Dairy, calcium, vitamin D and ovarian cancer risk in African-American women

BACKGROUND

No previous study has evaluated the associations of dairy products, lactose, calcium and vitamin D with the risk of ovarian cancer in African-American women, who are known to have high mortality from the disease, as well as to be at risk for calcium and vitamin D deficiency.

METHODS

We evaluated these associations among 490 ovarian cancer cases and 656 age- and site-matched controls of African-American descent recruited into the African American Cancer Epidemiology Study, a population-based case-control study in 11 geographical areas in the US. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

An increased ovarian cancer risk was observed for whole milk consumption and lactose intake (highest quartile vs lowest: OR=1.97, 95% CI: 1.25-3.10;P-trend: 0.008). Calcium intake was associated with a decreased risk of ovarian cancer (OR=0.51, 95 CI%: 0.30-0.86; P-trend: 0.009), but vitamin D intake was not. Longer sun exposure in summer months was found to predict a lower risk (OR=0.71, 95% CI: 0.51-0.99; P-trend: 0.049).

CONCLUSIONS

Our findings suggest that a high-calcium, low-lactose diet, and sun exposure in summer months may reduce the risk of ovarian cancer in African-American women.

Socioeconomic Status in Relation to the Risk of Ovarian Cancer in African-American Women: A Population-Based Case-Control Study

We investigated the association between socioeconomic status and ovarian cancer in African-American women. We used a population-based case-control study design that included case patients with incident ovarian cancer (n = 513) and age- and area-matched control participants (n = 721) from 10 states who were recruited into the African American Cancer Epidemiology Study from December 2010 through December 2014. Questionnaires were administered via telephone, and study participants responded to questions about several characteristics, including years of education, family annual income, and risk factors for ovarian cancer. After adjustment for established ovarian cancer risk factors, women with a college degree or more education had an odds ratio of 0.71 (95% confidence interval (CI): 0.51, 0.99) when compared with those with a high school diploma or less (P for trend = 0.02); women with family annual incomes of $75,000 or more had an odds ratio of 0.74 (95% CI: 0.47, 1.16) when compared with those with incomes less than $10,000 (P for trend = 0.055). When these variables were dichotomized, compared with women with a high school diploma or less, women with more education had an adjusted odds ratio of 0.72 (95% CI: 0.55, 0.93), and compared with women with an income less than $25,000, women with higher incomes had an adjusted odds ratio of 0.86 (95% CI: 0.66, 1.12). These findings suggest that ovarian cancer risk may be inversely associated with socioeconomic status among African-American women and highlight the need for additional evidence to more thoroughly characterize the association between socioeconomic status and ovarian cancer.

Reproductive factors and ovarian cancer risk in African-American women

PURPOSE

Reproductive characteristics, the most established ovarian cancer risk factors, differ markedly between African-American and white women. Studies in predominantly white populations suggest that associations between reproductive characteristics and ovarian cancer vary by timing of the events and menopause status. This analysis examined associations between number, duration, and timing of reproductive events and epithelial ovarian cancer among African-American women.

METHODS

Data from a multicenter case-control study of ovarian cancer in African-American women (641 cases/752 controls) were used to examine associations with oral contraceptive (OC) use and pregnancy characteristics. Odds ratios (ORs) and 95% confidence intervals (CIs) associated with reproductive characteristics were calculated with logistic regression models.

RESULTS

OC use (OR = 0.7, 95% CI 0.5-0.9), parity (OR = 0.5, 95% CI 0.3-0.6), and breastfeeding for >12 months (OR = 0.3, 95% CI 0.2-0.5) were inversely associated with ovarian cancer. More recent pregnancies and OC use had stronger associations with ovarian cancer than pregnancies or OC use that occurred earlier in life, especially among premenopausal women.

CONCLUSIONS

This study provides the first thorough documentation that pregnancy, breastfeeding, and OC use are inversely associated with ovarian cancer in African-American women, similar to what has been observed in white women. The associations with timing of the exposures suggest that these factors have both short- and long-term effects.

