Differences in Treatment and Outcome Between African-American and White Women With Endometrial Cancer

Purpose: To investigate disparities in treatment and outcomes between African-American and white women with endometrial cancer. Patients and Methods: We analyzed 1992 to 1998 Surveillance, Epidemiology, and End Results data for 21,561 women with epithelial cancers of the endometrium. Sequential Cox proportional hazard models were used to determine the association between tumor characteristics (stage, grade, and histologic type), sociodemographic characteristics (age and marital status), and treatment (surgery and radiation therapy) and the racial difference in mortality. Results: The unadjusted hazard ratio (HR) for death from endometrial cancer for African-American women compared with white women was 2.57. However, African-American women were significantly more likely to present with advanced-stage disease and have poorly differentiated tumors or tumors with an unfavorable histologic type and were significantly less likely to undergo definitive surgery at all stages of disease. Adjusting for tumor and sociodemographic characteristics lowered the HR for African-American women to 1.80. Further adjustment for the use of surgery reduced the HR to 1.51. The association between surgery and survival was stronger among white women (HR, 0.26) than among African-American women (HR, 0.44). Conclusion: African-American women with endometrial cancer are significantly less likely to undergo primary surgery and have significantly shorter survival than white women with endometrial cancer. Racial differences in treatment are associated with racial differences in survival. The association between use of surgery and survival is weaker among African-American than white women, raising questions about potential racial differences in the effectiveness of surgery.

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Postprandial endothelial function does not differ in women by race: an insulin resistance paradox?

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00434.2011 ◽

2012 ◽

Vol 302 (2) ◽

pp. E218-E225 ◽

Cited By ~ 5

Author(s):

Ranganath Muniyappa ◽

Vandana Sachdev ◽

Stanislav Sidenko ◽

Madia Ricks ◽

Darleen C. Castillo ◽

...

Keyword(s):

Insulin Resistance ◽

African American ◽

Insulin Sensitivity ◽

Endothelial Function ◽

African American Women ◽

Racial Differences ◽

White Women ◽

Sensitivity Index ◽

American Women ◽

Insulin Resistant

Insulin resistance is associated with endothelial dysfunction. Because African-American women are more insulin-resistant than white women, it is assumed that African-American women have impaired endothelial function. However, racial differences in postprandial endothelial function have not been examined. In this study, we test the hypothesis that African-American women have impaired postprandial endothelial function compared with white women. Postprandial endothelial function following a breakfast (20% protein, 40% fat, and 40% carbohydrate) was evaluated in 36 (18 African-American women, 18 white women) age- and body mass index (BMI)-matched (age: 37 ± 11 yr; BMI: 30 ± 6 kg/m2) women. Endothelial function, defined by percent change in brachial artery flow-mediated dilation (FMD), was measured at 0, 2, 4, and 6 h following a meal. There were no significant differences between the groups in baseline FMD, total body fat, abdominal visceral fat, and fasting levels of glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, or serum estradiol. Although African-American women were less insulin-sensitive [insulin sensitivity index (mean ± SD): 3.6 ± 1.5 vs. 5.2 ± 2.6, P = 0.02], both fasting triglyceride (TG: 56 ± 37 vs. 97 ± 49 mg/dl, P = 0.007) and incremental TG area under the curve (AUC0–6hr: 279 ± 190 vs. 492 ± 255 mg·dl−1·min−1·10−2, P = 0.008) were lower in African-American than white women. Breakfast was associated with a significant increase in FMD in whites and African-Americans, and there was no significant difference in postprandial FMD between the groups ( P > 0.1 for group × time interactions). Despite being insulin-resistant, postprandial endothelial function in African-American women was comparable to white women. These results imply that insulin sensitivity may not be an important determinant of racial differences in endothelial function.

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Racial Differences in Oncogene Mutations Detected in Early-Stage Low-Grade Endometrial Cancers

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31826b1110 ◽

2012 ◽

Vol 22 (8) ◽

pp. 1367-1372 ◽

Cited By ~ 13

Author(s):

Michele L. Cote ◽

Govindaraja Atikukke ◽

Julie J. Ruterbusch ◽

Sara H. Olson ◽

Shawnita Sealy-Jefferson ◽

...

