TY - JOUR
T1 - The effect of modifiable risk factors on breast cancer aggressiveness among black and white women
AU - Killelea, Brigid K.
AU - Gallagher, Emily J.
AU - Feldman, Sheldon M.
AU - Port, Elisa
AU - King, Tari
AU - Boolbol, Susan K.
AU - Franco, Rebeca
AU - Fei, Kezhen
AU - Le Roith, Derek
AU - Bickell, Nina A.
N1 - Funding Information:
Data was collected as part of a multi-center, prospective study looking at racial disparities in breast cancer aggressiveness with respect to insulin levels and insulin resistance (National Cancer Institute (NCI) grant 1R01CA17155801). Participants were recruited from multiple medical institutions in New York, New Jersey, Baltimore, and New Haven at the time of their breast cancer surgery. Inclusion criteria included women over the age of 21 with a primary diagnosis of incident, stage I-III breast cancer, who self-identified as Black or White. Women of Asian and white Hispanic descent were excluded, as they are more likely to have ER/PR negative tumors compared to non-Hispanic White women (26% vs. 19%, respectively), and could potentially attenuate the association between hormone receptor status and race. Women with a history of bariatric surgery for weight loss, a history of organ transplantation, a history of diabetes mellitus, and those with end stage renal disease or hepatic cirrhosis were excluded. We also excluded women who were taking oral or injected glucose-lowering medications, as these medications influence insulin levels, one of the primary endpoints of the main study. IRB approval was obtained at all participating institutions and patients signed informed consent. Patients were given a $25 gift card for participation.This work was supported by the National Institutes of Health grant 5R01CA171558-06.
Funding Information:
This work was supported by the National Institutes of Health grant 5R01CA171558-06 .
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/10
Y1 - 2019/10
N2 - 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 < 0.0001), comorbidities (69% vs 55%, p = 0.01), self-reported poor diet (70% vs 42%, p < 0.001), be sedentary (56% vs 46%, p = 0.03) and were less likely to consume alcohol (8% vs 32%, p < 0.0001) compared to white patients. Overall, 137 (18%) of the patients had poorer prognosis (NPI > 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 < 0.001), age (β = −0.011 per year, p = 0.002), healthy diet (β = −0.195, p = 0.02), and exercise (β = −0.004, p = 0.02) were associated with better prognosis, while black race (β = 0.247, p = 0.02) and triple negative cancer (β = 0.908, p < 0.0001) were associated with poor prognosis. Neither alcohol use nor BMI was significantly associated with NPI. Conclusion: Among modifiable risk factors, diet and exercise are associated with NPI. Unmodifiable factors including race and biologic subtype remain the most important determinants of prognosis.
AB - 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 < 0.0001), comorbidities (69% vs 55%, p = 0.01), self-reported poor diet (70% vs 42%, p < 0.001), be sedentary (56% vs 46%, p = 0.03) and were less likely to consume alcohol (8% vs 32%, p < 0.0001) compared to white patients. Overall, 137 (18%) of the patients had poorer prognosis (NPI > 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 < 0.001), age (β = −0.011 per year, p = 0.002), healthy diet (β = −0.195, p = 0.02), and exercise (β = −0.004, p = 0.02) were associated with better prognosis, while black race (β = 0.247, p = 0.02) and triple negative cancer (β = 0.908, p < 0.0001) were associated with poor prognosis. Neither alcohol use nor BMI was significantly associated with NPI. Conclusion: Among modifiable risk factors, diet and exercise are associated with NPI. Unmodifiable factors including race and biologic subtype remain the most important determinants of prognosis.
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U2 - 10.1016/j.amjsurg.2019.07.012
DO - 10.1016/j.amjsurg.2019.07.012
M3 - Article
C2 - 31375248
AN - SCOPUS:85069892047
SN - 0002-9610
VL - 218
SP - 689
EP - 694
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 4
ER -
