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

Source: https://onco.cc/key-papers/paper-carey-race-breast-cancer-subtypes-cbcs-jama-2006/  
OnCo record `paper-carey-race-breast-cancer-subtypes-cbcs-jama-2006` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2006 North Carolina study that found the basal-like subtype in 39 percent of breast cancers in premenopausal African American women against 16 percent in other women, offering a biological reason for the worse survival of young Black women with breast cancer.

## Summary

Carey, Perou, Livasy, Dressler and colleagues applied immunohistochemical surrogates for the gene-expression subtypes to 496 incident invasive breast cancers from the population-based Carolina Breast Cancer Study (1993 to 1996), which oversampled premenopausal and African American women. Basal-like was defined as oestrogen receptor-, progesterone receptor- and HER2-negative with cytokeratin 5/6 and/or HER1 positivity. The basal-like subtype was more prevalent among premenopausal African American women (39 percent) than postmenopausal African American women (14 percent) or non-African American women of any age (16 percent; p<0.001), and luminal A less prevalent (36 versus 59 and 54 percent). Compared with luminal A, basal-like tumours had more TP53 mutations (44 versus 15 percent), higher mitotic index (odds ratio 11.0), more nuclear pleomorphism (9.7) and higher grade (8.3). Breast cancer-specific survival differed by subtype, shortest for HER2-positive/oestrogen receptor-negative and basal-like tumours.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: tnbc-evidence
- Journal: JAMA
- Year: 2006
- DOI: 10.1001/jama.295.21.2492
- Authors: Carey LA, Perou CM, Livasy CA, et al.
- Findings: Basal-like prevalence 39 percent in premenopausal African American women vs 14 percent postmenopausal African American and 16 percent non-African American women (p<0.001).; Basal-like vs luminal A: TP53 mutation 44 vs 15 percent; mitotic index odds ratio 11.0; grade odds ratio 8.3.; Shortest breast cancer-specific survival in HER2-positive/oestrogen receptor-negative and basal-like subtypes.
- What it means: The paper that made race a biological as well as a social variable in triple-negative breast cancer, and the reason the US disparity is described as roughly twice the incidence in Black women; the UK POSH study later found a smaller but real excess.
- Caveats: Immunohistochemical surrogate for basal-like, not gene expression.; Ancestry, socioeconomic and reproductive factors are entangled; the study cannot separate them.

## Sources

- JAMA 2006: https://doi.org/10.1001/jama.295.21.2492
- PubMed: https://pubmed.ncbi.nlm.nih.gov/16757721/

## Connected records

- key papers: [Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer Registry](https://onco.cc/key-papers/paper-bauer-triple-negative-california-registry-cancer-2007/), [Ethnicity and outcome of young breast cancer patients in the United Kingdom: the POSH study](https://onco.cc/key-papers/paper-copson-posh-ethnicity-young-breast-cancer-uk-bjc-2014/), [Germline BRCA1 mutations and a basal epithelial phenotype in breast cancer](https://onco.cc/key-papers/paper-foulkes-brca1-basal-phenotype-jnci-2003/)
- cancers: [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- institutions: [UNC Lineberger Comprehensive Cancer Center](https://onco.cc/institutions/unc-lineberger/)
- terms: [Immunohistochemistry (IHC)](https://onco.cc/terms/ihc/)
- people: [Charles M. Perou](https://onco.cc/people/charles-perou/)
- bottlenecks: [Trials do not represent the people who get cancer](https://onco.cc/bottlenecks/b-trial-diversity/)
- journals: [JAMA](https://onco.cc/journals/jama/)
- roadmaps: [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/)
- ideas: [Close the gap between who gets triple-negative breast cancer and who is in its trials](https://onco.cc/ideas/idea-tnbc-disparities-in-access-and-outcomes/)

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