Breast Cancer In Hispanic Women Research Articles

Abstract PO5-09-09: Incidence of Breast Cancer in Hispanic Women Across the US: A Focus on Texas

Abstract Introduction Breast cancer (BC) is one of the most common cancers affecting the female population in the United States, particularly among the Hispanic community. According to the CDC, the incidence rate of new breast cancer cases in Hispanic women is 95.6 per 100,000 annually, and the mortality rate is 13.7 per 100,000 women annually. Texas is home to one of the largest Hispanic communities in the US. By analyzing the prevalence, mortality, and access to healthcare services in Texas, we can shed light on the unique aspects of breast cancer within the Hispanic population. Overall, this study will provide valuable insights and identify potential avenues for reducing disparities and improving healthcare outcomes for Hispanic women affected by breast cancer. Materials and methods This study used comparative data from State Cancer Profiles on the CDC and NIH databases. The database was used to generate an overall comparison of breast cancer in Hispanic women across different US states. Comparison factors analyzed include incidence, mortality, insurance, and screening efforts. Significant differences were noted especially in Texas. Graphs and quantitative data for comparison factors were generated. This data is from 2015-2019 unless noted. Results The incidence of breast cancer in Hispanic women in Texas (TX) is 93.5 (Age-Adjusted Incidence Rate-cases per 100,000) with a CI of (92.2-94.8). The incidence of BC in Hispanic women in the US averages 99.0 with a CI of 98.7-99.9. From the incidence data, Hispanic women in Texas have a lower overall incidence of BC compared to the rest of the Hispanic females in the US. When analyzing the mortality rate, Hispanic women in TX have an Age-Adjusted Death Rate (deaths per 100,000) of 15.2 (CI of 14.7-15.8). In the US, Hispanic women have an Age-Adjusted Death Rate (deaths per 100,000) of 13.0 (CI of 13.4-13.9). To analyze preventative measures, a graph reporting mammogram use in 2020 by state was gathered. In TX 2020, the estimated age-adjusted prevalence of mammograms among Hispanic females from 50-74 years old was 75.0% (CI of 67.0%-81.7%). Nationally, the age-adjusted prevalence among Hispanic females 50-74 years who reported mammogram screening in 2 years was 79.7% (CI of 76.6 – 82.4). As for Texas insurance rates in 2020, Hispanic women under 65 years old, 27.4 % reported being uninsured. In comparison, other ethnicities such as African American (non-Hispanic) women, 16.5% reported to be uninsured, and white (non-Hispanic) women in Texas 11.8 % reported to be uninsured. Additionally, to further analyze if the lack of preventative measures was causing women to have a higher mortality rate, the instance of late-stage diagnosis of BC in Texan Hispanic women was analyzed. The age-adjusted incidence rate of late-stage breast cancer in Hispanic women was reported to be 33.4 (CI of 32.6-34.2) and the national incidence of late-stage BC in Hispanic women is 35.0 (CI of 35.1-35.8). Conclusion Even with Texas having one of the largest Hispanic communities, Hispanic women with breast cancer in Texas are faced with obstacles that lead to an increase in their mortality rate. As seen in the results, Hispanic women have less incidence of BC (including late stage) than their equivalent across the US but Hispanic women in TX have higher mortality rates in comparison. This is additionally accompanied by a decrease in insured women and a decrease in the utilization of cancer screenings. Lack of access to affordable healthcare and lack of regulatory cancer screenings cause Hispanic women to meet their premature death. Further analysis of the effects of affordable health care or further molecular investigation of this population is encouraged to research to fully conclude the reason behind this population's disparities. Citation Format: Catalina Esguerra, Kemely Santos Barbosa, Roy Khalife, Anthony Magliocco. Incidence of Breast Cancer in Hispanic Women Across the US: A Focus on Texas [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-09-09.

