Associations of weight,weight change,and body mass with breast cancer risk in Hispanic and non-Hispanic white women

PURPOSE: A wealth of studies have examined the effects of weight, weight gain, and obesity on breast cancer risk; however, few have examined this relationship in Hispanic white women, a population with the highest rate of obesity in the U.S. METHODS: A population-based case-control study was conducted in New Mexico of Hispanic (n = 694) and non-Hispanic (n = 813) white women with incident breast cancer during the period of January 1, 1992 through December 31, 1994. Conditional logistic regression models were fitted to estimate the relative risk of breast cancer for levels of weight, weight change, and body mass index (BMI) and to assess differences in the effects by ethnicity, menopausal status, early life BMI, and estrogen receptor/progesterone receptor (ER/PR) expression in tumors. RESULTS: Weight change from age 18 to usual adult weight was associated with increased risk of breast cancer among Hispanics [4th quartile vs. baseline, odds ratio (OR): 2.41; 95% confidence interval (CI): 1.45-4.03] with no substantial variation by menopausal status. In non-Hispanic white women, weight change was a risk factor for those in the post-menopausal group (4th quartile vs. baseline, OR: 2.27; 95% CI: 1.09-4.73). The effect of usual BMI (test for interaction p = 0.04) and weight change (test for interaction p = 0.03) differed by ethnicity. Increased risk from weight gain was largely restricted to women who were lean at age 18 and those with ER(+)/PR(+) tumors. Height, weight at age 18, and BMI at age 18 were not associated with risk in either ethnic group. CONCLUSIONS: Weight change and obesity are risk factors for breast cancer in both Hispanic and non-Hispanic white women. However, the risk for Hispanic women is evident independent of menopausal status, while the risk for non-Hispanics is apparent in post-menopausal women. Due to the increasing prevalence of adult obesity, particularly among Hispanic women, adult weight gain may be an important modifiable risk factor for the primary prevention of breast cancer among Hispanic populations.     

Diet patterns and breast cancer risk in Hispanic and non-Hispanic white women: the Four-Corners Breast Cancer Study

BACKGROUND: There is a lower incidence of breast cancer among Hispanic women than among non-Hispanic white women. Little is known about the role of diet in this difference. OBJECTIVE: We examined the associations of dietary patterns (Western, Prudent, Native Mexican, Mediterranean, and Dieter) with risk for breast cancer in Hispanic women (757 cases, 867 controls) and non-Hispanic white women (1524 cases, 1598 controls) from the Four-Corners Breast Cancer Study. DESIGN: Dietary intake, physical activity, and other exposures were assessed by using interviews. Dietary patterns were defined via factor analysis. Risk was assessed by using logistic regression with adjustment for age, center, education, smoking, total activity, calories, dietary fiber, dietary calcium, height, parity, recent hormone exposure, family history of breast cancer, menopausal status, and body mass index x recent hormone exposure. RESULTS: The Western (odds ratio for highest versus lowest quartile: 1.32; 95% CI: 1.04, 168; P for trend < 0.01) and Prudent (1.42; 1.14, 1.77; P for trend < 0.01) dietary patterns were associated with greater risk, and the Native Mexican (0.68; 0.55, 0.85; P for trend < 0.01) and Mediterranean (0.76; 0.63, 0.92; P for trend < 0.01) dietary patterns were associated with lower risk of breast cancer. Body mass index modified the associations of the Western diet and breast cancer among postmenopausal women and those of the Native Mexican diet among premenopausal women. CONCLUSIONS: Associations of dietary patterns with breast cancer risk varied by menopausal and body mass index status, but there was little difference in associations between non-Hispanic white and Hispanic women.     

Perimenopausal health self-efficacy among Hispanic Caribbean and non-Hispanic white women

The perimenopausal experience varies among different ethnic and cultural groups. This research examined perimenopausal health self-efficacy of Latinas and non-Hispanic White women and variables that predicted health in 147 women ages 40 to 60 in the Northeast United States. Self-efficacy scores were similar for both groups. Latinas scored lower, however, in the Cognition/Decision Making subscale of the Perimenopausal Health Self-Efficacy Survey (PHS-ES). Perceived health was predicted by control over health and stress for both, and greater self-efficacy was associated with higher perceptions of health. Subtle differences existed between the two groups, which may reflect cultural beliefs and barriers to care during midlife.     

