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Racial Differences in Response to Neoadjuvant Chemotherapy: Impact on Breast and Axillary Surgical Management

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemotherapy (NAC), an increasingly used method for breast cancer patients, has the potential to downstage patient tumors and thereby have an impact on surgical options for treatment of the breast and axilla. Previous studies have identified racial disparities in tumor heterogeneity, nodal recurrence, and NAC completion. This report compares the effects of NAC response among non-Hispanic white women and black women in relation to surgical treatment of the breast and axilla.

Methods

A retrospective review of 85,303 women with stages 1 to 3 breast cancer in the National Cancer Database who received NAC between 1 January 2010 and 31 December 2016 was conducted. Differences in sociodemographic and clinical variables between black patients and white patients with breast cancer were tested.

Results

The study identified 68,880 non-Hispanic white and 16,423 non-Hispanic black women who received NAC. The average age at diagnosis was 54.8 years for the white women versus 52.5 years for the black women. A higher proportion of black women had stage 3 disease, more poorly differentiated tumors, and triple-negative subtype. The black women had lower rates of complete pathologic response, more breast-conservation surgery, and higher rates of axillary lymph node dissection, but fewer sentinel lymph node biopsies. Axillary management for the women who were downstaged showed more use of axillary lymph node dissection for black women compared with sentinel lymph node biopsy.

Conclusions

The black patients were younger at diagnosis, had more advanced disease, and were more likely to have breast-conservation surgery. De-escalating axillary surgery is being adopted increasingly but used disproportionately for white women.

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References

  1. Fahad Ullah M. Breast cancer: current perspectives on the disease status. In: Ahmad A (ed) Breast Cancer Metastasis and Drug Resistance: Challenges and Progress. Advances in Experimental Medicine and Biology. Springer International Publishing, Cham, Switzerland, 2019, pp 51–64. doi:https://doi.org/10.1007/978-3-030-20301-6_4.

  2. Iqbal J, Ginsburg O, Rochon PA, Sun P, Narod SA. Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. JAMA. 2015;313:165–73. https://doi.org/10.1001/jama.2014.17322.

    Article  CAS  PubMed  Google Scholar 

  3. Williams DR, Mohammed SA, Shields AE. Understanding and effectively addressing breast cancer in African American women: unpacking the social context. Cancer. 2016;122:2138–49. https://doi.org/10.1002/cncr.29935.

    Article  PubMed  Google Scholar 

  4. Hill DA, Prossnitz ER, Royce M, Nibbe A. Temporal trends in breast cancer survival by race and ethnicity: a population-based cohort study. PLoS ONE. 2019;14(10). https://doi.org/10.1371/journal.pone.0224064.

  5. Kohler BA, Sherman RL, Howlader N, et al. Annual report to the nation on the status of cancer, 1975–2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. J Natl Cancer Inst. 2015;107:djv048. doi:https://doi.org/10.1093/jnci/djv048.

  6. Yedjou CG, Sims JN, Miele L, et al. Health and racial disparity in breast cancer. Adv Exp Med Biol. 2019;1152:31–49. https://doi.org/10.1007/978-3-030-20301-6_3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Wheeler SB, Spencer JC, Pinheiro LC, Carey LA, Olshan AF, Reeder-Hayes KE. Financial impact of breast cancer in black versus white women. J Clin Oncol Off J Am Soc Clin Oncol. 2018;36:1695–701. https://doi.org/10.1200/JCO.2017.77.6310.

    Article  Google Scholar 

  8. Siddharth S, Sharma D. Racial disparity and triple-negative breast cancer in African-American women: a multifaceted affair between obesity, biology, and socioeconomic determinants. Cancer. 2018;10(12). https://doi.org/10.3390/cancers10120514.

  9. Cain H, Macpherson IR, Beresford M, Pinder SE, Pong J, Dixon JM. Neoadjuvant therapy in early breast cancer: treatment considerations and common debates in practice. Clin Oncol. 2017;29:642–52. https://doi.org/10.1016/j.clon.2017.06.003.

    Article  CAS  Google Scholar 

  10. Graham PJ, Brar MS, Foster T, et al. Neoadjuvant chemotherapy for breast cancer: is practice changing? A population-based review of current surgical trends. Ann Surg Oncol. 2015;22:3376–82. https://doi.org/10.1245/s10434-015-4714-x.

    Article  PubMed  Google Scholar 

  11. Knisely AT, Michaels AD, Mehaffey JH, et al. Race is associated with completion of neoadjuvant chemotherapy for breast cancer. Surgery. 2018;164:195–200. https://doi.org/10.1016/j.surg.2018.03.011.

    Article  PubMed  Google Scholar 

  12. Walsh SM, Zabor EC, Stempel M, Morrow M, Gemignani ML. Does race predict survival for women with invasive breast cancer? Cancer. 2019;125:3139–46. https://doi.org/10.1002/cncr.32296.

    Article  CAS  PubMed  Google Scholar 

  13. Fayanju OM, Ren Y, Suneja G, et al. Nodal response to neoadjuvant chemotherapy predicts receipt of radiation therapy after breast cancer diagnosis. Int J Radiat Oncol Biol Phys. 2020;106:377–89. https://doi.org/10.1016/j.ijrobp.2019.10.039.

    Article  CAS  PubMed  Google Scholar 

  14. Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project protocols B-18 and B-27. J Clin Oncol Off J Am Soc Clin Oncol. 2008;26:778–85. https://doi.org/10.1200/JCO.2007.15.0235.

