RESUMEN
BACKGROUND: Ductal carcinoma in situ (DCIS) is a non-obligate precursor to invasive breast cancer (IBC). Studies have indicated differences in DCIS outcome based on race or ethnicity, but molecular differences have not been investigated. METHODS: We examined the molecular profile of DCIS by self-reported race (SRR) and outcome groups in Black (n = 99) and White (n = 191) women in a large DCIS case-control cohort study with longitudinal follow up. RESULTS: Gene expression and pathway analyses suggested that different genes and pathways are involved in diagnosis and ipsilateral breast outcome (DCIS or IBC) after DCIS treatment in White versus Black women. We identified differences in ER and HER2 expression, tumor microenvironment composition, and copy number variations by SRR and outcome groups. CONCLUSIONS: Our results suggest that different molecular mechanisms drive initiation and subsequent ipsilateral breast events in Black versus White women.
Asunto(s)
Neoplasias de la Mama , Carcinoma Intraductal no Infiltrante , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Biomarcadores de Tumor/genética , Negro o Afroamericano/genética , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Neoplasias de la Mama/etnología , Carcinoma Intraductal no Infiltrante/genética , Carcinoma Intraductal no Infiltrante/patología , Carcinoma Intraductal no Infiltrante/etnología , Estudios de Casos y Controles , Variaciones en el Número de Copia de ADN , Perfilación de la Expresión Génica , Regulación Neoplásica de la Expresión Génica , Pronóstico , Receptor ErbB-2/metabolismo , Receptor ErbB-2/genética , Receptores de Estrógenos/metabolismo , Autoinforme , Microambiente Tumoral/genética , Blanco/genéticaRESUMEN
The purpose of this review was to synthesize the available literature on breast cancer-screening barriers, facilitators, and interventions among U.S. African immigrants. Following the integrative review framework and PRISMA guidelines for reporting systemic reviews, five electronic databases were searched: PubMed, CINAHL, PsycINFO, Medline, and Google Scholar. Studies were included if they were published in English language journals after 1 January 2000 and reported data on breast cancer-screening barriers, facilitators, or interventions among U.S. African immigrants. Barriers and facilitators reported by studies were descriptively examined and synthesized by two authors and classified as aligning with one of the three levels of influences based on the social-ecological model (intrapersonal, interpersonal, and community). Interventions promoting breast cancer screening were narratively summarized. Search procedures retrieved 1011 articles, with 12 meeting the criteria for inclusion in the review (6 qualitative and 6 quantitative). Intrapersonal barriers included limited awareness, fear of pain, language barriers, health concerns, transportation issues, costs, and negative past experiences. Interpersonal barriers involved modesty, spiritual beliefs, and lack of support, while community-level barriers included provider and healthcare-system challenges. Regarding facilitators, past screening experiences and health insurance were the most commonly reported intrapersonal facilitators. The only interpersonal facilitator identified was observing other women experience a breast cancer diagnosis and undergo treatment. Community-level facilitators included appointment reminders, scheduling assistance, culturally congruent interpreters, transportation to screening facilities, and patient navigators. Three articles reported outcomes of breast cancer-screening interventions. All three were pilot studies and reported increased knowledge and attitudes regarding breast cancer screening following the respective interventions. One study examined the uptake of breast cancer screening following the intervention, with results indicating an increase in screening. Findings provide a comprehensive synthesis of factors influencing breast cancer screening among African immigrants and highlight the need for future research on the topic. This review was registered with Prospero (CRD42024502826) before the initiation of search procedures.
Asunto(s)
Neoplasias de la Mama , Detección Precoz del Cáncer , Emigrantes e Inmigrantes , Humanos , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/etnología , Emigrantes e Inmigrantes/psicología , Femenino , Estados Unidos , Accesibilidad a los Servicios de SaludRESUMEN
Racial differences in breast cancer morbidity and mortality have been examined between Black/African American women and White women as part of efforts to characterize multilevel drivers of disease risk and outcomes. Current models of cancer disparities recognize the significance of physiological stress responses, yet data on stress hormones in Black/African American women with breast cancer and their social risk factors are limited. We examined cortisol levels in Black/African American breast cancer patients and tested their association with social and clinical factors to understand the relationship between stress responses and women's lived experiences. Seventy-two patients who completed primary surgical treatment were included in this cross-sectional study. Data on sociodemographic characteristics and chronic diseases were obtained by self-report. Breast cancer stage and diagnosis date were abstracted from electronic health records. Cortisol levels were determined from saliva samples. Compared to those without hypertension, patients with hypertension were 6.84 (95% CI 1.33, 35.0) times as likely to have high cortisol (p = 0.02). The odds of having high cortisol increased by 1.42 (95% CI 1.03, 1.95, p = 0.03) times for every point increase in negative life events. Hypertension and negative life events are associated with high cortisol levels in Black/African American patients. These findings illustrate the importance of understanding the lived experiences of these patients to enhance cancer health equity.
