Lower Incidence Of Breast Cancer Research Articles

Abstract PO4-09-12: Academic-community partnership bridges disparities in African American patient representation in accelerated partial breast irradiation clinical trials

Abstract Purpose/Objectives: Clinical outcomes in African American (AA) patients diagnosed with breast cancer continue to lag behind other racial groups. Thus, AA women are 41% more likely to die from breast cancer than White women despite lower incidence of breast cancer in AA women. Some of these disparities are related to barriers in access to standard-of-care treatments such as radiation therapy (RT). The prolonged nature of radiation treatments confers disproportionate higher burden (due to lost wages, transportation costs etc.) on economically disadvantaged groups such as AA women. Accelerated partial breast irradiation (ABPI), which dramatically reduces treatment time in appropriately selected patients, has the potential to mitigate financial toxicity, and improve access and treatment compliance for AA. However, underrepresentation of AA patients in APBI trials may pose a barrier to wide adoption of APBI treatments in this patient population. At our institution, we have established a unique partnership between our University Hospital and a county hospital that serves as a safety-net hospital for many economically disadvantaged groups and treats a large proportion of AA patients. The goal of this study is to determine if our unique academic-community partnership improves disparities in representation of AA patients in APBI trials. Methods: We performed a PUBMED search to identify 197 clinical trials involving ABPI. After excluding international trials and multiple reports from the same trials, we identified 80 unique studies that were based in the United States. A total of 20 studies investigating APBI provided demographics data, comprising 1735 total patients. AA enrollment rate in these trials was compared to APBI trials completed at our institution in partnership with our county hospital partner. Results: Out of 1785 patients enrolled in APBI trials in the United States where demographic information was available, 1488 patients were White (85.7%), 124 were Black (7.1%), 67 were Hispanic (3.9%), and 46 were Asian (2.7%), and 10 patients were classified as multiple or unknown (0.6%). We compared these results to two APBI trials conducted at our institution investigating 5-fraction and single fraction APBI regimens. Out of a total of 104 patients treated, 17 patients (16.3%) were Black. This difference in proportion of AA patient enrollment between our institution (16.3%) versus those reported in APBI trials across the United States (7.1%) was statistically significant (p < 0.05). Conclusion: Reporting and representation of AA patients in APBI trials remains low, which may lead to lower adoption of APBI treatments in AA patients. This may lead to underutilization of APBI, a convenient treatment with lower financial toxicity, among AA patients. Our study shows that effective academic-community partnerships can bridge such disparities in AA patient representation in APBI trials. Expansion of such academic-community partnerships across the country may bridge systemic disparities in AA patient representation in oncology clinical trials. Future studies are needed to determine if improved access to novel and convenient treatments such APBI will bridge existing disparities in clinical outcomes in patients diagnosed with breast cancer. Citation Format: Ev Kakadiaris, Brian Lue, Young Suk Kwon, Prasanna Alluri, D Nathan Kim, Ann Sprangler, Mona Arbab, Robert Timmerman, Asal Rahimi. Academic-community partnership bridges disparities in African American patient representation in accelerated partial breast irradiation clinical trials [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 PO4-09-12.

Abstract PO5-09-12: Unraveling the Intricacies of Racial Disparities in Breast Cancer in Brazil

