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Nyante SJ, Deal AM, Heiling HM, Kim KS, Kuzmiak CM, Calhoun BC, Ray EM. Trends in breast, colon, pancreatic, and uterine cancers in women during the COVID-19 pandemic in North Carolina. Cancer Med 2024; 13:e7156. [PMID: 38572934 PMCID: PMC10993709 DOI: 10.1002/cam4.7156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/03/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024] Open
Abstract
IMPORTANCE The COVID-19 pandemic led to reductions in primary care and cancer screening visits, which may delay detection of some cancers. The impact on incidence has not been fully quantified. We examined change in cancer incidence to determine how the COVID-19 pandemic may have altered the characteristics of cancers diagnosed among women. METHODS This study included female patients aged ≥18 years and diagnosed with breast (n = 9489), colon (n = 958), pancreatic (n = 669), or uterine (n = 1991) cancer at three hospitals in North Carolina. Using interrupted time series, we compared incidence of cancers diagnosed between March 2020 and November 2020 (during pandemic) with cancers diagnosed between January 2016 and February 2020 (pre-pandemic). RESULTS During the pandemic, incidence of breast and uterine cancers was significantly lower than expected compared to pre-pandemic (breast-18%, p = 0.03; uterine -20%, p = 0.05). Proportions of advanced pathologic stage and hormone receptor-negative breast cancers, and advanced clinical stage and large size uterine cancers were more prevalent during the pandemic. No significant changes in incidence were detected for pancreatic (-20%, p = 0.08) or colon (+14%, p = 0.30) cancers. CONCLUSION AND RELEVANCE In women, the COVID-19 pandemic resulted in a significant reduction in the incidence of breast and uterine cancers, but not colon or pancreatic cancers. A change in the proportion of poor prognosis breast and uterine cancers suggests that some cancers that otherwise would have been diagnosed at an earlier stage will be detected in later years. Continued analysis of long-term trends is needed to understand the full impact of the pandemic on cancer incidence and outcomes.
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Affiliation(s)
- Sarah J. Nyante
- Department of RadiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Allison M. Deal
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Hillary M. Heiling
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Kyung Su Kim
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Cherie M. Kuzmiak
- Department of RadiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Benjamin C. Calhoun
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of Pathology and Laboratory MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Emily M. Ray
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Division of Oncology, Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Nyante SJ, Abraham L, Bowles EJA, Lee CI, Kerlikowske K, Miglioretti DL, Sprague BL, Henderson LM. Racial and Ethnic Variation in Diagnostic Mammography Performance among Women Reporting a Breast Lump. Cancer Epidemiol Biomarkers Prev 2023; 32:1542-1551. [PMID: 37440458 PMCID: PMC10790330 DOI: 10.1158/1055-9965.epi-23-0289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/12/2023] [Accepted: 07/11/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND We evaluated diagnostic mammography among women with a breast lump to determine whether performance varied across racial and ethnic groups. METHODS This study included 51,014 diagnostic mammograms performed between 2005 and 2018 in the Breast Cancer Surveillance Consortium among Asian/Pacific Islander (12%), Black (7%), Hispanic/Latina (6%), and White (75%) women reporting a lump. Breast cancers occurring within 1 year were ascertained from cancer registry linkages. Multivariable regression was used to adjust performance statistic comparisons for breast cancer risk factors, mammogram modality, demographics, additional imaging, and imaging facility. RESULTS Cancer detection rates were highest among Asian/Pacific Islander [per 1,000 exams, 84.2 (95% confidence interval (CI): 72.0-98.2)] and Black women [81.4 (95% CI: 69.4-95.2)] and lowest among Hispanic/Latina women [42.9 (95% CI: 34.2-53.6)]. Positive predictive values (PPV) were higher among Black [37.0% (95% CI: 31.2-43.3)] and White [37.0% (95% CI: 30.0-44.6)] women and lowest among Hispanic/Latina women [22.0% (95% CI: 17.2-27.7)]. False-positive results were most common among Asian/Pacific Islander women [per 1,000 exams, 183.9 (95% CI: 126.7-259.2)] and lowest among White women [112.4 (95% CI: 86.1-145.5)]. After adjustment, false-positive and cancer detection rates remained higher for Asian/Pacific Islander and Black women (vs. Hispanic/Latina and White). Adjusted PPV was highest among Asian/Pacific Islander women. CONCLUSIONS Among women with a lump, Asian/Pacific Islander and Black women were more likely to have cancer detected and more likely to receive a false-positive result compared with White and Hispanic/Latina women. IMPACT Strategies for optimizing diagnostic mammography among women with a lump may vary by racial/ethnic group, but additional factors that influence performance differences need to be identified. See related In the Spotlight, p. 1479.
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Affiliation(s)
- Sarah J. Nyante
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | - Erin J. Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health; Fred Hutchinson Cancer Center, Seattle, WA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
- Department of Public Health Sciences, University of California, Davis, Davis, CA
| | - Brian L. Sprague
- Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT
| | - Louise M. Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Nyante SJ, Abraham L, Bowles EJA, Lee CI, Kerlikowske K, Miglioretti DL, Sprague BL, Henderson LM. Diagnostic Mammography Performance across Racial and Ethnic Groups in a National Network of Community-Based Breast Imaging Facilities. Cancer Epidemiol Biomarkers Prev 2022; 31:1324-1333. [PMID: 35712862 PMCID: PMC9272467 DOI: 10.1158/1055-9965.epi-21-1379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/16/2022] [Accepted: 04/26/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We evaluated differences in diagnostic mammography performance based on women's race/ethnicity. METHODS This cohort study included 267,868 diagnostic mammograms performed to evaluate screening mammogram findings at 98 facilities in the Breast Cancer Surveillance Consortium between 2005 and 2017. Mammogram assessments were recorded prospectively and breast cancers occurring within one year were ascertained. Performance statistics were calculated with 95% confidence intervals (CI) for each racial/ethnic group. Multivariable regression was used to control for personal characteristics and imaging facility. RESULTS Among non-Hispanic White (70%), non-Hispanic Black (13%), Asian/Pacific Islander (10%), and Hispanic (7%) women, the invasive cancer detection rate (iCDR, per 1,000 mammograms) and positive predictive value (PPV2) were highest among non-Hispanic White women (iCDR, 35.8; 95% CI, 35.0-36.7; PPV2, 27.8; 95% CI, 27.3-28.3) and lowest among Hispanic women (iCDR, 22.3; 95% CI, 20.2-24.6; PPV2, 19.4; 95% CI, 18.0-20.9). Short interval follow-up recommendations were most common among non-Hispanic Black women [(31.0%; 95% CI, 30.6%-31.5%) vs. other groups, range, 16.6%-23.6%]. False-positive biopsy recommendations were most common among Asian/Pacific Islander women [per 1,000 mammograms: 169.2; 95% CI, 164.8-173.7) vs. other groups, range, 126.5-136.1]. Some differences were explained by adjusting for receipt of diagnostic ultrasound or MRI for iCDR and imaging facility for short-interval follow-up. Other differences changed little after adjustment. CONCLUSIONS Diagnostic mammography performance varied across racial/ethnic groups. Addressing characteristics related to imaging facility and access, rather than personal characteristics, may help reduce some of these disparities. IMPACT Diagnostic mammography performance studies should include racially and ethnically diverse populations to provide an accurate view of the population-level effects.
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Affiliation(s)
- Sarah J. Nyante
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | - Erin J. Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health, Seattle, WA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA,Department of Public Health Sciences, University of California, Davis, Davis, CA
| | - Brian L. Sprague
- Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT
| | - Louise M. Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Alagoz O, Lowry KP, Kurian AW, Mandelblatt JS, Ergun MA, Huang H, Lee SJ, Schechter CB, Tosteson ANA, Miglioretti DL, Trentham-Dietz A, Nyante SJ, Kerlikowske K, Sprague BL, Stout NK. Impact of the COVID-19 Pandemic on Breast Cancer Mortality in the US: Estimates From Collaborative Simulation Modeling. J Natl Cancer Inst 2021; 113:1484-1494. [PMID: 34258611 PMCID: PMC8344930 DOI: 10.1093/jnci/djab097] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has disrupted breast cancer control through short-term declines in screening and delays in diagnosis and treatments. We projected the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. METHODS Three established Cancer Intervention and Surveillance Modeling Network breast cancer models modeled reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. Sensitivity analyses were performed to determine the effect of key model parameters, including the duration of the pandemic impact. RESULTS By 2030, the models project 950 (model range = 860-1297) cumulative excess breast cancer deaths related to reduced screening, 1314 (model range = 266-1325) associated with delayed diagnosis of symptomatic cases, and 151 (model range = 146-207) associated with reduced chemotherapy use in women with hormone positive, early-stage cancer. Jointly, 2487 (model range = 1713-2575) excess breast cancer deaths were estimated, representing a 0.52% (model range = 0.36%-0.56%) cumulative increase over breast cancer deaths expected by 2030 in the absence of the pandemic's disruptions. Sensitivity analyses indicated that the breast cancer mortality impact would be approximately double if the modeled pandemic effects on screening, symptomatic diagnosis, and chemotherapy extended for 12 months. CONCLUSIONS Initial pandemic-related disruptions in breast cancer care will have a small long-term cumulative impact on breast cancer mortality. Continued efforts to ensure prompt return to screening and minimize delays in evaluation of symptomatic women can largely mitigate the effects of the initial pandemic-associated disruptions.
