Abstract 3225: Time since last birth in relation to breast cancer mortality

Women who develop breast cancer less than 10 years after giving birth have been shown to have a poorer prognosis than women with a longer time since their last birth. Only a few studies have examined this relation separately by molecular features of the tumor; two observed poorer outcomes for women with hormone receptor positive tumors. A better understanding of the relation between time since last birth and risk of recurrence and death could lead to targeted treatments and/or surveillance of young women who develop breast cancer within 10 years of giving birth. There has been little research on this topic among Black women, who have a higher incidence of breast cancer at young ages compared to White women. We assessed the relation of time since last birth to breast cancer mortality according to estrogen receptor (ER) status of the primary tumor among breast cancer patients who are participants in the prospective Black Women’s Health Study (BWHS).

The BWHS includes 59,000 U.S. Black women who enrolled in the study in 1995 and have been followed by biennial questionnaire since then. The present analysis was restricted to parous women diagnosed before age 50 (N=658) because older patients would have been unlikely to have given birth within the past 10 years. ER status was positive for 348 cases, negative for 199, and unknown for 111. Follow-up time was from time of diagnosis to death or the end of 2018, whichever came first. Cox regression analysis, adjusted for age and stage at diagnosis, was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for breast cancer specific death for women diagnosed <10 years since last birth relative to women diagnosed ≥10 years since last birth.

The median age at diagnosis was 44, with 41% of cancers diagnosed at stage I, 43% at stage II, and 16% at stage III. About a third (31%) had given birth &lt10 years before diagnosis. During follow-up, there were 159 total deaths, 132 of which were due to breast cancer. Among women diagnosed with ER-positive breast cancer, the HR for breast cancer death for women who gave birth &lt10 years prior to diagnosis relative to women who had not had a recent birth was 2.45 (95% 1.07-5.58). The association was even stronger among women who survived the first five years, with an HR of 3.38 (95% CI 1.34-8.51). Time since last birth was not associated with ER-negative breast cancer mortality (HR 1.06, 95% CI 0.46-2.46).

Late recurrences are a particular problem with ER-positive breast cancer. The present findings suggest a relatively short interval (e.g., &lt10 years) between childbirth and a breast cancer diagnosis may increase risk of a late recurrence and death from ER-positive breast cancer. Greater awareness of this association may lead to improved surveillance of survivors of early-onset breast cancer.

Citation Format: Gary R. Zirpoli, Nelsy Castro-Webb, Kimberly A. Bertrand, Julie R. Palmer. Time since last birth in relation to breast cancer mortality [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3225.

Maximum and Time-Dependent Body Mass Index and Breast Cancer Incidence Among Postmenopausal Women in the Black Women's Health Study

While excess weight is an established risk factor for postmenopausal breast cancer, consideration of maximum body mass index (maxBMI; BMI is calculated as weight (kg)/height (m)2) or BMI at a point in time relevant for breast carcinogenesis may offer new insights. We prospectively evaluated maxBMI and time-dependent BMI in relation to breast cancer incidence among 31,028 postmenopausal women in the Black Women's Health Study. During 1995-2015, a total of 1,384 diagnoses occurred, including 787 estrogen-receptor (ER)-positive (ER+) cases and 310 ER-negative (ER-) cases. BMI was assessed at baseline and 2, 4, 6, and 8 years before diagnosis. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Compared with women with BMI <25, those with BMI ≥35 had increased risk of ER+ breast cancer but not ER- breast cancer. For BMI assessed 2 years before diagnosis, the HRs for ER+ breast cancer associated with maxBMI ≥35 and time-dependent BMI ≥35 were 1.42 (95% confidence interval (CI): 1.10, 1.84) and 1.63 (95% CI: 1.25, 2.13), respectively. The corresponding HR for time-dependent BMI assessed 6 years before diagnosis was 1.95 (95% CI: 1.45, 2.62). These findings suggest strong associations of BMI with risk of ER+ breast cancer in postmenopausal women, regardless of timing of BMI assessment.

Association of macronutrients and dietary patterns with risk of systemic lupus erythematosus in the Black Women's Health Study

BACKGROUND

Systemic lupus erythematosus (SLE) affects African-American (AA) women disproportionately. The few prospective studies assessing dietary intake in relation to risk of SLE have been conducted in predominantly white populations and have been null.

