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Sánchez-Díaz CT, Zeinomar N, Iyer HS, Perlstein M, Gonzalez BD, Hong CC, Bandera EV, Qin B. Comparing patient-reported outcomes and lifestyle factors before and after the COVID-19 pandemic among Black and Hispanic breast cancer survivors in New Jersey. J Cancer Surviv 2024:10.1007/s11764-024-01575-6. [PMID: 38561585 DOI: 10.1007/s11764-024-01575-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE The impact of the COVID-19 pandemic restrictions in the US since March 2020 on cancer survivorship among Black and Hispanic breast cancer (BC) survivors remains largely unknown. We aimed to evaluate associations of the pandemic with participant characteristics, patient-reported outcomes (PROs), and lifestyle factors among Black and Hispanic BC survivors in the Women's Circle of Health Follow-Up Study and the New Jersey BC Survivors Study. METHODS We included 447 Black (npre = 364 and npost = 83) and 182 Hispanic (npre = 102 and npost = 80) BC survivors who completed a home interview approximately 24 months post-diagnosis between 2017 and 2023. The onset of the pandemic was defined as March 2020. The association of the pandemic with binary outcomes was estimated using robust Poisson regression models. RESULTS Hispanic and Black BC survivors recruited after the onset of the pandemic reported higher socioeconomic status and fewer comorbidities. Black women in the post-pandemic group reported a higher prevalence of clinically significant sleep disturbance (prevalence ratio (PR) 1.43, 95% CI 1.23, 1.68), lower sleep efficiency, and lower functional well-being, compared to the pre-pandemic group. Hispanic women were less likely to report low health-related quality of life (vs. high; PR 0.62, 95% CI 0.45, 0.85) after the onset of the pandemic. CONCLUSIONS Ongoing research is crucial to untangle the impact of the pandemic on racial and ethnic minorities participating in cancer survivorship research, as well as PROs and lifestyle factors. IMPLICATIONS FOR CANCER SURVIVORS This study highlights the importance of considering the impact of the pandemic in all aspects of research, including the interpretation of findings.
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Affiliation(s)
- Carola T Sánchez-Díaz
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, 120 Albany St, New Brunswick, NJ, 08901, USA
| | - Nur Zeinomar
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, 120 Albany St, New Brunswick, NJ, 08901, USA
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Hari S Iyer
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, 120 Albany St, New Brunswick, NJ, 08901, USA
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Marley Perlstein
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, 120 Albany St, New Brunswick, NJ, 08901, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffit Cancer Center, Tampa, FL, USA
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Elisa V Bandera
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, 120 Albany St, New Brunswick, NJ, 08901, USA
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Bo Qin
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, 120 Albany St, New Brunswick, NJ, 08901, USA.
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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Phung MT, Lee AW, McLean K, Anton-Culver H, Bandera EV, Carney ME, Chang-Claude J, Cramer DW, Doherty JA, Fortner RT, Goodman MT, Harris HR, Jensen A, Modugno F, Moysich KB, Pharoah PDP, Qin B, Terry KL, Titus LJ, Webb PM, Wu AH, Zeinomar N, Ziogas A, Berchuck A, Cho KR, Hanley GE, Meza R, Mukherjee B, Pike MC, Pearce CL, Trabert B. A framework for assessing interactions for risk stratification models: the example of ovarian cancer. J Natl Cancer Inst 2023; 115:1420-1426. [PMID: 37436712 PMCID: PMC10637032 DOI: 10.1093/jnci/djad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/08/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023] Open
Abstract
Generally, risk stratification models for cancer use effect estimates from risk/protective factor analyses that have not assessed potential interactions between these exposures. We have developed a 4-criterion framework for assessing interactions that includes statistical, qualitative, biological, and practical approaches. We present the application of this framework in an ovarian cancer setting because this is an important step in developing more accurate risk stratification models. Using data from 9 case-control studies in the Ovarian Cancer Association Consortium, we conducted a comprehensive analysis of interactions among 15 unequivocal risk and protective factors for ovarian cancer (including 14 non-genetic factors and a 36-variant polygenic score) with age and menopausal status. Pairwise interactions between the risk/protective factors were also assessed. We found that menopausal status modifies the association among endometriosis, first-degree family history of ovarian cancer, breastfeeding, and depot-medroxyprogesterone acetate use and disease risk, highlighting the importance of understanding multiplicative interactions when developing risk prediction models.
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Affiliation(s)
- Minh Tung Phung
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Alice W Lee
- Department of Public Health, California State University, Fullerton, Fullerton, CA, USA
| | - Karen McLean
- Department of Gynecologic Oncology and Department of Pharmacology & Therapeutics, Elm & Carlton Streets, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hoda Anton-Culver
- Department of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Michael E Carney
- Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel W Cramer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jennifer Anne Doherty
- Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Renee T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Marc T Goodman
- Samuel Oschin Comprehensive Cancer Institute, Cancer Prevention and Genetics Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Community and Population Health Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Allan Jensen
- Department of Lifestyle, Reproduction and Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Francesmary Modugno
- Women’s Cancer Research Center, Magee-Women’s Research Institute and Hillman Cancer Center, Pittsburgh, PA, USA
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburg, PA, USA
| | - Kirsten B Moysich
- Division of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Paul D P Pharoah
- Department of Computational Biomedicine, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Kathryn L Terry
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Linda J Titus
- Public Health, Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
| | - Penelope M Webb
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Anna H Wu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nur Zeinomar
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Argyrios Ziogas
- Department of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Andrew Berchuck
- Division of Gynecologic Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Kathleen R Cho
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Gillian E Hanley
- Department of Obstetrics & Gynecology, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Bhramar Mukherjee
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Malcolm C Pike
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Celeste Leigh Pearce
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Britton Trabert
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
- Cancer Control and Populations Sciences Program, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
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Iyer HS, Zeinomar N, Omilian AR, Perlstein M, Davis MB, Omene CO, Pawlish K, Demissie K, Hong CC, Yao S, Ambrosone CB, Bandera EV, Qin B. Neighborhood Disadvantage, African Genetic Ancestry, Cancer Subtype, and Mortality Among Breast Cancer Survivors. JAMA Netw Open 2023; 6:e2331295. [PMID: 37647068 PMCID: PMC10469269 DOI: 10.1001/jamanetworkopen.2023.31295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023] Open
Abstract
Importance Racial disparities in breast cancer (BC) survival arise from multilevel causes, which may exert influence at different stages of BC progression. Clarifying the importance of genetic and social factors could help prioritize interventions. Objective To jointly examine associations between African genetic ancestry, social environment, and mortality from any cause and BC in Black BC survivors. Design, Setting, and Participants This population-based cohort study enrolled self-identified Black women aged 20 to 75 years with histologically confirmed BC from June 2005 to May 2019 and followed them up until death or censoring in September 2021. Participants lived in 10 New Jersey counties. Data were analyzed between December 2022 and April 2023. Exposures A neighborhood socioeconomic status (nSES) index composed of census tract measures (education, income, wealth, employment status, and occupation) was linked to residential addresses at diagnosis. Percentage African ancestry was estimated using the ADMIXTURE program. Main Outcomes and Measures Sequentially adjusted (age adjusted: age and interview year; fully adjusted: age adjusted with individual SES, lifestyle factors, and comorbidities) logistic regression models were fit to estimate associations with tumor subtypes (estrogen receptor-negative [ER-] vs estrogen receptor-positive [ER+]; triple-negative breast cancer [TNBC] vs luminal A), and Cox models were fit for associations with all-cause mortality (ACM) and breast cancer-specific mortality (BCSM). Models for BCSM were fit using Fine-Gray competing risks models, and robust standard errors were used to account for census tract-level clustering. Results Among 1575 participants, median (IQR) African ancestry was 85% (76%-90%), and median (IQR) age was 55 (46-63) years. A 10-percentage point increase in African ancestry was associated with higher odds of ER- vs ER+ (adjusted odds ratio [aOR], 1.08; 95% CI, 0.98-1.18) and TNBC vs luminal (aOR, 1.15; 95% CI, 1.02-1.31) tumors, but not with ACM or BCSM. A 1-IQR increase in nSES was associated with lower ACM (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.63-0.93), and the HR for BCSM was less than 1 but not statistically significant (aHR, 0.81; 95% CI, 0.62-1.04) in age-adjusted models, but associations attenuated following further adjustment for potential mediators (individual SES, lifestyles, comorbidities). Conclusions and Relevance In this cohort study of Black female BC survivors, higher African ancestry was associated with aggressive tumor subtypes. Compared with genetic ancestry, mediating pathways related to social environments may be more important for survival in these patients.
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Affiliation(s)
- Hari S. Iyer
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Nur Zeinomar
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Angela R. Omilian
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Marley Perlstein
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Melissa B. Davis
- Institute of Genomic Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Coral O. Omene
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Karen Pawlish
- Cancer Epidemiology Services, New Jersey State Cancer Registry, New Jersey Department of Health, Trenton
| | - Kitaw Demissie
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University School of Public Health, Brooklyn, New York
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Song Yao
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Fong AJ, Llanos AAM, Ashrafi A, Zeinomar N, Chokshi S, Bandera EV, Devine KA, Hudson SV, Qin B, O’Malley D, Paddock LE, Stroup AM, Evens AM, Manne SL. Sociodemographic and Health Correlates of Multiple Health Behavior Adherence among Cancer Survivors: A Latent Class Analysis. Nutrients 2023; 15:2354. [PMID: 37242237 PMCID: PMC10223681 DOI: 10.3390/nu15102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/24/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
The study aimed to (a) assess current levels of adherence to the National Comprehensive Cancer Network's multiple health behavior guidelines and (b) identify characteristics of cancer survivors associated with different adherence levels. Cancer survivors (N = 661) were identified through the state registry and completed questionnaires. Latent class analysis (LCA) was used to identify patterns of adherence. Associations between predictors with the latent classes were reported as risk ratios. LCA identified three classes: lower- (39.6%), moderate- (52.0%), and high-risk lifestyle (8.3%). Participants in the lower-risk lifestyle class had the highest probability of meeting most of the multiple health behavior guidelines compared to participants in the high-risk lifestyle class. Characteristics associated with membership in the moderate-risk lifestyle class included self-identifying as a race other than Asian/Asian American, being never married, having some college education, and having been diagnosed with later stage colorectal or lung cancer. Those in the high-risk lifestyle class were more likely to be male, never married, have a high school diploma or less, diagnosed with colorectal or lung cancer, and diagnosed with pulmonary comorbidities. Study findings can be used to inform development of future interventions to promote multiple health behavior adherence among higher risk cancer survivors.
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Affiliation(s)
- Angela J. Fong
- Section of Behavioral Sciences, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Adana A. M. Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Adiba Ashrafi
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Nur Zeinomar
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Sagar Chokshi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ 08901, USA
| | - Elisa V. Bandera
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Katie A. Devine
- Department of Pediatrics, Section of Pediatric Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Shawna V. Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Bo Qin
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Denalee O’Malley
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Lisa E. Paddock
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Antoinette M. Stroup
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Andrew M. Evens
- Department of Medicine, Division of Blood Disorders, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Sharon L. Manne
- Section of Behavioral Sciences, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
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Zeinomar N, Qin B, Amin S, Lin Y, Xu B, Chanumolu D, Omene CO, Pawlish KS, Demissie K, Ambrosone CB, Hong CC, Bandera EV. Association of Cigarette Smoking and Alcohol Consumption With Subsequent Mortality Among Black Breast Cancer Survivors in New Jersey. JAMA Netw Open 2023; 6:e2252371. [PMID: 36692882 PMCID: PMC10148653 DOI: 10.1001/jamanetworkopen.2022.52371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE There are limited data about how lifestyle factors are associated with breast cancer prognosis among Black or African American women because most of the evidence is based on studies of White breast cancer survivors. OBJECTIVE To examine the association of prediagnostic cigarette smoking and alcohol consumption with all-cause mortality and breast cancer-specific mortality in a cohort of Black breast cancer survivors. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included 1926 Black or African American breast cancer survivors who received a diagnosis from June 6, 2005, to May 21, 2019, identified in 10 counties in New Jersey through rapid case ascertainment by the New Jersey State Cancer Registry. Statistical analysis was conducted from January 1, 2021, to August 1, 2022. EXPOSURES Information on prediagnostic cigarette smoking, alcohol consumption, and additional covariates was collected during in-person interviews. The covariates examined included smoking status at the time of breast cancer diagnosis (currently smoking at the time of breast cancer diagnosis, formerly smoking, or never smoking), smoking duration (number of years smoking), smoking intensity (cigarettes smoked per day), number of pack-years of smoking, and regular alcohol consumption the year before diagnosis (categorized as nondrinkers, ≤3 drinks per week, or >3 drinks per week). MAIN OUTCOMES AND MEASURES Primary outcomes included breast cancer-specific mortality and all-cause mortality. RESULTS Among the 1926 women in the study, the mean (SD) age at breast cancer diagnosis was 54.4 (10.8) years. During 13 464 person-years of follow-up (median follow-up, 6.7 years [range, 0.5-16.0 years]), there were 337 deaths, of which 187 (55.5%) were breast cancer related. Compared with never smokers, current smokers at the time of breast cancer diagnosis had a 52% increased risk for all-cause mortality (hazard ratio [HR], 1.52; 95% CI, 1.15-2.02), which was most pronounced for those with 10 or more pack-years of smoking (HR, 1.84; 95% CI, 1.34-2.53). Similar findings were observed for breast cancer-specific mortality (current smokers vs never smokers: HR, 1.27; 95% CI, 0.87-1.85), although they were not statistically significant. There was no statistically significant association between alcohol consumption and all-cause mortality (>3 drinks per week vs nondrinkers: HR, 1.05; 95% CI, 0.73-1.51) or breast cancer-specific mortality (>3 drinks per week vs nondrinkers: HR, 1.06; 95% CI, 0.67-1.67). CONCLUSIONS AND RELEVANCE This population-based cohort study of Black breast cancer survivors suggests that current smoking at the time of diagnosis was associated with an increased risk of all-cause mortality, particularly among women with greater pack-years of smoking.