Abstract Abstract Background: Over the past three decades, numerous countries have experienced a substantial decrease in breast cancer (BC) fatality, attributed to heightened consciousness, widened and earlier screening, and enhanced therapeutic interventions. However, these advancements have not eradicated the disparity in BC treatment across different racial and ethnic groups. In Brazil, the causes of these disparities are diverse and intricate, resembling health inequalities among ethnic communities observed in other countries. This study aimed to investigate the trends in BC incidence and mortality rates in Brazil, considering clinicopathological and sociodemographic variations, and placing particular emphasis on the severity of racial disparity concerning race/skin color. Patients and methods: Incidence trends for women with BC were analyzed using data from 13 Brazilian Population-Based Cancer Registries covering the period 2010-2015. Crude incidence ratios (CIRs) and the annual average percent change (AAPC) were calculated. Clinical and sociodemographic information from 348 Hospital-Based Cancer Registries spanning from 2000 to 2019 was also utilized. Meanwhile, mortality data for the years 2000-2020 were obtained from the National Mortality Information System. Racial and skin color data were collected through a self-declaration process, following the classification proposed by the Brazilian Institute of Geography and Statistics, which included categories such as white, black, and brown/mixed race. In the analysis, black and brown/mixed race categories were combined as black. Yellow and indigenous categories were excluded. Statistical significance was defined as a p-value less than 0.05. To determine clinically relevant differences, a threshold of more than 5% disparity in proportional values was used as an arbitrary criterion. Results: Between 2010 and 2015, a total of 70,896 newly diagnosed cases of BC were recorded. Mean CIRs were 83.9/100,000 for the overall population, 101.3/100,000 for white women, and 59.7/100,000 for black women. Neither the group of white women (AAPC -1.7; 95% CI: -7.9 to 4.9; p = 0.506) nor the group of black women (AAPC -0.4; 95% CI: -5.0 to 4.5; p = 0.831) exhibited any significant changes in the incidence rate. Black women predominantly originated from underdeveloped regions (56.4%, p < 0.001), were referred by the public healthcare system in Brazil (79.0%, p < 0.001), had ≤ 8 years of schooling (68.7%, p < 0.001), were unmarried (50.9%, p< 0.001), reported alcohol consumption (20.9%, p < 0.001), and were diagnosed with advanced stage disease (60.1%, p < 0.001). The escalation in mortality rates among black women exhibited a notable difference, amounting to 3.8 times the increase observed among white women (AAPC + 2.3; 95% CI: 2.1 to 2.5; p < 0.001) (AAPC + 0.6; 95% CI: 0.5 to 0.7; p < 0.001). Conclusion: Despite the lower incidence of BC in black women compared to their white counterparts, there is a concerning rise in BC-related mortality rates among black women. This group exhibits a significantly unfavorable sociodemographic and clinicopathological profile. These results highlight the pressing need to address the multifaceted factors contributing to these disparities, encompassing socioeconomic disparities and unequal healthcare access. Keywords: Breast cancer; racial disparities; incidence; mortality. Citation Format: Jesse Lopes da Silva, Andreia Cristina De Melo, Mariana Espirito Santo Rodrigues, Lucas Zanetti de Albuquerque, Luiz Claudio Santos Thuler. Unraveling the Intricacies of Racial Disparities in Breast Cancer in Brazil [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 PO5-09-12.

Abstract 2137: Racial disparities in triple-negative breast cancer (TNBC) mortality rates in Hampton Roads Virginia and the effects of SIAH expression on prognosis

Abstract Background: While high-resolution imaging and advancements in therapies have significantly improved breast cancer survival rates, 43,170 breast cancer patients will die in the United States in 2023 alone. Triple-negative breast cancer (TNBC) is the most aggressive breast cancer subtype and disproportionately affects BRCA1 mutation carriers and young black women. Black/African American (AA) patients have the highest mortality and the shortest survival of any racial/ethnic group in the US. Persistent cancer racial disparities remain due to a variety of risk factors. The SEER/CDC data show an 8% lower breast cancer incidence rate and a 41% higher mortality rate in Black/AA patients compared to their white counterparts. Methods: Chart review was conducted using Sentara MD Office/EPIC and VOA iKnowMedicine portals to update tumor relapse, metastasis, and survival in 577 TNBC patients. Supported by strong evidence in developmental, evolutionary, and cancer biology, we hypothesize that persistent EGFR/K-RAS/SIAH pathway activation is a major driving force of TNBC malignancy, racial disparity, early relapse, and high mortality. We propose to integrate SIAH expression to augment the existing clinicopathological parameters to improve patient risk stratification, therapy quantification, and relapse/survival prediction at the 1st-line neoadjuvant settings. Results: We report that cancer disparity and high mortality rates are even more pronounced in our racially-diverse communities in Hampton Roads Virginia. We discovered that SIAH is a tumor-specific, therapy-responsive, and prognostic biomarker in TNBC. High SIAH expression in residual tumors reflects tumor-driving EGFR/K-RAS/SIAH pathway activation (ON) that will predict cancer disparity, treatment resistance, early relapse, and poor survival. Low SIAH expression in residual tumors reflect EGFR/K-RAS/SIAH pathway inactivation (OFF) that will predict tumor remission and prolonged survival. Conclusion: We detect a major racial disparity of TNBC patients at Sentara-EVMS-VOA. Our local Black/AA TNBC patients have a 1.6-fold higher mortality rate than their White counterparts. Encouraged by our preliminary data, we aim to develop a SIAH-centered biomarker panel by measuring the EGFR/K-RAS/SIAH pathway activation (ON)/inactivation (OFF), and use SIAH as a new prognostic biomarker to risk stratify patients, detect cancer racial disparities, forecast tumor relapse, and predict patient survival at 1st-line neoadjuvant settings. By targeting SIAH, individualized treatments can be created to allow for increased survival rates in at risk individuals with more aggressive TNBCs. Citation Format: Claire B. Piatak, Taylor N. Drake, Ashleigh Hannah, Jonathan Baker, Caroline L. Dasom, Emily L. Breeding, Janet S. Winston, Billur Samli, Rick Jansen, Michael Danso, Richard A. Hoefer, Amy H. Tang. Racial disparities in triple-negative breast cancer (TNBC) mortality rates in Hampton Roads Virginia and the effects of SIAH expression on prognosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2137.

