Are racial differences in obesity and insulin resistance related to aggressive breast cancer?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18157-e18157
Author(s):  
Emily Gallagher ◽  
Derek Leroith ◽  
Sheldon M. Feldman ◽  
Elisa R. Port ◽  
Neil B Friedman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Insulin Resistance ◽  
Black Women ◽  
Racial Differences ◽  
White Women ◽  
Fasting Blood Glucose ◽  
Prognostic Index ◽  
Nottingham Prognostic Index ◽  
Insulin Resistant ◽  
Aggressive Breast Cancer

e18157 Background: Black women are more likely to die of breast cancer and develop more aggressive subtypes than white women. Black women are also more likely to be obese and have insulin resistance than white women. Insulin resistance has been associated with faster tumor growth but has not been studied as a potential mediator of racial disparities in women with breast cancer. We hypothesized that black women would present with more aggressive breast cancer and this would be associated with obesity and insulin resistance. Methods: We recruited 1017 (80% white, 20% black) women with new primary breast cancer, measured fasting blood glucose and insulin, body mass index (BMI), triple negative breast cancer (TNBC) & Nottingham prognostic index (NPI). We classified aggressive breast cancer as NPI > 4.4. We calculated insulin resistance scores (HOMA) and classified insulin resistance as HOMA > 2.8. Patients self-identified race. Results: Of 1017 women, average age was 58 years (SD = 12.0). 373 (37%) were stage 2+ at time of diagnosis; 19% had an NPI > 4.4. Black women presented with higher stage of cancer than white women (stage 2+: 45% vs 35%; p = 0.01), more TNBC than white women (10% vs 5%, p = 0.01), were more insulin resistant (24% vs 11%, p < .0001), had higher BMI (31.4kg/m2 vs 26.6 kg/m2; p < .0001) and NPI > 4.4 (29% vs. 17%, p = 0.0002) than white women. HOMA score was positively but not significantly associated with NPI score (r = 0.05; p = 0.1). Multivariate mediation regression model suggested that HOMA_IR does not mediate the effect from black race to higher NPI score (β = 0.01; 95%CI: -0.017 to 0.039). Conclusions: In women with newly diagnosed breast cancer, black women are more likely to be obese, have higher HOMA & NPI scores than white women. While these data are consistent with the hypothesized relationship of hyperinsulinemia promoting more aggressive breast cancer, to date, insulin resistance does not appear to mediate the effect of race and poor prognostic breast cancer.

scholarly journals Insulin Resistance and Inflammation in Black Women with and without Breast Cancer: Cause for Concern

2016 ◽  
Vol 26 (4) ◽  
pp. 513 ◽  
Author(s):  
Kathleen A. Griffith ◽  
Seon Yoon Chung ◽  
Shijun Zhu ◽  
Alice S. Ryan
Keyword(s):  
Breast Cancer ◽  
Insulin Resistance ◽  
Black Women ◽  
White Women ◽  
Cancer Recurrence ◽  
Control Group ◽  
Study Objective ◽  
Increased Risk ◽  
Tnf Α ◽  
History Of

<p class="Pa7"><strong>Objective: </strong>After chemotherapy for breast cancer, Black women gain more weight and have an increased mortality rate compared with White women. Our study objective was to compare biomarkers associated with obesity in Black women with and without a history of breast cancer.</p><p class="Pa7"><strong>Design: </strong>Case-control</p><p class="Pa7"><strong>Setting: </strong>Academic/federal institution</p><p class="Pa7"><strong>Participants: </strong>Black women with a history of breast cancer (cases) and age-matched controls.</p><p class="Pa7"><strong>Methods: </strong>We compared insulin resistance, inflammation, and lipids in overweight and obese Black women with a history of breast cancer (n=19), age similar controls (n=25), and older controls (n=32). Groups did not differ on mean body mass index (BMI), which was 35.4 kg/m2, 36.0 kg/m2, and 33.0 kg/m2, respectively.</p><p class="Default"><strong>Main Outcome Measures: </strong>Insulin resis­tance (HOMA-IR); inflammation (TNF-α, IL-1b, IL-6, IL-8, CRP); lipids (cholesterol, triglycerides).</p><p class="Pa7"><strong>Results: </strong>Cases had 1.6 and 1.38 times higher HOMA-IR values compared with age similar and older controls, respectively (P≤.001 for both). TNF-α and IL-1b were significantly higher in cases compared with both control groups (P&lt;.001 for both). IL-6 was also higher in cases compared with age-similar controls (P=.007), and IL-8 was lower in cases compared with older controls (P&lt;.05). Lipids did not differ between cases and either control group.</p><p class="Default"><strong>Conclusions: </strong>Black women with breast cancer were significantly more insulin resis­tant with increased inflammation compared not only with age similar controls but with women who were, on average, a decade older. These biomarkers of insulin resistance and inflammation may be associated with increased risk of breast cancer recurrence and require ongoing evaluation, especially given the relatively abnormal findings com­pared with the controls in this underserved group. <em></em></p><p class="Default"><em>Ethn Dis. </em>2016;26(4):513-520; doi:10.18865/ed.26.4.513</p>

