Indirectness and interpretation in African American women’s discourse

IA19: Elucidating the origins of aggressive breast cancer in African American women

Evidence exists that increased levels of physical activity decrease the population burden of cardiovascular disease (CVD). Although risk factors for CVD, including plasma lipids and lipoproteins, have been associated with physical activity, studies including a sizeable number of minority participants are lacking. Our purpose was to interrogate the longitudinal effect of physical activity on plasma lipids and lipoproteins in the African American and white participants of the Atherosclerosis Risk in Communities (ARIC) Study. Nine years of follow-up data on 8,764 individuals aged 45-64 years at baseline were used in linear mixed-effects models to estimate the association between increases in baseline physical activity on mean change in HDL, LDL, total cholesterol, and triglyceride levels. Increases in the level of activity were associated with increases in HDL in all strata and decreases in triglycerides among white participants. Physical activity was associated with LDL in all women, while the association with total cholesterol was limited to African American women. This study is one of the few to investigate the effect of physical activity on lipids and lipoproteins in a race- and sex-specific manner. Overall our results highlight the importance of physical activity on plasma lipid profiles and provide evidence for novel differential associations.

Background. There is evidence to suggest that early life exposures including birthweight, history of having been breastfed during infancy, in utero exposure to maternal smoking, and parental education are associated with BC risk. Potential underlying mechanisms include variability in exposure to maternal endogenous sex and growth hormones. Also, parental socioeconomic status may be a proxy for environmental characteristics that impact biological processes in early life, and ultimately influence BC risk. Research has focused on EA women; relatively little is known about associations between early life exposures and BC risk for AA women. Methods. We conducted a case-control study in AA and EA women aged 22-75 years living in metropolitan New York City and eastern New Jersey (Women's Circle of Health Study). Breast cancer cases (AA n=827; EA n=772) were diagnosed with primary, incident, histologically confirmed invasive BC or ductal carcinoma in situ. Controls (AA n=905; EA n=715) were frequency matched to cases on age and race. Birthweight, history of having been breastfed during infancy, history of in utero exposure to maternal smoking, and parental education were by self-report using an interviewer-administered questionnaire. Results. Birthweight was not significantly associated with BC risk in this study for AA or EA women. Having been breastfed during infancy was associated with significantly increased BC risk for both groups (ORAA=1.60, 95% Cl: 1.27-2.02; OREA=1.45, 95% Cl: 1.14-1.85). For EA women, but not AA women, reporting in utero exposure to maternal smoking was associated with significantly decreased BC risk (OR=0.61, 95% Cl: 0.45-0.82). Among AA women, those born to mothers with at least a college degree had a significantly lower BC risk compared to AA women born to mothers with a high school or less education (OR=0.67, 95% Cl: 0.49-0.93). Among EA women, we found no association with maternal education. However, EA women born to fathers with at least a college degree had a significantly lower BC risk compared to EA women born to fathers with a high school or less education (OR=0.65, 95% Cl: 0.51-0.84). Conclusions. Our findings support the hypothesis that early life exposures impact adult BC risk. History of having been breastfed during infancy, in utero exposure to maternal smoking, and parental education were all associated with BC risk. While minor differences in risk estimates were found between EA and AA women, associations were similar. Citation Format: Mark L. Glasgow, Jo Freudenheim, Gary Zirpoli, Elisa Bandera, Christine Ambrosone. Early life exposures and breast cancer (BC) risk among African American (AA) and European American (EA) women. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr LB-13. doi:10.1158/1538-7445.AM2013-LB-13