Asunto(s)
Negro o Afroamericano , Neoplasias de la Mama , Supervivientes de Cáncer , Hidrocortisona , Estrés Psicológico , Humanos , Femenino , Neoplasias de la Mama/etnología , Negro o Afroamericano/psicología , Persona de Mediana Edad , Hidrocortisona/metabolismo , Supervivientes de Cáncer/psicología , Estudios Transversales , Anciano , Adulto , Saliva/metabolismo , Saliva/química , Factores de Riesgo , HipertensiónRESUMEN
INTRODUCTION/BACKGROUND: To assess racial/ethnic disparities in endocrine therapy (ET) adherence among women with breast cancer. MATERIALS AND METHODS: A retrospective cohort study of Arkansas All-Payer Claims Database (APCD) linked to Arkansas Cancer Registry (ACR). Women with stages 0-3 HR+ breast cancer diagnosed in 2013-2017 were followed from cancer diagnosis for a year to determine ET initiation. Among women who initiated ETs within 1 year of diagnosis, we assessed first-year compliance (proportion of days covered ≥ 0.8) and followed them for 5 years, censoring at death, end of data availability (December 21, 2019), or disenrollment from insurance coverage, whichever occurred first, to determine time to discontinuation. Regression analysis was conducted to determine racial/ethnic disparities in ET use adjusting for patients demographic, clinical, tumor characteristics and county-level socioeconomic factors. RESULTS: Among women with continuous insurance coverage, 81% initiated ET within 1 year of diagnosis; 80% were compliant in the first year of ET use and 27.4% discontinued ET by year 5 among those who initiated ET in the first year. There were no racial/ethnic differences in ET initiation or first-year compliance adjusting for covariates. NHB women were significantly less likely to discontinue ET within 5 years after ET initiation compared to NHW women after (HR, 95% CI, 0.76, 0.58-0.98; P = .035). CONCLUSION: After adjusting for patients' and tumor characteristics, there were no racial/ethnic differences in ET initiation within 1 year of diagnosis and ET compliance within first year of ET use. However, NHB women were less likely to discontinue ET within 5 years of initiation.
Asunto(s)
Antineoplásicos Hormonales , Neoplasias de la Mama , Disparidades en Atención de Salud , Cumplimiento de la Medicación , Humanos , Femenino , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Neoplasias de la Mama/etnología , Arkansas/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Antineoplásicos Hormonales/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Adulto , Anciano , Bases de Datos Factuales , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismoRESUMEN
OBJECTIVES: To understand and describe attitudes toward general health checkups, breast health knowledge, cultural beliefs, and health-promoting behaviors among Myanmar American immigrant women in the United States. SAMPLE & SETTING: 267 women participated in the study. 10 women were excluded because of missing data, so the total sample size was 257 participants. METHODS & VARIABLES: A descriptive, cross-sectional survey design was used to describe and investigate breast health perceptions and behaviors. RESULTS: Nearly 75% of the study sample reported having negative attitudes toward general health checkups and were found to have less accurate breast health knowledge and more fatalistic views about breast cancer. Only 29% of older women adhered to mammogram recommendations. Younger women reported more barriers to mammograms, and older women reported fewer barriers to mammograms. IMPLICATIONS FOR NURSING: This study demonstrated the need for additional research focusing on unique perspectives when investigating breast health practices among Myanmar American immigrant women. The findings highlight the essential need to build a strong partnership with stakeholders to combat breast health disparities and address the complex nature of acculturation.
Asunto(s)
Neoplasias de la Mama , Emigrantes e Inmigrantes , Conocimientos, Actitudes y Práctica en Salud , Mamografía , Humanos , Femenino , Adulto , Persona de Mediana Edad , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Estudios Transversales , Neoplasias de la Mama/etnología , Neoplasias de la Mama/psicología , Estados Unidos , Mianmar/etnología , Mamografía/estadística & datos numéricos , Mamografía/psicología , Anciano , Conocimientos, Actitudes y Práctica en Salud/etnología , Detección Precoz del Cáncer/estadística & datos numéricos , Detección Precoz del Cáncer/psicología , Asiático/psicología , Asiático/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven , Conductas Relacionadas con la Salud/etnología , Tamizaje Masivo/estadística & datos numéricos , Tamizaje Masivo/psicologíaRESUMEN
OBJECTIVE: To examine how women who have emigrated from the Middle East and North Africa (MENA) region perceive breast cancer risk and screening in Canada and how they approach breast health, and to explore barriers to breast cancer screening in this population. DESIGN: Focused ethnography. SETTING: Edmonton, Alta. PARTICIPANTS: Women who were born in MENA countries (eg, Egypt, Iraq, Lebanon, Libya, Saudi Arabia, Somalia, Sudan, and Syria) and had immigrated to Canada less than 5 years prior to study recruitment and lived in Edmonton, Alta. METHODS: Six focus groups were conducted over a 6-week period in July and August 2018 with 6 participants in each group (N=36); results were analyzed thematically. MAIN FINDINGS: Three broad themes were identified: knowledge about breast health, cancer risk, and screening services; barriers to maintaining breast health and to screening; and potential solutions for overcoming these barriers. Findings indicated participants have limited knowledge about breast cancer screening practices in Alberta and that multiple barriers to screening remain. CONCLUSION: This study can help inform the development of culturally appropriate interventions to overcome barriers and to motivate women from MENA countries to use breast cancer screening.