Macronutrient composition influence on breast cancer risk in Hispanic and non-Hispanic white women: the 4-Corners Breast Cancer Study

The association of dietary macronutrient composition with risk of breast cancer is not well understood. We investigated the macronutrient composition of diet in the 4-Corners Breast Cancer Study. Logistic regression models were used for case-control comparisons adjusted for age, center, education, smoking, total activity, calories, dietary fiber, dietary calcium, height, parity, recent hormone exposure, reference year body mass index (BMI), and the interaction of BMI and recent hormone exposure. Breast cancer risk declined with increasing dietary fat and increased with carbohydrates similarly across ethnicity and menopausal status. Associations of carbohydrate (direct) and fat (inverse), particularly saturated and monounsaturated fat, with breast cancer were present among normal and overweight postmenopausal women and absent among obese postmenopausal women. No substantive differences were noted in the association of macronutrients with risk of breast cancer between non-Hispanic white and Hispanic women. Associations of the macronutrients carbohydrate and fat with breast cancer risk were attenuated among postmenopausal obese women.     

Association of body composition and weight history with breast cancer prognostic markers: divergent pattern for Hispanic and non-Hispanic White women

Body composition and weight gain are breast cancer risk factors that may influence prognosis. The Health, Eating, Activity, and Lifestyle Study was designed to evaluate the relations of body composition, weight history, hormones, and lifestyle factors to prognosis for women with breast cancer. In the cross-sectional analysis of this cohort study specific to 150 Hispanic and 466 non-Hispanic White women in New Mexico diagnosed between 1996 and 1999, the authors hypothesized that obesity measures are associated with baseline prognostic markers and that these associations are modified by ethnicity. Ethnic-stratified multiple logistic regression analyses showed divergent results for a tumor size of 1.0 cm or more and, to a lesser extent, positive lymph node status. Among Hispanics, the highest quartile for body mass index (29.5 vs. <22.5 kg/m2: odds ratio (OR) = 0.16, 95% confidence interval (CI): 0.03, 0.84) and for waist circumference (> or =95.0 vs. <78.5 cm: OR = 0.09, 95% CI: 0.01, 0.78) was significantly associated with a reduced tumor size. In contrast, for overweight and obese non-Hispanic White women, there was an increased association with obesity-related measures, particularly striking for the highest quartile of waist circumference (OR = 2.76, 95% CI: 1.45, 5.26). These findings suggest that Hispanics may have a different breast cancer phenotype than non-Hispanic Whites, which associates differently with body composition and weight history.     

Contraceptive knowledge and use among low-income Hispanic immigrant women and non-Hispanic women

BACKGROUND: With the rising influx of Hispanics to the United States, there is an ongoing need to promote health and wellness care to this non-English-speaking, minority population group. Programs, specifically developed to address the unique cultural mores of Hispanics, need to focus on increasing knowledge about health issues, particularly in the area of reproductive health. A study was conducted in Memphis, TN, to examine the differences between low-income Hispanic immigrants' and low-income non-Hispanics' (1) contraceptive use; (2) reproduction and contraception knowledge; as well as (3) the demographic and knowledge factors associated with their choice of contraceptive, in order to better formulate successful educational programs for area Hispanics. STUDY DESIGN: A cross-sectional survey of 226 women, recruited through a federal assistance program in Tennessee, was performed over a 5-month period in 2000 to 2001. Women, between the ages of 18 and 42, were individually interviewed to learn more about their reproduction knowledge and method of contraception. RESULTS: This study found that knowledge about reproduction and contraceptive use was significantly lower among Hispanics than non-Hispanics. Furthermore, contraceptive use was significantly lower among Hispanics than among non-Hispanics. Hispanics were less likely to use the oral contraceptive or have a tubal ligation, preferring injectable contraceptive. Non-Hispanics, who were more likely to use contraceptive methods, were less likely to use injectables, preferring the oral contraceptive. Among Hispanics, knowledge about contraceptives, number of children and marital status were associated with contraceptive use. Among non-Hispanics, only education was associated with contraceptive use. CONCLUSION: Interventions targeting Hispanic immigrants should be developed to increase their knowledge about contraceptive methods.     