This essay examines the Iowa Federation of Colored Women's Clubs (IFCWC) campaign to operate a house for African American women at the University of Iowa from 1919 to 1950. (1) It seeks to add to a growing body of literature which focuses on African American philanthropy and collective black economic enterprises. An examination of the experiences of African American women at the University of Iowa and the IFCWC Home campaign offers an interesting case study that builds on recent research work on African American Women's philanthropy. (2) The IFCWC's economic enterprise developed because between 1913 and 1946, the University of Iowa barred African American students from campus and some student activities. The experiences of African American women at the University of Iowa are unique for two reasons: 1) the house they occupied was one of a few dormitories in the nation owned and operated by a formally organized group of African American women; and 2) the campaign to maintain the IFCWC Hom e provided mostly middle-class African American women students with the organizational, intellectual, and leadership skills necessary to become the next generation of black women activists. In general, the experiences of African American college women at predominantly white coeducational institutions in the early twentieth century are unique because white women often had the guidance and support of white women administrators and/or faculty. (3) African American women, on the other hand, had to look outside the university for such mentors and role models. The question remains then, how did the alliance with the IFCWC help to keep students connected to the African American community; and how did the community respond? How did limited employment prospects that resulted from race and gender prejudice help to bring about a sharply focused movement to make a college education available to a number of Iowa's young African American women? I contend that the IFCWC prepared African American women at the University of I owa to assume positions of leadership in organizations such as the IFCWC, National Association of Colored Women (NACW), the Order of the Eastern Star (OES), and the National Association for the Advancement of Colored People (NAACP), and a host of other local and regional civil rights organizations. (4) Upon graduation, these women also assumed responsibilities in their local communities in their effort to the race. This work places African American women's lives at the center of inquiry in a preexisting historiographical paradigm which often excludes them through a preoccupation with African American men and white women. A few scholars, such as Linda Perkins, Elizabeth Ihle, Jeanne Noble, and Ellen Lawson, have completed various studies on African American women's higher education. Other scholars, such as Amy Thompson McCandless, offer thorough and insightful comparisons of the southern white and southern black women's education in the twentieth century. Outside the works by this small group of historians, the experiences of college educated African American women have been marginal. Particularly missing from current studies is any examination of African American women in the midwest. (5) Although African American women's historiography has recently focused on Ohio, Indiana, and Illinois, these works avoid any elaborate discussions of African American women's history in midwestern states west of the Mississippi River su ch as Minnesota, Nebraska, and Iowa. (6) To be sure, this study is not only specific to Iowa, but to African American women who attended the University of Iowa. I contend that racism did not paralyze these women's struggle for equality. They transformed their experiences with racism into a call for social activism, racial uplift, and service to their communities. (7) As Kevin Gaines, Stephanie Shaw and other scholars point out, although African Americans agreed on the ideal of uplift they did not always agree on what types of behavior were appropriate. …

Body-composition differences between African American and white women: relation to resting energy requirements

Psychosocial and Spiritual Factors Associated With Smoking and Substance Use During Pregnancy in African American and White Low-Income Women

'Ending the HIV epidemic': where are African American women in the plan?

Cervical cancer incidence and mortality rates are higher in African Americans than in European Americans (white, non-Hispanic of European ancestry). The reasons for this disparity are not known. We recruited a population-based longitudinal cohort of 326 European American and 113 African American female college freshmen in Columbia, South Carolina, to compare clearance of high-risk human papillomavirus (HR-HPV) infection between ethnicities. HPV testing and typing from samples obtained for Papanicolaou testing occurred every 6 months. African American participants had an increased risk of testing positive for HR-HPV, compared with European American participants, but the frequency of incident HPV infection was the same in African American and European American women. Thus, exposure to HPV could not explain the higher rate of HPV positivity among African American women. The time required for 50% of participants to clear HR-HPV infection was 601 days for African American women (n = 63) and 316 days for European American women (n = 178; odds ratio [OR], 1.61; 95% confidence interval [CI], 1.08-2.53). African American women were more likely than European American women to have an abnormal result of a Papanicolaou test (OR, 1.58; 95% CI, 1.05-2.39). We propose that the longer time to clearance of HR-HPV among African American women leads to increased rates of abnormal results of Papanicolaou tests and contributes to the increased rates of cervical cancer observed in African American women.