OBJECTIVES

The present study assessed associations of macronutrients and dietary patterns with risk of SLE in AA women.

METHODS

Data from the Black Women's Health Study was collected prospectively via biennial questionnaires starting in 1995. Participants completed a self-administered 68-item FFQ in 1995. Self-reported SLE was verified through medical record review. We used multivariable (MV) Cox regression models to estimate HRs and 95% CIs for macronutrients, carbohydrates, proteins, total fats, PUFAs, ω-3 fatty acids, ω-6 fatty acids, MUFAs, saturated fats, trans fatty acids, Alternative Healthy Eating Index score, vegetable/fruit and meat/fried food dietary patterns, and a reduced rank regression (RRR)-derived dietary pattern in relation to SLE risk.

RESULTS

We confirmed a total of 114 incident cases of SLE among 51,934 women during 1995-2015. MVHRs and 95% CIs for the highest quintile of intake versus the lowest were HR: 1.96, 95% CI: 1.02, 3.67 for carbohydrates; HR: 0.66, 95% CI: 0.37, 1.18 for protein; and HR: 0.54, 95% CI: 0.28, 1.01 for total fats. MUFAs, saturated fatty acids, and trans fatty acids were significantly associated with a lower risk of SLE. An RRR-derived factor, rich in fruits and sugar-sweetened drinks and low in margarines and butter, red and processed meats, fried chicken, poultry, and eggs, which explained 53.4% of the total variation of macronutrients, was the only food pattern associated with increased SLE risk (HR: 1.88, 95% CI: 1.06, 3.35).

CONCLUSION

These analyses suggest that a diet high in carbohydrates and low in fats is associated with increased SLE risk in AA women.

Association of Child Abuse and Systemic Lupus Erythematosus in Black Women During Adulthood

OBJECTIVE

Exposure to psychosocial stressors may contribute to the onset of systemic lupus erythematosus (SLE) through dysregulation of the adaptive stress response. The present study was undertaken to assess the relationship of childhood physical and sexual abuse to risk of SLE among Black women.

METHODS

Using data from the Black Women's Health Study, we followed 36,152 women from 1995 through 2015 with biennial questionnaires. Women reported on exposure to abuse during childhood (up to age 11) in 2005. Self-reported cases of incident SLE were confirmed as meeting the American College of Rheumatology SLE classification criteria by medical record review. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for SLE among women exposed to physical or sexual abuse during childhood, controlling for potential confounders.

RESULTS

We confirmed 101 cases of incident SLE and identified patients who had completed questions on child abuse during 670,822 person-years of follow-up. Both physical and sexual abuse during childhood were associated with statistically significant increases in SLE incidence. The HR for SLE associated with ≥2 episodes of severe sexual abuse compared to no abuse was 2.51 (95% CI 1.29-4.85) after adjustment for alcohol consumption, smoking, body mass index, oral contraceptive use, age at menarche, and parental education. The multivariable-adjusted HR for SLE with ≥5 episodes of severe physical abuse was 2.37 (95% CI 1.13-4.99).

CONCLUSION

Our results suggest that sexual and physical abuse during childhood increase SLE risk during adulthood among Black women. Research is necessary both to confirm this finding and to understand potential mediating mechanisms.

Comparison of Hepatocellular Carcinoma in Hispanic and Non-Hispanic Patients

BACKGROUND

Hepatocellular carcinoma (HCC) is the fastest growing cancer in the United States. Studies have shown that compared to Blacks and non-Hispanic Whites, Hispanics have a higher HCC incidence and mortality rate. Most studies investigating HCC in Hispanics have been conducted utilizing data largely from the Western and Southern United States. These findings may, however, not be highly representative of Hispanics in the Northeast, given the nonhomogenous distribution and diversity of Hispanics across the United States.

METHODS

Some 148 HCC patients diagnosed between 1996 and 2012 were identified from a tertiary center in the northeastern United States. Hispanic patients were randomly matched to non-Hispanic White patients by year of diagnosis. Patient characteristics, HCC risk factors, treatment, and outcome were recorded. A Kaplan-Meier (KM) plot with log-rank tests was used for survival analysis.

