1
|
Smith A, Vidal GA, Pritchard E, Blue R, Martin MY, Rice LJ, Brown G, Starlard-Davenport A. Sistas Taking a Stand for Breast Cancer Research (STAR) Study: A Community-Based Participatory Genetic Research Study to Enhance Participation and Breast Cancer Equity among African American Women in Memphis, TN. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122899. [PMID: 30567326 PMCID: PMC6313663 DOI: 10.3390/ijerph15122899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/11/2018] [Accepted: 12/14/2018] [Indexed: 01/14/2023]
Abstract
African American women are substantially underrepresented in breast cancer genetic research studies and clinical trials, yet they are more likely to die from breast cancer. Lack of trust in the medical community is a major barrier preventing the successful recruitment of African Americans into research studies. When considering the city of Memphis, TN, where the percentage of African Americans is significantly higher than the national average and it has a high rate of breast cancer mortality inequities among African American women, we evaluated the feasibility of utilizing a community-based participatory (CBPR) approach for recruiting African American women into a breast cancer genetic study, called the Sistas Taking A Stand for Breast Cancer Research (STAR) study. From June 2016 and December 2017, African American women age 18 and above were recruited to provide a 2 mL saliva specimen and complete a health questionnaire. A total of 364 African American women provided a saliva sample and completed the health questionnaire. Greater than 85% agreed to be contacted for future studies. Educational workshops on the importance of participating in cancer genetic research studies, followed by question and answer sessions, were most successful in recruitment. Overall, the participants expressed a strong interest and a willingness to participate in the STAR study. Our findings highlight the importance of implementing a CBPR approach that provides an educational component detailing the importance of participating in cancer genetic research studies and that includes prominent community advocates to build trust within the community.
Collapse
Affiliation(s)
- Alana Smith
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - Gregory A Vidal
- Department of Medicine, The University of Tennessee West Cancer Center, Memphis, TN 38163, USA.
- Division of Hematology and Oncology, Department of Medicine, University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Memphis, TN 38138, USA.
| | - Elizabeth Pritchard
- Department of Medicine, The University of Tennessee West Cancer Center, Memphis, TN 38163, USA.
| | - Ryan Blue
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - Michelle Y Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - LaShanta J Rice
- School of Health Sciences, Online Learning, Stratford University, 3201 Jermantown Road, Ste 500, Fairfax, VA 22030, USA.
| | - Gwendolynn Brown
- Carin and Sharin Breast Cancer Support Group, Memphis, TN 38613, USA.
| | - Athena Starlard-Davenport
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| |
Collapse
|
2
|
Vidal G, Bursac Z, Miranda-Carboni G, White-Means S, Starlard-Davenport A. Racial disparities in survival outcomes by breast tumor subtype among African American women in Memphis, Tennessee. Cancer Med 2017; 6:1776-1786. [PMID: 28612435 PMCID: PMC5504313 DOI: 10.1002/cam4.1117] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/13/2017] [Accepted: 05/07/2017] [Indexed: 01/09/2023] Open
Abstract
Racial disparities in survival among African American (AA) women in the United States have been well documented. Breast cancer mortality rates among AA women is higher in Memphis, Tennessee as compared to 49 of the largest US cities. In this study, we investigated the extent to which racial/ethnic disparities in survival outcomes among Memphis women are attributed to differences in breast tumor subtype and treatment outcomes. A total of 3527 patients diagnosed with stage I-IV breast cancer between January 2002 and April 2015 at Methodist Health hospitals and West Cancer Center in Memphis, TN were included in the analysis. Kaplan-Meier survival curves were generated and Cox proportional hazards regression were used to compare survival outcomes among 1342 (38.0%) AA and 2185 (62.0%) non-Hispanic White breast cancer patients by race and breast tumor subtype. Over a mean follow-up time of 29.9 months, AA women displayed increased mortality risk [adjusted hazard ratio (HR), 1.65; 95% confidence interval (CI), 1.35-2.03] and were more likely to be diagnosed at advanced stages of disease. AA women with triple-negative breast cancer (TNBC) had the highest death rate at 26.7% compared to non-Hispanic White women at 16.5%. AA women with TNBC and luminal B/HER2- breast tumors had the highest risk of mortality. Regardless of race, patients who did not have surgery had over five times higher risk of dying compared to those who had surgery. These findings provide additional evidence of the breast cancer disparity gap between AA and non-Hispanic White women and highlight the need for targeted interventions and policies to eliminate breast cancer disparities in AA populations, particularly in Memphis, TN.
Collapse
Affiliation(s)
- Gregory Vidal
- Division of Hematology/Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, 38133.,The University of Tennessee West Cancer Center, Germantown, Tennessee
| | - Zoran Bursac
- Division of Biostatistics and Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gustavo Miranda-Carboni
- Division of Hematology/Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, 38133
| | - Shelley White-Means
- Department of Clinical Pharmacy, Consortium on Health Education, Economic Empowerment and Research (CHEER), University of Tennessee Health Science Center, Memphis, Tennessee, 38163
| | - Athena Starlard-Davenport
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, Tennessee, 38133
| |
Collapse
|
3
|
Wright N, Xia J, Cantuaria G, Klimov S, Jones M, Neema P, Il’yasova D, Krishnamurti U, Li X, Reid MD, Gupta M, Rida PCG, Osan R, Aneja R. Distinctions in Breast Tumor Recurrence Patterns Post-Therapy among Racially Distinct Populations. PLoS One 2017; 12:e0170095. [PMID: 28085947 PMCID: PMC5234824 DOI: 10.1371/journal.pone.0170095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/28/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Clinical studies have revealed a higher risk of breast tumor recurrence in African-American (AA) patients compared to European-American (EA) patients, contributing to the alarming inequality in clinical outcomes among the ethnic groups. However, distinctions in recurrence patterns upon receiving hormone, radiation, and/or chemotherapy between the races remain poorly characterized. METHODS We compared patterns and rates (per 1000 cancer patients per 1 year) of recurrence following each form of treatment between AA (n = 1850) and EA breast cancer patients (n = 7931) from a cohort of patients (n = 10504) treated between 2005-2015 at Northside Hospital in Atlanta, GA. RESULTS Among patients who received any combination of adjuvant therapy, AA displayed higher overall rates of recurrence than EA (p = 0.015; HR: 1.699; CI: 1.108-2.606). Furthermore, recurrence rates were higher in AA than EA among stage I (p = 0.031; HR: 1.736; CI: 1.052-2.864) and T1 classified patients (p = 0.003; HR: 2.009; CI: 1.263-3.197). Interestingly, among patients who received neoadjuvant chemotherapy, AA displayed higher rates of local recurrence than EA (p = 0.024; HR: 7.134; CI: 1.295-39.313). CONCLUSION Our analysis revealed higher incidence rates of recurrence in AA compared to EA among patients that received any combination of adjuvant therapy. Moreover, our data demonstrates an increased risk of tumor recurrence in AA than EA among patients diagnosed with minimally invasive disease. This is the first clinical study to suggest that neoadjuvant chemotherapy improves breast cancer recurrence rates and patterns in AA.
Collapse
Affiliation(s)
- Nikita Wright
- Department of Biology, Georgia State University, Atlanta, Georgia, United States of America
| | - Jun Xia
- Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia, United States of America
| | - Guilherme Cantuaria
- Department of Gynecologic Oncology, Northside Hospital Cancer Institute, Atlanta, Georgia, United States of America
| | - Sergey Klimov
- Department of Biology, Georgia State University, Atlanta, Georgia, United States of America
| | - Mildred Jones
- Department of Pathology Oncology Analytics, Northside Hospital Cancer Institute, Atlanta, GA, United States of America
| | - Pranay Neema
- Department of Biology, Georgia State University, Atlanta, Georgia, United States of America
| | - Dora Il’yasova
- School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Uma Krishnamurti
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Michelle D. Reid
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Meenakshi Gupta
- Clinical Pathology and Anatomic Pathology, West Georgia Hospitals, LaGrange, Georgia, United States of America
| | - Padmashree C. G. Rida
- Department of Biology, Georgia State University, Atlanta, Georgia, United States of America
| | - Remus Osan
- Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia, United States of America
- * E-mail: (RO); (RA)
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, Georgia, United States of America
- * E-mail: (RO); (RA)
| |
Collapse
|
4
|
Altinoz MA, Tunalı NE. Trinucleotide repeat expansions in human breast cancer-susceptibility genes: relevant targets for aspirin chemoprevention? Clin Transl Oncol 2015. [PMID: 26199016 DOI: 10.1007/s12094-015-1356-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Defining novel molecular mechanisms pertinent to aspirin chemoprevention of breast cancer (BC) and to explain controversial epidemiological results in this regard. METHODS Literature search in relevant databases with the following key words; aspirin, nucleotide repeat expansions, breast cancer. Human genome contains nucleotide repeat expansions and exon-1 of the androgen receptor gene AR contains a CAG string with an average of 20 repeats. Longer AR CAG repeats associate with lower AR protein functioning leading relatively higher estrogen receptor signals and higher risk of hormone receptor-positive BC. Nucleotide repeat expansions also exist in E2F4 and POLG genes in BC. In cell culture models, aspirin reduces CAG.CTG expansions in kidney cells and restores myogenic differentiation in cells obtained from tissues with myotonic dystrophy, a disorder caused by large CTG expansions. CONCLUSIONS We hypothesize that aspirin reduction of trinucleotide repeat expansions in breast cancer-susceptibility genes may be one of the relevant mechanisms of its chemopreventive effects.
