Open Access Highly Accessed Research article

Mortality risk of black women and white women with invasive breast cancer by hormone receptors, HER2, and p53 status

Huiyan Ma1*, Yani Lu1, Kathleen E Malone2, Polly A Marchbanks3, Dennis M Deapen4, Robert Spirtas6, Ronald T Burkman7, Brian L Strom8, Jill A McDonald3, Suzanne G Folger3, Michael S Simon9, Jane Sullivan-Halley1, Michael F Press5 and Leslie Bernstein1

Author Affiliations

1 Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA, 91010, USA

2 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA

3 Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA

4 Department of Preventive Medicine, University of Southern California, Los Angeles, CA, 90033, USA

5 Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA

6 Formerly Contraceptive and Reproductive Health Branch, Center for Population Research, National Institute of Child Health and Development, Bethesda, MD, 20892, USA

7 Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, MA, 01199, USA

8 Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, 19104, USA

9 Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, 48201, USA

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BMC Cancer 2013, 13:225  doi:10.1186/1471-2407-13-225

Published: 4 May 2013



Black women are more likely than white women to have an aggressive subtype of breast cancer that is associated with higher mortality and this may contribute to the observed black-white difference in mortality. However, few studies have investigated the black-white disparity in mortality risk stratified by breast cancer subtype, defined by estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status. Furthermore, it is not known whether additional consideration of p53 protein status influences black-white differences in mortality risk observed when considering subtypes defined by ER, PR and HER2 status.


Four biomarkers were assessed by immunohistochemistry in paraffin-embedded breast tumor tissue from 1,204 (523 black, 681 white) women with invasive breast cancer, aged 35–64 years at diagnosis, who accrued a median of 10 years’ follow-up. Multivariable Cox proportional hazards regression models were fit to assess subtype-specific black-white differences in mortality risk.


No black-white differences in mortality risk were observed for women with triple negative (ER-negative [ER-], PR-, and HER2-) subtype. However, older (50–64 years) black women had greater overall mortality risk than older white women if they had been diagnosed with luminal A (ER-positive [ER+] or PR+ plus HER2-) breast cancer (all-cause hazard ratio, HR, 1.88; 95% confidence interval, CI, 1.18 to 2.99; breast cancer-specific HR, 1.51; 95% CI, 0.83 to 2.74). This black-white difference among older women was further confined to those with luminal A/p53- tumors (all-cause HR, 2.22; 95% CI, 1.30 to 3.79; breast cancer-specific HR, 1.89; 95% CI, 0.93 to 3.86). Tests for homogeneity of race-specific HRs comparing luminal A to triple negative subtype and luminal A/p53- to luminal A/p53+ subtype did not achieve statistical significance, although statistical power was limited.


Our findings suggest that the subtype-specific black-white difference in mortality risk occurs mainly among older women diagnosed with luminal A/p53- breast cancer, which is most likely treatable. These results further suggest that factors other than subtype may be relatively more important in explaining the increased mortality risk seen in older black women.

Breast cancer; Mortality; Racial disparity; Triple negative; Luminal A; ER; PR; HER2; p53