IMPORTANCE Breast cancer incidence trends by age and race/ethnicity have been documented; it is less clear whether incidence trends of breast cancer molecular subtypes, which differ in risk factors and prognosis, also vary by age and race/ethnicity. OBJECTIVE To estimate annual percentage changes and trends in breast cancer molecular subtypespecific incidence rates by age at diagnosis and race/ethnicity in the US. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study included data from 18 cancer registries in the Surveillance, Epidemiology and End Results database, capturing 27.8% of the US population. Hispanic and non-Hispanic White, Black, and Asian/Pacific Islander women aged 25 to 84 years who were diagnosed with invasive breast cancer from 2010 to 2016 were included. Data were analyzed from September 2019 to February 2020. EXPOSURES Age and racial/ethnic groups. MAIN OUTCOMES AND MEASURES Annual percentage change (APC) and 95% CIs for age-standardized breast cancer incidence rates stratified by 15-year age groups at diagnosis and race/ ethnicity.

Multi-systemic biological risk (MSBR), a proxy for allostatic load, is a composite index of biomarkers representing dysregulation due to responses to chronic stress. this study examined the association of an MSBR index with cancer mortality. the sample included n = 13,628 adults aged 20-90 from the NHANES III Linked Mortality File (1988)(1989)(1990)(1991)(1992)(1993)(1994). The MSBR index included autonomic (pulse rate, blood pressure), metabolic (HoMA ir , triglycerides, waist circumference), and immune (white blood cell count, C-reactive protein) markers. We fit Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) of overall cancer mortality risk, according to quartiles (q) of the index. In multivariable models, compared to those in q1, q4 had a 64% increased risk for cancer mortality (HR = 1.64, 95% CI:1.13-2.40). The immune domain drove the association (HR per unit = 1.19, 95% CI:1.07-1.32). In stratified analyses, the HR for those with a BMI ≥ 25 was 1.12 per unit (95% CI:1.05-1.19) and those with a BMI < 25 was 1.04 per unit (95% CI:0.92-1.18). MSBR is positively associated with risk for cancer mortality in a US sample, particularly among those who are overweight or obese. The utilization of standard clinical measures comprising this index may inform population cancer prevention strategies.Multi-systemic biological risk (MSBR) is a proxy for allostatic load (AL). It is a metric of health risk that captures the complex biological cascade that occurs in autonomic, metabolic, and immune domains in response to chronic environmental and psychosocial stress 1-3 . The validity of the AL construct is established and demonstrates common variance and statistical coherence between, prominent primary mediators of the stress response (i.e., stress hormones), and secondary mediators reflecting the resulting biological alterations in autonomic, metabolic, and immune domains that accumulate over time [4][5][6][7][8] . Importantly, summary AL indices have demonstrated a non-additive, stronger magnitude of association with outcomes compared with the individual components of the index 9 .Previous research has shown that autonomic, metabolic, and immune disorders, share common risk factors with cancer outcomes 10-12 . Moreover, there is a strong physiological link between over-activation of the stress response and regulation of the tumor microenvironment [13][14][15] . In mechanistic animal studies where stress can demonstrably be reproduced, chronic responses to stress influence processes involved in tumorigenesis [16][17][18][19] . However, observational studies assessing self-report of stressful life events and cancer outcomes have generally been inconsistent [20][21][22][23][24][25] .Epidemiological studies show positive associations between higher levels of AL indices and cardiovascular disease (CVD), as well as mortality risk 26,27 . However, we are not aware of any studies that have examined an index of AL with cancer outcomes. With cancer being the second leading cause of de...

