Prostate cancer in black and white Americans

The prostate cancer incidence and mortality of black Americans is among the highest in the world. The reasons have not been adequately explained. Similar disparities have been noted for men of sub-Saharan origin living in Brazil and the Caribbean. Avenues of investigation have assessed racial and ethnic differences in diet as well as possible differences in the prevalence of genetics (both polymorphisms and mutations). There are studies to suggest that there are no racial differences in outcome when there is equal treatment. Several studies show that there are racial differences in patterns of care in the US and it has been hypothesized that this contributes to some of the racial disparity in survival after diagnosis.     

Familial breast cancer in black Americans

A family history of breast cancer is a major risk factor in this disease, but current information is based entirely on data concerning white families. Two black American families with apparent excesses of breast cancer were studied. Thus far no specific basis for the excess risk has been identified. Despite limited knowledge, a clinical approach to counseling unaffected women in these families may reduce the probability of their dying from breast cancer and may help them to cope with this difficult problem.     

Socioeconomic factors and breast cancer in black and white Americans

The incidence of breast cancer in the US is known to be higher among white than black women and among women of higher socioeconomic status (SES), but once a woman, either black or white, has the disease, she is more likely to have a recurrence and to die of breast cancer if she is of lower socioeconomic status. Explanations for these observed differences are varied and inconsistent making it clear that these reported differentials are not sufficiently understood. In understanding breast cancer in a multicultural setting, delay in diagnosis, follow-up, and treatment are frequently the focus of attention. However these factors do not sufficiently explain the observed differences between blacks and whites. A review of recent literature reveals an increasing focus on the role of SES in breast cancer etiology and progression; however, the confounding of SES with race/ethnicity (black vs. white) contributes to the insufficient understanding of the effect of these two factors. This report will focus on the interplay between race/ethnicity and SES and their relative effects upon analyses of survival from breast cancer. Findings are based on prospective clinical trial data. SES factors have been associated with most of the known or suspected risk factors for breast cancer incidence and progression. In addition to race/ethnicity, SES is also associated with diet, lifestyle factors, physical characteristics, and tumor characteristics. Without controlling for other risk factors, the ratios of risk for blacks with respect to whites for disease-free survival and overall survival were 1.30 (95% CI: 1.04–1.61) and 1.42 (95% CI: 1.15–1.76), respectively. However, after controlling for patient risk factors, such as the number of positive lymph nodes, tumor diameter, estrogen receptor status and socioeconomic factors, these differences decrease and are not statistically significant. Socioeconomic status is associated both with race/ethnicity and estrogen receptor status. A loglinear analysis demonstrates that the apparent association of race/ethnicity with estrogen receptor status is mediated by socioeconomic status. An implication of this finding is that environmental and lifestyle components rather than genetic factors associated with race may explain the observed differentials between black and white breast cancer patients. Knowledge of environmental factors associated with SES have the potential for providing important clues about the prevention and control of breast cancer.     

Association of RNASEL variants with prostate cancer risk in Hispanic Caucasians and African Americans.

PURPOSE: The RNASEL gene at 1q25 has been identified as a hereditary prostate cancer susceptibility gene, but to date, no study has investigated the role of RNASEL variants in Hispanic Caucasian men with prostate cancer. EXPERIMENTAL DESIGN: Two RNASEL common variants, located at amino acids 462 and 541, were genotyped in non-Hispanic Caucasian, Hispanic Caucasian, and African American prostate cancer cases and controls. RESULTS: The RNASEL 462 AA genotype was found to increase prostate cancer risk over 4-fold in Hispanic Caucasians [odds ratio (OR), 4.43; 95% confidence interval (95% CI), 1.68-11.68; P = 0.003] and over 10-fold in African Americans (OR, 10.41; 95% CI, 2.62-41.40; P = 0.001) when compared with the GG genotype. Analysis of the RNASEL 541 variant showed that Hispanic Caucasian patients with the GG genotype had a statistically significant increase in their risk for developing prostate cancer when compared with the TT and GT genotypes (OR, 1.91; 95% CI, 1.16-3.14; P = 0.01). A common G-T haplotype for the combination of the RNASEL 462 and 541 variants was found to occur more frequently in controls compared with cases in African Americans (P = 0.04) but not in non-Hispanic Caucasians or Hispanic Caucasians. CONCLUSIONS: This is the first study that investigates the association of prostate cancer risk with RNASEL variants in Hispanic men. Our data support the role of RNASEL as a predisposition gene for prostate cancer and showed a significant association between the RNASEL 462 variant and prostate cancer risk in African Americans and Hispanic Caucasians.     