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Affiliation(s)
- Oguzhan Alagoz
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Allison W Kurian
- Departments of Medicine and of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Mehmet A Ergun
- Department of Industrial Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Hui Huang
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sandra J Lee
- Department of Data Science, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Diana L Miglioretti
- Department of Public Health Sciences, University of California at Davis, Davis, CA, USA
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and the Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Sarah J Nyante
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology/Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - Brian L Sprague
- Department of Surgery and the University of Vermont Cancer Center, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Nyante SJ, Benefield TS, Kuzmiak CM, Earnhardt K, Pritchard M, Henderson LM. Population-level impact of coronavirus disease 2019 on breast cancer screening and diagnostic procedures. Cancer 2021; 127:2111-2121. [PMID: 33635541 PMCID: PMC8013451 DOI: 10.1002/cncr.33460] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND To understand how health care delays may affect breast cancer detection, the authors quantified changes in breast‐related preventive and diagnostic care during the coronavirus disease 2019 (COVID‐19) pandemic. METHODS Eligible women (N = 39,444) were aged ≥18 years and received a screening mammogram, diagnostic mammogram, or breast biopsy between January 1, 2019 and September 30, 2020, at 7 academic and community breast imaging facilities in North Carolina. Changes in the number of mammography or breast biopsy examinations after March 3, 2020 (the first COVID‐19 diagnosis in North Carolina) were evaluated and compared with the expected numbers based on trends between January 1, 2019 and March 2, 2020. Changes in the predicted mean monthly number of examinations were estimated using interrupted time series models. Differences in patient characteristics were tested using least squares means regression. RESULTS Fewer examinations than expected were received after the pandemic's onset. Maximum reductions occurred in March 2020 for screening mammography (−85.1%; 95% CI, −100.0%, −70.0%) and diagnostic mammography (−48.9%; 95% CI, −71.7%, −26.2%) and in May 2020 for biopsies (−40.9%; 95% CI, −57.6%, −24.3%). The deficit decreased gradually, with no significant difference between observed and expected numbers by July 2020 (diagnostic mammography) and August 2020 (screening mammography and biopsy). Several months after the pandemic's onset, women who were receiving care had higher predicted breast cancer risk (screening mammography, P < .001) and more commonly lacked insurance (diagnostic mammography, P < .001; biopsy, P < .001) compared with the prepandemic population. CONCLUSIONS Pandemic‐associated deficits in the number of breast examinations decreased over time. Utilization differed by breast cancer risk and insurance status, but not by age or race/ethnicity. Long‐term studies are needed to clarify the contribution of these trends to breast cancer disparities. In this observational study, the use of screening mammography, diagnostic mammography, and breast biopsy is significantly lower than expected after the onset of the COVID‐19 pandemic in North Carolina, but the deficits decrease over time. Health insurance status and predicted breast cancer risk are identified as predictors of mammography and biopsy receipt during the pandemic.
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Affiliation(s)
- Sarah J Nyante
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thad S Benefield
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cherie M Kuzmiak
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn Earnhardt
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael Pritchard
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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6
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Wang T, Bradshaw PT, Moorman PG, Nyante SJ, Nichols HB, Shantakumar S, Parada H, Khankari NK, Terry MB, Teitelbaum SL, Neugut AI, Gammon MD. Menopausal hormone therapy use and long‐term all‐cause and cause‐specific mortality in the Long Island Breast Cancer Study Project. Int J Cancer 2020; 147:3404-3415. [DOI: 10.1002/ijc.33174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/22/2020] [Accepted: 06/11/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Tengteng Wang
- Department of Epidemiology University of North Carolina Chapel Hill North Carolina USA
- Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts USA
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston Massachusetts USA
| | - Patrick T. Bradshaw
- Division of Epidemiology and Biostatistics University of California Berkeley California USA
| | - Patricia G. Moorman
- Department of Community and Family Medicine Duke University Durham North Carolina USA
| | - Sarah J. Nyante
- Department of Epidemiology University of North Carolina Chapel Hill North Carolina USA
- Department of Radiology University of North Carolina Chapel Hill North Carolina USA
| | - Hazel B. Nichols
- Department of Epidemiology University of North Carolina Chapel Hill North Carolina USA
| | - Sumitra Shantakumar
- Real World Evidence and Epidemiology Department GlaxoSmithKline Singapore Singapore
| | - Humberto Parada
- Division of Epidemiology and Biostatistics San Diego State University San Diego California USA
| | - Nikhil K. Khankari
- Division of Epidemiology Vanderbilt University Medical Center Nashville Tennessee USA
| | - Mary Beth Terry
- Department of Epidemiology Columbia University New York New York USA
| | - Susan L. Teitelbaum
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai New York New York USA
| | - Alfred I. Neugut
- Department of Epidemiology Columbia University New York New York USA
- Department of Medicine Columbia University New York New York USA
| | - Marilie D. Gammon
- Department of Epidemiology University of North Carolina Chapel Hill North Carolina USA
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7
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Du Z, Weinhold N, Song GC, Rand KA, Van Den Berg DJ, Hwang AE, Sheng X, Hom V, Ailawadhi S, Nooka AK, Singhal S, Pawlish K, Peters E, Bock C, Mohrbacher A, Stram A, Berndt SI, Blot WJ, Casey G, Stevens VL, Kittles R, Goodman PJ, Diver WR, Hennis A, Nemesure B, Klein EA, Rybicki BA, Stanford JL, Witte JS, Signorello L, John EM, Bernstein L, Stroup A, Stephens OW, Zangari M, Van Rhee F, Olshan A, Zheng W, Hu JJ, Ziegler R, Nyante SJ, Ingles SA, Press M, Carpten JD, Chanock S, Mehta J, Colditz GA, Wolf J, Martin TG, Tomasson M, Fiala MA, Terebelo H, Janakiraman N, Kolonel L, Anderson KC, Le Marchand L, Auclair D, Chiu BCH, Ziv E, Stram D, Vij R, Bernal-Mizrachi L, Morgan GJ, Zonder JA, Huff CA, Lonial S, Orlowski RZ, Conti DV, Haiman CA, Cozen W. Abstract PR05: A meta-analysis of genome-wide association study and eQTL analysis of multiple myeloma among African Americans. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-pr05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Persons of African ancestry (AA) experience a 1.5-2-fold risk of multiple myeloma (MM) compared to persons of European ancestry (EA). We assembled a set of MM patients with self-reported AA in order to evaluate the contribution of genetics to etiology in this high-risk group.
Methods: Here we present the results of a meta-analysis of two GWAS in 1,813 cases and 8,871 controls of AA. We also conducted an admixture mapping scan to identify risk alleles associated with local ancestry, fine-mapped the 23 known susceptibility loci to find markers that could better capture MM risk in individuals of AA, and constructed a polygenic risk score (PRS) to assess the aggregated effect of known MM risk alleles. Finally, we conducted an eQTL analysis measuring gene expression in those genes harboring a risk variant in malignant plasma cells from 292 of the patients from a single site.
Results: In GWAS analysis, we identified two suggestive novel loci located at 9p24.3 and 9p13.1 at P<1 × 10-6, but no genome-wide significant association was noted. In admixture mapping, we observed a genome-wide significant inverse association between local AA at 2p24.1-23.1 and MM risk in AA individuals. 20 of the 23 known EA risk variants showed directional consistency and 9 replicated at P<0.05 in AA individuals. In eight regions, we identified markers that better capture MM risk in persons of AA. AA individuals with a PRS in the top 10% had a 1.82-fold (95%CI: 1.56, 2.11) increased MM risk compared to those with average risk (25-75%). The strongest functional association was between the risk allele for variant rs56219066 at 5q15 and lower ELL2 expression (P= 5.1 × 10–12).
Conclusion: Our study shows that common genetic variation contributes to MM risk individuals of AA.
This abstract is also being presented as Poster C040.
Citation Format: Zhaohui Du, Niels Weinhold, Gregory Chi Song, Kristen A. Rand, David J. Van Den Berg, Amie E. Hwang, Xin Sheng, Victor Hom, Sikander Ailawadhi, Ajay K. Nooka, Seema Singhal, Karen Pawlish, Edward Peters, Cathryn Bock, Ann Mohrbacher, Alexander Stram, Sonja I. Berndt, William J. Blot, Graham Casey, Victoria L. Stevens, Rick Kittles, Phyllis J. Goodman, W. Ryan Diver, Anselm Hennis, Barbara Nemesure, Eric A. Klein, Benjamin A. Rybicki, Janet L. Stanford, John S. Witte, Lisa Signorello, Esther M. John, Leslie Bernstein, Antoinette Stroup, Owen W. Stephens, Maurizio Zangari, Frits Van Rhee, Andrew Olshan, Wei Zheng, Jennifer J. Hu, Regina Ziegler, Sarah J. Nyante, Sue Ann Ingles, Michael Press, John David Carpten, Stephen Chanock, Jayesh Mehta, Graham A Colditz, Jeffrey Wolf, Thomas G. Martin, Michael Tomasson, Mark A. Fiala, Howard Terebelo, Nalini Janakiraman, Laurence Kolonel, Kenneth C. Anderson, Loic Le Marchand, Daniel Auclair, Brian C.-H. Chiu, Elad Ziv, Daniel Stram, Ravi Vij, Leon Bernal-Mizrachi, Gareth J. Morgan, Jeffrey A. Zonder, Carol Ann Huff, Sagar Lonial, Robert Z. Orlowski, David V. Conti, Christopher A. Haiman, Wendy Cozen. A meta-analysis of genome-wide association study and eQTL analysis of multiple myeloma among African Americans [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr PR05.