Sex and Race Differences in the Risk of Ischemic Stroke Associated With Fasting Blood Glucose in REGARDS

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012296
Author(s):  
Tracy E. Madsen ◽  
D. Leann Long ◽  
April P. Carson ◽  
George Howard ◽  
Dawn O. Kleindorfer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Blood Glucose ◽  
Black Women ◽  
Racial Differences ◽  
White Women ◽  
Proportional Hazards ◽  
Fasting Blood Glucose ◽  
Cox Proportional Hazards ◽  
Race Differences ◽  
Prospective Longitudinal

Background:To investigate sex and race differences in the association between fasting blood glucose (FBG) and risk of ischemic stroke (IS).Methods:This prospective longitudinal cohort study included adults age ≥45 years at baseline in the Reasons for Geographic And Racial Differences in Stroke Study, followed for a median of 11.4 years. The exposure was baseline FBG (mg/dL); suspected IS events were ascertained by phone every 6 months and were physician-adjudicated. Cox proportional hazards were used to assess the adjusted sex/race-specific associations between FBG (by category and as a restricted cubic spline) and incident IS.Results:Of 20,338 participants, mean age was 64.5(SD 9.3) years, 38.7% were Black, 55.4% were women, 16.2% were using diabetes medications, and 954 IS events occurred. Compared to FBG <100, FBG ≥150 was associated with 59% higher hazards of IS (95%CI 1.21-2.08) and 61% higher hazards of IS among those on diabetes medications (95%CI 1.12-2.31). The association between FBG and IS varied by race/sex (HR, FBG ≥ 150 vs. FBG <100: White women 2.05 (95% CI 1.23-3.42), Black women 1.71 (95%CI 1.10-2.66), Black men 1.24 (95%CI 0.75-2.06), White men 1.46 (95%CI 0.93-2.28), pFBG*race/sex=0.004). Analyses using FBG splines suggest that sex was the major contributor to differences by race/sex subgroups.Conclusions:Sex differences in the strength and shape of the association between FBG and IS are likely driving the significant differences in the association between FBG and IS across race/sex subgroups. These findings should be explored further and may inform tailored stroke prevention guidelines.

Disparities at the Intersection of Race and Ethnicity: Examining Trends and Outcomes in Hispanic Women With Breast Cancer

2020 ◽  
pp. OP.20.00381
Author(s):  
Cosette D. Champion ◽  
Samantha M. Thomas ◽  
Jennifer K. Plichta ◽  
Edgardo Parrilla Castellar ◽  
Laura H. Rosenberger ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
Racial Differences ◽  
White Women ◽  
Hispanic Women ◽  
Hazard Ratio ◽  
Tumor Subtype ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Hispanic White