Asunto(s)
Neoplasias de la Mama , Detección Precoz del Cáncer , Emigrantes e Inmigrantes , Grupos Focales , Investigación Cualitativa , Humanos , Femenino , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/etnología , Detección Precoz del Cáncer/psicología , Detección Precoz del Cáncer/estadística & datos numéricos , Emigrantes e Inmigrantes/psicología , Alberta , Adulto , Persona de Mediana Edad , Conocimientos, Actitudes y Práctica en Salud/etnología , África del Norte/etnología , Medio Oriente/etnología , AncianoRESUMEN
PURPOSE: Palliative care plays essential roles in cancer care. However, differences in receipt among individuals identifying as Asian American, Native Hawaiian, and Other Pacific Islanders (AA&NHPI) with cancer are not well-characterized, especially when these diverse groups are disaggregated. We characterized disparities in receipt of palliative care among AA&NHPI patients with AJCC Stage IV prostate, breast, or lung cancer. METHODS: We performed multivariable logistic regressions were performed in this retrospective cohort analysis, using deidentified data from the National Cancer Database (NCDB) of patients diagnosed with AJCC analytic group stage IV breast, lung, or prostate cancer (2004-2018) who were White or of Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. We conducted multivariable logistic regression analyses in a retrospective cohort study using deidentified data from the National Cancer Database (NCDB). The study included patients diagnosed with AJCC analytic group Stage IV breast, lung, or prostate cancer between 2004 and 2018, who were White or identified as Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. Adjusted odds ratios and 95% confidence intervals of receiving palliative care were measured when comparing White vs. AA&NHPI patients as one cohort and White vs. disaggregated AA&NHPI patients, adjusting for clinical, socioeconomic, and demographic covariates. RESULTS: Among 775,289 individuals diagnosed with cancer (median age: 68 years), no significant differences in palliative care receipt were observed between White patients and aggregated AA&NHPI patients among patients with prostate, breast, or lung cancer. However, disaggregated analyses revealed reduced palliative care receipt for breast cancer patients of Asian Indian/Pakistani descent (AOR 0.75, 95% CI, 0.60-0.94, P = 0.011) and for lung cancer patients of Chinese, Vietnamese, Thai, and Asian Indian/Pakistani descent compared to White patients (Chinese AOR 0.88, [0.81-0.94], P = 0.001; Vietnamese AOR 0.89, [0.80 to 0.99], P = 0.032; Thai AOR 0.64, [0.44-0.92], P = 0.016; Asian Indian/Pakistani AOR 0.83, [0.74-0.93], P = 0.001). Palliative care was greater for patients of Japanese and Hawaiian descent with prostate cancer (Japanese AOR 1.92, [1.32-2.75], P = 0.001; Hawaiian AOR 2.09, [1.20-3.66], P = 0.009), breast cancer (Japanese AOR 1.72, [1.21-2.43], P = 0.001; Hawaiian AOR 1.70, [1.08-2.67], P = 0.021), and lung cancer (Japanese AOR 1.92, [1.70-2.17], P < 0.001; Hawaiian AOR 2.95, [2.5-3.5], P < 0.001), as well as patients of Other Pacific Islander descent with lung cancer (AOR 1.62, [1.34-1.96], P < 0.001). CONCLUSIONS AND RELEVANCE: Our findings demonstrate disparities in receipt of palliative care upon disaggregation of diverse AA&NHPI groups, the need for disaggregated research and targeted interventions that address the unique cultural, socioeconomic, and healthcare system barriers to palliative care receipt.