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Affiliation(s)
- Nur Zeinomar
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Saber Amin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Yong Lin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Baichen Xu
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Dhanya Chanumolu
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Coral O Omene
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Karen S Pawlish
- Cancer Epidemiology Services, New Jersey State Cancer Registry, New Jersey Department of Health, Trenton
| | - Kitaw Demissie
- Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, New York
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
- Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
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6
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Echeverri-Herrera S, Nowels MA, Qin B, Grafova IB, Zeinomar N, Chanumolu D, Duberstein PR, Bandera EV. Spirituality and financial toxicity among Hispanic breast cancer survivors in New Jersey. Support Care Cancer 2022; 30:9735-9741. [PMID: 36205780 DOI: 10.1007/s00520-022-07387-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 10/02/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Cancer survivors often incur significant out-of-pocket costs; this can result in financial toxicity, defined as the adverse financial impact of cancer due to direct or indirect costs related to the disease. There has been little research on whether spirituality is associated with the experience of financial toxicity. In this study, we tested the hypothesis that spirituality would be inversely associated with financial toxicity. METHODS We evaluated these associations in a cross-sectional study of Hispanic breast cancer survivors (n = 102) identified through the New Jersey State Cancer Registry. Participants completed the FACIT-Sp-12, which has two spirituality subscales (meaning/peace; faith). Financial toxicity was assessed using the 11-item COST measure; lower scores suggest worse toxicity. In multivariable linear regression analyses, we examined the associations between spirituality scores and financial toxicity, adjusting for age, race, education, household income, and insurance status. RESULTS The spirituality total score (β = 0.49, 95% confidence interval (CI): 0.17, 0.8), meaning/peace subscale score (β = 0.71, 95% CI: 0.12, 1.31), and faith (β = 0.71, 95% CI: 0.2, 1.21) subscale score were all inversely associated with financial toxicity. CONCLUSIONS Spirituality may be an important factor in ameliorating the detrimental effects of financial toxicity among Hispanic breast cancer survivors and should be considered in interventions for financial toxicity in this population.
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Affiliation(s)
- Susana Echeverri-Herrera
- Rutgers School of Public Health, Piscataway, NJ, USA.
- Department of Sociology and Criminology, University of New Mexico, MSC05 3080, 1915 Roma NE Ste. 1103, Albuquerque, NM, USA.
| | - Molly A Nowels
- Rutgers School of Public Health, Piscataway, NJ, USA
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, NJ, New Brunswick, USA
| | | | - Nur Zeinomar
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, NJ, New Brunswick, USA
| | - Dhanya Chanumolu
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, NJ, New Brunswick, USA
| | | | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, NJ, New Brunswick, USA
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Zeinomar N, Grant-Alfieri A, Burke KR, de Hoz M, Tehranifar P, Walker DAH, Morton T, Shepard P, Herbstman JB, Miller RL, Perera F, Terry MB. Cancer Risk Reduction Through Education of Adolescents: Development of a Tailored Cancer Risk-Reduction Educational Tool. J Cancer Educ 2022; 37:1220-1227. [PMID: 33523407 DOI: 10.1007/s13187-020-01943-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 06/12/2023]
Abstract
Growing evidence links adolescent exposures to cancer risk later in life, particularly for common cancers like breast. The adolescent time period is also important for cancer risk reduction as many individual lifestyle behaviors are initiated including smoking and alcohol use. We developed a cancer risk-reduction educational tool tailored for adolescents that focused on five modifiable cancer risk factors. To contextualize risk factors in adolescents' social and physical environments, the intervention also focused on structural barriers to individual- and community-level change, with an emphasis on environmental justice or the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. The educational tool consisted of a 50-min module that included an introduction to cancer biology including genetic susceptibility and environmental interactions, cancer burden in the local community, and risk reduction strategies. The module also included an interactive activity in which adolescent students identify cancer risk factors and brainstorm strategies for risk reduction at both the individual and community level. We administered the module to 12 classes of over 280 high school and college students in New York City. Cancer risk reduction strategies identified by the students included family- or peer-level strategies such as team physical activity and community-level action including improving parks and taxing sugary foods. We developed a novel and interactive cancer risk-reduction education tool focused on multiple cancers that can be adopted by other communities and educational institutions.
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Affiliation(s)
- Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, Room 1611, New York, NY, 10032, USA
| | - Amelia Grant-Alfieri
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kimberly R Burke
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Parisa Tehranifar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, Room 1611, New York, NY, 10032, USA
| | | | | | | | - Julie B Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rachel L Miller
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Division of Pulmonary, Allergy, Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Frederica Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, Room 1611, New York, NY, 10032, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA.
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Grant-Alfieri A, Burke K, Zeinomar N, Delgado ML, Terry MB. Cancer Education Interventions in Adolescents: A Systematic Review of Scope and Content. Health Educ Behav 2022; 49:993-1003. [PMID: 35898117 DOI: 10.1177/10901981221109142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Given the long induction time of many cancers and the fact that modifiable risk factors (e.g., cigarette smoking) including preventive factors (e.g., human papillomavirus [HPV] vaccination, healthy dietary and physical activity patterns) are influenced in adolescence, educating adolescents about cancer causation and risk reduction may have a large impact on reducing the cancer burden. We conducted a systematic review of literature evaluating the impact of cancer education interventions on adolescent knowledge of cancer risk reduction. We searched for articles published from 2000 to 2019 and identified 33 studies meeting our criteria. Given the methodological heterogeneity across studies, we briefly assessed effectiveness but focused on examining the design of the intervention and study. The majority of studies took place outside of the United States (67%). Most studies solely addressed skin or cervical cancer (67%) with only 18% (n = 6) discussing multiple cancers. The majority of interventions were a single-session (55%), did not involve a control or comparison group (67%), and were evaluated using a pre-test and a single post-test (61%); some studies administered multiple post-tests. Few studies (12%) investigated adolescents' knowledge of lifestyle and environmental risk factors at both the individual and community level. Most studies (94%) reported improvement in knowledge following an intervention. Our review revealed wide methodological variation and a deficit in research evaluating interventions that address multiple cancer types and risk factors. Future research should robustly test whether comprehensive cancer education for adolescents can reduce the cancer burden, particularly in communities with major cancer health disparities.
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Affiliation(s)
| | - Kimberly Burke
- Columbia University Mailman School of Public Health, New York, NY, USA.,Columbia University Irving Medical Center, New York, NY, USA
| | - Nur Zeinomar
- Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Mary Beth Terry
- Columbia University Mailman School of Public Health, New York, NY, USA.,Columbia University Irving Medical Center, New York, NY, USA
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Qin B, Kim K, Goldman N, Rundle AG, Chanumolu D, Zeinomar N, Xu B, Pawlish KS, Ambrosone CB, Demissie K, Hong CC, Lovasi GS, Bandera EV. Multilevel Factors for Adiposity Change in a Population-Based Prospective Study of Black Breast Cancer Survivors. J Clin Oncol 2022; 40:2213-2223. [PMID: 35333586 PMCID: PMC9273374 DOI: 10.1200/jco.21.02973] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Unfavorable weight change after breast cancer diagnosis increases the risk of mortality, but individual and neighborhood risk factors affecting postdiagnosis weight and body fat changes are unclear among Black women, who have higher rates of obesity and mortality than any other racial/ethnic group. METHODS Adiposity changes during the period approximately 10 months-24 months after diagnosis were evaluated among 785 women diagnosed between 2012 and 2018 and enrolled in the Women's Circle of Health Follow-Up Study, a population-based prospective cohort of Black breast cancer survivors in New Jersey. Multilevel factors for weight and fat mass change (with gain or loss defined as a relative difference of 3% or more, and considering whether changes were intentional or unintentional) were estimated using multivariable polytomous logistic regressions and multilevel models. RESULTS Adiposity gain was prevalent: 28% and 47% gained weight and body fat, respectively, despite a high baseline prevalence of overweight or obesity (86%). Risk factors for fat mass gain included receiving chemotherapy (relative risk ratio: 1.59, 95% CI, 1.08 to 2.33) and residing in neighborhoods with a greater density of fast-food restaurants (relative risk ratio comparing highest with lowest tertile: 2.18, 95% CI, 1.38 to 3.46); findings were similar for weight gain. Only 9% of women had intentional weight loss, and multilevel risk factors differed vastly from unintentional loss. CONCLUSION Both individual and neighborhood factors were associated with adiposity change among Black breast cancer survivors. Residential environment characteristics may offer clinically meaningful information to identify cancer survivors at higher risk for unfavorable weight change and to address barriers to postdiagnosis weight management.
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Affiliation(s)
- Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Kate Kim
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Noreen Goldman
- Office of Population Research, Princeton University, Princeton, NJ
| | - Andrew G. Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Dhanya Chanumolu
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Nur Zeinomar
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Baichen Xu
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Karen S. Pawlish
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ
| | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Kitaw Demissie
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University School of Public Health, Brooklyn, NY
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Gina S. Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Zeinomar N, Amin S, Qin B, Lin Y, Xu B, Chanumolu D, Omene CO, Pawlish KS, Demissie K, Ambrosone C, Hong CC, Bandera EV. Abstract PO-205: Association of pre-diagnostic cigarette smoking and alcohol consumption with mortality in Black breast cancer survivors. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: There is limited data about how lifestyle factors are associated with breast cancer (BC) prognosis in Black women, as the majority of evidence is based on studies conducted in White women. Given the 40% increased risk of death for Black women diagnosed with BC compared to White women, and the differences in prevalence of these modifiable risk factors between racial groups, better understanding how these factors, among others, are associated with survival in Black women is necessary to address existing cancer health disparities. The purpose of this study is to examine the association of pre-diagnostic cigarette smoking and alcohol consumption with survival in a cohort of Black breast cancer survivors. Methods: We studied 1895 women enrolled in the Women's Circle of Health Follow-up Study, a population-based cohort study of Black BC survivors in New Jersey enrolled within 10 months of diagnosis. Smoking and alcohol consumption history, along with information on potential covariates were collected during in-person interviews. We evaluated the association between pre-diagnostic cigarette smoking (status, duration, intensity, pack-years) and alcohol consumption (average number of total drinks/week) and all-cause and BC- specific mortality using Cox Proportional Hazards models and Fine and Gray competing risk models, adjusted for confounders. Results: During 12,019 person years of follow-up (median 5.9, maximum: 14.8 years), we observed 290 deaths, of which 175 were breast-cancer related deaths. Currently smoking, particularly in regular drinkers, was associated with worse survival. Compared to never smokers, current smokers had 56% increased risk for all-cause mortality (hazard ratio (HR):1.56, 95% confidence interval (CI): 1.17-2.07), and this was higher for current smokers with pack years above the median (HR: 1.80, 95% 1.30-2.5). While the multiplicative interaction of smoking and alcohol was not statistically significant, compared to non-regular drinkers who never smoked, current smokers who regularly drank had a 72% increased risk of all-cause mortality (HR:1.72, 95% CI: 1.11-2.67), whereas the association for current smokers that were not regular drinkers was less substantial (HR: 1.41, 95% CI: 0.95-2.09). We observed similar associations for BC-specific mortality, with a 60% increased risk of BC-specific mortality (HR: 1.6, 95% CI: 0.92-2.78) for current smokers who regularly drank, but no association for current smokers who were not regular drinkers. We did not observe an association for smoking and BC-specific mortality or for alcohol consumption and all-cause or BC-specific mortality. However, self-reported alcohol drinking was low in this population (only 12% of women reported consuming >3 drinks/week). Conclusion: In a population based-study of Black BC survivors, smoking prior to a BC diagnosis was associated with worse overall survival, particularly in women who also regularly consumed alcohol.
Citation Format: Nur Zeinomar, Saber Amin, Bo Qin, Yong Lin, Baichen Xu, Dhanya Chanumolu, Coral O Omene, Karen S Pawlish, Kitaw Demissie, Christine Ambrosone, Chi-Chen Hong, Elisa V Bandera. Association of pre-diagnostic cigarette smoking and alcohol consumption with mortality in Black breast cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-205.
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Affiliation(s)
- Nur Zeinomar
- 1Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
| | - Saber Amin
- 1Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
| | - Bo Qin
- 1Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
| | - Yong Lin
- 2Rutgers Cancer Institute of New Jersey and Rutgers School of Public Health, New Brunswick, NJ,
| | - Baichen Xu
- 1Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
| | | | - Coral O Omene
- 1Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
| | | | - Kitaw Demissie
- 4School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY,
| | | | - Chi-Chen Hong
- 5Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Elisa V Bandera
- 2Rutgers Cancer Institute of New Jersey and Rutgers School of Public Health, New Brunswick, NJ,
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11
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Omene C, Amin S, Zeinomar N, Qin B, Chanumolu D, Llanos AA, Hong CC, Demissie K, Bandera EV. Abstract PO-119: Association of body mass index with pathological complete response after neoadjuvant chemotherapy in a population-based cohort of Black breast cancer patients. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Pathologic complete response (pCR) to neoadjuvant chemotherapy is associated with improved event-free and distant recurrence free survival in women with stage II or III breast cancer (BC). While there is strong evidence that obesity is associated with reduced BC survival, its role on pCR after neoadjuvant chemotherapy among BC patients is unclear. Moreover, data regarding the association of pre-treatment BMI with response to neoadjuvant chemotherapy in Black women – who have the highest obesity prevalence than any other racial/ethnic groups and 40% worse survival outcomes compared to White women – are lacking. The purpose of this study was to examine the association of pretreatment BMI and subsequent pCR after neoadjuvant chemotherapy in Black BC patients. Methods: Data were abstracted from medical records of 131 Black BC patients who received neoadjuvant chemotherapy in the Women's Circle of Health Follow-up Study, a population-based cohort study of Black BC survivors in New Jersey. pCR was defined as absence of detectable invasive cancer in the breast and lymph nodes (ypT0/Tisand ypN0) at the time of surgery (noninvasive residual BC, i.e. DCIS was allowed). Tumor subtypes were defined by hormone receptor (HR, i.e., ER, PR) and HER2 status. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs) of the association between pretreatment obesity (BMI ≥30 kg/m2)vs. non-obese (<30 kg/m2), and pCR, after adjusting for covariates. The association with BMI in a continuous scale was also evaluated. Results: Mean age at BC diagnosis was 50±10.7 years, mean BMI was 31.4±7.1 kg/m2, and 69 (52.7%) women were obese. In terms of tumor subtype, 53 (40.5%) were HR+/HER2-, 40 (30.5%) were HER2+, and 38 (29.0%) were triple negative. All patients received standard chemotherapy regimens and 8.4% of patients had dose reductions due to toxicity. Almost one-third achieved pCR (38 [29.0%]). Consistent with prior evidence, our findings were suggestive of decreased odds of pCR among obese (OR 0.88, 95% CI: 0.39-1.99) compared to non-obese women, although the risk estimate was not statistically significant. We observed similar findings with BMI modeled as a continuous variable (OR 0.85, 95% CI: 0.62-1.15 per 5-unit increase in BMI). No substantive differences were observed by tumor subtype (HR+/HER2: OR 0.80, 95% CI: 0.44-1.46; HER2+: OR 0.93, 95% CI: 0.58-1.47; and triple negative BC: OR 0.86, 95% CI: 0.47-1.57 per 5-unit increase in BMI). Conclusion: Our findings suggest that among Black women, higher BMI is inversely associated with achieving pCR. However, risk estimates did not reach statistical significance, possibly due to small sample size. Alternatively, as shown by our and others' prior work, BMI may be an inadequate measure of adiposity, particularly in this population. Future work should evaluate the impact of body fat distribution and body composition on pCR response to neoadjuvant chemotherapy among Black women after a breast cancer diagnosis.
