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Samaroo K, Hosein A, Olivier LK, Ali J. Breast Cancer in the Caribbean. Cureus 2021; 13:e17042. [PMID: 34522520 PMCID: PMC8428164 DOI: 10.7759/cureus.17042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/22/2022] Open
Abstract
Breast cancer (BC) is one of the leading causes of death among women globally. In the Caribbean, there is a higher mortality rate compared with North American and European countries which have higher incidence rates. We conducted a literature review to examine the BC dynamic in the Caribbean and determine the areas where further investigations are needed. The PubMed database was used for identifying relevant studies using a combination of specific keyword searches. All studies focusing on BC within the defined Caribbean population were selected for this review. A total of 117 papers were included. The data were organized and presented under the following headings and reported according to the country where available: BC incidence and mortality, patient demographics, clinicopathology, genetics, behavioral risks, diagnosis and treatment, and BC control. Our review uncovered major variability in the incidence, management, etiology, and mortality of BC among Caribbean countries. Low-resource countries are burdened by more advanced disease with expected poorer BC outcomes (i.e., shorter periods of disease-free survival). Countries with established national cancer registries seem to have a better approach to the management of BC. The introduction of cancer treatment programs in association with international nonprofit groups has shown tremendous improvement in quality, accessible cancer care for patients, particularly in low- and middle-income settings. BC research is relatively limited in the Caribbean, lacking in both scope and consistency. The unique Caribbean BC population of diverse ethnicities, environmental influence, immigrants, socioeconomic status, and sociocultural practices allows an optimal opportunity for epidemiological investigations that can provide deeper insights into the status of BC.
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Affiliation(s)
- Kristy Samaroo
- Biomedical Engineering, The University of Trinidad & Tobago, Port of Spain, TTO
| | - Amalia Hosein
- Biomedical Engineering, The University of Trinidad & Tobago, Port of Spain, TTO
| | - Lyronne K Olivier
- General Surgeon/Breast Surgical Oncologist, Sangre Grande General Hospital, Port of Spain, TTO
| | - Jameel Ali
- Surgery, University of Toronto, Toronto, CAN
- Breast Unit, St. James Medical Complex, Port of Spain, TTO
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Ragin C, Banydeen R, Zhang C, Ben A, Calabrese V, Villa NN, Reville J, Dasgupta S, Bandyopadhyay M, Louden D, Dasgupta S. Breast Cancer Research in the Caribbean: Analysis of Reports From 1975 to 2017. J Glob Oncol 2018; 4:1-21. [PMID: 30481085 PMCID: PMC6818300 DOI: 10.1200/jgo.18.00044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Breast cancer is among the leading causes of death resulting from cancer in Caribbean women. Studies examining exogenous and genetically predetermined endogenous risk factors are critical to define breast cancer susceptibility in Caribbean women. The purpose of this systematic review is to assess the existing scientific literature in the last 42 years (1975 to 2017) to describe the body of research generated for the population of this region and determine future research directions. METHODS We selected published research articles using a combination of definite keyword searches in PubMed. Only articles presenting the Caribbean population as the focus of their research objectives were included in this analysis. RESULTS Studies on breast cancer in the Caribbean are limited. A majority of publications on Caribbean populations were descriptive, focusing on cancer trends and clinicopathologic factors. High incidence and mortality rates for breast cancer are reported for the region, and there seem to be some differences between countries in the frequency of cases according to age at presentation. A limited number of epidemiologic, behavioral, and genetic and molecular studies were conducted in more recent years. CONCLUSION A regional strategy for cancer registration is needed for the Caribbean to address possible underestimates of breast cancer incidence. Furthermore, behavioral, molecular, genetic, and epidemiologic investigations of breast cancer are critical to address the concerns related to currently described high incidence and mortality rates in the Caribbean.
