Survival differences between black and white women with triple-negative breast cancer (TNBC) appear to vanish when these tumors are detected by screening mammography, a single-center analysis suggested.
Four-year overall survival (OS) for African-American patients diagnosed with TNBC without the aid of screening was 59.1% (95% CI 45.8%-76.2%). Yet, when screening detected these cancers, the OS for this patient population was significantly higher, at 93.2% (95% CI 87.0%-99.9%, P<0.001), Lisa Newman, MD, MPH, of Weill Cornell Medicine in New York City, and colleagues reported.
Among white women in the study, no significant 4-year OS difference was found between patients with screen-detected TNBCs (87.5%, 95% CI 76.5%-100%) and those with cancers detected without screening (74.8%, 95% CI 62.3%-89.7%), they wrote in JAMA Surgery.
In addition, among the 106 African American and 87 white patients who were retrospectively identified from the Henry Ford Health System database, both patient groups had similar rates of local recurrence and distant relapse after a median follow-up of approximately 4 years.
“This work clearly shows that TNBC can be detected by screening mammography and that screening does save lives,” said Laurie Margolies, MD, a professor of radiology at Icahn School of Medicine at Mount Sinai in New York City. This study “argues for increased screening for all women and highlights the need for increased efforts to screen traditionally underserved populations.”
Julie Nangia, MD, a breast oncologist at the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine in Houston, pointed out that this is not the first time a study like this has been done.
She explained that African-American patients with breast cancer were thought to have poorer outcomes than white patients because previous studies lumped all types of breast cancer together. The problem with this is that white patients have a higher incidence of estrogen receptor (ER)-positive breast cancer, which has better outcomes.
“Many studies have shown that when you remove socio-economic factors and differences in histology/biology of cancer that whites and African Americans do the same in terms of outcomes,” she said in an email with MedPage Today.
But the current study doesn’t explain the twofold higher incidence of TNBC seen among black women compared with whites, noted Veronica Jones, MD, a breast surgeon at City of Hope in Duarte, California.
“The question at hand is why there is an increased incidence of triple-negative subtypes in African-American women and if there is any screening/prevention tool to address the disparity in incidence,” she told MedPage Today by email.
African American and white patients included in the analysis had several similarities, including extent of disease, type of treatment received, and use of private health insurance. One significant difference between the patient groups was the lower proportion of black women being referred for genetic testing or counseling compared with whites (21.7% vs 37.9%; P=0.03).
The analysis also showed the benefits of screening for both African American and white patients. Regardless of race, screen-detected cancers were more often node negative compared with non-screen-detected cancers (91% vs 59.6%. respectively; P<0.001) and primary tumors tended to be smaller (79.2% vs 37.1% had T1; P<0.001). Also, significantly more screened patients underwent lumpectomy than patients who were not screened (68.3% vs 46.1%; P=0.002).
A 2018 study by Margolies and co-authors in the Annals of Surgical Oncology similarly showed that breast cancers detected with early screening leads to a lower need for mastectomy, axillary dissection, and chemotherapy.
The analysis from Newman’s group further revealed that patients with screen-detected disease had a 79% reduced likelihood of death from any cause compared with patients for whom screening was not used to detect disease (HR 0.21, 95% CI 0.10-0.45, P<0.001). Also, patients who had high-grade disease had a more than threefold greater likelihood of death from any cause compared with patients without high-grade disease (HR 3.37, 95% CI 1.17-9.66).
Chen reported having no conflicts of interest to disclose. One co-author reporting receiving grant funding from the National Institutes of Health and another co-author reported receiving grant funding from Susan G. Komen and the Fashion Footwear Association of New York as well as serving on the American Society of Breast Surgeons breast cancer screening guideline committee. No other co-authors reported having conflicts of interest.
Margolies reported having no relevant conflicts of interest.
Nangia reported having no relevant conflicts of interest.
Jones reported having no relevant conflicts of interest.
Source: MedicalNewsToday.com
