Home mortgage discrimination and incidence of triple-negative and Luminal A breast cancer among non-Hispanic Black and non-Hispanic White females in California, 2006–2015

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Abstract

Purpose

In the United States, Black females are burdened by more aggressive subtypes and increased mortality from breast cancer compared to non-Hispanic (NH) White females. Institutional racism may contribute to these inequities. We aimed to characterize the association between home mortgage discrimination, a novel measure of institutional racism, and incidence of Luminal A and triple-negative breast cancer (TNBC) subtypes among NH Black and NH White females in California metropolitan areas.

Methods

We merged data from the California Cancer Registry on females aged 20 + diagnosed with primary invasive breast cancer between 2006 and 2015 with a census tract-level index of home mortgage lending bias measuring the odds of mortgage loan denial for Black versus White applicants, generated from the 2007–2013 Home Mortgage Disclosure Act database. Poisson regression estimated cross-sectional associations of census tract-level racial bias in mortgage lending with race/ethnicity- and Luminal A and TNBC-specific incidence rate ratios, adjusting for neighborhood confounders.

Results

We identified n = 102,853 cases of Luminal A and n = 15,528 cases of TNBC over the study period. Compared to NH Whites, NH Black females had higher rates of TNBC, lower rates of Luminal A breast cancer, and lived in census tracts with less racial bias in home mortgage lending. There was no evidence of association between neighborhood racial bias in mortgage lending at the time of diagnosis and either subtype among either racial/ethnic group.

Conclusion

Future research should incorporate residential history data with measures of institutional racism to improve estimation and inform policy interventions.

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Most cited references 45

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Breast cancer statistics, 2019

Carol DeSantis, Jiemin Ma, Mia Gaudet … (2019)

This article is the American Cancer Society's biennial update on female breast cancer statistics in the United States, including data on incidence, mortality, survival, and screening. Over the most recent 5-year period (2012-2016), the breast cancer incidence rate increased slightly by 0.3% per year, largely because of rising rates of local stage and hormone receptor-positive disease. In contrast, the breast cancer death rate continues to decline, dropping 40% from 1989 to 2017 and translating to 375,900 breast cancer deaths averted. Notably, the pace of the decline has slowed from an annual decrease of 1.9% during 1998 through 2011 to 1.3% during 2011 through 2017, largely driven by the trend in white women. Consequently, the black-white disparity in breast cancer mortality has remained stable since 2011 after widening over the past 3 decades. Nevertheless, the death rate remains 40% higher in blacks (28.4 vs 20.3 deaths per 100,000) despite a lower incidence rate (126.7 vs 130.8); this disparity is magnified among black women aged <50 years, who have a death rate double that of whites. In the most recent 5-year period (2013-2017), the death rate declined in Hispanics (2.1% per year), blacks (1.5%), whites (1.0%), and Asians/Pacific Islanders (0.8%) but was stable in American Indians/Alaska Natives. However, by state, breast cancer mortality rates are no longer declining in Nebraska overall; in Colorado and Wisconsin in black women; and in Nebraska, Texas, and Virginia in white women. Breast cancer was the leading cause of cancer death in women (surpassing lung cancer) in four Southern and two Midwestern states among blacks and in Utah among whites during 2016-2017. Declines in breast cancer mortality could be accelerated by expanding access to high-quality prevention, early detection, and treatment services to all women.

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Levels of racism: a theoretic framework and a gardener's tale.

Walton Jones (2000)

The author presents a theoretic framework for understanding racism on 3 levels: institutionalized, personally mediated, and internalized. This framework is useful for raising new hypotheses about the basis of race-associated differences in health outcomes, as well as for designing effective interventions to eliminate those differences. She then presents an allegory about a gardener with 2 flower boxes, rich and poor soil, and red and pink flowers. This allegory illustrates the relationship between the 3 levels of racism and may guide our thinking about how to intervene to mitigate the impacts of racism on health. It may also serve as a tool for starting a national conversation on racism.

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Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study.

Lisa A Carey, Charles Perou, Chad A Livasy … (2006)

