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1. A pooled analysis of body mass index and mortality among African Americans.

Author

Sarah S Cohen, Yikyung Park, Lisa B Signorello, Alpa V Patel, Deborah A Boggs, Laurence N Kolonel, Cari M Kitahara, Synnove F Knutsen, Elizabeth Gillanders, Kristine R Monroe, Amy Berrington de Gonzalez, Traci N Bethea, Amanda Black, Gary Fraser, Susan Gapstur, Patricia Hartge, Charles E Matthews, Song-Yi Park, Mark P Purdue, Pramil Singh, Chinonye Harvey, William J Blot, and Julie R Palmer

Subjects
Medicine, Science
Abstract

Pooled analyses among whites and East Asians have demonstrated positive associations between all-cause mortality and body mass index (BMI), but studies of African Americans have yielded less consistent results. We examined the association between BMI and all-cause mortality in a sample of African Americans pooled from seven prospective cohort studies: NIH-AARP, 1995-2009; Adventist Health Study 2, 2002-2008; Black Women's Health Study, 1995-2009; Cancer Prevention Study II, 1982-2008; Multiethnic Cohort Study, 1993-2007; Prostate, Lung, Colorectal and Ovarian Screening Trial, 1993-2009; Southern Community Cohort Study, 2002-2009. 239,526 African Americans (including 100,175 never smokers without baseline heart disease, stroke, or cancer), age 30-104 (mean 52) and 71% female, were followed up to 26.5 years (mean 11.7). Hazard ratios (HR) and 95% confidence intervals (CI) for mortality were derived from multivariate Cox proportional hazards models. Among healthy, never smokers (11,386 deaths), HRs (CI) for BMI 25-27.4, 27.5-29.9, 30-34.9, 35-39.9, 40-49.9, and 50-60 kg/m(2) were 1.02 (0.92-1.12), 1.06 (0.95-1.18), 1.32 (1.18-1.47), 1.54 (1.29-1.83), 1.93 (1.46-2.56), and 1.93 (0.80-4.69), respectively among men and 1.06 (0.99-1.15), 1.15 (1.06-1.25), 1.24 (1.15-1.34), 1.58 (1.43-1.74), 1.80 (1.60-2.02), and 2.31 (1.74-3.07) respectively among women (reference category 22.5-24.9). HRs were highest among those with the highest educational attainment, longest follow-up, and for cardiovascular disease mortality. Obesity was associated with a higher risk of mortality in African Americans, similar to that observed in pooled analyses of whites and East Asians. This study provides compelling evidence to support public health efforts to prevent excess weight gain and obesity in African Americans.

Published
2014
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2. Fruit and Vegetable Intake and Risk of Breast Cancer by Hormone Receptor Status

Author

Stephanie Scarmo, Walter C. Willett, Shumin M. Zhang, Anthony B. Miller, Yikyung Park, Leslie Bernstein, Elisabete Weiderpass, James R. Cerhan, Susan E. Hankinson, James M. Shikany, Donna Spiegelman, Laura Baglietto, Piet A. van den Brandt, S. Tsugane, Seungyoun Jung, Leo J. Schouten, Anne Zeleniuch-Jacquotte, Kathy J. Helzlsouer, Kala Visvanathan, Graham G. Giles, Deborah A. Boggs, Sabina Sieri, Marjorie L. McCullough, Mia M. Gaudet, Catherine Schairer, Xuehong Zhang, Julie E. Buring, Regina G. Ziegler, Thomas E. Rohan, Marie Löf, Gary G. Goodman, Stephanie A. Smith-Warner, Manami Inoue, Alicja Wolk, Marian L. Neuhouser, Kim Robien, Niclas Håkansson, Vittorio Krogh, Julie R. Palmer, Pamela L. Horn-Ross, Epidemiologie, RS: CAPHRI School for Public Health and Primary Care, and RS: GROW - School for Oncology and Reproduction