A program model for nurses involved with cancer education of black Americans

In the last 30 years, cancer incidence rates for black Americans have increased 27% in contrast to an increase of 12% for white cancer rates. In answer to this obvious need for intervention to lower the incidence and mortality rates, the Oncology Nursing Society held a one-day workshop which focused on the primary prevention of cancer in black Americans. For the 40 workshop openings, 540 black nurses from 40 states responded to a call for applicants. The impact of the workshop was measured by four pre- and post-tests which provided both qualitative and quantitative data and indicated that the experience made a significant impact on the participants. The workshop content focused on the epidemiology of the cancers which are most frequently found in blacks, cultural attitudes toward these cancers, and techniques for early detection. The success of the workshop was due to the active involvement of the participants in the learning process and serves as a model for training minority nurses for active, creative roles which can be instituted in the community to help lower the high cancer incidence rate among black Americans.     

Inclusion of black Americans in oncology clinical trials: the Louisiana State University Medical Center experience

Recruitment of patients from diverse ethnic, racial, and socioeconomic backgrounds for clinical trials is desirable for both scientific and ethical reasons. Participation rates in clinical trials are low for minorities and especially for black Americans. This report summarizes the experience at Louisiana State University Medical Center in Shreveport, Louisiana, in enrolling black Americans in oncology treatment and prevention trials. Barriers to enrollment are identified and discussed. Although major strides must still be made in the area of cancer prevention, the university's experience demonstrates that black Americans can be encouraged to participate in and can be enrolled in cancer clinical trials.     

Melanoma in children and adolescents

Childhood and adolescent melanoma is rare, accounting for only 1.3% for all cases of cancer in patients under the age of 20 years. However, in 15–19 year olds, melanoma accounts for up to 7% of all cancers. Review of reported cases in this age group reveals that predisposing ‘paediatric’ conditions such as a giant congenital melanocytic naevi or xeroderma pigmentosum are rarely present. Furthermore, inactivating germ-line mutations of the gene CDKN2A have only been reported in 1.5% of cases of early onset melanoma. Epidemiological studies suggest that interactions between solar exposure, development of naevi, pigmentary traits, and a family history of melanoma are the main determinants of melanoma development during the first 20 years of life. As yet, there are no available staging or treatment strategies for this group of patients so treatment recommendations are based on the adult experience. To improve our understanding of the natural history of melanoma and to identify the most appropriate therapies for young patients with this disease, practising physicians are encouraged to enroll their patients, especially those with advanced stage disease, in cooperative group trials which incorporate newer staging systems and promising therapies.     

Melanoma in children and adolescents

Melanoma is rarely described in the pediatric population. However, recent studies show that the incidence may be increasing. The diagnosis of melanoma presents unique challenges in this age group. There may be predisposing factors that affect children more than adults. A high index of suspicion is necessary in order to make a timely diagnosis. Prompt surgical treatment by individuals with expertise in care of patients with melanoma with potentially curative excision and appropriate lymph node evaluation is important to optimize survival. Careful review of all specimens by an experienced dermatopathologist is important. Through cooperation with adult trials and potential inclusion of pediatric patients in evaluations of new therapies, further progress against this disease can hopefully be addressed in all age groups.     