Metformin and other anti-diabetic medication use and breast cancer incidence in the Nurses' Health Studies.

We aimed to examine the association between the use of metformin and other anti-diabetic medications and breast cancer incidence within two large prospective cohort studies. We followed 185,181 women who participated in the Nurses' Health Study (NHS; 1994-2016) and the NHSII (1995-2017), with baseline corresponding to the date metformin was approved for type 2 diabetes (T2D) treatment in the US Information on T2D diagnosis, anti-diabetes medications, and other covariates was self-reported at baseline and repeatedly assessed by follow-up questionnaires every 2 years. Breast cancer cases were self-reported and confirmed by medical record review. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between medication use and breast cancer were estimated using Cox proportional hazards regression models, adjusting for breast cancer risk factors. During 3,324,881 person-years of follow-up, we ascertained 9,192 incident invasive breast cancer cases, of which 451 were among women with T2D. Compared with women without T2D (n = 169,263), neither metformin use (HR = 0.97; 95% CI = 0.81-1.15) nor other anti-diabetic medications use (HR = 1.11; 95% CI = 0.90-1.36) associated with significantly lower breast cancer incidence. Among women with T2D (n = 15,918), compared with metformin never users, metformin ever use was not significantly inversely associated with breast cancer (HR = 0.92; 95% CI = 0.74-1.15). Although we observed that past use of metformin was inversely associated with breast cancer in the T2D population (HR = 0.67; 95% CI = 0.48-0.94), current use (HR = 1.01; 95% CI = 0.80-1.27) and longer duration of metformin use were not associated with breast cancer (each 2-year interval: HR = 1.01; 95% CI = 0.95-1.07). Overall, metformin use was not associated with the risk of developing breast cancer among the overall cohort population or among women with T2D.

Variability of the mitochondrial genome in young Yakut patients with breast cancer

Background. The Sakha (Yakutia) population, the indigenous population of Siberia living in Yakutia, has one of the lowest rates of breast cancer (BC) incidence worldwide. The low BC incidence among the indigenous population of Yakutia has been reported by several authors, but to date the reasons for this phenomenon have not been fully elucidated. It should be noted that the study of factors that reduce the risk of BC is important for its prevention. In several studies, no hereditary BC was found in the Yakuts, and no pathogenic variants of the BRCA1/2 genes associated with hereditary syndromes of breast and ovarian cancers were found. In this regard, we decided to shift the focus to studying the mitochondrial genome of Sakha BC patients using the sequencing method.The purpose of the study was to identify BC-associated mitochondrial genome variants in Sakha patients.Material and Methods. The study included 14 Sakha patients diagnosed with BC. The median age of the patients was 49 years. DNA isolation was performed using phenol-chloroform extraction. DNA libraries were prepared using the Nextera Flex kit (Illumina, USA).Whole-genome sequencing of the mitochondrial genome was performed on a MiSeq instrument (Illuminа, USA). in the Shared Use Centre of the Research Institute of Medical Genetics, Tomsk National Research Centre of the Russian Academy of Sciences. The results obtained in BC patients were compared with those of control subjects.Results. In Sakha women with BC, 159 mitochondrial genome variants that differed from the human mitochondrial DNA (mtDNA) reference sequence (rCRS) were identified. Likely pathogenic variants m.3736G>A of the MT-ND1 gene and m.7279T>C of the MT-CO1 gene were shown to be associated with BC. For the first time, variants predisposing to BC (m.10398A>G; m.14783T>C; m.15043G>A; m.15301G>A) were identified. A distinctive feature of the mitochondrial genome of populations with a low BC incidence is a high level of mtDNA variants with changes in the length of the polycytosine region in the D310 locus.Conclusion. For the first time, mtDNA variants with changes in the length of the polycytosine tract in the D310 locus and likely pathogenic variants m.3736G>A of the MT-ND1 gene and m.7279T>C of the MT-CO1 gene were identified in Sakha BC women. The data obtained indicate that further studies on the role of the identified mtDNA variants in the development of BC using a larger sample of Sakha patients are required.

