Borderline Estrogen Receptor–Positive Breast Cancers in Black and White Women

Author:

Benefield Halei C1ORCID,Allott Emma H2ORCID,Reeder-Hayes Katherine E3,Perou Charles MORCID,Carey Lisa AORCID,Geradts Joseph4,Sun Xuezheng1,Calhoun Benjamin C536ORCID,Troester Melissa A1

Affiliation:

1. Department of Epidemiology, Gillings School of Global Public Health

2. University of North Carolina at Chapel Hill, Chapel Hill, NC; Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland, UK

3. Department of Medical Oncology

4. City of Hope National Medical Center, Department of Population Sciences, Duarte

5. Department of Genetics

6. Department of Pathology and Laboratory Medicine

Abstract

Abstract Background Some breast tumors expressing greater than 1% and less than 10% estrogen receptor (ER) positivity (ER-borderline) are clinically aggressive; others exhibit luminal biology. Prior ER-borderline studies included few black participants. Methods Using the Carolina Breast Cancer Study (phase I: 1993–1996; 2: 1996–2001; 3: 2008–2013), a population-based study that oversampled black women, we compared ER-borderline (n = 217) to ER-positive (n = 1885) and ER-negative (n = 757) tumors. PAM50 subtype and risk of recurrence score (ROR-PT, incorporates subtype, proliferation, tumor size) were measured. Relative frequency differences (RFD) were estimated using multivariable linear regression. Disease-free interval (DFI) was evaluated by ER category and endocrine therapy receipt, overall and by race, using Kaplan Meier and Cox models. Statistical tests were two-sided. Results ER-borderlines were more frequently basal-like (RFD = +37.7%, 95% confidence interval [CI] = 27.1% to 48.4%) and high ROR-PT (RFD = +52.4%, 95% CI = 36.8% to 68.0%) relative to ER-positives. Having a high ROR-PT ER-borderline tumor was statistically significantly associated with black race (RFD = +26.2%, 95% CI = 9.0% to 43.3%). Compared to ER-positives, DFI of ER-borderlines treated with endocrine therapy was poorer but not statistically significantly different (hazard ratio [HR] = 2.03, 95% CI = 0.89% to 4.65%), whereas DFI was statistically significantly worse for ER-borderlines without endocrine therapy (HR = 3.33, 95% CI = 1.84% to 6.02%). However, black women with ER-borderline had worse DFI compared to ER-positives, even when treated with endocrine therapy (HR = 2.77, 95% CI = 1.09% to 7.04%). Conclusions ER-borderline tumors were genomically heterogeneous, with survival outcomes that differed by endocrine therapy receipt and race. Black race predicted high-risk ER-borderlines and may be associated with poorer endocrine therapy response.

Funder

UNC Lineberger Comprehensive Cancer Center

University Cancer Research Fund

Susan G. Komen Foundation

National Cancer Institute of the National Institutes of Health

National Institute of Environmental Health Sciences

National Institutes of Health

Triangle Community Foundation

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

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