Breast cancer characteristics and outcomes among Hispanic Black and Hispanic White women

Evaluating breast cancer outcomes specific to Hispanics of different race (e.g. Hispanic Black, Hispanic White) may further explain variations in the burden of breast cancer among Hispanic women. Using data from the SEER 17 population-based registries, we evaluated the association between race/ethnicity and tumor stage, hormone receptor status, and breast cancer-specific mortality. The study cohort of 441,742 women, aged 20-79, who were diagnosed with primary invasive breast cancer between January 1, 1992 and December 31, 2008, included 44,246 Hispanic whites, 622 Hispanic Blacks, 44,797 non-Hispanic Blacks and 352,077 non-Hispanic whites. Hispanic black, Hispanic white and non-Hispanic black women had a 1.5-2.5 fold greater risk of presenting with stage IV breast cancer compared to non-Hispanic whites. All groups were significantly more likely than non-Hispanic whites to be diagnosed with ER+/PR- (1.1-1.5 fold increase) or ER-/PR- (1.4-2.2 fold increase) breast cancer. Hispanic black, Hispanic white and non-Hispanic black women had a 10-50?% greater risk of breast cancer-specific mortality compared to non-Hispanic whites. Our findings underscore the breast cancer disparities that continue to exist for Hispanic and black women, overall, as well as between Hispanic women of different race. These disparities highlight the factors that may lead to the poor outcomes observed among Hispanic and black women diagnosed with breast cancer, and for which targeted strategies aimed at reducing breast cancer disparities could be developed.     

Melanoma and pregnancy

The only consistent factor influencing prognosis of primary melanoma in pregnancy has been the stage of disease at diagnosis, not the pregnancy. However, several studies suggest that pregnant women may have melanoma diagnosed at a later stage of disease. Thus, suspicious changes in nevi during pregnancy warrant prompt biopsy-not observation or deferral to the postpartum period. No hormonal factors in pregnancy that clearly influence melanoma development have been identified; there is no increased risk of recurrent disease with subsequent pregnancy. Thus, the decision for further childbearing should be a prognostic and personal one. Placental and/or fetal metastasis are limited to patients with hematogenous dissemination. Except possibly for this reason in women with distant metastases, there are no medical data to justify therapeutic abortion. Recommendations to the pregnant woman or the woman of reproductive age should not differ from that of other patients with melanoma.     

Melanoma and sunburn

A computer-aided search identified 16 case-control studies which specifically assessed sunburn as a risk factor for cutaneous malignant melanoma. Using unadjusted estimates, a history of sunburn was associated with significantly increased risk of melanoma in all but one study. Four studies were defined as core studies after assessment of study quality; however, only two of these had sufficiently similar definitions of sunburn to allow pooling of results. Using pooled data, the risk of melanoma in those ever sunburned was 2.0 (95 percent confidence interval [CI]=1.6–2.6), while the highest category of sunburn exposure had a risk of 3.7 (CI=2.5–5.4). The suggestion that sunburns in childhood carry greater risk of melanoma cannot be supported by pooled analysis. This review demonstrated considerable variation in design and method among the studies, and identified sources of bias which prevented a pooled analysis using all available data. The need for strong epidemiologic evidence relating sunburn to melanoma, particularly in childhood, is of prime importance, since avoidance of sunburn is one of the few potential means of primary prevention of melanoma.     

Melanoma and Pregnancy

In the last half-century the incidence of cutaneous malignant melanoma has increased all over the world according to available reports. No association between risk of melanoma and age at menarche, first birth, menopause or duration of reproductive period has been proven so far. Studies on the effect of parity on relative risk and survival have given divergent results with multiparous women possibly having a better prognosis than nullipara. Women with melanoma diagnosed during pregnancy tend to have thicker tumours, shorter disease-free interval and, maybe, lower 10-year survival rate than non-pregnant matched controls. There is no conclusive evidence that therapeutic abortion improves the cure rate. Multivariate analysis has failed to unveil impaired prognosis in women who become pregnant subsequent to diagnosis.