Breast cancer and age in Black and White women in South East England

Black women have lower age-standardized breast cancer incidence rates than White women in the United Kingdom. However, little is known about such differences in risk in separate age groups. Records on female residents of South East England diagnosed with breast cancer between 1998 and 2003 were extracted from the Thames Cancer Registry database. Age-specific incidence rates were calculated for each 5-year age group using 2001 Census population data for White, Black Caribbean and Black African women. Black Caribbean and Black African breast cancer patients were younger than both the White patients and those with no ethnicity recorded. Black Caribbean and Black African women in the population also had a younger age profile than White women. The computed age-specific incidence rates in women aged under 50 were similar in the different ethnic groups, whereas in women aged 50 and over White women had higher rates. The younger age of Black Caribbean and Black African breast cancer patients in South East England reflects the younger age of these populations, rather than an increased risk of disease at younger ages.     

Behavioral risk factors among Black and White women newly diagnosed with breast cancer

BACKGROUND: To determine the rates of three behavioral risk factors (depression symptoms, smoking, and drinking) among women newly diagnosed with breast cancer and to examine if the rates under investigation differed between Black and White women. METHOD: Subjects were 147 women (47% Black, 53% White) newly diagnosed with breast cancer and participating in an epidemiologic interview study conducted at two metropolitan area cancer centers in the same city. The epidemiologic interview included women's tobacco, alcohol, and drug use history, medical and family history, and depression symptoms. RESULTS: Among all women in the sample, 33% reported clinically significant depression symptoms, 10% currently smoked cigarettes, and 57% currently drank alcohol. Seventy percent of women reported experiencing one or more behavioral risk factors, and White women were more likely than Black women to do so. After controlling for other demographic variables, White women were 50% more likely to report clinical symptoms of depression (odds ratio=1.55, 95% confidence interval=1.03, 2.30) and over two times more likely to report being current drinkers (odds ratio=2.19, 95% confidence interval=1.45, 3.30) than were Black women (p<0.05). CONCLUSIONS: The results suggest that certain behaviors of Black women may be associated with lower levels of self-reported distress. These findings also suggest the need for further research to examine behavioral comorbidity among women with breast cancer, and the roles that race, ethnicity, and culture may play in their expression.     

Diagnostic mammography performance and race: outcomes in Black and White women

BACKGROUND: A previous study compared the performance (sensitivity, specificity, positive predictive value, and cancer detection rate) of screening mammography in Black and White women. No study, to the authors' knowledge, has evaluated the difference in the performance of diagnostic mammography between Black and White women. METHODS: Univariate analysis was used to evaluate differences in characteristics and cancers between Black and White women. Stratified and adjusted logistic regression analyses were used to test the association of Black and White race with performance measures of diagnostic mammography. RESULTS: The sensitivity of diagnostic mammography was higher (91% vs. 84%) and specificity was lower (86% vs. 90%) among Black women compared with White women. After controlling for age, density, self-reported breast problems, and previous mammography, sensitivity was significantly higher (odds ratio [OR] = 1.82, 95% confidence interval [CI] = 1.22-2.80) and specificity was significantly lower (OR = 0.75, 95% CI = 0.70-0.81) among Black women. The crude cancer detection rate of mammography was higher for Black women (42.6/1000) than for White women (31.0/1000) and Black women had a higher proportion of cancers that were > 2.0 cm (57.4% vs. 46.2%) that were more often poorly differentiated (61.7% vs. 49.3%) and were more often estrogen-receptor and progesterone-receptor negative. CONCLUSIONS: Black women have lower specificity of diagnostic mammography and, consequently, more unnecessary workups than White women. Black women have higher sensitivity of diagnostic mammography, with cancers that are larger and more advanced than White women. Delay in responding to signs and symptoms would explain the size and later stage. However, more research is needed to understand the biologic differences of breast cancer characteristics between Black and White women.     