Breast Cancer in Hispanic Women

Breast Cancer in Hispanic Women

Abstract 3686: Differences in disease presentation, and treatment outcomes of neoadjuvant chemotherapy for breast cancer among Hispanics in a minority-serving institution

Abstract Background: Response to neoadjuvant chemotherapy (NAC) for breast cancer varies by tumor characteristics and therapy regimen. Studies suggest that patient ethnicity is associated with differences in disease presentation, response to treatment, and outcomes. There exists a paucity of literature on the presentation and outcomes of NAC for breast cancer in Hispanic women. Methods: This is an IRB-approved retrospective study of breast cancer patients who underwent NAC at an NCI-designated Comprehensive Cancer Center from 2005-2020. We reviewed demographics, disease presentation, response to treatment, and outcomes. ER and PR status were categorized as low positive (1-9%), positive (≥ 10%) and negative. Treatment factors reviewed included completion of chemotherapy and type of surgery performed. Treatment response was noted as percent residual cellularity (0%, <10%, 10-30%, >30-80% and >80%) in the surgical specimen and pathologic stage. Outcomes were assessed as overall survival (OS) and recurrence. Results: 365 patients received neoadjuvant chemotherapy from 2005-2020, and 196 (53.7%) self-identified as Hispanic. Median follow-up was 13.65 years. Highest clinical stage at diagnosis was most frequently IIA (31.2%), followed by IIB (32.3%), with non-significant Hispanic ethnicity differences, although Hispanic patients presented with higher clinical prognostic stages: IIIA or higher (40.5% vs. 24.0%). Hispanics more frequently had grade 3 tumors (60% vs. 48%), ER low positive (10% vs. 7%) and ER negative (48% vs. 36%) (p=0.02). No significant differences were noted in triple negative disease or HER2 positive disease. Hispanics were diagnosed at younger average ages (48.9 vs. 53.0 years, p=0.001). No statistically significant differences were noted in time from diagnosis to NAC initiation, completion of chemotherapy, or surgical treatment received (lumpectomy vs. mastectomy, and sentinel node biopsy vs. dissection). Mastectomy was more likely for late-stage disease (OR=2.73, 95% CI: 1.66-4.49, p<0.001); Hispanic women with late-stage disease had 1.09-fold higher odds of receiving mastectomy, but this was non-significant (95% CI: 0.66-1.79). No significant ethnic differences were noted in pCR (p=0.69) or residual tumor cellularity (p=0.63). There was no significant association between residual cellularity and OS. OS rates were similar for Hispanic vs. Non-Hispanic women (HR: 1.15, 95% CI: 0.64-2.08, p=0.63). No difference was noted in ethnicity-based recurrence rates (21.4 vs. 20.1%). Conclusion: Self-identified Hispanic patients were diagnosed at a younger age, presented with higher ER negative and low-positive disease and worse prognostic clinical stage. However, given standard of care chemotherapy, there were no significant differences in their treatment response or outcomes compared to non-Hispanic patients. Citation Format: Sangeetha Prabhakaran, Christopher McNicoll, Vernon S. Pankratz, Nadja Falk, Jacklyn Nemunaitis, Jain Zhou, Payton A. Sandoval-Belt. Differences in disease presentation, and treatment outcomes of neoadjuvant chemotherapy for breast cancer among Hispanics in a minority-serving institution [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3686.

Higher obesity and lower screening rates in Hispanic women and associated increased breast cancer in the United States.

10555 Background: To evaluate trends in postmenopausal breast cancer and mammogram utilization in Hispanic and White women in the United States. Methods: Data on postmenopausal breast cancer was obtained from the United States Cancer Statistics Public Use Database between 2001 and 2018. Rates of mammogram screening for women ages 18 and older were evaluated using the Behavioral Risk Factor Surveillance System (BRFSS) from 2000 and 2018. Obesity rates for women ages 18 and older were extracted from BRFSS between 2001 and 2016. SEER*Stat 8.3.8 and Joinpoint regression program 4.8.0.1 were used to calculate incidence trends. Breast cancer and obesity incidence and trends were described using average annual percent change (AAPC). Mammogram screening trends were described using average biennial percent change (ABPC). Age groups were divided into five-year or ten-year intervals. Results: Over the past eighteen years, early-stage breast cancer in Hispanic women has increased annually by 1.06% (p = 0.000) and advanced-stage has also increased annually by 0.81% (p = 0.000). In contrast, there was no increase in early-stage cancer in White women, however, advanced stage increased by 1.06% annually (p = 0.000). Compared to White woomen, Hispanic women are more likely to be unscreened with mammograms (18.17% vs. 40.06%). Over time, the unscreened population is decreasing at 3.43% for White women compared to only 1.24% in Hispanic women (p = 0.000, p = 0.001). Overall in the U.S., the never-screened population has decreased biennially by 2.88% (p = 0.000). In 2016, 33.16% of Hispanic women and 28.13% of White women were considered obese, and this obesity rate has been increasing at 2.6% and 2.4%, respectively (p = 0.000). Conclusions: Our data showed that early- and advanced-stage breast cancer has been increasing in Hispanic women in the United States. Hispanic women were also more likely to be obese and less likely to undergo screening compared to White women.

