Page 27 - Deleware Medical Journal - September/October 2019
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ORIGINAL RESEARCH
INTRODUCTION
Breast cancer is the most common cancer in women, with an estimated 268,600 new cases projected to occur in 2019, along with 41,760 breast 1 In Delaware alone, there are projected to be 930
new cases, along with 150 breast 1 Although the incidence of breast cancer is higher
in Caucasian patients, breast cancer- patients.1 Lower socioeconomic
status has been associated with health disadvantages and higher mortality across race and ethnicity.1 Further, a higher prevalence of risk factors that increase cancer incidence and mortality — including smoking and obesity — are seen in lower compared to higher socioeconomic status groups.1
Disease Control and Prevention (CDC) as a Body Mass Index (BMI) >30 kg/ m2.2 The prevalence of obesity is higher among AA women compared
to Caucasian women.3 Associations between obesity and incidence of breast cancer have been described throughout the literature. Berstad et al. analyzed data from the Women’s Contraceptive and Reproductive Experiences (CARE) study and calculated multivariate odds ratios as measures of relative risk of breast cancer associated with BMI at
of breast cancer.4 Results of the study reported an inverse relationship with BMI at age 18 and ER-/PR- breast cancer, while current BMI was positively associated with postmenopausal ER+/ PR+ breast cancer.2,4 Bandera et al. evaluated the impact of obesity and
body fat distribution on breast cancer subtypes in AA women,3 and found that in postmenopausal women, higher recent BMI was associated with increased hormone receptor-positive cancer
and decreased risk of triple negative
cancer.3 High young-adult BMI was also associated with decreased premenopausal hormone receptor-positive cancer and all subtypes of postmenopausal cancer.3 It was concluded that multiple mechanisms associating obesity with all subtypes of breast cancer may exist in AA women.2-3
constellation of metabolic dysfunctions including obesity, dyslipidemia, hypertension, and insulin resistance.5
It has been associated with increased risk of chronic diseases, including coronary artery disease, stroke, diabetes, and cancer.5 Dibaba et al. investigated the association between metabolic syndrome and risk of breast cancer mortality by menopausal status, obesity, and subtype.5 Data from 94,555 cancer-free women in the National Institutes of Health-AARP Diet and Health Study Cohort were used to evaluate for prospective associations between metabolic syndrome and risk of breast cancer.5 A 73% increased risk associated with metabolic syndrome and an independent increased risk
was associated with higher waist circumference, elevated cholesterol, and hypertension.5
AA patients living in Delaware have a decreased survival rate across all breast cancer types, which is consistent with nationwide trends in the literature.1 A literature review was performed to try
to identify possible etiologies of the decreased survival. The objective of this study was to assess whether the presence medical comorbidities was associated with decreased survival in AA breast cancer patients in Delaware.
METHODS
A retrospective database review from the HFGCCRI cancer registry from 2006-2010
was performed after receiving Christiana Care Health System Institutional Review Board approval. All patients who were over the age of 18, diagnosed, and
received treatments for breast cancer at
the HFGCCRI during this time period were included. Patients with incomplete registry entries were excluded from evaluation. Data from 1,672 breast cancer patients, 281 of whom were AA patients, were used for investigation. Twenty-eight patients designated as another race were excluded from analysis, leaving a total of 1,644 patients. Collection of demographic data included race, age of diagnosis, and BMI. In addition, collection of all patient comorbidity data included hypertension, >30). Data was analyzed by chi square analysis (P<0.05) and log-rank Mantel
Cox for survival, using Prism 6.0 software. hypertension, diabetes, and obesity.
RESULTS
Data from 1,644 breast cancer patients were analyzed. Breast cancer survival was found to be worse in AA patients. found to be twice as high in Caucasian patients compared to AA (log-rank Mantel Cox p=0.0001, HR =2.63 95%, CI 1.968-6.609). When looking at results were obtained.
Hypertension
A total of 803 out of 1,644 patients carried a diagnosis of hypertension (636 Caucasian and 167 AA). AA patients
are more likely to have hypertension than Caucasians (chi square p=0.001). Patients with hypertension have worse without (log-rank Mantel Cox p=0.037). difference was found between races (log- rank Mantel Cox p=0.2547).
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