RESULTS

Compared to non-Hispanic White patients (n=89), Hispanic HCC patients (n=59) were more likely to have chronic hepatitis C infection (69.5% vs. 38.2%, p < 0.01), alcoholic liver disease (37.3% vs. 21.4%, p = 0.04) and were less likely to have chronic hepatitis B infection (6.8% vs. 24.7%, p = 0.01), and private insurance (37.3% vs. 57.3%, p = 0.02). Hispanics were more likely to be diagnosed with an earlier stage disease (Barcelona Clinic Liver Cancer, BCLC stages A and B) compared to non-Hispanic patients (71.7% vs. 36.8%, p < 0.01) and were more likely to receive locoregional treatment. Although Hispanics trended towards improved overall survival, this finding did not hold when stratified by the BCLC stage.

CONCLUSION

Risk factors for HCC in the northeastern Hispanic population are like those found among Hispanics in other US regions. Other research suggests Hispanics are at increased risk for hepatic injury and HCC. However, HCC in this northeastern Hispanic population appears to be less aggressive (earlier stage and trend towards better overall survival) than non-Hispanics. Further research may be needed to identify potential differences by ethnic group for HCC risk factors, presentation, and outcomes.

A prospective study of reproductive factors in relation to risk of systemic lupus erythematosus among black women

OBJECTIVE

Systemic lupus erythematosus (SLE) occurs most commonly among reproductive age women, compatible with a potential role of reproductive factors, although past studies including women of mainly European ancestry have yielded conflicting results. We assessed relationships of reproductive factors to SLE risk among black women.

METHODS

We followed 58,243 participants in the Black Women's Health Study (BWHS) from 1995 - 2015 using biennial health questionnaires, on which participants reported reproductive and other factors. Self-reported incident SLE cases were confirmed as meeting 1997 American College of Rheumatology SLE classification criteria by medical record review. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for SLE for several reproductive factors, controlling for potential confounders.

RESULTS

During 954,476 person-years of follow-up, 125 incident cases of SLE were confirmed. Later age at menarche and longer duration of breast feeding were associated with increased risk of SLE. The multivariable HRs were 2.31 (95% CI, 1.30-4.11) for age at menarche ≥15 relative to age 12, and 1.73 (95% CI, 1.01-2.94) for breast feeding ≥6 months relative to none. There were no clear associations with parity, age at first birth, menopausal status, hysterectomy, age at menopause, or history of endometriosis.

CONCLUSION

Our results suggest that later menarchal age and breastfeeding of infants for ≥6 months vs. none may be associated with increased SLE risk among black women, while other reproductive factors did not appear related. The biological mechanisms underlying these potential associations should be pursued.

A Prospective Analysis of Intake of Red and Processed Meat in Relation to Pancreatic Cancer among African American Women

BACKGROUND

African Americans have the highest incidence of pancreatic cancer of any racial/ethnic group in the United States. There is evidence that consumption of red or processed meat and foods containing saturated fats may increase the risk of pancreatic cancer, but there is limited evidence in African Americans.

METHODS

Utilizing the Black Women's Health Study (1995-2018), we prospectively investigated the associations of red and processed meat and saturated fats with incidence of pancreatic adenocarcinoma (n = 168). A food frequency questionnaire was completed by 52,706 participants in 1995 and 2001. Multivariable-adjusted HRs and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression. We observed interactions with age (P _interaction = 0.01). Thus, results were stratified at age 50 (<50, ≥50).

RESULTS

Based on 148 cases among women aged ≥50 years, total red meat intake was associated with a 65% increased pancreatic cancer risk (HR_{Q4 vs. Q1} = 1.65; 95% CI, 0.98-2.78; P _trend = 0.05), primarily due to unprocessed red meat. There was also a nonsignificant association between total saturated fat and pancreatic cancer (HR_{Q4 vs. Q1} = 1.85; 95% CI, 0.92-3.72; P _trend = 0.08). Red meat and saturated fat intakes were not associated with pancreatic cancer risk in younger women, and there was no association with processed meat in either age group.

CONCLUSIONS

Red meat-specifically, unprocessed red meat-and saturated fat intakes were associated with an increased risk of pancreatic cancer in African-American women aged 50 and older, but not among younger women.

