Statin Use and Breast Cancer Prognosis in Black and White Women

Presentation Number: SH04-5
Date of Presentation: April 3rd, 2017

Amanda Leiter*1, Nina Bickell2, Derek LeRoith2, Kezhen Fei3, Rebeca Franco4 and Emily Jane Gallagher2
1Icahn School of Medicine at Mount Sinai, 2Icahn School of Medicine at Mount Sinai, New York, NY, 3Icahn School of Medicine at Mount Sinai, New York, NY, 4Icahn School of Medicine, New York, NY

Abstract

Background: Studies show decreased risk of breast cancer recurrence and improved survival with statin use. Black women are more likely than White women to have breast cancer with poor prognostic features, which cannot be completely explained by differences in screening, treatment, and established risk factors for breast cancer mortality. Additionally, Black women have higher rates of obesity and dyslipidemia.

Hypothesis: We hypothesized statin use may mediate the relationship between race and breast cancer prognosis in Black and White women with new primary breast cancer diagnosis.

Methods: We prospectively identified 587 women (487 White, 100 Black) with newly diagnosed primary invasive breast cancer from multiple medical centers at the time of their breast cancer surgery. We excluded women with known diabetes. Fasting lipids and glucose were obtained just before surgery. Participants were surveyed regarding socio-demographic characteristics, medical comorbidities, medications, and access to care. Blood pressure, weight, height, and waist circumference were recorded at the initial study visit. Final pathology reports with tumor characteristics (receptors, size, grade) were obtained. We calculated the Nottingham prognostic index (NPI), with participants’ categorized by prognosis: better (NPI ≤ 4.4) and worse (NPI>4.4). We compared statin use, anthropometric and socio-demographic characteristics using the Chi-square test (categorical variables) or t-test (continuous variables) according to race (Black vs White) and prognosis (better vs worse). We used multivariate logistic regression to control for confounders.

Results: Black women were more likely to be obese (47% vs 19%, p<0.01), have lower HDL (61±16 vs 69±19, mg/dl, p<0.01), lower triglycerides (TG) (87±37 vs 100±91 mg/dl, p=0.03), similar LDL (113±41 vs 113±36 mg/dl, p=0.90), and have triple negative receptor disease (14% vs 7%, p=0.02) when compared to White women. Women with worse prognosis were more likely to be Black (27% vs 15.4%, p=0.009), obese (BMI≥30, 23% vs 16%, p=0.07), pre-menopausal (21% vs 14%, p=0.02) and have a near significant association with LDL (107±38 vs 115±37 mg/dl, p=0.06) compared to women with a better prognosis. Black women were more likely than white women to use statins (18% vs 11%; p=0.07). Statin use was not associated with prognosis in unadjusted (18% vs 17%, p=0.90), adjusted (OR 1.14, 95% CI 0.56-2.31), and stratified models. Black race was associated with poor prognosis in the adjusted model (OR 2.13 95% CI 1.23-3.67) adjusting for age, LDL, menopausal status, metabolic syndrome and health care access.

Conclusions: In a population of women with newly diagnosed breast cancer, black women have worse prognosis than White women which could not be explained by differences in statin use.

 

Nothing to Disclose: AL, NB, DL, KF, RF, EJG