis, tumor size, grade, histological type, tumor laterality, lymph node, estrogen receptor, progesterone receptor, and treatments. Results: Among 454,154 patients (73.0{\%} White, 10.0{\%} Black, 7.8{\%} Asian/PI, and 9.2{\%} Hispanic), 54.3{\%} had tumors diagnosed in the upper-outer quadrant of the breast. Asian/PI women were more likely than White to have tumors diagnosed in the nipple/central portion of the breast and were less likely to have diagnosed in the upper-outer quadrant (P < 0.001), despite a similar distribution of breast quadrant between Black, Hispanic, and White women. Compared with White women, the multivariable-adjusted hazard ratios of breast cancer-specific mortality were 1.41 (95{\%} CI 1.37–1.44) in Black women, 0.82 (95{\%} CI 0.79–0.85) in Asian women, and 1.05 (95{\%} CI 1.02–1.09) in Hispanic women. Among Asian subgroups, Japanese American women had a lower risk of breast cancer-specific mortality (HR = 0.68, 95{\%} CI 0.62–0.74) compared with White women. Overall survival was similar to breast cancer-specific survival in each race group. The race-associated risks did not vary significantly by breast quadrants for breast cancer-specific mortality and all-cause mortality. Conclusions: Differences in breast cancer survival by race could not be attributed to tumor locations. Understanding the cultural, biological, and lifestyle factors that vary between White, African American, and ethnic subgroups of Asian American women may help explain these survival differences.",
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AU - Colditz, Graham A.

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N2 - Purpose: Tumors of the inner quadrants of the breast are associated with poorer survival than those of the upper-outer quadrant. It is unknown whether racial differences in breast cancer outcomes are modified by breast quadrant, in addition to comparisons among Asian subgroups. Methods: Using the Surveillance, Epidemiology, and End Results database, we analyzed data among women diagnosed with non-metastatic invasive breast cancer between 1990 and 2014. We performed Cox proportional hazards regression models to assess the associations of race with breast cancer-specific survival and overall survival, stratified by breast quadrants. The models were adjusted for age, year of the diagnosis, tumor size, grade, histological type, tumor laterality, lymph node, estrogen receptor, progesterone receptor, and treatments. Results: Among 454,154 patients (73.0% White, 10.0% Black, 7.8% Asian/PI, and 9.2% Hispanic), 54.3% had tumors diagnosed in the upper-outer quadrant of the breast. Asian/PI women were more likely than White to have tumors diagnosed in the nipple/central portion of the breast and were less likely to have diagnosed in the upper-outer quadrant (P < 0.001), despite a similar distribution of breast quadrant between Black, Hispanic, and White women. Compared with White women, the multivariable-adjusted hazard ratios of breast cancer-specific mortality were 1.41 (95% CI 1.37–1.44) in Black women, 0.82 (95% CI 0.79–0.85) in Asian women, and 1.05 (95% CI 1.02–1.09) in Hispanic women. Among Asian subgroups, Japanese American women had a lower risk of breast cancer-specific mortality (HR = 0.68, 95% CI 0.62–0.74) compared with White women. Overall survival was similar to breast cancer-specific survival in each race group. The race-associated risks did not vary significantly by breast quadrants for breast cancer-specific mortality and all-cause mortality. Conclusions: Differences in breast cancer survival by race could not be attributed to tumor locations. Understanding the cultural, biological, and lifestyle factors that vary between White, African American, and ethnic subgroups of Asian American women may help explain these survival differences.

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