Collapse
Affiliation(s)
- M A Altinoz
- Department of Immunology, Experimental Medicine Research Institute - DETAE, Istanbul University, Istanbul, Turkey.
| | - N E Tunalı
- Department of Molecular Biology and Genetics, Halic University, Istanbul, Turkey
| |
Collapse
|
5
|
Danforth DN. Disparities in breast cancer outcomes between Caucasian and African American women: a model for describing the relationship of biological and nonbiological factors. Breast Cancer Res 2013; 15:208. [PMID: 23826992 PMCID: PMC3706895 DOI: 10.1186/bcr3429] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Breast cancer is the most common malignancy in women in the United States but significant disparities exist for African American women compared to Caucasian women. African American women present with breast cancer at a younger age and with a greater incidence under the age of 50 years, develop histologically more aggressive tumors that are at a more advanced stage at presentation, and have a worse disease-free and overall survival than Caucasian women. The biological characteristics of the primary tumor play an important role in determining the outcome of the disparity, and significant differences have been identified between African American and Caucasian breast cancer in steroid receptor and growth factor receptor content, mutations in cell cycle components, chromosomal abnormalities, and tumor suppressor and other cancer genes. The consequences of the biological factors are influenced by a variety of nonbiological factors, including socioeconomic, health care access, reproductive, and confounding factors. The nonbiological factors may act directly to enhance (or inhibit) the consequences of the biological changes, indirectly to facilitate outcome of the disparity, or as a cofounding factor, driving the association between the biological factors and the disparity. The prevention and management of the disparities will require an understanding of the relationship of biological and nonbiological factors. The present review was undertaken to promote this understanding by describing the biological basis of the four major disparities - early age of onset, more advanced stage of disease, more aggressive histologic changes, and worse survival - and the important relationship to the nonbiological factors. A model is proposed to provide a comprehensive view of this relationship, with the goal of facilitating an understanding of each disparity and the issues that need to be addressed to eliminate the disparity.
Collapse
Affiliation(s)
- David N Danforth
- Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| |
Collapse
|
6
|
Griggs JJ, Hawley ST, Graff JJ, Hamilton AS, Jagsi R, Janz NK, Mujahid MS, Friese CR, Salem B, Abrahamse PH, Katz SJ. Factors associated with receipt of breast cancer adjuvant chemotherapy in a diverse population-based sample. J Clin Oncol 2012; 30:3058-64. [PMID: 22869890 DOI: 10.1200/jco.2012.41.9564] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Disparities in receipt of adjuvant chemotherapy may contribute to higher breast cancer fatality rates among black and Hispanic women compared with non-Hispanic whites. We investigated factors associated with receipt of chemotherapy in a diverse population-based sample. PATIENTS AND METHODS Women diagnosed with breast cancer between August 2005 and May 2007 (N = 3,252) and reported to the Detroit, Michigan, or Los Angeles County Surveillance, Epidemiology, and End Results (SEER) registry were recruited to complete a survey. Multivariable analyses examined factors associated with chemotherapy receipt. RESULTS The survey was sent to 3,133 patients; 2,290 completed a survey (73.1%), and 1,403 of these patients were included in the analytic sample. In multivariable models, disease characteristics were significantly associated with the likelihood of receiving chemotherapy. Low-acculturated Hispanics were more likely to receive chemotherapy than non-Hispanic whites (odds ratio [OR], 2.00; 95% CI, 1.31 to 3.04), as were high-acculturated Hispanics (OR, 1.43; 95% CI, 1.03 to 1.98). Black women were less likely to receive chemotherapy than non-Hispanic whites, but the difference was not significant (OR, 0.83; 95% CI, 0.64 to 1.08). Increasing age (even in women age < 50 years) and Medicaid insurance were associated with lower rates of chemotherapy receipt. CONCLUSION In this population-based sample, disease characteristics were strongly associated with receipt of chemotherapy, indicating that clinical benefit guides most treatment decisions. We found no compelling evidence that black women and Hispanics receive chemotherapy at lower rates. Interventions that address chemotherapy use rates according to age and insurance status may improve quality of systemic treatment.
Collapse
Affiliation(s)
- Jennifer J Griggs
- University of Michigan, North Campus Research Complex, 2800 Plymouth Rd, Bldg 16, 400S, Ann Arbor, MI 48109-2800, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Fackenthal JD, Zhang J, Zhang B, Zheng Y, Hagos F, Burrill DR, Niu Q, Huo D, Sveen WE, Ogundiran T, Adebamowo C, Odetunde A, Falusi AG, Olopade OI. High prevalence of BRCA1 and BRCA2 mutations in unselected Nigerian breast cancer patients. Int J Cancer 2012; 131:1114-23. [DOI: 10.1002/ijc.27326] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 10/05/2011] [Indexed: 11/07/2022]
|
8
|
Dumas NA, He D, Frost AR, Falany CN. Sulfotransferase 2B1b in human breast: differences in subcellular localization in African American and Caucasian women. J Steroid Biochem Mol Biol 2008; 111:171-7. [PMID: 18586095 PMCID: PMC2586421 DOI: 10.1016/j.jsbmb.2008.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 05/01/2008] [Accepted: 05/26/2008] [Indexed: 11/21/2022]
Abstract
Breast cancer (BC) is the most commonly diagnosed cancer among American women; however, the development of post-menopausal BC is significantly lower in African Americans as compared to Caucasians. Hormonal stimulation is important in BC development and differences in the conversion of dehydroepiandrosterone (DHEA) into estrogens may be involved in the lower incidence of post-menopausal BC in African American women. DHEA sulfation by sulfotransferase 2B1b (SULT2B1b) is important in regulating the conversion of DHEA into estrogens in tissues. SULT2B1b is localized in both cytosol and nuclei of some tissues including cancerous and associated-normal breast tissue. Immunohistochemical staining was used to evaluate the total expression and subcellular localization of SULT2B1b in African American and Caucasian breast tissues. Cell fractionation, immunoblot analysis and sulfation assays were used to characterize the subcellular expression and activity of SULT2B1b in BC tissues and T-47D breast adenocarcinoma cells. Immunohistochemical analysis of SULT2B1b showed that African Americans had a significantly greater amount of SULT2B1b in epithelial cells of associated-normal breast tissue as compared to Caucasians. Also, more SULT2B1b in African American associated-normal breast epithelial cells was localized in the nuclei than in Caucasians. Equivalent levels of SULT2B1b were detected in breast adenocarcinoma tissues from both African American and Caucasian women. Nuclei isolation and immunoblot analysis of both BC tissue and human T-47D breast adenocarcinoma cells demonstrated that SULT2B1b is present in nuclei and cytoplasm.
Collapse
Affiliation(s)
- Nicole A Dumas
- Department of Pharmacology and Toxicology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | | | | |
Collapse
|
9
|
Simon MS, Djuric Z, Dunn B, Stephens D, Lababidi S, Heilbrun LK. An Evaluation of Plasma Antioxidant Levels and the Risk of Breast Cancer: A Pilot Case Control Study. Breast J 2008; 6:388-395. [PMID: 11348397 DOI: 10.1046/j.1524-4741.2000.20067.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Antioxidant micronutrients found in fruits and vegetables have been shown in numerous studies to be protective against cancer. There is limited information on the relationship between blood antioxidant micronutrient levels and cancer among ethnic minorities. We conducted a pilot case-control study to evaluate the potential for accrual to a study of the association of plasma levels of beta-carotene, retinol, lycopene, alpha-tocopherol, and gamma-tocopherol with breast cancer risk among African American and Caucasian women seen at a large university medical center in Detroit. Cases included women with newly diagnosed invasive breast cancer who had not yet had any cancer-related therapy and who were age-matched to controls within 5 years. Plasma levels of micronutrients were analyzed by high-pressure liquid chromatography. Compared to the expected accrual based on cancer registry data, only 26% (11/42) of African American women with breast cancer enrolled, while 100% (16/16) of Caucasian cases enrolled. Control women were quickly accrued with only a 6% refusal rate. Among African American women, there was a weak inverse association between plasma lycopene levels and breast cancer risk, with a mean level of 0.17 &mgr;mol/L (SD = 0.18) among cases, and 0.24 &mgr;mol/L (SD = 0.18) among controls (p = 0.09). There was a weak direct association between plasma retinol levels and breast cancer risk among African American women, with a mean retinol level of 2.37 &mgr;mol/L (SD = 0.73) among cases and 1.98 &mgr;mol/L (SD = 0.49) among controls (p = 0.132). The interaction effect of race and lycopene was statistically significant (p = 0.048). Among the lowest lycopene tertile, the risk of breast cancer among Caucasian women was 0.76 and the risk of breast cancer among African American women was 2.29, although these odds ratios were not statistically significant. Our recruitment efforts were largely successful among Caucasian cases and controls, and African American controls, but were unsuccessful among African American cases. The results suggest a possible relationship between plasma lycopene level and breast cancer among African American women, but these results should be confirmed by a larger, more definitive study.