Characterization of Inflammatory Breast Cancer in Hispanic Women from Puerto Rico.

Background: Breast cancer (BC) is the most diagnosed cancer and the leading cause of cancer death among women in Puerto Rico (PR). Inflammatory breast cancer (IBC) is considered the most aggressive BC subtype. This study characterized the IBC population of Hispanic women living in Puerto Rico and aimed to estimate the IBC survival rate using data from the Puerto Rico Central Cancer Registry (PRCCR). Methods: This is a retrospective, population-based study using the PRCCR database and the Health Insurance Linkage Database (PRCCR-HILD). We analyzed data from patients that were diagnosed with IBC from January 1, 2008 to December 31, 2018. Patients were identified using the International Classification of Diseases for Oncology, 3rd edition (ICD-O-3) site codes C50.0-C50.9 and histology code 8530. Variables such as age at diagnosis, marital status, health insurance, geographic area of residence, staging variables, tumor receptor subtypes, treatment received, and overall survival (OS) were studied. Statistical analysis methods were employed to describe the population, estimate survival curves and examine the risk of dying. Results: The data of 51 patients were included. The mean age at diagnosis of IBC in the current study was 59 years old. A total of 62.8% of patients had no metastases at diagnosis and 64.7% were diagnosed with stage III disease. Most tumors presented with ER+/PR+/Her2- (21.6%), or a triple negative (ER-/PR-/Her2-, 15.7%) tumor concordance. The OS during the first year was 66% (90% CI: 0.54-0.76), whereas 36 months post-diagnosis was at a low 39% (90% CI: 0.27-0.59). The triple-negative subtype had the worst survival at 36 months (36% [90% CI: 0.11-0.62]). This study revealed through Cox regression analysis that women with stage IV disease and those with ER-/PR- tumor subtype have a higher risk of dying (HR 4.99; [90% CI: 2.30-10.83] and HR 4.74; [90% CI: 1.88-11.95]), respectively. Conclusions: Our results suggest that the Puerto Rican IBC patient population presents unique characteristics. This is the first research to describe the patient profile and characteristics of women diagnosed with IBC in PR. This research increases awareness about this lethal disease in PR.

Abstract 1760: Plasma vitamin D levels and DNA repair capacity in four molecular subtypes of women with breast cancer