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Affiliation(s)
- Zhaohui Du
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA,
| | - Niels Weinhold
- 2Myeloma Center, University of Arkansas For Medical Sciences, Little Rock, AR,
| | - Gregory Chi Song
- 2Myeloma Center, University of Arkansas For Medical Sciences, Little Rock, AR,
| | - Kristen A. Rand
- 3Millennium Pharmaceuticals Inc., Takeda Pharmaceutical Company Limited, Cambridge, MA,
| | - David J. Van Den Berg
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA,
| | - Amie E. Hwang
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA,
| | - Xin Sheng
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA,
| | - Victor Hom
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA,
| | | | - Ajay K. Nooka
- 5Winship Cancer Institute/Hematology and Medical Oncology, Emory University, Atlanta, GA,
| | - Seema Singhal
- 6Feinberg School of Medicine, Northwestern University, Chicago, IL,
| | | | - Edward Peters
- 8Louisiana State University School of Public Health, New Orleans, LA,
| | - Cathryn Bock
- 9Karmanos Cancer Center, Wayne State University, Detroit, MI,
| | - Ann Mohrbacher
- 10Department of Medicine, Division of Hematology, University of Southern California, Los Angeles, CA,
| | | | - Sonja I. Berndt
- 12National Cancer Institute, Division of Cancer Genetics and Epidemiology; NIH, DHHS, Bethesda, MD,
| | | | - Graham Casey
- 14University of Virginia, University of Virginia School of Medicine, Charlottesville, VA,
| | | | - Rick Kittles
- 16City of Hope National Medical Center, Duarte, CA,
| | | | - W. Ryan Diver
- 14University of Virginia, University of Virginia School of Medicine, Charlottesville, VA,
| | | | | | | | | | | | - John S. Witte
- 21University of California San Francisco, San Francisco, CA,
| | - Lisa Signorello
- 12National Cancer Institute, Division of Cancer Genetics and Epidemiology; NIH, DHHS, Bethesda, MD,
| | | | | | | | - Owen W. Stephens
- 2Myeloma Center, University of Arkansas For Medical Sciences, Little Rock, AR,
| | - Maurizio Zangari
- 2Myeloma Center, University of Arkansas For Medical Sciences, Little Rock, AR,
| | - Frits Van Rhee
- 2Myeloma Center, University of Arkansas For Medical Sciences, Little Rock, AR,
| | | | - Wei Zheng
- 13Vanderbilt University, Nashville, TN,
| | - Jennifer J. Hu
- 25University of Miami Miller School of Medicine, Miami, FL,
| | - Regina Ziegler
- 12National Cancer Institute, Division of Cancer Genetics and Epidemiology; NIH, DHHS, Bethesda, MD,
| | | | - Sue Ann Ingles
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA,
| | - Michael Press
- 26Department of Pathology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA,
| | - John David Carpten
- 27Center for Translational Genomics, Department of Translational Genomics, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA,
| | - Stephen Chanock
- 12National Cancer Institute, Division of Cancer Genetics and Epidemiology; NIH, DHHS, Bethesda, MD,
| | - Jayesh Mehta
- 6Feinberg School of Medicine, Northwestern University, Chicago, IL,
| | - Graham A Colditz
- 28Division of Oncology, Washington University School of Medicine, St. Louis, MO,
| | - Jeffrey Wolf
- 21University of California San Francisco, San Francisco, CA,
| | | | | | - Mark A. Fiala
- 28Division of Oncology, Washington University School of Medicine, St. Louis, MO,
| | | | | | | | - Kenneth C. Anderson
- 33J. Lipper Cancer Center for Multiple Myeloma, Dana-Farber Cancer Institute, Harvard University, Boston, MA,
| | | | | | - Brian C.-H. Chiu
- 35Department of Public Health Sciences, University of Chicago, Chicago, IL,
| | - Elad Ziv
- 21University of California San Francisco, San Francisco, CA,
| | | | - Ravi Vij
- 28Division of Oncology, Washington University School of Medicine, St. Louis, MO,
| | | | | | | | - Carol Ann Huff
- 39Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD,
| | - Sagar Lonial
- 5Winship Cancer Institute/Hematology and Medical Oncology, Emory University, Atlanta, GA,
| | - Robert Z. Orlowski
- 40Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - David V. Conti
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA,
| | - Christopher A. Haiman
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA,
| | - Wendy Cozen
- 1Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA,
- 26Department of Pathology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA,
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8
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Wang T, Nichols HB, Nyante SJ, Bradshaw PT, Moorman PG, Kabat GC, Parada H, Khankari NK, Teitelbaum SL, Terry MB, Santella RM, Neugut AI, Gammon MD. Urinary Estrogen Metabolites and Long-Term Mortality Following Breast Cancer. JNCI Cancer Spectr 2020; 4:pkaa014. [PMID: 32455334 PMCID: PMC7236781 DOI: 10.1093/jncics/pkaa014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/11/2019] [Accepted: 02/26/2020] [Indexed: 12/09/2022] Open
Abstract
Background Estrogen metabolite concentrations of 2-hydroxyestrone (2-OHE1) and 16-hydroxyestrone (16-OHE1) may be associated with breast carcinogenesis. However, no study has investigated their possible impact on mortality after breast cancer. Methods This population-based study was initiated in 1996–1997 with spot urine samples obtained shortly after diagnosis (mean = 96 days) from 683 women newly diagnosed with first primary breast cancer and 434 age-matched women without breast cancer. We measured urinary concentrations of 2-OHE1 and 16-OHE1 using an enzyme-linked immunoassay. Vital status was determined via the National Death Index (n = 244 deaths after a median of 17.7 years of follow-up). We used multivariable-adjusted Cox proportional hazards to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the estrogen metabolites-mortality association. We evaluated effect modification using likelihood ratio tests. All statistical tests were two-sided. Results Urinary concentrations of the 2-OHE1 to 16-OHE1 ratio (>median of 1.8 vs ≤median) were inversely associated with all-cause mortality (HR = 0.74, 95% CI = 0.56 to 0.98) among women with breast cancer. Reduced hazard was also observed for breast cancer mortality (HR = 0.73, 95% CI = 0.45 to 1.17) and cardiovascular diseases mortality (HR = 0.76, 95% CI = 0.47 to 1.23), although the 95% confidence intervals included the null. Similar findings were also observed for women without breast cancer. The association with all-cause mortality was more pronounced among breast cancer participants who began chemotherapy before urine collection (n = 118, HR = 0.42, 95% CI = 0.22 to 0.81) than among those who had not (n = 559, HR = 0.98, 95% CI = 0.72 to 1.34; Pinteraction = .008). Conclusions The urinary 2-OHE1 to 16-OHE1 ratio may be inversely associated with long-term all-cause mortality, which may depend on cancer treatment status at the time of urine collection.
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Affiliation(s)
- Tengteng Wang
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah J Nyante
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.,Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Patricia G Moorman
- Department of Community and Family Medicine, Duke University, Durham, NC, USA
| | | | - Humberto Parada
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, CA, USA
| | - Nikhil K Khankari
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan L Teitelbaum
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Regina M Santella
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA
| | - Alfred I Neugut
- Department of Epidemiology, Columbia University, New York, NY, USA.,Department of Medicine, Columbia University, New York, NY, USA
| | - Marilie D Gammon
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
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9
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Rodriguez J, Nyante SJ, Henderson L, Smith JK, Beck Dallaghan GL, Jordan SG. Radiology Resident Journal Club: Enhancements Add Educational Value. Acad Radiol 2020; 27:591-595. [PMID: 31281084 DOI: 10.1016/j.acra.2019.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/12/2019] [Accepted: 06/15/2019] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES Resident journal clubs are essential to develop skills to critically appraise existing literature. However, most reports of journal clubs focus on logistics of the activity and less on established roles of those involved. Our objective is to report on an innovative journal club from the perspective of key participants. MATERIALS AND METHODS Journal club schedule, assignments, evaluations, and analysis are proffered from our institution. The journal club goals were formulated as: (1) improving resident understanding of research (biostatistical and epidemiologic) methods and statistical concepts, (2) teaching critical appraisal skills, and (3) promoting the use of evidence-based medicine. Each session's format is interactive, consisting of a 10 minute lecture with radiology examples of a research or statistical concept, followed by a journal club style discussion. Crucial to the success of this curriculum has been input and engagement of multiple parties: radiology residents, epidemiologist directors, and subspecialist clinician educator faculty members. CONCLUSION A well-thought out and well-run resident journal club offers numerous solutions to radiology residencies. To residency program leadership and to each individual resident annually, resident journal club offers cutting edge medical knowledge, interactive conferences in the formal didactic curriculum, resident training in critical thinking skills and research design, resident training in interpersonal and communication skills, opportunity for residents to be teachers, and expanded resident interprofessional education. It meets Accreditation Council for Graduate Medical Education common program, Residency Review Committee diagnostic radiology program, and American Board of Radiology Milestones requirements.
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Affiliation(s)
- Justin Rodriguez
- UNC Health Care PGY4 Resident Physician, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sarah J Nyante
- Department of Radiology, University of North Carolina School of Medicine, 321 South Columbia Street, Chapel Hill, NC 27514
| | - Louise Henderson
- Department of Radiology, University of North Carolina School of Medicine, 321 South Columbia Street, Chapel Hill, NC 27514
| | - J Keith Smith
- Department of Radiology, University of North Carolina School of Medicine, 321 South Columbia Street, Chapel Hill, NC 27514
| | - Gary L Beck Dallaghan
- Office of Medical Education, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sheryl G Jordan
- Department of Radiology, University of North Carolina School of Medicine, 321 South Columbia Street, Chapel Hill, NC 27514.
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10
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Nyante SJ, Marsh MW, Benefield T, Earnhardt K, Lee SS, Henderson LM. Supplemental Breast Imaging Utilization After Breast Density Legislation in North Carolina. J Am Coll Radiol 2020; 17:6-14. [PMID: 31271735 PMCID: PMC6938553 DOI: 10.1016/j.jacr.2019.05.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Breast density notification laws are increasingly common but little is known of how they affect supplemental screening use. The aim of this study was to investigate supplemental screening before and after density notification in North Carolina, where notification has been required since 2014. METHODS Breast screening data from Carolina Mammography Registry participants aged 40 to 79 years with no personal histories of breast cancer or breast implants were evaluated. Supplemental screening was defined as a nondiagnostic digital breast tomosynthesis (DBT), whole-breast ultrasound, or breast MRI performed within 3 months of negative or benign results on screening mammography (2-D or DBT). Supplemental screening before (2012-2013) and after (2014-2016) the notification law was compared using logistic regression. RESULTS During the study period, 78,967 women underwent 145,279 index screening mammographic examinations. Supplemental screening use was similar before and after the notification law, regardless of breast density (dense breasts: adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 0.58-1.75; nondense breasts: aOR, 0.63; 95% CI, 0.38-1.04). Although there was no change in supplemental screening, new use of any screening DBT from 2014 to 2016 was greater for women with dense breasts (versus nondense breasts; aOR, 1.15; 95% CI, 1.08-1.23). CONCLUSIONS Data suggest that supplemental screening use in North Carolina did not change after enactment of a breast density notification law, though the increase in new use of any screening DBT was greater for women with dense breasts. The short-term lack of change in supplemental screening should be considered as additional notification laws are developed.
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Affiliation(s)
- Sarah J Nyante
- Department of Radiology and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Mary W Marsh
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thad Benefield
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn Earnhardt
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sheila S Lee
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Louise M Henderson
- Department of Radiology and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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11
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Wang T, Bradshaw PB, Nyante SJ, Nichols HB, Moorman PG, Kabat GC, Teitelbaum SL, Neugut AI, Gammon MD. Abstract 3294: Urinary estrogen metabolites and long-term all-cause and cause-specific mortality following breast cancer diagnosis: A population-based study. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-3294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Estrogen metabolites play a role in breast cancer development. Previous studies have particularly focused on the two competing metabolism pathways which yield metabolites 2-hydroxyestrone (2-OHE1) and 16-hydroxyestrone (16-OHE1). 2-OHE1 has been shown to have antiestrogenic effects, but 16-OHE1has strong estrogenic and even genotoxic activity. No study has investigated their biologically plausible role in predicting prognosis/mortality among women diagnosed with breast cancer.
