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Underserved African-American and White Women with Breast Cancer Have Similar Prognostic Profiles for Estrogen Receptor and Tumor Grade - ARTEMIS - May 02, 2006

The racial disparity in breast cancer prognosis and survival may have more to do with socioeconomic status, rather than biological factors, according to a study of women diagnosed and treated at a public hospital. The results were presented at the annual meeting of the American Association for Cancer Research.

Though the population sample was relatively small, including 341 African-American and 94 white women, the results suggest that low economic standing contributes to similarly poor prognostic profiles for tumor grade and estrogen receptor status in both races, according to the researchers.

"This is the first study of its kind in the U.S. based on data from a single institution," said Keith A. Dookeran, M.B.B.S, FRCS (Ed), leader of the research team at the Minority-Based-Community Clinical Oncology Program at Stroger Hospital of Cook County. "Most of the other studies of the apparent difference in breast cancer prognosis between African-American and white women drew on data from many different geographic areas."

When Dookeran and his team narrowed the study population to patients at a single, public institution, and adjusted the data for age and stage of disease, they found no significant difference in tumor grade or estrogen receptor status between white and African-American women.

"Cook County Hospital is a public hospital," Dookeran said. "The women here are largely uninsured and of low socioeconomic status, and they appear to have similar prognostic indicators with high-grade and ER-negative tumors, be they African-American or white".

"Our results suggest that low socioeconomic status, regardless of race, is associated with a particular tumor phenotype."

Other research attributes the poorer prognosis for breast cancer in African-American women, compared to white women, to the more frequent occurrence in blacks of high-grade, estrogen receptor negative tumors that hinder treatment options.

High-grade- and estrogen receptor-negative tumors signal an aggressive breast cancer with a lower rate of survivability. Estrogen receptor-negative tumors are so called because they do not express the genes that bind to estrogen, the hormone which plays a crucial role in the development and progression of the disease. Some of the most effective chemotherapy treatments for breast cancer act by targeting the receptors and inhibiting their ability to stimulate estrogen production in the breast.

Dookeran and his colleagues at the NCI-supported Minority-Based-Community Clinical Oncology Program at Stroger Hospital wondered whether there really is a connection between race and breast tumor biology when all the other variables were factored into the inequity equation, such as, access to preventative care and diagnostic testing; availability of health insurance; socioeconomic standing; and geographic location.

"African-American women are more commonly underserved and have low socioeconomic status (SES), and other studies suggest that SES, not simply race, is associated with this prognostic profile," said Dookeran.

To assure a consistent standard of diagnosis and a common quality of care, Dookeran and his colleagues studied only women from the Minority-Based-Community Clinical Oncology Program at Stroger Hospital.

After adjusting for age, the researchers found no significant differences between races regarding stage, ER status and tumor grade. Furthermore, disease-free, distant disease-free and overall survival were similar for both races overall, and also for ER positive subsets.

SOURCE: Annual Meeting of the American Association for Cancer Research, April 3, 2006, Washington, DC