Asunto(s)
Asiático , Disparidades en Atención de Salud , Nativos de Hawái y Otras Islas del Pacífico , Cuidados Paliativos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Asiático/estadística & datos numéricos , Neoplasias de la Mama/terapia , Neoplasias de la Mama/patología , Neoplasias de la Mama/etnología , Estudios de Cohortes , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Modelos Logísticos , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/etnología , Neoplasias Pulmonares/patología , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Metástasis de la Neoplasia , Neoplasias/terapia , Neoplasias/etnología , Neoplasias/patología , Cuidados Paliativos/estadística & datos numéricos , Neoplasias de la Próstata/terapia , Neoplasias de la Próstata/etnología , Neoplasias de la Próstata/patología , Estudios Retrospectivos , Estados UnidosRESUMEN
PURPOSE: Asian American, Native Hawaiian, and Pacific Islander (AANHPI) patient populations are often defined as one monolithic group in medical research despite cultural, socioeconomic, and clinical heterogeneity. Although the general AANHPI population is underrepresented in reception of postmastectomy breast reconstruction, existing literature has not characterized the disaggregation of such rates for AANHPI ethnic subgroups. METHODS: Patients who underwent mastectomy were identified in the 2007 to 2020 registries within the Surveillance, Epidemiology and End Results database. Patients were stratified by race and ethnicity, and additional demographic and oncologic variables were collected. Multivariate binary logistic regression was conducted to assess for reception of postmastectomy immediate breast reconstruction (p < 0.05). RESULTS: Among 33,422 AANHPI patients who underwent mastectomy, South Asian patients were associated with the highest breast reconstruction rates (33%) and Melanesians with the lowest (15%). Overall, AANHPI patients were associated with a lower breast reconstruction rate than non-Hispanic Whites (27% vs. 35%; p < 0.001). This difference increased from 6.4% in 2007 to 10% in 2020. After controlling for demographic and oncologic covariates, all AANHPI ethnic subgroups predicted a lower likelihood of breast reconstruction than non-Hispanic Whites (p < 0.001). Odds ratios for reconstruction ranged from 0.17 [95% confidence interval (95% CI), 0.11-0.27] for Melanesian patients to 0.45 (95% CI, 0.42-0.48) for South Asian patients. CONCLUSIONS: Disparities in the receipt of immediate breast reconstruction exist within the AANHPI patient population in the United States. This analysis supported the need for disaggregation in plastic surgery research for improved knowledge and targeted interventions.
Asunto(s)
Asiático , Neoplasias de la Mama , Mamoplastia , Mastectomía , Nativos de Hawái y Otras Islas del Pacífico , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Asiático/estadística & datos numéricos , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/etnología , Mamoplastia/estadística & datos numéricos , Mastectomía/estadística & datos numéricos , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Programa de VERF , Estados UnidosRESUMEN
BACKGROUND: Hereditary breast cancer is characterised by the presence of a pathogenic sequence variant passed from one generation to the next. These cancers are aggressive, develop early, and account for 5 - 10% of all breast cancer cases. In South Africa (SA), the common variants that predispose to hereditary breast cancer have been well documented among white patients and form part of screening panels during targeted testing. For non-white patients, common variants are not well understood, and as such, all populations are offered the same test optimised for white patients. This carries a risk of misdiagnosis, the consequences of which include recurrence and increased mortality. OBJECTIVES: To retrospectively describe genetic trends in the black African and Indian breast cancer patients from KwaZulu-Natal Province, SA. METHODS: We reviewed clinical and genetic data of breast cancer and high-risk patients who consulted at Inkosi Albert Luthuli Central Hospital between 2011 and 2021. Inclusion criteria were based on clinical and demographic characteristics as defined by SA clinical guidelines. RESULTS: Black African patients were young (mean 37.6 years, standard deviation 11.16) and had the majority of triple-negative tumours (37.5%). Indians represented 50% of bilateral breast cancers and of high-risk individuals. We identified 30 pathogenic BRCA1/2 sequence variants, four large genomic rearrangements and 13 variants of unknown significance. Twenty black patients carried 12, 13 white patients carried 4, 25 Indian patients carried 16, and 3 coloured patients carried 3 pathogenic sequence variants. The most frequent variants were BRCA2 c.5771_5774del, p.Ile1924fs among black patients, BRCA2 c.7934del, p.Arg2645fs among white patients, and BRCA2 c.8754+1G>A among Indian patients. None of the founder mutations common in white patients was reported in either black, Indian or coloured patients, which explains why black, Coloured and Indian SA patients consistently test negative during targeted screening. CONCLUSION: This study highlights unique genetic trends for SA populations and the need for more inclusive targeted tests that are optimal for these populations.