IMPACT

The accumulating evidence-including now in African-American women-suggests that diet, a modifiable factor, plays a role in the etiology of pancreatic cancer, suggesting opportunities for prevention.

Gestational Diabetes and Risk of Breast Cancer in African American Women

BACKGROUND

Gestational diabetes mellitus (GDM) has been hypothesized to increase breast cancer risk, but results from the few prior epidemiologic studies are conflicting, and no studies have examined the association in African American women.

METHODS

We analyzed data from the prospective Black Women's Health Study to evaluate associations of history of GDM with breast cancer risk among 41,767 parous African American women, adjusting for potential confounders. HRs and 95% confidence intervals (CI) were estimated from multivariable Cox proportional hazards regression models.

RESULTS

There was no evidence of an association between history of GDM and risk of invasive breast cancer, overall or by estrogen receptor status.

CONCLUSIONS

Results of this study do not support the hypothesis that GDM is an important risk factor for breast cancer in African American women overall.

IMPACT

On the basis of these data, breast cancer risk is not increased among African American women with a history of GDM compared with parous women without a history of GDM.

Perceived racial discrimination and risk of insomnia among middle-aged and elderly Black women

STUDY OBJECTIVE

To assess whether perceived racial discrimination is associated with insomnia among Black women.

METHODS

Data on everyday and lifetime racism and insomnia symptoms were collected from questionnaires administered in the Black Women's Health Study, an ongoing prospective cohort of Black women recruited in 1995 from across the United States. In 2009, participants completed five questions on the frequency of discriminatory practices in daily life (everyday racism) and six questions on ever experiencing unfair treatment in key institutional contexts (lifetime racism). In 2015, the Insomnia Severity Index was used to assess insomnia symptoms. We estimated odds ratios and 95% confidence intervals for associations of racism with insomnia, using multivariable logistic regression models adjusted for potential confounders.

RESULTS

The 26 139 participants in the analytic sample were 40-90 years old (median = 57 years, SD = 9.6 years). Higher levels of everyday racism and lifetime racism were positively associated with subthreshold (ptrend < .01) and clinical insomnia (ptrend < .01). Results remained unchanged after further adjustment for sleep duration and shift work.

CONCLUSIONS

Higher levels of perceived racism were associated with increased odds of insomnia among middle-aged and elderly Black women. Thus, perceived racism may contribute to multiple racial health disparities resulting from insomnia. Helping minority populations cope with their experiences of discrimination may decrease the significant public health impact of sleep disruption and subsequent diagnoses.

Relationship of Cigarette Smoking and Alcohol Consumption to Incidence of Systemic Lupus Erythematosus in a Prospective Cohort Study of Black Women

OBJECTIVE

Systemic lupus erythematosus (SLE) affects black women more frequently than other racial/gender groups. In past studies, largely consisting of white and Asian cohorts, cigarette smoking was associated with increased SLE risk, and moderate alcohol consumption was associated with decreased SLE risk. The aim of this study was to assess associations of smoking and alcohol consumption with the risk of incident SLE among black women, using data from a long-term, prospective, follow-up study.

METHODS

The Black Women's Health Study enrolled 59,000 black women in 1995 and collected data on demographics, health status, and medical and lifestyle variables. Follow-up questionnaires that were given every 2 years identified incident disease and updated risk factors. Cases of incident SLE that met the American College of Rheumatology revised criteria for SLE as updated in 1997 were confirmed through medical record review. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for associations of cigarette smoking and alcohol intake with incidence of SLE.

RESULTS

A total of 127 incident SLE cases from 1995 to 2015 (mean age 43 years at diagnosis) were confirmed. Compared to never smokers, the risk of SLE among ever smokers was elevated, but not significantly (HR 1.45 [95% CI 0.97-2.18]). Risk was similar for current and past smoking and increased nonsignificantly with increasing pack-years. The HR was 0.71 (95% CI 0.45-1.12) for current drinking relative to never drinking, with a HR of 0.43 (95% CI 0.19-0.96) for ≥4 drinks/week.

CONCLUSION

Findings from this large study of SLE risk among black women are consistent with previous results from studies in other populations of increased risk of SLE associated with cigarette smoking and decreased risk with moderate alcohol consumption.