Keyword(s):

African American ◽

Endometrial Cancer ◽

Endometrial Carcinoma ◽

African American Women ◽

Racial Differences ◽

Early Stage ◽

Fisher Exact Test ◽

Low Grade ◽

Urban Hospital ◽

American Women

ObjectiveTo describe the pattern and frequency of oncogene mutations in white and African American women with endometrial cancer and to determine if racial differences in oncogene mutations exist among women with pathologically similar tumors.MethodsPatients with endometrial cancer from a large urban hospital were identified through medical records, and representative formalin-fixed paraffin-embedded tumor blocks were retrieved. The study sample included 150 patients (84 African Americans) who underwent total abdominal hysterectomy for endometrial cancer. The Sequenom MassARRAY system and the OncoCarta Assay version 1.0 (Sequenom) were used to test for 238 mutations in 19 common oncogenes. The χ2test and the Fisher exact test were used to assess differences in distribution of variables by race and oncogene mutation status.ResultsThere were 20 mutations identified in 2 oncogenes (PIK3CAandKRAS) in tumors from 19 women (12.7%). Most of the mutations were found inPIK3CA(16/20). Thirteen percent of endometrioid tumors harbored mutations (11PIK3CAand 2KRAS) as did 29% of the malignant mixed Mullerian tumors (3PIK3CAand 1KRAS). There were no observed mutations in serous, clear cell, or mucinous tumor types. Among low-grade endometrioid cancers, tumors from African American patients were significantly associated with harboring either aKRASorPIK3CAmutation (P= 0.04), with 7PIK3CAmutations and all 4KRASmutations identified in African American women.ConclusionsThis study provides preliminary evidence that oncogene mutation frequency of some subtypes of histologically similar endometrial carcinoma differ by race. Additional studies are needed to further explore this phenomenon in patients with endometrial carcinoma.

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Race-Specific Association of Caesarean-Section Delivery with Body Size at Age 2 Years

Ethnicity & Disease ◽

10.18865/ed.26.1.61 ◽

2016 ◽

Vol 26 (1) ◽

pp. 61 ◽

Cited By ~ 1

Author(s):

Andrea E Cassidy-Bushrow ◽

Ganesa Wegienka ◽

Suzanne Havstad ◽

Albert M. Levin ◽

Susan V. Lynch ◽

...

Keyword(s):

African American ◽

Caesarean Section ◽

African American Women ◽

Birth Cohort ◽

Racial Differences ◽

White Women ◽

Specific Effect ◽

Delivery Mode ◽

Font Size ◽

African American Mothers

Objectives: African American children are at higher risk of obesity than White children and African American women are more likely to undergo caesarean-section (CS) delivery than White women. CS is associated with childhood obesity, however, little is known whether this relationship varies by race.We examined if the association of CS with obesity at age 2 years varied by race. Design: Longitudinal birth cohort.Setting: Birth cohort conducted in a health care system in metropolitan Detroit, Michigan with follow-up at age 2 years.Participants: 639 birth cohort participants; 367 children (57.4%) were born to African American mothers and 230 (36.0%) children were born via CS.Main Outcome Measure: Obesity defined as body mass index ≥95th percentile at age 2 years.Results: Slightly more children of African American (n=37; 10.1%) than non-African American mothers (n=18; 6.6%) were obese (P=.12). There was evidence of effect modification between race and delivery mode with obesity at age 2 years (interaction P=.020). In children of African-American mothers, CS compared to vaginal birth was associated with a significantly higher odds of obesity (aOR=2.35 (95% CI: 1.16, 4.77), P=.017). In contrast, delivery mode was not associated with obesity at age 2 years in children of non-African-American mothers (aOR=.47 (95% CI: .13, 1.71), P=.25). Conclusions: There is evidence for a race-specific effect of CS on obesity at age 2 years; potential underlying mechanisms may be racial differences in the developing gut microbiome or in epigenetic programming. Future research is needed to determine if this racial difference persists into later childhood. Ethn Dis. 2016;26(1):61-68; doi:10.18865/ed.26.1.61

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African American Women and Domestic Violence: Addressing their Voice of Silence

10.35455/brk12345678 ◽

2019 ◽

Author(s):

Bernice Kennedy ◽

Chalice Rhodes (Former Jenkins)

Keyword(s):

United States ◽

Domestic Violence ◽

African American ◽

Black Women ◽

African American Women ◽

White Women ◽

The United States ◽

Slave Owner ◽

American Women ◽

Strong Black Women

Abstract Historically, during slavery, the international slave trade promoted normalization of violence against African American women. During slavery, African American women endured inhuman conditions because of the majority race views of them as being over-sexualized, physically strong, and immoral. This perception of the African American women as being highly sexual and more sexual than white women results in slave owner justifying their sexual violation and degrading of the African American women. The stereotypical representations of African American women as strong, controlling, dangerous, fearless, and invulnerable may interfere with the African American women receiving the needed services for domestic violence in the community. The Strong Black Women Archetype has been dated back to slavery describing their coping mechanism in dealing with oppression by developing a strong, less traditionally female role. The authors developed a model: The Multidimensional Perspectives of Factors Contributing to Domestic Violence of African American Women in the United States. This model depicts historically, the factors contributing to domestic violence of African American women in the United States. Also, this model addressed the African American women subscribing to the Strong Black Women Archetype to cope with domestic violence. Despite the increase in domestic violence in African American women, they focused more on the issue of racism instead of sexism in America. African American women have experienced the two obstacles of racism and sexism in America. However, African American women and men believe racism is more critical than sexism. Therefore, domestic violence in the African American population may remain silent because of cultural loyalty. However, the voice of silence of African American females is gradually changing with the upcoming generations.