Asunto(s)
Proteína BRCA1 , Proteína BRCA2 , Población Negra , Neoplasias de la Mama , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Población Negra/genética , Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias de la Mama/genética , Neoplasias de la Mama/etnología , Predisposición Genética a la Enfermedad , Mutación , Estudios Retrospectivos , Sudáfrica/epidemiologíaRESUMEN
OBJECTIVE: This study aimed to assess ethnic inequalities in the coverage and utilization of cancer screening services among women in Peru. METHODS: Data from the 2017-2023 Demographic and Family Health Survey in Peru were analyzed to evaluate ethnic disparities in screening coverage for breast and cervical cancer, including clinical breast examination (CBE), Pap smear test (PST), and mammography. Measures such as the GINI coefficient and Slope Index of Inequality (SII) were used to quantify coverage and utilization disparities among ethnic groups. RESULTS: The study included 70,454 women aged 30-69. Among women aged 40-69, 48.31% underwent CBE, 84.06% received PST, and 41.69% underwent mammography. It was found inequalities in coverage for any cancer screening (GINI: 0.10), mammography (GINI: 0.21), CBE (GINI: 0.19), and PST (GINI: 0.06), in 25 Peruvian regions. These inequalities were more pronounced in regions with larger populations of Quechua, Aymara, and Afro-Peruvian women. In rural areas, Quechua or Aymara women (SII: -0.83, -0.95, and - 0.69, respectively) and Afro-Peruvian women (SII: -0.80, -0.92, and - 0.58, respectively) experienced heightened inequalities in the uptake of CBE, mammography, and PST, respectively. Like Quechua or Aymara women (SII: -0.50, SII: -0.52, and SII: -0.50, respectively) and Afro-Peruvian women (SII: -0.50, SII: -0.58, and SII: -0.44, respectively) with only a primary education. CONCLUSION: Ethnic inequalities affect breast and cervical cancer screening coverage across regions in Peru. In Quechua, Aymara, and Afro-Peruvian women the uptake of mammography, CBE, and PST was less frequently than their white or mestizo counterparts. These inequalities are attributed to sociodemographic conditions such as lower education levels and residence in rural or non-capital areas.
Asunto(s)
Neoplasias de la Mama , Detección Precoz del Cáncer , Disparidades en Atención de Salud , Mamografía , Prueba de Papanicolaou , Neoplasias del Cuello Uterino , Humanos , Femenino , Perú/etnología , Persona de Mediana Edad , Adulto , Detección Precoz del Cáncer/estadística & datos numéricos , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Mamografía/estadística & datos numéricos , Anciano , Prueba de Papanicolaou/estadística & datos numéricos , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/etnología , Etnicidad/estadística & datos numéricos , Factores Socioeconómicos , Frotis Vaginal/estadística & datos numéricosAsunto(s)
Antineoplásicos Hormonales , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias de la Mama , Ensayos Clínicos como Asunto , Femenino , Humanos , Factores de Edad , Aminopiridinas/administración & dosificación , Aminopiridinas/uso terapéutico , Antineoplásicos Hormonales/administración & dosificación , Antineoplásicos Hormonales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Población Negra , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/etnología , Ensayos Clínicos como Asunto/normas , Quinasa 4 Dependiente de la Ciclina/antagonistas & inhibidores , Quinasa 6 Dependiente de la Ciclina/antagonistas & inhibidores , Purinas/administración & dosificación , Purinas/uso terapéutico , Factores Raciales , Proyectos de Investigación/normas , Factores de TiempoAsunto(s)
Antineoplásicos Hormonales , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias de la Mama , Ensayos Clínicos como Asunto , Femenino , Humanos , Aminopiridinas/administración & dosificación , Aminopiridinas/uso terapéutico , Antineoplásicos Hormonales/administración & dosificación , Antineoplásicos Hormonales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/etnología , Neoplasias de la Mama/patología , Ensayos Clínicos como Asunto/normas , Quinasa 4 Dependiente de la Ciclina/antagonistas & inhibidores , Quinasa 6 Dependiente de la Ciclina/antagonistas & inhibidores , Purinas/administración & dosificación , Purinas/uso terapéutico , Proyectos de Investigación/normas , Factores de Edad , Factores Raciales , Factores de Tiempo , Población NegraAsunto(s)
Antineoplásicos Hormonales , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias de la Mama , Ensayos Clínicos como Asunto , Femenino , Humanos , Factores de Edad , Aminopiridinas/administración & dosificación , Aminopiridinas/uso terapéutico , Antineoplásicos Hormonales/administración & dosificación , Antineoplásicos Hormonales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Población Negra , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/etnología , Neoplasias de la Mama/patología , Ensayos Clínicos como Asunto/normas , Terapia Combinada , Quinasa 4 Dependiente de la Ciclina/antagonistas & inhibidores , Quinasa 6 Dependiente de la Ciclina/antagonistas & inhibidores , Purinas/administración & dosificación , Purinas/uso terapéutico , Factores Raciales , Proyectos de Investigación/normas , Factores de TiempoRESUMEN