Citation Format: Coral Omene, Saber Amin, Nur Zeinomar, Bo Qin, Dhanya Chanumolu, Adana A.M. Llanos, Chi-Chen Hong, Kitaw Demissie, Elisa V. Bandera. Association of body mass index with pathological complete response after neoadjuvant chemotherapy in a population-based cohort of Black breast cancer patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-119.
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Affiliation(s)
- Coral Omene
- 1Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
| | - Saber Amin
- 1Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
| | - Nur Zeinomar
- 1Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
| | - Bo Qin
- 1Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
| | | | - Adana A.M. Llanos
- 1Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
- 2Rutgers School of Public Health, New Brunswick, NJ,
| | - Chi-Chen Hong
- 3Roswell Park Comprehensive Cancer Center, Buffalo, NY,
| | - Kitaw Demissie
- 4SUNY Downstate Health Sciences University, School of Public Health, Brooklyn, NY
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12
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Kehm RD, MacInnis RJ, John EM, Liao Y, Kurian AW, Genkinger JM, Knight JA, Colonna SV, Chung WK, Milne R, Zeinomar N, Dite GS, Southey MC, Giles GG, McLachlan SA, Whitaker KD, Friedlander ML, Weideman PC, Glendon G, Nesci S, Phillips KA, Andrulis IL, Buys SS, Daly MB, Hopper JL, Terry MB. Recreational Physical Activity and Outcomes After Breast Cancer in Women at High Familial Risk. JNCI Cancer Spectr 2021; 5:pkab090. [PMID: 34950851 PMCID: PMC8692829 DOI: 10.1093/jncics/pkab090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/08/2021] [Accepted: 10/14/2021] [Indexed: 12/13/2022] Open
Abstract
Background Recreational physical activity (RPA) is associated with improved survival after breast cancer (BC) in average-risk women, but evidence is limited for women who are at increased familial risk because of a BC family history or BRCA1 and BRCA2 pathogenic variants (BRCA1/2 PVs). Methods We estimated associations of RPA (self-reported average hours per week within 3 years of BC diagnosis) with all-cause mortality and second BC events (recurrence or new primary) after first invasive BC in women in the Prospective Family Study Cohort (n = 4610, diagnosed 1993-2011, aged 22-79 years at diagnosis). We fitted Cox proportional hazards regression models adjusted for age at diagnosis, demographics, and lifestyle factors. We tested for multiplicative interactions (Wald test statistic for cross-product terms) and additive interactions (relative excess risk due to interaction) by age at diagnosis, body mass index, estrogen receptor status, stage at diagnosis, BRCA1/2 PVs, and familial risk score estimated from multigenerational pedigree data. Statistical tests were 2-sided. Results We observed 1212 deaths and 473 second BC events over a median follow-up from study enrollment of 11.0 and 10.5 years, respectively. After adjusting for covariates, RPA (any vs none) was associated with lower all-cause mortality of 16.1% (95% confidence interval [CI] = 2.4% to 27.9%) overall, 11.8% (95% CI = -3.6% to 24.9%) in women without BRCA1/2 PVs, and 47.5% (95% CI = 17.4% to 66.6%) in women with BRCA1/2 PVs (RPA*BRCA1/2 multiplicative interaction P = .005; relative excess risk due to interaction = 0.87, 95% CI = 0.01 to 1.74). RPA was not associated with risk of second BC events. Conclusion Findings support that RPA is associated with lower all-cause mortality in women with BC, particularly in women with BRCA1/2 PVs.
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Affiliation(s)
- Rebecca D Kehm
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Robert J MacInnis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Esther M John
- Department of Medicine and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Yuyan Liao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Allison W Kurian
- Division of Medical Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeanine M Genkinger
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah V Colonna
- Division of Medical Oncology, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Wendy K Chung
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY, USA
| | - Roger Milne
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Nur Zeinomar
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Gillian S Dite
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa C Southey
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Department of Clinical Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medical Oncology, St Vincent’s Hospital, Fitzroy, Melbourne, Victoria, Australia
| | - Kristen D Whitaker
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Michael L Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Prue C Weideman
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Stephanie Nesci
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kelly-Anne Phillips
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Departments of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Saundra S Buys
- Department of Medicine and Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
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Zeinomar N, Bandera EV, Qin B. Toward Understanding the Etiology of Male Breast Cancer: An Ongoing Research Challenge. JNCI Cancer Spectr 2021; 5:pkab079. [PMID: 34703984 PMCID: PMC8536819 DOI: 10.1093/jncics/pkab079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nur Zeinomar
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Liu C, Zeinomar N, Chung WK, Kiryluk K, Gharavi AG, Hripcsak G, Crew KD, Shang N, Khan A, Fasel D, Manolio TA, Jarvik GP, Rowley R, Justice AE, Rahm AK, Fullerton SM, Smoller JW, Larson EB, Crane PK, Dikilitas O, Wiesner GL, Bick AG, Terry MB, Weng C. Generalizability of Polygenic Risk Scores for Breast Cancer Among Women With European, African, and Latinx Ancestry. JAMA Netw Open 2021; 4:e2119084. [PMID: 34347061 PMCID: PMC8339934 DOI: 10.1001/jamanetworkopen.2021.19084] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Multiple polygenic risk scores (PRSs) for breast cancer have been developed from large research consortia; however, their generalizability to diverse clinical settings is unknown. OBJECTIVE To examine the performance of previously developed breast cancer PRSs in a clinical setting for women of European, African, and Latinx ancestry. DESIGN, SETTING, AND PARTICIPANTS This cohort study using the Electronic Medical Records and Genomics (eMERGE) network data set included 39 591 women from 9 contributing medical centers in the US that had electronic medical records (EMR) linked to genotype data. Breast cancer cases and controls were identified through a validated EMR phenotyping algorithm. MAIN OUTCOMES AND MEASURES Multivariable logistic regression was used to assess the association between breast cancer risk and 7 previously developed PRSs, adjusting for age, study site, breast cancer family history, and first 3 ancestry informative principal components. RESULTS This study included 39 591 women: 33 594 with European, 3801 with African, and 2196 with Latinx ancestry. The mean (SD) age at breast cancer diagnosis was 60.7 (13.0), 58.8 (12.5), and 60.1 (13.0) years for women with European, African, and Latinx ancestry, respectively. PRSs derived from women with European ancestry were associated with breast cancer risk in women with European ancestry (highest odds ratio [OR] per 1-SD increase, 1.46; 95% CI, 1.41-1.51), women with Latinx ancestry (highest OR, 1.31; 95% CI, 1.09-1.58), and women with African ancestry (OR, 1.19; 95% CI, 1.05-1.35). For women with European ancestry, this association with breast cancer risk was largest in the extremes of the PRS distribution, with ORs ranging from 2.19 (95% CI, 1.84-2.53) to 2.48 (95% CI, 1.89-3.25) for the 3 different PRSs examined for those in the highest 1% of the PRS compared with those in the middle quantile. Among women with Latinx and African ancestries at the extremes of the PRS distribution, there were no statistically significant associations. CONCLUSIONS AND RELEVANCE This cohort study found that PRS models derived from women with European ancestry for breast cancer risk generalized well for women with European, Latinx, and African ancestries across different clinical settings, although the effect sizes for women with African ancestry were smaller, likely because of differences in risk allele frequencies and linkage disequilibrium patterns. These results highlight the need to improve representation of diverse population groups, particularly women with African ancestry, in genomic research cohorts.
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Affiliation(s)
- Cong Liu
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
| | - Nur Zeinomar
- Department of Epidemiology, Columbia University Irving Medical Center, New York, New York
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Wendy K. Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Krzysztof Kiryluk
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ali G. Gharavi
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
| | - Katherine D. Crew
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ning Shang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
| | - Atlas Khan
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - David Fasel
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
| | - Teri A. Manolio
- National Human Genome Research Institute, Bethesda, Maryland
| | - Gail P. Jarvik
- Department of Medicine, University of Washington, Seattle
| | - Robb Rowley
- National Human Genome Research Institute, Bethesda, Maryland
| | - Ann E. Justice
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
| | - Alanna K. Rahm
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Jordan W. Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric B. Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Paul K. Crane
- Department of Medicine, University of Washington, Seattle
| | - Ozan Dikilitas
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Georgia L. Wiesner
- Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexander G. Bick
- Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University Irving Medical Center, New York, New York
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
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15
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Bandera EV, Qin B, Lin Y, Zeinomar N, Xu B, Chanumolu D, Llanos AAM, Omene CO, Pawlish KS, Ambrosone CB, Demissie K, Hong CC. Association of Body Mass Index, Central Obesity, and Body Composition With Mortality Among Black Breast Cancer Survivors. JAMA Oncol 2021; 7:2780856. [PMID: 34086040 PMCID: PMC8377573 DOI: 10.1001/jamaoncol.2021.1499] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/31/2021] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Obesity disproportionately affects Black women, who also have a higher risk of death after a breast cancer diagnosis compared with women of other racial/ethnic groups. However, few studies have evaluated the association of measures of adiposity with mortality among Black breast cancer survivors. OBJECTIVE To assess the association of measures of adiposity with survival after a breast cancer diagnosis among Black women. DESIGN, SETTING, AND PARTICIPANTS This prospective population-based cohort study comprised 1891 women with stage 0 to IV breast cancer who self-identified as African American or Black and were ages 20 to 75 years. The New Jersey State Cancer Registry was used to identify women living in 10 counties in New Jersey who were recruited from March 1, 2006, to February 29, 2020, and followed up until September 2, 2020. EXPOSURES Measures of adiposity, including body mass index, body fat distribution (waist circumference and waist-to-hip ratio), and body composition (percent body fat and fat mass index), were collected during in-person interviews at approximately 10 months after breast cancer diagnosis. MAIN OUTCOMES AND MEASURES All-cause and breast cancer-specific mortality. RESULTS Among 1891 women, the mean (SD) age at breast cancer diagnosis was 54.5 (10.8) years. During a median follow-up of 5.9 years (range, 0.5-14.8 years), 286 deaths were identified; of those, 175 deaths (61.2%) were associated with breast cancer. A total of 1060 women (56.1%) had obesity, and 1291 women (68.3%) had central obesity. Higher adiposity, particularly higher waist-to-hip ratio, was associated with worse survival. Women in the highest quartile of waist-to-hip ratio had a 61% increased risk of dying from any cause (hazard ratio [HR], 1.61; 95% CI, 1.12-2.33) and a 68% increased risk of breast cancer death (HR, 1.68; 95% CI, 1.04-2.71) compared with women in the lowest quartile. The risks of all-cause and breast cancer-specific death were similarly high among women in the highest quartile for waist circumference (HR, 1.74 [95% CI, 1.26-2.41] and 1.64 [95% CI, 1.08-2.48], respectively), percent body fat (HR, 1.53 [95% CI, 1.09-2.15] and 1.81 [95% CI, 1.17-2.80]), and fat mass index (HR, 1.57 [95% CI, 1.11-2.22] and 1.74 [95% CI, 1.10-2.75]); however, the risk was less substantial for body mass index (HR, 1.26 [95% CI, 0.89-1.79] and 1.33 [95% CI, 0.84-2.10]). In analyses stratified by estrogen receptor status, menopausal status, and age, a higher waist-to-hip ratio was associated with a higher risk of all-cause death among women who had estrogen receptor-negative tumors (HR, 2.24; 95% CI, 1.14-4.41), women who were postmenopausal (HR, 2.15; 95% CI, 1.28-3.61), and women who were 60 years or older at diagnosis (HR per 0.10-U increase, 1.76; 95% CI, 1.37-2.26). CONCLUSIONS AND RELEVANCE In this population-based cohort study, central obesity and higher adiposity were associated with higher all-cause and breast cancer-specific mortality among Black breast cancer survivors. Simple measures of body fat distribution and body composition were found to be useful tools for identifying Black women with a higher risk of death after a breast cancer diagnosis.