A prospective study of obesity and risk of systemic lupus erythematosus (SLE) among Black women

BACKGROUND

Obesity may influence systemic lupus erythematous (SLE) pathogenesis via stimulation of systemic inflammation, but the relationship between obesity and SLE risk is unclear. Past studies have predominantly assessed White women, while Black women have higher prevalence of both obesity and SLE.

METHODS

We prospectively assessed the relationship between Body Mass Index (BMI, kg/m²) and incident SLE within the Black Women's Health Study (median age 38 at entry in 1995). Height and weight at age 18 and during follow-up were self-reported. We confirmed incident SLE cases by updated American College of Rheumatology criteria and collected covariates prospectively. Cox proportional hazards regression models, adjusted for potential confounders, estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for categories of updated BMI and risk of SLE, relative to BMI 20-24.9 ("normal" BMI). Secondary analyses investigated BMI at age 18, BMI in 1995 at cohort entry, cumulative updated BMI and "lagged" BMI (≥4 years prior to outcome window to address possible reverse causation).

RESULTS

Adult obesity was not related to SLE risk: HR for BMI ≥30 ("obesity") relative to normal BMI at ≥4 years prior to SLE diagnosis was 0.90 (95% CI 0.53-1.54). However, obesity at age 18 was associated with increased risk: HR 2.38 (95% CI 1.26-4.51) for ≥30 vs. normal BMI.

CONCLUSIONS

Among these Black women, obesity as a teenager was associated with increased SLE risk in adulthood. Further studies are necessary to understand the biologic mechanisms and windows of exposure for the relationship of obesity to SLE pathogenesis.

Type II Diabetes and Incidence of Estrogen Receptor Negative Breast Cancer in African American Women

White women with type II diabetes (T2D) have an estimated 20% increased risk of developing breast cancer. Little is known about associations by breast cancer subtype or among African American (AA) women, who are disproportionately affected by T2D and estrogen receptor negative (ER-) breast cancer. We assessed the relation of T2D to incidence of ER- and ER+ breast cancer in data from the Black Women's Health Study, a prospective cohort of AA women enrolled in 1995 and followed biennially. During 847,934 person-years of follow-up, there were 1,851 incident invasive breast cancers, including 914 ER+ and 468 ER- cases. Multivariable Cox proportional hazards models were used to compute HRs for breast cancer incidence associated with T2D relative to no T2D, controlling for body mass index (BMI) and other potential confounders. The HR for T2D relative to no T2D was 1.18 [95% confidence interval (CI) 1.00-1.40] for overall breast cancer incidence, with the increase accounted for by ER- cancer: HRs were 1.02 (95% CI, 0.80-1.31) for ER+ and 1.43 (95% CI, 1.03-2.00) for ER- cancer. The HR for T2D and ER- breast cancer was highest among nonobese women (1.92; 95% CI, 1.22-3.04). The findings suggest that AA women with T2D are at increased risk of developing ER- breast cancer and that poor metabolic health may be more important than obesity for this subtype. Given the high prevalence of T2D in AA women, the observed association could, in part, explain racial disparities in incidence of ER- breast cancer. Cancer Res; 77(22); 6462-9. ©2017 AACR.

Abstract 5286: Type 2 diabetes and increased risk of estrogen receptor-negative breast cancer in African American women

Introduction: Type 2 diabetes (T2D) is hypothesized to be a risk factor for breast cancer. Possible mechanisms include adverse effects of impaired glucose regulation on endogenous hormone levels and increased inflammation of adipose tissue, which may be favorable to breast epithelial cell transformation, tumor-related angiogenesis, and cancer cell invasion. Recent meta-analyses suggest that T2D may be associated with a 15-20% increase in risk, but whether that increase is due to residual confounding by body mass index (BMI) is uncertain. Further, few studies have reported results separately by estrogen receptor (ER) status of the tumor, none have had appreciable numbers of ER- cases, and the only previous report on the association in African American (AA) women analyzed all subtypes together.

