Acculturation and Ethnic Variations in Breast Cancer Risk Factors, Gail Model Risk Estimates and Mammographic Breast Density

Abstract

(95% CI, 1.18-1.51) among never or former smokers (p-trend < 0.001). This positive trend for PCa mortality was mainly observed among men with BMI measured more than 5 years before diagnosis, and among those age >65 years old at diagnosis. Compared with never smokers, current smokers had significantly elevated risk of PCa death, with a HR of 1.92 (95% CI, 1.52-2.43) regardless of the time of measurement, age at diagnosis and BMI. After further adjusting for tumor stage and grade, the association between BMI, smoking and PCa death was attenuated but remained statistical significant. CON-CLUSIONS: In this consortium study of eight large cohorts, smoking and overweight/obesity before diagnosis were significant predictors for subsequent PCa-specific mortality. Smoking significantly modifies the association of BMI and PCa-specific mortality. observed in their birth country and in the US. This transition of risk may partly be explained by uptake of risk factors associated with acculturation. Investigating whether immigration and acculturation risk patterns are similarly reflected in disease biomarkers can provide insight into mechanisms underlying the transition of risk. We examined differences in the distribution of BC risk factors, absolute risk estimates and mammographic density by ethnicity and acculturation. We used data from 366 women recruited from an urban mammography clinic (ages 40-64 years) to compare BC risk factors and Gail model risk estimates across US-born white, US-born African American [AA], US-born Hispanic and foreign-born Hispanic women. We used linear regression models to examine the associations of immigration and acculturation indicators (e.g., generational status, age and life stage at immigration, language use) with percent density and dense breast area, measured from mammograms. Differences in BC risk factors were mostly observed for ethnic groups, with white women having higher reproductive and lifestyle risk profiles (e.g., lower parity, older age at first birth, higher alcohol intake), Hispanics having shorter height and AAs having larger body mass index (BMI) and waist circumference. The average lifetime and 5-year Gail estimates were highest in whites (11.4% & 1.4%), intermediate in AAs (7.2% & 1.0%) and lowest in Hispanics (6.9% & 0.7% in US-born and 6.6% & 0.8% in foreign-born). After adjusting for age, BMI and parity, lower linguistic acculturation, shorter residence in the US, and later age at immigration were associated with lower percent density (all p values for trend across acculturation levels <0.05); e.g., monolingual Spanish and bilingual speakers respectively had on average 5.6% (95% CI, À10.0-À1.3) and 3.8% (95% CI, À8.1-0.4) lower percent density than monolingual English speakers. Similar but more modest associations were observed for dense area. The increase in BC risk after immigration to the US and subsequent acculturation may operate via influences on mammographic density in Hispanic women. Hamilton JG, Salerno M, Amoroso K, Sheehan M, Harlan Fleischut M, Glogowski E, S...

Considerations of Methodological Approaches in the Recruitment and Retention of Immigrant Participants

“…Immigrant groups compared to U.S.-born natives fare worse across many health conditions, including diabetes, heart disease, depression, and cancer [11,12], and display complex determinants influencing the health paradox [13]. In fact, disease manifestation (e.g., breast cancer) occurs the longer immigrants reside in the U.S. [14,15]. Speculations to the disparate health conditions of immigrant groups may be related to health care access and utilization [16,17].…”

Breast density in multiethnic women presenting for screening mammography

“…The vast majority of the studies assessing breast density and cancer risk have been conducted among White women, with limited inclusion of minority populations . The data on Hispanic women are more limited . Results are conflicting .…”

“…[13][14][15] The data on Hispanic women are more limited. 16,17 Results are conflicting. 15,16,18,19 Razzaghi et al 12 found that White cases and controls had a greater percentage of "extremely dense" and "heterogeneously dense" breasts compared with African-American cases and controls.…”

“…16,17 Results are conflicting. 15,16,18,19 Razzaghi et al 12 found that White cases and controls had a greater percentage of "extremely dense" and "heterogeneously dense" breasts compared with African-American cases and controls. Furthermore, the BI-RADS density category with greatest prevalence among African-Americans was "scattered fibroglandular densities."…”