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The effect of modifiable risk factors on breast cancer aggressiveness among black and white women.

ABSTRACT: INTRODUCTION:Although breast cancer incidence is higher among white women, black women are more likely to have aggressive tumors with less favorable histology, and to have a worse prognosis. Obesity and alcohol consumption have been identified as two modifiable risk factors for breast cancer, while physical activity may offer protection. Little however is known about the association of these factors with race on the severity of breast cancer. METHODS:Data collected as part of a large prospective study looking at insulin resistance and race among women with breast cancer was queried for patient characteristics, lifestyle factors and tumor characteristics. The association with Nottingham Prognostic Index (NPI) was assessed with different models using univariate and multivariate linear regression. RESULTS:Among 746 women in our cohort, 82% (n?=?615) were white and 18% (n?=?131) were black, mean age 58 years. Black patients were more likely to have high BMI (31.0 vs. 26.7, p??4.4), which was significantly associated with younger age (55.6 vs 58.5 years, p?=?0.02), black race (27% vs 15%, p?=?0.001), triple negative cancer (15% vs 6%, p?=?0.003), and poor diet (54% vs 45%, p?=?0.046) compared to patients with better prognosis (NPI???4.4). On multivariate analysis, (model R2?=?0.12; p?

SUBMITTER: Killelea BK

PROVIDER: S-EPMC7029579 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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The effect of modifiable risk factors on breast cancer aggressiveness among black and white women.

Killelea Brigid K BK Gallagher Emily J EJ Feldman Sheldon M SM Port Elisa E King Tari T Boolbol Susan K SK Franco Rebeca R Fei Kezhen K Le Roith Derek D Bickell Nina A NA

American journal of surgery 20190718 4

<h4>Introduction</h4>Although breast cancer incidence is higher among white women, black women are more likely to have aggressive tumors with less favorable histology, and to have a worse prognosis. Obesity and alcohol consumption have been identified as two modifiable risk factors for breast cancer, while physical activity may offer protection. Little however is known about the association of these factors with race on the severity of breast cancer.<h4>Methods</h4>Data collected as part of a la ...[more]

PMID: 31375248

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Project description:Importance:An improved model for risk stratification can be useful for guiding public health strategies of breast cancer prevention. Objective:To evaluate combined risk stratification utility of common low penetrant single nucleotide polymorphisms (SNPs) and epidemiologic risk factors. Design, Setting, and Participants:Using a total of 17?171 cases and 19?862 controls sampled from the Breast and Prostate Cancer Cohort Consortium (BPC3) and 5879 women participating in the 2010 National Health Interview Survey, a model for predicting absolute risk of breast cancer was developed combining information on individual level data on epidemiologic risk factors and 24 genotyped SNPs from prospective cohort studies, published estimate of odds ratios for 68 additional SNPs, population incidence rate from the National Cancer Institute-Surveillance, Epidemiology, and End Results Program cancer registry and data on risk factor distribution from nationally representative health survey. The model is used to project the distribution of absolute risk for the population of white women in the United States after adjustment for competing cause of mortality. Exposures:Single nucleotide polymorphisms, family history, anthropometric factors, menstrual and/or reproductive factors, and lifestyle factors. Main Outcomes and Measures:Degree of stratification of absolute risk owing to nonmodifiable (SNPs, family history, height, and some components of menstrual and/or reproductive history) and modifiable factors (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared], menopausal hormone therapy [MHT], alcohol, and smoking). Results:The average absolute risk for a 30-year-old white woman in the United States developing invasive breast cancer by age 80 years is 11.3%. A model that includes all risk factors provided a range of average absolute risk from 4.4% to 23.5% for women in the bottom and top deciles of the risk distribution, respectively. For women who were at the lowest and highest deciles of nonmodifiable risks, the 5th and 95th percentile range of the risk distribution associated with 4 modifiable factors was 2.9% to 5.0% and 15.5% to 25.0%, respectively. For women in the highest decile of risk owing to nonmodifiable factors, those who had low BMI, did not drink or smoke, and did not use MHT had risks comparable to an average woman in the general population. Conclusions and Relevance:This model for absolute risk of breast cancer including SNPs can provide stratification for the population of white women in the United States. The model can also identify subsets of the population at an elevated risk that would benefit most from risk-reduction strategies based on altering modifiable factors. The effectiveness of this model for individual risk communication needs further investigation.

Dataset Information

The effect of modifiable risk factors on breast cancer aggressiveness among black and white women.

Publications

The effect of modifiable risk factors on breast cancer aggressiveness among black and white women.

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