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Meaning of Pregnancy Terms Among African-American Women

The Qualitative Report ◽

10.46743/2160-3715/2017.2543 ◽

2017 ◽

Author(s):

Stephanie Solomon ◽

Sandra Suther ◽

Ivette Lopez ◽

Alicestine Ashford ◽

Linda Amankwaa ◽

...

Keyword(s):

African American ◽

African American Women ◽

White Women ◽

Childbearing Age ◽

American Women ◽

Planning Policy ◽

Pregnancy Intendedness ◽

Women's Lives ◽

Recurrent Patterns ◽

Descriptive Method

The concept of pregnancy intendedness is complex and may not bear the same meaning to all women. Moreover, researcher definition and women’s meaning were thought to be different. Some researchers have indicated that it is unclear how well women understand and relate to questions used by the National Survey of Family Growth (NSFG) and how the classifications relate to women’s lives. The purpose of this study was to explore the meaning of terms such as planned and/or intended pregnancy among African-American women of childbearing age using a qualitative exploratory descriptive method. Although African-American women want children, they are three times as likely to experience an unintended pregnancy as white women. Data extracted from transcripts were coded and analyzed for recurrent patterns and themes. For this study, the Theory of Planned Behavior (Ajzen & Fishbein, 1980) was employed to frame interview questions and to interpret data. Findings suggest participants and partners often did not have the same perceptions or meanings of pregnancy planning or intentions. These findings have implications for research and family planning policy.

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African American Women, Racism and Triple Oppression

Interdisciplinary Journal of Management and Social Sciences ◽

10.3126/ijmss.v1i1.34615 ◽

2020 ◽

Vol 1 (1) ◽

pp. 113-117

Author(s):

Rajendra Prasad Chapagain

Keyword(s):

African American ◽

African American Women ◽

Racial Discrimination ◽

Black Men ◽

Black Males ◽

White Women ◽

Black American ◽

American Women ◽

Black American Women ◽

Sexual Repression

African American women have been made multiple victims: racial discrimination by the white community and sexual repression by black males of their own community. They have been subjected to both kind of discrimination - racism and sexism. It is common experience of black American women. Black American women do have their own peculiar world and experiences unlike any white or black men and white women. They have to fight not only against white patriarchy and white women's racism but also against sexism of black men within their own race. To be black and female is to suffer from the triple oppression- sexism, racism and classicism.

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Determinants of Mammographic Breast Density by Race Among a Large Screening Population

JNCI Cancer Spectrum ◽

10.1093/jncics/pkaa010 ◽

2020 ◽

Author(s):

Justin Xavier Moore ◽

Yunan Han ◽

Catherine Appleton ◽

Graham Colditz ◽

Adetunji T Toriola

Keyword(s):

African American ◽

African American Women ◽

Breast Density ◽

White Women ◽

Menopausal Status ◽

Dense Breast ◽

Mammographic Breast Density ◽

Age At First Birth ◽

American Women ◽

Hispanic White

Abstract BACKGROUND Due to mixed reports from smaller studies, we examined associations of race with mammographic breast density and evaluated racial differences in the determinants of breast density. METHODS Participants included 37,839 women (23,166 non-Hispanic White, and 14,673 African American women) receiving screening mammograms at the Joanne Knight Breast Health Center at Washington University School of Medicine, St. Louis, Missouri from June 2010 to December 2015. Mammographic breast density was assessed using Breast Imaging Reporting and Data System (5th edition). To determine the association of race and participant characteristics with mammographic breast density, we used multivariable polytomous logistic regression models (reference group: almost entirely fatty). RESULTS African American women had increased odds of extremely dense (adjusted odds ratio (AOR) = 1.31, 95% CI = 1.13–1.52) and reduced odds of heterogeneously dense breasts (AOR= 0.91, 95% CI = 0.84 – 0.99) compared to non-Hispanic White women. Altogether, race, parity and age at first birth, age, current body mass index (BMI), BMI at age 18, menarche, family history of breast cancer, oral contraceptive use, alcohol, and menopausal status explained 33% of the variation in mammographic breast density. Among African American and non-Hispanic White women these factors explained nearly 28.6% and 33.6% of the variation in mammographic density, respectively. Current BMI provided the greatest explanation of breast density (26.2% overall, 22.2% in African American, and 26.2% in non-Hispanic White women). CONCLUSIONS The determinants of mammographic breast density were generally similar between African-American women and non-Hispanic white women. After adjustments for confounders, African Americans had higher likelihood of extremely dense breast but lower likelihood of heterogeneously dense breast. The greatest explanation of breast density was provided by BMI, regardless of race.