Background Well-tolerated and commonly used medications are increasingly assessed for reducing breast cancer risk. These include metformin and statins, both linked to reduced hormone availability and cell proliferation or growth and sometimes prescribed concurrently. We investigated independent and joint associations of these medications with mammographic breast density (MBD), a useful biomarker for the effect of chemopreventive agents on breast cancer risk. Methods Using data from a cross-sectional study of 770 women (78% Hispanic, aged 40–61 years, in a mammography cohort with high cardiometabolic burden), we examined the association of self-reported “ever” use of statins and metformin with MBD measured via clinical Breast Imaging Reporting and Data System (BI-RADS) density classifications (relative risk regression) and continuous semi-automated percent and size of dense area (Cumulus) (linear regression), adjusted for age, body mass index, education, race, menopausal status, age at first birth, and insulin use. Results We observed high statin (27%), metformin (13%), and combination (9%) use, and most participants were overweight/obese (83%) and parous (87%). Statin use was associated with a lower likelihood of high density BI-RADS (RR = 0.60, 95% CI = 0.45 to 0.80), percent dense area (PD) (β = − 6.56, 95% CI = − 9.05 to − 4.06), and dense area (DA) (β = − 9.05, 95% CI = − 14.89 to − 3.22). Metformin use was associated with lower PD and higher non-dense area (NDA), but associations were attenuated by co-medication with statins. Compared to non-use of either medication, statin use alone or with metformin were associated with lower PD and DA (e.g., β = − 6.86, 95% CI: − 9.67, − 4.05 and β = − 7.07, 95% CI: − 10.97, − 3.17, respectively, for PD) and higher NDA (β = 25.05, 95% CI: 14.06, 36.03; β = 29.76, 95% CI: 14.55, 44.96, respectively). Conclusions Statin use was consistently associated with lower MBD, measured both through clinical radiologist assessment and continuous relative and absolute measures, including dense area. Metformin use was associated with lower PD and higher NDA, but this may be driven by co-medication with statins. These results support that statins may lower MBD but need confirmation with prospective and clinical data to distinguish the results of medication use from that of disease.

BackgroundEvidence from basic research links exposure to endocrine disrupting chemicals (EDCs) with a higher risk for breast cancer. However, there is less evidence from observational epidemiological research and the results are equivocal. Therefore, we examined the association between occupational exposure to substances where exposure to EDCs is likely and the risk of breast cancer.MethodsA prospective study consisting of a population-based cohort of 33,458 Singaporean Chinese women aged 45–74 years enrolled in the Singapore Chinese Health Study (SCHS) from 1993 to 98 and followed through 2014. Subjects’ self-reported occupational exposure and duration to industries, job titles, and substance types were garnered at baseline, and cases of incident breast cancer (N = 988) were determined by linkage with the Singapore Cancer Registry. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated for exposure to substances, job titles, and industries.ResultsThere was no association between cumulative exposure to substances via occupation where EDC exposure is likely and risk of breast cancer. These results were consistent for hypothesized high (HR 0.94, 95% CI: 0.66–1.35), medium (HR 1.03 95% CI: 0.77–1.38) and low (HR 0.74, 95% CI 0.48–1.13) combined substance exposure groups when compared with those who were not exposed via occupation. Similar null associations were observed when examining job titles and industry categories.ConclusionsThere was no association between EDC related occupational exposures and breast cancer risk in working women of the Singaporean Chinese Health Study. Future studies that employ rigorous methods with regard to exposure assessment of EDCs are needed.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5862-2) contains supplementary material, which is available to authorized users.

It is well established that chronic and persistent inflammation contributes to cancer development. Chronic inflammation is often associated with periodontal disease, or gum disease. Periodontal disease, which can be prevented or ameliorated by following proper oral hygiene, is known to be associated with various systemic disorders including coronary heart disease and some cancers, including head and neck cancer and pancreatic cancer. However, little is known about its potential association with breast cancer, with only one report in which periodontal disease was a positive predictor for breast cancer in a Swedish cohort. To examine if a potential link exists between periodontal disease and breast cancer in a separate cohort, mammography patients from the UC Irvine Athena Breast Health Network cohort were recruited to participate in a survey that included questions about their periodontal health. Diagnosis of invasive breast cancer, DCIS, and benign breast diseases was determined through data extraction from electronic medical records. There was no association between periodontal disease and DCIS or invasive breast cancer. However, there was a significant difference in the frequency of breast cysts among women with periodontal disease compared to women without periodontal disease (p&lt;0.01). Women with periodontal disease were at least 4-fold more likely to have breast cysts, even after adjusting for potential confounders including age, race/ethnicity, and smoking history (p&lt;0.05). To our knowledge, this is the first report on an association between periodontal disease and breast cysts. Our data suggest that further studies on potential links between periodontal disease and breast health are warranted. Citation Format: Hannah Lui Park, Teofilia Acheampong, Kathleen Nguyen, Cindy Nguyen, Argyrios Ziogas, Richard Kelly, Andrea Alvarez, Kathryn M. Larsen, Deborah Goodman, Hoda Anton-Culver. Association of periodontal disease and breast health in women undergoing screening mammography. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2599.