Collapse
Affiliation(s)
- Michael S. Simon
- Division of Hematology and Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan, and British Columbia Cancer Agency, Vancouver, British Columbia
| | | | | | | | | | | |
Collapse
|
10
|
Genetic variation in IGFBP2 and IGFBP5 is associated with breast cancer in populations of African descent. Hum Genet 2008; 123:247-55. [PMID: 18210156 DOI: 10.1007/s00439-008-0468-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 01/11/2008] [Indexed: 01/21/2023]
Abstract
The insulin-like growth factor (IGF) signaling pathway is thought to play a major role in the etiology of breast cancer. Although incidence rates of breast cancer overall are lower in African Americans than in Caucasians, African-American women have a higher incidence under age 40 years, are diagnosed with more advanced disease, and have poorer prognosis. We investigated the association of breast cancer and genetic variants in genes in the IGF signaling pathway in a population-based case-control study of African-American women. We found significant associations at a locus encompassing parts of the IGFBP2 and IGFBP5 genes on chromosome 2q35, which we then replicated in a case-control study of Nigerian women. Based on those initial findings, we genotyped a total of 34 single nucleotide polymorphisms (SNPs) across the region in both study populations. Statistically significant associations with breast cancer were observed across approximately 50 kb of DNA sequence encompassing three exons in the 3' end of IGFBP2 and three exons in the 3' end of IGFBP5. SNPs were associated with breast cancer risk with P values as low as P = 0.0038 and P = 0.01 in African-Americans and Nigerians, respectively. This study is the first to report associations between genetic variants in IGFBP2 and IGFBP5 and breast cancer risk.
Collapse
|
11
|
Progesterone receptor expression is a marker for early stage breast cancer: implications for progesterone receptor as a therapeutic tool and target. Cancer Lett 2007; 258:253-61. [PMID: 17950525 DOI: 10.1016/j.canlet.2007.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 09/07/2007] [Accepted: 09/11/2007] [Indexed: 11/20/2022]
Abstract
We determined the association of estrogen receptor (ER) and progesterone receptor (PR) expression in invasive breast cancer with stage at diagnosis. Univariate analyses indicated that although ER and PR expression were inversely associated with grade (P<0.0001), only PR expression (P<0.01) was inversely associated with stage. Multivariate analyses, adjusted for covariates, including HER-2/neu expression, indicated that PR (odds ratio (OR), 0.88; confidence interval (CI), 0.77-0.99; P=0.03) and not ER expression (OR, 1.04; CI, 0.94-1.16; P=0.45) was inversely associated with stage. PR and not ER expression is a marker for early stage breast cancer.
Collapse
|
12
|
Winter JL, Stackhouse BL, Russell GB, Kute TE. Measurement of PTEN expression using tissue microarrays to determine a race-specific prognostic marker in breast cancer. Arch Pathol Lab Med 2007; 131:767-72. [PMID: 17488163 DOI: 10.5858/2007-131-767-mopeut] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2006] [Indexed: 11/06/2022]
Abstract
CONTEXT African American women with breast cancer have worse prognoses than non-African Americans and might benefit with a race-specific prognostic marker such as PTEN (phosphatase and tensin homologue), a tumor suppressor protein. Reduced PTEN expression is associated with worse outcomes and resistance to trastuzumab in human epidermal growth factor receptor 2-positive breast cancers. Standardized PTEN evaluation is therefore needed. OBJECTIVE To assess PTEN as a race-specific prognostic marker in breast cancer by using a novel semiquantitative score and a percent staining assessment. DESIGN Between 1991 and 1996, 146 patients with invasive ductal adenocarcinoma were grouped by race and recurrence; there was a median follow-up of 7.2 years with 63 recurrences. Immunostaining of PTEN in tissue microarrays was correlated with race, recurrence, node positivity, stage, size, age, estrogen/progesterone receptor status, grade, and DNA ploidy. RESULTS No significant racial difference was detected in mean PTEN values using either the semiquantitative score (P = .46) or the percent staining (P = .54). Unrelated to race, the percentage of tumor cells with positive PTEN expression correlated with longer time to recurrence (P = .047), positive estrogen receptor status (P = .009), and lower tumor grade (P = .005). The semiquantitative score correlated with positive estrogen receptor status (P = .01) and lower tumor grade (P = .001). CONCLUSIONS PTEN expression is not a race-specific biologic prognostic marker for invasive ductal adenocarcinoma. Increased PTEN expression correlates with longer time to recurrence, positive estrogen receptor status, and lower tumor grade. The novel semiquantitative score may be used to evaluate PTEN expression, but the approximate percentage of tumor cells with any PTEN staining may be the most useful measure of PTEN expression.
Collapse
Affiliation(s)
- Jerald Luke Winter
- Department of Pathology, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA
| | | | | | | |
Collapse
|
13
|
Affiliation(s)
- Lisa A Newman
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|
14
|
Abstract
PURPOSE/OBJECTIVES To examine the delay in seeking treatment and worry experiences of African American women with breast cancer. DESIGN Descriptive, correlational. SETTING Urban northeastern United States. SAMPLE 60 African American women diagnosed with breast cancer. METHODS Consenting participants completed the worry subscale of the Ware Health Perception questionnaire and a Demographic and Illness-Related Information Sheet during a one-hour personal interview. Data analysis consisted of descriptive statistics and Pearson correlations. MAIN RESEARCH VARIABLES Delay in seeking treatment, worry about breast cancer and symptoms, and sociodemographic characteristics. FINDINGS Contrary to the literature, participants reported short patient and provider delay. As a result of little variability in delay, predicting those for whom worry was a deterrent or a motivator to seek prompt treatment was not possible. CONCLUSIONS Although delay does exist, African American women with sociodemographic characteristics similar to white women who do not delay are likely to have similarly short symptom durations. Further study to determine who is helped and who is hurt by worry and other possible intervening factors would be useful. Including biologic characteristics such as tumor staging and hormone receptor information in future studies would allow for a closer examination of stage at diagnosis and biologic influence. IMPLICATIONS FOR NURSING Interventions with African American women cannot assume that delay exists. Strategies that consider both individual and cultural group differences are essential to the early seeking of a diagnosis and treatment for breast cancer symptoms among African American women.
Collapse
|
15
|
Stackhouse BL, Williams H, Berry P, Russell G, Thompson P, Winter JL, Kute T. Measurement of glut-1 expression using tissue microarrays to determine a race specific prognostic marker for breast cancer. Breast Cancer Res Treat 2005; 93:247-53. [PMID: 16228617 DOI: 10.1007/s10549-005-5158-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND African-American women (AAW) have more adverse tumor characteristics than non-African American women (non-AAW) and there is a need for a specific predictive marker for AAW recurrence. Tumors with higher grade and proliferative activity are associated with overexpression of the glucose transporter (Glut-1). An examination of Glut-1 expression relative to recurrence and no recurrence was conducted on both groups to determine if it predicts prognosis and could predict a race specific prognosis. METHODS A breast cancer data set containing clinical information including race and biological characteristics was generated between 1991 and 1996. Tissue samples were selected from this group with similar characteristics in both racial groups for a retrospective analysis of Glut-1 expression using tissue microarrays (TMAs). Mean Glut-1 expression for intensity and percent of tumor cells staining was determined using standard immunohistochemistry. RESULTS Clinical and biological differences were noted in the original data set between AAW and non-AAW. No significant difference between races was noted in mean Glut-1 values using a subset which had similar characteristics. The mean Glut-1 did not predict recurrence but a rounded score did indicate that higher levels of Glut-1 expression was indicative of a lower disease free survival (p = 0.063). The actual average mean for AAW with no recurrence was significantly lower than any other group (p = 0.04). Conclusions. TMA analysis for Glut-1 expression may be useful to predict disease free survival but it does not predict race specific recurrence.