Abstract 3407: Gene expression subtypes of high grade serous ovarian cancer in African American women

Ovarian cancer accounts for 5% of cancer deaths and is the fifth leading cause of cancer death in women in the United States. While incidence is higher in European American (EA) than African American (AA) women, five-year survival is worse for AA women (36%) than EA women (44%). Access to appropriate surgery and treatment is a major contributor but does not completely explain this disparity. The Cancer Genome Atlas (TCGA) identified four gene expression-based subtypes of the most common and lethal histotype, high grade serous carcinoma (HGSC): mesenchymal, proliferative, differentiated, and immunoreactive. We sought to characterize similarities and differences in gene expression-based subtypes arising in AA and EA women to determine whether there are underlying biologic features that may influence survival. We performed two distinct analyses, first using TCGA data and second using cases from the population-based African American Cancer Epidemiology Study (AACES). For both we summarized differential expression patterns for each subtype with moderated t statistic vectors for >10,000 genes using Significance Analysis of Microarrays. We calculated Pearson's correlations of these vectors to determine concordance of expression patterns between subtypes across EA and AA women. In TCGA, we observed correlations of subtype-specific expression patterns between the 24 AA and 475 EA tumors of 0.52-0.60 for each of the four subtypes. Thus, while analogous subtypes can be identified in AA and EA women, the magnitude of these correlations suggests that there are potential differences in gene expression patterns between AA and EA tumors that are assigned to the same subtype. We generated additional data from 58 AACES HGSC cases using the Affymetrix Human Transcriptome Array 2.0. Instead of assigning these tumors to previously-defined subtypes, we clustered samples to identify four subtypes de novo. We observed concordance with two of the TCGA subtypes; correlations for the mesenchymal-like and proliferative-like subtypes were 0.56-0.65. The mesenchymal-like subtype was more common in these AA women than in the TCGA EA women (33% versus 25%), and the proliferative-like subtype was marginally less common (14% versus 19%). Concordance for the differentiated-like subtype was considerably lower, at 0.21, and this subtype was less common in AA than EA women (19% versus 34%). Another subtype comprising 34% of the AA samples was only weakly correlated (-0.21-0.10) with any of the TCGA subtypes, suggesting that it is a novel subtype. The limited data available on HGSC in AA women suggest that at least two subtypes are comparable to those in EA women but differ in prevalence, and that there may be a novel subtype in AA women that does not strongly correspond to those described in EA women.

Citation Format: Jennifer A. Doherty, Casey S. Greene, James E. Rudd, Laura J. Tafe, Anthony J. Alberg, Elisa V. Bandera, Jill Barnholtz-Sloan, Melissa Bondy, Michele L. Cote, Ellen Funkhouser, Patricia G. Moorman, Edward S. Peters, Ann G. Schwartz, Paul Terry, Rex Bentley, Andrew Berchuck, Jeffrey R. Marks, Joellen M. Schildkraut. Gene expression subtypes of high grade serous ovarian cancer in African American women. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3407.

Abstract 3446: Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and the risk of glioma: Results from the Glioma International Case Control Study

Background: Numerous epidemiologic studies have examined the association between aspirin (ASA), non-steroid anti-inflammatory drugs (NSAIDs) and the development of glioma, but the results have been inconsistent. The goal of this study was to evaluate the relationship between the intake of these drugs and glioma risk in a large, international case-control study.

Methods: Between 2010 and 2015, the Glioma International Case-Control Study (GICC) recruited newly diagnosed glioma cases and matched controls in 14 different sites across five countries. Each subject was interviewed using a standardized questionnaire to obtain NSAIDs and ASA use. We examined the associations between ever use (at least > 6 months), duration of drug use and glioma histology. Ever use data on 4533 glioma cases and 4171 controls was combined using maximum likelihood estimation/restricted maximum likelihood meta-analysis methods. Furthermore, based on a priori hypotheses, we performed subgroup analyses based on gender and glioma histological grades.