Breast cancer-specific survival among immigrants and non-immigrants invited to BreastScreen Norway

IntroductionWe have previously shown that immigrants have lower attendance in BreastScreen Norway than non-immigrants and that non-Western immigrants have lower incidence of breast cancer, but more advanced disease. PurposeTo compare breast cancer-specific survival for immigrants versus non-immigrants diagnosed with screen-detected or symptomatic breast cancer. Material and methodsWe analyzed data from 28,320 women aged 50–69 diagnosed with breast cancer after being invited to BreastScreen Norway. We divided women into three groups; non-immigrants, immigrants from Western countries and immigrants from non-Western countries. We stratified our analyses according to detection mode (screen-detected breast cancer, interval cancer and cancer detected outside screening), and used cox regression to model the association between immigrants/non-immigrants and time to breast cancer death. ResultsAmong screen-detected breast cancers, 28.7% were histologic grade 3 among immigrants from non-Western countries compared to 21.3% among non-immigrants. Interval cancers and cancers detected outside screening had larger tumor diameter and a higher percentage were histologic grade 3 and lymph node positive among immigrants from non-Western countries compared to non-immigrants. Hazard ratio (95% confidence interval) adjusted for age and year of diagnosis for time to breast cancer death compared to non-immigrants was 0.70 (0.39–1.27) for immigrants from Western countries and 0.52 (0.23–1.17) for immigrants from non-Western countries. ConclusionDespite more advanced histopathological tumor characteristics among immigrants from non-Western countries compared to non-immigrants, we did not observe statistically significant differences in breast-cancer specific survival between the two groups. Keeping in mind the low number of breast cancer deaths and possible overestimation of survival among immigrants, this might imply that equity in outcome can be achieved through adequate follow-up and treatment despite inequal access.

Mammography Compliance for Arizona and New Mexico Hispanic and American Indian Women 2016-2018.

Hispanic and American Indian (AI) women experience lower breast cancer incidence than non-Hispanic White (NHW) women, but later-stage diagnoses and lower survival rates, suggesting issues with screening and healthcare access. Between 1999-2015, NHW breast cancer incidence decreased by 10% but increased by 8% for AI women. This study used 2016 and 2018 Behavioral Risk Factor Surveillance System data for Arizona and New Mexico to explore mammography screening. Analyses included Hispanic, AI, and NHW women aged ≥40 years (n = 12,830) to calculate age-specific compliance by race/ethnicity, logistic regression, and adjusted and sample-weighted evaluated associations between compliance and socio-economic covariates. In total, 75.1% of Hispanic women aged 50-74 reported mammography in the past two years (United States Preventive Services Task Force compliant) compared to 73.9% of NHW and 71.0% of AI women. Women who reported doctor visits in the past 12 months were likelier to comply than those without (AOR = 4.2 for Hispanic, 2.9 for AI, and 3.2 for NHW women). Reporting access to a personal doctor was related to compliance, except for AI women. While screening compliance was over 74%, visiting a healthcare provider in the past 12 months was essential. AI women reported issues that suggest unique challenges when deciding on mammography.

Is Breast Imaging in Male Patients With Benign Lumps Necessary? A Retrospective Study to Assess Concordance Between Clinical Diagnosis and Imaging Findings.

Breast imaging for male patients is a controversial topic due to the high prevalence of gynecomastia compared to male breast cancer. Worldwide, men are undergoing more breast imaging despite the low incidence of male breast cancer. Gynecomastia is a benign condition, but the anxiety it causes and unnecessary medical costs are still high. In accordance with Royal College of Radiology guidelines, a retrospective study was performed in two cycles to determine if mammography or ultrasound should be included in the workup of male patients who were referred to a breast care unit for a lump that was deemed benign by doctors. There was 100% concordance between clinical diagnosis and imaging findings. In this population imaging was not necessary in cases of probable gynecomastia and benign conditions found during a clinical assessment. Standardised patient assessment methods can improve care and ensure accurate evaluation.

18F-fluorodeoxyglucose positron emission tomography/computed tomography findings of breast cancer with signet ring cell differentiation: A single-center experience

Aim: Due to the low incidence of breast cancer with signet ring cell (SRC) differentiation, which constitutes less than 1% of all breast cancers, little is known about its imaging features. The aim of this study was to evaluate the utility of 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) in staging breast cancer with SRC differentiation.
 
 Methods: We conducted a retrospective analysis of 14 patients with histologically confirmed breast cancer with SRC differentiation who underwent 18F-FDG PET/CT at our institution between 2014 and 2023. The imaging findings were analyzed in terms of maximum standardized uptake value (SUVmax), lesion size, and the presence of regional or distant metastases were statistically evaluated.
 