Collapse
|
16
|
McCullough ML, Feigelson HS, Diver WR, Patel AV, Thun MJ, Calle EE. Risk factors for fatal breast cancer in African-American women and White women in a large US prospective cohort. Am J Epidemiol 2005; 162:734-42. [PMID: 16120696 DOI: 10.1093/aje/kwi278] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
African-American women have a higher lifetime risk of fatal breast cancer than do White women. Recent studies suggest that breast cancer risk factors may vary by race. The authors examined risk factors for fatal breast cancer in postmenopausal African-American women and White women in a large US prospective cohort. In 1982, 21,143 African-American women and 409,093 White women in the Cancer Prevention Study II completed a questionnaire on reproductive, medical, anthropometric, and demographic factors. During a 20-year follow-up, 257 deaths from breast cancer occurred among African-American women and 4,265 among Whites. Cox proportional hazards modeling was used to calculate multivariate-adjusted rate ratios, stratified by race. Higher body mass index, taller height, and physical inactivity were associated with increased breast cancer mortality rates in both groups. A college education was associated with higher mortality from breast cancer only in Africa-American women (hazard ratio = 1.62, 95% confidence interval: 1.13, 2.30; p(trend) = 0.01, vs. less than a high school education). Most other risk factors were associated with breast cancer rates similarly in both groups. With few exceptions, established breast cancer risk factors were similarly associated with risk of death from breast cancer among African-American women and White women.
Collapse
Affiliation(s)
- Marjorie L McCullough
- Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA 30329-4251, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Halbert CH, Kessler LJ, Mitchell E. Genetic testing for inherited breast cancer risk in African Americans. Cancer Invest 2005; 23:285-95. [PMID: 16100940 DOI: 10.1081/cnv-58819] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
As genetic testing for BRCA1 and BRCA2 (BRCA1/2) mutations is increasingly integrated into the clinical management of high-risk women, it will be important to understand barriers and motivations for genetic counseling among women from underserved minority groups to ensure equitable access to these services. Therefore, the purpose of this review was to synthesize literature on knowledge and attitudes about genetic counseling and testing for inherited breast cancer risk in African Americans. We also review studies that evaluated genetic testing intentions in this population. We conducted a search of the PubMed database to identify studies related to BRCA1/2 testing in African Americans that were published between 1995 and 2003. Overall, studies have evaluated ethnic differences in knowledge and attitudes about genetic testing or have compared African American and Caucasian women in terms of genetic testing intentions. These studies have shown that knowledge about breast cancer genetics and exposure to information about the availability of testing is low among African Americans, whereas expectations about the benefits of genetic testing are endorsed highly. However, much less is known about the psychological and behavioral impact of genetic testing for BRCA1/2 mutations in African Americans. Additional research is needed to understand barriers and motivations for participating in genetic testing for inherited cancer risk in African Americans. The lack of studies on psychological functioning, cancer surveillance, and preventive behaviors following testing is a significant void; however, for these studies to be conducted, greater access to genetic counseling and testing in African Americans will be needed.
Collapse
Affiliation(s)
- Chanita Hughes Halbert
- Abramson Cancer Center and Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
| | | | | |
Collapse
|
18
|
Berger FG. The interleukin-6 gene: a susceptibility factor that may contribute to racial and ethnic disparities in breast cancer mortality. Breast Cancer Res Treat 2004; 88:281-5. [PMID: 15609131 DOI: 10.1007/s10549-004-0726-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Breast cancer prognosis differs among racial and ethnic groups. Though the incidence of breast cancer is lower in African-Americans than in Caucasians, mortality is higher. While socioeconomic, psychosocial, and lifestyle issues are undoubtedly important in such disparities, genetic factors that differ among populations and that are involved in the molecular pathways regulating tumor development may also play roles. In this communication, I summarize recent investigations of the gene encoding the pro-inflammatory cytokine interleukin-6 (IL-6), and suggest that this gene is a susceptibility factor that determines racial and/or ethnic differences in breast cancer survival. Published studies of a G/C polymorphism at nucleotide -174 within the promoter region of the IL-6 gene are consistent with this suggestion. This polymorphism alters expression of the cytokine. In addition, allele and genotype frequencies at the -174 site differ dramatically among racial and ethnic groups. Finally, the variant genotypes are associated with alterations in breast cancer survival. In all, these observations argue for additional studies of the IL-6 gene polymorphism as a predisposing genetic factor that contributes to racial and ethnic differences in breast cancer prognosis.
Collapse
Affiliation(s)
- Franklin G Berger
- Department of Biological Sciences, Coker Life Sciences Building, University of South Carolina, Columbia, SC, 29208, USA.
| |
Collapse
|
19
|
Cunningham JE, Butler WM. Racial disparities in female breast cancer in South Carolina: clinical evidence for a biological basis. Breast Cancer Res Treat 2004; 88:161-76. [PMID: 15564799 DOI: 10.1007/s10549-004-0592-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Racial disparities in breast cancer outcomes are well documented: African-American (AA) women have markedly poorer survival than do European-American (EA) women. A growing literature suggests that AA women have, on average, tumors of more aggressive histopathology, even if discovered early. We investigated this in our South Carolina population. METHODS Tumor registry data for 1687 AA and EA women with breast cancers newly diagnosed during 2000-2002 at the two Palmetto Health hospitals in Columbia, SC, were reviewed. RESULTS Corresponding to our regional population, 31% of cancers were in AA women. In both racial groups, 19% were in situ. Among women with invasive cancers, AA women had significantly earlier age at diagnosis than did EA women. Fewer AA women had lobular carcinoma (p = 0.001) or Her-2 over-expressing disease (7 versus 19%, p = 0.001). Significantly more AA women had high-grade cancer, larger tumors, axillary metastases and ER negative/PR negative tumors. After controlling for T-stage, AA women were significantly more likely to have high-grade and/or ER negative disease. Detection of invasive cancers by screening mammogram was less frequent in AA women (40 versus 53%, p < 0.000), and in small ER negative cancers. CONCLUSIONS At diagnosis, breast cancers in AA women tend to have the hallmarks of more aggressive and less treatable disease, even in small tumors, a pattern resembling that of breast cancers in younger EA women. Whatever the causes, these observations suggest breast cancer is biologically different in AA women. This may contribute substantially to the poorer outcomes in African-American women.
Collapse
Affiliation(s)
- Joan E Cunningham
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29203, USA.
| | | |
Collapse
|
20
|
Porter PL, Lund MJ, Lin MG, Yuan X, Liff JM, Flagg EW, Coates RJ, Eley JW. Racial differences in the expression of cell cycle-regulatory proteins in breast carcinoma. Cancer 2004; 100:2533-42. [PMID: 15197793 DOI: 10.1002/cncr.20279] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND African-American (AA) women are more likely to be diagnosed with an advanced stage of breast carcinoma than are white women. After adjustment for disease stage, many studies indicate that tumors in AA women are more likely than tumors in white women are to exhibit a high level of cell proliferation and features of poor prognosis. The purpose of the current study was to compare tumor characteristics and cell cycle alterations in AA women and white women that might affect the aggressiveness of breast carcinoma. METHODS The study included 124 AA and 397 white women, ages 20-54 years. These women were enrolled in a case-control study in Atlanta, Georgia, between 1990 and 1992. Breast tumor specimens obtained from these women were centrally reviewed for histologic characteristics and evaluated for expression of estrogen and progesterone receptors (ER/PR), c-ErbB-2, Ki-67, p53, cyclin E, cyclin D1, p27, p16, pRb, and p21 by immunohistochemistry. Logistic regression models were used to assess the age- and stage-adjusted associations of various tumor characteristics with race. RESULTS The odds of a breast carcinoma diagnosis at a younger age and at a later stage were higher for AA women than for white women. After adjustment for disease stage and age at diagnosis, AA women also were found to have increased odds of having a higher-grade tumor, a higher mitotic index, marked tumor necrosis, ductal histology, loss of ER and PR, overexpression of cyclin E, p16, and p53 and low expression of cyclin D1 at diagnosis. CONCLUSIONS The observed differences between tumor specimens obtained from AA women and tumor specimens obtained from white women, independent of stage and age at diagnosis, indicated that race may be a determinant, or a surrogate for other determinants, of aggressive breast carcinoma and specific cell cycle defects.
