Proposal presentation of racial disparities and breast cancer

1. Does Race Affect Survival of Patients with
Triple Negative Breast Cancer in the
Louisiana?
MADHAV KC, MPH
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER- NEW ORLEANS

2. Background
 Excluding skin cancer, breast cancer is most common type of cancer in US women and second most
common cause of death among women from cancer.
 About 12.4 percent of US women will develop breast cancer during their life time
 The average number of new cases of female breast cancer in United States is 125 per 100,000 women per
year and the average number of deaths due to breast cancer is 21.5 per 100,000 women per year (SEER 18
2009-2013, age adjusted).
 Average number of new cases of breast cancer in Louisiana is 123.4 cases per 100,000 women per year
and the average number of deaths is 24.5 cases per 100,000 women per year

3. Breast Cancer
 Breast cancer is a heterogeneous disease
 Subtypes of breast cancer based on presence and absence of hormone (estrogen or
progesterone) receptors (HR+/HR-) and excess levels of growth promoting protein human
epidermal growth factor receptor 2 (HER2+/HER2-) can be classified as:.
 Luminal A (HR+/HER2- )
 Luminal B (HR+/HER2+ )
 Triple Negative (HR-/HER2-)
 HER2 enriched (HR-/HER2+ )

4. Triple Negative Breast Cancer (TNBC)
 TNBC is characterized by the absence of estrogen receptor (ER),
progesterone receptor (PR), and human epidermal growth factor
receptor 2 (HER2) hormone
 TNBC accounts for 10-20% of all invasive breast cancer, and it is most
important subtype, because of its aggressive nature and poor
prognosis.
 Majority of TNBC are basal-like sub-type and BRCA1-related breast
cancer are both triple negative and basal-like.

5. Breast Cancer in LA
10.5
4.4
60.8
13.4
0
20
40
60
80
HR+/HER2+ HR-/HER2+ HR+/HER2- Triple negative
Incidenceper100,000
Breast Cancer Subtypes
Incidence (2009-2013) of Breast Cancer by subtype in Louisiana
Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane
Katrina Impacted Louisiana Cases, Nov 2015 Sub (2000-2013) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2014
Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2016, based on the November 2015
submission.

6. Breast Cancer in Louisiana vs USA
10.5
4.4
60.8
13.4
9.4
4.1
66.7
10.8
0
20
40
60
80
HR+/HER2+ HR-/HER2+ HR+/HER2- Triple negative
Incidenceper100,000
Breast Cancer Subtypes
Incidence rate (2009-2013) of breast cancer by its subtype in Louisiana VS. USA
Louisiana All Registries
Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane
Katrina Impacted Louisiana Cases, Nov 2015 Sub (2000-2013) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2014
Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2016, based on the November 2015
submission.

7. Rationale
 TNBC is significantly higher in African American women, especially pre-menopausal age group than
Caucasian women and the overall mortality rate due to the breast cancer is also higher, despite a lower
incidence rate
 Death rates due to breast cancer is higher in Louisiana than US this might be because of the fact that it
has second largest proportion of African American women and higher prevalence of triple negative
breast cancer among this group
 Though, racial disparity is linked to differences in socio economic status and accessibility of health care
services, race is still a strong single predictor of TNBC survival after adjusting socioeconomic status and
health care accessibility
 However, the results of epidemiological studies in assessment of role of race in TNBC survival are
inconsistent

8. Objectives
 Main Objective: To assess the relationship between race and survival outcomes of women who
are diagnosed with Triple Negative Breast Cancer in Louisiana
 Specific Objectives:
 To calculate the frequency of triple negative breast cancer in Louisiana
 To perform the descriptive analysis of triple negative breast cancer patient
 To compare the incidence rate of triple negative breast cancer by demographic characteristics
 To calculate the relative survival rate among patients with triple negative breast cancer
 To assess the effect of race on relative survival for patients with triple negative breast cancer.

9. Methods
 Study Design: Retrospective analytical study using National Cancer Institute (NCI), Surveillance,
Epidemiology and End Results (SEER) data.
 Data source: SEER 18 registries research data, Nov 2015 Sub (1992-2013) will be considered as the
primary database for this research project which cover about 22% of the US population.
 Statistical Analysis:
 Frequency and percentage of variable of interests will be calculated as the first step of data
analyses in SAS. Similarly, chi-squared test will be performed to evaluate the association between
categorical variables.
 The survival outcome of patient with triple negative breast cancer will be analyzed by Kaplan Meier
survival method (PROC LIFETEST) and the log-rank test will be performed in SEER*Stat and SAS®9.4.
Multivariate analysis (PROC PHREG) will also be performed by using the Cox Proportional hazard
regression model.

10. CEESP-Overview
Study Location
Louisiana Tumor Registry
LSU Health Sciences Center School of Public Health
2020 Gravier Street, New Orleans, LA 70112

11. Future Plan after CEESP
 Ph.D in Cancer Epidemiology
 Contribute to create cancer database/Registry in Nepal
 Carryout Epidemiological studies in common cancer
 Provide training and research services on cancer epidemiology in Nepal
 Advocate to make cancer a priority program in health system of Nepal

12. References
 1. American Cancer Society. Lifetime Probability of Developing and Dying from Cancer for 23 sites, 2009-2011; 2015.
 2. Maniscalco L, Lefante C, Hsieh M, Andrews A, B. M, Ferguson D, et al. Cancer in Louisiana, 2009-2013. New Orleans: Louisiana Tumor
Registry, 2015.
 3. Criscitiello C, Azim HA, Jr., Schouten PC, Linn SC, Sotiriou C. Understanding the biology of triple-negative breast cancer. Ann Oncol
2012;23 Suppl 6:vi13-8.
 4. Schwentner L, Wockel A, Konig J, Janni W, Ebner F, Blettner M, et al. Adherence to treatment guidelines and survival in triple-negative
breast cancer: a retrospective multi-center cohort study with 9,156 patients. BMC Cancer 2013;13:487.
 5. Bao PP, Cai H, Peng P, Gu K, Su Y, Shu XO, et al. Body mass index and weight change in relation to triple-negative breast cancer survival.
Cancer Causes Control 2016;27(2):229-36.
 6. Liu Z, Zhang XS, Zhang S. Breast tumor subgroups reveal diverse clinical prognostic power. Sci Rep 2014;4:4002.
 7. American Cancer Society. Breast Cancer Facts & Figures 2015-2016. Atlanta: American Cancer Society, Inc. 2015.
 8. Sturtz LA, Melley J, Mamula K, Shriver CD, Ellsworth RE. Outcome disparities in African American women with triple negative breast
cancer: a comparison of epidemiological and molecular factors between African American and Caucasian women with triple negative breast
cancer. BMC Cancer 2014;14:62.
 9. Sachdev J, Ahmed S, Mirza M, Farooq A, Kronish L, Jahanzeb M. Does Race Affect Outcomes in Triple negative Breast cancer? Breast
Cancer: Basic and Clinical Research 2010;4.
 10. Polite BN, Cirrincione C, Fleming GF, Berry DA, Seidman A, Muss H, et al. Racial differences in clinical outcomes from metastatic breast
cancer: a pooled analysis of CALGB 9342 and 9840--Cancer and Leukemia Group B. J Clin Oncol 2008;26(16):2659-65.