Eva Rubin MD, Presenter: Nothing to Disclose

To determine whether there are differences between African-American and Caucasian women in presentation, age, risk factors, type cancers, use of MRI for staging, surgical treatment and reconstruction, and outcome.

291 patients with a cancer diagnosis made by percutaneous biopsy in 2007 and 2008 analyzed. 36 exclusions including 2 Asian women, 4 women with unknown ethnicity, and 30 women with unavailable mammograms. The final dataconsists of 79 African-American and 176 Caucasian women. Information on patient age at diagnosis, screen-detected vs symptomatic, breast density, reproductive factors, type cancers, MRI use for staging, surgical treatment chosen and use of reconstruction was tabulated.

Median age of was 55 AA (range 39-89) and 63 W (range 37-103). Cancers were less likely to be screen-detected in AA women (60.8% vs. 73.9%). Breast densities were significantly different: BIRADS 1 + 2 (89.9 % in AA women, 66.5% in W women). DCIS (32.9%) in AA and 25.6% W. Invasive lobular cancers represented 3.8% cancers in AA women vs. 13.% in W. Invasive tumors were more often high grade in AA women (47.2% vS.23.7%). Triple-negative cancers 24.5% invasive cancers AA and 13.7% W. Node-positive in 32.1% AA and 21.4% W. The percentage of cancer-associated calcifications was the same in both groups (40.5 % AA vs. 38.1% W). MRI use was similar 58.2% in AA and 52.3% in W . AA women with BC were more likely to be nulliparous than W women (12.9 vs. 6.7%) or multiparous--4 or more children in (60.7%) of AA parous women and (13.7 %) of W. Mastectomy rates were higher in AA women (49.2% ) than W women (38.5%) and reconstruction rates were lower (22.6 vs. 40%).

Disparities were observed in screen detection, mastectomy rates, and use of reconstruction --although use of MRI did not differ. Expected differences in tumor biology were present--younger age at diagnosis, increased prevalence of high grade and node-positive cancers, and significantly higher percentage of triple negative cancers. Significant differences in the prevalence of fatty breasts in the AA population may allow improved detectability of cancer in AA women, particularly since 40.5% of the cancers were associated with microcalcifications.

Lowering the age of initiation of screening makes sense in AA women. Enhanced scrutiny for presence of calcifications is also recommended.

Rubin, E, Breast Cancer Imaging in African-American Women: A Comparison Study.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12036721.html