Methods: We used data from the prospective Black Women’s Health Study to examine the relation of T2D to incidence of invasive breast cancer, overall and by ER subtype, among 54,337 AA women free from T2D and breast cancer at baseline and followed for 20 years. Included were 1,851 incident breast cancer cases, with 468 classified as ER- and 914 as ER+; data on ER status were not available for 469 cases. Participants were asked about medical conditions on each biennial questionnaire. In a validation study, 95% of self-reports of diabetes were confirmed by medical records. Cox proportional hazards regression was used to compute incidence rate ratios (IRR) for breast cancer for women with T2D relative to women without T2D, controlling for age, family history of breast cancer, BMI at age 18, waist-hip ratio, years of education, and reproductive factors.

Results: The multivariable IRR for T2D versus no diabetes was 1.20 (95% confidence interval 1.01-1.41) for all breast cancer, 1.42 (1.02-1.98) for ER- breast cancer, and 1.06 (0.83-1.36) for ER+ breast cancer. Most cases had had diabetes for at least five years before the breast cancer diagnosis. IRRs for ≥5 years duration of diabetes were 1.46 (1.02-2.07) for ER- and 1.08 (0.83-1.41) for ER+ breast cancer. Recent BMI was not associated with increased risk of either ER subtype and was not a confounder in the present analyses. BMI at age 18, which was inversely associated with breast cancer risk in this and other studies, was the only appreciable confounder; in multivariable models that did not control for BMI at age 18, IRRs were 1.37 (0.99-1.90) and 1.03 (0.81-1.33) for ER- and ER+ breast cancer, respectively.

Conclusions: The findings suggest that AA women with T2D are at increased risk of ER- breast cancer. AA women are about two times as likely to be diagnosed with ER- breast cancer as are U.S. white women and also have a markedly higher prevalence of T2D. Their higher prevalence of diabetes may contribute to the disparity in incidence of ER- breast cancer. The next step will be to assess whether risk of ER- breast cancer among diabetic women differs according to how well the diabetes is controlled.

Citation Format: Julie R. Palmer, Nelsy Castro-Webb, Kimberly A. Bertrand, Traci N. Bethea, Lynn Rosenberg. Type 2 diabetes and increased risk of estrogen receptor-negative breast cancer in African American women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5286. doi:10.1158/1538-7445.AM2017-5286

Diabetes and breast cancer mortality in Black women

PURPOSE

Breast cancer mortality is higher in Black women than in White women. The prevalence of type 2 diabetes mellitus is also higher, yet data on whether diabetes affects breast cancer mortality in this population are lacking. We investigated the relation of diabetes at the time of breast cancer diagnosis to breast cancer mortality in the Black Women's Health Study, a prospective cohort study.

METHODS

1,621 Black women with invasive breast cancer diagnosed in 1995-2013 were followed by mailed questionnaires and searches of the National Death Index. Multivariable Cox regression analysis was used to compute hazard ratios (HRs) for diabetes in relation to breast cancer mortality and all-cause mortality, with adjustment for age, stage, treatment modality, estrogen receptor (ER) status, and body mass index.

RESULTS

There were 368 deaths during follow-up, of which 273 were due to breast cancer. Breast cancer mortality was significantly increased in women who had been diagnosed with diabetes at least 5 years before breast cancer occurrence, HR 1.86 (95% CI 1.20-2.89), with elevations observed for both ER+ and ER- breast cancer. All-cause mortality was also higher in diabetics, with HRs of 1.54 (95% CI 1.12-2.07) overall and 2.26 (95% CI 1.62-3.15) for ≥5-year duration of diabetes relative to non-diabetics.

CONCLUSIONS

Our results present the first solid evidence of a positive association of type 2 diabetes with breast cancer mortality in Black women. Given the higher prevalence and earlier onset of type 2 diabetes in Black women, it is likely that diabetes contributes to racial disparities in breast cancer mortality.

Neighborhood and Individual Socioeconomic Status and Asthma Incidence in African American Women

OBJECTIVE

Individual socioeconomic status (SES) has been associated with asthma incidence but whether neighborhood SES has an influence is unknown. We assessed the contributions of neighborhood socioeconomic status (SES), neighborhood housing density, neighborhood racial composition, and individual SES to the development of adult-onset asthma in Black women, accounting for other known or suspected risk factors.

DESIGN AND PARTICIPANTS

Prospective cohort study conducted among 47,779 African American women followed with biennial health questionnaires from 1995 to 2011.