Subjects
Oncology, Adult, Risk, Cancer Research, medicine.medical_specialty, medicine.drug_class, Estrogen receptor, Breast Neoplasms, Article, Breast cancer, Feeding behavior, Internal medicine, Surveys and Questionnaires, Receptors, Vegetables, medicine, Biomarkers, Tumor, Humans, Prospective Studies, skin and connective tissue diseases, Prospective cohort study, Progesterone, Aged, Clinical Trials as Topic, Tumor, Postmenopausal women, business.industry, Medicine (all), Feeding Behavior, Middle Aged, medicine.disease, Estrogen, Pooled analysis, Female, Multivariate Analysis, Receptors, Estrogen, Receptors, Progesterone, Food Habits, Fruit, Hormone receptor, business, Biomarkers
Abstract

Estrogen receptor-negative (ER(-)) breast cancer has few known or modifiable risk factors. Because ER(-) tumors account for only 15% to 20% of breast cancers, large pooled analyses are necessary to evaluate precisely the suspected inverse association between fruit and vegetable intake and risk of ER(-) breast cancer.Among 993 466 women followed for 11 to 20 years in 20 cohort studies, we documented 19 869 estrogen receptor positive (ER(+)) and 4821 ER(-) breast cancers. We calculated study-specific multivariable relative risks (RRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression analyses and then combined them using a random-effects model. All statistical tests were two-sided.Total fruit and vegetable intake was statistically significantly inversely associated with risk of ER(-) breast cancer but not with risk of breast cancer overall or of ER(+) tumors. The inverse association for ER(-) tumors was observed primarily for vegetable consumption. The pooled relative risks comparing the highest vs lowest quintile of total vegetable consumption were 0.82 (95% CI = 0.74 to 0.90) for ER(-) breast cancer and 1.04 (95% CI = 0.97 to 1.11) for ER(+) breast cancer (P (common-effects) by ER status.001). Total fruit consumption was non-statistically significantly associated with risk of ER(-) breast cancer (pooled multivariable RR comparing the highest vs lowest quintile = 0.94, 95% CI = 0.85 to 1.04).We observed no association between total fruit and vegetable intake and risk of overall breast cancer. However, vegetable consumption was inversely associated with risk of ER(-) breast cancer in our large pooled analyses.

Published
2013

3. Carotenoid intakes and risk of breast cancer defined by estrogen receptor and progesterone receptor status: a pooled analysis of 18 prospective cohort studies

Author

Seungyoun Jung, Shoichiro Tsugane, Alicja Wolk, Susan M. Gapstur, Leslie Bernstein, Shumin M. Zhang, Piet A. van den Brandt, Deborah A. Boggs, Marjorie L. McCullough, Edward Giovannucci, Leo J. Schouten, Thomas E. Rohan, Polyna Khudyakov, Stephanie A. Smith-Warner, Susan E. Hankinson, Marian L. Neuhouser, Julie A. Ross, Kala Visvanathan, James M. Shikany, Laura Baglietto, Yikyung Park, Graham G. Giles, Elisabete Weiderpass, Susanna C. Larsson, Kathy J. Helzlsouer, Regina G. Ziegler, Xuehong Zhang, Walter C. Willett, Anthony B. Miller, Julie E. Buring, Gary G. Goodman, Kim Robien, Marie Löf, Manami Inoue, Donna Spiegelman, Pamela L. Horn-Ross, Julie R. Palmer, Epidemiologie, RS: CAPHRI School for Public Health and Primary Care, and RS: GROW - School for Oncology and Reproduction

Subjects
Oncology, Adult, medicine.medical_specialty, Estrogen receptor, Medicine (miscellaneous), Breast Neoplasms, Xanthophylls, chemistry.chemical_compound, Young Adult, Breast cancer, Risk Factors, Zeaxanthins, Internal medicine, Surveys and Questionnaires, Progesterone receptor, Receptors, medicine, 80 and over, Humans, Prospective Studies, Prospective cohort study, Progesterone, Aged, Nutrition and Dietetics, business.industry, Medicine (all), Lutein, food and beverages, Cancer, Progesterone Receptor Status, Middle Aged, medicine.disease, beta Carotene, Carotenoids, Estrogen, Zeaxanthin, Endocrinology, chemistry, Multivariate Analysis, Female, business, Aged, 80 and over, Follow-Up Studies, Receptors, Estrogen, Receptors, Progesterone, Cohort study
Abstract