Results: Use of ASA for > 6 months was associated with a 33% lower glioma risk compared to those who never took it (adjusted Meta-OR 0.67, 95% CI 0.54-0.83). Duration of intake showed a significant trend test (p < 0.0001), with ORs became lower for increasing number of years of ASA use. In subgroup analyses, intake of ASA was significantly associated with glioma risk in both men and women (adjusted Meta-OR = 0.65, 95% CI 0.51-0.84 for men; adjusted Meta-OR = 0.74, 95% CI 0.58-0.93 for women). ASA intake was protective for grade IV glioma (glioblastoma) and grade II/III glioma (adjusted meta-OR 0.63, 95% CI 0.5-0.8 for glioblastoma; adjusted meta-OR 0.67, 95% CI 0.50 - 0.89 for grade II/III glioma). For NSAIDs intake, ever use > 6 months was not associated with glioma risk (adjusted meta-OR 0.87, 95% CI 0.71-1.07). However, NSAIDs use was protective for women (adjusted meta-OR 0.72, 95% CI 0.55-0.93) in subgroup analyses but not for men (adjusted meta-OR 1.03; 95% CI 0.86-1.23). The interaction between gender, NSAIDs and glioma risk was significant (p-value 0.0076).. Sensitivity analyses excluding those who took ASA or NSAIDs within the past 12 months for headache, and the removal of proxy respondents did not change our results.

Conclusion: ASA was associated with a significant protective effect for glioma, but NSAIDs were only associated with reduced glioma risk in women. Given the possibility of recall bias in case-control studies of brain tumors, we may verify dosage and duration of drug intake in those countries with electronic pharmacy records within the GICC.

Citation Format: Rose K. Lai, Renke Zhou, E. Susan Amirian, Christoffer Johansen, Michael E. Scheurer, Georgina N. Armstrong, Ching C. Lau, Elizabeth B. Claus, Jill S. Barnholtz-Sloan, Dora Il’yasova, Joellen Schildkraut, Francis Ali-Osman, Siegal Sadetzki, Richard Houlston, Robert B. Jenkins, Daniel Lachance, Sara H. Olson, Jonine L. Bernstein, Ryan T. Merrell, Margaret R. Wrensch, Faith G. Davis, Sanjay Shete, Christopher I. Amos, Beatrice S. Melin, Melissa Bondy. Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and the risk of glioma: Results from the Glioma International Case Control Study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3446.

Abstract 1754: Body powder use and ovarian cancer: the African American Cancer Epidemiology Study

Findings of epidemiologic studies indicate an increased risk of ovarian cancer among women who use powders applied to perineal areas. Although African American (AA) women have a high prevalence of powder use, this relationship has not been thoroughly investigated in this group of women. The objective of the present study was to evaluate the relationship between use of genital and non-genital powder in invasive epithelial ovarian cancer (EOC). Subjects are women enrolled in the African American Epidemiology Cancer Study (AACES), an ongoing, population-based case-control study of EOC in AA women in 11 geographic locations in the U.S. Newly diagnosed EOC cases were identified by SEER and state cancer registries, gynecologic oncology departments or hospitals, and were between the ages of 20-79 years. AA controls were identified through random digit dialing and frequency matched to cases on state of residence and five year age groups. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between genital powder and non-genital powder exposure and risk of EOC, while controlling for several confounders, including age at diagnosis/interview, study site, education, tubal ligation, parity, BMI, duration of oral contraceptive use, first degree family history of breast or ovarian cancer, and interview year. Due to experimental models suggesting a relationship with inert particulates and estrogen, we also examined potential effect modification of this relationship by hormone therapy use among postmenopausal women. Body powder use was common in this study population (62.8% of cases and 52.9% of controls). Any genital powder use was associated with a 44% increased risk of EOC (OR = 1.44, 95% CI = 1.11-1.86) and a dose-response relationship was present for duration of body powder use applied to genital areas, p<0.05. A 31% increased EOC risk was observed for non-genital powder use (OR = 1.31, 95% CI = 0.95-1.79), and this relationship was strongest among non-serous cases (OR = 2.28, 95% CI = 1.39-3.74). Although not statistically significant, hormone therapy may be a potential modifier of the effect of body powder use on EOC risk. Among ever users of hormone therapy, any genital powder use was associated with over a 2-fold increase in risk (OR = 2.68, 95% CI = 1.33-5.40), while an OR of 1.24 (95% CI = 0.87-1.79) was present for never users of hormone therapy. Having an upper respiratory condition was associated with both genital and non-genital powder use suggesting a systemic inflammatory response may explain the associations we observed with EOC for non-genital powder use. In conclusion, body powder use was prevalent among AA women and strongly associated with EOC risk.