Abstract Background: Vitamin D regulates estrogen synthesis among other mechanisms involved in breast cancer (BC) carcinogenesis. An important gap, to our knowledge, is whether blood levels of vitamin D are associated with DNA repair capacity in women with BC. Previously, we reported that a low DNA repair capacity (DRC) is a risk factor for BC and that DRC levels are associated with estrogen receptor (ER) positivity in women with BC. Moreover, we also reported that there is an intrinsic variability in DRC levels among the four principal BC subtypes. Therefore, our aim is to study the link between DRC and plasma vitamin D levels in BC and among BC subtypes. Methods: Treatment-naïve BC cases and controls were selected from our cohort of Hispanic women (n=1,187). DRC was assessed in lymphocytes through the host-cell reactivation assay. Vitamin D was measured using LC/MS/MS. Results: Women with BC (n=91) had higher (+6.6 ng/ml) vitamin D than controls (n=22) (p=0.007). There were significant differences in vitamin D levels (p<0.05) between BC cases with high (≥3.8%) (n=17) and low (<3.8%) (n=74) DRC levels. Vitamin D and DRC were negatively correlated in BC cases (r=-0.2296, p=0.03). When women with BC and low DRC levels (n=56) were stratified into: luminal A (n=17), luminal B (n=11), HER2+ (n=10), and triple-negative (n=18), women with HER2+ and TNBC showed the highest levels of vitamin D (p<0.05). Women with ER- had higher levels (+7.6 ng/ml) of vitamin D than women with ER+ tumors (p=0.005). After finding that plasma vitamin D levels from women with BC and controls were significantly different when stratified by DRC levels and BC subtypes, ROC curves were constructed to examine whether these levels could allow us to discriminate between our four study groups. Significant differences (p=0.0126) were found for cases and controls with low DRC; AUC of 0.7178. When considering all women with BC independently of DRC levels, the AUC was 0.7353 (p=0.0300). Conclusions: This study provides the first evidence of a link between vitamin D and DRC levels in women with BC. We also present data as to how vitamin D varies across four molecular subtypes of BC in Hispanic women. Impact: Our results fills an important gap on the link between plasma vitamin D and DRC levels in women with BC. Funding: This study was supported by grants #S06GM008239-20, 9SC1CA182846-04, and 5SC1CA157250-02, 5U54CA163071-04, 5R25GM096955-08. Citation Format: Carmen Ortiz, Jarline Encarnacion, Ralphdy Vergne, Luis Padilla, Jaime Matta. Plasma vitamin D levels and DNA repair capacity in four molecular subtypes of women with breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1760.

Abstract P1-06-05: The impact of ethnicity on normal breast biology

Abstract The incidence of/mortality from the most aggressive triple negative breast cancer (TNBC) is higher in African American- (AA) than Caucasian (CA)-women. In contrast, breast cancer in Hispanic-women is generally less aggressive. There is an ongoing debate as to whether AA-women have an increased incidence of TNBCs that have poor outcome or there are unique biological factors in AA-women that promote aggressive biology. Through unique approaches, we provide evidence for distinct biology in the normal breasts of CA-women, AA-women, and Hispanic-women. Using resources from the Komen Normal Tissue Bank and a primary cell culturing system that enabled propagation of normal epithelial cells of different lineages including mature-luminal, luminal-progenitor, and stem cells from different ethnic groups, we have identified a subpopulation of CD44high/CD24- cells that are unique to AA-women (p=0.0001). This AA-women-specific subpopulation expressed higher levels of Collagen 3A1, Collagen 5A2, CTNNB1 (β-Catenin of Wnt), FOXC2, and ZEB1 compared to common CD44+/CD24+ subpopulation in every breast. Gene expression pattern in the AA-specific CD44high/CD24- population showed marked similarity to gene expression pattern in the recently described PROCR+ multi-potent mammary stem cells. Indeed, the breast epithelial cells of AA-women were enriched for PROCR-positive stem cells compared to CA-women or Hispanic-women (p=0.015). In contrast to cells from CA- and AA-women, cells isolated from the healthy breast of Hispanic-women displayed mostly differentiated features as they were enriched for CD49f-/EpCAM+ and CD271-/EpCAM+ mature cells. Cells from CA-women, AA-women and Hispanic-women are currently being immortalized to determine the cell types that are preferentially immortalized in each of these ethnic groups. These results suggest ethnicity-dependent differences in Wnt, extracellular matrix, and epithelial to mesenchymal transition (EMT) signaling in normal breast epithelial cells and differences in the proportion of cells that are susceptible to immortalization/transformation. This work is supported by Susan G. Komen for the Cure to HN (SAC110025). Citation Format: Nakshatri H, Anjanappa M, Bhat-Nakshatri P. The impact of ethnicity on normal breast biology. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-06-05.

