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. 2021 May 17;21(1):554.
doi: 10.1186/s12885-021-08125-8.

The Will Rogers phenomenon, breast cancer and race

Mary R Nittala  1 , Eswar K Mundra  2 , S Packianathan  2 , Divyang Mehta  2 , Maria L Smith  2 , William C Woods  2 , Shawn McKinney  3 , Barbara S Craft  4 , Srinivasan Vijayakumar  5
Affiliations

The Will Rogers phenomenon, breast cancer and race

Mary R Nittala et al. BMC Cancer. .

Abstract

Background: The Will Rogers phenomenon [WRP] describes an apparent improvement in outcome for patients' group due to tumor grade reclassification. Staging of cancers is important to select appropriate treatment and to estimate prognosis. The WRP has been described as one of the most important biases limiting the use of historical cohorts when comparing survival or treatment. The main purpose of this study is to assess whether the WRP exists with the move from the AJCC 7th to AJCC 8th edition in breast cancer [BC] staging, and if racial differences are manifested in the expression of the WRP.

Methods: This is a retrospective analysis of 300 BC women (2007-2017) at an academic medical center. Overall survival [OS] and disease-free survival [DFS] was estimated by Kaplan-Meier analysis. Bi and multi-variate Cox regression analyses was used to identify racial factors associated with outcomes.

Results: Our patient cohort included 30.3% Caucasians [Whites] and 69.7% African-Americans [Blacks]. Stages I, II, III, and IV were 46.2, 26.3, 23.1, and 4.4% of Whites; 28.7, 43.1, 24.4, and 3.8% of Blacks respectively, in anatomic staging (p = 0.043). In prognostic staging, 52.8, 18.7, 23, and 5.5% were Whites while 35, 17.2, 43.5, and 4.3% were Blacks, respectively (p = 0.011). A total of Whites (45.05% vs. 47.85%) Blacks, upstaged. Whites (16.49% vs. 14.35%) Blacks, downstaged. The remaining, 38.46 and 37.79% patients had their stages unchanged. With a median follow-up of 54 months, the Black patients showed better stage-by-stage 5-year OS rates using 8th edition compared to the 7th edition (p = 0.000). Among the Whites, those who were stage IIIA in the 7th but became stage IB in the 8th had a better prognosis than stages IIA and IIB in the 8th (p = 0.000). The 8th showed complex results (p = 0.176) compared to DFS estimated using the 7th edition (p = 0.004).

Conclusion: The WRP exists with significant variability in the move from the AJCC 7th to the 8th edition in BC staging (both White and Black patients). We suggest that caution needs to be exercised when results are compared across staging systems to account for the WRP in the interpretation of the data.

Keywords: Breast cancer; Racial disparities; Will Rogers phenomenon.

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Conflict of interest statement

There is no conflict of interest present for authors relative to this research.

Figures

Fig. 1
Fig. 1
Flow chart for Breast Cancer Patients Cohort selection. UMMC, University of Mississippi Medical Center; ER, estrogen receptor; PR, progesterone receptor, HER2, human epidermal growth factor receptor 2; n, number; %, percentage
Fig. 2
Fig. 2
The Kaplan- Meier survival curves (years) for AJCC 7th anatomic staging and AJCC 8th prognostic staging for Caucasian and African- American women diagnosed with breast cancer. AJCC, American Joint Committee
Fig. 3
Fig. 3
The Kaplan- Meier disease-free survival curves (years) for AJCC 7th anatomic staging and AJCC 8th prognostic staging for Caucasian and African- American women diagnosed with breast cancer. AJCC, American Joint Committee
See this image and copyright information in PMC

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