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

Breast Cancer Res Treat. 2009 Jan;113(2):357-70. doi: 10.1007/s10549-008-9926-3. Epub 2008 Mar 7.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers, Tumor / analysis
  • Black or African American / statistics & numerical data*
  • Breast Neoplasms / chemistry
  • Breast Neoplasms / ethnology*
  • Breast Neoplasms / mortality
  • Breast Neoplasms / pathology
  • Breast Neoplasms / therapy
  • Carcinoma / chemistry
  • Carcinoma / ethnology*
  • Carcinoma / mortality
  • Carcinoma / pathology
  • Carcinoma / therapy
  • Cohort Studies
  • Female
  • Georgia / epidemiology
  • Humans
  • Middle Aged
  • Multicenter Studies as Topic / statistics & numerical data
  • Neoplasm Proteins / analysis*
  • Proportional Hazards Models
  • Receptor, ErbB-2 / analysis
  • Receptors, Estrogen / analysis
  • Receptors, Progesterone / analysis
  • Risk Factors
  • Socioeconomic Factors
  • Survival Analysis
  • Urban Population
  • White People / statistics & numerical data*
  • Young Adult


  • Biomarkers, Tumor
  • Neoplasm Proteins
  • Receptors, Estrogen
  • Receptors, Progesterone
  • Receptor, ErbB-2