Abstract A82: Identifying differentially expressed microRNAs as investigational tools in postpartum breast cancer in Hispanic women

Abstract The risk of breast cancer transiently increases immediately following pregnancy; peaking between 3-7 years. The biology that underlies this risk window and the effect on the natural history of the disease is unknown. MicroRNAs (miRNAs) are small, non-coding RNAs that have been shown to be dysregulated in breast cancer. Utilizing a quantitative RT-PCR approach, we profiled the expression pattern of 355 miRNAs across 56 formalin-fixed, paraffin embedded breast tumor tissue samples from multiparous Hispanic women. Based on a data-driven splitting of the expression pattern of the 355 miRNAs, the case series was separated into two groups based on time since last full-term pregnancy (TSLFTP): a) an early group representing women diagnosed with breast cancer ≤ 5.2 years postpartum (n=12); and b) a late group representing women diagnosed with breast cancer ≥ 5.3 years postpartum (n=44). We identified 15 miRNAs with significant differential expression between the early and late postpartum groups. Ten miRNAs had a two-fold or higher difference in expression, with miR-138, miR-660, miR-31, miR-135b, miR-17, miR-454, and miR-934 overexpressed in the early versus the late group; while miR-892a, miR-199a-5p, and miR-542-5p were overexpressed in the late versus the early postpartum group. Further analysis of the miRNA expression data demonstrated that 60% of the identified differentially expressed miRNAs are encoded on the X chromosome, with several miRNAs found together in miRNA gene clusters. Additionally, DNA methylation, measured using a Sequenom MassARRAY, demonstrated that three out of five tested miRNA genes (mir-31, mir-135b, and mir-138-2) had a lower mean methylation in the early versus late postpartum group, and negatively correlated with miRNA expression. In summary, we have identified miRNAs that are differentially expressed and differentially methylated between tumors of the early versus late postpartum, suggesting that potential differences in epigenetic regulation may exist in the postpartum breast cancers. Citation Format: José L. Muñoz-Rodríguez, Lukas Vrba, Chengcheng Hu, Patricia A. Thompson, Maria Elena Martinez, Bernard W. Futscher. Identifying differentially expressed microRNAs as investigational tools in postpartum breast cancer in Hispanic women. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A82.

Differentially expressed microRNAs in postpartum breast cancer in Hispanic women.

The risk of breast cancer transiently increases immediately following pregnancy; peaking between 3-7 years. The biology that underlies this risk window and the effect on the natural history of the disease is unknown. MicroRNAs (miRNAs) are small non-coding RNAs that have been shown to be dysregulated in breast cancer. We conducted miRNA profiling of 56 tumors from a case series of multiparous Hispanic women and assessed the pattern of expression by time since last full-term pregnancy. A data-driven splitting analysis on the pattern of 355 miRNAs separated the case series into two groups: a) an early group representing women diagnosed with breast cancer ≤ 5.2 years postpartum (n = 12), and b) a late group representing women diagnosed with breast cancer ≥ 5.3 years postpartum (n = 44). We identified 15 miRNAs with significant differential expression between the early and late postpartum groups; 60% of these miRNAs are encoded on the X chromosome. Ten miRNAs had a two-fold or higher difference in expression with miR-138, miR-660, miR-31, miR-135b, miR-17, miR-454, and miR-934 overexpressed in the early versus the late group; while miR-892a, miR-199a-5p, and miR-542-5p were underexpressed in the early versus the late postpartum group. The DNA methylation of three out of five tested miRNAs (miR-31, miR-135b, and miR-138) was lower in the early versus late postpartum group, and negatively correlated with miRNA expression. Here we show that miRNAs are differentially expressed and differentially methylated between tumors of the early versus late postpartum, suggesting that potential differences in epigenetic dysfunction may be operative in postpartum breast cancers.

The risk of developing invasive breast cancer in Hispanic women : a look across Hispanic subgroups.