Evelyn M. Simien is assistant professor in the department of political science at the University of Connecticut, Storrs. Her current research interests include African American public opinion ancl political behavior, black feminist thought andcritical race theory, survey research, and quantitative methodoloqy. She can be reached at simien@uconn.e7u. African American women have a long history of political activism, starting with anti-slavery networks, civil rights organizations, and black feminist collectives (Collins 2000). Overcoming racism and sexism has had a profound impact on African American women's political activism by inspiring them to actively participate in social movements, political parties, campaigns, elections, and, ultimately, run for public office. Nonetheless, efforts to transform the curriculum and integrate the perspectives of African American women have met with varying degrees of success. African American women's political activism within the civil rights movement has not been accurately documented but rather conveniently forgotten. African American women were instrumental to the movement in their roles as organizers, fundraisers, and leaders in orchestrating tremendously successful grassroots campaigns that advanced black liberation and attested to their leadership capabilities. It is this writer's view that African American women of the civil rights movement should not to be presented as victims or celebrated as mainstream heroines from a contributionist approach. Perhaps Rosa Parks is the easiest for instructors to use in this way, considering the frequent trivialization of her role in the Montgomery Bus Boycott. It is in this regard that Cedric the Entertainer's comedic performance in the film, Barbershop, becomes illustrative. He insists that all Rosa Parks did was sit down because she was tired, which minimizes her role as an important civil rights activist. Obviously, this message is problematic. However, it is indicative of an educational system that treats black history month as cultural enrichment. During the month of February, students learn about black firsts and their achievements to develop tolerance for difference as opposed to challenge basic assumptions about cultural stereotypes (Higginbotham 1990; Omolade 1993; Banks 2003). An alternative or transformative approach to the curriculum enables students to critically evaluate political processes. Such an approach allows students to consider why, for example, African American women are conspicuously absent from the curriculum on black leadership and civil rights. Students can begin to question and understand how race, sexuality, class, and gender dynamics operate within the context of the movement. They come to appreciate multiple perspectives and realities as they relate to the unequal distribution of power and privilege in the United States, thereby creating a new framework by which students view key concepts, issues, themes, and problems inherent to the movement that counter mainstream perspectives. African American women are then integrated into the curriculum as leaders, performing roles similar to those of black men without privileging one experience over the other. Therefore, black liberation is not equated with black masculinity or manhood. My course on the civil rights movement is designed to introduce students to black leadership, specifically the principles, goals, and strategies used by African American men and women to secure basic citizenship rights. It provides a fairly broad, yet comprehensive account of the civil rights movement so students can develop a critical perspective of historical and contemporary trends in African American political life. An in-depth analysis of the civil rights movement often inspires students to become more informed and politically active citizens. Through critical examination of the major philosophical and theoretical arguments contesting interlocking systems of oppression, students arrive at some understanding of how African American men and women influenced the political process via public persuasion, litigation, grassroots mobilization, and direct action despite different movement experiences determined by race, sexuality, class, and gender dynamics (Weber 2001). This course is unique in that it expands the curriculum on black leadership and civil rights to include African American women thereby offering students an alternative vision that recognizes African American

Background: To identify molecular factors associated with survival disparities, multiple studies have identified differentially expressed genes in tumors from African American women (AAW) compared to Caucasian women (CW), however, it is not clear whether these changes, such as increased expression of PHSPL, SOS1 and CRYBB2P1 in tumors from AAW, are clinically meaningful or represent population artifact. Gene expression data were thus evaluated in breast tumors with defined intrinsic subtypes, non-malignant breast tissue and blood from patients without breast disease. Methods: Gene expression data was generated using U133 2.0 microarrays for 184 breast tumors from AAW and CW matched by subtype, grade, age and presence of local or distant metastases, from 44 benign biopsy specimens, and from 143 peripheral blood samples from patients without current or past invasive breast disease. Principal component analysis (PCA) was performed using Partek Genomics Suite 6.6 and differentially expressed genes were detected using ANOVA with FDR<0.05, 2-fold difference defining significance. Results: When all tumors were analyzed together, only PSPHL, CRYBB2P1 and SOS1 were differentially expressed, each at significantly higher levels in tumors from AAW. When analyzed by subtype, PSPHL, CRYBB2P1, SOS1 and AMFR were expressed at higher levels in luminal A tumors (n=86) and SOS1 at higher levels in basal-like tumors (n=66) from AAW; no differentially expressed genes were detected in HER2-enriched (n=18) or luminal B (n=14) tumors. AMFR, CRYBB2P1, PSPHL and SOS1 were also expressed at significantly higher levels in both non-malignant breast tissue from AAW patients, and in blood specimens from disease-free AAW patients compared to non-malignant and blood specimens from CW. Conclusions: PCA demonstrates that molecular profiles of tumors from AAW are highly similar to those from CW; the few genes that are differentially expressed in tumor specimens are not associated with breast cancer as the same changes are also found in disease-free breast tissues as well as blood from patients without breast disease. Lack of meaningful genetic differences, even within specific tumor subtypes, suggests that disparity differences between AAW and CW with breast cancer are not attributable to molecular differences inherent to the tumors, but likely stem from other factors such as genetic predisposition to the development of basal-like tumors or altered provision of or response to treatment. Citation Format: Allyson L. Valente, Craig D. Shriver, Rachel E. Ellsworth. Gene expression profiling of breast tumors from African American and Caucasian women: Are molecular differences meaningful. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3270. doi:10.1158/1538-7445.AM2014-3270