Collapse
Affiliation(s)
- Peggy L Porter
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Choi DH, Shin DB, Lee MH, Lee DW, Dhandapani D, Carter D, King BL, Haffty BG. A comparison of five immunohistochemical biomarkers and HER-2/neu gene amplification by fluorescence in situ hybridization in white and Korean patients with early-onset breast carcinoma. Cancer 2003; 98:1587-95. [PMID: 14534873 DOI: 10.1002/cncr.11703] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The objective of this article was to compare five tumor markers between white women in the U.S. and native Korean women with early-onset breast carcinoma. METHODS Sixty Korean women who were diagnosed with breast carcinoma at age 45 years or younger and 60 white women with breast carcinoma who were matched by age were selected for this study. The median age of both groups was 37 years. Paraffin embedded blocks of the primary tumor were processed for immunohistochemical staining of estrogen receptor (ER), progesterone receptor (PR), p53, cyclin D1, and HER-2/neu. RESULTS The proportion of tumors that stained positive for ER, PR, p53, and cyclin D1 in the Korean women were 47.5%, 42.4%, 28.8%, and 40.9%, respectively; in the white women, the proportions were 43.9%, 52.6%, 21.1%, and 59.1%, respectively. The differences between the white patients and the Korean patients were not statistically significant with respect to any of those variables. A significant difference was found in the expression of HER-2/neu. Specifically, positive HER-2/neu status was observed in 47.5% of Korean women, compared with overexpression in only 15.8% of white women (P < 0.001). Fluorescence in situ hybridization analysis for HER-2/neu gene amplification on all HER-2/neu positive samples that scored 2 + and 3 + demonstrated a significant difference (P = 0.007) in gene amplification between the two populations. Differences in HER-2/neu positivity were observed for the entire cohort as well as among the subsets of patients with negative and positive lymph node status. No association was found between immunoreactivity for the five markers and axillary lymph node metastasis. CONCLUSIONS The findings of high positivity of HER-2/neu expression and gene amplification in Korean women with early-onset breast carcinoma may have potential implications for local and systemic management of breast carcinoma, especially anti-HER-2/neu therapy for patients with hormone receptor negativity. Further research will be needed to identify biologic and genetic factors and their effects on the survival between different racial groups.
Collapse
Affiliation(s)
- Doo Ho Choi
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
| | | | | | | | | | | | | | | |
Collapse
|
22
|
del Carmen MG, Hughes KS, Halpern E, Rafferty E, Kopans D, Parisky YR, Sardi A, Esserman L, Rust S, Michaelson J. Racial differences in mammographic breast density. Cancer 2003; 98:590-6. [PMID: 12879477 DOI: 10.1002/cncr.11517] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND African American women have a lower incidence but a higher mortality from breast carcinoma than Caucasians. A proposed explanation for this discrepancy is the decreased efficacy of screening among African American women. Increased breast density in African American women may result in decreased sensitivity of mammography. The purpose of this article is to determine whether there is a difference in mammographic breast density between African American and Caucasian women. METHODS A series of 769 women were recruited from 5 sites. Mammograms were reviewed centrally by seven reviewers using Breast Imaging Reporting and Data System categories converted to numeric values. The mean mammographic densities for Caucasian, African American, and Latina patients were compared using a two-way analysis of covariance. The mean values for each race were estimated adjusting for the reader as well as for each patient's age and body mass index (BMI). RESULTS African American women had the lowest mean breast density. The reported density in this group was 2.43, compared with 2.69 among Caucasians and 2.65 among Latina patients. After adjusting for age and BMI as well as the reader, there was still an independent racial effect on breast density (P = 0.0050). CONCLUSIONS Mammographic breast density was lower in African American women than in Caucasians and Latinas. This discrepancy may be an intrinsic racial difference due to undetermined causes. Factors, such as the growth rate of tumors and the incidence of calcifications, must be studied to confirm that other forces do not have a negative impact on the efficacy of screening mammograms in African American women.
Collapse
Affiliation(s)
- Marcela G del Carmen
- Vincent Memorial Gynecologic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Kotwall CA, Brinker CC, Covington DL, Hall TL, Maxwell JG. Prognostic Indices in Breast Cancer are Related to Race. Am Surg 2003. [DOI: 10.1177/000313480306900503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
African-American (AA) women have a higher mortality from breast cancer than Caucasians (C). This may be attributed to stage of disease at presentation, but specific prognostic factors are not well identified. We sought to identify prognostic factors in our database of early-stage (stage I and II) breast cancer from 1990 to 1999. There were 153 tumors in 150 AA women and 773 tumors in 760 C women. Prognostic factors are listed according to race with relative risk (RR) and 95 per cent confidence intervals. AA women presented significantly more often than C women under the age of 50 years (RR = 1.8) with palpable disease (RR = 1.3), higher-grade tumors (RR = 1.5), more estrogen receptor-negative disease (RR = 1.7), more progesterone receptor-negative disease (RR = 1.4), higher proliferation indices (RR = 1.9), and more lymph node-positive disease (RR = 1.6). Many of these adverse prognostic features persisted in “good” prognostic groups, i.e., those women over the age of 50 years with tumors <20 mm and having node-negative disease. We conclude that prognostic factors are related to race with AA women presenting at an earlier age and more often with palpable disease. More importantly AA women presented significantly more often with higher-grade tumors, hormone receptor-negative tumors, higher proliferation indices, and node-positive disease. These findings may explain a higher breast cancer mortality in AA women.
Collapse
Affiliation(s)
- Cyrus A. Kotwall
- Coastal Area Health Education Center, Wilmington
- New Hanover Health Network, Wilmington
- University of North Carolina—Chapel Hill, Chapel Hill, North Carolina
| | | | - Deborah L. Covington
- Coastal Area Health Education Center, Wilmington
- University of North Carolina—Chapel Hill, Chapel Hill, North Carolina
| | - Tana L. Hall
- Coastal Area Health Education Center, Wilmington
| | - J. Gary Maxwell
- Coastal Area Health Education Center, Wilmington
- New Hanover Health Network, Wilmington
- University of North Carolina—Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
24
|
Wolff MS, Britton JA, Wilson VP. Environmental risk factors for breast cancer among African-American women. Cancer 2003; 97:289-310. [PMID: 12491493 DOI: 10.1002/cncr.11023] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There are few unequivocably established environmental carcinogens for breast cancer in women. Nevertheless, environmental factors are believed to explain much of the international variation in breast cancer risk and possibly differences among racial/ethnic groups. Along with lifestyle, some adverse exposures may be higher in minority racial/ethnic groups and in underserved populations that experience higher ambient contamination. Associations have been found between environmental agents and breast cancer in subgroups of women who can be identified by common susceptibility traits as well as by timing of exposures at certain milestones of reproductive life. Susceptibility can be defined by social, environmental, and genetic modalities-factors that may predominate in certain racial/ethnic groups but that also transcend racial/ethnic boundaries. For example, genes involved in transcription and estrogen metabolism have rapid variants that are more prevalent among African-Americans, yet risk accompanying metabolic changes from these genes will prevail in all racial/ethnic groups. Lack of reliable exposure assessment remains a principal obstacle to elucidating the role of environmental exposures in breast cancer. Resources must be identified and consolidated that will enable scientists to improve exposure assessment and to assemble studies of sufficient size to address questions regarding exposure, susceptibility, and vulnerability factors in breast cancer. Breast cancer studies should be expanded to examine combinations of chemicals as well as competing or complementary exposures such as endogenous hormones, dietary intake, and behavioral factors.
Collapse
Affiliation(s)
- Mary S Wolff
- Department of Community and Preventative Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | | | | |
Collapse
|
25
|
Middleton LP, Chen V, Perkins GH, Pinn V, Page D. Histopathology of breast cancer among African-American women. Cancer 2003; 97:253-7. [PMID: 12491489 DOI: 10.1002/cncr.11021] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although the overall incidence of breast cancer in African-American women is lower than in white women, African-American women younger than 50 years old have a higher incidence of breast cancer than white women. African-American women with breast cancer have a poorer survival rate than white women and are more likely to die of breast cancer in almost every age group. To explain this disparity, we studied a substantial body of literature that reported a biologic difference in the tumors found in African-American and white women. Specifically, more aggressive histopathologic patterns have been described among African-American patients with breast cancer when compared with white women. In addition, there are data that support an ethnicity-related variation in the expression of breast tumor hormonal markers. The objective of this study was to critically evaluate the existing published data on the histologic features of breast cancer to determine whether breast cancer in African-American women is a histologically more aggressive disease than in white women. We conclude that the aggressive tumor histology reported in African-American women has not been analyzed carefully with respect to the age of the patient at the time of diagnosis and the stage of disease at presentation. Furthermore, there is a need for central pathology review using accepted, published criteria for diagnosis of uncommon and controversial histologic subtypes of breast cancer.