Current evidence on breast cancer among US Hispanic women indicates a significant public health threat, although few studies have assessed the heterogeneity in breast cancer risk among Hispanics of different origin. The 2000 and 2005 National Health Interview Survey Cancer Control Modules were used to examine the Breast Cancer Risk Assessment Tool (BCRAT) 5-year risk and lifetime risk of invasive breast cancer among Mexican/Mexican American, Puerto Rican, Cuban/Cuban American, Dominican (Republic), Central/South American, Other Hispanic, and non-Hispanic white (NHW) women ages 35 to 84 years. Multiple linear regression models were used to compare the BCRAT 5-year and lifetime breast cancer risk between 1) Hispanics and NHWs and 2) Hispanic subgroups. Hispanic women had significantly lower mean BCRAT 5-year and lifetime breast cancer risk compared with NHW women (P < .001). Among Hispanic subgroups, Cuban/Cuban Americans had a higher BCRAT 5-year risk (P < .05), whereas Dominicans had a higher lifetime risk (P < .001) compared with Mexican/Mexican Americans. Approximately 2.6% of Hispanic women were at high risk for breast cancer (BCRAT 5-year risk ≥1.67%), ranging from 1% of Central/South Americans to 3.7% of Puerto Ricans; few Hispanics (0.2%) had a lifetime risk ≥20%. The current findings indicate that Hispanic women have a significantly lower risk of breast cancer compared with NHW women, although the risk according to BCRAT differed significantly between specific Hispanic subgroups. We provide estimates of the number of US Hispanic women from six subgroups who may be eligible for prophylactic breast cancer chemoprevention. The authors concluded that future studies should further investigate the heterogeneity in breast cancer risk and risk factors between Hispanic women of different origins.

Diabetes, physical activity and breast cancer among Hispanic women

Purpose: We assessed the association between diabetes and breast cancer and whether physical activity modified the effect of diabetes on breast cancer in Hispanic women. Methods: We used data from a case-control study of breast cancer among Hispanic women aged 30–79 conducted between 2003 and 2008 on the Texas–Mexico border. In-person interviews were completed with 190 incident breast cancer cases ascertained through surgeons and oncologists, and 979 controls who were designated as both high-risk ( n = 511) and low-risk ( N = 468) for breast cancer (with respective response rates of 97%, 83% and 74%). Results: After adjustment for menopausal status and mammography screening, there was no effect of diabetes on breast cancer risk (high-risk control group odds ratio [OR] 1.02, 95% confidence interval [CI] 0.71–1.48; low-risk control group OR 0.87, 0.58–1.30). Women who had a diabetes history and did not exercise were at no risk of breast cancer (OR 0.96, 95% CI 0.63–1.48) or a slightly reduced breast cancer risk (low-risk control group OR 0.72, 95% CI 0.46–1.15) depending on the control group used, while women with diabetes who did exercise had significantly reduced breast cancer risk (OR 0.41, 95% CI 0.21–0.83) regardless of the control group used (high-risk control group p-value for interaction = 0.013, low-risk control group p-value for interaction 0.183). Conclusions: Should other studies confirm our results, physical activity should be explored as a means of reducing breast cancer risk in diabetic women.

Serum insulin-like growth factor (IGF)-1 and IGF binding protein-3 in relation to breast cancer among Hispanic and white, non-Hispanic women in the US Southwest

Insulin-like growth factor 1 (IGF-1) and IGF binding protein 3 (IGFBP-3) have been positively associated with breast cancer, especially among premenopausal women. Hispanic women have lower levels of IGF-1 and IGFBP-3 than non-Hispanic white (NHW) women, although no studies have adequately assessed the relationship among IGF-1, IGFBP-3, and breast cancer in Hispanic women. We investigated the association among IGF-1, IGFBP-3, and breast cancer within a subset of participants (n = 184 cases, 522 controls) of a population-based case-control study of women living in the U.S. Southwest. Serum levels of IGF-1 and IGFBP-3 were measured in fasting blood samples, and associations among IGF-1, IGFBP-3, and breast cancer were calculated using logistic regression, adjusting for age, study center, ethnicity, education, recent hormone exposure, body mass index, parity, total energy expenditure, total calories, and cholesterol. Both IGF-1 and IGFBP-3 were statistically significantly associated with breast cancer overall (highest vs. lowest quartile (Q4 vs. Q1) for IGF-1: odds ratio (OR) = 1.92, 95% confidence interval (CI) = 1.07-3.43); for IGFBP-3: OR = 3.04, 95% CI = 1.63-5.67). Positive associations were observed for both premenopausal breast cancer and postmenopausal breast cancer. IGF-1 was associated with breast cancer in NHW women (Q4 vs. Q1: OR = 2.82, 95% CI = 1.36-5.83), but not in Hispanic women (Q4 vs. Q1: OR = 0.81, 95% CI = 0.29-2.27). IGFBP-3 was associated with breast cancer in both ethnic groups (Q4 vs. Q1 for NHW: OR = 3.32, 95% CI = 1.45-7.60; Q4 vs. Q1 for Hispanics: OR = 2.15, 95% CI = 0.76-6.04). In conclusion, the association between IGF-1 and breast cancer differed by ethnicity, while no ethnic differences were observed in IGFBP-3-associated breast cancer.