In the United States, obesity prevalence has been increasing steadily over the years in all racial/ethnic groups, but is markedly higher in African American (AA) (57.2%) and Hispanic women (46.9%), compared to non-Hispanic white (NHW) (38.2%) and NH Asian (12.4%) women (1). Obesity has been shown to affect cancer risk and progression and can also play a role on disease presentation, treatment efficacy and toxicity, and complicate clinical management of cancer due to obesity-related comorbidities such as hypertension and diabetes (2). Given the high prevalence of obesity in African American and Hispanic women and different metabolic consequences, understanding how it influences cancer risk, detection, disease presentation, clinical management, and progression and possible differences by race/ethnicity is crucial. Breast cancer is the most common cancer among women worldwide, with wide variation in incidence and mortality across geographic regions. In the US, incidence rates have been historically higher in NHW women, but AA and Hispanic women tend to develop the disease at an earlier age and with more aggressive features. In particular, they are more likely to get ER- and triple-negative (TN) tumors, which are more difficult to treat and have worse prognosis. More recent data show that incidence rates in NHW and AA women converged in 2012 due to an increase in incidence in AA women and relatively stable incidence in NHW women3. Death rates are higher in AA than in NHW women, and this mortality difference has been widening over time. Causes of these disparities in risk and survival are likely to be multifactorial, and obesity has been implicated. There is strong evidence, mostly from studies conducted in NHW women, that obesity and weight gain during adulthood are associated with increased risk of postmenopausal breast cancer, particularly among women not using menopausal hormone therapy (4). Obesity during adolescence and young adulthood has been associated with reduced breast cancer risk (4). There is also growing evidence that the association differs by hormone receptor subtype, and that what we have historically known for the association of obesity and breast cancer only applies to ER+ tumors. Few studies have evaluated the association of obesity with the risk of ER- and TN breast cancer and the evidence is inconsistent. In the AMBER Consortium (5), which included four studies in AA women, we found that for ER+ breast cancer, obesity reduced risk for premenopausal women and increased risk for postmenopausal women. However, the risk of TN breast cancer was reduced for postmenopausal women with high BMI, but elevated for those with a high waist-to-hip ratio. One possible explanation for these findings is that TN tumors may be more influenced by components of the metabolic syndrome (central obesity, insulin resistance, dyslipidemia, hypertension) than by estrogens, as suggested by others (6). While more limited, there is growing evidence that obesity is associated with worse breast cancer outcomes, particularly for HR+ tumors (7), with no conclusive evidence on differences by race/ethnicity. Ovarian cancer is the most lethal gynecologic cancer. With difficulties in early detection due to vague symptoms and the lack of effective screening tools, 60% of ovarian malignancies are detected when the disease is already at distant stage when 5-year survival is only 29% (8). Compared to NHW, incidence is lower in AA and Hispanic women, but survival is worse in both groups, after adjusting for age and stage (9) comparable to the incidence and mortality differences observed for breast cancer. Little is known about how the epidemiology of ovarian cancer may differ by race/ethnicity, but there is suggestive evidence that there may be differences in risk profiles, tumor subtype distribution, and clinical management, which may all be affected by obesity. For example, in KP ROCS (Kaiser Permanente Research on Ovarian Cancer Survival), a cohort study of ovarian cancer patients among Kaiser Permanente Northern California members, AA and Hispanic women were more likely to have chemotherapy dose reduction and unfavorable survival compared to NHW, after adjusting for clinical characteristics and detailed treatment information (10). Obesity was the most important predictor of chemotherapy dose reduction (11). There is a general misconception that obesity is not prevalent among ovarian cancer patients. In KP ROCS, 58.5% of AA and 40.7% of Hispanic ovarian cancer patients were obese at diagnosis, compared to 29.5% of NHW (10). Fewer than 1% of Hispanic women and none of the AA women were underweight at diagnosis. In AACES (African American Cancer Epidemiology Study), a multisite case-control study of ovarian cancer in AA women, 61.8% of the cases were obese approximately one year before diagnosis (12). There is growing evidence that obesity increases ovarian cancer risk (13), but most studies were conducted in NHW women. In AACES, we found elevated risk of ovarian cancer with higher BMI and weight gain during adulthood among AA postmenopausal women (12). The impact of body mass index (BMI) on ovarian cancer survival is less clear, but meta-analyses and pooled analyses have suggested that obesity before an ovarian cancer diagnosis might be associated with lower survival, with weaker evidence for BMI at diagnosis. In KP ROCS we found that the association of prediagnosis and at-diagnosis obesity with ovarian cancer varied by stage, with lower survival among obese women with localized disease and better survival among obese women with late-stage disease (14). We found no major differences by race/ethnicity in the impact of obesity on survival, but statistical power was limited as analyses included few AA and Hispanic women. Conclusion: There is growing evidence that higher body fatness is associated with increased breast and ovarian cancer risk and worse outcomes after diagnosis with these cancers, but there are multiple research gaps to fully understand these associations (15). Better methods are needed to measure adiposity, but tools also need to be feasible for use in population-based studies to allow the inclusion of large and multiethnic populations. The role of obesity on cancer risk and survival needs to be evaluated by tumor subtype, menopausal status, use of menopausal hormone therapy, and racial/ethnic subgroup with consideration of country of origin and genetic ancestry. The impact of body fatness during critical exposure windows and the impact of weight changes throughout the cancer continuum are also poorly understood. Cancer survival studies need to take into account prognostic factors, including chemotherapy dosing and obesity-related comorbidities that can have a direct impact on cancer clinical management and survival.

