Race and triple negative threats to breast cancer survival: A population-based study in Atlanta, GA

Mary Jo Lund, Katrina F. Trivers, Peggy L. Porter, Ralph J. Coates, Brian Leyland-Jones, Otis W. Brawley, Elaine W. Flagg, Ruth M. O'Regan, Sheryl G.A. Gabram, J. William Eley

Research output: Contribution to journalArticlepeer-review

274 Scopus citations


Background: Breast cancers with a triple negative tumor (TNT) subtype (as defined by lacking protein expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)) preclude the use of available targeted therapies and may contribute to poor outcome and to the historically poorest survival observed among African-American (AA) women. This study examines association of the ER/PR/HER2 subtypes with race and breast cancer survival. Methods: Breast tumors from a population-based cohort of 116 AA and 360 white Atlanta women aged 20-54, diagnosed from 1990 to 1992 were centrally reviewed and tested by immunohistochemistry. Multivariate survival analyses within subtypes (TNT, ER-PR-HER2+, ER+/PR+HER2+, ER+/PR+HER2-) were conducted using weighted Cox regression and included socio-demographic, prognostic, and treatment factors. Results: TNTs were more prevalent among young women and particularly among AA women (Odds Ratio [OR] = 1.9, 95% Confidence Interval [CI] 1.2-2.9), adjusting for age, stage, grade, and poverty index. Overall mortality was higher for AA women (Hazard Ratio [HR] = 1.9, 95% CI, 1.5-2.5) and differed by subtypes (P < 0.001). Within the TNT subtype, racial differences in survival persisted, after additional adjustment for treatment and comorbidities (HR = 2.0, 95% CI 1.0-3.7). TNTs were uniquely associated with high expression of p16, p53, and Cyclin E; and low Bcl-2 and Cyclin D1 expression. Conclusions: The high prevalence of TNTs among younger women and particularly younger AA women, along with unique protein expression patterns and poorer survival, suggests varying gene-environment etiologies with respect to age and race/ethnicity and a need for effective therapies.

Original languageEnglish (US)
Pages (from-to)357-370
Number of pages14
JournalBreast Cancer Research and Treatment
Issue number2
StatePublished - Jan 2009
Externally publishedYes


  • African-American
  • Breast cancer
  • Race
  • Survival
  • Triple negative
  • Tumor subtypes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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