PURPOSE: We sought to examine tumor subtype, stage at diagnosis, time to surgery (TTS), and overall survival (OS) among Hispanic patients of different races and among Hispanic and non-Hispanic (NH) women of the same race. METHODS: Women 18 years of age or older who had been diagnosed with stage 0-IV breast cancer and who had undergone lumpectomy or mastectomy were identified in the National Cancer Database (2004-2014). Tumor subtype and stage at diagnosis were compared by race/ethnicity. Multivariable linear regression and Cox proportional hazards modeling were used to estimate associations between race/ethnicity and adjusted TTS and OS, respectively. RESULTS: A total of 44,374 Hispanic (American Indian [AI]: 79 [0.2%]; Black: 1,011 [2.3%]; White: 41,126 [92.7%]; Other: 2,158 [4.9%]) and 858,634 NH women (AI: 2,319 [0.3%]; Black: 97,206 [11.3%]; White: 727,270 [84.7%]; Other: 31,839 [3.7%]) were included. Hispanic Black women had lower rates of triple-negative disease (16.2%) than did NH Black women (23.5%) but higher rates than did Hispanic White women (13.9%; P < .001). Hispanic White women had higher rates of node-positive disease (23.2%) versus NH White women (14.4%) but slightly lower rates than Hispanic (24.6%) and NH Black women (24.5%; P < .001). Hispanic White women had longer TTS versus NH White women regardless of treatment sequence (adjusted means: adjuvant chemotherapy, 42.71 v 38.60 days; neoadjuvant chemotherapy, 208.55 v 201.14 days; both P < .001), but there were no significant racial differences in TTS among Hispanic patients. After adjustment, Hispanic White women (hazard ratio, 0.77 [95% CI, 0.74 to 0.81]) and Black women (hazard ratio, 0.75 [95% CI, 0.58 to 0.96]) had improved OS versus NH White women (reference) and Black women (hazard ratio, 1.15 [95% CI, 1.12 to 1.18]; all P < .05). CONCLUSION: Hispanic women had improved OS versus NH women, but racial differences in tumor subtype and nodal stage among Hispanic women highlight the importance of disaggregating racial/ethnic data in breast cancer research.

scholarly journals Employment Changes Following Breast Cancer Diagnosis: The Effects of Race and Place

2019 ◽  
Vol 112 (6) ◽  
pp. 647-650 ◽  
Author(s):  
Jennifer C Spencer ◽  
Jason S Rotter ◽  
Jan M Eberth ◽  
Whitney E Zahnd ◽  
Robin C Vanderpool ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
Racial Differences ◽  
Cancer Diagnosis ◽  
Rural Women ◽  
White Women ◽  
Indirect Costs ◽  
Breast Cancer Diagnosis ◽  
Income Loss ◽  
Breast Cancer Study

Abstract The financial implications of breast cancer diagnosis may be greater among rural and black women. Women with incident breast cancer were recruited as part of the Carolina Breast Cancer Study. We compared unadjusted and adjusted prevalence of cancer-related job or income loss, and a composite measure of either outcome, by rural residence and stratified by race. We included 2435 women: 11.7% were rural; 48.5% were black; and 38.0% reported employment changes after diagnosis. Rural women more often reported employment effects, including reduced household income (43.6% vs 35.4%, two-sided χ2 test P = .04). Rural white, rural black, and urban black women each more often reported income reduction (statistically significant vs. urban white women), although these groups did not meaningfully differ from each other. In multivariable regression, rural differences were mediated by socioeconomic factors, but racial differences remained. Programs and policies to reduce financial toxicity in vulnerable patients should address indirect costs of cancer, including lost wages and employment.

scholarly journals Health Care Segregation, Physician Recommendation, and Racial Disparities in BRCA1/2 Testing Among Women With Breast Cancer

2016 ◽  
Vol 34 (22) ◽  
pp. 2610-2618 ◽  
Author(s):  
Anne Marie McCarthy ◽  
Mirar Bristol ◽  
Susan M. Domchek ◽  
Peter W. Groeneveld ◽  
Younji Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
Racial Disparities ◽  
Racial Differences ◽  
White Women ◽  
Physician Recommendation ◽  
Study Objective ◽  
Black And White ◽  
Physician Characteristics ◽  
White Patients