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Affiliation(s)
- Elisa V. Bandera
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick
| | - Bo Qin
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick
| | - Yong Lin
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Nur Zeinomar
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick
| | - Baichen Xu
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Dhanya Chanumolu
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick
| | - Adana A. M. Llanos
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Coral O. Omene
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick
| | - Karen S. Pawlish
- Cancer Epidemiology Services, New Jersey State Cancer Registry, Trenton
| | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kitaw Demissie
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, School of Public Health, Brooklyn, New York
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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16
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Kehm RD, Oskar S, Tehranifar P, Zeinomar N, Rundle AG, Herbstman JB, Perera F, Miller RL, Terry MB. Associations of prenatal exposure to polycyclic aromatic hydrocarbons with pubertal timing and body composition in adolescent girls: Implications for breast cancer risk. Environ Res 2021; 196:110369. [PMID: 33131678 PMCID: PMC8552520 DOI: 10.1016/j.envres.2020.110369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/09/2020] [Accepted: 10/19/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND While animal data support an association between prenatal exposure to endocrine disrupting chemicals (EDCs) and altered mammary gland development and tumorigenesis, epidemiologic studies have only considered a few classes of EDCs in association with pubertal growth and development in girls. Polycyclic aromatic hydrocarbons (PAH) are a class of EDCs that have not been rigorously evaluated in terms of prenatal exposure and pubertal growth and development in girls. OBJECTIVE In a New York City birth cohort of Black and Hispanic girls (n = 196; recruited 1998-2006), we examined associations of prenatal PAH exposure with self-reported age at growth spurt onset, breast development onset and menarche, and clinical measures of adolescent body composition including body mass index, waist-to-hip ratio, and body fat measured at ages 11-20 years. METHODS We measured prenatal exposure to PAH using personal air monitoring data collected from backpacks worn by mothers during the third trimester of pregnancy (data available for all 196 girls) and biomarkers of benzo[α]pyrene-DNA adducts in umbilical cord blood (data available for 106 girls). We examined associations of prenatal PAH with the timing of pubertal milestones and adolescent body composition (11-20 years) using multivariable linear regression models adjusted for race/ethnicity, household public assistance status at birth, and age at outcome assessment. We also fit models further adjusted for potential mediators, including birthweight and childhood body size (BMI-for-age z-score measured at 6-8 years). RESULTS Girls in the highest versus lowest tertile of ambient exposure to PAH, based on a summary measure of eight carcinogenic higher-molecular weight non-volatile PAH compounds (Σ8 PAH), had a 0.90 year delay in growth spurt onset (95% confidence interval (CI) = 0.25, 1.55; n = 196), a 0.35 year delay in breast development onset (95% CI = -0.26, 0.95; n = 193), and a 0.59 year delay in menarche (95% CI = 0.06, 1.11; n = 191) in models adjusted for race/ethnicity and household public assistance at birth. The statistically significant associations for age at growth spurt onset and menarche were not impacted by adjustment for birthweight or childhood body size. No differences in BMI-for-age z-score, waist-to-hip ratio, or percent body fat were found between girls in the highest versus lowest tertile of ambient Σ8 PAH. Results were similar when we evaluated benzo[α]pyrene-DNA adduct levels. DISCUSSION Our results suggest that prenatal exposure to PAH might delay pubertal milestones in girls, but findings need to be replicated in other cohorts using prospectively collected data on pubertal outcomes.
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Affiliation(s)
- Rebecca D Kehm
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sabine Oskar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Parisa Tehranifar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Frederica Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rachel L Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
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17
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Abstract
Polygenic risk scores (PRSs) have been consistently associated with elevated breast cancer risk in cohort studies and are associated with risk in both women with and those without a family history of breast cancer. However, before clinical implementation, several issues must be addressed, including understanding the potential clinical utility and optimal method to communicate personalized screening recommendations that incorporate the PRS. Several trials are under way to answer some of these questions and facilitate clinical implementation. Because these PRSs have been developed in women of European ancestry, it is important to understand the limitations of their predictive ability in other ancestral groups. Finally, the value of the PRS will lie in considering it along with other clinical, familial, and rare genetic factors that are currently used in personalized risk assessment of breast cancer.
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Affiliation(s)
- Nur Zeinomar
- Mailman School of Public Health, Columbia University, New York, New York (N.Z.)
| | - Wendy K Chung
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Columbia University, New York, New York (W.K.C.)
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18
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MacInnis RJ, Knight JA, Chung WK, Milne RL, Whittemore AS, Buchsbaum R, Liao Y, Zeinomar N, Dite GS, Southey MC, Goldgar D, Giles GG, Kurian AW, Andrulis IL, John EM, Daly MB, Buys SS, Phillips KA, Hopper JL, Terry MB. Comparing 5-Year and Lifetime Risks of Breast Cancer using the Prospective Family Study Cohort. J Natl Cancer Inst 2020; 113:785-791. [PMID: 33301022 DOI: 10.1093/jnci/djaa178] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/06/2020] [Accepted: 10/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical guidelines often use predicted lifetime risk from birth to define criteria for making decisions regarding breast cancer screening rather than thresholds based on absolute 5-year risk from current age. METHODS We used the Prospective Family Cohort Study of 14 657 women without breast cancer at baseline in which, during a median follow-up of 10 years, 482 women were diagnosed with invasive breast cancer. We examined the performances of the International Breast Cancer Intervention Study (IBIS) and Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) risk models when using the alternative thresholds by comparing predictions based on 5-year risk with those based on lifetime risk from birth and remaining lifetime risk. All statistical tests were 2-sided. RESULTS Using IBIS, the areas under the receiver-operating characteristic curves were 0.66 (95% confidence interval = 0.63 to 0.68) and 0.56 (95% confidence interval = 0.54 to 0.59) for 5-year and lifetime risks, respectively (Pdiff < .001). For equivalent sensitivities, the 5-year incidence almost always had higher specificities than lifetime risk from birth. For women aged 20-39 years, 5-year risk performed better than lifetime risk from birth. For women aged 40 years or older, receiver-operating characteristic curves were similar for 5-year and lifetime IBIS risk from birth. Classifications based on remaining lifetime risk were inferior to 5-year risk estimates. Results were similar using BOADICEA. CONCLUSIONS Our analysis shows that risk stratification using clinical models will likely be more accurate when based on predicted 5-year risk compared with risks based on predicted lifetime and remaining lifetime, particularly for women aged 20-39 years.
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Affiliation(s)
- Robert J MacInnis
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
| | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wendy K Chung
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.,Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Alice S Whittemore
- Department of Health Research and Policy and of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Richard Buchsbaum
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yuyan Liao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Gillian S Dite
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
| | - Melissa C Southey
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - David Goldgar
- Department of Dermatology and Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Allison W Kurian
- Department of Medicine and Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | | | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Department of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Esther M John
- Department of Epidemiology & Population Health and Medicine and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Saundra S Buys
- Department of Medicine and Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA
| | - Kelly-Anne Phillips
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
| | - Mary Beth Terry
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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19
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Moslehi R, Tsao HS, Zeinomar N, Stagnar C, Fitzpatrick S, Dzutsev A. Integrative genomic analysis implicates ERCC6 and its interaction with ERCC8 in susceptibility to breast cancer. Sci Rep 2020; 10:21276. [PMID: 33277540 PMCID: PMC7718875 DOI: 10.1038/s41598-020-77037-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023] Open
Abstract
Up to 30% of all breast cancer cases may be inherited and up to 85% of those may be due to segregation of susceptibility genes with low and moderate risk [odds ratios (OR) ≤ 3] for (mostly peri- and post-menopausal) breast cancer. The majority of low/moderate-risk genes, particularly those with minor allele frequencies (MAF) of < 30%, have not been identified and/or validated due to limitations of conventional association testing approaches, which include the agnostic nature of Genome Wide Association Studies (GWAS). To overcome these limitations, we used a hypothesis-driven integrative genomics approach to test the association of breast cancer with candidate genes by analyzing multi-omics data. Our candidate-gene association analyses of GWAS datasets suggested an increased risk of breast cancer with ERCC6 (main effect: 1.29 ≤ OR ≤ 2.91, 0.005 ≤ p ≤ 0.04, 11.8 ≤ MAF ≤ 40.9%), and implicated its interaction with ERCC8 (joint effect: 3.03 ≤ OR ≤ 5.31, 0.01 ≤ pinteraction ≤ 0.03). We found significant upregulation of ERCC6 (p = 7.95 × 10-6) and ERCC8 (p = 4.67 × 10-6) in breast cancer and similar frequencies of ERCC6 (1.8%) and ERCC8 (0.3%) mutations in breast tumors to known breast cancer susceptibility genes such as BLM (1.9%) and LSP1 (0.3%). Our integrative genomics approach suggests that ERCC6 may be a previously unreported low- to moderate-risk breast cancer susceptibility gene, which may also interact with ERCC8.
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Affiliation(s)
- Roxana Moslehi
- School of Public Health, Cancer Research Center, University at Albany, State University of New York (SUNY), Albany, NY, 12144, USA.
| | - Hui-Shien Tsao
- School of Public Health, Cancer Research Center, University at Albany, State University of New York (SUNY), Albany, NY, 12144, USA
- New York State Office of Children and Family Services, New York, USA
| | - Nur Zeinomar
- School of Public Health, Cancer Research Center, University at Albany, State University of New York (SUNY), Albany, NY, 12144, USA
- Mailman School of Public Health, Columbia University, New York, USA
| | - Cristy Stagnar
- School of Public Health, Cancer Research Center, University at Albany, State University of New York (SUNY), Albany, NY, 12144, USA
- Drukier Institute for Children's Health, Weill Cornell Medicine, New York, USA
| | - Sean Fitzpatrick
- School of Public Health, Cancer Research Center, University at Albany, State University of New York (SUNY), Albany, NY, 12144, USA
| | - Amiran Dzutsev
- Cancer Vaccine Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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20
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MacInnis RJ, Liao Y, Knight JA, Milne RL, Whittemore AS, Chung WK, Leoce N, Buchsbaum R, Zeinomar N, Dite GS, Southey MC, Goldgar D, Giles GG, McLachlan SA, Weideman PC, Nesci S, Friedlander ML, Glendon G, Andrulis IL, John EM, Daly MB, Buys SS, Phillips KA, Hopper JL, Terry MB. Considerations When Using Breast Cancer Risk Models for Women with Negative BRCA1/BRCA2 Mutation Results. J Natl Cancer Inst 2020; 112:418-422. [PMID: 31584660 DOI: 10.1093/jnci/djz194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 09/06/2019] [Accepted: 09/17/2019] [Indexed: 01/20/2023] Open
Abstract
The performance of breast cancer risk models for women with a family history but negative BRCA1 and/or BRCA2 mutation test results is uncertain. We calculated the cumulative 10-year invasive breast cancer risk at cohort entry for 14 657 unaffected women (96.1% had an affected relative) not known to carry BRCA1 or BRCA2 mutations at baseline using three pedigree-based models (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm, BRCAPRO, and International Breast Cancer Intervention Study). During follow-up, 482 women were diagnosed with invasive breast cancer. Mutation testing was conducted independent of incident cancers. All models underpredicted risk by 26.3%-56.7% for women who tested negative but whose relatives had not been tested (n = 1363; 63 breast cancers). Although replication studies with larger sample sizes are needed, until these models are recalibrated for women who test negative and have no relatives tested, caution should be used when considering changing the breast cancer risk management intensity of such women based on risk estimates from these models.
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Affiliation(s)
- Robert J MacInnis
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Yuyan Liao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York
| | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Parkville, Victoria, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Alice S Whittemore
- Departments of Health Research and Policy and Biomedical Data Science, Stanford University School of Medicine, Stanford
| | - Wendy K Chung
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York.,Departments of Pediatrics and Medicine, Columbia University, New York
| | - Nicole Leoce
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York
| | - Richard Buchsbaum
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York
| | - Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York
| | - Gillian S Dite
- Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Melissa C Southey
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - David Goldgar
- Department of Medicine and Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Parkville, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Department of Medical Oncology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Prue C Weideman
- Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephanie Nesci
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael L Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | | | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,The Research Department, The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Departments of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Esther M John
- Department of Medicine and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA
| | - Saundra S Buys
- Department of Medicine and Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT
| | - Kelly Anne Phillips
- Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Parkville, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York
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21
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Zeinomar N, Oskar S, Kehm RD, Sahebzeda S, Terry MB. Environmental exposures and breast cancer risk in the context of underlying susceptibility: A systematic review of the epidemiological literature. Environ Res 2020; 187:109346. [PMID: 32445942 PMCID: PMC7314105 DOI: 10.1016/j.envres.2020.109346] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND The evidence evaluating environmental chemical exposures (ECE) and breast cancer (BC) risk is heterogeneous which may stem in part as few studies measure ECE during key BC windows of susceptibility (WOS). Another possibility may be that most BC studies are skewed towards individuals at average risk, which may limit the ability to detect signals from ECE. OBJECTIVES We reviewed the literature on ECE and BC focusing on three types of studies or subgroup analyses based on higher absolute BC risk: BC family history (Type 1); early onset BC (Type 2); and/or genetic susceptibility (Type 3). METHODS We systematically searched the PubMed database to identify epidemiologic studies examining ECE and BC risk published through June 1, 2019. RESULTS We identified 100 publications in 56 unique epidemiologic studies. Of these 56 studies, only 2 (3.6%) were enriched with BC family history and only 11% of studies (6/56) were specifically enriched with early onset cases. 80% of the publications from these 8 enriched studies (Type 1: 8/10 publications; Type 2: 8/10 publications) supported a statistically significant association between ECE and BC risk including studies of PAH, indoor cooking, NO2, DDT; PCBs, PFOSA; metals; personal care products; and occupational exposure to industrial dyes. 74% of Type 3 publications (20/27) supported statistically significant associations for PAHs, traffic-related air pollution, PCBs, phthalates, and PFOSAs in subgroups of women with greater genetic susceptibility due to variants in carcinogen metabolism, DNA repair, oxidative stress, cellular apoptosis and tumor suppressor genes. DISCUSSION Studies enriched for women at higher BC risk through family history, younger age of onset and/or genetic susceptibility consistently support an association between an ECE and BC risk. In addition to measuring exposures during WOS, designing studies that are enriched with women at higher absolute risk are necessary to robustly measure the role of ECE on BC risk.
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Affiliation(s)
- Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sabine Oskar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rebecca D Kehm
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Shamin Sahebzeda
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA.
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22
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Kehm RD, Lilge L, Walter EJ, Zeinomar N, McDonald JA, Tehranifar P, Herbstman JB, Miller RL, Terry MB. Abstract A15: Prenatal exposure to polycyclic aromatic hydrocarbons and breast tissue composition in adolescent girls. Cancer Prev Res (Phila) 2020. [DOI: 10.1158/1940-6215.envcaprev19-a15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Polycyclic aromatic hydrocarbons (PAH) are common environmental pollutants that result from incomplete combustion of biomass and fossil fuels. PAH have endocrine-disrupting properties and are known animal carcinogens. Evidence from case-control studies suggests an association between PAH and breast cancer risk, but longitudinal research on PAH exposure during critical windows of susceptibility, such as prenatally and in early life, is limited. The purpose of this study was to prospectively examine whether prenatal exposure to PAH is associated with breast tissue composition, an intermediate marker of breast cancer risk, in adolescent girls. We studied 105 adolescent girls in the Columbia Center for Children’s Environmental Health (CCCEH) birth cohort, which recruited nonsmoking African American and Dominican American pregnant women living in three low-income neighborhoods in New York City from 1998-2006. Women wore a small backpack holding a personal air monitor for 2 consecutive days during the 3rd trimester of pregnancy, which measured concentrations of pyrene and 8 other carcinogenic PAH (summed and categorized into tertiles for analysis). Girls completed a follow-up clinic visit in adolescence (ages 11.2-19.6 years, median=15.8), at which time breast tissue composition was measured by optical spectroscopy (OS). OS is a novel and noninvasive tool that provides a broad compositional view of the breast by capturing variation in the amount of water, lipid, oxy-hemoglobin, deoxy-hemoglobin, and collagen, as well as overall cellular and connective tissue density. OS measured red and near-infrared light transmission of 7 wavelengths (650-1060 nm) at 4 source-detector distances in each breast quadrant, resulting in 16 overlapping tissue volumes. Principal component analysis was used to reduce spectral data and generate principal component (PC) scores for each participant, which were averaged over both breasts. We used multivariable linear regression to examine associations of prenatal PAH measures (pyrene and Σ8 PAH) with each of the first 4 OS PCs, which explained >99% of the spectral variation in the sample. Models were adjusted for age, ethnicity, body mass index (BMI) at time of OS measurement, age at breast development, and mothers’ prepregnancy BMI. After adjusting for covariates, PC1 scores were significantly lower on average in the highest compared to lowest tertile of prenatal ambient Σ8 PAH (β = -0.42, 95% CI = -0.81 to -0.02, p = 0.04). PC1 covered 91.8% of the spectral variations and represents overall light attenuation from higher scattering due to higher cellularity and connective tissues. PC1 also mapped to multiple chromophores including hemoglobin and collagen. No associations were found between prenatal ambient Σ8 PAH and PCs 2-4, and no associations with OS PCs were found for pyrene. To conclude, we found evidence suggesting that prenatal exposure to PAH is associated with breast tissue composition in adolescent girls.
