Impact of molecular subtype and race on HR+, HER2− breast cancer survival

PURPOSE: There is an urgent need to understand the biological factors contributing to the racial survival disparity among women with hormone receptor-positive (HR+), HER2− breast cancer. In this study, we examined the impact of PAM50 subtype on 10-year mortality rate in women with HR+, HER2− breast cancer by race. METHODS: Women with localized, HR+, HER2− breast cancer diagnosed between 2002 to 2012 from two population-based cohorts were evaluated. Archival tumors were obtained and classified by PAM50 into four molecular subtypes (i.e., luminal A, luminal B, HER2-enriched, and basal-like). The molecular subtypes within HR+, HER2− breast cancers and corresponding 10-year mortality rate were compared between Black and Non-Hispanic White (NHW) women using Cox proportional hazard ratios and survival analysis, adjusting for covariates. RESULTS: In this study, 318 women with localized, HR+, HER2− breast cancer were included—227 Black (71%) and 91 NHW (29%). Young Black women (age≤50) had the highest proportion of HR+,non-luminal A tumors (47%), compared to young NHW (10%), older Black women (31%), and older NHW (30%). Overall, women with HR+,non-luminal A subtypes had a higher 10-year mortality rate compared to HR+, luminal A subtypes after adjustment for age, stage and income (HR 4.21 for Blacks, 95% CI=1.74–10.18 and HR 3.44 for NHW, 95% CI=1.31–9.03). Among HR+, non-luminal A subtypes there was however no significant racial difference in 10-yr mortality observed (Black vs. NHW: HR 1.23, 95% CI=0.58–2.58). CONCLUSION: Molecular subtype classification highlights racial disparities in PAM50 subtype distribution among women with HR+, HER2− breast cancer. Among women with HR+, HER2− breast cancer, racial survival disparities are ameliorated after adjusting for molecular subtype.