Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2021 Apr 6;113(4):390-399.
doi: 10.1093/jnci/djaa148.

Race, Ethnicity, and Clinical Outcomes in Hormone Receptor-Positive, HER2-Negative, Node-Negative Breast Cancer in the Randomized TAILORx Trial

Kathy S Albain  1 , Robert J Gray  2 , Della F Makower  3 , Amir Faghih  4 , Daniel F Hayes  5 , Charles E Geyer  6 , Elizabeth C Dees  7 , Matthew P Goetz  8 , John A Olson  9 , Tracy Lively  10 , Sunil S Badve  11 , Thomas J Saphner  12 , Lynne I Wagner  13 , Timothy J Whelan  14 , Matthew J Ellis  15 , William C Wood  16 , Maccon M Keane  17 , Henry L Gomez  18 , Pavan S Reddy  19 , Timothy F Goggins  20 , Ingrid A Mayer  21 , Adam M Brufsky  22 , Deborah L Toppmeyer  23 , Virginia G Kaklamani  24 , Jeffrey L Berenberg  25 , Jeffrey Abrams  10 , George W Sledge  26 , Joseph A Sparano  3
Affiliations
Randomized Controlled Trial

Race, Ethnicity, and Clinical Outcomes in Hormone Receptor-Positive, HER2-Negative, Node-Negative Breast Cancer in the Randomized TAILORx Trial

Kathy S Albain et al. J Natl Cancer Inst. .

Abstract

Background: Black race is associated with worse outcomes in early breast cancer. We evaluated clinicopathologic characteristics, the 21-gene recurrence score (RS), treatment delivered, and clinical outcomes by race and ethnicity among women who participated in the Trial Assigning Individualized Options for Treatment.

Methods: The association between clinical outcomes and race (White, Black, Asian, other or unknown) and ethnicity (Hispanic vs non-Hispanic) was examined using proportional hazards models. All P values are 2-sided.

Results: Of 9719 eligible women with hormone receptor-positive, HER2-negative, node-negative breast cancer, there were 8189 (84.3%) Whites, 693 (7.1%) Blacks, 405 (4.2%) Asians, and 432 (4.4%) with other or unknown race. Regarding ethnicity, 889 (9.1%) were Hispanic. There were no substantial differences in RS or ESR1, PGR, or HER2 RNA expression by race or ethnicity. After adjustment for other covariates, compared with White race, Black race was associated with higher distant recurrence rates (hazard ratio [HR] = 1.60, 95% confidence intervals [CI] = 1.07 to 2.41) and worse overall survival in the RS 11-25 cohort (HR = 1.51, 95% CI = 1.06 to 2.15) and entire population (HR = 1.41, 95% CI = 1.05 to 1.90). Hispanic ethnicity and Asian race were associated with better outcomes. There was no evidence of chemotherapy benefit for any racial or ethnic group in those with a RS of 11-25.

Conclusions: Black women had worse clinical outcomes despite similar 21-gene assay RS results and comparable systemic therapy in the Trial Assigning Individualized Options for Treatment. Similar to Whites, Black women did not benefit from adjuvant chemotherapy if the 21-gene RS was 11-25. Further research is required to elucidate the basis for this racial disparity in prognosis.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Clinical outcomes by race in the cohort with a 21-gene recurrence score of 11 to 25 randomly assigned to endocrine therapy alone or chemoendocrine therapy. A) Invasive disease-free survival (IDFS), (B) relapse-free interval (RFI), (C) distant relapse-free interval (DRFI), and (D) overall survival (OS). Two-sided log-rank test P values are for the overall comparison of the 4 race groups and are not adjusted for effects of other factors. Oth/Unk = other/unknown.
Figure 2.
Figure 2.
Clinical outcomes by race in the entire cohort. A) Invasive disease-free survival (IDFS), (B) relapse-free interval (RFI), C) distant relapse-free interval (DRFI), and D) overall survival (OS). Two-sided log-rank test P values are for the overall comparison of the 4 race groups or 3 ethnicity groups and are not adjusted for effects of other factors. Oth/Unk = other/unknown.
See this image and copyright information in PMC

Comment in

References

    1. DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A.. Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin. 2016;66(1):31–42. - PubMed
    1. Albain KS, Unger JM, Crowley JJ, Coltman CA Jr, Hershman DL.. Racial disparities in cancer survival among randomized clinical trials patients of the Southwest Oncology Group. J Natl Cancer Inst. 2009;101(14):984–992. - PMC - PubMed
    1. Bach PB, Schrag D, Brawley OW, Galaznik A, Yakren S, Begg CB.. Survival of blacks and whites after a cancer diagnosis. JAMA. 2002;287(16):2106–2113. - PubMed
    1. Crew KD, Neugut AI, Wang X, et al. Racial disparities in treatment and survival of male breast cancer. J Clin Oncol. 2007;25(9):1089–1098. - PubMed
    1. Newman LA, Mason J, Cote D, et al. African-American ethnicity, socioeconomic status, and breast cancer survival: a meta-analysis of 14 studies involving over 10,000 African-American and 40,000 White American patients with carcinoma of the breast. Cancer. 2002;94(11):2844–2854. - PubMed

Publication types

MeSH terms

Substances