Citation Format: Rebecca D. Kehm, Lothar Lilge, E. Jane Walter, Nur Zeinomar, Jasmine A. McDonald, Parisa Tehranifar, Julie B. Herbstman, Rachel L. Miller, Mary Beth Terry. Prenatal exposure to polycyclic aromatic hydrocarbons and breast tissue composition in adolescent girls [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr A15.
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23
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Zeinomar N, Wu HC, Ma X, Herbstman JB, Perera FP, Miller RL, Terry MB. Abstract C082: Prenatal exposure to polycyclic aromatic hydrocarbons and altered DNA methylation in breast cancer-related genes. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-c082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background/Purpose: Minority populations, particularly young African American women, bear a disproportionate burden of more aggressive breast cancer subtypes. These racial/ethnic disparities can be partially explained by the distribution of risk factors, including urban environmental exposures. Polycyclic aromatic hydrocarbons (PAH) are widespread carcinogenic and hormonally active environmental contaminants with disproportionately high exposure in urban low income and/or communities of racial and ethnic minorities. In our Columbia's Children Center for Environmental Health (CCCEH) birth cohort, prenatal PAH exposure has been associated with lower global DNA methylation in umbilical cord white blood cells (WBC). We extend this work to examine whether prenatal PAH exposure is associated with altered WBC DNA methylation in genes associated with breast cancer risk, including DNA repair, growth, and age at menarche.
Methods: CCCEH enrolled nonsmoking African-American and Dominican pregnant women in New York City between 1998 and 2006 and followed their children through 9 years of age. We examined measures of PAH exposure through two primary sources: 1) prospective maternal personal air monitoring in the third trimester of pregnancy, and 2) PAH-DNA adducts measured in maternal blood at delivery and umbilical cord blood. We examined differences in WBC DNA methylation in 21 candidate genes in 223 girls (ages 7 or 9 years) by prenatal PAH exposure using targeted massively parallel bisulfite sequencing. For each amplicon, we used multivariable linear regression models to assess the association of DNA methylation and the three measures of prenatal PAH exposure. We adjusted all models for girls' age and race/ethnicity and tested for confounding by socioeconomic and reproductive variables and having a smoker in the house prenatally and at year 7 or 9. The sum levels of eight airborne PAH were analyzed as a log-transformed continuous variable (n=223). PAH-DNA adducts in maternal (n=185) and cord blood (n=115) were categorized as below the limit of detection (reference), and above and below the median in those with detectible adducts.
Results: We found significantly different methylation levels by ethnicity in five candidate genes; we did not observe varied methylation by girls' age or BMI at the time of blood collection. We observed evidence of decreased methylation in DNA repair gene BRCA1 (Δ = -2.3, p-value 0.06) with increasing airborne PAH levels. For cord blood PAH-DNA adducts, compared to those with non-detectable adducts, we observed decreased methylation in an imprinted gene associated with breast cancer and body weight regulation, H19 (Δ = -6.5, p-value 0.001) in girls with the highest level of detectable adducts (above the median in those with detectable adducts).
Conclusions: Preliminary findings from this urban cohort suggest that measures of prenatal exposure to PAH may result in altered methylation in genes related to breast cancer risk and body weight in young girls.
Citation Format: Nur Zeinomar, Hui-Chen Wu, Xinran Ma, Julie B. Herbstman, Frederica P. Perera, Rachel L. Miller, Mary Beth Terry. Prenatal exposure to polycyclic aromatic hydrocarbons and altered DNA methylation in breast cancer-related genes [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C082.
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Affiliation(s)
- Nur Zeinomar
- 1Columbia University Mailman School of Public Health, New York, NY,
| | - Hui-Chen Wu
- 1Columbia University Mailman School of Public Health, New York, NY,
| | - Xinran Ma
- 1Columbia University Mailman School of Public Health, New York, NY,
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24
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Terry MB, Daly MB, Phillips KA, Ma X, Zeinomar N, Leoce N, Dite GS, MacInnis RJ, Chung WK, Knight JA, Southey MC, Milne RL, Goldgar D, Giles GG, Weideman PC, Glendon G, Buchsbaum R, Andrulis IL, John EM, Buys SS, Hopper JL. Risk-Reducing Oophorectomy and Breast Cancer Risk Across the Spectrum of Familial Risk. J Natl Cancer Inst 2020; 111:331-334. [PMID: 30496449 PMCID: PMC6410936 DOI: 10.1093/jnci/djy182] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/02/2018] [Accepted: 09/07/2018] [Indexed: 02/06/2023] Open
Abstract
There remains debate about whether risk-reducing salpingo-oophorectomy (RRSO), which reduces ovarian cancer risk, also reduces breast cancer risk. We examined the association between RRSO and breast cancer risk using a prospective cohort of 17 917 women unaffected with breast cancer at baseline (7.2% known carriers of BRCA1 or BRCA2 mutations). During a median follow-up of 10.7 years, 1046 women were diagnosed with incident breast cancer. Modeling RRSO as a time-varying exposure, there was no association with breast cancer risk overall (hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 0.87 to 1.24) or by tertiles of predicted absolute risk based on family history (HR = 0.68, 95% CI = 0.32 to 1.47, HR = 0.94, 95% CI = 0.70 to 1.26, and HR = 1.10, 95% CI = 0.88 to 1.39, for lowest, middle, and highest tertile of risk, respectively) or for BRCA1 and BRCA2 mutation carriers when examined separately. There was also no association after accounting for hormone therapy use after RRSO. These findings suggest that RRSO should not be considered efficacious for reducing breast cancer risk.
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Affiliation(s)
- Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA
| | - Kelly Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Xinran Ma
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Nicole Leoce
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Gillian S Dite
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
| | - Robert J MacInnis
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Wendy K Chung
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY.,Departments of Pediatrics and Medicine, Columbia University, New York, NY
| | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Melissa C Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - David Goldgar
- Department of Medicine and Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Prue C Weideman
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,The Research Department, The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Richard Buchsbaum
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Departments of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Esther M John
- Department of Medicine and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - Saundra S Buys
- Department of Medicine and Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
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25
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Kehm RD, Genkinger JM, MacInnis RJ, John EM, Phillips KA, Dite GS, Milne RL, Zeinomar N, Liao Y, Knight JA, Southey MC, Chung WK, Giles GG, McLachlan SA, Whitaker KD, Friedlander M, Weideman PC, Glendon G, Nesci S, Investigators KC, Andrulis IL, Buys SS, Daly MB, Hopper JL, Terry MB. Recreational Physical Activity Is Associated with Reduced Breast Cancer Risk in Adult Women at High Risk for Breast Cancer: A Cohort Study of Women Selected for Familial and Genetic Risk. Cancer Res 2020; 80:116-125. [PMID: 31578201 PMCID: PMC7236618 DOI: 10.1158/0008-5472.can-19-1847] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/13/2019] [Accepted: 09/23/2019] [Indexed: 12/14/2022]
Abstract
Although physical activity is associated with lower breast cancer risk for average-risk women, it is not known if this association applies to women at high familial/genetic risk. We examined the association of recreational physical activity (self-reported by questionnaire) with breast cancer risk using the Prospective Family Study Cohort, which is enriched with women who have a breast cancer family history (N = 15,550). We examined associations of adult and adolescent recreational physical activity (quintiles of age-adjusted total metabolic equivalents per week) with breast cancer risk using multivariable Cox proportional hazards regression, adjusted for demographics, lifestyle factors, and body mass index. We tested for multiplicative interactions of physical activity with predicted absolute breast cancer familial risk based on pedigree data and with BRCA1 and BRCA2 mutation status. Baseline recreational physical activity level in the highest four quintiles compared with the lowest quintile was associated with a 20% lower breast cancer risk (HR, 0.80; 95% confidence interval, 0.68-0.93). The association was not modified by familial risk or BRCA mutation status (P interactions >0.05). No overall association was found for adolescent recreational physical activity. Recreational physical activity in adulthood may lower breast cancer risk for women across the spectrum of familial risk. SIGNIFICANCE: These findings suggest that physical activity might reduce breast cancer risk by about 20% for women across the risk continuum, including women at higher-than-average risk due to their family history or genetic susceptibility.See related commentary by Niehoff et al., p. 23.
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Affiliation(s)
- Rebecca D Kehm
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Jeanine M Genkinger
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Robert J MacInnis
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Esther M John
- Department of Medicine and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Kelly-Anne Phillips
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia; Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Gillian S Dite
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia; Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Yuyan Liao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Melissa C Southey
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia; Department of Clinical Pathology, The University of Melbourne, Melbourne, Australia
| | - Wendy K Chung
- Department of Pediatrics and Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia; Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia; Department of Medical Oncology, St Vincent's Hospital, Melbourne, Australia
| | - Kristen D Whitaker
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Michael Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Prue C Weideman
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Stephanie Nesci
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - kConFab Investigators
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia; The Research Department, The Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada; Departments of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Saundra S Buys
- Department of Medicine and Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.
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26
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Zeinomar N, Knight JA, Genkinger JM, Phillips KA, Daly MB, Milne RL, Dite GS, Kehm RD, Liao Y, Southey MC, Chung WK, Giles GG, McLachlan SA, Friedlander ML, Weideman PC, Glendon G, Nesci S, Andrulis IL, Buys SS, John EM, MacInnis RJ, Hopper JL, Terry MB. Alcohol consumption, cigarette smoking, and familial breast cancer risk: findings from the Prospective Family Study Cohort (ProF-SC). Breast Cancer Res 2019; 21:128. [PMID: 31779655 PMCID: PMC6883541 DOI: 10.1186/s13058-019-1213-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022] Open
Abstract
Background Alcohol consumption and cigarette smoking are associated with an increased risk of breast cancer (BC), but it is unclear whether these associations vary by a woman’s familial BC risk. Methods Using the Prospective Family Study Cohort, we evaluated associations between alcohol consumption, cigarette smoking, and BC risk. We used multivariable Cox proportional hazard models to estimate hazard ratios (HR) and 95% confidence intervals (CI). We examined whether associations were modified by familial risk profile (FRP), defined as the 1-year incidence of BC predicted by Breast Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA), a pedigree-based algorithm. Results We observed 1009 incident BC cases in 17,435 women during a median follow-up of 10.4 years. We found no overall association of smoking or alcohol consumption with BC risk (current smokers compared with never smokers HR 1.02, 95% CI 0.85–1.23; consuming ≥ 7 drinks/week compared with non-regular drinkers HR 1.10, 95% CI 0.92–1.32), but we did observe differences in associations based on FRP and by estrogen receptor (ER) status. Women with lower FRP had an increased risk of ER-positive BC associated with consuming ≥ 7 drinks/week (compared to non-regular drinkers), whereas there was no association for women with higher FRP. For example, women at the 10th percentile of FRP (5-year BOADICEA = 0.15%) had an estimated HR of 1.46 (95% CI 1.07–1.99), whereas there was no association for women at the 90th percentile (5-year BOADICEA = 4.2%) (HR 1.07, 95% CI 0.80–1.44). While the associations with smoking were not modified by FRP, we observed a positive multiplicative interaction by FRP (pinteraction = 0.01) for smoking status in women who also consumed alcohol, but not in women who were non-regular drinkers. Conclusions Moderate alcohol intake was associated with increased BC risk, particularly for women with ER-positive BC, but only for those at lower predicted familial BC risk (5-year BOADICEA < 1.25). For women with a high FRP (5-year BOADICEA ≥ 6.5%) who also consumed alcohol, being a current smoker was associated with increased BC risk.
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Affiliation(s)
- Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 1611, New York, NY, 10032, USA
| | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeanine M Genkinger
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 1611, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Kelly-Anne Phillips
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Gillian S Dite
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
| | - Rebecca D Kehm
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 1611, New York, NY, 10032, USA
| | - Yuyan Liao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 1611, New York, NY, 10032, USA
| | - Melissa C Southey
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Department of Clinical Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Wendy K Chung
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA.,Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Department of Medical Oncology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Michael L Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Prue C Weideman
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
| | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Stephanie Nesci
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Departments of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Saundra S Buys
- Department of Medicine and Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Esther M John
- Department of Medicine and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert J MacInnis
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 1611, New York, NY, 10032, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA.