Purpose Racial disparities in BRCA1/2 testing have been documented, but causes of these disparities are poorly understood. The study objective was to investigate whether the distribution of black and white patients across cancer providers contributes to disparities in BRCA1/2 testing. Patients and Methods We conducted a population-based study of women in Pennsylvania and Florida who were 18 to 64 years old and diagnosed with invasive breast cancer between 2007 and 2009, linking cancer registry data, the American Medical Association Physician Masterfile, and patient and physician surveys. The study included 3,016 women (69% white, 31% black), 808 medical oncologists, and 732 surgeons. Results Black women were less likely to undergo BRCA1/2 testing than white women (odds ratio [OR], 0.40; 95% CI, 0.34 to 0.48; P < .001). This difference was attenuated but not eliminated by adjustment for mutation risk, clinical factors, sociodemographic characteristics, and attitudes about testing (OR, 0.66; 95% CI, 0.53 to 0.81; P < .001). The care of black and white women was highly segregated across surgeons and oncologists (index of dissimilarity 64.1 and 61.9, respectively), but adjusting for clustering within physician or physician characteristics did not change the size of the testing disparity. Black women were less likely to report that they had received physician recommendation for BRCA1/2 testing even after adjusting for mutation risk (OR, 0.66; 95% CI, 0.54 to 0.82; P < .001). Adjusting for physician recommendation further attenuated the testing disparity (OR, 0.76; 95% CI, 0.57 to 1.02; P = .06). Conclusion Although black and white patients with breast cancer tend to see different surgeons and oncologists, this distribution does not contribute to disparities in BRCA1/2 testing. Instead, residual racial differences in testing after accounting for patient and physician characteristics are largely attributable to differences in physician recommendations. Efforts to address these disparities should focus on ensuring equity in testing recommendations.

Are racial differences in obesity and insulin resistance related to aggressive breast cancer?

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 12125-12125
Author(s):  
Emily Gallagher ◽  
Derek Leroith ◽  
Sheldon M. Feldman ◽  
Elisa R. Port ◽  
Neil Friedman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Insulin Resistance ◽  
Racial Differences ◽  
Aggressive Breast Cancer

scholarly journals Associations of race and ethnicity with risk of developing invasive breast cancer after lobular carcinoma in situ

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Vanessa Dania ◽  
Ying Liu ◽  
Foluso Ademuyiwa ◽  
Jason D. Weber ◽  
Graham A. Colditz
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
Racial Differences ◽  
Invasive Breast Cancer ◽  
Hormone Receptor ◽  
Carcinoma In Situ ◽  
White Women ◽  
Lobular Carcinoma ◽  
Lobular Carcinoma In Situ

Abstract Background Lobular carcinoma in situ (LCIS) of the breast is a risk factor of developing invasive breast cancer. We evaluated the racial differences in the risks of subsequent invasive breast cancer following LCIS. Methods We utilized data from the Surveillance, Epidemiology, and End Results registries to identify 18,835 women diagnosed with LCIS from 1990 to 2015. Cox proportional hazards regression was used to estimate race/ethnicity-associated hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of subsequent invasive breast cancer. Results During a median follow-up of 90 months, 1567 patients developed invasive breast cancer. The 10-year incidence was 7.9% for Asians, 8.2% for Hispanics, 9.3% for whites, and 11.2% for blacks (P = 0.046). Compared to white women, black women had significantly elevated risks of subsequent invasive breast cancer (HR 1.33; 95% CI 1.11, 1.59), and invasive cancer in the ipsilateral breast (HR 1.37; 95% CI 1.08, 1.72) and in the contralateral breast (HR 1.33; 95% CI 1.00, 1.76). Black women had significantly higher risks of invasive subtypes negative for both estrogen receptor and progesterone receptor (HR 1.86; 95% CI 1.14, 3.03) and invasive subtypes positive for one or both of receptors (HR 1.30; 95% CI 1.07, 1.59). The risk of subsequent invasive breast cancer was comparable in Asian women and Hispanic women compared with white women. Conclusions Black women had a significantly higher risk of developing invasive breast cancer, including both hormone receptor-positive and hormone receptor-negative subtypes, after LCIS compared with white counterparts. It provides an opportunity to address health disparities.

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

2012 ◽  
Vol 302 (2) ◽  
pp. E218-E225 ◽  
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.

