Breast cancer risk factors in two distinct ethnic groups: Indian and Pakistani vs. American premenopausal women

A meta-analysis and in silico analysis of polymorphic variants conferring breast cancer risk in the Indian subcontinent

Background: Genetic association studies on breast cancer on the Indian subcontinent have yielded conflicting results, and the precise effect of these variants on breast cancer pathogenesis is not known. Methods: Genomic variants, as obtained from selected studies from the Indian subcontinent, were subjected to random-effects and fixed-effect meta-analysis. Functional annotation of the relevant variants was done through a tried and tested in silico pipeline. Results: We found rs4646903/CYP1A1, rs1799814/CYP1A1, rs61886492/GCPII, del2/GSTM1, rs4680/COMT and rs1801394/MTRR to be associated with breast cancer. The del2/GSTM1 holds the association in premenopausal women. Conclusions: This is the first study of its kind from the Indian subcontinent analysing the extent of association of variants across populations followed by their functional annotation in the disease pathway.

Dietary Patterns and Breast Cancer Risk: A Multi-Centre Case Control Study among North Indian Women

Evidence from India, a country with unique and distinct food intake patterns often characterized by lifelong adherence, may offer important insight into the role of diet in breast cancer etiology. We evaluated the association between Indian dietary patterns and breast cancer risk in a multi-centre case-control study conducted in the North Indian states of Punjab and Haryana. Eligible cases were women 30⁻69 years of age, with newly diagnosed, biopsy-confirmed breast cancer recruited from hospitals or population-based cancer registries. Controls (hospital- or population-based) were frequency matched to the cases on age and region (Punjab or Haryana). Information about diet, lifestyle, reproductive and socio-demographic factors was collected using a structured interviewer-administered questionnaire. All participants were characterized as non-vegetarians, lacto-vegetarians (those who consumed no animal products except dairy) or lacto-ovo-vegetarians (persons whose diet also included eggs). The study population included 400 breast cancer cases and 354 controls. Most (62%) were lacto-ovo-vegetarians. Breast cancer risk was lower in lacto-ovo-vegetarians compared to both non-vegetarians and lacto-vegetarians with odds ratios (95% confidence intervals) of 0.6 (0.3⁻0.9) and 0.4 (0.3⁻0.7), respectively. The unexpected difference between lacto-ovo-vegetarian and lacto-vegetarian dietary patterns could be due to egg-consumption patterns which requires confirmation and further investigation.

Lifelong vegetarianism and breast cancer risk: a large multicentre case control study in India

BACKGROUND

The lower incidence of breast cancer in Asian populations where the intake of animal products is lower than that of Western populations has led some to suggest that a vegetarian diet might reduce breast cancer risk.

METHODS

Between 2011 and 2014 we conducted a multicentre hospital based case-control study in eight cancer centres in India. Eligible cases were women aged 30-70 years, with newly diagnosed invasive breast cancer (ICD10 C50). Controls were frequency matched to the cases by age and region of residence and chosen from the accompanying attendants of the patients with cancer or those patients in the general hospital without cancer. Information about dietary, lifestyle, reproductive and socio-demographic factors were collected using an interviewer administered structured questionnaire. Multivariate logistic regression models were used to estimate the odds ratio (OR) and 95% confidence intervals for the risk of breast cancer in relation to lifelong vegetarianism, adjusting for known risk factors for the disease.

RESULTS

The study included 2101 cases and 2255 controls. The mean age at recruitment was similar in cases (49.7 years (SE 9.7)) and controls (49.8 years (SE 9.1)). About a quarter of the population were lifelong vegetarians and the rates varied significantly by region. On multivariate analysis, with adjustment for known risk factors for the disease, the risk of breast cancer was not decreased in lifelong vegetarians (OR 1.09 (95% CI 0.93-1.29)).

CONCLUSIONS

Lifelong exposure to a vegetarian diet appears to have little, if any effect on the risk of breast cancer.