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Latina and African American Women: Continuing Disparities in Health

International Journal of Health Services ◽

10.2190/mncj-nb8e-m0wa-1fgm ◽

1993 ◽

Vol 23 (3) ◽

pp. 555-584 ◽

Cited By ~ 34

Author(s):

Marsha Lillie-Blanton ◽

Rose Marie Martinez ◽

Andrea Kidd Taylor ◽

Betty Garman Robinson

Keyword(s):

African American ◽

Social Class ◽

Health Services ◽

African American Women ◽

Racial Differences ◽

Family Income ◽

Work Conditions ◽

Social Conditions ◽

Minority Population ◽

American Women

Women of all races have faced incredible challenges as they sought to realize the promises of America. For women of color, these challenges were compounded by the second-class citizenship of U.S. racial and ethnic minority population groups. In an effort to assess the quality of life experienced by Latina and African American women, this article provides descriptive information on racial/ethnic differences in women's social conditions, health status, exposure to occupational and environmental risks, and use of health services. When possible, indices are stratified by family income to limit the effects of social class on the comparison of racial differences. The authors provide evidence that Latina and African American women are more likely than nonminority women to encounter social environments (e.g., poverty, densely populated neighborhoods, hazardous work conditions) that place them at risk for ill-health and injury. Although persistent racial disparities in health are often attributed to the lifestyle behaviors of racial minority populations, they are undoubtedly a consequence of poorer social conditions as well as barriers in access to quality health services. To achieve further gains, public policies must reduce social inequalities (i.e., by gender, race, and social class) and assure greater equity in access to resources that facilitate healthier environments and lifestyles. Public health initiatives should be community-based, reflecting a shared partnership that actively engages minority women in decision-making about their lives.

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Body mass index at age 18 years and recent body mass index in relation to risk of breast cancer overall and ER/PR/HER2-defined subtypes in white women and African-American women: a pooled analysis

Breast Cancer Research ◽

10.1186/s13058-017-0931-5 ◽

2018 ◽

Vol 20 (1) ◽

Cited By ~ 11

Author(s):

Huiyan Ma ◽

Giske Ursin ◽

Xinxin Xu ◽

Eunjung Lee ◽

Kayo Togawa ◽

...

Keyword(s):

Breast Cancer ◽

Body Mass Index ◽

African American ◽

African American Women ◽

Body Mass ◽

White Women ◽

Pooled Analysis ◽

American Women

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Does Universal Coverage Mitigate Racial Disparities in Potentially Avoidable Maternal Complications?

American Journal of Perinatology ◽

10.1055/s-0040-1701195 ◽

2020 ◽

Author(s):

Anju Ranjit ◽

Tomas Andriotti ◽

Cathaleen Madsen ◽

Tracey Koehlmoos ◽

Barton Staat ◽

...

Keyword(s):

African American ◽

Racial Disparities ◽

African American Women ◽

White Women ◽

Racial Group ◽

Direct Care ◽

Health Coverage ◽

African American Mothers ◽

Maternal Complications ◽

American Women

Abstract Objective Potentially avoidable maternity complications (PAMCs) have been validated as an indicator of access to quality prenatal care. African-American mothers have exhibited a higher incidence of PAMCs, which has been attributed to unequal health coverage. The objective of this study was to assess if racial disparities in the incidence of PAMCs exist in a universally insured population. Study Design PAMCs in each racial group were compared relative to White mothers using multivariate logistic regression. Stratified subanalyses assessed for adjusted differences in the odds of PAMCs for each racial group within direct versus purchased care. Results A total of 675,553 deliveries were included. Among them, 428,320 (63%) mothers were White, 112,170 (17%) African-American, 37,151 (6%) Asian/Pacific Islanders, and 97,912 (15%) others. African-American women (adjusted odds ratio [aOR]: 1.05, 95% CI: 1.02–1.08) were more likely to have PAMCs compared with White women, and Asian women (aOR: 0.92, 95% CI: 0.89–0.95) were significantly less likely to have PAMCs compared with White women. On stratified analysis according to the system of care, equal odds of PAMCs among African-American women compared with White women were realized within direct care (aOR: 1.03, 95% CI: 1.00–1.07), whereas slightly higher odds among African-American persisted in purchased (aOR: 1.05, 95% CI: 1.01–1.10). Conclusion Higher occurrence of PAMCs among minority women sponsored by a universal health coverage was mitigated compared with White women. Protocol-based care as in the direct care system may help overcome health disparities.

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