Breast cancer awareness among older women

The aim of this study was to elicit the level of breast cancer awareness in older women. A cross-sectional study-specific questionnaire survey of 712 British women aged 67-73 years (response rate 83.8%), assessing knowledge of symptoms and risk and confidence to detect a change, was conducted. Over 85% of respondents were aware that a lump was a symptom of breast cancer but knowledge of non-lump symptoms was limited. Knowledge of risk was poor; 50% believed that the lifetime risk of developing breast cancer was less than 1 in 100 women and 75% were not aware that age is a risk factor. Thirty-one percent of women reported low levels of confidence to detect a breast change and 19% rarely or never checked their breasts. Those with fewer educational qualifications had poorer knowledge of symptoms, less awareness of lifetime and age-related risks, but were more likely to check their breasts than more highly educated women. This national survey demonstrates a significant lack of the prerequisite knowledge and confidence to detect a breast change. Raising breast cancer awareness and promoting early presentation among older women is important, as they are more at risk of breast cancer and more likely to delay seeking help with breast cancer symptoms than younger women.     

Low incidence of familial breast cancer among Hispanic women

There is a paucity of data on familial patterns of breast cancer among minority populations. This study compared the frequency of cancer in 1,095 first-degree relatives of 50 White, 46 Black, and 49 Hispanic breast-cancer patients referred to The University of Texas M. D. Anderson Cancer Center (United States). Family histories of cancer were derived from a self-administered questionnaire on risk factors. Expected numbers of cancers were calculated from the Connecticut Tumor Registry for White and Black relatives and from the New Mexico Tumor Registry for Hispanic relatives. Family history of a first-degree relative with breast cancer was the most important risk factor for both Black and White patients. Significantly elevated standardized incidence ratios (SIR) for breast cancer were noted among White (SIR=4.5, 95 percent confidence interval [CI]=1.2–11.4) and Black (SIR=4.1, CI=1.1–10.4) relatives younger than age 45. Despite the small number of Black patients, the combined effect of family history of breast cancer and the relative's age at diagnosis (under 45 years) was associated with an SIR of 7.1 (CI=1.9–18.1). A deficit of cancer was noted in Hispanic women; only one patient reported having a first-degree relative with breast cancer. These findings, although based on small numbers, suggest that Hispanics have a lower rate of familial breast cancer than Whites and Blacks, and that they may possess protective factors that reduce their risk for breast cancer.Dr Bondy, Ms Halabi, and Dr Vogel are with the Department of Medical Oncology and Dr Spitz and Mr Fueger are from the Department of Cancer Prevention and Control of The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. Address correspondence to Dr Bondy at the Department of Medical Oncology, Box 501, 1515 Holcombe Blvd., Houston, Texas 77030, USA. This paper was presented at the 1991 meeting of the American Association for Cancer Research in Houston, Texas.     

Breast cancer characteristics and HIV among 1,092 women in Soweto, South Africa

In the low-income HIV-endemic regions of sub-Saharan Africa, malignancies related to HIV have long been recognized as a major public health problem. However, epithelial malignancies associated with older age, such as breast cancer, are also rising dramatically in those regions. We compared consecutive HIV-positive and -negative black women diagnosed with breast cancer at a large public hospital in Soweto, South Africa, on age, year of diagnosis, stage, grade, and receptor status, and grouped HIV-positive patients by CD4 cell counts. We computed prevalence ratios of the associations of HIV status and CD4 category with stage, grade, receptor status, and among the HIV-positive patients, receipt of ART, controlling for age and year of diagnosis. Of 1,092 patients, 765 were tested for HIV; 151 (19.7 %) tested positive, a prevalence similar to that in the source population. Although, HIV-positive patients were younger than HIV-negative patients (p < 0.001), HIV status was not associated with the tumor characteristics. Thirty-seven women (25.9 %) had CD4 cell counts <200 cells/μl. Patients in that severely immunocompromised group were older than those in the other groups (p = 0.01). This study is the first to analyze the association of HIV with breast cancer in a large sample. Based on similar HIV prevalence in our sample and the population of the hospital’s catchment area, clinicians serving HIV-endemic communities should promote routine HIV testing of younger breast cancer patients and immediate treatment of those who test positive, prior to the initiation of chemotherapy. Research is needed on treatment and outcomes given HIV and low CD4 cell count.     