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Bellanger M, Zeinomar N, Tehranifar P, Terry MB. Are Global Breast Cancer Incidence and Mortality Patterns Related to Country-Specific Economic Development and Prevention Strategies? J Glob Oncol 2019; 4:1-16. [PMID: 30085889 PMCID: PMC6223528 DOI: 10.1200/jgo.17.00207] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose There remains considerable international variation in breast cancer incidence and mortality, but a comprehensive examination of rates by country level economic, development and cancer prevention policies is lacking. Materials and Methods We compared GLOBOCAN 2012 age-specific breast cancer incidence and mortality rates for 177 countries by using development and policy data available from the WHO Global Cancer Country Profiles data base. We classified each country on the basis of gross national income per capita from the World Development Indicators data base, as follows: low-income country (LIC), lower-middle–income country (LMIC), upper-middle–income country (UMIC), and high-income country (HIC). Results There were 1,651,326 breast cancer cases and 516,868 breast cancer deaths estimated in 2012. Approximately three quarters of all breast cancer cases and 60% of the breast cancer deaths were in women from HICs and UMICs. Age and country-level income explained approximately 60% of the international variation in breast cancer incidence and mortality in women of all ages (adjusted R2 = 58% and 60%, respectively). Economic development indicators additionally increased the overall variation in incidence and mortality by approximately 5%. In women younger than age 50 years, country-level income explained 68% of incidence and 59% of mortality; economic development indicators additionally increased this percentage by approximately 4%. Country-level cancer prevention policy indicators contributed little to explanation of the overall variation in incidence and mortality after analysis accounted for age and country-level income; however, an overall resource summary index of greater economic development and cancer prevention policies was related to lower mortality within each major income level. Conclusion Although breast cancer incidence increases with higher income levels in all ages, women in the poorest countries bear a relatively higher burden of breast cancer mortality, particularly women younger than age 50 years.
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Affiliation(s)
- Martine Bellanger
- Martine Bellanger, Ecole des Hautes Etudes en Sante Publique - University Sorbonne Paris Cite, Paris, France; Nur Zeinomar, Prisa Tehranifar, and Mary Beth Terry, Columbia University; Parisa Tehranifar and Mary Beth Terry, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; and Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry, International Breast Cancer and Nutrition Project, Lafayette, IN
| | - Nur Zeinomar
- Martine Bellanger, Ecole des Hautes Etudes en Sante Publique - University Sorbonne Paris Cite, Paris, France; Nur Zeinomar, Prisa Tehranifar, and Mary Beth Terry, Columbia University; Parisa Tehranifar and Mary Beth Terry, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; and Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry, International Breast Cancer and Nutrition Project, Lafayette, IN
| | - Parisa Tehranifar
- Martine Bellanger, Ecole des Hautes Etudes en Sante Publique - University Sorbonne Paris Cite, Paris, France; Nur Zeinomar, Prisa Tehranifar, and Mary Beth Terry, Columbia University; Parisa Tehranifar and Mary Beth Terry, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; and Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry, International Breast Cancer and Nutrition Project, Lafayette, IN
| | - Mary Beth Terry
- Martine Bellanger, Ecole des Hautes Etudes en Sante Publique - University Sorbonne Paris Cite, Paris, France; Nur Zeinomar, Prisa Tehranifar, and Mary Beth Terry, Columbia University; Parisa Tehranifar and Mary Beth Terry, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; and Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry, International Breast Cancer and Nutrition Project, Lafayette, IN
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28
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Terry MB, Zeinomar N. Response to Lee et al 2019: Essential to frame study implications within the context of prior findings from enriched cohorts for underlying familial risk of breast cancer. Occup Environ Med 2019; 76:592. [PMID: 31300563 DOI: 10.1136/oemed-2019-105936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/15/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, NY, New York, USA
| | - Nur Zeinomar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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29
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Kehm RD, Hopper JL, John EM, Phillips KA, MacInnis RJ, Dite GS, Milne RL, Liao Y, Zeinomar N, Knight JA, Southey MC, Vahdat L, Kornhauser N, Cigler T, Chung WK, Giles GG, McLachlan SA, Friedlander ML, Weideman PC, Glendon G, Nesci S, Andrulis IL, Buys SS, Daly MB, Terry MB. Regular use of aspirin and other non-steroidal anti-inflammatory drugs and breast cancer risk for women at familial or genetic risk: a cohort study. Breast Cancer Res 2019; 21:52. [PMID: 30999962 PMCID: PMC6471793 DOI: 10.1186/s13058-019-1135-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/05/2019] [Indexed: 01/23/2023] Open
Abstract
Background The use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with reduced breast cancer risk, but it is not known if this association extends to women at familial or genetic risk. We examined the association between regular NSAID use and breast cancer risk using a large cohort of women selected for breast cancer family history, including 1054 BRCA1 or BRCA2 mutation carriers. Methods We analyzed a prospective cohort (N = 5606) and a larger combined, retrospective and prospective, cohort (N = 8233) of women who were aged 18 to 79 years, enrolled before June 30, 2011, with follow-up questionnaire data on medication history. The prospective cohort was further restricted to women without breast cancer when medication history was asked by questionnaire. Women were recruited from seven study centers in the United States, Canada, and Australia. Associations were estimated using multivariable Cox proportional hazards regression models adjusted for demographics, lifestyle factors, family history, and other medication use. Women were classified as regular or non-regular users of aspirin, COX-2 inhibitors, ibuprofen and other NSAIDs, and acetaminophen (control) based on self-report at follow-up of ever using the medication for at least twice a week for ≥1 month prior to breast cancer diagnosis. The main outcome was incident invasive breast cancer, based on self- or relative-report (81% confirmed pathologically). Results From fully adjusted analyses, regular aspirin use was associated with a 39% and 37% reduced risk of breast cancer in the prospective (HR = 0.61; 95% CI = 0.33–1.14) and combined cohorts (HR = 0.63; 95% CI = 0.57–0.71), respectively. Regular use of COX-2 inhibitors was associated with a 61% and 71% reduced risk of breast cancer (prospective HR = 0.39; 95% CI = 0.15–0.97; combined HR = 0.29; 95% CI = 0.23–0.38). Other NSAIDs and acetaminophen were not associated with breast cancer risk in either cohort. Associations were not modified by familial risk, and consistent patterns were found by BRCA1 and BRCA2 carrier status, estrogen receptor status, and attained age. Conclusion Regular use of aspirin and COX-2 inhibitors might reduce breast cancer risk for women at familial or genetic risk. Electronic supplementary material The online version of this article (10.1186/s13058-019-1135-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca D Kehm
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Esther M John
- Department of Medicine and Stanford Cancer Institute, Stanford University School of Medicine, 780 Welch Road, Stanford, CA, 94304, USA
| | - Kelly-Anne Phillips
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Robert J MacInnis
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia.,Cancer Epidemiology, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Gillian S Dite
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia.,Cancer Epidemiology, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Yuyan Liao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, Ontario, M5G 1X5, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T3M7, Canada
| | - Melissa C Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Linda Vahdat
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA.,C Anthony and Jean Whittingham Cancer Center, 34 Maple Street, Norwalk, CT, 06856, USA
| | - Naomi Kornhauser
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA
| | - Tessa Cigler
- Weill Cornell Medicine Breast Center, 428 E 72nd St, New York, NY, 10021, USA
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University, 1150 St Nicholas Ave, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia.,Cancer Epidemiology, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Medical Oncology, St Vincent's Hospital, 41 Victoria St, Fitzroy, VIC, 3065, Australia
| | - Michael L Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Barker St, Randwick, NSW, 2031, Australia
| | - Prue C Weideman
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, Ontario, M5G 1X5, Canada
| | - Stephanie Nesci
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC, 3000, Australia
| | | | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, Ontario, M5G 1X5, Canada.,Departments of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
| | - Saundra S Buys
- Department of Medicine and Huntsman Cancer Institute, University of Utah Health, 2000 Cir of Hope Dr, Salt Lake City, UT, 84103, USA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.
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30
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Roberts ME, Zeinomar N, Solomon BD, Terry MB, Chung WK. Response to Wang et al. Genet Med 2019; 21:2158. [PMID: 30824819 DOI: 10.1038/s41436-019-0469-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Nur Zeinomar
- Department of Epidemiology, Columbia University, New York, NY, USA
| | | | - Mary Beth Terry
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Wendy K Chung
- Department of Pediatrics and Medicine, Columbia University, New York, NY, USA
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31
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Zeinomar N, Phillips KA, Daly MB, Milne RL, Dite GS, MacInnis RJ, Liao Y, Kehm RD, Knight JA, Southey MC, Chung WK, Giles GG, McLachlan SA, Friedlander ML, Weideman PC, Glendon G, Nesci S, Andrulis IL, Buys SS, John EM, Hopper JL, Terry MB. Benign breast disease increases breast cancer risk independent of underlying familial risk profile: Findings from a Prospective Family Study Cohort. Int J Cancer 2019; 145:370-379. [PMID: 30725480 DOI: 10.1002/ijc.32112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/28/2018] [Accepted: 12/12/2018] [Indexed: 12/30/2022]
Abstract
Benign breast disease (BBD) is an established breast cancer (BC) risk factor, but it is unclear whether the magnitude of the association applies to women at familial or genetic risk. This information is needed to improve BC risk assessment in clinical settings. Using the Prospective Family Study Cohort, we used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of BBD with BC risk. We also examined whether the association with BBD differed by underlying familial risk profile (FRP), calculated using absolute risk estimates from the Breast Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) model. During 176,756 person-years of follow-up (median: 10.9 years, maximum: 23.7) of 17,154 women unaffected with BC at baseline, we observed 968 incident cases of BC. A total of 4,704 (27%) women reported a history of BBD diagnosis at baseline. A history of BBD was associated with a greater risk of BC: HR = 1.31 (95% CI: 1.14-1.50), and did not differ by underlying FRP, with HRs of 1.35 (95% CI: 1.11-1.65), 1.26 (95% CI: 1.00-1.60), and 1.40 (95% CI: 1.01-1.93), for categories of full-lifetime BOADICEA score <20%, 20 to <35%, ≥35%, respectively. There was no difference in the association for women with BRCA1 mutations (HR: 1.64; 95% CI: 1.04-2.58), women with BRCA2 mutations (HR: 1.34; 95% CI: 0.78-2.3) or for women without a known BRCA1 or BRCA2 mutation (HR: 1.31; 95% CI: 1.13-1.53) (pinteraction = 0.95). Women with a history of BBD have an increased risk of BC that is independent of, and multiplies, their underlying familial and genetic risk.
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Affiliation(s)
- Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Kelly-Anne Phillips
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Gillian S Dite
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, Australia
| | - Robert J MacInnis
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Yuyan Liao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Rebecca D Kehm
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Melissa C Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, VIC, Australia
| | - Wendy K Chung
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY.,Department of Pediatrics and Medicine, Columbia University, New York, NY
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Parkville, VIC, Australia.,Department of Medical Oncology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Michael L Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Prue C Weideman
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, Australia
| | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Stephanie Nesci
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | -
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,The Research Department, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Departments of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Saundra S Buys
- Department of Medicine and Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Esther M John
- Department of Medicine and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, Australia
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
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32
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Kehm RD, Phillips KA, Daly MB, Andrulis IL, Liao Y, Ma X, Zeinomar N, MacInnis RJ, Dite GS, John EM, Buys SS, Milne RL, Hopper JL, Terry MB. Abstract PD6-05: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd6-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
Citation Format: Kehm RD, Phillips K-A, Daly MB, Andrulis IL, Liao Y, Ma X, Zeinomar N, MacInnis RJ, Dite GS, John EM, Buys SS, Milne RL, Hopper JL, Terry MB. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD6-05.
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Affiliation(s)
- RD Kehm
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - K-A Phillips
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - MB Daly
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - IL Andrulis
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Y Liao
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - X Ma
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - N Zeinomar
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - RJ MacInnis
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - GS Dite
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - EM John
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - SS Buys
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - RL Milne
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - JL Hopper
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - MB Terry
- Columbia University Mailman School of Public Health, New York, NY; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
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Affiliation(s)
| | - Nur Zeinomar
- Department of Epidemiology, Columbia University, New York, NY, USA
| | | | - Mary Beth Terry
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Wendy K Chung
- Department of Pediatrics and Medicine, Columbia University, New York, NY, USA
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Hopper JL, Dite GS, MacInnis RJ, Liao Y, Zeinomar N, Knight JA, Southey MC, Milne RL, Chung WK, Giles GG, Genkinger JM, McLachlan SA, Friedlander ML, Antoniou AC, Weideman PC, Glendon G, Nesci S, Andrulis IL, Buys SS, Daly MB, John EM, Phillips KA, Terry MB. Age-specific breast cancer risk by body mass index and familial risk: prospective family study cohort (ProF-SC). Breast Cancer Res 2018; 20:132. [PMID: 30390716 PMCID: PMC6215632 DOI: 10.1186/s13058-018-1056-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/02/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The association between body mass index (BMI) and risk of breast cancer depends on time of life, but it is unknown whether this association depends on a woman's familial risk. METHODS We conducted a prospective study of a cohort enriched for familial risk consisting of 16,035 women from 6701 families in the Breast Cancer Family Registry and the Kathleen Cunningham Foundation Consortium for Research into Familial Breast Cancer followed for up to 20 years (mean 10.5 years). There were 896 incident breast cancers (mean age at diagnosis 55.7 years). We used Cox regression to model BMI risk associations as a function of menopausal status, age, and underlying familial risk based on pedigree data using the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA), all measured at baseline. RESULTS The strength and direction of the BMI risk association depended on baseline menopausal status (P < 0.001); after adjusting for menopausal status, the association did not depend on age at baseline (P = 0.6). In terms of absolute risk, the negative association with BMI for premenopausal women has a much smaller influence than the positive association with BMI for postmenopausal women. Women at higher familial risk have a much larger difference in absolute risk depending on their BMI than women at lower familial risk. CONCLUSIONS The greater a woman's familial risk, the greater the influence of BMI on her absolute postmenopausal breast cancer risk. Given that age-adjusted BMI is correlated across adulthood, maintaining a healthy weight throughout adult life is particularly important for women with a family history of breast cancer.