 Results: The histological subtypes of SRC differentiated primary tumors were 9 invasive lobular, and 5 invasive ductal carcinoma. More intense 18F-FDG uptake was observed in primary tumoral lesions of the ductal subtype (mean SUVmax: 18.8±9.8; range: 2.6–28.9) compared to the lobular subtype (mean SUVmax: 2.6±1.3; range: 1.5–5.1) (p=0.007, Z=2.600). Among the patients included in the study, axillary lymph node metastasis was present in 64% (n=9) of the cases, with lymph node metastasis identified in five cases classified as ductal carcinoma. Additionally, distant organ metastasis was identified in 21% (n=3) of patients, comprising two patients with ductal carcinoma and one with lobular carcinoma.
 
 Conclusion: Despite the general consensus that signet-ring cell tumors have a low affinity for 18F-FDG, our study has observed the possibility of high 18F-FDG uptake in cases of ductal carcinoma. However, in cases of lobular carcinoma, where 18F-FDG uptake tends to be low, considering alternative PET radiopharmaceuticals for imaging could be a viable option.

Endogenous and exogenous risk factors affecting the incidence of breast cancer in the population of Yakutia

The purpose of the study: to analyze the breast cancer incidence and breast cancer risk factors for the population of the Republic of Sakha (Yakutia) in 2011-2020. Material and Methods. The incidence of breast cancer in the population of Yakutia was analyzed using the data collected from population-based cancer registries of the Russian cancer statistics covering the period 2011-2020. The analysis of breast cancer risk factors was carried out using the data from systematic reviews published over the past 5 years (2018-2022). Results. The age-standardized incidence rates of breast cancer among the indigenous population of the Republic of Sakha (Yakutia) were lower than those in other Siberian ethnic groups and the Slavic population, amounting to 12.7 per 100,000 population. The rise in the breast cancer incidence rates in the region for 2011-2020 was associated with the aging of the population, since the trend in the population growth was not observed in the analysis of age-standardized rates. Conclusion. The breast cancer incidence rates among the indigenous population of the Republic of Sakha (Yakutia) are significantly lower compared to those observed in other ethnic groups living in Siberia. The rise in the breast cancer incidence rates in Yakutia is related to the aging of the population. The low age-standardized breast cancer incidence rates may be explained by a low consumption of hormonal agents and natural reproductive behavior. The search for ethno-specific mutations associated with breast cancer in the Yakut population as endogenous risk factors is of great importance. Further studies are required to elucidate the role of North-adaptive genetic mutations in the development of breast cancer. The assessment of the role of natural polyphenolic compounds, the content of which is high in wild berries (historically, a significant proportion of the food consumed by indigenous people), as a protective factor, is promising.

The effect of attendance in the Dutch breast cancer screening program on breast tumor characteristics among migrant women.

In general, migrant women have a lower breast cancer (BC) incidence rate and higher BC mortality than autochthonous women. Further, migrant women show lower participation in the national BC screening program. To further investigate those aspects, we aimed to determine differences in incidence and tumor characteristics between autochthonous and migrant BC patients in Rotterdam, the Netherlands. We selected women diagnosed with BC in Rotterdam during 2012-2015 from the Netherlands Cancer Registry. Incidence rates were calculated by migrant status (i.e., women with or without migration background). Multivariable analyses revealed adjusted odds ratios (OR) and 95% confidence intervals (CI) on the association between migration status and patient and tumor characteristics, additionally stratified by screening attendance (yes/no). In total 1372 autochthonous and 450 migrant BC patients were included for analysis. BC incidence was lower among migrants than among autochthonous women. Overall, migrant women were younger at BC diagnosis (53 vs. 64 years, p<0.001), and had higher risks of positive lymph nodes (OR 1.76, 95% CI 1.33-2.33) and high grade tumors (OR 1.35, 95% CI 1.04-1.75). Especially non-screened migrant women had higher risk of positive nodes (OR 2.73, 95% CI 1.43-5.21). Among the subgroup of screened women, we observed no significant differences between migrant and autochthonous patients. Migrant women have lower BC incidence than autochthonous women, but diagnosis was more often at younger age and with unfavorable tumor characteristics. Attending the screening program strongly reduces the latter. Therefore, promotion of participation in the screening program is recommended.

Analysis of Knowledge About Male Breast Cancer Among Patients at Tertiary Medical Center.

In the overall population, the incidence of breast cancer in men is lower than in women. Men's breast cancer awareness is affected both by the low incidence of breast cancer in men and by the presence of a perception that breast cancer can only be seen in women in society. This study aims to determine this awareness and guide future studies on improving social awareness. This study examined male and female patients aged 18 to 75 years who were admitted to our hospital's general surgery outpatient clinic. A questionnaire containing questions about male breast cancer was administered to the patients, and the study was conducted face-to-face voluntarily. A total of 411 patients, 270 female and 141 male, participated in the study. The results showed that 61.1% of the participants were unaware of the possibility of breast cancer in men. Evaluation of the relationship between awareness and gender revealed that women were more knowledgeable than men (p = .006). Educational status also had a significant influence on awareness (p = .001). Awareness of male breast cancer in society is low. Raising public awareness of this issue will enable men to be diagnosed earlier, at a lower stage, and thus to better respond to treatment, increasing their survival time.

