Highlights
- •Screen detected cancer in AA women was less likely to manifest as AD and more likely to present with calcifications (MG).
- •Even accounting for tumor histology, AA women were more likely to have screen detected oval/round malignant masses.
- •Controlled for histology, AA women were more likely to have masses with non-spiculated (MG) and circumscribed margins (US).
- •AA women were also more likely to present clinically with high density masses demonstrating posterior enhancement.
- •AA women were more likely to have non-dense breast composition and more likely to have TNBC subtype than NLW women.
- •AD= Architectural distortion, MG= Mammogram, US= Ultrasound, TNBC= Triple negative breast cancer.
Abstract
Purpose
To assess differences in the mammographic and sonographic appearance of breast cancer
in African American (AA) and Non-Latina White (NLW) women.
Methods
We identified AA and NLW women with biopsy proven ductal carcinoma in situ or invasive
breast cancer between June 1, 2015 and May 31, 2018. Racial differences in Breast
Imaging and Reporting Data System (BI-RADS) imaging features were analyzed by imaging
cohorts, i.e. screen detected vs. clinical presentation, using logistic regression
adjusted for histology and molecular subtypes.
Results
We analyzed 270 AA women with 278 cancers (166 screen detected, 112 clinical) and
586 NLW women with 599 cancers (397 screen detected, 202 clinical). Compared with
NLW women, AA women had higher rates of non-dense breast composition (almost entirely
fatty 12.0% vs. 4.6%, scattered fibroglandular 50.9% vs. 45.2%; overall P < 0001)
in both cohorts and were less likely to have screen detected architectural distortion,
(odds ratio (OR) = 0.38, 95% CI 0.18–0.80). AA women were less likely than NLW women
to have screen detected irregular than oval/round masses (mammography: OR = 0.36,
95% CI 0.19–0.68; sonography: OR = 0.48, 95% CI 0.24–0.94), and more likely to present
clinically with high density masses (OR = 3.03, 95% CI 1.12–8.20) demonstrating posterior
enhancement (OR = 3.02, 95% CI 1.11–8.27).
Conclusion
There are racial differences in the mammographic and sonographic appearance of breast
cancer even after accounting for higher rates of triple negative breast cancer in
AA women. Understanding these differences may provide breast imagers with a framework
to approach breast cancer diagnosis in the AA population in clinical practice.
Keywords
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References
- Cancer statistics for African American/Black people 2022.CA Cancer J Clin. 2022; 72: 202-229https://doi.org/10.3322/caac.21718
- Annual report to the nation on the status of cancer, 1975–2014, featuring survival.J Natl Cancer Inst. 2017; 109
- Barriers related to mammography use for breast cancer screening among minority women.J Natl Med Assoc. 2010; 102: 206-218
- Racial differences in no-show rates for screening mammography.Cancer. 2021; 127: 1857-1863
- Comparative access to and use of digital breast tomosynthesis screening by women's race/ethnicity and socioeconomic status.JAMA Netw Open. 2021; 4e2037546
- Access to care as a barrier to mammography for black women.Policy Polit Nurs Pract. 2021; 22: 28-40
- The influence of race, ethnicity, and individual socioeconomic factors on breast cancer stage at diagnosis.Am J Public Health. 2006; 96: 2173-2178
- Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer.JAMA. 1998; 279: 1801-1807
- Disparities in breast cancer stage at diagnosis: importance of race,poverty, and age.J Health Dispar Res Pract. 2017; 10: 34-45
- Racial/ethnic disparities in time to a breast cancer diagnosis: the mediating effects of health care facility factors.Med Care. 2015; 53: 872-878
- Race, breast cancer subtypes, and survival in the Carolina breast cancer study.JAMA. 2006; 295: 2492-2502
- Absence of an anticipated racial disparity in interval breast cancer within a large health care organization.Ann Epidemiol. 2017; 27: 654-658