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Affiliation(s)
- Camille Ragin
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Rishika Banydeen
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Christine Zhang
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Athena Ben
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Victoria Calabrese
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Nina N. Villa
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Jade Reville
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Shaoni Dasgupta
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Mausumi Bandyopadhyay
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Delroy Louden
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Subhajit Dasgupta
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
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Associations of anthropometric measures on breast cancer risk in pre- and postmenopausal women--a case-control study. J Physiol Anthropol 2016; 35:7. [PMID: 26951106 PMCID: PMC4782382 DOI: 10.1186/s40101-016-0090-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/26/2016] [Indexed: 01/01/2023] Open
Abstract
Background The type of silhouette and quantity of fat tissue are correlated with hormonal imbalance which plays a substantial role in breast carcinogenesis. The goal of the study was to investigate the association between various anthropometric characteristics and breast cancer risk. Methods Detailed anthropometric assessment was conducted on 487 women of whom 193 had diagnosed breast cancer and were consecutive patients in the Oncology Center, Cracow, Poland between 2002 and 2004. Measurements were divided into four categories: overall body size (body mass index [BMI], waist circumference [WC], waist-hip ratio [WHR]), regional body sizes (skinfold thicknesses, circumferences), thickness of the skeleton (widths, chest diameters), and body proportions. Additionally, results were analyzed in regard to menopausal status. Differences between groups were assessed using Student’s t test and Mann-Whitney’s test. Models of logistic regression for selected data were built to estimate the odds ratio. Results were considered statistically significant when the P value was less than 0.05. Results The BMI in both groups was negatively associated with the risk of cancer. Among premenopausal women, WHR increased the risk of breast cancer (WHR > 0.83, OR, 2.72; 95 % CI, 1.01–7.27). Anthropometric indices of hip-to-shoulder ratio in postmenopausal (≥84.2 mm, OR, 0.02; 95 % CI, 0.01–0.11) and trunk-to-height ratio in both premenopausal women (≥32.76, OR, 0.09; 95 % CI, 0.03–0.28) and postmenopausal women (≥32.76, OR, 0.13; 95 % CI, 0.05–0.33) were strongly related to a decreased risk of breast cancer. Thicknesses of the triceps and subscapular skinfolds increased the risk of breast cancer. Conclusions Women with breast cancer present with an obese type of silhouette with a specific concentration of fat tissue in the central and upper parts of the body.
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Bandera EV, Maskarinec G, Romieu I, John EM. Racial and ethnic disparities in the impact of obesity on breast cancer risk and survival: a global perspective. Adv Nutr 2015; 6:803-19. [PMID: 26567202 PMCID: PMC4642425 DOI: 10.3945/an.115.009647] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Obesity is a global concern, affecting both developed and developing countries. Although there are large variations in obesity and breast cancer rates worldwide and across racial/ethnic groups, most studies evaluating the impact of obesity on breast cancer risk and survival have been conducted in non-Hispanic white women in the United States or Europe. Given the known racial/ethnic differences in tumor hormone receptor subtype distribution, obesity prevalence, and risk factor profiles, we reviewed published data for women of African, Hispanic, and Asian ancestry in the United States and their countries of origin. Although the data are limited, current evidence suggests a stronger adverse effect of obesity on breast cancer risk and survival in women of Asian ancestry. For African Americans and Hispanics, the strength of the associations appears to be more comparable to that of non-Hispanic whites, particularly when accounting for subtype and menopausal status. Central obesity seems to have a stronger impact in African-American women than general adiposity as measured by body mass index. International data from countries undergoing economic transition offer a unique opportunity to evaluate the impact of rapid weight gain on breast cancer. Such studies should take into account genetic ancestry, which may help elucidate differences in associations between ethnically admixed populations. Overall, additional large studies that use a variety of adiposity measures are needed, because the current evidence is based on few studies, most with limited statistical power. Future investigations of obesity biomarkers will be useful to understand possible racial/ethnic biological differences underlying the complex association between obesity and breast cancer development and progression.