Breast cancer histology and receptor status characterization in Asian Indian and Pakistani women in the U.S.--a SEER analysis

Background

Recent reports suggest increase in estrogen receptor (ER), progesterone receptor (PR) negative breast cancer yet little is known about histology or receptor status of breast cancer in Indian/Pakistani women.in the U.S.

Methods

We examined the United States National Cancer Institute's Surveillance Epidemiology and End Results (SEER) Cancer program to assess: a) frequency of breast cancer by age, b) histologic subtypes, c) receptor status of breast cancer and, d) survival in Indians/Pakistanis compared to Caucasians. There were 360,933 breast cancer cases diagnosed 1988-2006. Chi-Square analyses and Cox proportional hazards models, to estimate relative risks for breast cancer mortality after adjusting for confounders, were performed using Statistical Analysis Software 9.2.

Results

Among Asian Indian/Pakistani breast cancer patients, 16.2% were < 40 yrs. old compared to 6.23% in Caucasians (p < 0.0001). Asian Indian women had more invasive ductal carcinoma (69.1 vs. 65.7%, p < 0.0001), inflammatory cancer (1.4% vs. 0.8, p < 0.0001) and less invasive lobular carcinoma (4.2% vs. 8.1%, p < 0.0001) than Caucasians. Asian Indian/Pakistani women had more ER/PR negative breast cancer (30.6% vs. 21.8%, p = 0.0095) than Caucasians. Adjusting for stage at diagnosis, age, tumor grade, nodal status, and histology, Asian Indian/Pakistani women's survival was similar to Caucasians, while African Americans' was worse.

Conclusions

Asian Indian/Pakistani women have higher frequency of breast cancer (particularly in age < 40), ER/PR negative invasive ductal and inflammatory cancer than Caucasians.

The association between lipid profiles and breast cancer among Taiwanese women

BACKGROUND

Breast cancer incidence increased seven-fold from 1979 to 2002, and it has become the second most common cancer in Taiwanese women. Although the relationship between high-density lipoprotein cholesterol (HDL-C) and breast cancer has been studied, no consistent association has been explicitly confirmed. The aim of this study was to demonstrate the relationship between breast cancer and lipid profiles in Taiwanese women.

METHODS

A total of 150 breast cancer patients before treatment and 71 healthy controls were enrolled. Lipid profiles in fasting serum were measured after participants gave their consent.

RESULTS

The breast cancer patients had significantly lower values for HDL-C and apolipoprotein A-I (apoA-I), lower apoA-I/apoB ratios and higher values for very-low-density lipoprotein cholesterol (VLDL-C) than controls. After logistic regression analysis, the breast cancer patients had significantly higher values for VLDL-C and lower values for apoA-I after controlling for HDL-C and the apoA-I/apoB ratio.

CONCLUSIONS

Our findings demonstrate that higher VLDL-C and lower apoA-I values were significantly associated with breast cancer, with a greater association between apoA-I values and the development of breast cancer than for HDL-C values.

Cultural perspectives of international breast health and breast cancer education

PURPOSE

To (a) describe teaching-learning strategies to foster cultural exchange among participants in the Train-The-Trainer (TTT) International Breast Health Program; (b) describe participants' perceptions of cultural influences on breast health and breast cancer; and (c) explore lessons learned about cultural influences on breast health TTT educational programs.

ORGANIZING CONSTRUCT

The TTT curriculum was grounded in the belief that nurses can effectively deliver breast health and breast cancer education, that educational programs must be culturally relevant and sensitive to the needs of the target population, and that an urgent need exists worldwide to reduce the burden of breast cancer.

METHODS

A total of 32 nurses from 20 countries participated in three TTT programs held before the biennial meetings of the International Society of Nurses in Cancer Care (ISNCC) since 2000, with follow-up by E-mail survey. Narrative descriptions of their perspectives and experiences are reported.

RESULTS

Teaching-learning strategies incorporated cultural values into a TTT program to engage participants in sharing their individual and collective experiences about women with breast cancer.