METHODS AND MAIN OUTCOME MEASURES

Incident asthma was defined as new self-report of doctor-diagnosed asthma with concurrent use of asthma medication. We assessed neighborhood SES, indicated by census variables representing income, education, and wealth, and housing density and % African American population, as well as individual SES, indicated by highest education of participant/spouse. Cox proportional hazards models were used to derive multivariable hazard ratios (HRs) and 95% CIs for the association of individual SES and neighborhood variables with asthma incidence.

RESULTS

During a 16-year follow-up period, 1520 women reported incident asthma. Neighborhood factors were not associated with asthma incidence after control for individual SES, body mass index, and other factors. Compared with college graduates, the multivariable HR for asthma was 1.13 (95% CI 1.00-1.28) for women with some college education and 1.23 (95% CI 1.05-1.44) for women with no more than a high school education.

CONCLUSIONS

Individual SES, but not neighborhood SES or other neighborhood factors, was associated with the incidence of adult-onset asthma in this population of African American women.

Family History of Cancer in Relation to Breast Cancer Subtypes in African American Women

BACKGROUND

The evidence on the relation of family history of cancers other than breast cancer to breast cancer risk is conflicting, and most studies have not assessed specific breast cancer subtypes.

METHODS

We assessed the relation of first-degree family history of breast, prostate, lung, colorectal, ovarian, and cervical cancer and lymphoma or leukemia, to the risk of estrogen receptor-positive (ER(+)), ER(-), and triple-negative breast cancer in data from the African American Breast Cancer Epidemiology and Risk Consortium. Multivariable logistic regression models were used to calculate ORs and 95% confidence intervals (CI).

RESULTS

There were 3,023 ER(+) and 1,497 ER(-) breast cancer cases (including 696 triple-negative cases) and 17,420 controls. First-degree family history of breast cancer was associated with increased risk of each subtype: OR = 1.76 (95% CI, 1.57-1.97) for ER(+), 1.67 (1.42-1.95) for ER(-), and 1.72 (1.38-2.13) for triple-negative breast cancer. Family history of cervical cancer was associated with increased risk of ER(-) (OR = 2.39; 95% CI, 1.36-4.20), but not ER(+) cancer. Family history of both breast and prostate cancer was associated with increased risk of ER(+) (3.40; 2.42-4.79) and ER(-) (2.09; 1.21-3.63) cancer, but family history of both breast and lung cancer was associated only with ER(-) cancer (2.11; 1.29-3.46).

CONCLUSIONS

A family history of cancers other than breast may influence the risk of breast cancer, and associations may differ by subtype.

IMPACT

Greater surveillance and counseling for additional screening may be warranted for women with a family history of cancer.

Active and passive smoking and the incidence of asthma in the Black Women's Health Study

RATIONALE

Evidence linking active or passive smoking to the incidence of adult-onset asthma is inconsistent with both positive and inverse associations being reported. Most previous studies of active smoking have not accounted for passive smoke exposure, which may have introduced bias.

OBJECTIVES

To assess the separate associations of active and passive smoking to the incidence of adult-onset asthma in the U.S. Black Women's Health Study, a prospective cohort of African American women followed since 1995 with mailed biennial questionnaires.

METHODS

Active smoking status was reported at baseline and updated on all follow-up questionnaires. Passive smoke exposure during childhood, adolescence, and adulthood was ascertained in 1997. Asthma cases comprised women who reported doctor-diagnosed asthma with concurrent asthma medication use. Cox regression models were used to derive multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for former and current smoking and for passive smoking among nonsmokers compared with a reference category of never active or passive smokers.

MEASUREMENTS AND MAIN RESULTS

Among 46,182 participants followed from 1995 to 2011, 1,523 reported incident asthma. The multivariable HRs for former active smoking, current active smoking, and passive smoking only were, respectively, 1.36 (95% CI, 1.11-1.67), 1.43 (95% CI, 1.15-1.77), and 1.21 (95% CI, 1.00-1.45), compared with never active/passive smoking.

CONCLUSIONS

In this large population with 16 years of follow-up, active smoking increased the incidence of adult-onset asthma, and passive smoke exposure increased the risk among nonsmokers. Continued efforts to reduce exposure to tobacco smoke may have a beneficial effect on the incidence of adult-onset asthma.

