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Cancer Causes Control. 2016 May;27(5):627-36. doi: 10.1007/s10552-016-0736-3. Epub 2016 Mar 21.

Mortality risk from comorbidities independent of triple-negative breast cancer status: NCI-SEER-based cohort analysis.

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Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA.
Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
Department of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico, Albuquerque, NM, USA.
Yale School of Public Health, New Haven, CT, USA.
Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, CT, USA.
Helen & Harry Gray Cancer Center, Hartford Hospital, Hartford HealthCare System, Hartford, CT, USA.
The Hospital of Central Connecticut, Hartford HealthCare System, Hartford, CT, USA.
New England Sickle Cell Institute, Department of Medicine and Neag Cancer Center, University of Connecticut Health, Farmington, CT, USA.
Department of Occupational and Environmental Medicine, Yale School of Medicine, New Haven, CT, USA.



A comparatively high prevalence of comorbidities among African-American/Blacks (AA/B) has been implicated in disparate survival in breast cancer. There is a scarcity of data, however, if this effect persists when accounting for the adverse triple-negative breast cancer (TNBC) subtype which occurs at threefold the rate in AA/B compared to white breast cancer patients.


We reviewed charts of 214 white and 202 AA/B breast cancer patients in the NCI-SEER Connecticut Tumor Registry who were diagnosed in 2000-2007. We employed the Charlson Co-Morbidity Index (CCI), a weighted 17-item tool to predict risk of death in cancer populations. Cox survival analyses estimated hazard ratios (HRs) for all-cause mortality in relation to TNBC and CCI adjusting for clinicopathological factors.


Among patients with SEER local stage, TNBC increased the risk of death (HR 2.18, 95 % CI 1.14-4.16), which was attenuated when the CCI score was added to the model (Adj. HR 1.50, 95 % CI 0.74-3.01). Conversely, the adverse impact of the CCI score persisted when controlling for TNBC (Adj. HR 1.49, 95 % CI 1.29-1.71; per one point increase). Similar patterns were observed in SEER regional stage, but estimated HRs were lower. AA/B patients with a CCI score of ≥3 had a significantly higher risk of death compared to AA/B patients without comorbidities (Adj. HR 5.65, 95 % CI 2.90-11.02). A lower and nonsignificant effect was observed for whites with a CCI of ≥3 (Adj. HR 1.90, 95 % CI 0.68-5.29).


comorbidities at diagnosis increase risk of death independent of TNBC, and AA/B patients may be disproportionately at risk.


Breast cancer; Cancer survival disparity; Charlson Co-Morbidity Index; Co-morbidity; TNBC

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