In breast tumors, somatic mutation frequencies in TP53 and PIK3CA vary by tumor subtype and ancestry. Emerging data suggest tumor mutation status is associated with germline variants and genetic ancestry. We aimed to identify germline variants that are associated with somatic TP53 or PIK3CA mutation status in breast tumors. A genome-wide association study was conducted in 2,850 women of European ancestry with breast cancer using TP53 and PIK3CA mutation status (positive or negative) as well as specific functional categories [e.g., TP53 gain-of-function (GOF) and loss-of-function, PIK3CA activating] as phenotypes. Germline variants showing evidence of association were selected for validation analyses and tested in multiple independent datasets. Discovery association analyses found five variants associated with TP53 mutation status with P values <1 × 10-6 and 33 variants with P values <1 × 10-5. Forty-four variants were associated with PIK3CA mutation status with P values <1 × 10-5. In validation analyses, only variants at the ESR1 locus were associated with TP53 mutation status after multiple comparisons corrections. Combined analyses in European and Malaysian populations found ESR1 locus variants rs9383938 and rs9479090 associated with the presence of TP53 mutations overall (P values 2 × 10-11 and 4.6 × 10-10, respectively). rs9383938 also showed association with TP53 GOF mutations (P value 6.1 × 10-7). rs9479090 showed suggestive evidence (P value 0.02) for association with TP53 mutation status in African ancestry populations. No other variants were significantly associated with TP53 or PIK3CA mutation status. Larger studies are needed to confirm these findings and determine if additional variants contribute to ancestry-specific differences in mutation frequency. SIGNIFICANCE: Emerging data show ancestry-specific differences in TP53 and PIK3CA mutation frequency in breast tumors suggesting that germline variants may influence somatic mutational processes. This study identified variants near ESR1 associated with TP53 mutation status and identified additional loci with suggestive association which may provide biological insight into observed differences.
Asunto(s)
Neoplasias de la Mama , Fosfatidilinositol 3-Quinasa Clase I , Receptor alfa de Estrógeno , Estudio de Asociación del Genoma Completo , Mutación de Línea Germinal , Proteína p53 Supresora de Tumor , Adulto , Femenino , Humanos , Persona de Mediana Edad , Neoplasias de la Mama/genética , Neoplasias de la Mama/etnología , Fosfatidilinositol 3-Quinasa Clase I/genética , Receptor alfa de Estrógeno/genética , Predisposición Genética a la Enfermedad/genética , Polimorfismo de Nucleótido Simple , Proteína p53 Supresora de Tumor/genética , Población Blanca/genéticaRESUMEN
Importance: Neighborhood deprivation has been associated with increased breast cancer mortality among White women, but findings are inconsistent among Black women, who experience different neighborhood contexts. Accounting for interactions among neighborhood deprivation, race, and other neighborhood characteristics may enhance understanding of the association. Objective: To investigate whether neighborhood deprivation is associated with breast cancer mortality among Black and White women and whether interactions with rurality, residential mobility, and racial composition, which are markers of access, social cohesion, and segregation, respectively, modify the association. Design, Setting, and Participants: This population-based cohort study used Georgia Cancer Registry (GCR) data on women with breast cancer diagnosed in 2010 to 2017 and followed-up until December 31, 2022. Data were analyzed between January 2023 and October 2023. The study included non-Hispanic Black and White women with invasive early-stage (I-IIIA) breast cancer diagnosed between 2010 and 2017 and identified through the GCR. Exposures: The Neighborhood Deprivation Index (NDI), assessed in quintiles, was derived through principal component analysis of 2011 to 2015 block group-level American Community Survey (ACS) data. Rurality, neighborhood residential mobility, and racial composition were measured using Georgia Public Health Department or ACS data. Main Outcomes and Measures: The primary outcome was breast cancer-specific mortality identified by the GCR through linkage to the Georgia vital statistics registry and National Death Index. Cox proportional hazards regression was used to estimate age-adjusted and multivariable-adjusted hazard ratios (HRs) and 95% CIs for the association between neighborhood deprivation and breast cancer mortality. Results: Among the 36â¯795 patients with breast cancer (mean [SD] age at diagnosis, 60.3 [13.1] years), 11â¯044 (30.0%) were non-Hispanic Black, and 25â¯751 (70.0%) were non-Hispanic White. During follow-up, 2942 breast cancer deaths occurred (1214 [41.3%] non-Hispanic Black women; 1728 [58.7%] non-Hispanic White women). NDI was associated with an increase in breast cancer mortality (quintile 5 vs 1, HR, 1.36; 95% CI, 1.19-1.55) in Cox proportional hazards models. The association was present only among non-Hispanic White women (quintile 5 vs 1, HR, 1.47; 95% CI, 1.21-1.79). Similar race-specific patterns were observed in jointly stratified analyses, such that NDI was associated with increased breast cancer mortality among non-Hispanic White women, but not non-Hispanic Black women, irrespective of the additional neighborhood characteristics considered. Conclusions and Relevance: In this cohort study, neighborhood deprivation was associated with increased breast cancer mortality among non-Hispanic White women. Neighborhood racial composition, residential mobility, and rurality did not explain the lack of association among non-Hispanic Black women, suggesting that factors beyond those explored here may contribute to breast cancer mortality in this racial group.
