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Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study.

Publication ,  Journal Article
Carey, LA; Perou, CM; Livasy, CA; Dressler, LG; Cowan, D; Conway, K; Karaca, G; Troester, MA; Tse, CK; Edmiston, S; Deming, SL; Geradts, J ...
Published in: JAMA
June 7, 2006

CONTEXT: Gene expression analysis has identified several breast cancer subtypes, including basal-like, human epidermal growth factor receptor-2 positive/estrogen receptor negative (HER2+/ER-), luminal A, and luminal B. OBJECTIVES: To determine population-based distributions and clinical associations for breast cancer subtypes. DESIGN, SETTING, AND PARTICIPANTS: Immunohistochemical surrogates for each subtype were applied to 496 incident cases of invasive breast cancer from the Carolina Breast Cancer Study (ascertained between May 1993 and December 1996), a population-based, case-control study that oversampled premenopausal and African American women. Subtype definitions were as follows: luminal A (ER+ and/or progesterone receptor positive [PR+], HER2-), luminal B (ER+ and/or PR+, HER2+), basal-like (ER-, PR-, HER2-, cytokeratin 5/6 positive, and/or HER1+), HER2+/ER- (ER-, PR-, and HER2+), and unclassified (negative for all 5 markers). MAIN OUTCOME MEASURES: We examined the prevalence of breast cancer subtypes within racial and menopausal subsets and determined their associations with tumor size, axillary nodal status, mitotic index, nuclear pleomorphism, combined grade, p53 mutation status, and breast cancer-specific survival. RESULTS: The basal-like breast cancer subtype was more prevalent among premenopausal African American women (39%) compared with postmenopausal African American women (14%) and non-African American women (16%) of any age (P<.001), whereas the luminal A subtype was less prevalent (36% vs 59% and 54%, respectively). The HER2+/ER- subtype did not vary with race or menopausal status (6%-9%). Compared with luminal A, basal-like tumors had more TP53 mutations (44% vs 15%, P<.001), higher mitotic index (odds ratio [OR], 11.0; 95% confidence interval [CI], 5.6-21.7), more marked nuclear pleomorphism (OR, 9.7; 95% CI, 5.3-18.0), and higher combined grade (OR, 8.3; 95% CI, 4.4-15.6). Breast cancer-specific survival differed by subtype (P<.001), with shortest survival among HER2+/ER- and basal-like subtypes. CONCLUSIONS: Basal-like breast tumors occurred at a higher prevalence among premenopausal African American patients compared with postmenopausal African American and non-African American patients in this population-based study. A higher prevalence of basal-like breast tumors and a lower prevalence of luminal A tumors could contribute to the poor prognosis of young African American women with breast cancer.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

June 7, 2006

Volume

295

Issue

21

Start / End Page

2492 / 2502

Location

United States

Related Subject Headings

  • Receptors, Progesterone
  • Receptors, Estrogen
  • Receptor, erbB-2
  • Receptor, ErbB-2
  • Middle Aged
  • Menopause
  • Keratins
  • Keratin-6
  • Keratin-5
  • Humans
 

Citation

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Carey, L. A., Perou, C. M., Livasy, C. A., Dressler, L. G., Cowan, D., Conway, K., … Millikan, R. C. (2006). Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA, 295(21), 2492–2502. https://doi.org/10.1001/jama.295.21.2492
Carey, Lisa A., Charles M. Perou, Chad A. Livasy, Lynn G. Dressler, David Cowan, Kathleen Conway, Gamze Karaca, et al. “Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study.JAMA 295, no. 21 (June 7, 2006): 2492–2502. https://doi.org/10.1001/jama.295.21.2492.
Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, et al. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 2006 Jun 7;295(21):2492–502.
Carey, Lisa A., et al. “Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study.JAMA, vol. 295, no. 21, June 2006, pp. 2492–502. Pubmed, doi:10.1001/jama.295.21.2492.
Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, Karaca G, Troester MA, Tse CK, Edmiston S, Deming SL, Geradts J, Cheang MCU, Nielsen TO, Moorman PG, Earp HS, Millikan RC. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 2006 Jun 7;295(21):2492–2502.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

June 7, 2006

Volume

295

Issue

21

Start / End Page

2492 / 2502

Location

United States

Related Subject Headings

  • Receptors, Progesterone
  • Receptors, Estrogen
  • Receptor, erbB-2
  • Receptor, ErbB-2
  • Middle Aged
  • Menopause
  • Keratins
  • Keratin-6
  • Keratin-5
  • Humans