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Breast

E90: Triple-Negative Breast Cancer in Young Black Women

Introduction: Triple-negative breast cancer (TNBC) accounts for 40-50% of cancers in young Black women. Historically, Black race has been associated with poor prognosis in breast cancer; whether age contributes to worse clinical outcomes in the setting of an aggressive molecular subtype is unclear. We sought to examine factors associated with overall survival (OS) and breast cancer-specific survival (BCSS) in Black women with TNBC at our institution.

Methods: A retrospective review of an institutional database identified Black women with operable TNBC from 2005-2020. Clinicopathologic, treatment, and outcomes variables in women < 40 and ≥ 40 years of age were compared using Cox proportional hazard models. The Kaplan-Meier method was used to estimate OS and BCSS.

Results: We identified 397 Black women with a median age of 55 years (range 23-88); 39 (9.8%) were age < 40 years and 358 (90%) were age ≥ 40 years. Median tumor size was larger in younger women (3 cm vs 2 cm; p = 0.01). Younger women were more likely to be diagnosed because of a physical finding than with imaging (p < 0.001), have a BRCA mutation (p < 0.001), and present at a more advanced clinical stage (p = 0.004) (Table). Compared to women age ≥ 40 years, those age < 40 years were more likely to receive mastectomy (62% vs 31%; p < 0.001), neoadjuvant chemotherapy (46% vs 27%; p = 0.05), and postmastectomy radiation with and without nodal irradiation (15% and 10% vs 13% and 4%; p = 0.008). On multivariable analysis, presence of lymphovascular invasion (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.07-3.07; p = 0.03), positive node status (HR 2.95, 95% CI 1.49-5.86, p = 0.002), extracapsular extension (HR 2.75, 95% CI 1.53-4.93, p < 0.001), and clinical stage 3 disease (HR 5.32, 95% CI 2.24-12.6, p < 0.001) were associated with worse BCSS, but not associated with age. At a median follow-up of 6.2 years, the 5-year OS and BCSS rates were 81.2% and 84%, respectively, in women age < 40 years, and 80.9% and 85.3% in those age ≥ 40 years.

Conclusions: Black women age < 40 years with TNBC in our study were more likely to present with physical findings and more advanced stage of disease, requiring more aggressive locoregional and systemic treatment compared to women age > 40 years. Young age at diagnosis was not an independent predictor of outcome, and was associated with higher stage of disease. The advanced nature of disease at presentation highlights the need to improve strategies to increase awareness in young Black women at risk for this aggressive subtype of breast cancer.

Learning Objectives:

  • Identify if age is associated with outcomes in Black women with triple-negative breast cancer
  • Summarize characteristics and outcomes of triple-negative breast cancer in Black women
  • Identify factors associated with survival in Black women with triple-negative breast cancer