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Affiliation(s)
- Elisa V Bandera
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | | | | | - Esther M John
- Cancer Prevention Institute of California, Fremont, CA; and Department of Health Research and Policy (Epidemiology) and Stanford Cancer Institute, Stanford School of Medicine, Stanford, CA
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Fourkala EO, Burnell M, Cox C, Ryan A, Salter LC, Gentry-Maharaj A, Parmar M, Jacobs I, Menon U. Association of skirt size and postmenopausal breast cancer risk in older women: a cohort study within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). BMJ Open 2014; 4:e005400. [PMID: 25252818 PMCID: PMC4185339 DOI: 10.1136/bmjopen-2014-005400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Several studies suggest that overall and central-obesity are associated with increased breast cancer (BC) risk in postmenopausal-women. However, there are no studies investigating changes of central obesity and BC. We report on the association of BC risk with self-reported skirt size (SS; waist-circumference proxy) changes between 20s and postmenopausal-age. DESIGN Prospective cohort-study. SETTING UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) involving the nine trial centres in England. PARTICIPANTS Postmenopausal-women aged >50 with no known history of BC prior to or on the day of completion of the study-entry questionnaire. INTERVENTIONS At recruitment and at study entry, women were asked to complete a questionnaire. Women were followed-up via 'flagging' at the NHS Information Centre in England and the Hospital Episode Statistics. MAIN OUTCOME-MEASURE Time to initial BC diagnosis. RESULTS Between 2 January 2005 and 1 July 2010, 92,834 UKCTOCS participants (median age 64.0) completed the study-entry questionnaire. During median follow-up of 3.19 years (25th-75th centile: 2.46-3.78), 1090 women developed BC. Model adjusted analysis for potential confounders showed body mass index (BMI) at recruitment to UKCTOCS (HR for a 5 unit change=1.076, 95% CI 1.012 to 1.136), current SS at study entry (HR=1.051; 95% CI 1.014 to 1.089) and change in SS per 10 years (CSS) (HR=1.330; 95% CI 1.121 to 1.579) were associated with increased BC risk but not SS at 25 (HR=1.006; 95% CI 0.958 to 1.056). CSS was the most predictive singe adiposity measure and further analysis including both CSS and BMI in the model revealed CSS remained significant (HR=1.266; 95% CI 1.041 to 1.538) but not BMI (HR=1.037; 95% CI 0.970 to 1.109). CONCLUSIONS CSS is associated with BC risk independent of BMI. A unit increase in UK SS (eg, 12-14) every 10-years between 25 and postmenopausal-age is associated with postmenopausal BC risk by 33%. Validation of these results could provide women with a simple and easy to understand message. TRIAL REGISTRATION NUMBER ISRCTN22488978.
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Affiliation(s)
| | - Matthew Burnell
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Catherine Cox
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Andy Ryan
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | | | | | | | - Ian Jacobs
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
- Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Usha Menon
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
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Munsell MF, Sprague BL, Berry DA, Chisholm G, Trentham-Dietz A. Body mass index and breast cancer risk according to postmenopausal estrogen-progestin use and hormone receptor status. Epidemiol Rev 2014; 36:114-36. [PMID: 24375928 PMCID: PMC3873844 DOI: 10.1093/epirev/mxt010] [Citation(s) in RCA: 255] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 12/20/2022] Open
Abstract
To assess the joint relationships among body mass index, menopausal status, and breast cancer according to breast cancer subtype and estrogen-progestin medication use, we conducted a meta-analysis of 89 epidemiologic reports published in English during 1980-2012 identified through a systematic search of bibliographic databases. Pooled analysis yielded a summary risk ratio of 0.78 (95% confidence interval (CI): 0.67, 0.92) for hormone receptor-positive premenopausal breast cancer associated with obesity (body mass index (weight (kg)/height (m)(2)) ≥30 compared with <25). Obesity was associated with a summary risk ratio of 1.39 (95% CI: 1.14, 1.70) for receptor-positive postmenopausal breast cancer. For receptor-negative breast cancer, the summary risk ratios of 1.06 (95% CI: 0.70, 1.60) and 0.98 (95% CI: 0.78, 1.22) associated with obesity were null for both premenopausal and postmenopausal women, respectively. Elevated postmenopausal breast cancer risk ratios associated with obesity were limited to women who never took estrogen-progestin therapy, with risk ratios of 1.42 (95% CI: 1.30, 1.55) among never users and 1.18 (95% CI: 0.98, 1.42) among users; too few studies were available to examine this relationship according to receptor subtype. Future research is needed to confirm whether obesity is unrelated to receptor-negative breast cancer in populations of postmenopausal women with low prevalence of hormone medication use.