Citation Format: Lauren C. Peres, Sarah E. Abbott, Anthony J. Alberg, Elisa V. Bandera, Jill Barnholtz-Sloan, Melissa Bondy, Michele L. Cote, Ellen Funkhouser, Edward S. Peters, Ann G. Schwartz, Paul D. Terry, Sydnee Crankshaw, Fabian Camacho, Frances Wang, Patricia G. Moorman, Joellen M. Schildkraut. Body powder use and ovarian cancer: the African American Cancer Epidemiology Study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1754.

Semiparametric model for semi-competing risks data with application to breast cancer study

For many forms of cancer, patients will receive the initial regimen of treatments, then experience cancer progression and eventually die of the disease. Understanding the disease process in patients with cancer is essential in clinical, epidemiological and translational research. One challenge in analyzing such data is that death dependently censors cancer progression (e.g., recurrence), whereas progression does not censor death. We deal with the informative censoring by first selecting a suitable copula model through an exploratory diagnostic approach and then developing an inference procedure to simultaneously estimate the marginal survival function of cancer relapse and an association parameter in the copula model. We show that the proposed estimators possess consistency and weak convergence. We use simulation studies to evaluate the finite sample performance of the proposed method, and illustrate it through an application to data from a study of early stage breast cancer.

Mode of Delivery in Premature Neonates: Does It Matter?

OBJECTIVE

Despite the current prevalence of preterm births, no clear guidelines exist on the optimal mode of delivery. Our objective was to investigate the effects of mode of delivery on neonatal outcomes among premature infants in a large cohort.

STUDY DESIGN

We applied a retrospective cohort study design to a database of 6,408 births. Neonates were stratified by birth weight and a composite score was calculated to assess neonatal outcomes. The results were then further stratified by fetal exposure to antenatal steroids, birth weight, and mode of delivery.

RESULTS

No improvement in neonatal outcome with cesarean delivery (CD) was noted when subjects were stratified by mode of delivery, both in the presence or absence of antenatal corticosteroid administration. In the 1,500 to 1,999 g subgroup, there appears to be an increased risk of respiratory distress syndromes in neonates born by CD.

CONCLUSION

In our all-comers cohort, replicative of everyday obstetric practice, CD did not improve neonatal outcomes in preterm infants.

Obesity, weight gain, and ovarian cancer risk in African American women

Although there is growing evidence that higher adiposity increases ovarian cancer risk, little is known about its impact in African American (AA) women, the racial/ethnic group with the highest prevalence of obesity. We evaluated the impact of body mass index (BMI) 1 year before diagnosis and weight gain since age 18 years on ovarian cancer risk in a population-based case-control study in AA women in 11 geographical areas in the US. Cases (n = 492) and age and site matched controls (n = 696) were identified through rapid case ascertainment and random-digit-dialing, respectively. Information was collected on demographic and lifestyle factors, including self-reported height, weight at age 18 and weight 1 year before diagnosis/interview. Multivariable logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CI), adjusting for potential covariates. Obese women had elevated ovarian cancer risk, particularly for BMI ≥ 40 kg/m(2) compared to BMI <25 (OR = 1.72, 95% CI: 1.12-2.66; p for trend: 0.03). There was also a strong association with weight gain since age 18 (OR: 1.52; 95% CI: 1.07-2.16; p for trend: 0.02) comparing the highest to lowest quartile. In stratified analyses by menopausal status, the association with BMI and weight gain was limited to postmenopausal women, with a 15% (95% CI: 1.05-1.23) increase in risk per 5 kg/m(2) of BMI and 6% (95% CI: 1.01-1.10) increase in risk per 5 kg of weight gain. Excluding hormone therapy users essentially did not change results. Obesity and excessive adult weight gain may increase ovarian cancer risk in post-menopausal AA women.

Analgesic medication use and risk of epithelial ovarian cancer in African American women

BACKGROUND

Existing literature examining analgesic medication use and epithelial ovarian cancer (EOC) risk has been inconsistent, with the majority of studies reporting an inverse association. Race-specific effects of this relationship have not been adequately addressed.

METHODS

Utilising data from the largest population-based case-control study of EOC in African Americans, the African American Cancer Epidemiology Study, the relationship between analgesic use (aspirin, non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen) and risk of EOC was estimated by multivariate logistic regression. The association of frequency, duration, and indication of analgesic use on EOC risk was also assessed.

