The Will Rogers Phenomenon, Breast Cancer and Race

Abstract

Background: There are very few studies demonstrating Will Roger's phenomenon [WRP] in breast cancer [BC] especially among African Americans [AA]. We hypothesize that WRP’s existence in BC, including among AA’s. In this retrospective patient cohort with a sizeable AA population, the presence of WRP is investigated.

Methods: This is a retrospective analysis of 300 BC women (2007- 2017) at an academic medical center. Overall survival [OS] and disease-free survival [DFS], estimated by Kaplan-Meier analysis. Bi and multi-variate Cox regression analyses, used to identify racial factors associated with outcomes.

Findings: Our patient cohort included 30.3%Caucasians [C] and 69.7%AA. Stages I, II, III, and IV were 46.2%, 26.3%, 23.1%, and 4.4% of C; 28.7%, 43.1%, 24.4%, and 3.8% of AA respectively, in anatomic staging (p=0.043). In prognostic staging, 52.8%, 18.7%, 23%, and 5.5% were C while 35%, 17.2%, 43.5%, and 4.3% were AA, respectively (p=0.011).A total of C (45.05% vs. 47.85%) AA, upstaged. C (16.49% vs. 14.35%) AA, down-staged. Remaining, 38.46% and 37.79% patients had their stages unchanged.With a median follow-up of 54 months, the AA patients showed better stage-by-stage 5-year OS rates using 8^th edition compared to the 7^th edition (p=0.000). Among the C, those who were stage IIIA in the 7^th but became stage IB in the 8^th had a better prognosis than stages IIA and IIB in the 8^th (p=0.000). The 8^th showed complex results (p=0.176) compared to DFS estimated using the 7^th’s (p=0.004).

Interpretation: The WRP exists with significant variability in the move from the AJCC 7^th to the 8^th edition in BCS (both C and AA patients). We suggest that caution needs to be exercised when results are compared across staging systems to account for the WRP in the interpretation of the data.

Funding: This research did not receive specific grant from any funding agencies.

Declaration of Interests: There is no conflict of interest present for authors relative to this case
report.

Ethics Approval Statement: Institutional review board approval (IRB #2018-0218) obtained and a browser-based database tool, research electronic data capture (RedCap) was used to gather and store the patient's information in password-protected computers. The written consent was waived due to the retrospective nature of the study and patient identifiers were removed before extracting the data.