Methods: In the Long Island Breast Study Project, spot urine samples were obtained from 687 women diagnosed with first primary breast cancer (shortly after diagnosis) in 1996-1997. Urinary concentrations of estrogen metabolites 2-OHE1 and 16-OHE1 were measured using enzyme linked immuno-assay. Vital status was determined by the National Death Index through December 31, 2014; 244 deaths (84 breast cancer-specific and 80 cardiovascular diseases-specific) were identified. We used multivariable-adjusted Cox proportional hazards regression model to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause, breast cancer and cardiovascular diseases mortality as related to the two individual metabolites and their ratio (2-OHE1/16-OHE1). Multiplicative interactions with menopausal hormone therapy, body mass index, menopausal status, and breast cancer treatments were evaluated with likelihood ratio tests.
Results: During a median follow-up of 18 years, urinary concentration of the 2-OHE1/16-OHE1 ratio (> median of 1.8 vs. ≤ median of 1.8) was associated with reduced risk of all-cause mortality (HR=0.74, 95% CI=0.56-0.98) among women with breast cancer. This inverse association with the 2-OHE1/16-OHE1 ratio was also observed for breast cancer mortality (HR=0.73, 95% CI=0.45-1.17) and cardiovascular diseases mortality (HR=0.76, 95% CI=0.47-1.23), although the 95%CIs included the null. The 2-OHE1/16-OHE1 ratio-mortality associations did not significantly differ by menopausal hormone therapy, body mass index, and menopausal status at the time of urine collection (Pinteration >0.05). Consistent patterns of association were not observed between the individual metabolites and mortality outcomes.
Conclusion: To our knowledge, our study represents the first population-based epidemiologic evidence suggesting that the urinary concentration of the 2-OHE1/16-OHE1 ratio measured shortly after breast cancer diagnosis may be associated with improved overall mortality for breast cancer survivors. Future investigation is necessary to confirm our findings and to further understand the underlying biological mechanisms for estrogen metabolism–mortality relationships following breast cancer diagnosis.
Citation Format: Tengteng Wang, Patrick B. Bradshaw, Sarah J. Nyante, Hazel B. Nichols, Patricia G. Moorman, Geoffrey C. Kabat, Susan L. Teitelbaum, Alfred I. Neugut, Marilie D. Gammon. Urinary estrogen metabolites and long-term all-cause and cause-specific mortality following breast cancer diagnosis: A population-based study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3294.
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Affiliation(s)
- Tengteng Wang
- 1The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Sarah J. Nyante
- 1The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hazel B. Nichols
- 1The University of North Carolina at Chapel Hill, Chapel Hill, NC
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12
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Nyante SJ, Biritwum R, Figueroa J, Graubard B, Awuah B, Addai BW, Yarney J, Clegg-Lamptey JN, Ansong D, Nyarko K, Wiafe S, Oppong J, Boakye I, Brotzman M, Adjei R, Afriyie LT, Garcia-Closas M, Brinton LA. Recruiting population controls for case-control studies in sub-Saharan Africa: The Ghana Breast Health Study. PLoS One 2019; 14:e0215347. [PMID: 30990841 PMCID: PMC6467449 DOI: 10.1371/journal.pone.0215347] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 04/01/2019] [Indexed: 01/18/2023] Open
Abstract
Background In case-control studies, population controls can help ensure generalizability; however, the selection of population controls can be challenging in environments that lack population registries. We developed a population enumeration and sampling strategy to facilitate use of population controls in a breast cancer case-control study conducted in Ghana. Methods Household enumeration was conducted in 110 census-defined geographic areas within Ghana’s Ashanti, Central, Eastern, and Greater Accra Regions. A pool of potential controls (women aged 18 to 74 years, never diagnosed with breast cancer) was selected from the enumeration using systematic random sampling and frequency-matched to the anticipated distributions of age and residence among cases. Multiple attempts were made to contact potential controls to assess eligibility and arrange for study participation. To increase participation, we implemented a refusal conversion protocol in which initial non-participants were re-approached after several months. Results 2,528 women were sampled from the enumeration listing, 2,261 (89%) were successfully contacted, and 2,106 were enrolled (overall recruitment of 83%). 170 women were enrolled through refusal conversion. Compared with women enrolled after being first approached, refusal conversion enrollees were younger and less likely to complete the study interview in the study hospital (13% vs. 23%). The most common reasons for non-participation were lack of interest and lack of time. Conclusions Using household enumeration and repeated contacts, we were able to recruit population controls with a high participation rate. Our approach may provide a blue-print for others undertaking epidemiologic studies in populations that lack accessible population registries.
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Affiliation(s)
- Sarah J. Nyante
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- * E-mail:
| | | | | | - Barry Graubard
- National Cancer Institute, Rockville, MD, United States of America
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13
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Couture HD, Williams LA, Geradts J, Nyante SJ, Butler EN, Marron JS, Perou CM, Troester MA, Niethammer M. Image analysis with deep learning to predict breast cancer grade, ER status, histologic subtype, and intrinsic subtype. NPJ Breast Cancer 2018; 4:30. [PMID: 30182055 PMCID: PMC6120869 DOI: 10.1038/s41523-018-0079-1] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 11/09/2022] Open
Abstract
RNA-based, multi-gene molecular assays are available and widely used for patients with ER-positive/HER2-negative breast cancers. However, RNA-based genomic tests can be costly and are not available in many countries. Methods for inferring molecular subtype from histologic images may identify patients most likely to benefit from further genomic testing. To identify patients who could benefit from molecular testing based on H&E stained histologic images, we developed an image analysis approach using deep learning. A training set of 571 breast tumors was used to create image-based classifiers for tumor grade, ER status, PAM50 intrinsic subtype, histologic subtype, and risk of recurrence score (ROR-PT). The resulting classifiers were applied to an independent test set (n = 288), and accuracy, sensitivity, and specificity of each was assessed on the test set. Histologic image analysis with deep learning distinguished low-intermediate vs. high tumor grade (82% accuracy), ER status (84% accuracy), Basal-like vs. non-Basal-like (77% accuracy), Ductal vs. Lobular (94% accuracy), and high vs. low-medium ROR-PT score (75% accuracy). Sampling considerations in the training set minimized bias in the test set. Incorrect classification of ER status was significantly more common for Luminal B tumors. These data provide proof of principle that molecular marker status, including a critical clinical biomarker (i.e., ER status), can be predicted with accuracy >75% based on H&E features. Image-based methods could be promising for identifying patients with a greater need for further genomic testing, or in place of classically scored variables typically accomplished using human-based scoring.
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Affiliation(s)
- Heather D Couture
- 1Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Lindsay A Williams
- 2Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Joseph Geradts
- 3Department of Pathology, Dana-Farber Cancer Institute, Boston, MA 02115 USA
| | - Sarah J Nyante
- 4Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Ebonee N Butler
- 2Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - J S Marron
- 5Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA.,6Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Charles M Perou
- 5Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA.,7Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Melissa A Troester
- 2Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA.,5Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Marc Niethammer
- 1Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA.,8Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
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14
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Puvanesarajah S, Nyante SJ, Kuzmiak CM, Chen M, Tse CK, Sun X, Allott EH, Kirk EL, Carey LA, Perou CM, Olshan AF, Henderson LM, Troester MA. PAM50 and Risk of Recurrence Scores for Interval Breast Cancers. Cancer Prev Res (Phila) 2018; 11:327-336. [PMID: 29622545 PMCID: PMC5984721 DOI: 10.1158/1940-6207.capr-17-0368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/01/2018] [Accepted: 03/28/2018] [Indexed: 12/20/2022]
Abstract
Breast cancers detected after a negative breast screening examination and prior to the next screening are referred to as interval cancers. These cancers generally have poor clinical characteristics compared with screen-detected cancers, but associations between interval cancer and genomic cancer characteristics are not well understood. Mammographically screened women diagnosed with primary invasive breast cancer from 1993 to 2013 (n = 370) were identified by linking the Carolina Breast Cancer Study and the Carolina Mammography Registry. Among women with a registry-identified screening mammogram 0 to 24 months before diagnosis, cancers were classified as screen-detected (N = 165) or interval-detected (N = 205). Using logistic regression, we examined the association of mode of detection with cancer characteristics (clinical, IHC, and genomic), overall, and in analyses stratified on mammographic density and race. Interval cancer was associated with large tumors [>2 cm; OR, 2.3; 95% confidence interval (CI), 1.5-3.7], positive nodal status (OR, 1.8; 95% CI, 1.1-2.8), and triple-negative subtype (OR, 2.5; 95% CI, 1.1-5.5). Interval cancers were more likely to have non-Luminal A subtype (OR, 2.9; 95% CI, 1.5-5.7), whereas screen-detected cancers tended to be more indolent (96% had low risk of recurrence genomic scores; 71% were PAM50 Luminal A). When stratifying by mammographic density and race, associations between interval detection and poor prognostic features were similar by race and density status. Strong associations between interval cancers and poor-prognosis genomic features (non-Luminal A subtype and high risk of recurrence score) suggest that aggressive tumor biology is an important contributor to interval cancer rates. Cancer Prev Res; 11(6); 327-36. ©2018 AACR.
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Affiliation(s)
| | - Sarah J Nyante
- Department of Radiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Cherie M Kuzmiak
- Department of Radiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Mengjie Chen
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Chiu-Kit Tse
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Xuezheng Sun
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Emma H Allott
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Erin L Kirk
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Lisa A Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Charles M Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Louise M Henderson
- Department of Radiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa A Troester
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
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15
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Mullooly M, Khodr ZG, Dallal CM, Nyante SJ, Sherman ME, Falk R, Liao LM, Love J, Brinton LA, Gierach GL. Epidemiologic Risk Factors for In Situ and Invasive Breast Cancers Among Postmenopausal Women in the National Institutes of Health-AARP Diet and Health Study. Am J Epidemiol 2017. [PMID: 28637226 DOI: 10.1093/aje/kwx206] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Comparing risk factor associations between invasive breast cancers and possible precursors may further our understanding of factors related to initiation versus progression. Accordingly, among 190,325 postmenopausal participants in the National Institutes of Health-AARP Diet and Health Study (1995-2011), we compared the association between risk factors and incident ductal carcinoma in situ (DCIS; n = 1,453) with that of risk factors and invasive ductal carcinomas (n = 7,525); in addition, we compared the association between risk factors and lobular carcinoma in situ (LCIS; n = 186) with that of risk factors and invasive lobular carcinomas (n = 1,191). Hazard ratios and 95% confidence intervals were estimated from multivariable Cox proportional hazards regression models. We used case-only multivariable logistic regression to test for heterogeneity in associations. Younger age at menopause was associated with a higher risk of DCIS but lower risks of LCIS and invasive ductal carcinomas (P for heterogeneity < 0.01). Prior breast biopsy was more strongly associated with the risk of LCIS than the risk of DCIS (P for heterogeneity = 0.04). Increased risks associated with use of menopausal hormone therapy were stronger for LCIS than DCIS (P for heterogeneity = 0.03) and invasive lobular carcinomas (P for heterogeneity < 0.01). Associations were similar for race, age at menarche, age at first birth, family history, alcohol consumption, and smoking status, which suggests that most risk factor associations are similar for in situ and invasive cancers and may influence early stages of tumorigenesis. The differential associations observed for various factors may provide important clues for understanding the etiology of certain breast cancers.