Breast cancer screening among Cambodian American women

Our aim was to describe and identify factors associated with breast cancer screening among Cambodian American women. We conducted a cross-sectional survey of 1,365 households using bilingual and bicultural interviewers. We found that low proportions of Cambodian American women were up to date on their clinical breast examinations (CBE; 42%) and mammograms (40%). More than 80% of women with female physicians have had at least one prior screening, and 52% have had the tests recently. Women with male Asian American physicians were less likely to have had screening as compared to women with female non-Asian physicians: ever had CBE (odds ratio [OR], 0.26); recent CBE (OR, 0.39); ever had mammogram (OR, 0.36); and recent mammogram (OR, 0.22). Breast cancer screening among Cambodian American women lags behind the general U.S. population. Tailored promotion efforts should address barriers and promote cancer screening by physicians, staff, and organizations serving this population.     

Investigating reversals of association for utilization of recent mammography among Hispanic and Non-Hispanic Black women

Objective  

Several papers have found that Hispanic and Non-Hispanic Black women have higher adjusted odds ratios for recent mammography when compared with Non-Hispanic White women, even though their crude percentages were lower than, or about equal to, Non-Hispanic White women’s. This paper investigates the existence of “reversals” of association for recent mammography and describes an analysis strategy for identifying variables that might produce them.     

Depression and sexual adjustment following breast cancer in low‐income Hispanic and non‐Hispanic White women

Objective: Hispanics are the largest and fastest growing ethnic minority group in the United States and breast cancer is the most commonly diagnosed cancer in Hispanic women. However, Hispanics are underrepresented in the psychosocial breast cancer literature. Methods: This study included 677 low‐income women (425 Hispanic, 252 non‐Hispanic White) enrolled in the Medi‐Cal Breast and Cervical Cancer Treatment Program. Data were gathered through phone interviews conducted in English or Spanish 6 and 18 months following breast cancer diagnosis. We focus on three variables that the literature indicates are salient for breast cancer survivors: sexual function, body image and depression. Results: Results of an ANCOVA indicated worse sexual function for Hispanic women, even after controlling for significant covariates. Hispanics reported significantly less sexual desire, greater difficulty relaxing and enjoying sex, and greater difficulty becoming sexually aroused and having orgasms than non‐Hispanic White women. Both Hispanic and non‐Hispanic White women endorsed a lack of sexual desire more frequently than problems with sexual function. Body image did not differ between Hispanic and non‐Hispanic White women. In all, 38% of Hispanic and 48% of non‐Hispanic White women scored above cut‐off scores for depressive symptoms. While there was no ethnic difference in depressive symptoms, single women reported more depressive symptoms than partnered women. Conclusions: Findings suggest that low‐income breast cancer survivors may experience symptoms of depression more than a year following diagnosis, and that sexual dysfunction may be particularly salient for low‐income Hispanic women. Copyright © 2009 John Wiley & Sons, Ltd.     

Breast and cervical cancer screening among Appalachian women.

Medical service shortages, rural residence, and socioeconomic and cultural factors may pose barriers to breast and cervical cancer screening among women living in the Appalachian region of the United States. This study determined the rates of breast and cervical cancer screening in Appalachia and identified factors associated with screening. Data from the Behavioral Risk Factor Surveillance System, 1996 to 1998, for the Appalachian region were analyzed to determine the percentage of women > or =40 years of age who had had a mammogram or clinical breast examination (CBE) within the past 2 years and the percentage of women > or =18 years of age who had had a Pap test within the past 3 years. Screening rates were compared with those for women living elsewhere in the United States. Screening rates were further assessed according to demographic, socioeconomic, and physical and behavioral health factors. Multiple logistic regression analyses were conducted to examine the predictors of screening. Overall, 14,520 Appalachian women > or =18 years of age reported on Pap tests; 13,223 women > or =40 years of age reported on mammogram screening, and 13,124 women reported on CBE screening. Among Appalachian women, 68.8% [95% confidence interval (CI), 67.8-69.9] had a mammogram, 75.1% (95% CI, 74.1-76.1) had a CBE in the past 2 years, and 82.4% (95% CI, 81.5-83.3) had a Pap test in the past 3 years. These rates were at most approximately 3% lower than those for women living elsewhere in the United States, but these differences were statistically significant. Older women and women with less education or income were screened less commonly. Women who had visited a doctor within the past year were more likely to have been screened. Additional interventions are needed to increase breast and cervical cancer screening rates for Appalachian women to meet the goals of Healthy People 2010, targeting in particular population groups found to have lower screening rates.     