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Affiliation(s)
| | | | | | | | - Amy Trentham-Dietz
- Correspondence to Dr. Amy Trentham-Dietz, University of Wisconsin, 610 Walnut Street, WARF Room 307, Madison, WI 53726 (e-mail: )
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John EM, Phipps AI, Sangaramoorthy M. Body size, modifying factors, and postmenopausal breast cancer risk in a multiethnic population: the San Francisco Bay Area Breast Cancer Study. SPRINGERPLUS 2013; 2:239. [PMID: 23762816 PMCID: PMC3676738 DOI: 10.1186/2193-1801-2-239] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 04/29/2013] [Indexed: 01/07/2023]
Abstract
Data on body size and postmenopausal breast cancer in Hispanic and African American women are inconsistent, possibly due to the influence of modifying factors. We examined associations between adiposity and risk of breast cancer defined by hormone receptor status in a population-based case-control study conducted from 1995-2004 in the San Francisco Bay Area. Multivariate adjusted odds ratios and 95% confidence intervals were calculated using unconditional logistic regression. Associations with body size were limited to women not currently using menopausal hormone therapy (801 cases, 1336 controls). High young-adult body mass index (BMI) was inversely associated with postmenopausal breast cancer risk, regardless of hormone receptor status, whereas high current BMI and high adult weight gain were associated with two-fold increased risk of estrogen receptor and progesterone receptor positive breast cancer, but only in women with a low young-adult BMI (≤22.4 kg/m(2)) or those with ≥15 years since menopause. Odds ratios were stronger among non-Hispanic Whites than Hispanics and African Americans. Waist circumference and waist-to-height ratio increased breast cancer risk in Hispanics and African Americans only, independent of BMI. These findings emphasize the importance of considering tumor hormone receptor status and other modifying factors in studies of racially/ethnically diverse populations.
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Affiliation(s)
- Esther M John
- />Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA 94538 USA
- />Division of Epidemiology, Department of Health Research and Policy, and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Amanda I Phipps
- />Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109 USA
| | - Meera Sangaramoorthy
- />Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA 94538 USA
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Zagami SE, Golmakani N, Shandiz FH, Saki A. Evaluating the Relationship between Body Size and Body Shape with the Risk of Breast Cancer. Oman Med J 2013; 28:389-94. [PMID: 24223241 DOI: 10.5001/omj.2013.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/05/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aims to determine the relationship between body size and body shape with the risk of breast cancer. METHODS In this case control study, 480 women participated (240 women with breast cancer in case group and 240 healthy women in control group). After completing the interview form, the weight, height, waist circumference, hip circumference and breast size, were measured. The data were analyzed using statistical test by SPSS11.5. RESULTS The present study showed that the mean of hip circumference were significantly different in both groups (p=0.036). The size of the breast was statistically significant between the two groups. Thyroid type, one of the body shapes, was more seen in the case group than control group (p<0.001). CONCLUSION This study revealed that the risk of breast cancer increases with increased hip circumference. In addition, the results indicate that body shape may be a useful predictor in determining the risk of breast cancer. More studies should be designed to address this subject.