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Affiliation(s)
- Maeve Mullooly
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Zeina G Khodr
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Cher M Dallal
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, College Park, Maryland
| | - Sarah J Nyante
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mark E Sherman
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Roni Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Jeffrey Love
- Strategic Issues Research, AARP Research Center, Washington, DC
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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16
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Nyante SJ, Ozdowski E, Tan X, Lawton TJ. Abstract 5308: Tissue-based heterogeneity in lobular carcinoma in situ. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Lobular carcinoma in situ (LCIS) is a preinvasive breast lesion associated with a 6 to 11-fold increased risk of invasive breast cancer. Despite this increased risk, little is known regarding what qualities of LCIS predispose individual patients to invasive cancer. Given recent advances in understanding of the importance of etiologic heterogeneity within breast cancer, we sought to characterize morphologic markers of heterogeneity in LCIS and surrounding tissue, with the hypothesis that features with lesional variation may be important candidate predictors of breast cancer risk. We identified 64 patients aged ≥ 18 years who were diagnosed with LCIS at a single institution from 2004-2014. Patients with concurrent invasive breast cancer in the same breast were excluded. Archival slides of each case were reviewed by an experienced breast pathologist to confirm the presence of LCIS and characterize the LCIS type (classic, florid, or pleomorphic). The number of lobules involved with LCIS, presence of calcifications or necrosis associated with LCIS, and presence of other benign lesions [atypical lobular hyperplasia (ALH), atypical ductal hyperplasia (ADH), flat epithelial atypia, fibroadenoma, intraductal papilloma] were recorded. Age at surgery and surgery type were abstracted from medical records. The two-sided Fisher’s exact test was used to examine differences in proportions. The mean age of the cases was 53 years, and the most common surgery type was excisional/incisional biopsy or lumpectomy (55%), followed by core biopsy (25%) and mastectomy (20%). Calcifications were associated with LCIS in 41% of cases. Women were more likely to have florid LCIS when calcifications were present compared to when calcifications were absent (P<0.01). Additionally, cases with calcifications were more likely to have more than 10 lobules affected by LCIS (P<0.01). Associations between calcifications and extent of LCIS persisted when the sample was restricted to cases where classic LCIS was the primary type. Moreover, the presence of calcifications was not associated with surgery type (P=0.36), suggesting that the results were not due to sampling bias. Other benign lesions were present in the majority of cases, but were not associated with LCIS characteristics (all P>0.05). ALH was the most common other lesion, present in 70% of samples.. Our results demonstrate that LCIS-associated calcifications are common and are associated with more extensive disease, even among LCIS characterized as ‘classic’. In invasive breast cancer, the presence of certain types of calcifications has been associated with poor prognosis. A next step in this research is to understand whether the heterogeneity we observed in LCIS can be ascribed to a specific calcification morphology and/or distribution. Understanding this will help us elucidate the potential biological mechanism and determine whether LCIS calcifications are a viable marker for the prediction of breast cancer risk.
Citation Format: Sarah J. Nyante, Emily Ozdowski, Xianming Tan, Thomas J. Lawton. Tissue-based heterogeneity in lobular carcinoma in situ [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5308. doi:10.1158/1538-7445.AM2017-5308
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Affiliation(s)
- Sarah J. Nyante
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Emily Ozdowski
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Xianming Tan
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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17
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Gaudet MM, Carter BD, Brinton LA, Falk RT, Gram IT, Luo J, Milne RL, Nyante SJ, Weiderpass E, Beane Freeman LE, Sandler DP, Robien K, Anderson KE, Giles GG, Chen WY, Feskanich D, Braaten T, Isaacs C, Butler LM, Koh WP, Wolk A, Adami HO, White E, Margolis KL, Thun MJ, Gapstur SM. Pooled analysis of active cigarette smoking and invasive breast cancer risk in 14 cohort studies. Int J Epidemiol 2017; 46:881-893. [PMID: 28031315 PMCID: PMC5837778 DOI: 10.1093/ije/dyw288] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 11/15/2022] Open
Abstract
Background The 2014 US Surgeon General's report noted research gaps necessary to determine a causal relationship between active cigarette smoking and invasive breast cancer risk, including the role of alcohol consumption, timing of exposure, modification by menopausal status and heterogeneity by oestrogen receptor (ER) status. Methods To address these issues, we pooled data from 14 cohort studies contributing 934 681 participants (36 060 invasive breast cancer cases). Cox proportional hazard regression models were used to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Results Smoking duration before first birth was positively associated with risk ( P -value for trend = 2 × 10 -7 ) with the highest HR for initiation >10 years before first birth (HR = 1.18, CI 1.12-1.24). Effect modification by current alcohol consumption was evident for the association with smoking duration before first birth ( P -value=2×10 -4 ); compared with never-smoking non-drinkers, initiation >10 years before first birth was associated with risk in every category of alcohol intake, including non-drinkers (HR = 1.15, CI 1.04-1.28) and those who consumed at least three drinks per day (1.85, 1.55-2.21). Associations with smoking before first birth were limited to risk of ER+ breast cancer ( P -value for homogeneity=3×10 -3 ). Other smoking timing and duration characteristics were associated with risk even after controlling for alcohol, but were not associated with risk in non-drinkers. Effect modification by menopause was not evident. Conclusions Smoking, particularly if initiated before first birth, was modestly associated with ER+ breast cancer risk that was not confounded by amount of adult alcohol intake. Possible links with breast cancer provide additional motivation for young women to not initiate smoking.
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Affiliation(s)
- Mia M Gaudet
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Brian D Carter
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Inger T Gram
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Roger L Milne
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Sarah J Nyante
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Laura E Beane Freeman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH/DHHS, Research Triangle Park, NC, USA
| | - Kim Robien
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Wendy Y Chen
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Diane Feskanich
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Tonje Braaten
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Claudine Isaacs
- Department of Oncology, School of Medicine, Georgetown University, Washington, DC, USA
- Lombardi Comprehensive Cancer Center at Georgetown University, Washington, DC, USA
| | - Lesley M Butler
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Woon-Puay Koh
- Duke-NUS Graduate Medical School Singapore, Singapore, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alicja Wolk
- Department of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health Community, Boston, MA, USA
| | - Emily White
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Karen L Margolis
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | - Michael J Thun
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
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18
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Brinton LA, Awuah B, Nat Clegg-Lamptey J, Wiafe-Addai B, Ansong D, Nyarko KM, Wiafe S, Yarney J, Biritwum R, Brotzman M, Adjei AA, Adjei E, Aitpillah F, Edusei L, Dedey F, Nyante SJ, Oppong J, Osei-Bonsu E, Titiloye N, Vanderpuye V, Brew Abaidoo E, Arhin B, Boakye I, Frempong M, Ohene Oti N, Okyne V, Figueroa JD. Design considerations for identifying breast cancer risk factors in a population-based study in Africa. Int J Cancer 2017; 140:2667-2677. [PMID: 28295287 DOI: 10.1002/ijc.30688] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/30/2017] [Accepted: 02/08/2017] [Indexed: 02/04/2023]
Abstract
Although breast cancer is becoming more prevalent in Africa, few epidemiologic studies have been undertaken and appropriate methodologic approaches remain uncertain. We therefore conducted a population-based case-control study in Accra and Kumasi, Ghana, enrolling 2,202 women with lesions suspicious for breast cancer and 2,161 population controls. Biopsy tissue for cases prior to neoadjuvant therapy (if given), blood, saliva and fecal samples were sought for study subjects. Response rates, risk factor prevalences and odds ratios for established breast cancer risk factors were calculated. A total of 54.5% of the recruited cases were diagnosed with malignancies, 36.0% with benign conditions and 9.5% with indeterminate diagnoses. Response rates to interviews were 99.2% in cases and 91.9% in controls, with the vast majority of interviewed subjects providing saliva (97.9% in cases vs. 98.8% in controls) and blood (91.8% vs. 82.5%) samples; lower proportions (58.1% vs. 46.1%) provided fecal samples. While risk factor prevalences were unique as compared to women in other countries (e.g., less education, higher parity), cancer risk factors resembled patterns identified elsewhere (elevated risks associated with higher levels of education, familial histories of breast cancer, low parity and larger body sizes). Subjects with benign conditions were younger and exhibited higher socioeconomic profiles (e.g., higher education and lower parity) than those with malignancies, suggesting selective referral influences. While further defining breast cancer risk factors in Africa, this study showed that successful population-based interdisciplinary studies of cancer in Africa are possible but require close attention to diagnostic referral biases and standardized and documented approaches for high-quality data collection, including biospecimens.