Nativity and papillary thyroid cancer incidence rates among Hispanic women in California

BACKGROUND:

Overall, the incidence of papillary thyroid cancer in Hispanic women residing in the United States (US) is similar to that of non‐Hispanic white women. However, little is known as to whether rates in Hispanic women vary by nativity, which may influence exposure to important risk factors.

METHODS:

Nativity‐specific incidence rates among Hispanic women were calculated for papillary thyroid cancer using data from the California Cancer Registry (CCR) for the period 1988‐2004. For the 35% of cases for whom birthplace information was not available from the CCR, nativity was statistically imputed based on age at Social Security number issuance. Population estimates were extracted based on US Census data. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were also estimated.

RESULTS:

In young (age <55 years) Hispanic women, the incidence of papillary thyroid cancer among US‐born women (10.65 per 100,000) was significantly greater than that for foreign‐born women (6.67 per 100,000; IRR, 1.60 [95% CI, 1.44‐1.77]). The opposite pattern was observed in older women. The age‐specific patterns showed marked differences by nativity: among foreign‐born women, rates increased slowly until age 70 years, whereas among US‐born women, incidence rates peaked during the reproductive years. Incidence rates increased over the study period in all subgroups.

CONCLUSION:

Incidence rates of papillary thyroid cancer vary by nativity and age among Hispanic women residing in California. These patterns can provide insight for future etiologic investigations of modifiable risk factors for this increasingly common and understudied cancer. Cancer 2012;. © 2011 American Cancer Society.     

Anthropometric measures and breast cancer risk among Hispanic women in Puerto Rico

Cancer Causes & Control - Increased risk of postmenopausal breast cancer associated with anthropometric measures including Body Mass Index (BMI), adult weight gain, and waist circumference has...     

Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women

Purpose Lymphedema of the arm is a potential complication of breast cancer therapy. This study examines pre-disposing factors that may operate in conjunction with treatment-related factors in the development of arm lymphedema in a large cohort of White and Black breast cancer survivors. Methods 494 women (271 White and 223 Black) with in situ to Stage III-A primary breast cancer completed a baseline interview within 18 months of diagnosis. Information on lymphedema was collected during a follow-up interview, conducted on average 50 months after diagnosis. Self-reported data were used to classify women with or without lymphedema. Multivariable logistic regression models were developed to identify risk factors for arm lymphedema. Results Arm lymphedema was associated with younger age at diagnosis (odds ratio, OR per year of age = 0.96; 95% confidence interval, CI = 0.93–0.99), positive history of hypertension (OR = 2.31; 95% CI = 1.38–3.88), obesity (OR for body mass index, BMI≥30 = 2.48; 95% CI = 1.05–5.84) and having had surgery where 10 or more lymph nodes were excised (OR = 2.16; 95% CI = 1.12–4.17). While Black women had higher prevalence of arm lymphedema than White women (28% vs. 21%), race was not associated with lymphedema risk in models adjusted for multiple factors (adjusted OR = 1.01; 95% CI = 0.63–1.63). Conclusion Risk of arm lymphedema did not differ significantly for Black and White women. Risk factors identified in this study offer opportunities for interventions (weight loss, control of blood pressure, use of sentinel node biopsy where possible) for reducing incidence of lymphedema or controlling the symptoms associated with this condition.     

Black Hispanic and Black Non-Hispanic Breast Cancer Survival Data Analysis with Half-normal Model Application