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Affiliation(s)
- Samira Ebrahimzadeh Zagami
- MSc of Midwifery, Instructor and Faculty of Midwifery, Department of Midwifery, School of Nursing & Midwifery, Mashhad University of Medical Sciences, Daneshghah Street, Mashhad, Iran
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9
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Bandera EV, Chandran U, Zirpoli G, Gong Z, McCann SE, Hong CC, Ciupak G, Pawlish K, Ambrosone CB. Body fatness and breast cancer risk in women of African ancestry. BMC Cancer 2013; 13:475. [PMID: 24118876 PMCID: PMC3853021 DOI: 10.1186/1471-2407-13-475] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 10/12/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Obesity has been shown to be inversely associated with breast cancer risk in premenopausal women, while increasing risk in postmenopausal women. However, the current evidence is largely based on studies in Caucasian populations. Associations in women of African ancestry (AA), who have a higher prevalence of obesity, have been evaluated in few studies and results suggest different effects. METHODS We evaluated the impact of body size, body fat distribution, and body composition on breast cancer risk among AA women (978 cases and 958 controls) participating in the Women's Circle of Health Study, a multi-site case-control study in New York City (NYC) and New Jersey (NJ). Cases were newly diagnosed with histologically confirmed ductal carcinoma in situ or invasive breast cancer, age 20-75 yrs. In NYC, cases were recruited through hospitals with the largest referral patterns for AA women and controls through random digit dialing (RDD). In NJ, cases were identified in seven counties in NJ thorough the NJ State Cancer Registry, and controls through RDD and community-based recruitment. During in-person interviews, questionnaires were administered and detailed anthropometric measurements were obtained. Body composition was assessed by bioelectrical impedance analysis. RESULTS BMI did not have a major impact on pre- or post-menopausal breast cancer, but was significantly associated with reduced risk of ER-/PR- tumors among postmenopausal women (OR: 0.37; 95% CI: 0.15-0.96 for BMI > 30 vs. BMI < 25). Furthermore, increased premenopausal breast cancer risk was found for higher waist and hip circumferences after adjusting for BMI, with ORs of 2.25 (95% CI: 1.07-4.74) and 2.91 (95% CI: 1.39-6.10), respectively, comparing the highest vs. lowest quartile. While ORs for higher fat mass and percent body fat among postmenopausal women were above one, confidence intervals included the null value. CONCLUSIONS Our study suggests that in AA women BMI is generally unrelated to breast cancer. However, higher waist and hip circumferences were associated with increased pre-menopausal breast cancer risk, while general obesity was associated with decreased risk of ER-/PR- tumors. Larger studies are needed to confirm findings and to evaluate the impact of obesity on breast cancer subtypes.
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Affiliation(s)
- Elisa V Bandera
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
- Rutgers School of Public Health, Piscataway, NJ, USA
| | - Urmila Chandran
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
- Rutgers School of Public Health, Piscataway, NJ, USA
| | - Gary Zirpoli
- Department of Cancer Prevention & Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Zhihong Gong
- Department of Cancer Prevention & Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Susan E McCann
- Department of Cancer Prevention & Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Chi-Chen Hong
- Department of Cancer Prevention & Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Gregory Ciupak
- Department of Cancer Prevention & Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Karen Pawlish
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ, USA
| | - Christine B Ambrosone
- Department of Cancer Prevention & Control, Roswell Park Cancer Institute, Buffalo, NY, USA
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10
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Suzuki S, Kojima M, Tokudome S, Mori M, Sakauchi F, Wakai K, Fujino Y, Lin Y, Kikuchi S, Tamakoshi K, Tamakoshi A. Obesity/weight gain and breast cancer risk: findings from the Japan collaborative cohort study for the evaluation of cancer risk. J Epidemiol 2013; 23:139-45. [PMID: 23438695 PMCID: PMC3700246 DOI: 10.2188/jea.je20120102] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We analyzed data from the Japan Collaborative Cohort Study (36 164 women aged 40-79 years at baseline in 1988-1990 with no previous diagnosis of breast cancer and available information on weight and height) to examine the association between baseline body mass index (BMI)/weight gain from age 20 years and breast cancer risk in a non-Western population. METHODS The participants were followed prospectively from enrollment until 1999-2003 (median follow-up: 12.3 years). During follow-up, breast cancer incidence was mainly confirmed through record linkage to population-based cancer registries. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% CIs for the association between breast cancer risk and body size. RESULTS In 397 644.1 person-years of follow-up, we identified 234 breast cancer cases. Among postmenopausal women, the adjusted HR increased with BMI, with a significant linear trend (P < 0.0001). Risk was significantly increased among women with a BMI of 24 or higher (HR: 1.50, 95% CI: 1.09-2.08 for BMI of 24-28.9, and 2.13, 1.09-4.16 for BMI ≥ 29) as compared with women with a BMI of 20 to 23.9. Weight gain after age 20 years and consequent overweight/obesity were combined risk factors for postmenopausal breast cancer risk. This combined effect was stronger among women aged 60 years or older. However, the HRs were not significant in premenopausal women. CONCLUSIONS Our findings support the hypothesis that weight gain and consequent overweight/obesity are combined risk factors for breast cancer among postmenopausal women, particularly those aged 60 years or older.
