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Characterizing inflammatory breast cancer among Arab Americans in the California, Detroit and New Jersey Surveillance, Epidemiology and End Results (SEER) registries (1988–2008)

Kelly A Hirko12*, Amr S Soliman3, Mousumi Banerjee4, Julie Ruterbusch5, Joe B Harford6, Robert M Chamberlain17, John J Graff8, Sofia D Merajver129 and Kendra Schwartz10

Author Affiliations

1 Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA

2 Center for Global Health, University of Michigan, Ann Arbor, MI, 48104, USA

3 Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE, 68198-4395, USA

4 Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA

5 Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA

6 Department of Health and Human Services, Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA

7 Dept. of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

8 Department of Radiation Oncology, Cancer Institute of New Jersey - Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA

9 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA

10 Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA

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SpringerPlus 2013, 2:3  doi:10.1186/2193-1801-2-3

Published: 7 January 2013

Abstract

Introduction

Inflammatory breast cancer (IBC) is characterized by an apparent geographical distribution in incidence, being more common in North Africa than other parts of the world. Despite the rapid growth of immigrants to the United States from Arab nations, little is known about disease patterns among Arab Americans because a racial category is rarely considered for this group. The aim of this study was to advance our understanding of the burden of IBC in Arab ethnic populations by describing the proportion of IBC among different racial groups, including Arab Americans from the Detroit, New Jersey and California Surveillance, Epidemiology and End Results (SEER) registries.

Methods

We utilized a validated Arab surname algorithm to identify women of Arab descent from the SEER registries. Differences in the proportion of IBC out of all breast cancer and IBC characteristics by race and menopausal status were evaluated using chi-square tests for categorical variables, t-tests and ANOVA tests for continuous variables, and log-rank tests for survival data. We modeled the association between race and IBC among all women with breast cancer using hierarchical logistic regression models, adjusting for individual and census tract-level variables.

Results

Statistically significant differences in the proportion of IBC out of all breast cancers by race were evident. In a hierarchical model, adjusting for age, estrogen and progesterone receptor, human epidermal growth receptor 2, registry and census-tract level education, Arab-Americans (OR=1.5, 95% CI=1.2,1.9), Hispanics (OR=1.2, 95% CI=1.1,1.3), Non-Hispanic Blacks (OR=1.3, 95% CI=1.2, 1.4), and American Indians/Alaskans (OR=1.9, 95% CI=1.1, 3.4) had increased odds of IBC, while Asians (OR=0.6, 95% CI=0.6, 0.7) had decreased odds of IBC as compared to Non-Hispanic Whites.

Conclusions

IBC may be more common among certain minority groups, including Arab American women. Understanding the descriptive epidemiology of IBC by race may generate hypotheses about risk factors for this aggressive disease. Future research should focus on etiologic factors that may explain these differences.

Keywords:
Inflammatory breast cancer; Arab; Race; Hierarchical logistic regression