Mediation of Racial and Ethnic Disparities in Estrogen/Progesterone Receptor–Negative Breast Cancer by Socioeconomic Position and Reproductive Factors

Abstract

Hispanic and non-Hispanic black breast cancer patients are more likely than non-Hispanic white patients to be diagnosed with breast cancer that is negative for estrogen and progesterone receptors (ER/PR-negative). This disparity might be transmitted through socioeconomic and reproductive factors. Data on 746 recently diagnosed breast cancer patients (300 non-Hispanic white, 303 non-Hispanic black, 143 Hispanic) were obtained from the population-based Breast Cancer Care in Chicago Study (Chicago, Illinois, 2005-2008). Income, educational level, and census tract measures of concentrated disadvantage and affluence were combined into a single measure of socioeconomic position (SEP). Parity and age at first birth were combined into a single measure of reproductive factors (RPF). We constructed path models to estimate direct and indirect associations of SEP and RPF, and we estimated average marginal controlled direct associations. Compared with non-Hispanic white patients, non-Hispanic black patients and Hispanic patients were more likely to have ER/PR-negative disease (28% and 20% for non-Hispanic black patients and Hispanic patients, respectively, vs. 12% for non-Hispanic white patients; P ≤ 0.001). The ethnic disparity in ER/PR-negative breast cancer (prevalence difference = 0.13, 95% confidence interval: 0.07, 0.18) was reduced by approximately 60% (prevalence difference = 0.05, 95% confidence interval: -0.04, 0.13) after control for SEP and RPF. At least part of the ethnic disparity in the aggressiveness of breast tumors might be transmitted through social influences on tumor biology.

Racial/Ethnic Differences in the Impact of Neighborhood Social and Built Environment on Breast Cancer Risk: The Neighborhoods and Breast Cancer Study

“…We had limited power to examine differential nSES-breast cancer associations by race/ethnicity/nativity and breast cancer subtypes. Socio-cultural factors might influence tumor biology, leading to more aggressive phenotypes among African Americans and Hispanics compared to NHWs (33, 34). …”

What mediates the racial/ethnic disparity in psychosocial stress among breast cancer patients?

“…The Breast Cancer Care in Chicago (BCCC) was a population-based, cross-sectional study of newly diagnosed breast cancer patients ( n = 989). The study has been described in detail elsewhere [ 10 , 19 , 20 ]. Eligible BCCC participants were women between 25 and 79 years of age at diagnosis, who self-identified as nH white ( n = 397), nH AA ( n = 411), or Hispanic ( n = 181), resided in Chicago and were diagnosed with a first primary breast cancer (in situ or invasive) between 2005 and 2008 ( n = 981).…”

“…SEP was defined using: (1) educational completion defined in years; (2) annual household income; and (3) two measures of SEP based on each woman’s census tract of residence (concentrated disadvantage or concentrated affluence) [ 19 ]. Concentrated disadvantage was defined as the percentage of families in the census tract with incomes below the poverty line; percentage of families receiving public assistance; percentage of persons unemployed; and percentage of female-headed households with children.…”

Breast cancer subtype and survival among Indigenous American women in Peru

“…The statistical significance of the differences in patient and tumor characteristics between women from the Selva and Sierra regions were tested using Fisher’s exact test. Adjusted prevalence of TNBC by region was obtained using a model based standardization procedure [ 19 , 20 ]. Prevalence’s were adjusted by age at diagnosis (categorized as <40, 41–50, 51–65, 65+), tumor stage (categorized as stage 1, which included 7 patients who had in situ disease, stage 2 and stage 3 /4), as well as a dichotomized tumor stage variable (categorized as 0/1/2 and 3/ 4).…”