Population-based case-control study of diabetes and breast cancer risk in Hispanic and non-Hispanic White women living in US southwestern states

Diabetes mellitus has been associated with breast cancer, although no studies appear to have adequately assessed the association in Hispanic women, a population with a high prevalence of diabetes. The authors investigated this association in a population-based case-control study of Hispanic and non-Hispanic White women living in the southwestern United States. Breast cancer cases diagnosed in 1999-2004 were identified through state cancer registries (1,526 non-Hispanic Whites, 798 Hispanics). Age- and ethnicity-matched controls (1,599 non-Hispanic Whites, 924 Hispanics) were selected from commercial mailing lists and driver's license and Social Security records. Diabetes history was assessed through interviewer-administered questionnaires. Odds ratios and 95% confidence intervals were calculated using logistic regression, adjusting for age, body mass index at age 15 years, and parity. Having any type of diabetes was not associated with breast cancer overall (odds ratio = 0.94, 95% confidence interval: 0.78, 1.12). Type 2 diabetes was observed among 19% of Hispanics and 9% of non-Hispanic Whites but was not associated with breast cancer in either group. Gestational diabetes was inversely associated with breast cancer in both ethnic groups, especially when first diagnosed at age < or =35 years (odds ratio = 0.54, 95% confidence interval: 0.37, 0.79). In this study, diabetes was not associated with breast cancer overall, although the inverse association with gestational diabetes warrants further investigation.     

Severe injury among Hispanic and non-Hispanic white children in Washington state

OBJECTIVES: The authors' anecdotal experience at a regional Level I trauma center was that Hispanic children were overrepresented among burn patients, particularly among children with burns due to scalding from hot food. This study describes injury incidence and severity among Hispanic and non-Hispanic white infants, children, and adolescents with serious traumatic injuries in Washington State. METHODS: Data from the Washington State Trauma Registry for 1995-1997 were used to identify injured individuals aged < or = 19 years. Ratios of overall and mechanism-specific injury incidence rates for Hispanic children relative to non-Hispanic white children were calculated using denominator estimates derived from U.S. Census Bureau population data. Hispanic children and non-Hispanic white children were also compared on several measures of severity of injury. RESULTS: In 1995-1997, serious traumatic injuries were reported to the Registry for 231 Hispanic children aged < or = 19 years (rate: 54 per 100,000 person-years) and for 2,123 non-Hispanic white children (56 per 100,000 person-years), yielding an overall rate ratio (RR) of 1.0 (95% confidence interval [CI] 0.8, 1.1). Motor vehicle crashes and falls accounted for one-third to one-half of the injuries for each group. Infants, children, and adolescents identified as Hispanic had higher rates of injuries related to hot objects (i.e., burns) (RR=2.3; 95% CI 1.3, 4.1), guns (RR=2.2; 95% CI 1.5 to 3.3), and being cut or pierced (RR=3.5; 95% CI 2.2 to 5.5). The Hispanic group had a lower injury rate for motor vehicle accidents (RR=0.7; 95% CI 0.5, 0.9). Mortality rates were similar (RR=1.1; 95% CI 0.7, 1.7). The mean length of hospital stay was 5.5 days for the Hispanic group and 8.8 days for the non-Hispanic white group (difference=3.3 days; 95% CI -0.7, 7.4). CONCLUSIONS: The study found little difference between Hispanic and non-Hispanic white infants, children, and adolescents in the burden of traumatic pediatric injury. However, burns, guns, drowning, and being pierced/cut appeared to be particularly important mechanisms of injury for Hispanic children. More specific investigations targeted toward these injury types are needed to identify the underlying preventable risk factors involved.     

Psychosocial correlates of cervical cancer screening among older Hispanic women

Early detection through screening can reduce mortality rates of cervical cancer, and yet Hispanic women who have incidence rates higher than their non-Hispanic White counterparts are least likely to participate in cancer screening initiatives. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the psychosocial correlates associated with older Hispanic women’s participation in cervical cancer screening services. Logistic regression models were used. Findings indicated that greater life satisfaction and religiosity were associated with a greater likelihood of participating in cervical cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.     

Comparison of baseline dietary intake of Hispanic and matched non-Hispanic white breast cancer survivors enrolled in the Women's Healthy Eating and Living study