Asunto(s)
Negro o Afroamericano , Neoplasias de la Mama , Características de la Residencia , Población Blanca , Humanos , Femenino , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/etnología , Población Blanca/estadística & datos numéricos , Persona de Mediana Edad , Negro o Afroamericano/estadística & datos numéricos , Georgia/epidemiología , Características de la Residencia/estadística & datos numéricos , Anciano , Adulto , Características del Vecindario/estadística & datos numéricos , Estudios de Cohortes , Sistema de Registros , Disparidades en el Estado de SaludRESUMEN
BACKGROUND: Associations between reproductive factors and risk of breast cancer differ by subtype defined by joint estrogen receptor (ER), progesterone receptor (PR), and HER2 expression status. Racial and ethnic differences in the incidence of breast cancer subtypes suggest etiologic heterogeneity, yet data are limited because most studies have included non-Hispanic White women only. METHODS: We analyzed harmonized data for 2,794 breast cancer cases and 4,579 controls, of whom 90% self-identified as African American, Asian American or Hispanic. Questionnaire data were pooled from three population-based studies conducted in California and data on tumor characteristics were obtained from the California Cancer Registry. The study sample included 1,530 luminal A (ER-positive and/or PR-positive, HER2-negative), 442 luminal B (ER-positive and/or PR-positive, HER2-positive), 578 triple-negative (TN; ER-negative, PR-negative, HER2-negative), and 244 HER2-enriched (ER-negative, PR-negative, HER2-positive) cases. We used multivariable unconditional logistic regression models to estimate subtype-specific ORs and 95% confidence intervals associated with parity, breast-feeding, and other reproductive characteristics by menopausal status and race and ethnicity. RESULTS: Subtype-specific associations with reproductive factors revealed some notable differences by menopausal status and race and ethnicity. Specifically, higher parity without breast-feeding was associated with higher risk of luminal A and TN subtypes among premenopausal African American women. In contrast, among Asian American and Hispanic women, regardless of menopausal status, higher parity with a breast-feeding history was associated with lower risk of luminal A subtype. Among premenopausal women only, luminal A subtype was associated with older age at first full-term pregnancy (FTP), longer interval between menarche and first FTP, and shorter interval since last FTP, with similar OR estimates across the three racial and ethnic groups. CONCLUSIONS: Subtype-specific associations with reproductive factors overall and by menopausal status, and race and ethnicity, showed some differences, underscoring that understanding etiologic heterogeneity in racially and ethnically diverse study samples is essential. Breast-feeding is likely the only reproductive factor that is potentially modifiable. Targeted efforts to promote and facilitate breast-feeding could help mitigate the adverse effects of higher parity among premenopausal African American women.
Asunto(s)
Neoplasias de la Mama , Menopausia , Receptor ErbB-2 , Receptores de Estrógenos , Receptores de Progesterona , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/etnología , Neoplasias de la Mama/genética , Neoplasias de la Mama/metabolismo , California/epidemiología , Estudios de Casos y Controles , Minorías Étnicas y Raciales , Etnicidad/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Paridad , Receptor ErbB-2/metabolismo , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Historia Reproductiva , Factores de Riesgo , Asiático , Negro o AfroamericanoRESUMEN
BACKGROUND: Improved screening uptake is essential for early breast cancer detection, women's health and reducing health disparities. However, minority ethnic and deprived communities often face lower breast cancer screening rates and limited access to culturally tailored educational materials. A recent review found limited culturally tailored materials for breast cancer education. AIM: To investigate the culturally appropriate interfaces and preferences of salon staff in educating their clients about breast cancer METHOD: We used a two-stage approach, following the Double Diamond framework; discover and define phases. Relevant breast cancer materials (i.e., based on cultural appropriateness, English language presentation, and alignment with the UK context) were assessed using the Suitability Assessment of Materials (SAM) toolkit. Interviews with ethnically diverse salon staff provided insights into their needs and preferences for client education materials. Thematic analysis was applied to interview transcripts. RESULTS: Cultural appropriateness was evident in 9/14 (64%) of the materials identified (e.g., targeting black ethnicities with positive representations). Of those, six of them demonstrated an overall SAM rating of 76% ("Superior"). Thematic analysis of interviews identified seven key themes, including the importance of engagement strategies, education and awareness for health promotion, salon staff's role, preferred training methods, supportive materials, inclusivity, representation, and participant satisfaction. CONCLUSION: This study highlights the SAM toolkit's role in selecting suitable educational materials for breast cancer prevention. The research offers prospects for improving breast cancer awareness in ethnically diverse communities and addressing healthcare access disparities, with salon hairdressers emerging as crucial advocates for health promotion.