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Affiliation(s)
- Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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11
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Ogundiran TO, Huo D, Adenipekun A, Campbell O, Oyesegun R, Akang E, Adebamowo C, Olopade OI. Body fat distribution and breast cancer risk: findings from the Nigerian breast cancer study. Cancer Causes Control 2012; 23:565-74. [PMID: 22367701 DOI: 10.1007/s10552-012-9916-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 02/07/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE The relationship between overall obesity and breast cancer risk has been well recognized, but the role of central obesity in breast cancer development is uncertain. METHODS Between 1998 and 2009, 1,233 invasive breast cancer cases and 1,101 community controls were recruited into the Nigerian Breast Cancer Study at Ibadan, Nigeria. Logistic regressions were used to calculate multivariate odds ratio (OR) and 95% confidence intervals (CI), adjusting for age, body mass index (BMI), and other known risk factors for breast cancer. RESULTS The OR for the highest quartile group of waist circumference relative to the lowest was 2.39 (95% CI, 1.59-3.60; P-trend < 0.001). Comparing women with waist/hip ratio (WHR) in the lowest quartile group, the OR for women in the highest quartile category was 2.15 (95% CI, 1.61-2.85; P-trend < 0.001). An inverse association was observed between hip circumference and breast cancer, with an OR of 0.36 for the highest quartile (95% CI, 0.24-0.55; P-trend < 0.001). The effects of these three measures existed in both pre- and postmenopausal women. Of note, we found a significant interaction between WHR and BMI (P-interaction = 0.016): the OR comparing the highest to the lowest WHR quartile was 2.81 (95% CI, 1.90-4.16) for women with BMI < 25 kg/m2 and 1.70 (95% CI, 1.11-2.61) for women with BMI ≥ 25 kg/m2. CONCLUSIONS These results suggest that central adiposity, measured by waist circumference and waist/hip ratio, was an important risk factor for breast cancer in Nigerian women, and the effect of central adiposity was strong in normal-weight women.
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Affiliation(s)
- Temidayo O Ogundiran
- Department of Surgery College of Medicine, University of Ibadan, Ibadan, Nigeria
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12
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The role of anthropometric and nutritional factors on breast cancer risk in African-American women. Public Health Nutr 2011; 15:738-48. [PMID: 22122844 DOI: 10.1017/s136898001100303x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE While the role of nutrition, physical activity and body size on breast cancer risk has been extensively investigated, most of these studies were conducted in Caucasian populations. However, there are well-known differences in tumour biology and the prevalence of these factors between African-American and Caucasian women. The objective of the present paper was to conduct a review of the role of dietary factors, anthropometry and physical activity on breast cancer risk in African-American women. DESIGN Twenty-six research articles that presented risk estimates on these factors in African-American women and five articles involving non-US black women were included in the current review. SETTING Racial disparities in the impact of anthropometric and nutritional factors on breast cancer risk. SUBJECTS African-American and non-US black women. RESULTS Based on the few studies that presented findings in African-American women, an inverse association with physical activity was found for pre- and postmenopausal African-American women, while the association for anthropometric and other dietary factors, such as alcohol, was unclear. Studies assessing the effect by molecular subtypes in African-American women were too few and based on sample sizes too small to provide definitive conclusions. CONCLUSIONS The effect of certain nutrition and lifestyle factors on breast cancer in African-American women is not starkly distinct from those observed in white women. However, there is an enormous need for further research on this minority group to obtain more confirmatory findings.