CONCLUSIONS

Developing countries are increasingly multicultural. Developed countries have large immigrant populations that generally maintain the cultural values and practices about breast cancer from the country of origin. These "lessons learned" are important in planning other educational programs.

Phyto-oestrogen intake and plasma concentrations in South Asian and native British women resident in England

Phyto-oestrogens, naturally occurring hormone-like chemicals in plant food, may play a protective role against hormone-related chronic diseases. South Asian migrants in the UK have a lower incidence of hormone-related cancer than their hosts but the extent to which this difference may be due to phytoestrogen intake is not known. The aim was to compare habitual phytoestrogen intake in first-generation South Asian migrant women and native British women. South Asian (n 221) and native British women (n 50) were recruited from general practitioner lists and were asked to provide monthly 24h recalls for a period of 1 year. An enhanced phytoestrogen database was compiled using data from a literature search and unpublished data. A sub-sample of South Asian women (n 100) and the native British women (n 40) also provided blood samples every 3 months during the 1-year period. The median daily intakes (μg/d) of isoflavones (184·2 v. 333·9) and lignans (110·8 v. 148·8) were significantly lower in South Asians than in the native British (P<0·001, P=0·04 respectively).There were no significant differences in mean plasma isoflavone levels (nmol/l) but plasma enterolactone was significantly lower in the South Asians (13·9 (sd17·5) v. 28·5 (SD23·3),P<0·001). The main sources of phytoestrogens were bread and vegetables in both ethnic groups. Habitual phytoestrogen intake in South Asian and native British women was below 1mg/d and was higher in the native British diet. The present study does not support the hypothesis that differences in phytoestrogen intake, or in circulating levels, could explain differences in hormone-related cancer risks between these two populations.

Personal cancer prevention and screening practices among Asian Indian physicians in the United States

This study examines personal cancer prevention and screening practices of Asian Indian physicians. Asian Indians are the third largest group of Asian Pacific Islanders (APIs) residing in the United States. Using a cross-sectional study approach, we investigated cancer prevention and screening practices of 254 randomly selected Asian Indian physicians in the United States. Results showed that prevalence of conventional risk factors were low, e.g., smoking, alcohol consumption. Nutrition-related behaviors indicated 31-48% met the Food Guide Pyramid's recommendations for daily intake of fruits, vegetables, low fat/cholesterol diet, and grains. Certain cancer prevention and screening practices failed to meet age appropriate recommendations of leading health agencies. For men age 50 and over, only 27% ever had a flexible sigmoidoscopy and 25% ever had a fecal occult blood test (FOBT); 84% of women age 40 and over ever had a mammogram and 87% of women ever had a Papanicalou (Pap) smear. With respect to cancer screening behaviors, the respondents were less likely to engage in these preventive screenings (with the exception of mammography) than the general US population and the APIs (except Pap smears). Additionally, our respondents were less likely than other physicians to practice cancer screening behaviors. Results support the need to promote regular cancer prevention and screening among Asian Indian physicians.

Asian Indian women: knowledge, attitudes and behaviors toward breast cancer early detection

Education programs have been developed to promote adherence to recommended breast cancer screening guidelines. Few studies have assessed the degree to which ethnic subgroups are perceiving and acting on the proffered information. Such assessment is vital to the creation of efficient public health interventions. This paper describes the reported breast cancer knowledge, attitudes, and screening behaviors of 194 American Asian Indian women. While monthly breast self exam adherence was low, only 40.7%, 61.3% of women 40 and older, and 70% of women 50 and older, reported having had a mammogram within the past 12 months. These rates for annual mammography screening are high relative to many other ethnic groups. While the results are encouraging, the respondents may not be representative of all Asian Indian women. The majority of these women reported that their breast cancer knowledge is inadequate. They were willing to be called upon to share with others any knowledge they gained. There is a clear opportunity for public health nurses to provide Asian Indian women with a more comprehensive understanding of breast health and disease. Those women can then share their health knowledge with other women within their ethnic group.