RESULTS

Aspirin use, overall, was associated with a 44% lower EOC risk (OR=0.56; 95% CI=0.35-0.92) and a 26% lower EOC risk was observed for non-aspirin NSAID use (OR=0.74; 95% CI=0.52-1.05). The inverse association was strongest for women taking aspirin to prevent cardiovascular disease and women taking non-aspirin NSAIDs for arthritis. Significantly decreased EOC risks were observed for low-dose aspirin use, daily aspirin use, aspirin use for <5 years, and occasional non-aspirin NSAID use for a duration of ⩾5 years. No association was observed for acetaminophen use.

CONCLUSIONS

Collectively, these findings support previous evidence that any NSAID use is inversely associated with EOC risk.

Abstract A73: Obesity, weight gain, and ovarian cancer risk in African American women

Background: There is growing evidence that obesity increases ovarian cancer risk. However, little is known about the impact of body fatness and weight gain in African American women, the racial/ethnic group with the highest prevalence of obesity according to national data.

Methods: We evaluated the association between ovarian cancer risk and body mass index (BMI) at age 18, recent BMI, and weight gain since age 18 years in the African American Cancer Epidemiology Study (AACES), an ongoing, population-based case-control study of ovarian cancer in African American women in 11 geographical areas in the US. Cases (n=492) and age and site matched controls (n=696) were identified through rapid case ascertainment and random-digit-dialing, respectively. A computer-assisted telephone interview was used to collect information on ovarian cancer risk factors, including self-reported height, weight at age 18, and weight one year before diagnosis/interview. Multivariable logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CI), adjusting for potential covariates, including age, region, education, parity, tubal ligation, oral contraceptive use, age at menarche, menopausal status, and family history of breast/ovarian cancer.

Results: Sixty two percent of the cases and fifty six percent of the controls were obese (BMI≥30). Obese women had elevated ovarian cancer risk, particularly for recent BMI≥40 compared to BMI &lt;25 (OR=1.72, 95% CI: 1.12, 2.66; p for trend: 0.03). No relationship was observed for BMI at age 18. However, there was a strong association with weight gain since age 18 years (OR: 1.68; 95% CI: 1.19-2.39; p for trend: 0.006) comparing the highest to lowest quartile. In stratified analyses by menopausal status, the association with recent BMI persisted in postmenopausal women (OR: 1.94; 95% CI: 1.14-3.30), but was weak and not statistically significant in pre-menopausal women (OR: 1.28; 95% CI: 0.56-2.92). Excluding postmenopausal hormone therapy users essentially did not change results. There was also a strong association with weight gain among postmenopausal women with 14% increased risk per 10 kg of weight gain (OR: 1.14: 95% CI: 1.05-1.23).

Conclusion: Our findings suggest that obesity and excessive adult weight gain may increase ovarian cancer risk in post-menopausal African American women.

Citation Format: Elisa V. Bandera, Bo Qin, Anthony J. Alberg, Jill Barnholtz-Sloan, Melissa Bondy, Michelle Cote, Ellen Funkhouser, Edward Peters, Ann Schwartz, Paul Terry, Patricia G. Moorman, Joellen Schildkraut. Obesity, weight gain, and ovarian cancer risk in African American women. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A73.

Abstract B43: A preponderance of post-menopausal HER2+ breast cancer in the Vietnamese population

Background: Though breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death in women worldwide, relatively little is understood about the differences in prevalence and biology between various populations. For example, breast cancer is far less common in Asia than in North America, and the biology of breast cancer is likely different between these groups as well. There is some limited data to suggest that Asian breast cancer patients may have 35-40% rate of HER2+ breast cancer [1,2], as compared to 15-23% within the general American population [3,4].

Methods: To further examine this possibility, we reviewed our data at the Harris Health Systems' Smith Clinic in Houston, Texas from September 2010 through September 2014 to further characterize the Vietnamese breast cancer patients seen during that time. Using Fisher's Exact Test, we compared our subset of Vietnamese breast cancer patients with the publicly available SEER data from 2010[4].