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Affiliation(s)
- Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Florence Dedey
- Korle Bu Teaching Hospital, Accra, Ghana.,University of Ghana, Accra, Ghana
| | - Sarah J Nyante
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.,Currently at the University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | | | | | | | | | | | | | | | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.,Currently at the Usher Institute of Population Health Sciences and Informatics, Edinburgh Cancer Research Centre, Edinburgh, Scotland
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19
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Mullooly M, Yang HP, Falk RT, Nyante SJ, Cora R, Pfeiffer RM, Radisky DC, Visscher DW, Hartmann LC, Carter JM, Degnim AC, Stanczyk FZ, Figueroa JD, Garcia-Closas M, Lissowska J, Troester MA, Hewitt SM, Brinton LA, Sherman ME, Gierach GL. Relationship between crown-like structures and sex-steroid hormones in breast adipose tissue and serum among postmenopausal breast cancer patients. Breast Cancer Res 2017; 19:8. [PMID: 28103902 PMCID: PMC5244534 DOI: 10.1186/s13058-016-0791-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/05/2016] [Indexed: 01/16/2023] Open
Abstract
Background Postmenopausal obesity is associated with increased circulating levels of androgens and estrogens and elevated breast cancer risk. Crown-like structures (CLS; microscopic foci of dying adipocytes surrounded by macrophages) are proposed to represent sites of increased aromatization of androgens to estrogens. Accordingly, we examined relationships between CLS and sex-steroid hormones in breast adipose tissue and serum from postmenopausal breast cancer patients. Methods Formalin-fixed paraffin embedded benign breast tissues collected for research from postmenopausal women (n = 83) diagnosed with invasive breast cancer in the Polish Breast Cancer Study (PBCS) were evaluated. Tissues were immunohistochemically stained for CD68 to determine the presence of CLS per unit area of adipose tissue. Relationships were assessed between CD68 density and CLS and previously reported sex-steroid hormones quantified using radioimmunoassays in serum taken at the time of diagnosis and in fresh frozen adipose tissue taken at the time of surgery. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the relationships between hormones (in tertiles) and CLS. Results CLS were observed in 36% of benign breast tissues, with a higher frequency among obese versus lean women (54% versus 17%, p = 0.03). Detection of CLS was not related to individual hormone levels or breast tumor pathology characteristics. However, detection of CLS was associated with hormone ratios. Compared with women in the highest tertile of estrone:androstenedione ratio in fat, those in the lowest tertile were less likely to have CLS (OR 0.12, 95% CI 0.03–0.59). A similar pattern was observed with estradiol:testosterone ratio in serum and CLS (lowest versus highest tertile, OR 0.18, 95% CI 0.04–0.72). Conclusions CLS were more frequently identified in the breast fat of obese women and were associated with increased ratios of select estrogens:androgens in the blood and tissues, but not with individual hormones. Additional studies on CLS, tissue and blood hormone levels, and breast cancer risk are needed to understand and confirm these findings. Electronic supplementary material The online version of this article (doi:10.1186/s13058-016-0791-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maeve Mullooly
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA. .,Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA.
| | - Hannah P Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | - Sarah J Nyante
- Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Renata Cora
- Independent contractor, CT(ASCP), MB(ASCP), Stamford, CT, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | | | | | | | | | | | - Frank Z Stanczyk
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jonine D Figueroa
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, UK
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland
| | - Melissa A Troester
- Department of Epidemiology and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | - Mark E Sherman
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
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20
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Rand KA, Song C, Dean E, Serie DJ, Curtin K, Sheng X, Hu D, Huff CA, Bernal-Mizrachi L, Tomasson MH, Ailawadhi S, Singhal S, Pawlish K, Peters ES, Bock CH, Stram A, Van Den Berg DJ, Edlund CK, Conti DV, Zimmerman T, Hwang AE, Huntsman S, Graff J, Nooka A, Kong Y, Pregja SL, Berndt SI, Blot WJ, Carpten J, Casey G, Chu L, Diver WR, Stevens VL, Lieber MR, Goodman PJ, Hennis AJM, Hsing AW, Mehta J, Kittles RA, Kolb S, Klein EA, Leske C, Murphy AB, Nemesure B, Neslund-Dudas C, Strom SS, Vij R, Rybicki BA, Stanford JL, Signorello LB, Witte JS, Ambrosone CB, Bhatti P, John EM, Bernstein L, Zheng W, Olshan AF, Hu JJ, Ziegler RG, Nyante SJ, Bandera EV, Birmann BM, Ingles SA, Press MF, Atanackovic D, Glenn MJ, Cannon-Albright LA, Jones B, Tricot G, Martin TG, Kumar SK, Wolf JL, Deming Halverson SL, Rothman N, Brooks-Wilson AR, Rajkumar SV, Kolonel LN, Chanock SJ, Slager SL, Severson RK, Janakiraman N, Terebelo HR, Brown EE, De Roos AJ, Mohrbacher AF, Colditz GA, Giles GG, Spinelli JJ, Chiu BC, Munshi NC, Anderson KC, Levy J, Zonder JA, Orlowski RZ, Lonial S, Camp NJ, Vachon CM, Ziv E, Stram DO, Hazelett DJ, Haiman CA, Cozen W. A Meta-analysis of Multiple Myeloma Risk Regions in African and European Ancestry Populations Identifies Putatively Functional Loci. Cancer Epidemiol Biomarkers Prev 2016; 25:1609-1618. [PMID: 27587788 PMCID: PMC5524541 DOI: 10.1158/1055-9965.epi-15-1193] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 06/20/2016] [Accepted: 07/05/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Genome-wide association studies (GWAS) in European populations have identified genetic risk variants associated with multiple myeloma. METHODS We performed association testing of common variation in eight regions in 1,318 patients with multiple myeloma and 1,480 controls of European ancestry and 1,305 patients with multiple myeloma and 7,078 controls of African ancestry and conducted a meta-analysis to localize the signals, with epigenetic annotation used to predict functionality. RESULTS We found that variants in 7p15.3, 17p11.2, 22q13.1 were statistically significantly (P < 0.05) associated with multiple myeloma risk in persons of African ancestry and persons of European ancestry, and the variant in 3p22.1 was associated in European ancestry only. In a combined African ancestry-European ancestry meta-analysis, variation in five regions (2p23.3, 3p22.1, 7p15.3, 17p11.2, 22q13.1) was statistically significantly associated with multiple myeloma risk. In 3p22.1, the correlated variants clustered within the gene body of ULK4 Correlated variants in 7p15.3 clustered around an enhancer at the 3' end of the CDCA7L transcription termination site. A missense variant at 17p11.2 (rs34562254, Pro251Leu, OR, 1.32; P = 2.93 × 10-7) in TNFRSF13B encodes a lymphocyte-specific protein in the TNF receptor family that interacts with the NF-κB pathway. SNPs correlated with the index signal in 22q13.1 cluster around the promoter and enhancer regions of CBX7 CONCLUSIONS: We found that reported multiple myeloma susceptibility regions contain risk variants important across populations, supporting the use of multiple racial/ethnic groups with different underlying genetic architecture to enhance the localization and identification of putatively functional alleles. IMPACT A subset of reported risk loci for multiple myeloma has consistent effects across populations and is likely to be functional. Cancer Epidemiol Biomarkers Prev; 25(12); 1609-18. ©2016 AACR.
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Affiliation(s)
- Kristin A Rand
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Chi Song
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | | | | | - Karen Curtin
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Xin Sheng
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Donglei Hu
- University of California at San Francisco, San Francisco, California
| | - Carol Ann Huff
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Michael H Tomasson
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University, St. Louis, Missouri
| | | | - Seema Singhal
- Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois
| | - Karen Pawlish
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, New Jersey
| | - Edward S Peters
- Louisiana State University School of Public Health, Louisiana State University, New Orleans, Louisiana
| | - Cathryn H Bock
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Alex Stram
- Genomic Health, Inc., Redwood City, California
| | - David J Van Den Berg
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Christopher K Edlund
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - David V Conti
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | | | - Amie E Hwang
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Scott Huntsman
- University of California at San Francisco, San Francisco, California
| | - John Graff
- Rutgers-Robert Wood Johnson Medical School, Rutgers State University of New Jersey, New Brunswick, New Jersey
| | - Ajay Nooka
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Yinfei Kong
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Silvana L Pregja
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, U.S. NIH, Bethesda, Maryland
| | - William J Blot
- International Epidemiology Institute, Rockville, Maryland
- Division of Epidemiology, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - John Carpten
- The Translational Genomics Research Institute, Phoenix, Arizona
| | - Graham Casey
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Lisa Chu
- Cancer Prevention Institute of California, Fremont, California
- Stanford University School of Medicine and Stanford Cancer Institute, Palo Alto, California
| | | | | | - Michael R Lieber
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | | | - Anselm J M Hennis
- Stony Brook University, Stony Brook, New York
- Chronic Disease Research Centre and Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados
| | - Ann W Hsing
- Stanford University School of Medicine and Stanford Cancer Institute, Palo Alto, California
| | - Jayesh Mehta
- Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois
| | - Rick A Kittles
- Department of Surgery, University of Arizona, Tucson, Arizona
| | - Suzanne Kolb
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Eric A Klein
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Adam B Murphy
- Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois
| | | | | | - Sara S Strom
- The University of Texas MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Ravi Vij
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University, St. Louis, Missouri
| | | | - Janet L Stanford
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lisa B Signorello
- Harvard School of Public Health, Harvard University, Boston, Massachusetts
| | - John S Witte
- Institute for Human Genetics, University of California, San Francisco, San Francisco, California
| | | | - Parveen Bhatti
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Esther M John
- Cancer Prevention Institute of California, Fremont, California
- Stanford University School of Medicine and Stanford Cancer Institute, Palo Alto, California
| | - Leslie Bernstein
- Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, California
| | - Wei Zheng
- International Epidemiology Institute, Rockville, Maryland
| | - Andrew F Olshan
- Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer J Hu
- Sylvester Comprehensive Cancer Center and Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida
| | - Regina G Ziegler
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, U.S. NIH, Bethesda, Maryland
| | - Sarah J Nyante
- Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Elisa V Bandera
- Rutgers-Robert Wood Johnson Medical School, Rutgers State University of New Jersey, New Brunswick, New Jersey
| | - Brenda M Birmann
- Harvard School of Public Health, Harvard University, Boston, Massachusetts
| | - Sue A Ingles
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Michael F Press
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | | | - Martha J Glenn
- University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Brandt Jones
- University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Thomas G Martin
- University of California at San Francisco, San Francisco, California
| | | | - Jeffrey L Wolf
- University of California at San Francisco, San Francisco, California
| | | | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, U.S. NIH, Bethesda, Maryland
| | | | | | - Laurence N Kolonel
- University of Hawaii Cancer Center, University of Hawaii, Honolulu, Hawaii
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, U.S. NIH, Bethesda, Maryland
| | | | - Richard K Severson
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | | | | | | | | | - Ann F Mohrbacher
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Graham A Colditz
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University, St. Louis, Missouri
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council of Victoria, Melbourne, Victoria, Australia
- School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
- Monash University, Melbourne, Melbourne, Victoria, Australia
| | - John J Spinelli
- BC Cancer Agency, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Nikhil C Munshi
- Dana Farber Cancer Institute, Harvard School of Medicine, Harvard University, Boston, Massachusetts
| | - Kenneth C Anderson
- Dana Farber Cancer Institute, Harvard School of Medicine, Harvard University, Boston, Massachusetts
| | - Joan Levy
- Multiple Myeloma Research Foundation, Norwalk, Connecticut
| | - Jeffrey A Zonder
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Robert Z Orlowski
- The University of Texas MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Sagar Lonial
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nicola J Camp
- University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Elad Ziv
- University of California at San Francisco, San Francisco, California
| | - Daniel O Stram
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Dennis J Hazelett
- Center for Bioinformatics and Computational Biology, Cedars Sinai Medical Center, Los Angeles, California.