Gene expression analysis has identified several breast cancer subtypes, including basal-like, human epidermal growth factor receptor-2 positive/estrogen receptor negative (HER2+/ER-), luminal A, and luminal B. To determine population-based distributions and clinical associations for breast cancer subtypes. Immunohistochemical surrogates for each subtype were applied to 496 incident cases of invasive breast cancer from the Carolina Breast Cancer Study (ascertained between May 1993 and December 1996), a population-based, case-control study that oversampled premenopausal and African American women. Subtype definitions were as follows: luminal A (ER+ and/or progesterone receptor positive [PR+], HER2-), luminal B (ER+ and/or PR+, HER2+), basal-like (ER-, PR-, HER2-, cytokeratin 5/6 positive, and/or HER1+), HER2+/ER- (ER-, PR-, and HER2+), and unclassified (negative for all 5 markers). We examined the prevalence of breast cancer subtypes within racial and menopausal subsets and determined their associations with tumor size, axillary nodal status, mitotic index, nuclear pleomorphism, combined grade, p53 mutation status, and breast cancer-specific survival. The basal-like breast cancer subtype was more prevalent among premenopausal African American women (39%) compared with postmenopausal African American women (14%) and non-African American women (16%) of any age (P<.001), whereas the luminal A subtype was less prevalent (36% vs 59% and 54%, respectively). The HER2+/ER- subtype did not vary with race or menopausal status (6%-9%). Compared with luminal A, basal-like tumors had more TP53 mutations (44% vs 15%, P<.001), higher mitotic index (odds ratio [OR], 11.0; 95% confidence interval [CI], 5.6-21.7), more marked nuclear pleomorphism (OR, 9.7; 95% CI, 5.3-18.0), and higher combined grade (OR, 8.3; 95% CI, 4.4-15.6). Breast cancer-specific survival differed by subtype (P<.001), with shortest survival among HER2+/ER- and basal-like subtypes. Basal-like breast tumors occurred at a higher prevalence among premenopausal African American patients compared with postmenopausal African American and non-African American patients in this population-based study. A higher prevalence of basal-like breast tumors and a lower prevalence of luminal A tumors could contribute to the poor prognosis of young African American women with breast cancer.

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Author and article information

Contributors

Eli K. Michaels:

ORCID: http://orcid.org/0000-0001-9209-2560

elikmichaels@berkeley.edu

Journal

Journal ID (nlm-ta): Cancer Causes Control

Journal ID (iso-abbrev): Cancer Causes Control

Title: Cancer Causes & Control

Publisher: Springer International Publishing (Cham )

ISSN (Print): 0957-5243

ISSN (Electronic): 1573-7225

Publication date (Electronic): 3 February 2022

Publication date PMC-release: 3 February 2022

Publication date (Print): 2022

Volume: 33

Issue: 5

Pages: 727-735

Affiliations

[1 ]GRID grid.47840.3f, ISNI 0000 0001 2181 7878, Division of Epidemiology, Berkeley School of Public Health, , University of California, ; 2121 Berkeley Way #5302, Berkeley, CA 94720-7360 USA

[2 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Department of Epidemiology and Biostatistics, , University of California, ; San Francisco, CA USA

[3 ]Greater Bay Area Cancer Registry, San Francisco, CA USA

[4 ]GRID grid.30760.32, ISNI 0000 0001 2111 8460, Division of Epidemiology and Social Sciences, , Institute for Health and Equity, Medical College of Wisconsin, ; Milwaukee, WI USA

[5 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Helen Diller Family Comprehensive Cancer Center, , University of California, ; San Francisco, CA USA

Author information

Eli K. Michaels http://orcid.org/0000-0001-9209-2560

Article

Publisher ID: 1557

DOI: 10.1007/s10552-022-01557-y

PMC ID: 9010391

PubMed ID: 35113296

SO-VID: fbc3cfed-7fd5-4869-ba2f-50e73e608470

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 25 May 2021

Date accepted : 24 January 2022

Funding

Funded by: California Department of Public Health pursuant to California Health and Safety Code Section

Award ID: 103885

Funded by: Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries

Award ID: 5NU58DP006344

Funded by: National Cancer Institute’s Surveillance, Epidemiology and End Results Program

Award ID: HHSN261201800032I

Funded by: National Cancer Institute’s Surveillance, Epidemiology and End Results Program

Award ID: HHSN261201800015I

Award ID: HHSN261201800009I

Funded by: FundRef http://dx.doi.org/10.13039/100009634, Susan G. Komen;

Award ID: GTDR14301469

Award Recipient : Eli K. Michaels

Funded by: National Cancer Institute

Award ID: R01CA214805

Award Recipient : Kirsten M. M. Beyer

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: triple negative breast cancer,tnbc,incidence rates,social environment,neighborhood context,institutional racism

Data availability:

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: triple negative breast cancer, tnbc, incidence rates, social environment, neighborhood context, institutional racism

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Home mortgage discrimination and incidence of triple-negative and Luminal A breast cancer among non-Hispanic Black and non-Hispanic White females in California, 2006–2015

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Abstract

Purpose

Methods

Results

Conclusion

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Karger: Oncology

Most cited references 45

Breast cancer statistics, 2019

Levels of racism: a theoretic framework and a gardener's tale.

Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study.

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Cited by 2

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