Collapse
Affiliation(s)
- Lavinia P Middleton
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
| | | | | | | | | |
Collapse
|
26
|
Abstract
With continued advances in strategies to detect cancer early and treat it effectively along with the aging of the population, the number of individuals living years beyond a cancer diagnosis can be expected to continue to increase. This paper reviews current prevalence data for cancer survivors; discusses definitional issues; examines cancer survivorship as a scientific research area; provides an overview of medical and psychosocial sequelae of cancer diagnosis and treatment experienced by survivors, gaps in knowledge and emerging research priorities; explores the role of weight, nutrition and physical activity as key variables carrying the potential to affect physiologic or psychosocial sequelae of cancer and its treatment; and discusses the evolving paradigm of cancer survivorship research. A large and growing community of cancer survivors is one of the major achievements of cancer research over the past three decades. Both length and quality of survival are important end points. Many cancer survivors are at risk for and develop physiologic and psychosocial late and long-term effects of cancer treatment that may lead to premature mortality and morbidity. Interventions--therapeutic and lifestyle--carry the potential to treat or ameliorate these late effects and must be developed, examined and disseminated if found effective. Diet, weight and physical activity interventions hold considerable promise for ameliorating multiple adverse sequelae of cancer and its treatment and should be investigated in larger populations of cancer survivors, those who are long-term survivors, those with understudied cancer sites and ethnocultural minority or medically underserved groups.
Collapse
Affiliation(s)
- Noreen M Aziz
- Office of Cancer Survivorship, National Cancer Institute, Bethesda, MD 20892, USA.
| |
Collapse
|
27
|
Mandelblatt JS, Kerner JF, Hadley J, Hwang YT, Eggert L, Johnson LE, Gold K. Variations in breast carcinoma treatment in older medicare beneficiaries: is it black or white. Cancer 2002; 95:1401-14. [PMID: 12237908 DOI: 10.1002/cncr.10825] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To evaluate associations between race and breast carcinoma treatment. METHODS Data from 984 black and 849 white Medicare beneficiaries 67 years or older with local breast carcinoma and a subset of 732 surviving women interviewed 3-4 years posttreatment were used to calculate adjusted odds of treatment, controlling for age, comorbidity, attitudes, region, and area measures of socioeconomic and health care resources. RESULTS Sixty-seven percent of women received a mastectomy and 33% received breast-conserving surgery. The odds of radiation omission were 48% higher (95% confidence interval [CI] 1.01-2.19) for blacks than for whites after considering covariates, but the absolute number of women who failed to receive this modality was small (11%). In race-stratified models, the odds of having radiation omitted were significantly higher among blacks living greater distances from a cancer center (vs. lesser) or living in areas with high poverty (vs. low), but these factors did not affect radiation use among whites. Among those interviewed, blacks reported perceiving more ageism and racism in the health care system than whites (P = 0.001). The independent odds of receiving mastectomy (vs. breast conservation and radiation) were 2.72 times higher (95% CI 1.25-5.92) among women reporting the highest quartile of perceived ageism scores, compared with the lowest, and higher perceived ageism tended to be associated with higher odds of radiation omission (P = 0.06). CONCLUSIONS Older black women with localized breast carcinoma may have a different experience obtaining treatment than their white counterparts. The absolute number of women receiving nonstandard care was small and the effects were small to moderate. However, if these patterns persist, it will be important to evaluate whether such experiences contribute to within-stage race mortality disparities.
Collapse
Affiliation(s)
- Jeanne S Mandelblatt
- Department of Oncology, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC, USA.
| | | | | | | | | | | | | |
Collapse
|
28
|
Liberman L, Freeman HP, Chandra S, Stein AL, McCord C, Godfrey D, Dershaw DD. Carcinoma detection at the breast examination center of Harlem. Cancer 2002; 95:8-14. [PMID: 12115310 DOI: 10.1002/cncr.10640] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Breast carcinoma is one of the leading causes of excess mortality rates in Harlem, an inner-city neighborhood with the highest mortality rates and worst life expectancy in New York City. This study reports the results of a breast carcinoma screening and diagnostic program in Harlem. METHODS Retrospective review was performed of a database of 49,750 visits to the Breast Examination Center of Harlem from 1995 to 2000. During this period, 181 breast carcinomas were diagnosed in 178 women. The medical records of these 178 women were reviewed to determine the method of detection, stage, and treatment. RESULTS Among these women, 89% were black or Hispanic, 45% had no medical insurance, and 38% had incomes below federal poverty guidelines. Breast carcinoma stage, known for 167 carcinomas, was Stage 0 in 38 (23%), Stage I in 38 (23%), Stage II in 63 (38%), Stage III in 24 (14%), and Stage IV in 4 (2%). Fifty-six cases (34%) were minimal breast carcinomas. Of 181 breast carcinomas, 122 (67%) were palpable and 59 (33%) were nonpalpable, detected only by mammography in asymptomatic women. Nonpalpable, as opposed to palpable, breast carcinomas were significantly more likely to be ductal carcinoma in situ (30 of 55 [54%] vs. 8 of 112 [7%], P < 0.0000001) or minimal breast carcinoma (39 of 55 [71%] vs. 17 of 112 [15%], P = 0.0000001) and were more likely to be treated with breast-conserving surgery (47 of 56 [84%] vs. 76 of 110 [69%], P < 0.04). CONCLUSIONS A breast carcinoma screening and diagnostic program has been established in Harlem, a traditionally underserved area in New York City. Early, curable breast carcinomas were detected but outreach remains a challenge, particularly for the uninsured.
Collapse
Affiliation(s)
- Laura Liberman
- Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
| | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
A review of the literature on breast cancer was conducted to identify gaps in knowledge as it relates breast cancer risk, race, and survival. The discussion has been divided into three broad categories: (1) breast cancer basics and the relationships between risks, race, and survival; (2) influence of race and socioeconomic status on breast cancer morbidity and mortality; and (3) relationship between age and mammography screening. All of the cited studies reveal evidence of a linkage between race and breast cancer survival, however, the effects of socioeconomic factors and race needs to be examined. Results suggest that African-American women and lower income women need to be targeted for early detection. Many of the analyses among younger women (20-39 years) reported that very little disease occurrence in young black women was associated with the socioeconomic factors studied. Conclusions from all studies indicate that more aggressive screening and public education programs directed toward younger black women is warranted. The gaps in knowledge identified included the lack of an explanation of early onset breast cancer with high penetrance as well as an explanation of African-American women's resistance to self-examination and mammography screening and other barriers to diagnostic treatment. Future studies should also examine the link between familial breast cancer and genetic mutations.
Collapse
|
30
|
Aziz NM, Rowland JH. Cancer survivorship research among ethnic minority and medically underserved groups. Oncol Nurs Forum 2002; 29:789-801. [PMID: 12058154 DOI: 10.1188/02.onf.789-801] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To review the current state of knowledge about the impact of cancer on ethnoculturally diverse and medically underserved survivors. DATA SOURCES MEDLINE, CancerLit, and Psychlit searches from 1966-present were conducted to locate articles about survivorship outcomes among minority and underserved populations. DATA SYNTHESIS 65 articles were identified and grouped into one of four content areas: physiologic; psychosocial; health services, patterns of care, and quality of care; and health-promoting behaviors and lifestyles. CONCLUSIONS Despite limited information, researchers found a consistent theme: the need to recognize and address the socioeconomic and cultural variables that affect adaptation to and survival from cancer among diverse groups of survivors. IMPLICATIONS FOR NURSING The researchers found specific variations in risk for, response to, and recovery from cancer that provide direction for changes in nursing practice that may reduce the burden of cancer in these often vulnerable populations.
Collapse
Affiliation(s)
- Noreen M Aziz
- National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, USA.
| | | |
Collapse
|
31
|
Talley LI, Grizzle WE, Waterbor JW, Brown D, Weiss H, Frost AR. Hormone receptors and proliferation in breast carcinomas of equivalent histologic grades in pre- and postmenopausal women. Int J Cancer 2002; 98:118-27. [PMID: 11857395 DOI: 10.1002/ijc.10171] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Breast cancers in younger, premenopausal women are more likely to exhibit an adverse prognostic profile (including negative steroid hormone receptors and a high rate of cellular proliferation) and poor outcome than breast cancers in postmenopausal women. It has been hypothesized that this adverse prognostic profile is a result of the higher histologic grade of breast cancers in pre- compared with post-menopausal women. To assess the association of expression of steroid hormone receptors and indicators of proliferation while controlling for histologic grade, we identified 100 infiltrating ductal carcinomas from premenopausal women 45 years of age or younger and 100 from postmenopausal women 65 years of age or older. The carcinomas were selected so that the histologic grades (low versus high) were distributed equally between the 2 groups. Estrogen receptors (ER), progesterone receptors (PR), p27(Kip1) and Ki-67 (to measure rate of proliferation) were assessed by immunohistochemistry and compared between groups. Clinical information and survival data were also analyzed. ER content was lower and proliferation was higher in carcinomas in premenopausal women (p = 0.048 and p = 0.005, respectively). By univariate analysis, p27(Kip1) and PR were not different between the groups; however, in multivariate analysis, p27(Kip1) was higher in postmenopausal women, but only in a subgroup with highly proliferative carcinomas. Overall survival was similar in the pre- and postmenopausal women. Furthermore, low p27(Kip1) and African-American ethnicity predicted a poorer overall survival in the premenopausal, but not in the postmenopausal, women in our study. After controlling for histologic grade, a lower expression of ER and a higher proliferative index were detected in breast carcinomas in premenopausal women. Therefore, some prognostic indicators, such as ER and proliferative rate, may be more closely associated with menopausal status than histologic grade. Our data also suggest that some prognostic factors are not equally effective as predictors of survival in pre- and postmenopausal women.