Asunto(s)
Neoplasias de la Mama , Detección Precoz del Cáncer , Promoción de la Salud , Humanos , Femenino , Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/etnología , Promoción de la Salud/métodos , Peluquería , Reino Unido , Industria de la Belleza , Investigación Cualitativa , Educación del Paciente como Asunto , Etnicidad , Adulto , Competencia CulturalRESUMEN
BACKGROUND: Latin America (LATAM) encompasses a vast region with diverse populations. Despite publicly funded health care systems providing universal coverage, significant socioeconomic and ethno-racial disparities persist in health care access across the region. Breast cancer (BC) incidence and mortality rates in Brazil are comparable to those in other LATAM countries, supporting the relevance of Brazilian data, with Brazil's health care policies and expenditures often serving as models for neighboring countries. We evaluated the impact of mobility on oncological outcomes in LATAM by analyzing studies of patients with BC reporting commuting routes or travel distances to receive treatment or diagnosis. METHODS: We searched MEDLINE (PubMed), Embase, Cochrane CENTRAL, LILACS, and Google Scholar databases. Studies eligible for inclusion were randomized controlled trials and observational studies of patients with BC published in English, Portuguese, or Spanish and conducted in LATAM. The primary outcome was the impact of mobility or travel distance on oncological outcomes. Secondary outcomes included factors related to mobility barriers and access to health services. For studies meeting eligibility, relevant data were extracted using standardized forms. Risk of bias was assessed using the Newcastle-Ottawa Scale. Quantitative and qualitative evidence synthesis focused on estimating travel distances based on available data. Heterogeneity across distance traveled or travel time was addressed by converting reported travel time to kilometers traveled and estimating distances for unspecified locations. RESULTS: Of 1142 records identified, 14 were included (12 from Brazil, 1 from Mexico, and 1 from Argentina). Meta-analysis revealed an average travel distance of 77.8 km (95% CI, 49.1-106.48) to access BC-related diagnostic or therapeutic resources. Nonetheless, this average fails to precisely encapsulate the distinct characteristics of each region, where notable variations persist in travel distance, ranging from 88 km in the South to 448 km in the North. CONCLUSION: The influence of mobility and travel distance on access to BC care is multifaceted and should consider the complex interplay of geographic barriers, sociodemographic factors, health system issues, and policy-related challenges. Further research is needed to comprehensively understand the variables impacting access to health services, particularly in LATAM countries, where the challenges women face during treatment remain understudied. TRIAL REGISTRATION: CRD42023446936.
Asunto(s)
Neoplasias de la Mama , Accesibilidad a los Servicios de Salud , Viaje , Humanos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Femenino , Neoplasias de la Mama/terapia , Neoplasias de la Mama/etnología , América Latina , Viaje/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricosRESUMEN
Breast cancer poses a global health challenge, yet the influence of ethnicity on the tumor microenvironment (TME) remains understudied. In this investigation, we examined immune cell infiltration in 230 breast cancer samples, emphasizing diverse ethnic populations. Leveraging tissue microarrays (TMAs) and core samples, we applied multiplex immunofluorescence (mIF) to dissect immune cell subtypes across TME regions. Our analysis revealed distinct immune cell distribution patterns, particularly enriched in aggressive molecular subtypes triple-negative and HER2-positive tumors. We observed significant correlations between immune cell abundance and key clinicopathological parameters, including tumor size, lymph node involvement, and patient overall survival. Notably, immune cell location within different TME regions showed varying correlations with clinicopathologic parameters. Additionally, ethnicities exhibited diverse distributions of cells, with certain ethnicities showing higher abundance compared to others. In TMA samples, patients of Chinese and Caribbean origin displayed significantly lower numbers of B cells, TAMs, and FOXP3-positive cells. These findings highlight the intricate interplay between immune cells and breast cancer progression, with implications for personalized treatment strategies. Moving forward, integrating advanced imaging techniques, and exploring immune cell heterogeneity in diverse ethnic cohorts can uncover novel immune signatures and guide tailored immunotherapeutic interventions, ultimately improving breast cancer management.