{"entity":{"id":"paper-carey-race-breast-cancer-subtypes-cbcs-jama-2006","kind":"paper","name":"Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study","aka":[],"tldr":"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.","asOf":"2026-09-24","links":[{"label":"JAMA 2006","url":"https://doi.org/10.1001/jama.295.21.2492"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/16757721/"}],"tags":["tnbc-evidence"],"related":["paper-foulkes-brca1-basal-phenotype-jnci-2003","paper-copson-posh-ethnicity-young-breast-cancer-uk-bjc-2014"],"cancers":["tnbc"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["unc-lineberger"],"pathways":[],"terms":["ihc"],"trials":[],"people":["charles-perou"],"bottlenecks":["b-trial-diversity"],"keyPapers":[],"journals":["jama"],"dependsOn":[],"notes":[],"journal":"JAMA","year":2006,"doi":"10.1001/jama.295.21.2492","pmid":"16757721","authors":"Carey LA, Perou CM, Livasy CA, et al.","paperType":"observational","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."],"whatItMeans":"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."],"changedPractice":true,"participants":496},"route":"/key-papers/paper-carey-race-breast-cancer-subtypes-cbcs-jama-2006/","neighbours":{"paper":[{"id":"paper-bauer-triple-negative-california-registry-cancer-2007","kind":"paper","name":"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","route":"/key-papers/paper-bauer-triple-negative-california-registry-cancer-2007/"},{"id":"paper-copson-posh-ethnicity-young-breast-cancer-uk-bjc-2014","kind":"paper","name":"Ethnicity and outcome of young breast cancer patients in the United Kingdom: the POSH study","route":"/key-papers/paper-copson-posh-ethnicity-young-breast-cancer-uk-bjc-2014/"},{"id":"paper-foulkes-brca1-basal-phenotype-jnci-2003","kind":"paper","name":"Germline BRCA1 mutations and a basal epithelial phenotype in breast cancer","route":"/key-papers/paper-foulkes-brca1-basal-phenotype-jnci-2003/"}],"cancer":[{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"institution":[{"id":"unc-lineberger","kind":"institution","name":"UNC Lineberger Comprehensive Cancer Center","route":"/institutions/unc-lineberger/"}],"term":[{"id":"ihc","kind":"term","name":"Immunohistochemistry (IHC)","route":"/terms/ihc/"}],"person":[{"id":"charles-perou","kind":"person","name":"Charles M. Perou","route":"/people/charles-perou/"}],"bottleneck":[{"id":"b-trial-diversity","kind":"bottleneck","name":"Trials do not represent the people who get cancer","route":"/bottlenecks/b-trial-diversity/"}],"journal":[{"id":"jama","kind":"journal","name":"JAMA","route":"/journals/jama/"}],"roadmap":[{"id":"tnbc-roadmap","kind":"roadmap","name":"Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem","route":"/roadmaps/tnbc-roadmap/"}],"idea":[{"id":"idea-tnbc-disparities-in-access-and-outcomes","kind":"idea","name":"Close the gap between who gets triple-negative breast cancer and who is in its trials","route":"/ideas/idea-tnbc-disparities-in-access-and-outcomes/"}]}}