| | - Christopher A Haiman
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
| | - Wendy Cozen
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
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Gierach GL, Curtis RE, Pfeiffer RM, Mullooly M, Ntowe EA, Hoover RN, Nyante SJ, Feigelson HS, Glass AG, Berrington de Gonzalez A. Association of Adjuvant Tamoxifen and Aromatase Inhibitor Therapy With Contralateral Breast Cancer Risk Among US Women With Breast Cancer in a General Community Setting. JAMA Oncol 2016; 3:186-193. [PMID: 27711920 DOI: 10.1001/jamaoncol.2016.3340] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Within 10 years after breast cancer diagnosis, roughly 5% of patients develop contralateral breast cancer (CBC). Randomized trials have found that therapy including tamoxifen citrate and aromatase inhibitors (AIs) reduces CBC risk. But little is known about the magnitude and duration of protective associations within the context of real-world clinical management settings, where varying durations of and gaps in treatment are common. Objective To determine the association between adjuvant tamoxifen and AI therapy and CBC risk within a general community setting. Design, Setting, and Participants A retrospective cohort study of CBC risk among 7541 patients diagnosed with a first primary unilateral invasive breast cancer at Kaiser Permanente Institute for Health Research (Colorado) or Kaiser Permanente Northwest Center for Health Research (Oregon) between January 1, 1990, and December 31, 2008. Data were analyzed from 1 year after diagnosis of the first breast cancer through the earliest of the following events: CBC diagnosis, other second cancer diagnosis, death, last tumor registry follow-up, exit from the Kaiser Permanente health care plan, or end of study follow-up (December 31, 2010, for Oregon and December 31, 2011, for Colorado). Exposures Adjuvant tamoxifen use and AI therapy were treated as time-dependent exposures, assessed using electronic prescription records. Main Outcomes and Measures Incident CBC based on long-term systematic follow-up. Results Among 7541 women with invasive breast cancer, median age at initial breast cancer diagnosis was 60.6 years (age range, 24.9-84.9 years). Women were predominantly (92.9% [7009 of 7541]) of white race. During a median of 6.3 years (range, 1-20.9 years) of follow-up, 248 women developed CBC (45 in situ and 203 invasive). Contralateral breast cancer risk decreased significantly with increasing tamoxifen therapy duration. In current users, the relative risk (RR) per year of tamoxifen use was 0.76 (95% CI, 0.64-0.89), with an estimated 66% (RR, 0.34; 95% CI, 0.29-0.40) RR reduction for 4 years of use compared with nonusers. Risk reductions were slightly smaller for past users but were still significant at least 5 years after stopping tamoxifen therapy (RR per year of use, 0.85; 95% CI, 0.71-0.995). In addition, AI use without tamoxifen therapy was associated with reduced CBC risk (RR for AI users compared with nonusers, 0.48; 95% CI, 0.22-0.97). Risk reductions were most apparent among women whose primary and CBCs were estrogen receptor positive. Conclusions and Relevance Tamoxifen therapy was associated with reduced CBC risk during treatment and after its cessation, with risk progressively decreasing as tamoxifen therapy duration increased. Among those surviving at least 5 years, tamoxifen use for at least 4 years was estimated to prevent 3 CBCs per 100 women by 10 years after an estrogen receptor-positive first breast cancer, an absolute risk reduction that is consistent with findings from clinical trials. If adjuvant endocrine therapy is indicated for breast cancer treatment, these findings in concert with trial data suggest that women should be encouraged to complete the full course.
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Affiliation(s)
- Gretchen L Gierach
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Rochelle E Curtis
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maeve Mullooly
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland4Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Estelle A Ntowe
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Robert N Hoover
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sarah J Nyante
- Department of Radiology, School of Medicine, The University of North Carolina at Chapel Hill
| | | | - Andrew G Glass
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Amy Berrington de Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Nyante SJ, Lee SS, Benefield TS, Hoots TN, Henderson LM. The association between mammographic calcifications and breast cancer prognostic factors in a population-based registry cohort. Cancer 2016; 123:219-227. [PMID: 27683209 DOI: 10.1002/cncr.30281] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Mammographic calcifications can be a marker of malignancy, but their association with prognosis is less well established. In the current study, the authors examined the relationship between calcifications and breast cancer prognostic factors in the population-based Carolina Mammography Registry. METHODS The current study included 8472 invasive breast cancers diagnosed in the Carolina Mammography Registry between 1996 and 2011 for which information regarding calcifications occurring within 2 years of diagnosis was reported. Calcification-specific Breast Imaging Reporting and Data System (BI-RADS) assessments were reported prospectively by a radiologist. Tumor characteristic data were obtained from the North Carolina Central Cancer Registry and/or pathology reports. Multivariable-adjusted associations between the presence of calcifications in the breast affected by cancer and tumor characteristics were estimated using logistic regression. Statistical tests were 2-sided. RESULTS The presence of calcifications was found to be positively associated with tumors that were high grade (vs low grade: odds ratio [OR], 1.43; 95% confidence interval [95% CI], 1.10-1.88) or had an in situ component (vs without: OR, 2.15; 95% CI, 1.81-2.55). Calcifications were found to be inversely associated with hormone receptor-negative status (vs positive status: OR, 0.73; 95% CI, 0.57-0.93), size >35 mm (vs ≤8 mm: OR, 0.47; 95% CI, 0.37-0.61), and lobular tumors (vs ductal: OR, 0.39; 95% CI, 0.22-0.69). The association between the presence of calcifications and an in situ component was limited to BI-RADS category 4 and 5 calcifications and was absent for BI-RADS category 2 or 3 calcifications (P for heterogeneity <.01). The association with tumor size was found to be strongest for BI-RADS categories 3 and 4 (P for heterogeneity <.01). CONCLUSIONS Calcifications were found to be associated with both unfavorable (high grade) and favorable (small size, hormone receptor positivity) prognostic factors. Detailed analysis of the biological features of calcifications is necessary to understand the mechanisms driving these associations. Cancer 2017;123:219-227. © 2016 American Cancer Society.
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Affiliation(s)
- Sarah J Nyante
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sheila S Lee
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thad S Benefield
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tiffany N Hoots
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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23
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Mullooly M, Nyante SJ, Pfeiffer RM, Cora R, Figueroa JD, Hoover RN, Glass AG, Aiello Bowles EJ, Brinton LA, Berrington de Gonzalez A, Mark SE, Gierach GL. Abstract 4283: Relationship between mammographic breast density and measures of terminal duct lobular unit involution among women diagnosed with estrogen receptor positive breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-4283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: High mammographic breast density (MD) and reduced levels of terminal duct lobular unit (TDLU) involution (the histologic source of most breast cancers) have been associated with increased risk of developing breast cancer. Data relating MD and TDLU involution to breast cancer characteristics and outcomes are sparse. Therefore, we assessed these relationships among women with invasive ER-positive breast cancer.
Methods: The analysis focused on women with ER-positive breast cancers who were diagnosed at Kaiser Permanente Northwest (1990-2008) and followed through the end of 2010. Cases comprised of those who died of breast cancer (n = 54) and controls those that did not die of breast cancer (n = 180) over similar follow-up. Three reproducible measures that are inversely related to TDLU involution were evaluated in digitized hematoxilin and eosin stained sections in benign breast tissues surrounding the tumors: TDLU counts per unit area, TDLU span and median number of acini per TDLU. Percentage MD was estimated from digitized mammograms using computer-assisted thresholding software (Cumulus). Univariate associations between TDLU measurements and patient characteristics, tumor size, and disease stage at diagnosis, were calculated using Mann Whitney Wilcoxon rank test. TDLU measurements were related to baseline MD using analysis of covariance models and adjusted for age, body mass index (BMI), tumor size, stage, year of diagnosis and smoking.
Results: TDLUs were observed in 95% of cases and 89% of controls. All TDLU measurements declined with age (p<0.001 for each TDLU measurement). Among cases, TDLU measures were not significantly associated with tumor characteristics. Controls with regional spread had greater TDLU span (p = 0.05) and median acini counts per TDLU (p = 0.03) than those with localized disease; these TDLU metrics also showed a borderline significant association with larger tumor size (>2cm) (p = 0.07 and p = 0.06, respectfully). All TDLU measures were associated with MD among controls (TDLU count: p = 0.04; TDLU span: p = 0.06; median acini count per TDLU: p = 0.01), whereas among cases only, TDLU span showed a significant association MD (p = 0.003).
Conclusion: Preliminarily, our data suggest that among women with non-fatal ER-positive breast cancers, TDLU involution was associated with localized tumor stage, size and MD, whereas these relationships were less evident among women who died of their disease. Ongoing analyses will determine whether measures of MD and TDLU involution are independent predictors of breast cancer outcomes in this patient population.
Citation Format: Maeve Mullooly, Sarah J. Nyante, Ruth M. Pfeiffer, Renata Cora, Jonine D. Figueroa, Robert N. Hoover, Andrew G. Glass, Erin J. Aiello Bowles, Louise A. Brinton, Amy Berrington de Gonzalez, Sherman E. Mark, Gretchen L. Gierach. Relationship between mammographic breast density and measures of terminal duct lobular unit involution among women diagnosed with estrogen receptor positive breast cancer. [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 4283.