Collapse
Affiliation(s)
- Lynya I Talley
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | |
Collapse
|
32
|
Elhaji YA, Gottlieb B, Lumbroso R, Beitel LK, Foulkes WD, Pinsky L, Trifiro MA. The polymorphic CAG repeat of the androgen receptor gene: a potential role in breast cancer in women over 40. Breast Cancer Res Treat 2001; 70:109-16. [PMID: 11768600 DOI: 10.1023/a:1012942910375] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Previous investigations into the relationship of CAG-repeat lengths in the androgen receptor (AR) gene to female breast cancer (BC) have yielded somewhat confusing results. Decreased AR transactivational activity lowers androgen:estrogen balance, and may thereby effect functional hyperestrogenicity. This may promote the pathogenesis of BC. To elucidate whether longer CAG repeats of the AR gene (AR), which correlate with lower transactivational activity of the AR, are associated with BC in women over 40, we examined the distribution of CAG-repeat lengths in BC tissue from this population. The BC tissue was histologically graded as: Grade 1, well differentiated (WD); Grade 2, moderately differentiated (MD); and Grade 3, poorly-differentiated (PD). Analysis showed significant differences as compared to controls when CAG lengths greater than 21 were examined, and that alleles with > or = 26 repeats were 2.4-fold more frequent in BC samples than in constitutional samples from a normal population. A significant shift to greater CAG-repeat lengths, appeared in WD and MD tumors only. Our results give some indication as to the progression of BC by suggesting that hypotransactive ARs with long polyglutamine (polyGln) tracts may have a role in the initiation and/or progression of BC. PD tumors tended to have shorter than normal CAG-repeat lengths. In this case it is hypothesized that the ARs have now become hypertransactive, possibly coinciding with the estrogen resistance that is associated with PD tumors. Whether this shift is of germline or somatic origin was not clear, though the appearance in 14% of the BC samples of a third CAG-repeat length indicates that it may be somatic.
Collapse
Affiliation(s)
- Y A Elhaji
- Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada
| | | | | | | | | | | | | |
Collapse
|
33
|
Mancino AT, Rubio IT, Henry-Tillman R, Smith LF, Landes R, Spencer HJ, Erkman L, Klimberg VS. Racial differences in breast cancer survival: the effect of residual disease. J Surg Res 2001; 100:161-5. [PMID: 11592786 DOI: 10.1006/jsre.2001.6232] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND A survival difference has been seen in numerous studies between African-American (AA) and Caucasian (C) women with breast cancer. The purpose of this study was to elucidate the differences in patient characteristics and outcomes between AA and C women with breast cancer in our population. METHODS We performed a retrospective analysis of 1345 women with newly diagnosed breast cancer who were entered into our tumor registry from October 1980 to December 1998. RESULTS The association between race and stage at presentation was significant, as was the difference in the overall median survival between C and AA women. The data revealed no significant differences in survival between C and AA women presenting with Stage I or II disease. However, the differences between the median survival times for AA and C women presenting with Stage III and IV disease were both highly significant. A significantly lower percentage of AA women became "disease free" after initial therapy as compared with C women (P < 0.001). Interestingly, when data were stratified by stage, only in Stage III and IV were there significant differences between the races for becoming disease free. CONCLUSIONS AA women tend to present at a later stage and have poorer survival from later-stage disease as compared with C women. The poorer survival appears to be related to the decreased ability to achieve disease-free status in AA women with advanced disease. The underlying causes of this difference in treatment outcome need further evaluation.
Collapse
Affiliation(s)
- A T Mancino
- Department of Surgery, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR 72205, USA
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Donnellan R, Kleinschmidt I, Chetty R. Cyclin E immunoexpression in breast ductal carcinoma: pathologic correlations and prognostic implications. Hum Pathol 2001; 32:89-94. [PMID: 11172300 DOI: 10.1053/hupa.2001.21141] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abnormalities of the cell cycle are present in all neoplasms. Cyclin E, which regulates the G1/S phase transition of the cell cycle, plays an important role in many different cancers. To further investigate the role of cyclin E in invasive breast ductal carcinomas in South African women, representative sections from 157 mastectomy and axillary clearance specimens were stained with the cyclin E antibody. The results were compared with known clinicopathologic prognostic factors, namely lymph node metastases, size, estrogen receptor status, and histologic grade. Positive (nuclear) cyclin E immunostaining strongly correlates with negative estrogen receptor status and high grade. These correlations may account for the observation that although cyclin E staining is associated with poor prognosis in univariate analysis, no prognostic significance remains after multivariate analysis.
Collapse
Affiliation(s)
- R Donnellan
- Department of Pathology, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa
| | | | | |
Collapse
|
35
|
McTiernan A. Associations between energy balance and body mass index and risk of breast carcinoma in women from diverse racial and ethnic backgrounds in the U.S. Cancer 2000; 88:1248-55. [PMID: 10705363 DOI: 10.1002/(sici)1097-0142(20000301)88:5+<1248::aid-cncr12>3.0.co;2-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is increasing epidemiologic evidence of an association between body mass index and energy expenditure and the risk of breast carcinoma. Women who are overweight or obese, especially women who gain weight throughout adulthood, are at an increased risk for developing breast carcinoma after menopause. Conversely, overweight women are at a reduced risk for developing breast carcinoma in the premenopausal years. The association between body mass index and breast carcinoma risk has been observed in women from several racial and ethnic backgrounds. Many studies have found an association between increased physical activity and reduced risk for breast cancer. Studies regarding physical activity and breast carcinoma risk have been conducted primarily with white women; therefore, the cross-racial/ethnic patterns with this risk factor are unknown. This article reviews data regarding the associations between body mass index, physical activity, and breast carcinoma risk and presents potential mechanisms for the observed associations, such as sex hormones, reproduction, growth hormones, insulin, and immune function. It outlines challenges in measuring physical activity and body mass index across populations. Finally, the current study discusses limitations of the available data and suggests future research priorities. Obesity and a sedentary lifestyle may be two important risk factors for breast carcinoma that can be modified and thus may have significant public health impact in women from various racial and ethnic backgrounds.
Collapse
Affiliation(s)
- A McTiernan
- Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA
| |
Collapse
|
36
|
|
37
|
Connor CS, Touijer AK, Krishnan L, Mayo MS. Local recurrence following breast conservation therapy in African-American women with invasive breast cancer. Am J Surg 2000; 179:22-6. [PMID: 10737572 DOI: 10.1016/s0002-9610(99)00258-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND African-American women have a lower survival rate than white women following a diagnosis of invasive breast cancer. Limited information is available regarding the impact of race on results of breast conservation therapy (BCT). METHODS Local recurrence rates were compared in 71 African-American patients (73 breasts) and 204 white patients (208 breasts) with stage I and II breast cancer treated with BCT. RESULTS Overall 5-year actuarial recurrence rates were 13% in African-Americans and 4% in whites (P = 0.075). These rates were 9% and 4%, respectively, if patients with local skin/soft tissue recurrences were excluded (P = 0.587). Exclusion of these skin/soft tissue failures eliminated any significant difference seen in recurrence between stage II African-American and white patients (P = 0.163). African-American women had less favorable recurrences, including tumor in more than one quadrant or local skin/ soft tissue involvement (P = 0.001). CONCLUSIONS Overall actuarial recurrence rates were slightly higher, but not significantly different, in African-American and white women following BCT. A much less favorable pattern of local recurrence was seen in the African-American patients (P = 0.001), which may represent the presence of more biologically aggressive tumors in these women.