OBJECTIVE: To assess the reported baseline dietary intake of Hispanic and non-Hispanic white breast cancer survivors in the Women's Healthy Eating and Living study, a randomized plant-based dietary intervention clinical trial. DESIGN: Dietary data from 4 days repeated 24-hour recalls within 3 weeks included daily total intake of energy, protein, carbohydrates, cholesterol, total fat, monounsaturated fat, saturated fat, polyunsaturated fat, fruit/vegetable servings, carotenoids, alcohol, caffeine, and percentage of energy from protein, carbohydrates, alcohol, and fats. SUBJECTS: One hundred sixty-five Hispanic breast cancer survivors age-matched to 165 non-Hispanic white breast cancer survivors diagnosed with Stage I, II, or IIIA primary operable breast cancer. STATISTICAL ANALYSES: Two-sample t tests and Wilcoxon rank sum tests to compare dietary intake, and logistic and ordinal logistic regression analyses to examine the association between ethnicity, alcohol, and lycopene consumption, while controlling for place of birth, education, body mass index, and time since diagnosis. RESULTS: Hispanics were more likely to be foreign-born (P<0.001), less educated (P<0.0001) and to consume higher amounts of lycopene (P=0.029), while non-Hispanic whites were more likely to consume alcohol (P=0.001). However, no differences were observed in the average amounts of alcohol consumed or total percents of energy from alcohol. Both groups consumed more than five servings of fruits and vegetables daily. Being Hispanic remained a significant predictor of lower alcohol use (P=0.004) and higher lycopene consumption (P=0.005) after controlling for place of birth, education, body mass index, and time since diagnosis. CONCLUSIONS: There are more similarities than differences in the dietary intake of Hispanic and non-Hispanic white breast cancer survivors in the Women's Healthy Eating and Living study. Further analysis is needed to determine if higher lycopene consumption shown among the Hispanic participants will translate to greater protection against breast cancer recurrence or increased survival.     

Participation in physical activity among normal- and overweight Hispanic and non-Hispanic white adolescents

BACKGROUND: The purpose of this study was to determine the relation between weight status and participation in physical activity (PA) among Hispanic and non-Hispanic white (NHW) adolescent boys and girls. METHODS: In this cross-sectional study, height and weight were measured and a modified 2001 Youth Risk Behavior Survey was administered to 1,302 Hispanic and NHW adolescents, aged 14-17 years, attending high school in Nueces County, Texas. Linear regression analysis was used to assess the relation between weight status (normal weight or "at risk for overweight and overweight" [AR&O]) and PA, including moderate PA, vigorous PA, strength training, participation in team sports, and TV viewing, according to gender and ethnicity. RESULTS: Thirty-eight percent of adolescents were AR&O, including 32% and 48% of Hispanic girls and boys, respectively, and 22% and 35% of NHW girls and boys, respectively. As expected, boys reported participating in more PAs than girls. Compared with NHW girls, both normal weight and AR&O Hispanic girls reported significantly fewer bouts of moderate activity, less involvement in team sports, and more time watching TV. Normal weight boys reported participating in significantly more vigorous activity than those who were AR&O. Hispanic boys reported more strength training than NHWs; however, they watched significantly more hours of TV than NHW boys. CONCLUSIONS: Hispanic and NHW high school students reported participation in different PAs; this information may be useful for planning health and physical education curriculum.     

Cervical papillomavirus infection and cervical dysplasia in Hispanic, Native American, and non-Hispanic white women in New Mexico.

BACKGROUND: Human papillomavirus infections of the cervix are found with varying frequencies in different populations worldwide, and have been associated with cervical cytologic abnormalities. METHODS: We studied 1,603 randomly selected Hispanic, Native American, and non-Hispanic White women in New Mexico to determine the prevalence of cervical HPV infection in these ethnic groups, and its association with Pap smear abnormalities, using a new commercial dot-blot hybridization assay. RESULTS: Nine percent of all women screened had evidence of cervical HPV infection (13.7% of non-Hispanic White women, 9.7% of Hispanics, and 6.6% of Native American women). Prevalence was higher in younger women ages 14-19 years than in older age groups. Over half of women with cervical HPV infection (n = 145) had normal Pap smears. The proportion of infected women increased among those with more advanced cytopathologic abnormalities; 5.6 percent with normal Pap smears had cervical HPV vs 66.7 percent with moderate-severe dysplasia. CONCLUSIONS: Cervical HPV infection is common among New Mexico clinic attendees, varies in prevalence among the three major ethnic groups, and is strongly associated with cervical cytopathologic abnormalities.     

Disparities in breast cancer treatment among American Indian, Hispanic and non-Hispanic White Women Enrolled in Medicare

Because racial/ethnic disparities in breast cancer survival have persisted, we investigated differences in breast cancer treatment among American Indian, Hispanic, and non-Hispanic White (NHW) women. Surveillance, Epidemiology and End Results data linked to Medicare claims in New Mexico and Arizona (1987-1997) among enrollees aged 65 and older were used to identify treatment, treatment interval, and mortality risk associated with delays in care. We identified 2,031 women (67 American Indian, 333 Hispanic and 1,631 NHW women with time to treatment information. Treatment intervals from diagnosis to surgery (all stages, 18 versus 4 days, p.