Results: Among the Vietnamese patients from the Smith Clinic, we found that out of 33 patients with invasive breast cancer, 15 (45%) had HER2+ breast cancer. Interestingly, 64% of the HER2+ cohort was post-menopausal, and 50% of the post-menopausal women had HER2+ breast cancer. Compared with the 2010 SEER data that encompasses 28% of all US breast cancer patients diagnosed that year, regardless of race, the Smith Clinic Vietnamese cohort had a statistically significant higher rate of HER2+ breast cancer, with an odds ratio of 4.7 (45% vs. 15%, p &lt;0.001). Among the women greater than 50 years old in both groups, the Vietnamese women had a higher rate of HER2+ breast cancer than the same age group in the SEER data group (odds ratio 7.0, p &lt;0.001).

Conclusion: The patterns observed in this small Vietnamese cohort, and others, do not mirror those seen in the general, multi-racial American breast cancer population. The rate of HER2+ breast cancer in the Smith Clinic Vietnamese group is twice that of the general American population. Other, larger studies have supported the findings of this small group, including a 242-patient study in Vietnam which demonstrated a 41% rate of HER2+ breast cancer; 55% of post-menopausal women had HER2 mutated tumors in this group [1]. Generally, other studies have associated older age and post-menopausal status with a lower rate of HER2+ breast cancer [5,6], but the opposite is true in these Vietnamese women. This unique pattern of breast cancer in Vietnamese women may suggest an underlying genetic or environmental driver, similar to the higher rate of triple negative breast cancer in BRCA1 carriers, or HER2+ breast cancer in women with p53 mutations. We plan to conduct further epidemiologic and genetic research in a larger cohort of Vietnamese breast cancer patients to determine whether an underlying germline genetic mutation or environmental exposure may explain this unusual pattern of breast cancer.

References:

1. Thang, V.H., et al., HER2 status in operable breast cancers from Vietnamese women: Analysis by immunohistochemistry (IHC) and automated silver enhanced in situ hybridization (SISH). Acta oncologica, 2011. 50(3): p. 360-6.

2. Telli, M.L., et al., Asian ethnicity and breast cancer subtypes: a study from the California Cancer Registry. Breast cancer research and treatment, 2011. 127(2): p. 471-8.

3. Owens, M.A., B.C. Horten, and M.M. Da Silva, HER2 amplification ratios by fluorescence in situ hybridization and correlation with immunohistochemistry in a cohort of 6556 breast cancer tissues. Clinical breast cancer, 2004. 5(1): p. 63-9.

4. Howlader, N., et al., US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. J Natl Cancer Inst, 2014. 106(5).

5. Dickens, C., et al., Racial comparison of receptor-defined breast cancer in Southern African women: subtype prevalence and age-incidence analysis of nationwide cancer registry data. Cancer Epidemiol Biomarkers Prev, 2014. 23(11): p. 2311-21.

6. de Kruijf, E.M., et al., Comparison of frequencies and prognostic effect of molecular subtypes between young and elderly breast cancer patients. Mol Oncol, 2014. 8(5): p. 1014-25.

Citation Format: Polly Niravath, Susan G. Hilsenbeck, Melissa Bondy. A preponderance of post-menopausal HER2+ breast cancer in the Vietnamese population. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B43.

Recreational physical activity and ovarian cancer risk in African American women

The literature on recreational physical activity (RPA) and ovarian cancer risk is inconclusive and most studies of RPA and ovarian cancer have been conducted in white populations. This study is the first to investigate the association between RPA and ovarian cancer in an exclusively African American (AA) population. We analyzed data from an ongoing U.S. population-based, case-control study of AA women, which included 393 women recently diagnosed with invasive epithelial ovarian cancer (IEOC) and 611 controls. A baseline interview assessed RPA frequency, intensity, and duration. Each RPA intensity was assigned a metabolic equivalent of task (MET) value and MET-min/week were calculated. Unconditional multivariable logistic regression was performed to investigate associations between RPA and IEOC risk. Compared with sedentary women, predominantly mild intensity RPA was significantly inversely associated with IEOC risk for women reporting above median (>297) MET-min/week (odds ratio [OR] = 0.52; 95% confidence interval [CI]: 0.34, 0.78) and nonsignificantly for <297 MET-min/week (OR = 0.71; 95% CI: 0.44, 1.12). Predominantly moderate intensity RPA was associated with significantly increased risk for women reporting above median (>540) MET-min/week (OR = 1.51; 95% CI: 1.03, 2.23). Predominantly strenuous intensity RPA was nonsignificantly associated with lower IEOC risk for women reporting above median (>1800) MET-min/week (OR = 0.72; 95% CI: 0.33, 1.57). The inverse associations for mild and strenuous intensity RPA were most pronounced in obese women (body mass index >30 kg/m(2) ). The findings that mild and strenuous RPA may reduce the risk of IEOC particularly among obese women are difficult to reconcile with the increased risk observed for moderate RPA. Further research is warranted to determine whether these findings are genuine and, if so, their mechanistic basis.