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13
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John EM, Sangaramoorthy M, Phipps AI, Koo J, Horn-Ross PL. Adult body size, hormone receptor status, and premenopausal breast cancer risk in a multiethnic population: the San Francisco Bay Area breast cancer study. Am J Epidemiol 2011; 173:201-16. [PMID: 21084558 PMCID: PMC3011952 DOI: 10.1093/aje/kwq345] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Accepted: 09/10/2010] [Indexed: 11/12/2022] Open
Abstract
Large body size has been associated with a reduced risk of premenopausal breast cancer in non-Hispanic white women. Data on other racial/ethnic populations are limited. The authors examined the association between premenopausal breast cancer risk and adult body size in 672 cases and 808 controls aged ≥35 years from a population-based case-control study conducted in 1995-2004 in the San Francisco Bay Area (Hispanics: 375 cases, 483 controls; African Americans: 154 cases, 160 controls; non-Hispanic whites: 143 cases, 165 controls). Multivariate adjusted odds ratios and 95% confidence intervals were calculated using unconditional logistic regression. Height was associated with increased breast cancer risk (highest vs. lowest quartile: odds ratio = 1.77, 95% confidence interval: 1.23, 2.53; P(trend) < 0.01); the association did not vary by hormone receptor status or race/ethnicity. Body mass index (measured as weight (kg) divided by height (m) squared) was inversely associated with risk in all 3 racial/ethnic groups, but only for estrogen receptor- and progesterone receptor-positive tumors (body mass index ≥30 vs. <25: odds ratio = 0.42; 95% confidence interval: 0.29, 0.61). Other body size measures (current weight, body build, adult weight gain, young adult weight and body mass index, waist circumference, and waist-to-height ratio) were similarly inversely associated with risk of estrogen receptor- and progesterone receptor-positive breast cancer but not estrogen receptor- and progesterone receptor-negative disease. Despite racial/ethnic differences in body size, inverse associations were similar across the 3 racial/ethnic groups when stratified by hormone receptor status.
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Affiliation(s)
- Esther M John
- Cancer Prevention Institute of California, Fremont, 94538, USA.
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Hajian-Tilaki KO, Gholizadehpasha AR, Bozorgzadeh S, Hajian-Tilaki E. Body mass index and waist circumference are predictor biomarkers of breast cancer risk in Iranian women. Med Oncol 2010; 28:1296-301. [PMID: 20661665 DOI: 10.1007/s12032-010-9629-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 07/08/2010] [Indexed: 01/02/2023]
Abstract
Both obesity and breast cancer incidence increased dramatically during two recent decades in a rapidly changing society in northern Iran. In this study, we examined the ability of body mass index (BMI) and waist circumference (WC) as predictor biomarkers of breast cancer risk in Iranian women. In a case-control study of 100 new cases of histological confirmed breast cancer and 200 age-matched controls, in Babol, we measured weight, height, waist and hip circumference at time of diagnosis with standard methods. The data of demographic, characteristics, reproductive and lifestyle factors were collected by interview. We used both regression and receiver operator characteristics (ROC) analysis to estimate the predictive ability of BMI and WC for breast cancer as estimated by area under the curve (AUC). The results showed a significant difference in the mean of weight, BMI and WC between patients and controls in pre- and postmenopausal women (P<0.001). While after adjusting for BMI, no longer an association between WC and breast cancer was found. The overall accuracy of observed BMI and WC were 0.79 (95% CI: 0.74-0.84) and 0.68 (95% CI: 0.61-0.74), respectively. The accuracy of BMI and WC were 0.82 (95% CI: 0.76-0.89), 0.75(0.67-0.83) for premenopausal and 0.77(0.68-0.85), 0.60 (0.50-0.71) for postmenopausal women, respectively. BMI and WC are predictor biomarkers of breast cancer risk in both pre- and postmenopausal Iranian women while after adjusting for BMI, no longer an association between WC and breast cancer was observed. These findings imply to perform breast cancer screening program in women with a higher BMI and WC.
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Affiliation(s)
- K O Hajian-Tilaki
- Department of Social Medicine and Health, Babol University of Medical Sciences, and Department of Surgery, Shahid Beheshti Hospital, Babol, Iran.