    Article  Google Scholar 

  15. Gu J, Groot G, Boden C, Busch A, Holtslander L, Lim H. Review of factors influencing women’s choice of mastectomy versus breast conserving therapy in early-stage breast cancer: a systematic review. Clin Breast Cancer. 2018;18:e539–54. https://doi.org/10.1016/j.clbc.2017.12.013.

    Article  PubMed  Google Scholar 

  16. Franceschini G, Di Leone A, Natale M, Sanchez MA, Masett R. Conservative surgery after neoadjuvant chemotherapy in patients with operable breast cancer. Ann Ital Chir. 2018;89:290.

    PubMed  Google Scholar 

  17. National Cancer Database. American College of Surgeons. Retrieved 16 September 2020 at https://www.facs.org/quality-programs/cancer/ncdb.

  18. Pastoriza JM, Karagiannis GS, Lin J, et al. Black race and distant recurrence after neoadjuvant or adjuvant chemotherapy in breast cancer. Clin Exp Metastasis. 2018;35:613–23. https://doi.org/10.1007/s10585-018-9932-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Killelea BK, Yang VQ, Wang S-Y, et al. Racial differences in the use and outcome of neoadjuvant chemotherapy for breast cancer: results from the National Cancer Database. J Clin Oncol Off J Am Soc Clin Oncol. 2015;33:4267–76. https://doi.org/10.1200/JCO.2015.63.7801.

    Article  Google Scholar 

  20. Chavez-MacGregor M, Litton J, Chen H, et al. Pathological complete response in breast cancer patients receiving anthracycline and taxane-based neoadjuvant chemotherapy: evaluating the effect of race/ethnicity. Cancer. 2010;116:4168–77. https://doi.org/10.1002/cncr.25296.

    Article  PubMed  Google Scholar 

  21. Tichy JR, Deal AM, Anders CK, Reeder-Hayes K, Carey LA. Race, response to chemotherapy, and outcome within clinical breast cancer subtypes. Breast Cancer Res Treat. 2015;150:667–74. https://doi.org/10.1007/s10549-015-3350-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Richardson LC. Patterns and trends in age-specific black-white differences in breast cancer incidence and mortality–United States, 1999–2014. MMWR Morb Mortal Wkly Rep. 2016;65(40). https://doi.org/10.15585/mmwr.mm6540a1.

  23. Akinyemiju TF, Vin-Raviv N, Chavez-Yenter D, Zhao X, Budhwani H. Race/ethnicity and socioeconomic differences in breast cancer surgery outcomes. Cancer Epidemiol. 2015;39:745–51. https://doi.org/10.1016/j.canep.2015.07.010.

    Article  PubMed  Google Scholar 

  24. Kish JK, Yu M, Percy-Laurry A, Altekruse SF. Racial and ethnic disparities in cancer survival by neighborhood socioeconomic status in Surveillance, Epidemiology, and End Results (SEER) registries. JNCI Monogr. 2014;2014:236–43. https://doi.org/10.1093/jncimonographs/lgu020.

    Article  Google Scholar 

  25. Vona-Davis L, Rose DP. The influence of socioeconomic disparities on breast cancer tumor biology and prognosis: a review. J Womens Health. 2009;18:883–93. https://doi.org/10.1089/jwh.2008.1127.

    Article  Google Scholar 

  26. Moo T-A, Sanford R, Dang C, Morrow M. Overview of breast cancer therapy. PET Clin. 2018;13:339–54. https://doi.org/10.1016/j.cpet.2018.02.006.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310:1455–61. https://doi.org/10.1001/jama.2013.278932.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel lymph node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14:609–18. https://doi.org/10.1016/S1470-2045(13)70166-9.

    Article  PubMed  Google Scholar 

  29. Mamtani A, Barrio AV, King TA, et al. How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases? Results of a prospective study. Ann Surg Oncol. 2016;23:3467–74. https://doi.org/10.1245/s10434-016-5246-8.

    Article  PubMed  PubMed Central  Google Scholar 

  30. McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: patient perceptions and precautionary behaviors. J Clin Oncol Off J Am Soc Clin Oncol. 2008;26:5220–6. https://doi.org/10.1200/JCO.2008.16.3766.

    Article  Google Scholar 

  31. Meeske KA, Sullivan-Halley J, Smith AW, et al. Risk factors for arm lymphedema following breast cancer diagnosis in black women and white women. Breast Cancer Res Treat. 2009;113:383–91. https://doi.org/10.1007/s10549-008-9940-5.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA

    Theresa Relation MD, PhD, Samilia Obeng-Gyasi MD, MPH, Yaming Li MD, MS, Mariam F. Eskander MD, MPH, Allan Tsung MD & Bridget A. Oppong MD

  2. Department of Economics, Indiana University Purdue University, Indianapolis, IN, USA

    Oindrila Bhattacharyya MS

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  1. Theresa Relation MD, PhD
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  2. Samilia Obeng-Gyasi MD, MPH
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Correspondence to Bridget A. Oppong MD.

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Disclosure

The National Cancer Database (NCDB) is a joint project of the Commission on Cancer (CoC) by the American College of Surgeons and the American Cancer Society. The NCDB of the CoC and the hospitals participating in the NCDB of the CoC are the source of the de-identified data used in this study. They have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Relation, T., Obeng-Gyasi, S., Bhattacharyya, O. et al. Racial Differences in Response to Neoadjuvant Chemotherapy: Impact on Breast and Axillary Surgical Management. Ann Surg Oncol 28, 6489–6497 (2021). https://doi.org/10.1245/s10434-021-09657-w

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