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Background: Multisystemic biologic risk is a clinically meaningful and practical surrogate for allostatic load, a metric of health risk used to express shared physiologic variance in multiple biologic systems, based on the hypothesis that recurrent exposure to external stressors leads to progressive dysregulation. Allostatic load and proxies capture the complex biologic cascade that occurs in cardiovascular, metabolic, and immune domains in response to chronic environmental and psychosocial stress. Previous research has demonstrated positive associations between higher indices of multisystemic biologic risk and declining cognition, physical function, and increased cardiovascular disease and mortality risk. However, we are not aware of any research testing the association between an index of multisystemic biologic risk and cancer outcomes. Aim: To examine the association of an index of multisystemic biologic risk (MSBRI) with cancer mortality using data from NHANES, and whether the association differed by race/ethnicity and age. Methods: In 8,996 participants in the NHANES III (year 1989-94), age ≥ 40 years with complete data, we created an index of MSBRI using biomarkers from domains of cardiovascular (pulse rate, blood pressure), metabolic (HOMA-IR, triglycerides, waist circumference), and immune (white blood cell count, c-reactive protein, fibrinogen level). Participants were assigned a score for each biomarker informed by clinical cut points, or based upon evidence in the literature indicating a threshold of risk for disease, and each marker within each domain was scored 0 (low), 1 (moderate), and 2 (high); a higher score represents hypothesized higher risk (range 0-14). Cancer mortality was ascertained from linkage to the National Death Index and participants were followed until 2011. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for overall cancer mortality risk with the MSBRI, adjusting for age, sex, education, income, U.S. region, insurance, physical activity, smoking, alcohol, and BMI. All models utilized the appropriate survey weights. Results: There were 621 cancer deaths during follow-up. Non-Hispanic black, Mexican-Americans, and women (overall) had higher average levels of the MSBRI. On a per-unit basis of the MSBRI, the HR (95% CI) for cancer mortality was 1.11 (1.02-1.21) for each unit of increase in score. Additionally, there was evidence that the association may differ by race/ethnicity. Among the non-Hispanic white sample, the per-unit HR (95% CI) for the MSBRI was 1.06 (1.00-1.12), whereas the HR (95% CI) for non-Hispanic Black, Mexican American, and “Other” (all other race ethnicities not including the aforementioned groups) were, respectively, 1.04 (0.95-1.13), 1.07 (0.98-1.18), and 1.23 (1.07-1.42). There was also evidence that the association may differ by age. The HR (95% CI) was 1.09 (0.97-1.24) for participants &gt; 50 years of age, and 1.28 (1.05-1.56) for ages ≤ 50 years. Conclusions: There was strong, positive association between a higher score on an index of multisystemic biologic risk (proxy for allostatic load) and risk for cancer mortality in the NHANES III follow-up cohort. The results also suggest that the association may differ by race/ethnicity and age. These results are some of the first to link a proxy for allostatic load with a major cancer outcome, and because the formulation of the index relied upon common clinical measures, this index may have clinical utility for cancer prediction and thus clinical and population cancer prevention strategies. Citation Format: Teofilia Acheampong, Andrew Odegaard. Multisystemic biologic risk index and cancer mortality: Differences by age group and race/ethnicity [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A54.

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