Incidence of Breast Cancer and Enterococcus Infection: A Retrospective Analysis.

Enterococci role in the microbiome remains controversial, and researches regarding enterococcal infection (EI) and its sequelae are limited. The gut microbiome has shown to play an important role in immunology and cancer. Recent data have suggested a relationship between the gut microbiome and breast cancer (BC). Patients in a Health Insurance Portability and Accountability Act (HIPAA) compliant national database (2010 - 2020) were used for this retrospective study. International Classification of Disease (ICD) Ninth and Tenth Codes, Current Procedural Terminology (CPT), and National Drug Codes were used to identify BC diagnosis and EI. Patients were matched for age, sex, Charlson comorbidity index (CCI), antibiotic treatment, obesity, and region of residence. Statistical analyses were implemented to assess significance and estimate odds ratio (OR). EI was associated with a decreased incidence of BC (OR = 0.60, 95% confidence interval (CI): 0.57 - 0.63) and the difference was statistically significant (P < 2.2 × 10-16). Treatment for EI was controlled for in both EI and noninfected populations. Patients with a prior EI and treated with antibiotics were compared to patients with no history of EI and received antibiotics. Both populations subsequently developed BC. Results remained statistically significant (P < 2.2 × 10-16) with an OR of 0.57 (95% CI: 0.54 - 0.60). In addition to standard matching protocol, obesity was controlled for in both groups by exclusively containing obese patients, but one group with prior EI and the other without. In obese patients, a lower incidence of BC was shown in the infected group compared to the noninfected group. Results were statistically significant (P < 2.2 × 10-16) with an OR of 0.56 (95% CI: 0.53 - 0.58). Age of BC diagnosis with and without a prior EI was analyzed and demonstrated increased BC incidence with increasing age in both groups, but less in the EI group. Incidence of BC based on region was analyzed, which showed lower BC incidence across all regions in the EI group. This study shows a statistically significant correlation between EI and decreased incidence of BC. Further exploration is needed to identify and understand not only the role of enterococcus in the microbiome, but also the protective mechanism(s) and impact of EI on BC development.

THE ROLE OF ADAPTIVE VARIANTS OF THE EDAR GENE IN THE DEVELOPMENT OF BREAST CANCER. (Abstracts of the report at the scientific and practical conference "Molecular and biological mechanisms of human health formation in the North" on November 17–18, 2022, Yakutsk)

There are suggestions in the literature about the involvement of the 370A EDAR allele in the development of breast cancer. Unfortunately, the question of what the frequency of the allele is among patients with breast cancer has not been clarified, and studies, even using the case-control method, have not been conducted to clarify the role of this mutation in its development. It is unclear what role the 370A mutation of the EDAR gene plays in the low incidence of breast cancer in Yakut women.

Examining Associations between Source of Cancer Information and Mammography Behavior among Black Church-Going Women.

Black women have a slightly lower breast cancer incidence rate than White women, but breast cancer mortality is approximately 40% higher among Black women than among White women. Early detection by mammography may improve survival outcomes. Outlets providing information on cancer and cancer screening often present data, including mammography recommendations, that are unreliable, accessible, and/or inconsistent. We examined associations between sources of cancer information and mammography behavior among Black church-going women. A logistic regression model was used to examine associations between self-reported preferred source of cancer information (provider, cancer organization, social network, internet, or other media (e.g., books, magazines)) and self-reported most recent source of cancer information (same categories as preferred sources), respectively, and having received a mammogram within the prior 12 months. Participants were 832 Black women over 40 years old, recruited from three churches in Houston, Texas. Data were collected in 2012. Overall, 55.41% of participants indicated their preferred source of cancer information was a provider, 21.88% the internet, 11.54% other media, 10.22% a cancer organization, and 0.96% their social network. In contrast, 17.88% of participants indicated their most recent source of cancer information was a provider, 63.02% the internet, 12.04% other media, 4.50% a cancer organization, and 2.55% their social network. About 70% of participants indicated receiving a mammogram in the prior 12 months. Results indicated that women who most recently sought information from the internet had lower odds of having a mammogram than those who most recently sought information from a provider (aOR: 0.546, CI95%: 0.336–0.886, p = 0.014). These results reveal an opportunity to advance health equity by encouraging Black church-going women to obtain cancer information from providers rather than from the internet as a method to enhance mammography use. These results also reveal an opportunity to investigate what modifiable social determinants or other factors prevent Black church-going women from seeking cancer information from their preferred source, which was a provider for the majority of the sample, and designing interventions to better actualize this preference.

