Racial disparities in breast cancer diagnosis and treatment by hormone receptor and HER2 status

Cancer Epidemiol Biomarkers Prev. 2015 Nov;24(11):1666-72. doi: 10.1158/1055-9965.EPI-15-0293. Epub 2015 Oct 13.


Background: African American and Hispanic women are more likely to be diagnosed with aggressive forms of breast cancer. Disparities within each subtype of breast cancer have not been well documented.

Methods: Using data from 18 SEER cancer registries, we identified 102,064 women aged 20 years or older, diagnosed with invasive breast cancer in 2010-2011, and with known stage, hormone receptor (HR), and HER2 status. Associations between race/ethnicity and cancer stage and receipt of guideline-concordant treatment were evaluated according to HR/HER2 status.

Results: Overall, African American and Hispanic women were 30% to 60% more likely to be diagnosed with stage II-IV breast cancer compared with non-Hispanic whites. African American women had 40% to 70% higher risks of stage IV breast cancer across all four subtypes. American Indian/Alaska Native women had a 3.9-fold higher risk of stage IV triple-negative breast cancer. African American and Hispanic whites were 30% to 40% more likely to receive non-guideline-concordant treatment for breast cancer overall and across subtypes.

Conclusions: Women in several racial/ethnic groups are more likely to be diagnosed with more advanced stage breast cancer. African American and American Indian/Alaska Native women in particular had the highest risk of being diagnosed with stage IV triple-negative breast cancer. African American and Hispanic women were also consistently at higher risk of not receiving guideline-concordant treatment across subtypes.

Impact: These findings provide important characterization of which subtypes of breast cancer racial/ethnic disparities in stage and treatment persist.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Asian / statistics & numerical data
  • Black or African American / statistics & numerical data*
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / ethnology
  • Breast Neoplasms / genetics
  • Breast Neoplasms / therapy
  • Female
  • Genotype
  • Guideline Adherence / statistics & numerical data*
  • Healthcare Disparities / statistics & numerical data*
  • Hispanic or Latino / statistics & numerical data*
  • Humans
  • Indians, North American / statistics & numerical data
  • Middle Aged
  • Neoplasm Staging
  • Receptor, ErbB-2 / genetics*
  • Receptors, Estrogen / genetics
  • SEER Program
  • Triple Negative Breast Neoplasms / diagnosis
  • Triple Negative Breast Neoplasms / ethnology
  • Triple Negative Breast Neoplasms / genetics
  • Triple Negative Breast Neoplasms / therapy
  • United States
  • White People / statistics & numerical data
  • Young Adult


  • Receptors, Estrogen
  • ERBB2 protein, human
  • Receptor, ErbB-2