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
. 2021 Feb;30(2):351-363.
doi: 10.1158/1055-9965.EPI-20-1291. Epub 2020 Dec 18.

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

Esther M John  1   2   3 , Valerie McGuire  4 , Allison W Kurian  4   2   3 , Jocelyn Koo  3 , Salma Shariff-Marco  5   6 , Scarlett Lin Gomez  5   6 , Iona Cheng  5   6 , Theresa H M Keegan  7 , Marilyn L Kwan  8 , Leslie Bernstein  9 , Cheryl Vigen  10 , Anna H Wu  10
Affiliations

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

Esther M John et al. Cancer Epidemiol Biomarkers Prev. 2021 Feb.

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest:

The authors declare no potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Breast cancer-specific mortality for ER+ or PR+ breast cancer. This figure depicts hazard ratios and 95% confidence intervals for joint associations of race/ethnicity and healthcare, sociodemographic, and lifestyle characteristics with breast cancer-specific mortality. The following symbols are used for each racial/ethnic group: ┼ for non-Hispanic Whites, ▪ for Hispanics, ▴ for African Americans, ● for Asian Americans.
Figure 2.
Figure 2.
All-cause mortality for ER+ or PR+ breast cancer. This figure depicts hazard ratios and 95% confidence intervals for joint associations of race/ethnicity and healthcare, sociodemographic, and lifestyle characteristics with all-cause mortality. The following symbols are used for each racial/ethnic group: ┼ for non-Hispanic Whites, ▪ for Hispanics, ▴ for African Americans, ● for Asian Americans.
Figure 3.
Figure 3.
Breast cancer-specific mortality for ER− and PR− breast cancer. This figure depicts hazard ratios and 95% confidence intervals for joint associations of race/ethnicity and healthcare, sociodemographic, and lifestyle characteristics with breast cancer-specific mortality. The following symbols are used for each racial/ethnic group: ┼ for non-Hispanic Whites, ▪ for Hispanics, ▴ for African Americans, ● for Asian Americans.
Figure 4.
Figure 4.
All-cause mortality for ER− and PR− breast cancer. This figure depicts hazard ratios and 95% confidence intervals for joint associations of race/ethnicity and healthcare, sociodemographic, and lifestyle characteristics with all-cause mortality. The following symbols are used for each racial/ethnic group: ┼ for non-Hispanic Whites, ▪ for Hispanics, ▴ for African Americans, ● for Asian Americans.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020;701:7–30. - PubMed
    1. DeSantis CE, Ma J, Goding Sauer A, Newman LA, Jemal A. Breast cancer statistics, 2017, racial disparity in mortality by state. CA Cancer J Clin 2017;676:439–48. - PubMed
    1. Hunt BR, Hurlbert MS. Black:white disparities in breast cancer mortality in the 50 largest cities in the United States, 2005–2014. Cancer Epidemiol 2016. - PubMed
    1. Li CI, Malone KE, Daling JR. Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 2003;1631:49–56. - PubMed
    1. Ooi SL, Martinez ME, Li CI. Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Res Treat 2011;1273:729–38. - PMC - PubMed

Publication types

Substances