Variation in tumor natural history contributes to racial disparities in breast cancer stage at diagnosis

Nataliya G. Batina, Amy Trentham-Dietz, Ronald E. Gangnon, Brian L. Sprague, Marjorie A. Rosenberg, Natasha K. Stout, Dennis G. Fryback, Oguzhan Alagoz*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Black women tend to be diagnosed with breast cancer at a more advanced stage than whites and subsequently experience elevated breast cancer mortality. We sought to determine whether there are racial differences in tumor natural history that contribute to these disparities. We used the University of Wisconsin Breast Cancer Simulation Model, a validated member of the National Cancer Institute's Cancer Intervention and Surveillance Modeling Network, to evaluate the contribution of racial differences in tumor natural history to observed disparities in breast cancer incidence. We fit eight natural history parameters in race-specific models by calibrating to the observed race- and stage-specific 1975-2000 U.S. incidence rates, while accounting for known racial variation in population structure, underlying risk of breast cancer, screening mammography utilization, and mortality from other causes. The best fit models indicated that a number of natural history parameters must vary between blacks and whites to reproduce the observed stage-specific incidence patterns. The mean of the tumor growth rate parameter was 63.6 % higher for blacks than whites (0.18, SE 0.04 vs. 0.11, SE 0.02). The fraction of tumors considered highly aggressive based on their tendency to metastasize at a small size was 2.2 times greater among blacks than whites (0.41, SE 0.009 vs. 0.019, SE 0.008). Based on our simulation model, breast tumors in blacks grow faster and are more likely to metastasize earlier than tumors in whites. These differences suggest that targeted prevention and detection strategies that go beyond equalizing access to mammography may be needed to eliminate breast cancer disparities.

Original languageEnglish (US)
Pages (from-to)519-528
Number of pages10
JournalBreast Cancer Research and Treatment
Issue number2
StatePublished - Apr 2013
Externally publishedYes


  • Black women
  • Breast cancer natural history
  • Racial disparities
  • Simulation model
  • White women

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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