Collapse
Affiliation(s)
- C S Connor
- Department of Surgery, University of Kansas Medical Center, Kansas City 66160-7308, USA
| | | | | | | |
Collapse
|
38
|
Abstract
BACKGROUND African American breast cancer patients have a higher mortality rate than their Caucasian counterparts. The purpose of this study was to evaluate whether race is a poor prognostic factor in breast cancer survival after multiple other prognostic factors are taken into account. STUDY DESIGN The tumor registry data from two institutions between the years 1982 and 1995 were combined for the analysis. A total of 1,745 patients, including 1,297 African American and 448 Caucasian women, were available for analysis. Race, age, income, stage, histologic findings, type of operation, and treating institution were evaluated as possible key prognostic variables. RESULTS In a univariate Cox proportional hazards regression analysis, African American patients with breast cancer were 1.27 times more likely to die than Caucasians when death from disease was measured (p = 0.01, 95% confidence interval 1.03 to 1.47). When all factors were included in a Cox regression analysis, only the stage of disease at diagnosis, age, and whether the patient had a therapeutic surgical treatment were statistically significant. Race, income, hospital, and histologic findings were not significant, although they were significant when used in a univariate analysis. CONCLUSIONS Poor survival of African American breast cancer patients seems to be related to their advanced stage at presentation and young age. To improve survival in these women, efforts should be concentrated on aggressive screening at a young age to detect the disease at an earlier stage.
Collapse
Affiliation(s)
- M B El-Tamer
- State University of New York, Health Science Center at Brooklyn, USA
| | | | | |
Collapse
|
39
|
Ganz PA, Rowland JH, Meyerowitz BE, Desmond KA. Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors. Recent Results Cancer Res 1999; 152:396-411. [PMID: 9928575 DOI: 10.1007/978-3-642-45769-2_38] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Little is known about the long-term effects of adjuvant therapy on quality of life, sexual functioning and symptoms in breast cancer survivors. Between January 1996 and June 1997, we surveyed 1098 women who had been diagnosed with early stage breast cancer between 1 and 5 years earlier. The breast cancer survivors were recruited in two large metropolitan centers in the USA. They completed a survey battery that contained standardized measures of health-related quality of life (HRQL), depression, body image, sexual functioning, and symptoms. A total of 1096 had usable responses for these analyses. In this sample, n = 356 had received tamoxifen (TAM) alone, n = 180 received chemotherapy (CHEM) alone, n = 395 received CHEM + TAM, and n = 265 received no adjuvant therapy (NO RX). There were significant differences in the mean age of each group, with the TAM group being the oldest (mean 62.6 years) and the CHEM group being the youngest (mean 46.8 years). Both age and time since diagnosis were controlled for in all statistical analyses. We found no significant differences in global quality of life among the four treatment groups. For the MOS-SF-36, there were no significant differences on the subscale scores except for the physical functioning subscale (p = 0.0002); the NO RX group had the highest functioning. There were no significant differences in depression scores among the four treatment groups. The MOS-SF-36 physical functioning composite score differed by treatment group (p = 0.012); the NO RX group had a physical functioning composite score that was at the mean for a normal healthy population of women, while those in the adjuvant treatment groups scored slightly lower. The mental health composite score was not significantly different among the four treatment groups and approximated scores from the normal population of healthy women. There were no differences in body image scores among the four treatment groups; however, sexual functioning scores did differ (p = 0.0078) with patients receiving chemotherapy (either alone or with tamoxifen) experiencing more problems. Hot flashes, night sweats, and vaginal discharge differed by treatment (p = 0.0001); all symptoms were reported more often in breast cancer survivors on tamoxifen. Vaginal dryness and pain with intercourse also differed significantly by adjuvant treatment, occurring more often in survivors treated with chemotherapy. Overall, breast cancer survivors function at a high level, similar to healthy women without cancer. However, compared to survivors with no adjuvant therapy, those who received chemotherapy have significantly more sexual problems, and those treated with tamoxifen experience more vasomotor symptoms.
Collapse
Affiliation(s)
- P A Ganz
- Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | | | | | | |
Collapse
|
40
|
The Estrogenicity of Selected Nutrients, Phytochemicals, Pesticides, and Pollutants. Breast Cancer 1999. [DOI: 10.1007/978-1-59259-456-6_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
41
|
Abstract
BACKGROUND A significant disparity in mortality rates exists between black and white patients with breast carcinoma. This study was designed to compare breast carcinoma tumor characteristics by race and to examine the possible reasons for these differences. METHODS Female patients with an initial diagnosis of breast carcinoma between January 1, 1985 and December 31, 1993 were selected from the Yale-New Haven Hospital Tumor Registry for this retrospective cohort study. All black patients were eligible and white patients were selected randomly and matched to each black patient by year of diagnosis. Data were gathered from multiple sources including the hospital, the Connecticut Tumor Registry, and the U. S. Census. All pathology specimens were reviewed at Yale-New Haven Hospital. RESULTS The final cohort had 100 black and 300 white patients. The black patients tended to be younger than white patients at the time of diagnosis (mean age 55 years vs. 60 years; P = 0.001). A significant racial difference was noted in eight tumor characteristics: stage, size of the tumor, lymph node status, presence of necrosis, vascular/lymphatic invasion, ductal carcinoma in situ, perineural invasion, and progesterone receptor status. Although income, medical insurance coverage, and method of tumor detection explained some pathology differences, black patients still were more likely to have necrosis and a larger tumor size, even after adjustment. CONCLUSIONS Black patients with breast carcinoma tend to be diagnosed at a younger age and in a few important respects have different tumor characteristics compared with white patients, even after controlling for income, medical insurance coverage, and method of tumor detection after screening mammography. These differences may have etiologic and clinical implications.
Collapse
Affiliation(s)
- J G Elmore
- Division of General Internal Medicine, University of Washington, Seattle 98195-6429, USA
| | | | | | | |
Collapse
|
42
|
Abstract
This review compares the prevalence of hyperinsulinemic insulin resistance in Caucasian-American women with that in Japanese-American and Pima Indian minority groups in the United States. It also examines the differences in breast cancer risk between these ethnic groups and suggests that risk may be modulated by ethnic genetic susceptibility to the effect of the Western diet in precipitating insulin resistance. It is widely agreed that the Western diet with its high saturated fatty acid content and high n-6/n-3 ratio of polyunsaturated fatty acids (PUFAs) favors the manifestation of hyperinsulinemia in individuals who are genetically predisposed. A number of case-control studies have shown hyperinsulinemia to be a marker of increased breast cancer risk, particularly in obese postmenopausal women. Mechanisms that have been postulated include an increased sex steroid level associated with a decreased serum level of sex hormone-binding globulin and an increased bioactive level of insulin-like growth factor I, which may synergize with estrogen in promoting mammary carcinogenesis. Dietary supplements rich in n-3 PUFAs have been shown to inhibit the growth of human breast cancer implants in nude mice, and members of the n-3 PUFA series can inhibit the growth of human breast cancer cell lines in vitro. On the basis of this experimental evidence, some have proposed dietary supplements rich in n-3 PUFAs for breast cancer protection. However, increased consumption of PUFAs requires increased intake of antioxidants. Vitamin E may be the most suitable agent, especially because of its added advantage that in animal models it is reported to reduce the incidence of carcinogen-induced mammary tumors. Preliminary trials of the combination may best be planned as adjuvant treatment after primary surgery for breast cancer, and the insulin hypothesis could be tested in the trials by monitoring fasting insulin and sex steroid levels.
Collapse
Affiliation(s)
- B A Stoll
- Oncology Department, St. Thomas' Hospital, London, United Kingdom
| |
Collapse
|
43
|
Abstract
Infiltrating ductal carcinoma is the most common form of breast cancer, and major risk factors are nonmodifiable. Current screening recommendations offer the best chance of early diagnosis. Staging takes into account the size of primary tumor, number of positive lymph nodes at surgery, and location of distant metastases. Treatment options include various combinations of surgical procedures, radiotherapy, chemotherapy, and endocrine therapy.
Collapse
Affiliation(s)
- R B Saenz
- Department of Family Medicine, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA
| | | |
Collapse
|
44
|
Abstract
In 1986, the National Cancer Institute published its cancer control objectives for the nation, which included projected reductions in breast cancer mortality. The reductions were estimated to be 25.0% from reducing fat, 16.0% from expanding use of breast cancer screening services, and 14.3% from expanding access to state-of-the-art breast cancer treatment. During the same decade, the U.S. population aged and became significantly more ethnically diverse, and accompanying this increase in ethnic diversity was endemic poverty, disproportionately experienced by black and Hispanic minorities. These populations may be seen as medically underserved. With respect to breast cancer, as well as many other cancers, the medically underserved are understudied, not well understood by many in the medical and academic research community, and attended by health care institutions that are under-funded and often do not have the resources necessary to ensure access to state-of-the-art cancer screening, clinical follow-up, diagnosis, and treatment. At the same time, medically underserved women are more likely to be diagnosed with late-stage breast cancer, and some groups (e.g. black women) bear the greatest breast cancer mortality burden in the nation. In this special issue of Breast Cancer Research and Treatment, eight papers describe what we know and what we don't about breast cancer prevention and control in medically underserved populations.
Collapse
Affiliation(s)
- J F Kerner
- Vincent T. Lombardi Cancer Center, Georgetown University Medical Center, Washington D.C. 20007, USA.
| |
Collapse
|