Background: Epidemiologic studies examining associations between carotenoid intakes and risk of breast cancer by estrogen receptor (ER) and progesterone receptor (PR) status are limited. Objective: We investigated these associations in a pooled analysis of 18 cohort studies. Design: Of 1,028,438 participants followed for a maximum follow-up of 26 y across studies, 33,380 incident invasive breast cancers were identified. Study-specific RRs and 95% CIs were estimated by using Cox proportional hazards regression and then pooled by using a random-effects model. Results: α-Carotene, β-carotene, and lutein/zeaxanthin intakes were inversely associated with the risk of ER-negative (ER−) breast cancer (pooled multivariable RRs of the comparison between the highest and lowest quintiles): α-carotene (0.87; 95% CI: 0.78, 0.97), β-carotene (0.84; 95% CI: 0.77, 0.93), and lutein/zeaxanthin (0.87; 95% CI: 0.79, 0.95). These variables were not inversely associated with the risk of ER-positive (ER+) breast cancer (pooled multivariable RRs for the same comparison): α-carotene (1.04; 95% CI: 0.99, 1.09), β-carotene (1.04; 95% CI: 0.98, 1.10), and lutein/zeaxanthin (1.00; 95% CI: 0.93, 1.07). Although the pooled RRs for quintile 5 for β-cryptoxanthin were not significant, inverse trends were observed for ER− and ER+ breast cancer (P-trend ≤ 0.05). Nonsignificant associations were observed for lycopene intake. The associations were largely not appreciably modified by several breast cancer risk factors. Nonsignificant associations were observed for PR-positive and PR-negative breast cancer. Conclusions: Intakes of α-carotene, β-carotene, and lutein/zeaxanthin were inversely associated with risk of ER−, but not ER+, breast cancer. However, the results need to be interpreted with caution because it is unclear whether the observed association is real or due to other constituents in the same food sources.

Published
2012

4. Physical Activity and the Incidence of Obesity in Young African-American Women

Author

Deborah A. Boggs, Lynn Rosenberg, Kristen Kipping-Ruane, and Julie R. Palmer

Subjects
Gerontology, Adult, Time Factors, Epidemiology, Ethnic group, Walking, Article, Surveys and Questionnaires, medicine, Humans, Obesity, Prospective Studies, Prospective cohort study, Exercise, Proportional Hazards Models, African american, Proportional hazards model, business.industry, Incidence (epidemiology), Incidence, Public Health, Environmental and Occupational Health, Age Factors, Reproducibility of Results, medicine.disease, Middle age, United States, Black or African American, medicine.symptom, business, Weight gain, Follow-Up Studies
Abstract

Obesity occurs more commonly among African-American women than among other racial/ethnic groups, and most weight gain occurs before middle age.The study prospectively investigated the relationship of vigorous exercise and brisk walking to the incidence of obesity (BMI ≥ 30) among African-American women aged40 years.During 1995-2009 in the Black Women's Health Study, the current authors followed 20,259 African-American women who were aged40 years and not obese at baseline. BMI, exercise, and walking were assessed at baseline and on biennial follow-up questionnaires. Data for BMI were collected through 2009. Data for exercise and walking were collected through 2007. Validation and reproducibility data indicated that reporting was more accurate for vigorous exercise than for brisk walking. Cox proportional hazards models estimated incidence rate ratios (IRRs) and 95% CIs of incident obesity for hours/week of vigorous exercise and walking relative to "little or no exercise" (1 hour/week of vigorous exercise and1 hour/week of brisk walking). The analyses were conducted in 2012.The incidence of obesity decreased with increasing vigorous exercise; the IRR was 0.77 (95% CI=0.69, 0.85) for ≥ 7 hours/week relative to little or no exercise; the IRRs were reduced both among women with a healthy weight (BMI25) at baseline and among women who were overweight (BMI 25-30) at baseline. The IRRs for brisk walking for exercise and walking for transport were1.0 for most levels of walking, but without clear trends of decreasing risk with increasing time spent walking.The results suggest that vigorous exercise may reduce the incidence of obesity among young African-American women. Results for brisk walking were inconclusive.