Racial differences in the financial impact of breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18293-e18293
Author(s):  
Stephanie B. Wheeler ◽  
Jennifer Spencer ◽  
Laura C Pinheiro ◽  
Lisa A. Carey ◽  
Andrew F Olshan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
Black Women ◽  
Racial Differences ◽  
White Women ◽  
Large Population ◽  
Financial Impact ◽  
Barriers To Treatment ◽  
Financial Barriers ◽  
Transportation Barriers

e18293 Background: Racial variation in the adverse financial impact of cancer may contribute to observed differences in the initiation and completion of guideline-recommended adjuvant treatments. We describe racial differences in the financial impact of breast cancer diagnosis in a large, population-based, prospective cohort study. Methods: Patients were recruited via rapid case ascertainment through the North Carolina cancer registry as part of the Carolina Breast Cancer Study, with oversampling of black women and women younger than 50. Participants provided medical records and survey data on demographics, socioeconomic status, treatments, and financial impact of cancer. We used chi-square tests and multivariable logistic regression to understand racial differences in financial impact of breast cancer through 25 months post-diagnosis. Results: Our sample included 1,196 non-Hispanic blacks and 1,236 non-Hispanic whites. Since diagnosis, compared to white women, black women more often reported: any adverse financial impact of cancer (59% vs 39%, p < 0.0001); lost income (49% vs 35%, p < 0.0001); lost job due to cancer (13% vs 6%, p < 0.0001); financial barriers to treatment (24% vs 10%, p < 0.0001); transportation barriers to treatment (15% vs 3%, p < 0.0001); and lost health insurance (9% vs 3%, p < 0.0001). In multivariable models, black women had higher odds of: experiencing any adverse financial impact of cancer (Adjusted Odds Ratio [AOR]: 1.9 (1.6-2.3)); losing income (AOR: 1.5 (1.3-1.9)); losing their job (AOR: 2.1 (1.5-2.8)); experiencing financial barriers to treatment (AOR: 2.2 (1.7-2.9)); experiencing transportation barriers to treatment (AOR: 4.8 (3.2-7.1)); and losing their health insurance (AOR: 2.6 (1.7-4.1)). Conclusions: Compared to whites, black women with breast cancer experience significantly worse financial impact of cancer. Disproportionate financial strain may contribute to higher stress, lower treatment compliance, and worse outcomes, among black women. Efforts to alleviate the adverse financial impact of cancer treatment and to improve communication between patients and providers about potential financial distress may be particularly valuable for black women, due to their greater financial vulnerability.

scholarly journals Racial Differences in Patterns of Care Among Medicaid-Enrolled Patients With Breast Cancer

2006 ◽  
Vol 2 (5) ◽  
pp. 205-213 ◽  
Author(s):  
Gretchen Kimmick ◽  
Fabian Camacho ◽  
Kristi Long Foley ◽  
Edward A. Levine ◽  
Rajesh Balkrishnan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Black Women ◽  
Adjuvant Chemotherapy ◽  
Racial Differences ◽  
Low Income ◽  
White Women ◽  
The United States ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy

Purpose Suboptimal care among minority and low-income patients may explain poorer survival. There is little information describing patterns of health care in Medicaid-insured women with breast cancer in the United States. Using a previously created and validated database linking Medicaid claims and state-wide tumor registry data, we describe patterns of breast cancer care within a low-income population. Methods Sample characteristics were described by frequencies and means. Logistic regressions were used to determine predictors of type of surgery, use of radiation therapy after breast-conserving surgery (BCS), and use of adjuvant chemotherapy. Results The sample consisted of 974 women. The dataset included only white (58%) and black (42%) women. Sixty-seven percent were treated with mastectomy; 43% received adjuvant chemotherapy; and 67% of women receiving BCS received adjuvant radiation. In multivariate analysis, predictors of BCS were young age, black race, and smaller tumor size. Furthermore, there was a trend toward more black than white women with tumors 4 cm or larger having BCS (18% v 8%; P = .06). Race was not related to use of adjuvant radiation therapy after BCS or to use of adjuvant chemotherapy. Conclusion In this group of patients with breast cancer enrolled in Medicaid, black women were more likely than white women to have BCS. Race was not associated with adjuvant radiation therapy or chemotherapy use. Factors affecting the quality of care delivered to low-income and minority patients are complex, and better care lies in exploring areas that need improvement.

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