Background: Breast cancer is the second leading cause of cancer death for women in the United States.Differences in survival of breast cancer have been noted among racial and ethnic groups, but the reasons forthese disparities remain unclear. This study presents the characteristics and the survival curve of two racial andethnic groups and evaluates the effects of race on survival times by measuring the lifetime data-based half-normalmodel. Materials and Methods: The distributions among racial and ethnic groups are compared using femalebreast cancer patients from nine states in the country all taken from the National Cancer Institute’s Surveillance,Epidemiology, and End Results cancer registry. The main end points observed are: age at diagnosis, survivaltime in months, and marital status. The right skewed half-normal statistical probability model is used to showthe differences in the survival times between black Hispanic (BH) and black non-Hispanic (BNH) female breastcancer patients. The Kaplan-Meier and Cox proportional hazard ratio are used to estimate and compare therelative risk of death in two minority groups, BH and BNH. Results: A probability random sample method wasused to select representative samples from BNH and BH female breast cancer patients, who were diagnosed duringthe years of 1973-2009 in the United States. The sample contained 1,000 BNH and 298 BH female breast cancerpatients. The median age at diagnosis was 57.75 years among BNH and 54.11 years among BH. The results ofthe half-normal model showed that the survival times formed positive skewed models with higher variability inBNH compared with BH. The Kaplan-Meir estimate was used to plot the survival curves for cancer patients; thistest was positively skewed. The Kaplan-Meier and Cox proportional hazard ratio for survival analysis showedthat BNH had a significantly longer survival time as compared to BH which is consistent with the results of thehalf-normal model. Conclusions: The findings with the proposed model strategy will assist in the healthcarefield to measure future outcomes for BH and BNH, given their past history and conditions. These findings mayprovide an enhanced and improved outlook for the diagnosis and treatment of breast cancer patients in theUnited States.     

Differences in estrogen receptor subtype according to family history of breast cancer among Hispanic, but not non-Hispanic White women

BACKGROUND: Pathologic differences have been reported among breast tumors when comparing ethnic populations. Limited research has been done to evaluate the ethnic-specific relationships between breast cancer risk factors and the pathologic features of breast tumors. METHODS: Given that genetic variation may contribute to ethnic-related etiologic differences in breast cancer, we hypothesized that tumor characteristics differ according to family history of breast cancer among Hispanic and non-Hispanic White (NHW) women. Logistic regression models were used to compute odds ratios (OR) and 95% confidence intervals (95% CI) to assess this relationship in the population-based, case-control 4-Corners Breast Cancer Study (1,537 cases and 2,452 controls). RESULTS: Among Hispanic women, having a family history was associated with a 2.7-fold increased risk of estrogen receptor (ER) negative (95% CI, 1.59-4.44), but not ER positive tumors (OR, 1.04; 95% CI, 0.71-1.54) when compared with women without breast cancer. In contrast, there was an increased risk for ER positive (OR, 1.89; 95% CI, 1.50-2.38) and a marginally significant increased risk for ER negative tumors (OR, 1.41; 95% CI, 0.92-2.17) among NHW women. When comparing tumor characteristics among invasive cases, those with a family history also had a significantly higher proportion of ER negative tumors among Hispanics (39.2% versus 25.8%; P=0.02), but not among NHWs (16.3% versus 21.1%; P=0.13). CONCLUSIONS: These results may reflect ethnic-specific predisposing genetic factors that promote the development of specific breast tumor subtypes, and emphasize the importance of evaluating the relationship between breast cancer risk factors and breast tumor subtypes among different ethnic populations.     

Breast cancer knowledge, attitudes and practices among Nepalese women

Although Nepal has an epidemic of early-onset, aggressive, advanced breast cancer, breast cancer knowledge and screening practices of Nepalese women have not been assessed. This paper summarises the results of a physician-administrated survey of gynaecologic inpatients (n= 100) admitted between 1 December 2009 and 31 January 2010 at a Nepalese University. Mean knowledge score of the participants was 65%, significantly higher among highly educated women (P= 0.008), professionals (P= 0.014) and women counselled during medical visits (P= 0.030). Study participants, including highly educated women, had many misconceptions. This included lack of awareness of painless nature and non-lump symptoms of breast cancer as well as the belief that traditional health care can be curative. The majority of participants were unaware of clinical breast examination (68%) and mammography (56%). Only 10% of the participants had undergone breast evaluation in the last 2 years. The practice of breast evaluation was more common among Buddhists (P= 0.043), and women counselled during medical visits (P < 0.001), with high economic status (P= 0.022), higher education (P= 0.013) and a family history of breast cancer (P= 0.049). Counselling during medical visits and higher education level were associated with better knowledge of and screening practices for breast cancer in the studied population.