Disparities in Breast Cancer Screening Between Caucasian and Asian American Women.

Asian American women have lower breast cancer incidence and mortality than their non-Hispanic White (NHW) counterparts. We sought to determine whether differences in screening practices could explain, in part, the variation in breast cancer detection rate. The 2015 National Health Interview Survey, an annual survey that is representative of the civilian, noninstitutionalized American population, was used to determine whether mammography usage was different between Asian and NHW women. Women ≥40y of age who identified as either Asian or NHW were included. A total of 7990 women ≥40y of age (6.12% Asian, 93.88% NHW), representing 53,275,420 women in the population, were included in our cohort of interest; 71.49% of Asian and 74.46% of NHW women reported having had a mammogram within the past 2 y (P=0.324). Controlling for education, insurance, family income, marital status, and whether they were born in the United States, Asians were less likely to have had a mammogram within the past 2 y than their NHW counterparts (odds ratio=0.68; 95% confidence interval: 0.46-0.99, P=0.047). Of patients who had an abnormal mammogram, there was no difference in the biopsy rate (20.35% versus 25.97%, P=0.4935) nor in the rate of cancer diagnosis among those who had a biopsy (7.70% versus 12.86%, P=0.211) between Asian and NHW women, respectively. Our findings suggest that the lower breast cancer incidence among the Asian population may, in part, be explained by a lower screening mammography rate in this population.

Comparative Study on Clinicopathological Characteristics of Breast Cancer in Vietnam and Italy

Background: In Vietnam and Italy, breast cancer (BC) occurs in women more frequently than any other cancer. Vietnam has a substantially lower incidence of breast cancer than Italy, but a higher mortality rate. Most Vietnamese patients present to the hospital with severe tumors at the late stages of diagnosis. The purpose of this study was to compare clinicopathologic features, biomarkers, and subtypes of BC between Vietnamese women and Italian ones. Methods: The sample was collected from all Vietnamese patients undergoing surgery with the diagnosis of primary invasive breast carcinoma in Hue Central Hospital as well as Hue University Hospital in Vietnam during 1 year from April 2016 to April 2017, and from the same category of women in Sassari University Hospital, Italy during the year 2016. The study parameters in both groups consisted of age at diagnosis, tumor size, histologic grade, histologic type, axillary node status, stages of diagnosis, biomarkers (Estrogen Receptor - ER, Progesterone Receptor - PR, Ki-67 cell proliferation marker - Ki-67, Human epidermal growth factor receptor 2 - HER2), and molecular subtypes of BC. Results: 323 patients were collected in total (235 from Sassari, Italy, and 88 from Thua Thien - Hue province, Vietnam). Vietnamese patients were diagnosed at a younger age than Italian patients, at just 52.5 on average, while the figure for Italian was 62. The Vietnamese BC patients also had a bigger tumor in size, higher grade, more axillary node positivity as well as a later stage of disease in comparison with Italian ones. The proportion of ER-positive was higher in the Italian group than that in Vietnam (88.1 vs 55.7%). The high Ki-67 expression prevalence was significantly higher in Vietnamese patients compared with Italian (81.8 vs 45.1%). The HER2-positive rate in Vietnam was 33%, higher than that in Italy (8.1%). Histologic grade and cell proliferation index Ki-67 were significantly correlated with HER2 positivity in both groups. Conclusions: Vietnamese patients demonstrated more aggressive tumor features and worse prognostic biomarkers than Italian patients. The prevalence of HER2 positive and high Ki-67 expression in Vietnamese patients was considerably higher than in Italian patients. The remarkable differences in clinicopathological characteristics between the two populations suggest the diversity of biological tumor, ethnicity, and environment as well as the effectiveness of the screening program.