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Affiliation(s)
- John L. Hopper
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC Australia
| | - Gillian S. Dite
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC Australia
| | - Robert J. MacInnis
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC Australia
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC Australia
| | - Yuyan Liao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, 7th Floor, New York, NY USA
| | - Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, 7th Floor, New York, NY USA
| | - Julia A. Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Melissa C. Southey
- Department of Pathology, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, VIC Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, CA VIC 3168 USA
| | - Roger L. Milne
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC Australia
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC Australia
| | - Wendy K. Chung
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY USA
- Departments of Pediatrics and Medicine, Columbia University, New York, NY USA
| | - Graham G. Giles
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC Australia
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC Australia
| | - Jeanine M. Genkinger
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, 7th Floor, New York, NY USA
| | - Sue-Anne McLachlan
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Parkville, VIC Australia
- Department of Medical Oncology, St Vincent’s Hospital, Fitzroy, VIC Australia
| | - Michael L. Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW Australia
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW Australia
| | - Antonis C. Antoniou
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - Prue C. Weideman
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC Australia
| | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON Canada
| | - Stephanie Nesci
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - kConFab Investigators
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC Australia
- The Research Department, The Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Irene L. Andrulis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON Canada
- Departments of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Saundra S. Buys
- Department of Medicine and Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT USA
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA USA
| | - Esther M. John
- Department of Medicine and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA USA
| | - Kelly Anne Phillips
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC Australia
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC Australia
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, 7th Floor, New York, NY USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY USA
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Roberts ME, Jackson SA, Susswein LR, Zeinomar N, Ma X, Marshall ML, Stettner AR, Milewski B, Xu Z, Solomon BD, Terry MB, Hruska KS, Klein RT, Chung WK. MSH6 and PMS2 germ-line pathogenic variants implicated in Lynch syndrome are associated with breast cancer. Genet Med 2018; 20:1167-1174. [PMID: 29345684 PMCID: PMC6051923 DOI: 10.1038/gim.2017.254] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/05/2017] [Indexed: 12/28/2022] Open
Abstract
PURPOSE An association of Lynch syndrome (LS) with breast cancer has been long suspected; however, there have been insufficient data to address this question for each of the LS genes individually. METHODS We conducted a retrospective review of personal and family history in 423 women with pathogenic or likely pathogenic germ-line variants in MLH1 (N = 65), MSH2 (N = 94), MSH6 (N = 140), or PMS2 (N = 124) identified via clinical multigene hereditary cancer testing. Standard incidence ratios (SIRs) of breast cancer were calculated by comparing breast cancer frequencies in our study population with those in the general population (Surveillance, Epidemiology, and End Results 18 data). RESULTS When evaluating by gene, the age-standardized breast cancer risks for MSH6 (SIR = 2.11; 95% confidence interval (CI), 1.56-2.86) and PMS2 (SIR = 2.92; 95% CI, 2.17-3.92) were associated with a statistically significant risk for breast cancer whereas no association was observed for MLH1 (SIR = 0.87; 95% CI, 0.42-1.83) or MSH2 (SIR = 1.22; 95% CI, 0.72-2.06). CONCLUSION Our data demonstrate that two LS genes, MSH6 and PMS2, are associated with an increased risk for breast cancer and should be considered when ordering genetic testing for individuals who have a personal and/or family history of breast cancer.
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Affiliation(s)
| | | | | | - Nur Zeinomar
- Department of Epidemiology, Columbia University, New York, New York, USA
| | - Xinran Ma
- Department of Epidemiology, Columbia University, New York, New York, USA
| | | | | | | | | | | | - Mary Beth Terry
- Department of Epidemiology, Columbia University, New York, New York, USA
| | | | | | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University, New York, New York, USA
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Moslehi R, Zeinomar N, Stagnar C, Tsao HS, Dzutsev A. Abstract 246: An integrative genetic epidemiologic approach to identify susceptibility genes for post-menopausal breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Up to 30% of common (peri- and post-menopausal) breast cancer cases in the general population are believed to be due to segregation of mutations and variations with low to medium risk [i.e., 1.5< relative risk <20] for breast cancer. The majority of these genes remain to be identified. We used a hypothesis-driven integrative genetic epidemiologic approach to test the association of post-menopausal breast cancer with Nucleotide Excision Repair (NER) genes using several gene expression microarray and genome-wide association studies (GWAS) datasets. Methods: As per inclusion criteria, all datasets contained Caucasian cases with invasive ductal breast carcinoma diagnosed post-menopause (≥50 years of age) and healthy controls (with no personal history of breast cancer). Raw data from four gene expression microarray datasets (GSE5764, GSE10797, GSE10780, E-TABM-276) were used for pathway and meta-analysis. Raw data from three GWAS datasets, the Cancer Genetic Markers of Susceptibility (CGEMS) (1089 cases, 1093 controls), a nested case-control (351 cases, 884 controls) within National Surgical Adjuvant Breast and Bowel Project (NSABP), and a nested case-control (465 cases and 1394 controls) within the Women's Health Initiative (WHI) Hormone Therapy Trials, were analyzed using logistic regression models adjusting for covariates. Linkage disequilibrium patterns and deviations from Hardy-Weinberg Equilibrium (HWE) were assessed for single nucleotide polymorphisms (SNPs) within all candidate genes. Individual haplotypes and diplotypes were determined for all subjects. Odd ratios (OR) and 95% confidence intervals (CI) were calculated. Results: Individual analysis of gene expression microarray datasets and meta-analysis of GSE10780 and E-TABM-276 identified significant up-regulation of several NER genes including ERCC6 (P=7.95*10-6) and ERCC8 (P=4.67*10-6). Increased risk of breast cancer was found in association with variations in ERCC6 in all GWAS datasets. ERCC6 SNPs were in strong LD in all datasets with no deviations from HWE. In CGEMS, increased risk of breast cancer was found with ERCC6 rs4253082 (OR=1.32, 95%CI: 1.09-1.61, P=0.005), rs3750749 (OR=1.40, 95%CI: 1.07-1.8, P=0.01), and rs3750751 (OR=2.91, 95%CI: 1.05-8.06, P=0.04). In NSABP, increased risk of breast cancer was found with ERCC6 rs2229760 (OR=1.37, 95%CI: 1.02-1.83, P=0.03). In WHI, increased risk of breast cancer was found with ERCC6 rs1012553 (OR=1.35, 95%CI: 1.07-1.71, P=0.01) and rs2228528 (OR=1.29, 95%CI: 1.01-1.66, P=0.04). Gene-gene interaction analysis was significant for interactions between ERCC6 and several NER genes, including between specific diplotypes in ERCC6 and ERCC8 (Pinteraction=0.0009 in CGEMS). Conclusion: Genes involved in the NER pathway, including ERCC6 and ERCC8, may be associated with low to medium risk for susceptibility to post-menopausal breast cancer.
Citation Format: Roxana Moslehi, Nur Zeinomar, Cristy Stagnar, Hui-Shien Tsao, Amiran Dzutsev. An integrative genetic epidemiologic approach to identify susceptibility genes for post-menopausal breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 246.
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Roberts ME, Zeinomar N, Solomon BD, Terry MB, Chung WK. Response to ten Broeke et al. Genet Med 2018; 21:258-259. [PMID: 29795440 DOI: 10.1038/s41436-018-0031-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/20/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Nur Zeinomar
- Department of Epidemiology, Columbia University, New York, New York, USA
| | | | - Mary Beth Terry
- Department of Epidemiology, Columbia University, New York, New York, USA
| | - Wendy K Chung
- Department of Pediatrics and Medicine, Columbia University, New York, New York, USA
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Moslehi R, Zeinomar N, Boscoe FP. Incidence of cutaneous malignant melanoma in Iranian provinces and American states matched on ultraviolet radiation exposure: an ecologic study. Environ Pollut 2018; 234:699-706. [PMID: 29241156 PMCID: PMC5921862 DOI: 10.1016/j.envpol.2017.11.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Ultraviolet radiation (UVR), with UVB and UVA as the relevant components, is a risk factor for melanoma. Complete ascertainment and registration of melanoma in Iran was conducted in five provinces (Ardabil, Golestan, Mazandaran, Gilan and Kerman) during 1996-2000. The aim of our study was to compare population-based incidence data from these provinces with rates in the United States (US) while standardizing ambient UVR. METHODS Population-based rates representing all incident cases of melanoma (1996-2000) across the five Iranian provinces were compared to rates of melanoma among white non-Hispanics in the US. Overall age-standardized rates (ASR) for Iran and the US (per 100,000 person-years adjusted to 2000 world population) and standardized rate ratios (SRR) were calculated. We measured erythemally-weighted average solar UVR exposures (with contributions from both UVB and UVA range) of the five Iranian provinces using data from NASA's Total Ozone Mapping Spectrometer and selected five US states (Kentucky, Utah, Texas, Oklahoma, and Hawaii) with matching UVR exposure to each province. Incidence rates of melanoma during 1996-2000 in each Iranian province were compared to rates among white non-Hispanics in its UVR-matched US state. RESULTS The overall male and female ASRs of melanoma were 0.60 (95%CI: 0.56-0.64) and 0.46 (95%CI: 0.42-0.49), respectively, for Iran and 22.78 (95%CI: 22.42-23.14) and 16.61 (95%CI: 16.30-16.92) for the US. SRRs of melanoma comparing US to Iran were 37.97 (95%CI: 35.78-40.29) for males and 36.11 (95%CI: 33.69-38.70) for females, indicating significantly higher incidence in the US. ASRs and age-specific rates of melanoma for both genders were significantly lower in each Iranian province compared to its UVR-matched US state. CONCLUSION The markedly lower incidence rates of melanoma in Iranian provinces with similar UVR exposures to US states underscore the need for additional comparative studies to decipher the influence of other extrinsic and intrinsic factors on the risk of this malignancy.
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Affiliation(s)
- Roxana Moslehi
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York (SUNY), New York, USA; Cancer Research Center, University at Albany, SUNY, New York, USA.
| | - Nur Zeinomar
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York (SUNY), New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
| | - Francis P Boscoe
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York (SUNY), New York, USA; New York State Cancer Registry, New York State Department of Health, New York, USA.
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Zeinomar N, Phillips KA, Liao Y, MacInnis RJ, Dite GS, Daly MB, John EM, Andrulis IL, Buys SS, Hopper JL, Terry MB. Abstract P6-09-04: Benign breast disease and breast cancer risk across the spectrum of familial risk using a prospective family study cohort (ProF-SC). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-09-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Benign breast disease (BBD) is one of the strongest risk factors for breast cancer but it is unclear whether the strength of the association with BBD and breast cancers varies by breast cancer family history. Few studies of BBD enrich specifically for putative genetic factors by over-sampling based on family history let alone evaluate potential interactions with measures of underlying familial risk. The aim of this study was to evaluate how risk associated with BBD is modified by underlying familial risk so as to guide clinical management and risk assessment of women with BBD.
Methods: Using a prospective family study cohort of 17,154 women unaffected with breast cancer at baseline and followed by questionnaire at regular intervals, we examined the association between BBD and breast cancer risk using Cox Proportional Hazards models. We classified women as having BBD if they reported at baseline having been told by a doctor that they had BBD, such as a non-cancerous cyst or breast lump. We did not have information on histologic sub-type. We confirmed self-reported diagnosis of BBD with pathology reports in a subset of the New York cohort and found high agreement between self-reported and pathologically confirmed BBD (93.5%). We assessed multiplicative and additive interactions with underlying familial risk profile (FRP) defined as either fixed-time horizon of 1-year, or total lifetime risk, estimated from the Breast Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) model.
Results: During 176,756 person-years of follow-up (mean 10.2, maximum 23.7 years), we observed 968 incident breast cancers cases with an average age at diagnosis of 55.8 years and average age at enrollment into the cohort of 46.8 years. At baseline, 4,704 (27%) women reported having a previous diagnosis of BBD. Compared to women with no history of BBD, breast cancer risk was increased in women of all ages (HR: 1.37, 95% CI: 1.19,1.56), and in women up to age 45 years (using attained age models) (HR: 1.40, 95% CI: 1.01,1.93). In terms of recency of BBD, we found that the increased risk associated with BBD remained 21 years or more after the initial BBD diagnosis (HR: 1.37, 95% CI: 1.11, 1.68). We found no evidence for multiplicative interactions with FRP, which implies that the increase in absolute risk associated with BBD depends on a woman's FRP (Table 1).
Conclusions: Women with a history of BBD have an increased risk of breast cancer that multiplies their underlying familial risk (FRP). These results could prove to be valuable for risk counseling and clinical management.
Table 1: Cumulative Incidence of Breast Cancer to age 45, 55, and 65 by BBD and underlying FRP as measured by 10-year BOADICEA score.AgeNo BBD, <3.4 %BBD, <3.4%No BBD, ≥3.4%BBD, ≥3.4%454.6 (3.8, 5.6)6.1(4.7, 8.0)12.1 (10.2, 14.5)16.1 (13.1, 19.7)557.4 (6.3, 8.7)9.8 (7.5, 12.8)19.1 (16.6, 22.0)25.0 (21.7, 28.9)659.7 (8.2, 11.5)12.8 (9.9, 16.5)24.5 (21.8, 27.6)31.8 (28.3, 35.7)
Citation Format: Zeinomar N, Phillips KA, Liao Y, MacInnis RJ, Dite GS, Daly MB, John EM, Andrulis IL, Buys SS, Hopper JL, Terry MB. Benign breast disease and breast cancer risk across the spectrum of familial risk using a prospective family study cohort (ProF-SC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-09-04.
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Affiliation(s)
- N Zeinomar
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - KA Phillips
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - Y Liao
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - RJ MacInnis
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - GS Dite
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - MB Daly
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - EM John
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - IL Andrulis
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - SS Buys
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - JL Hopper
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - MB Terry
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
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Terry MB, Phillips KA, Daly MB, Andrulis IL, Liao Y, Ma X, Zeinomar N, MacInnis RJ, Dite GS, John EM, Buys SS, Hopper JL. Abstract P6-09-01: Risk-reducing oophorectomy and breast cancer risk across the spectrum of familial risk using a prospective family study cohort (ProF-SC). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-09-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Whether risk-reducing salpingo oophorectomy (RRSO) reduces breast cancer risk in addition to reducing ovarian cancer risk is controversial with some arguing that the previous evidence of a reduction in breast cancer risk from RRSO was due to bias. Evidence from independent prospective cohorts of high-risk women is needed to resolve this controversy.
Methods: Using a prospective family study cohort of 17,810 women unaffected with breast cancer at baseline, we examined the association between RRSO and breast cancer risk using Cox Proportional Hazards models. We compared results estimating RRSO as a non-time-dependent variable to results treating RRSO as a time-dependent variable, because failing to account for the time-varying nature of a covariate person- time prior to RRSO, should it exist, will incorrectly attribute the cancer-free person-time to RRSO. We separately examined the association with RRSO in BRCA1 and BRCA2 mutation carriers and non-carriers, and further performed gene-stratified analyses in women with BRCA1 and BRCA2 only. We also assessed multiplicative interactions with underlying familial risk profile (FRP), defined as total lifetime risk estimated from the Breast Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) model.