Background: Experimental evidence supports a protective role of Vitamin D level in breast carcinogenesis, but epidemiologic evidence is inconsistent. African Americans have high prevalence of Vitamin D deficiency and the African American women with breast cancer have the highest mortality rate. The aim of this study is to investigate the association of Vitamin D levels with breast cancer risk and disease progression in African American and Hispanic women. Methods: This is a cases-control study of 660 African American and Hispanic women with and without breast cancer in South Los Angeles. Blood samples were collected prior cancer treatment and the serum 25-hydroxyvitamin D (25(OH) D was measured by Quest Diagnostics. Information regarding BMI and clinical factors were obtained by medical record abstraction. Logistic Regression with multivariate analysis was used for determining the association of Vitamin D deficiency (<20ng/ml) with breast cancer. Kaplan-Meier survival analysis and Cox Regression with multivariate analysis were used to assess disease-free survival and the relative risk of disease progression. Results: Our data shows that 69.2% of African American women and 37.8% of Hispanic women suffer from Vitamin D deficiency in our cohort. African American women had significant lower level of Vitamin D3 compared with Hispanic women in all age groups. The lower Vitamin D3 level was observed among age groups of 31 to 50 in African Americans. The deficiency in Vitamin D levels was significantly associated with breast cancer in both African Americans (OR=2.5, p=0.007) and Hispanics (OR=1.9, p=0.009). Interestingly, we found that a significant association of Vitamin D deficiency with trip negative breast cancer (TNBC) in African Americans (OR=3.2, p=0.04), but not in Hispanics. The lowest Vitamin D3 level was observed in African American women with TNBC. There was no significant association of Vitamin D deficiency with tumor size, lymph node involvement and tumor stage. The deficiency of Vitamin D3 level was not associated with disease progression in this cohort of women. Conclusion: Our data suggests that a significant association of Vitamin D deficiency with breast cancer in both African Americans and Hispanics, especially more associated with type of TNBC in African American women in our cohort. Citation Format: Yanyuan Wu, Marianna Sarkissyan, Sheilah Clayton, Jay Vadgama. Association of Vitamin D deficiency with breast cancer in African-American and Hispanic women in south Los Angeles [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5279. doi:10.1158/1538-7445.AM2017-5279

Socioeconomic and racial disparities among infertility patients seeking care

A variety of factors are predictors of breast cancer risk. However, the studies conducted to establish these risk factors have rarely included African American women. The few studies with sufficient numbers of African-American women suggest that risk factors for breast cancer among African-American women are similar to those of white women. Although risk factors may be similar for African-American and white women, differences in the prevalence of risk factors may explain the differences in patterns of incidence. The authors reviewed the epidemiologic studies of breast cancer among African-American women and identified resources with information regarding the prevalence of risk factors among African American and white women. Considerable variation exists in the studies of breast cancer risk factors among African American women. Because few studies have included sufficient numbers of African-American women, no firm conclusions can be drawn regarding whether risk estimates for African American women differ from those of white women. Estimates of the prevalence of breast cancer risk factors indicate that African American and white women differ in terms of their ages at menarche, menstrual cycle patterns, birth rates, lactation histories, patterns of oral contraceptive use, levels of obesity, frequency of menopausal hormone use, physical activity patterns, and alcohol intake. The risk factor profile of African-American women appears to differ from that of white women. This may explain in part, the higher incidence rates for African Americans before age 45 years and the lower incidence rates at older ages. Discussions of these data at a workshop highlighted the need for future research on breast cancer risk among African Americans. This research should acknowledge the heterogeneous heritage, cultural beliefs, and cultural knowledge of African-American women. Studies conducted in collaboration with the African-American community of women and with the breast cancer advocacy community can benefit from assistance in the design of questionnaires and recruitment of participants.

PCN173 - Carbohydrate intake and Breast Cancer risk in African American and European American Women in the Women’s circle of Health Study