Diet patterns and breast cancer risk in Hispanic and non-Hispanic white women: the Four-Corners Breast Cancer Study

BackgroundThere is a lower incidence of breast cancer among Hispanic women than among non-Hispanic white women. Little is known about the role of diet in this difference. ObjectiveWe examined the associations of dietary patterns (Western, Prudent, Native Mexican, Mediterranean, and Dieter) with risk for breast cancer in Hispanic women (757 cases, 867 controls) and non-Hispanic white women (1524 cases, 1598 controls) from the Four-Corners Breast Cancer Study. DesignDietary intake, physical activity, and other exposures were assessed by using interviews. Dietary patterns were defined via factor analysis. Risk was assessed by using logistic regression with adjustment for age, center, education, smoking, total activity, calories, dietary fiber, dietary calcium, height, parity, recent hormone exposure, family history of breast cancer, menopausal status, and body mass index × recent hormone exposure. ResultsThe Western (odds ratio for highest versus lowest quartile: 1.32; 95% CI: 1.04, 168; P for trend < 0.01) and Prudent (1.42; 1.14, 1.77; P for trend < 0.01) dietary patterns were associated with greater risk, and the Native Mexican (0.68; 0.55, 0.85; P for trend < 0.01) and Mediterranean (0.76; 0.63, 0.92; P for trend < 0.01) dietary patterns were associated with lower risk of breast cancer. Body mass index modified the associations of the Western diet and breast cancer among postmenopausal women and those of the Native Mexican diet among premenopausal women. ConclusionsAssociations of dietary patterns with breast cancer risk varied by menopausal and body mass index status, but there was little difference in associations between non-Hispanic white and Hispanic women.

Breast Cancer among Hispanic and non-Hispanic White Women in Arizona

Breast cancer in Hispanic women is poorly understood and data on tumor hormone receptor status in this population are limited. Using data from the Arizona Cancer Registry, we assessed differences in tumor characteristics between Hispanic and non-Hispanic White (NHW) women using logistic regression modeling. 25,494 invasive breast cancer cases (23,657 NHWs and 1,837 Hispanics) reported to the cancer registry in 1995 to 2003 were included in the analysis. In age-adjusted models, compared with NHW women, Hispanics were more likely to have high-grade cancers, larger tumors, a greater number of positive lymph nodes, and advanced stage at diagnosis. Hispanic women were less likely to have tumors that are both estrogen and progesterone receptor positive (ER+/PR+), particularly those under age 60. The profile of tumor presentation in Hispanic women in Arizona is consistent with a more aggressive disease pattern and less favorable prognosis than that of NHWs.

A single-gene biomarker identifies breast cancers associated with immature cell type and short duration of prior breastfeeding

The pathogenesis of breast cancers that do not express estrogen receptors or Her-2/neu receptors (ER-/HER2- phenotype) is incompletely understood. We had observed markedly elevated gene expression of gamma-aminobutyric acid type A (GABA(A)) receptor subunit pi (GABApi, GABRP) in some breast cancers with ER-/HER2- phenotype. In this study, transcriptional profiles (TxPs) were obtained from 82 primary invasive breast cancers by oligonucleotide microarrays. Real-time reverse transcription-polymerase chain reaction (RT-PCR) was used to measure GABApi gene expression in a separate cohort of 121 invasive breast cancers. GABApi gene expression values from TxP and RT-PCR were standardized and compared with clinicopathologic characteristics in the 203 patients. GABApi gene expression was increased in 16% of breast cancers (13/82 TxP, 20/ 121 RT-PCR), particularly in breast cancers with ER-/HER2- phenotype (60%), and breast cancers with basal-like genomic profile (60%). The profile of genes coexpressed with GABApi in these tumors was consistent with an immature cell type. In multivariate linear regression analysis, the level of GABApi gene expression was associated with ER-/HER2- phenotype (P < 0.0001), younger age at diagnosis (P = 0.0003), and shorter lifetime duration of breastfeeding (< or = 6 months) in all women (P = 0.017) and specifically in parous women (P = 0.013). GABApi gene expression was also associated with combinations of high grade with ER-/HER2- phenotype (P = 0.002), and with Hispanic ethnicity (P = 0.036). GABApi gene expression is increased in breast cancers of immature (undifferentiated) cell type and is significantly associated with shorter lifetime history of breastfeeding and with high-grade breast cancer in Hispanic women.

