Environment and Breast Cancer: Science Review
About
Race, anthropometric factors, and stage at diagnosis of breast cancer
Moorman, P. G., Jones, B. A., Millikan, R. C., Hall, I. J., Newman, B. American Journal of Epidemiology. 2001. 153, 284-91.
Topic area
Body size
Body size
Study design
Prospective cohort
Prospective cohort
Funding agency
NCI
NCI
Study Participants
Number of Cases
442 (women diagnosed with later stage of breast cancer) (188 black) (254 white)
442 (women diagnosed with later stage of breast cancer) (188 black) (254 white)
Menopausal Status
Post menopausal
The menopausal status of women included in this study is listed here.
Pre menopausalPost menopausal
Number in Cohort
Cohort: 791 women diagnosed with breast cancer (302 black) (489 white)
Cohort: 791 women diagnosed with breast cancer (302 black) (489 white)
Cohort participation rate
No, (61%)
No, (61%)
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
In: women who participated in a case-control study, the Carolina Breast Cancer Study, carried out in 24 counties in central and eastern North Carolina; diagnosed with breast cancer between 5/93 and 5/96; age 20 to 74 years at recruitment; resided in the 24 country study area; no previous breast cancer
Ex: women whose physician did not consent; had a history of breast cancer; died before being contacted; could not be contacted; refused to participate; women with missing anthropometric data and medical record information on tumor stage
Comment about participation selection
Strengths: in-person interview; anthropometric data obtained by trained staff; analyzed stage of diagnosis by BMI and WHR; showed that racial differences in anthropometric factors contribute to the observed difference between African-America women and White women in stage at diagnosis of breast cancer; showed the percent change in odds ratio for race by different risk factors; analyzed breast cancer stage at diagnosis by race Limitations: low participation rate; limited information on participants' mammographic screening history; used education as a measure of socioeconomic status; did not obtain information on the participants' access to health care or their cultural beliefs and attitudes; lack of information on brassiere size and method of breast cancer discovery
Strengths: in-person interview; anthropometric data obtained by trained staff; analyzed stage of diagnosis by BMI and WHR; showed that racial differences in anthropometric factors contribute to the observed difference between African-America women and White women in stage at diagnosis of breast cancer; showed the percent change in odds ratio for race by different risk factors; analyzed breast cancer stage at diagnosis by race Limitations: low participation rate; limited information on participants' mammographic screening history; used education as a measure of socioeconomic status; did not obtain information on the participants' access to health care or their cultural beliefs and attitudes; lack of information on brassiere size and method of breast cancer discovery
Exposures investigated
BMI and WHR
BMI and WHR
How exposure was measured
Questionnaire, in person Anthropometric measurement, researcher-administered
Questionnaire, in person Anthropometric measurement, researcher-administered
Breast cancer outcome investigated
Breast cancer recurrence or progression
Breast cancer recurrence or progression
Ethnic groups with separate analysis
If this study provided a separate analysis by ethnic or racial group, the groups are listed here.
African Americans
Non-hispanic White Americans
Confounders considered
Other breast cancer risk factors, such as family history, age at first birth, and hormone replacement therapy use, that were taken into account in the study.
Adequately controlled, Confounders: age, obesity (BMI) and WHR
Genetic characterization included
If the study analyzed relationships between environmental factors and inherited genetic variations, this field will be marked “Yes.” “No”, if not.
No
Strength of associations reported
Association between severely obese women (BMI > 32.3) and later stage of breast cancer at diagnosis (stage > II), OR=1.71(1.18-2.46),
Association between severely obese women (BMI > 32.3) and great tumor size at diagnosis (tumor > 2cm), OR=1.63(1.15-2.32)
Association between severely obese women (BMI > 32.3) and distant metastasis OR= 3.07(1.31-7.17)
Association between highest tertile of W/H ratio (WHR >0.86) and later stage of breast cancer at diagnosis (stage > II), OR=2.21(1.50-3.26)
Association between highest tertile of W/H ratio (WHR >0.86) and great tumor size at diagnosis (tumor > 2cm), OR=2.60(1.76-3.86)
Association between highest tertile of W/H ratio (WHR >0.86) and positive lymph nodes, OR=1.87(1.27-2.77)
Association between highest tertile of W/H ratio (WHR >0.86) and distant metastasis OR=8.48(2.16-33.38)
Association between severely obese women (BMI > 32.3) and later stage of breast cancer at diagnosis (stage > II), OR=1.71(1.18-2.46),
Association between severely obese women (BMI > 32.3) and great tumor size at diagnosis (tumor > 2cm), OR=1.63(1.15-2.32)
Association between severely obese women (BMI > 32.3) and distant metastasis OR= 3.07(1.31-7.17)
Association between highest tertile of W/H ratio (WHR >0.86) and later stage of breast cancer at diagnosis (stage > II), OR=2.21(1.50-3.26)
Association between highest tertile of W/H ratio (WHR >0.86) and great tumor size at diagnosis (tumor > 2cm), OR=2.60(1.76-3.86)
Association between highest tertile of W/H ratio (WHR >0.86) and positive lymph nodes, OR=1.87(1.27-2.77)
Association between highest tertile of W/H ratio (WHR >0.86) and distant metastasis OR=8.48(2.16-33.38)
Results Comments
There is a 34.2% decrease in the odds ratio for race of a later stage of breast cancer diagnosis when severe obesity, waist to hip ratio and mammographic screening variables are taken into account. This study provides evidence that racial differences in anthropometric factors contribute to the observed difference between African-American women and White women in stage at diagnosis of breast cancer.
There is a 34.2% decrease in the odds ratio for race of a later stage of breast cancer diagnosis when severe obesity, waist to hip ratio and mammographic screening variables are taken into account. This study provides evidence that racial differences in anthropometric factors contribute to the observed difference between African-American women and White women in stage at diagnosis of breast cancer.
Author address
Department of Epidemiology and Public Health, School of Medicine, Yale University, New Haven, CT, USA. patricia.moorman@duke.edu
Department of Epidemiology and Public Health, School of Medicine, Yale University, New Haven, CT, USA. patricia.moorman@duke.edu