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15
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Interaction between menopausal status and obesity in affecting breast cancer risk. Maturitas 2010; 66:33-8. [PMID: 20181446 DOI: 10.1016/j.maturitas.2010.01.019] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 01/26/2010] [Accepted: 01/27/2010] [Indexed: 01/12/2023]
Abstract
Obesity has a complex relationship to breast cancer risk that differs in premenopausal and postmenopausal women. Before the menopause, the level of adiposity is inversely related to risk, indicative of a protective effect, whereas in postmenopausal women, particularly the elderly, the association is a positive one, consistent with obesity being a risk factor. The importance of high estrogen production in adipose tissue, with consequent elevation of circulating biologically available estradiol, in the promotional effect of obesity on postmenopausal breast carcinogenesis is well established; the resulting tumors express both estrogen and progesterone receptors. The mechanism(s) for the protective effect in premenopausal women is less well understood, but the breast cancers that do develop in the presence of obesity are most often estrogen and progesterone receptor negative, consistent with the selection of non-estrogen-dependent tumor cells which are dependent on growth factors such as insulin, insulin-like growth factor-I and some adipokines. The influence of menopausal status on the relationships between adiposity and breast cancer appears to be modified within each category by age; the protective effect before the menopause may be limited to younger women (<35 years), and the adverse effect was found to apply specifically to older postmenopausal women. Although randomized trials of weight reduction for postmenopausal breast cancer prevention have not been performed, observational studies suggested that risk reduction does occur; in addition, other health benefits of weight control need to be considered regardless of menopausal status.
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Nemesure B, Wu SY, Hennis A, Leske MC. Body size and breast cancer in a black population--the Barbados National Cancer Study. Cancer Causes Control 2009; 20:387-94. [PMID: 18987981 PMCID: PMC2659612 DOI: 10.1007/s10552-008-9253-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 10/19/2008] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the relationship between body size and incident breast cancer in an African-origin Caribbean population. METHODS This investigation is based on 222 incident breast cancer cases and 454 controls from the Barbados National Cancer Study (BNCS) in whom body size variables that included height, weight, body-mass index (BMI), waist and hip circumferences (WC, HC), and waist-hip ratio (WHR) were compared. Multivariate-adjusted logistic regression analyses were performed and the findings are presented as odds ratios (ORs) with 95% confidence intervals (CI). RESULTS Although 33% of cases and 39% of controls were obese (BMI > or = 30 kg/m(2)), BMI was not found to be a significant predictor of breast cancer in the multivariate analyses. Tall stature increased risk among women > or =50 years (OR = 2.16, 95% CI (1.02, 4.58)), and a dual effect with age was suggested for both WC and WHR (decreased risk for those aged < or =50 years; increased risk among those > or =50 years). CONCLUSIONS Body size appears to influence the risk of breast cancer in this population of African origin. The BNCS data suggest that a few, but not all body size factors play a role in breast cancer risk, and that age may affect these relationships.
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Affiliation(s)
- Barbara Nemesure
- Department of Preventive Medicine, L3 HSC Room 086, Stony Brook University, Stony Brook, NY 11794-8036, USA, e-mail:
| | - Suh-Yuh Wu
- Department of Preventive Medicine, L3 HSC Room 086, Stony Brook University, Stony Brook, NY 11794-8036, USA, e-mail:
| | - Anselm Hennis
- Department of Preventive Medicine, L3 HSC Room 086, Stony Brook University, Stony Brook, NY 11794-8036, USA, e-mail:
- Chronic Disease Research Centre, University of the West Indies, Bridgetown, Barbados
- Ministry of Health, Bridgetown, Barbados
| | - M. Cristina Leske
- Department of Preventive Medicine, L3 HSC Room 086, Stony Brook University, Stony Brook, NY 11794-8036, USA, e-mail:
| | - Barbados National Cancer Study Group
- Department of Preventive Medicine, L3 HSC Room 086, Stony Brook University, Stony Brook, NY 11794-8036, USA, e-mail:
- Chronic Disease Research Centre, University of the West Indies, Bridgetown, Barbados
- Ministry of Health, Bridgetown, Barbados
- Faculty of Chemical and Biological Sciences, University of the West Indies, Bridgetown, Barbados
- Translational Genomics, Phoenix, AZ, USA
- National Human Genome Research Institute, Bethesda, MD, USA
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