Results: During a median 10.7 years of follow-up (maximum 23.7 years), we observed 1,040 incident cases of breast cancer with an average age at diagnosis of 55.8 years and average age at enrollment into the cohort of 46.8 years. A total of 2434 (14%) women reported at baseline having a RRSO. We observed decreased risk of breast cancer associated with RRSO for both BRCA1(N= 650) and BRCA2(N=557) mutation carriers when RRSO was treated as a fixed covariate (HR= 0.60, 95% CI=0.40-0.92 and HR= 0.40, 95%CI = 0.23-0.69, respectively). In contrast, when we treated RRSO as a time-varying covariate, for both BRCA1 and BRCA2 carriers, we no longer observed a decreased risk for BRCA1 and BRCA2 carriers (HR= 1.67, 95% CI=1.05-2.67 and HR= 0.97, 95%CI = 0.53-1.80, respectively). There was no association between RRSO and breast cancer risk for non-carriers (N=16,603), whether we treated RRSO as a fixed or time varying covariate (HR= 0.88, 95% CI=0.72-1.08 and HR= 1.06, 95%CI = 0.85-1.30, respectively).
Conclusions: Our findings provide an independent replication that the reduced risk of breast cancer previously observed in BRCA1 and BRCA2 mutation carrier women may be from bias in counting person-time. Clinical management of high-risk women should counsel based on the reduced risk of ovarian cancer from RRSO, but not breast cancer.
Citation Format: Terry MB, Phillips KA, Daly MB, Andrulis IL, Liao Y, Ma X, Zeinomar N, MacInnis RJ, Dite GS, John EM, Buys SS, Hopper JL. Risk-reducing oophorectomy and breast cancer risk across the spectrum of familial risk using a prospective family study cohort (ProF-SC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-09-01.
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Affiliation(s)
- MB Terry
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - KA Phillips
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - MB Daly
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - IL Andrulis
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - Y Liao
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - X Ma
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - N Zeinomar
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - RJ MacInnis
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - GS Dite
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - EM John
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - SS Buys
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - JL Hopper
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
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Zeinomar N, Thai A, Cloud AJ, McDonald JA, Liao Y, Terry MB. Alcohol consumption and breast cancer-specific and all-cause mortality in women diagnosed with breast cancer at the New York site of the Breast Cancer Family Registry. PLoS One 2017; 12:e0189118. [PMID: 29244822 PMCID: PMC5731703 DOI: 10.1371/journal.pone.0189118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose Alcohol consumption is an established and important risk factor for breast cancer incidence in the general population. However, the relationship between alcohol and mortality among women with breast cancer is less clear. This study examines the effect of alcohol consumption on mortality in women affected with breast cancer at baseline from a high-risk family breast and ovarian cancer registry. Methods We studied 1116 women affected with breast cancer at baseline from the Metropolitan New York Registry. The examined reported alcohol consumption (total of beer, wine, liquor) was defined as the average number of drinks per week reported from age 12 to age at baseline. We assessed vital status of each participant using participant or family reported data and we used the National Death Index to supplement deaths reported through family updates. We used Cox proportional hazards models to estimate the association between alcohol intake and overall mortality (HRO), breast cancer-specific mortality (HRBC), and non-breast cancer mortality (HRNBC), adjusted for confounders. Results After a mean follow-up of 9.1 years, we observed 211 total deaths and 58 breast cancer deaths. Compared to non-drinkers, we found that both low and moderate to heavy levels of alcohol intake were not associated with greater overall mortality (≤3 drinks/week: HRO: 0.66, 95% CI: 0.38–1.14); > 3 drinks/week: HRO: 1.16, 95% CI: 0.85–1.58), breast cancer–specific mortality (≤ 3 drinks/week: HRBC:0.62, 95% CI: 0.19–2.03; >3 drinks/week: HR BC: 0.96, 95% CI: 0.49–1.89), or non-breast cancer-specific mortality (≤3 drinks/week: HR NBC: 0.73, 95% CI: 0.32–1.6; >3 drinks/week: HRNBC: 1.18, 95% CI: 0.75–1.86). Conclusions Alcohol intake reported from age 12 to age at baseline was not associated with overall or breast cancer-specific mortality in this cohort of affected women with a family history of breast cancer.
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Affiliation(s)
- Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Ashley Thai
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Ann J. Cloud
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Jasmine A. McDonald
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Yuyan Liao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, United States of America
- * E-mail:
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Moslehi R, Boscoe FB, Zeinomar N. Abstract 5212: A comparative descriptive study of cutaneous malignant melanoma. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-5212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objectives: Incidence of cutaneous malignant melanoma has increased worldwide in the past several decades, particularly in developed countries. Melanoma is believed to be a multifactorial condition, with exposure to ultraviolet radiation (UVR) as a major environmental risk factor. We matched five provinces in Iran with five states in the United States (US) based on measurements of solar UVB exposure and conducted a comparison of population-based incidence rates of melanoma in each province and state.
Methods: Solar UVB exposure was measured using data from NASA's Total Ozone Mapping Spectrometer (TOMS) for the period between January 1, 1997 and December 31, 2000 at a geographic resolution of one degree. UV exposures (in mW/m2) for each state and province were calculated by averaging the values of the grid points within each state and province. Population-based incidence data for five Iranian provinces (Ardabil, Golestan, Mazandaran, Gilan and Kerman) were obtained from their respective cancer registries. Incidence rates among white non-Hispanic individuals in the five US states (Kentucky, Utah, Texas, Oklahoma, and Hawaii) with matching average UVB exposure to the Iranian provinces were obtained from the North American Association of Central Cancer Registries. Furthermore, population-based incidence rates of melanoma for the overall U.S. population were obtained from the Surveillance, Epidemiology, and End Results (SEER) program for the 13 SEER areas (1996-2000). All incidence rates were calculated per 100,000 person-years and were age-adjusted using the 2000 standard populations.
Results: Annual UVB exposure from 1996-2000 ranged from an average of 138.52 in Ardabil to 227.44 in Kerman. The exposures of the corresponding US states ranged from 124.95 in Kentucky to 246.34 in Hawaii during the same period. The overall male and female rates of melanoma were 0.59 and 0.46, respectively, for Iran and 14.9 (95%CI: 14.7-15.2) and 10.5 (95%CI: 10.4-10.7), respectively, for the US. Age-standardized rates (ASR) of melanoma among males for the five Iranian provinces in comparison to their UVR-matched US states were as follows: 0.30 (22.6) for Ardabil (Kentucky), 1.20 (26.6) for Golestan (Utah), 0.73 (18.1) for Mazandaran (Texas), 0.17 (15.8) for Gilan (Oklahoma), and 0.90 (75.3) for Kerman (Hawaii). ASR of melanoma among females were as follows: 0.20 (16.0) for Ardabil (Kentucky), 0.60 (17.5) for Golestan (Utah), 0.47 (10.6) for Mazandaran (Texas), 0.17 (8.9) for Gilan (Oklahoma), and 0.90 (36.5) for Kerman (Hawaii).
Conclusion: The markedly higher incidence rates of melanoma in selected US states compared to Iranian provinces with similar UVR exposure patterns may be due to differences in lifestyle, pigmentation, or genetic profiles, as well as under-reporting in Iran compared to the US. Our findings underscore the need for additional studies to decipher the multitude of extrinsic and intrinsic factors involved in the etiology of this multifactorial condition.
Citation Format: Roxana Moslehi, Francis B. Boscoe, Nur Zeinomar. A comparative descriptive study of cutaneous malignant melanoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 5212.
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Affiliation(s)
- Roxana Moslehi
- 1Department of Epidemiology and Biostatistics, School of Public Health, and Cancer Research Center, University at Albany, State University of New York, Albany, NY
| | | | - Nur Zeinomar
- 3Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York and Department of Epidemiology, Mailman School of Public Health, Columbia University, NY
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Abstract
We determined the effectiveness of a community-based breast cancer education intervention among understudied populations in the New York State (NYS) Capital Region by assessing and comparing baseline and post-education breast cancer knowledge. Participants included 417 students recruited from five colleges/universities and 67 women from four community group organizations. Baseline and post-education knowledge was assessed via self-administered mostly multiple-choice questionnaires. An open-ended question soliciting opinions about public health prevention strategies against breast cancer was included on college/university students' questionnaires. Effectiveness of education intervention was estimated through a paired t test. Stratified analysis was done using demographic and descriptive variables. Answers to the open-ended questions were analyzed qualitatively. The mean percentage of correct answers increased from 39.9% at baseline to 80.8% post-education (P < 0.0001) among college/university students and from 43.5% to 77.8% (P < 0.0001) among community group members. Effectiveness remained statistically significant in all stratified analyses with similarly high percentage of correct answers achieved post-education irrespective of knowledge level at baseline. Stratified analysis also revealed similar patterns of improvement in overall knowledge and narrowing of the gap in post-education knowledge. Primary prevention emerged as the dominant theme post-education in students' responses to the open-ended question, signifying the effectiveness of our education in raising awareness about modifiable risk factors and inspiring proactive thinking about public health prevention strategies. This community-based education intervention was effective in increasing breast cancer knowledge among demographically diverse groups with low levels of baseline knowledge in the NYS Capital Region. Our findings provide leads for future public health prevention strategies.
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Affiliation(s)
- Nur Zeinomar
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, NY
| | - Roxana Moslehi
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, NY
- Cancer Research Center, University at Albany, State University of New York, NY
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Zeinomar N, Moslehi R. Abstract 2527: Impact of community-based breast cancer education intervention in New York State Capital Region. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-2527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objectives: We conducted a community-based education intervention among targeted understudied groups in the New York State Capital Region to assess baseline knowledge of breast cancer and determine the effectiveness of newly developed educational tools in improving knowledge.
Methods: We recruited 417 students from five participating colleges/universities and 67 women from four community group organizations. Educational intervention involved about an hour-long lecture on breast cancer using Microsoft PowerPoint® presentations tailored to each of the two participating groups of colleges/universities and community group organizations. Baseline and post-education knowledge was assessed via self-administered questionnaires. In addition to multiple choice questions, pre- and post-education questionnaires designed for college/university students also contained an open-ended question soliciting their suggestions for public health preventive actions against breast cancer. The effectiveness of our education intervention in improving breast cancer knowledge was estimated using a paired t-test. Descriptive and qualitative analyses of demographic variables and answers to the open-ended questions were also conducted.
Results: Our analyses revealed a statistically significant improvement (P<0.0001) in mean percentage of correct answers among both participating groups of college/university students (from 39.9% at baseline to 80.8% post-education) and community group members (from 43.5% at baseline to 77.8% post-education). The effectiveness remained statistically significant in stratified analyses (by demographic variables as well as by other variables such as being or knowing a breast cancer survivor or having attended a breast cancer lecture or seminar in the past). Analysis of the answers to the open-ended questions revealed a shift in the attitudes of college/university students, brought about by our education intervention, regarding preventive efforts. While secondary prevention was the major theme pre-education (mentioned by ∼51% of respondents), primary prevention emerged as the major theme post-education (mentioned by ∼80% of respondents).
Conclusions: This community-based education intervention was motivated by lack of a readily available breast cancer educational tool as well as lack of information about baseline knowledge of breast cancer among communities in the New York State Capital Region. Our findings of low levels of both baseline knowledge and prior attendance in a breast cancer lecture/seminar by participants in our study underscore the importance of education interventions. Our community-based education intervention was effective in increasing knowledge about breast cancer among college students and community group members in upstate New York. Our findings provide leads for public health prevention strategies.
Citation Format: Nur Zeinomar, Roxana Moslehi. Impact of community-based breast cancer education intervention in New York State Capital Region. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2527. doi:10.1158/1538-7445.AM2013-2527
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Affiliation(s)
- Nur Zeinomar
- University at Albany, State University of New York, Albany, NY
| | - Roxana Moslehi
- University at Albany, State University of New York, Albany, NY
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Koleilat I, Zeinomar N, Nigam A. Liver and Pancreatic Major Resections Do Not Require Routine Post-operative Intensive Care Unit Stay. J Surg Res 2013. [DOI: 10.1016/j.jss.2012.10.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hosler AS, Zeinomar N, Asare K. Diabetes-related services and programs in small local public health departments, 2009-2010. Prev Chronic Dis 2011; 9:E07. [PMID: 22172174 PMCID: PMC3277392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Local health departments (LHDs) vary in their capacity to perform public health services by the size of population they serve. Little is known about the extent of emerging primary prevention activities at small LHDs. The objectives of this study were to describe various diabetes-related patient care and primary prevention services offered by small LHDs (those serving a population of less than 150,000) and explore factors associated with the diversity of these services. METHODS During 2009 through 2010, we interviewed directors of a nationally representative sample of small LHDs by telephone to obtain information about staff structure, diabetes services, and partnerships. We obtained data for demographic characteristics and health status of the population from secondary sources. We analyzed the number of patient care services and primary prevention programs through multivariate regression analyses. RESULTS Fifty-eight small LHDs completed the survey, a response rate of 81%. Most (n = 47) had at least 1 diabetes-related patient care service; referral to diabetes specialists was the most frequently identified service (n = 44). Nearly half of small LHDs also engaged in obesity prevention for adults (n = 26) or children (n = 26), but only 7 had a diabetes prevention program. Diversity of patient care services was positively associated with the proportion of the population that was rural, time commitment of a certified diabetes educator, and total staff size. Diversity of primary prevention programs was positively associated with intensity of collaboration with the state diabetes program and total staff size and inversely associated with the proportion of racial/ethnic minorities in the jurisdiction. CONCLUSION Most small LHDs function as a link to local diabetes care services. Staff capacity, collaboration with the state health department, and local population factors appear to influence the diversity of diabetes-related services at small LHDs.
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Affiliation(s)
- Akiko S. Hosler
- Department of Epidemiology and Biostatistics, University at Albany (SUNY) School of Public Health
| | - Nur Zeinomar
- University at Albany (SUNY), Rensselaer, New York
| | - Kofi Asare
- University at Albany (SUNY), Rensselaer, New York
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Hosler AS, Zeinomar N, Asare K. Diabetes-Related Services and Programs in Small Local Public Health Departments, 2009-2010. Prev Chronic Dis 2011. [DOI: 10.5888/pcd9.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Zeinomar N, Caracciolo B, Andresen E, Brumback B, Defries E. Natural Disaster and Disability: Case Study of the Florida 2004 Hurricane Season Based on the Behavioral Risk Factor Surveillance System (BRFSS). Ann Epidemiol 2007. [DOI: 10.1016/j.annepidem.2007.07.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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