The Association Between Body Mass Index and Presenting Symptoms in African American Women with Ovarian Cancer

BACKGROUND

Ovarian cancer, the most lethal gynecologic malignancy, typically comes to clinical attention due to nonspecific gastrointestinal or pelvic symptoms. African Americans with ovarian cancer have a greater mortality burden than whites and are also much more likely to be obese. The objective of this study is to explore whether the presentation and duration of symptoms differ by body mass index (BMI) in African Americans with ovarian cancer.

METHODS

We conducted a case-only analysis using data from a multicenter population-based study of invasive epithelial ovarian cancer in African American women. Information on risk factors and symptoms leading to diagnosis was obtained in a telephone interview. Frequency and duration of symptoms by BMI categories were compared using logistic regression and linear regression analyses.

RESULTS

Of the 326 women, ∼60% was obese (BMI ≥30), with 30.8% having a BMI ≥35 kg/m(2). Ninety-four percent of women reported ≥1 symptom during the year before diagnosis. We observed differences in frequency of symptoms by BMI categories, with most being reported more frequently by the heaviest women. The reported duration of symptoms was longer in women with higher BMI, with statistically significant trend tests for 6 of the 10 symptoms evaluated.

CONCLUSION

BMI appears to impact ovarian cancer symptomatology. Women with higher BMI report having symptoms for a longer period of time before diagnosis of ovarian cancer. Healthcare providers should be vigilant and consider ovarian cancer in the differential diagnosis for obese women presenting with abdominal and pelvic symptoms.

Elafin is downregulated during breast and ovarian tumorigenesis but its residual expression predicts recurrence

INTRODUCTION

Elafin is an endogenous serine protease inhibitor. The majority of breast cancer cell lines lack elafin expression compared to human mammary epithelial cells. In this study, we hypothesized that elafin is downregulated during breast and ovarian tumorigenesis.

METHODS

We examined elafin expression by immunohistochemistry (IHC) in specimens of normal breast tissue (n = 24), ductal carcinoma in situ (DCIS) (n = 54), and invasive breast cancer (n = 793). IHC analysis of elafin expression was also performed in normal fallopian tube tissue (n = 20), ovarian cystadenomas (n = 9), borderline ovarian tumors (n = 21), and invasive ovarian carcinomas (n = 216). To understand the significance of elafin in luminal breast cancer cell lines, wild-type or M25G elafin (lacking the protease inhibitory function) were exogenously expressed in MCF-7 and T47D cells.

RESULTS

Elafin expression was downregulated in 24% of DCIS and 83% of invasive breast tumors when compared to elafin expression in the normal mammary epithelium. However, the presence of elafin-positive cells in invasive breast tumors, even at low frequency, correlated with poor recurrence-free survival (RFS), reduced overall survival (OS), and clinicopathological markers of aggressive tumor behavior. Elafin-positive cells were an especially strong and independent prognostic marker of reduced RFS in IHC-defined luminal A-like tumors. Elafin was also downregulated in 33% of ovarian cystadenomas, 43% of borderline ovarian tumors, and 86% of invasive ovarian carcinomas when compared to elafin expression in the normal fallopian tube. In ovarian tumors, elafin-positive cells were correlated with reduced RFS, OS and disease-specific survival (DSS) only in stage I/II patients and not in stage III/IV patients. Notably, exogenous expression of elafin or elafin M25G in the luminal breast cancer cell lines MCF-7 and T47D significantly decreased cell proliferation in a protease inhibitory domain-independent manner.

CONCLUSIONS

Elafin predicts poor outcome in breast and ovarian cancer patients and delineates a subset of endocrine receptor-positive breast cancer patients susceptible to recurrence who could benefit from more aggressive intervention. Our in vitro results suggest that elafin arrests luminal breast cancer cells, perhaps suggesting a role in tumor dormancy.