We Can Reduce Breast Cancer Mortality

In my search for a topic for this column, I turned to my tried-and-true strategy of choosing a condition or issue that is featured in the month when the article will be published. I can usually find one that primarily affects women and something that I haven’t written about recently (or ever). As I did my research for this article, I selected a serious subject that touches on several content areas in my writing formula. October is dedicated to raising awareness about breast cancer, a disease that affects people across the adult life span. In their annual statistics published in January 2022, 1 Siegel R.L. Miller K.D. Fuchs H.E. Jamal A. Cancer statistics, 2022. CA Cancer J Clin. 2022; 72: 7-33 Crossref PubMed Scopus (1334) Google Scholar the American Cancer Society reported an overall 32% decline in death rates from all cancer in the United States between 1991 and 2019. Cancer remains the second most common cause of death; cardiovascular disease is still number one. Some of the decrease in cancer deaths is attributed to a decline in lung cancer due to smoking cessation and the increased survival rates for lung cancer because of earlier detection. Unfortunately, breast cancer rates in aggregate have not had the same downward progression, remaining static over the last decade. However, for Black women, breast cancer mortality has increased and has become the number one cause of death. 1 Siegel R.L. Miller K.D. Fuchs H.E. Jamal A. Cancer statistics, 2022. CA Cancer J Clin. 2022; 72: 7-33 Crossref PubMed Scopus (1334) Google Scholar Although Black women have a lower incidence of breast cancer, their risk of dying from the disease is more than 40% higher than that for White women. 1 Siegel R.L. Miller K.D. Fuchs H.E. Jamal A. Cancer statistics, 2022. CA Cancer J Clin. 2022; 72: 7-33 Crossref PubMed Scopus (1334) Google Scholar There are a number of institutional and social structural factors contributing to the disparities in morbidity and mortality for breast cancer and other diseases in Black women. These have existed for generations, but only recently have they been examined and acknowledged. Section Editor Denise G. Link, PhD, WHNP-BC, FAAN, FAANP, is a clinical professor emerita at Arizona State University Edson College of Nursing and Health Innovation in Phoenix. She can be reached at [email protected] .

Estrogen therapy and breast cancer in randomized clinical trials: a narrative review.

In the Women's Health Initiative (WHI) randomized trial with 10,739 postmenopausal women with prior hysterectomy, conjugated equine estrogen (CEE) alone significantly reduced breast cancer incidence and breast cancer mortality. In contrast, epidemiological studies in a meta-analysis from the Collaborative Group on Hormonal Factors in Breast Cancer (Collaborative Group) with 108,647 breast cancers and the Million Women's Study cohort significantly associated estrogen-alone therapy with higher breast cancer incidence and breast cancer mortality. The Collaborative Group included a meta-analysis of five smaller randomized trials and the WHI randomized trial; however, findings were restricted to the Collaborative Group appendix. Our objective is to facilitate understanding of these discordant results. Data sources supporting our review findings include the randomized WHI CEE-alone trial and the meta-analysis of five smaller randomized trials evaluating estrogen alone. We summarize the smaller randomized trials' details of breast cancer relevance and place the findings in clinical context. We review findings of the WHI randomized trial evaluating CEE alone in the context of issues raised by Collaborative Group and the Million Women Study authors. We trace the evolution of the time-from-menopause, "window of opportunity" concept and augment the Collaborative Group meta-analysis by including the most recent WHI findings. Consideration of the smaller randomized trials evaluating estrogen alone with breast cancer signals that the WHI findings of lower breast cancer incidence and lower breast cancer mortality with CEE-alone use are not a "stand-alone" outcome or due to the play of chance. The serial reports of consistent favorable breast cancer findings through 20 years of cumulative follow-up suggest CEE-alone use initiates changes that persist. After full consideration of risks and benefits, randomized trial evidence provides reassurance for postmenopausal women with prior hysterectomy who are close to menopause considering estrogen alone for climacteric symptom management.

Long-term dietary intervention influence on physical activity in the Women's Health Initiative Dietary Modification randomized trial.

In the Women's Health Initiative (WHI) Dietary Modification (DM) randomized trial, dietary intervention significantly reduced breast cancer mortality (P = 0.02). In observational studies, physical activity is associated with lower breast cancer incidence. Currently, dietary intervention influence on other health-related behaviors is unknown. Therefore, we evaluated whether the WHI dietary intervention influenced self-directed physical activity. Of 48,835 postmenopausal women, 19,541 were randomized to dietary intervention (18 nutritionist-led group sessions first year, then quarterly sessions throughout 8.5years [median] intervention) and 29,294 to a usual diet comparison (written health-related materials only). Neither randomization group received specific or ongoing instructions to increase physical activity. Episodes per week of moderate or vigorous recreational physical activity (MVPA) were serially reported. Marginal longitudinal logistic regression models were used to assess physically inactive (MVPA = 0) or physically active (MVPA > 0) participants by randomization group. Marginal Poisson regression models estimated mean weekly MVPA. At entry, 45.6% of all participants reported physical inactivity (MVPA = 0). In 43,760 women with MVPA information, throughout 15.9years (median) cumulative follow-up, dietary intervention group participation was associated with 7% lower physical inactivity rate (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.91, 0.95, P < 0.001) and a 4% higher mean MVPA (ratio of means [RM] 1.04 95% CI 1.02, 1.06, P < 0.001), relative to the comparison group. In a randomized trial setting, a low-fat dietary pattern intervention was associated with a long-term, favorable influence on self-directed recreational physical activity. NCT00000611.