- Comorbidity and survival disparities among black and white patients with breast cancer.JAMA. 2005; 294: 1765-1772
- Breast cancer mortality in african-american and non-hispanic white women by molecular subtype and stage at diagnosis: a population-based study.Cancer Epidemiol Biomarkers Prev. 2015; 24: 1039-1045
- Mammographic appearance of breast cancer in African-American women: report of 100 consecutive cases.Acad Radiol. 1998; 5: 2-8
- Molecular classification and molecular forecasting of breast cancer: ready for clinical application?.J Clin Oncol. 2005; 23: 7350-7360
- Age-specific incidence of breast cancer subtypes: understanding the black-white crossover.J Natl Cancer Inst. 2012; 104: 1094-1101
- Breast carcinoma with basal phenotype: mammographic findings.AJR Am J Roentgenol. 2008; 191: 346-351
- Radiological features of triple-negative breast cancers (73 cases).Diagn IntervImaging. 2012; 93: 183-190
- Imaging features of sporadic breast cancer in women under 40 years old: 97 cases.Eur Radiol. 2013; 23: 3237-3245
- Imaging of triple-negative breast cancer.Ann Oncol. 2012; 23: vi23-vi29
- Mammography and ultrasound features of triple-negative breast cancer.Breast Cancer. 2011; 18: 146-151
- Mammographic and ultrasonographic features of triple-negative breast cancer: a comparison with other breast cancer subtypes.Acta Radiol. 2013; 54: 889-894
- Mammographic and clinicopathological features of triple-negative breast cancer.Br J Radiol. 2014; 87: 20130496
- Triple-negative breast cancer: what crucial information can imaging add to the diagnosis, treatment and prognosis?.Int J Womens Health Wellness. 2019; 5
- Is there a correlation between the presence of a spiculated mass on mammogram and luminal a subtype breast cancer?.Korean J Radiol. 2016; 17: 846-852
- Mammographic tumour appearance is related to clinicopathological factors and surrogate molecular breast cancer subtype.Sci Rep. 2020; 10: 20814
- ACR BI-RADS atlas, breast imaging reporting and data system.5th ed. American College of Radiology, Reston VA2013
- The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories.AJR Am J Roentgenol. 1998; 171: 35-40
- BI-RADS for sonography: positive and negative predictive values of sonographic features.AJR Am J Roentgenol. 2005; 184: 1260-1265
- AJCC cancer staging manual.in: Amin MB E.S. Greene F. Byrd D.R. AJCC cancer staging manual. Springer International Publishing, 2017
- Racial disparities in triple negative breast cancer: a review of the role of biologic and non-biologic factors.Front Public Health. 2020; 8576964
- Triple-negative breast cancer in African-American women: disparities versus biology.Nat Rev Cancer. 2015; 15: 248-254
- Differences in prevalence of obesity among black, white, and Hispanic adults - United States, 2006-2008.MMWR Morb Mortal Wkly Rep. 2009; 58: 740-744
- Twenty-five year trends in the incidence of ductal carcinoma in situ in US women.J Am Coll Surg. 2019; 228: 932-939
- Outcomes by race in breast cancer screening with digital breast tomosynthesis versus digital mammography.J Am Coll Radiol. 2021; 18: 906-918
- Tomosynthesis-detected architectural distortion: management algorithm with radiologic-pathologic correlation.Radiographics. 2016; 36: 311-321
- Digital mammography versus breast tomosynthesis: impact of breast density on diagnostic performance in population-based screening.Radiology. 2019; 293: 60-68
- Breast tomosynthesis: what do we know and where do we stand?.Diagn Interv Imaging. 2019; 100: 537-551
- Tumor desmoplastic stroma - its utility as a prognostic marker for breast carcinoma.AnnPatholLabMed. 2019; 6: 496-501
- Ultrasonographic findings of triple-negative breast cancer.Int J Clin Exp Med. 2015; 8: 10040-10043
Article info
Publication history
Published online: November 16, 2022
Accepted:
November 8,
2022
Received in revised form:
October 17,
2022
Received:
July 19,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
