Alcohol and Tobacco Use in an Ethnically Diverse Sample of Breast Cancer Patients, Including Sea Island African Americans: Implications for Survivorship.

Vivian J Bea,Tonya R Hazelton,Rita Kramer,Susan Bolick,Marvella E Ford,Dana Burshell,Kendrea D Knight,Heidi Varner,Deborah Hurley,Catishia Mosley,Anthony J Alberg,Joan E Cunningham,Colleen E Bauza

doi:10.3389/fonc.2018.00392

Abstract

Background/Objective: Data suggest that modifiable risk factors such as alcohol and tobacco use may increase the risk of breast cancer (BC) recurrence and reduce survival. Female BC mortality in South Carolina is 40% higher among African Americans (AAs) than European Americans (EAs). Given this substantial racial disparity, using a cross-sectional survey design we examined alcohol and tobacco use in an ethnically diverse statewide study of women with recently diagnosed invasive breast cancer. This included a unique South Carolina AA subpopulation, the Sea Islanders (SI), culturally isolated and with the lowest European American genetic admixture of any AA group.Methods: Participants (42 EAs, 66 non-SI AAs, 29 SIs), diagnosed between August 2011 and December 2012, were identified through the South Carolina Central Cancer Registry and interviewed by telephone within 21 months of diagnosis. Self-reported educational status, alcohol consumption and tobacco use were obtained using elements of the Behavior and Risk Factor Surveillance System questionnaire.Results: Alcohol: EAs were approximately twice as likely to consume alcohol (40%) and to be moderate drinkers (29%) than either AA group (consumers: 24% of non-SI AAs, 21% of SIs; moderate drinkers 15 and 10% respectively). Users tended to be younger, significantly among EAs and non-SI AAs, but not SIs, and to have attained more education. Heavy drinking was rare (≤1%) and binge drinking uncommon (≤10%) with no differences by race/ethnicity. Among both AA subgroups but not EAs, alcohol users were six to nine times more likely to have late stage disease (Regional or Distant), statistically significant but with wide confidence intervals. Tobacco: Current cigarette smoking (daily or occasional) was reported by 14% of EAs, 14% of non-SI AAs and 7% of SIs. Smoking was inversely associated with educational attainment. Use of both alcohol and cigarettes was reported by 3–6% of cases.Conclusions: Prevalences of alcohol and cigarette use were similar to those in the general population, with alcohol consumption more common among EAs. Up to half of cases used alcohol and/or tobacco. Given the risks from alcohol for disease recurrence, and implications of smoking for various health outcomes, these utilization rates are of concern.

Highlights

With the advent of better detection methods and more effective adjuvant therapies, cancer survivorship has steadily increased, with an estimated 3.3 million female breast cancer survivors in the United States as of 2014 [1]
We have described patterns of alcohol and cigarette use among recently diagnosed invasive breast cancer cases belonging to the three major racial/ethnic groups of South Carolina: European American (EA), and AAs with and without Sea Island ancestry
In our statewide sample we found that race-specific patterns of alcohol consumption and cigarette use were similar to or perhaps lower than those in the general South Carolina population, with EAs more likely to consume alcohol than AAs

Summary

Introduction

With the advent of better detection methods and more effective adjuvant therapies, cancer survivorship has steadily increased, with an estimated 3.3 million female breast cancer survivors in the United States as of 2014 [1]. According to SEER data for 2006–2012, 5-year relative survival from invasive breast cancer was 12% lower in AA’s This disparity in survival is present across all stages of breast cancer, with the least disparity seen with localized disease (5%) but increasing to 13% for regional and 33% for distant stage breast cancer [1]. This national disproportionality is observed in South Carolina, where female breast cancer mortality rates averaged 40% higher among AAs than EAs (28.6 and 20.4/100,000 respectively for 2007–2016) [2]. In light of increases in survivorship, research has focused on factors that may affect prognosis and survival and whether these factors contribute to the persistent disparities in mortality

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