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Ethnicity and outcome of young breast cancer patients in the United Kingdom: the POSH study

Ethnicity and outcome of young breast cancer patients in the United Kingdom: the POSH study
Ethnicity and outcome of young breast cancer patients in the United Kingdom: the POSH study

BACKGROUND: Black ethnic groups have a higher breast cancer mortality than Whites. American studies have identified variations in tumour biology and unequal health-care access as causative factors. We compared tumour pathology, treatment and outcomes in three ethnic groups in young breast cancer patients treated in the United Kingdom.

METHODS: Women aged ≤ 40 years at breast cancer diagnosis were recruited to the POSH national cohort study (MREC: 00/06/69). Personal characteristics, tumour pathology and treatment data were collected at diagnosis. Follow-up data were collected annually. Overall survival (OS) and distant relapse-free survival (DRFS) were assessed using Kaplan-Meier curves, and multivariate analyses were performed using Cox regression.

RESULTS: Ethnicity data were available for 2915 patients including 2690 (91.0%) Whites, 118 (4.0%) Blacks and 87 (2.9%) Asians. Median tumour diameter at presentation was greater in Blacks than Whites (26.0 mm vs 22.0 mm, P=0.0103), and multifocal tumours were more frequent in both Blacks (43.4%) and Asians (37.0%) than Whites (28.9%). ER/PR/HER2-negative tumours were significantly more frequent in Blacks (26.1%) than Whites (18.6%, P=0.043). Use of chemotherapy was similarly high in all ethnic groups (89% B vs 88.6% W vs 89.7% A). A 5-year DRFS was significantly lower in Blacks than Asians (62.8% B vs 77.0% A, P=0.0473) or Whites (62.8 B% vs 77.0% W, P=0.0053) and a 5-year OS for Black patients, 71.1% (95% CI: 61.0-79.1%), was significantly lower than that of Whites (82.4%, 95% CI: 80.8-83.9%, W vs B: P=0.0160). In multivariate analysis, Black ethnicity had an effect on DRFS in oestrogen receptor (ER)-positive patients that is independent of body mass index, tumour size, grade or nodal status, HR: 1.60 (95% CI: 1.03-2.47, P=0.035).

CONCLUSION: Despite equal access to health care, young Black women in the United Kingdom have a significantly poorer outcome than White patients. Black ethnicity is an independent risk factor for reduced DRFS particularly in ER-positive patients.

Adult, Breast Neoplasms, Cohort Studies, Female, Health Services Accessibility, Humans, Prospective Studies, Treatment Outcome, United Kingdom, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
0007-0920
230-41
Copson, E.
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Maishman, T.
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Gerty, S.
b2013815-27c9-4a7d-ad42-071f60a8000f
Eccles, B.
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Stanton, L.
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Cutress, R.I.
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Altman, D.G.
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Durcan, L.
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Simmonds, P.
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Jones, L.
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Tapper, W.
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Eccles, Diana
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Copson, E.
a94cdbd6-f6e2-429d-a7c0-462c7da0e92b
Maishman, T.
cf4259a4-0eef-4975-9c9d-a2c3d594f989
Gerty, S.
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Eccles, B.
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Stanton, L.
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Cutress, R.I.
68ae4f86-e8cf-411f-a335-cdba51797406
Altman, D.G.
c8c0dc66-dd65-4b27-bbce-40bc744536ff
Durcan, L.
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Simmonds, P.
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Jones, L.
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Tapper, W.
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Eccles, Diana
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Copson, E., Maishman, T., Gerty, S., Eccles, B., Stanton, L., Cutress, R.I., Altman, D.G., Durcan, L., Simmonds, P., Jones, L., Tapper, W. and Eccles, Diana (2013) Ethnicity and outcome of young breast cancer patients in the United Kingdom: the POSH study. British Journal of Cancer, 110 (1), 230-41. (doi:10.1038/bjc.2013.650).

Record type: Article

Abstract

BACKGROUND: Black ethnic groups have a higher breast cancer mortality than Whites. American studies have identified variations in tumour biology and unequal health-care access as causative factors. We compared tumour pathology, treatment and outcomes in three ethnic groups in young breast cancer patients treated in the United Kingdom.

METHODS: Women aged ≤ 40 years at breast cancer diagnosis were recruited to the POSH national cohort study (MREC: 00/06/69). Personal characteristics, tumour pathology and treatment data were collected at diagnosis. Follow-up data were collected annually. Overall survival (OS) and distant relapse-free survival (DRFS) were assessed using Kaplan-Meier curves, and multivariate analyses were performed using Cox regression.

RESULTS: Ethnicity data were available for 2915 patients including 2690 (91.0%) Whites, 118 (4.0%) Blacks and 87 (2.9%) Asians. Median tumour diameter at presentation was greater in Blacks than Whites (26.0 mm vs 22.0 mm, P=0.0103), and multifocal tumours were more frequent in both Blacks (43.4%) and Asians (37.0%) than Whites (28.9%). ER/PR/HER2-negative tumours were significantly more frequent in Blacks (26.1%) than Whites (18.6%, P=0.043). Use of chemotherapy was similarly high in all ethnic groups (89% B vs 88.6% W vs 89.7% A). A 5-year DRFS was significantly lower in Blacks than Asians (62.8% B vs 77.0% A, P=0.0473) or Whites (62.8 B% vs 77.0% W, P=0.0053) and a 5-year OS for Black patients, 71.1% (95% CI: 61.0-79.1%), was significantly lower than that of Whites (82.4%, 95% CI: 80.8-83.9%, W vs B: P=0.0160). In multivariate analysis, Black ethnicity had an effect on DRFS in oestrogen receptor (ER)-positive patients that is independent of body mass index, tumour size, grade or nodal status, HR: 1.60 (95% CI: 1.03-2.47, P=0.035).

CONCLUSION: Despite equal access to health care, young Black women in the United Kingdom have a significantly poorer outcome than White patients. Black ethnicity is an independent risk factor for reduced DRFS particularly in ER-positive patients.

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More information

Accepted/In Press date: 1 October 2013
e-pub ahead of print date: 22 October 2013
Keywords: Adult, Breast Neoplasms, Cohort Studies, Female, Health Services Accessibility, Humans, Prospective Studies, Treatment Outcome, United Kingdom, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
Organisations: Cancer Sciences, Clinical Trials Unit

Identifiers

Local EPrints ID: 359714
URI: http://eprints.soton.ac.uk/id/eprint/359714
ISSN: 0007-0920
PURE UUID: 1a7fdf6a-998a-41ed-bdac-a4825b41150c
ORCID for L. Stanton: ORCID iD orcid.org/0000-0001-8181-840X
ORCID for W. Tapper: ORCID iD orcid.org/0000-0002-5896-1889
ORCID for Diana Eccles: ORCID iD orcid.org/0000-0002-9935-3169

Catalogue record

Date deposited: 11 Nov 2013 10:32
Last modified: 09 Nov 2021 03:16

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Contributors

Author: E. Copson
Author: T. Maishman
Author: S. Gerty
Author: B. Eccles
Author: L. Stanton ORCID iD
Author: R.I. Cutress
Author: D.G. Altman
Author: L. Durcan
Author: P. Simmonds
Author: L. Jones
Author: W. Tapper ORCID iD
Author: Diana Eccles ORCID iD

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