Reproductive risk factors for breast cancer in Hispanic and non-Hispanic white women: the New Mexico Women's Health Study.

The authors conducted a population-based case-control study of breast cancer in Hispanic women in New Mexico. Hispanic and non-Hispanic white women with incident breast cancer, aged 30-74 years and diagnosed between 1992 and 1994, were identified by the New Mexico Tumor Registry. Controls were selected using random digit dialing and frequency matched by ethnicity, age, and region. Information on reproductive history, lactation, and other risk factors was collected through in-person interviews; 719 Hispanics and 836 non-Hispanic whites were included in the analysis. Conditional logistic regression was used to estimate relative risk of breast cancer for reproductive factors and to assess ethnic differences in effects. Older age at first full-term birth was associated with breast cancer among Hispanics; the odds ratio for women aged 27 years and older at first full-term birth compared with women 18 years or younger was 2.26 (95% confidence interval 1.17-4.38) compared with 1.60 (95% confidence interval 0.86-3.01) for non-Hispanic whites. Higher parity was associated with reduced risk of breast cancer for non-Hispanic whites, but not Hispanics (p < 0.008). Longer lactation was associated with reduced risk in premenopausal Hispanic women and premenopausal and postmenopausal non-Hispanic white women. Reproductive factors explained 17% of the ethnic difference in breast cancer incidence for postmenopausal women and none of the difference for premenopausal women.

Dietary fiber, Hispanics, and breast cancer risk?

The cancer rates of immigrant populations in the United States must be taken into account when looking at the importance of diet and culture as it relates to cancer prevention. Unfortunately, some nutrition studies targeted toward nontraditional white populations have not adequately confronted the issue of cultural meaning in efforts to gather dietary data accurate enough to support nutritional analyses, identify marginal diets, or relate risk to dietary patterns. The study presented here resolves many of the culturally specific issues utilizing awareness, attention, and judicious combination of culturally sensitive qualitative and quantitative research techniques. The importance of such a study in an Hispanic population is based on the fact that the age-adjusted rate of breast cancer in countries such as Mexico is among the lowest in the world. In addition, although one of the fastest-growing minority groups in the United States, Hispanic women living in this country have been shown to have the lowest incidence of the mortality rates from this disease across most geographic regions of the United States. Therefore, one might speculate that dietary factors, which have been shown to play a role in breast cancer prevention, may account for this difference. It is well recognized that the traditional Hispanic diet is rich in protective nutrients such as dietary fiber. It is known that through complex mechanisms, dietary fiber works to reduce the amount of estrogens in the body. Research also indicates that it is the level of endogenous estrogen in the body that may influence the onset of breast cancer. In order to better understand how dietary factors may be associated with breast cancer in Hispanic women, it is important that one develop the proper tools to discern any potential differences. Therefore, we developed an approach to obtaining dietary fiber information from a small cohort of 22 Houston-area Hispanic women as a vanguard study for a larger breast cancer prevention trial. Two separate dietary assessment instruments were utilized, a three-day food record and the Southwest Food Frequency Questionnaire. The mean intake of dietary fiber was 16 g/day according to the food record and 21 g/day according to the SWFFQ. Fruits, vegetables, breads, cereals, and beans provided for most of the participants' dietary fiber intake. These results support evidence that the Hispanic population's dietary fiber intake is higher than that for other groups, and this may help explain the lower incidence of breast cancer among some Hispanic populations.