Published
2013

5. Prenatal DES exposure in relation to breast size

Author

Linda Titus-Ernstoff, Elizabeth E. Hatch, Julie R. Palmer, William C. Strohsnitter, Ervin Adam, Rebecca Troisi, Robert N. Hoover, and Deborah A. Boggs

Subjects
Adult, Cancer Research, medicine.medical_specialty, Diethylstilbestrol, Breast Neoplasms, Article, Cohort Studies, Young Adult, Breast cancer, Pregnancy, Risk Factors, medicine, Humans, Young adult, Mammary Glands, Human, Gynecology, business.industry, medicine.disease, Oncology, In utero, Prenatal Exposure Delayed Effects, Cohort, Female, business, Body mass index, medicine.drug, Cohort study
Abstract

Prenatal DES exposure has been associated with increased risk of breast cancer, but the mechanisms are unknown. Larger bra cup size has also been associated with increased breast cancer risk, although not consistently. We investigated the relation of prenatal DES exposure to mammary gland mass, as estimated by bra cup size. In 2006, 3,222 DES-exposed and 1,463 unexposed women reported their bra cup size, band size (chest circumference), and weight at age 20. Prevalence ratios (PR) were calculated for DES exposure in relation to large bra cup size, with control for year of birth and study cohort. Primary analyses were carried out among women who reported a chest circumference of no more than 32 inches because their cup size would be less influenced by fat mass. Within this group, DES-exposed women had an estimated 45 % increased prevalence (95 % CI 0.97–2.18) of large cup size (C or greater) relative to unexposed women. The PR was further increased among women in this group who had a body mass index of

Published
2013

6. Prospective approach to breast cancer risk prediction in African American women: the black women's health study model.

Author

Boggs DA, Rosenberg L, Adams-Campbell LL, and Palmer JR

Subjects
Adult, Black or African American, Aged, Area Under Curve, Black People, Breast Neoplasms diagnosis, Calibration, Data Interpretation, Statistical, Female, Humans, Incidence, Middle Aged, Models, Theoretical, Prospective Studies, Reproducibility of Results, Risk Assessment, Women's Health, Breast Neoplasms epidemiology, Breast Neoplasms ethnology
Abstract

Purpose: Breast cancer risk prediction models have underestimated risk for African American women, contributing to lower recruitment rates in prevention trials. A model previously developed for African American women was found to underestimate risk in the Black Women's Health Study (BWHS)., Methods: We developed a breast cancer risk model for African American women using relative risks derived from 10 years of follow-up of BWHS participants age 30 to 69 years at baseline. Using the subsequent 5 years of follow-up data, we evaluated calibration as the ratio of expected to observed number of breast cancers and assessed discriminatory accuracy using the concordance statistic., Results: The BWHS model included family history, previous biopsy, body mass index at age 18 years, age at menarche, age at first birth, oral contraceptive use, bilateral oophorectomy, estrogen plus progestin use, and height. There was good agreement between predicted and observed number of breast cancers overall (expected-to-observed ratio, 0.96; 95% CI, 0.88 to 1.05) and in most risk factor categories. Discriminatory accuracy was higher for women younger than age 50 years (area under the curve [AUC], 0.62; 95% CI, 0.58 to 0.65) than for women age ≥ 50 years (AUC, 0.56; 95% CI, 0.53 to 0.59). Using a 5-year predicted risk of 1.66% or greater as a cut point, 2.8% of women younger than 50 years old and 32.2% of women ≥ 50 years old were classified as being at elevated risk of invasive breast cancer., Conclusion: The BWHS model was well calibrated overall, and the predictive ability was best for younger women. The proportion of women predicted to meet the 1.66% cut point commonly used to determine eligibility for breast cancer prevention trials was greatly increased relative to previous models., (© 2015 by American Society of Clinical Oncology.)

Published
2015
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