Comparison of Hispanic and non-Hispanic patients with HCC

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Background: In the U.S., Hispanics have a higher incidence of hepatocellular cancer (HCC) and higher disease-specific mortality. The country of origin for Hispanics varies throughout the U.S. However, little is known about Hispanics with HCC in the Northeast. We compared Hispanic and non-Hispanic patients with HCC at a Boston teaching hospital. Methods: Hispanic patients with HCC seen at Beth Israel Deaconess Medical Center (BIDMC) from 1998-2012 were identified in our database. Ethnicity was determined from demographic and language preference information in electronic medical records and supplemented by comparing surnames with the 1990 Census Spanish Surname List. The comparison group was identified by randomly choosing non-Hispanic patients diagnosed the same years as Hispanic patients. We compared both groups using Chi Squared test. Results: 59 Hispanic and 89 non-Hispanic patients with HCC were included in the analysis. The majority (48%) of Hispanic HCC patients were Puerto Rican. Although the median age at diagnosis was similar (59.1 vs 60.3 years for Hispanics and non-Hispanics), there were more women in the Hispanic cohort (28.8% vs 12.4% p0.012). Hispanics had greater odds of not having private insurance (OR 4.24, 95%CI: 2.101, 8.554). Evaluation of HCC risk factors revealed Hispanics were significantly more likely to have hepatitis C (OR 3.68, 95% CI: 1.830, 7.420). In addition, the incidence of Metabolic Syndrome was significantly higher for Hispanics (44.7% vs. 21.7% p0.025). Although individual components of metabolic syndrome were higher in Hispanics, they were not statistically significant: hypertension (52.5% vs 40.4%), Diabetes Mellitus (39% vs 25%), BMI ≥ 30 (39% vs 27%), hypertrigylceridemia (57% vs 52%) and low HDL levels (50% vs 41%). Hispanics were more likely to have received Transarterial Chemoembolization (TACE) and Radiofrequency ablation (RFA) treatments (OR 2.48, 95% CI: 1.261, 4.858). Conclusions: Hispanic HCC patients at BIDMC were more likely to have hepatitis C, metabolic syndrome and to be female than their non-Hispanic counterparts. Outreach to Hispanic communities to identify patients with hepatitis C and metabolic syndrome, particularly in women, may improve HCC prevention, screening and treatment outcomes.

Cross-sectional study of conjugated linoleic acid in adipose tissue and risk of diabetes

BACKGROUND

Some experimental studies on conjugated linoleic acid (CLA) and insulin regulation suggested that CLA could be associated with risk of diabetes, but epidemiologic studies are lacking.

OBJECTIVE

The aim of the study was to test whether the amount of CLA in adipose tissue is associated with risk of diabetes.

DESIGN

A cross-sectional design was used to test the study hypothesis in 232 adults with diabetes and 1512 adults without diabetes who lived in Costa Rica. The cis-9, trans-11 and trans-10, cis-12 CLA isomers in adipose tissue and 48 other fatty acids were assessed by using gas chromatography. Prevalence ratios (PRs) and 95% CIs were estimated by using Poisson regression adjusted for potential confounders.

RESULTS

The mean (±SD) percentage of total fatty acids of CLA for the cis-9, trans-11 isomer in adipose tissue was 0.57 ± 0.18% in adults without diabetes and 0.53 ± 0.17% in adults with diabetes (P = 0.0078). The trans-10, cis-12 CLA isomer was not detected in adipose tissue. The cis-9, trans-11 CLA isomer was associated with a lower risk of diabetes. In comparison with the first quintile, the PR (95% CI) for the fifth quintile was 0.48 (0.31, 0.76) (P-trend = 0.0005) in the basic and 0.46 (0.29, 0.72) (P-trend = 0.0002) in the multivariable model. Additional adjustment for other fatty acids in adipose tissue including trans-9 16:1, which is a fatty acid that was previously associated with diabetes, did not modify the results.

CONCLUSION

The observed inverse association between the cis-9, trans-11 CLA in adipose tissue and diabetes risk is consistent with the hypothesis that CLA may be involved in insulin regulation.