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Affiliation(s)
| | - Sarah J. Nyante
- 2Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Renata Cora
- 3Independent contractor, CT(ASCP), MB(ASCP), Stamford, CT
| | - Jonine D. Figueroa
- 4Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Andrew G. Glass
- 5Kaiser Permanente Northwest Center for Health Research, Portland, OR
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Mullooly M, Pfeiffer RM, Nyante SJ, Heckman-Stoddard BM, Perloff M, Jatoi I, Brinton LA, Aiello Bowles EJ, Hoover RN, Glass A, Berrington de Gonzalez A, Sherman ME, Gierach GL. Mammographic Density as a Biosensor of Tamoxifen Effectiveness in Adjuvant Endocrine Treatment of Breast Cancer: Opportunities and Implications. J Clin Oncol 2016; 34:2093-7. [PMID: 27022110 DOI: 10.1200/jco.2015.64.4492] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
| | | | - Sarah J Nyante
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | | | | | - Ismail Jatoi
- University of Texas Health Science Center, San Antonio, TX
| | | | | | | | - Andrew Glass
- Kaiser Permanente Northwest Center for Health Research, Portland, OR
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25
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Gierach GL, Curtis RE, Pfeiffer RM, Mullooly M, Hoover RN, Nyante SJ, Feigelson HS, Glass AG, Berrington de Gonzalez A. Abstract P5-12-01: Adjuvant endocrine therapy and risk of contralateral breast cancer among a cohort of U.S. women with breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-12-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The increasing incidence of estrogen receptor (ER)-positive breast cancer in the U.S. in concert with the aging population and improved survival have resulted in an increased number of women at risk of developing a second contralateral primary breast cancer. Results from randomized clinical trials have suggested a reduced risk of contralateral breast cancer among women taking tamoxifen or aromatase inhibitors. However, little is known about the duration of beneficial effects of endocrine therapy within the context of real life treatment scenarios, where gaps in treatment and varying durations of use may influence risk.
Methods: We assessed contralateral breast cancer risk associated with adjuvant tamoxifen treatment among a cohort of 7,541 women, ages 24-85 years, who were members of Kaiser Permanente (KP) Northwest or Colorado, and were diagnosed with invasive breast cancer between 1990 and 2008 and remained at risk of contralateral breast cancer for at least one year. We also assessed risk in relation to aromatase inhibitor use, though statistical power was somewhat limited due to the relatively recent introduction of aromatase inhibitors in this older cohort. Use of tamoxifen, aromatase inhibitors and other treatments was ascertained from KP prescription and medical records. Relative risks (RR) and 95% confidence intervals (CI) were estimated using multivariable Poisson regression adjusting for study site, age at and year of diagnosis, stage at diagnosis, ER status, chemotherapy, and radiotherapy.
Results: Over a median (range) of 6.3 (1.0-20.9) years of follow-up, 248 women developed contralateral breast cancer. Among patients surviving at least five years (n=4,668), 58% were prescribed tamoxifen with a median (range) duration of use of 4.2 (0.25-16.2) years. In models evaluating joint effects of tamoxifen duration and time since last use, we observed a statistically significant reduced risk of contralateral breast cancer among current tamoxifen users (RR=0.47, 95% CI: 0.30, 0.74) and among former users with 4+ years of tamoxifen (RR=0.39, 95% CI: 0.24, 0.63) as compared with women not treated with tamoxifen. Former users with 1-4 years of tamoxifen demonstrated a suggestive reduction in risk (RR=0.71, 95% CI: 0.45, 1.10), but there was no evidence of risk reduction for former users with <1 year of tamoxifen (RR=0.96, 95% CI: 0.56, 1.64). The reduced risks associated with 4+ years of tamoxifen persisted among patients surviving at least 7 years but were attenuated among those with more than 10 years since their first primary diagnosis. Aromatase inhibitor use was also associated with reduced contralateral breast cancer risk (RR=0.46, 95% CI: 0.22, 0.97). In subgroup analyses restricted to women whose first primary cancer was ER-positive (n=5,951), findings were consistent with those observed in the overall cohort.
Conclusions: Adjuvant tamoxifen and aromatase inhibitor therapy considerably reduce the risk of contralateral breast cancer. Furthermore, our data suggest that tamoxifen protects against contralateral breast cancer while women are being treated and that the protective effect appears to continue after cessation with longer durations of use.
Citation Format: Gierach GL, Curtis RE, Pfeiffer RM, Mullooly M, Hoover RN, Nyante SJ, Feigelson HS, Glass AG, Berrington de Gonzalez A. Adjuvant endocrine therapy and risk of contralateral breast cancer among a cohort of U.S. women with breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-12-01.
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Affiliation(s)
- GL Gierach
- National Cancer Institute, Bethesda, MD; University of North Carolina at Chapel Hill, Chapel Hill, NC; Kaiser Permanente Institute for Health Research, Denver, CO; Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | - RE Curtis
- National Cancer Institute, Bethesda, MD; University of North Carolina at Chapel Hill, Chapel Hill, NC; Kaiser Permanente Institute for Health Research, Denver, CO; Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | - RM Pfeiffer
- National Cancer Institute, Bethesda, MD; University of North Carolina at Chapel Hill, Chapel Hill, NC; Kaiser Permanente Institute for Health Research, Denver, CO; Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | - M Mullooly
- National Cancer Institute, Bethesda, MD; University of North Carolina at Chapel Hill, Chapel Hill, NC; Kaiser Permanente Institute for Health Research, Denver, CO; Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | - RN Hoover
- National Cancer Institute, Bethesda, MD; University of North Carolina at Chapel Hill, Chapel Hill, NC; Kaiser Permanente Institute for Health Research, Denver, CO; Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | - SJ Nyante
- National Cancer Institute, Bethesda, MD; University of North Carolina at Chapel Hill, Chapel Hill, NC; Kaiser Permanente Institute for Health Research, Denver, CO; Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | - HS Feigelson
- National Cancer Institute, Bethesda, MD; University of North Carolina at Chapel Hill, Chapel Hill, NC; Kaiser Permanente Institute for Health Research, Denver, CO; Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | - AG Glass
- National Cancer Institute, Bethesda, MD; University of North Carolina at Chapel Hill, Chapel Hill, NC; Kaiser Permanente Institute for Health Research, Denver, CO; Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | - A Berrington de Gonzalez
- National Cancer Institute, Bethesda, MD; University of North Carolina at Chapel Hill, Chapel Hill, NC; Kaiser Permanente Institute for Health Research, Denver, CO; Kaiser Permanente Northwest Center for Health Research, Portland, OR
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Nyante SJ, Sherman ME, Pfeiffer RM, Berrington de Gonzalez A, Brinton LA, Bowles EJA, Hoover RN, Glass A, Gierach GL. Longitudinal Change in Mammographic Density among ER-Positive Breast Cancer Patients Using Tamoxifen. Cancer Epidemiol Biomarkers Prev 2015; 25:212-6. [PMID: 26545407 DOI: 10.1158/1055-9965.epi-15-0412] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/09/2015] [Indexed: 11/16/2022] Open
Abstract
Tamoxifen-associated mammographic density (MD) reductions are linked to improved breast cancer survival. We evaluated MD at six time points to determine the timing of greatest reduction following tamoxifen initiation. We sampled 40 Kaiser Permanente Northwest estrogen receptor (ER)-positive breast cancer patients from a prior study of MD change, according to tamoxifen use duration and age at diagnosis: <4 years tamoxifen and ≤50 years (N = 6) or >50 years (N = 10) old; ≥4 years tamoxifen and ≤50 years (N = 13) or >50 years (N = 11) old. A single reader evaluated percent MD in the contralateral breast on baseline (pre-diagnosis) and five approximately yearly post-diagnostic (T1 to T5) mammograms. Mean MD change was calculated. Interactions with age (≤50 and >50 years), tamoxifen duration (<4 and ≥4 years), and baseline MD (tertiles) were tested in linear regression models. Overall, the largest MD decline occurred by T1 (mean 4.5%) with little additional decline by T5. Declines differed by tertile of baseline MD (Pinteraction < 0.01). In the highest tertile, the largest reduction occurred by T1 (mean 14.9%), with an additional reduction of 3.6% by T5. Changes were smaller in the middle and lowest baseline MD tertiles, with cumulative reductions of 3.0% and 0.4% from baseline to T5, respectively. There were no differences by age (Pinteraction = 0.36) or tamoxifen duration (Pinteraction = 0.42). Among ER-positive patients treated with tamoxifen and surviving ≥5 years, most of the MD reduction occurred within approximately 12 months of tamoxifen initiation, suggesting that MD measurement at a single time point following tamoxifen initiation can identify patients with substantial density declines.
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Affiliation(s)
- Sarah J Nyante
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland. Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | | | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | | | - Robert N Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Andrew Glass
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Peskoe SB, Joshu CE, Rohrmann S, McGlynn KA, Nyante SJ, Bradwin G, Dobs AS, Kanarek N, Nelson WG, Platz EA. Circulating total testosterone and PSA concentrations in a nationally representative sample of men without a diagnosis of prostate cancer. Prostate 2015; 75:1167-76. [PMID: 25919471 PMCID: PMC4475411 DOI: 10.1002/pros.22998] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/11/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND The association between serum sex steroid hormones and PSA in a general population has not been described. METHODS Included were 378 men aged 40-85 years who participated in the National Health and Nutrition Examination Survey in 2001-2004, who did not have a prostate cancer diagnosis, and had not had a recent biopsy, rectal examination, cystoscopy, or prostate infection or inflammation. Serum total PSA, total testosterone, androstanediol glucuronide (3α-diol-G), estradiol, and sex hormone binding globulin (SHBG) concentrations were previously measured. Free testosterone was estimated by mass action. We applied sampling weights and calculated geometric mean PSA concentration by hormone quintiles adjusting for age and race/ethnicity, and also for body mass index, waist circumference, smoking, diabetes, and mutually for hormones. We estimated the OR of PSA ≥2.5 ng/ml per hormone quintile using logistic regression. RESULTS Geometric mean PSA increased across testosterone quintiles after age and race/ethnicity (Q1: 0.80, Q5: 1.14 ng/ml; P-trend = 0.002) and multivariable (Q1: 0.79, Q5: 1.16 ng/ml; P-trend = 0.02) adjustment; patterns were similar for free testosterone and 3α-diol-G. SHBG was inversely associated with PSA only after multivariable adjustment (Q1: 1.32, Q5: 0.82 nmol/L; P-trend = 0.01). Estradiol and PSA were not associated. The OR of PSA ≥2.5 ng/ml was 1.54 (95% CI 1.18-2.01) per testosterone quintile after age and race/ethnicity adjustment, and 1.78 (95% CI 1.16-2.73) after multivariable adjustment. CONCLUSIONS In this nationally representative sample, men with higher testosterone had higher PSA even after taking into account other hormones and modifiable factors. Men with higher SHBG had lower PSA, but only after multivariable adjustment.
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Affiliation(s)
- Sarah B Peskoe
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Corinne E Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sabine Rohrmann
- Department of Chronic Disease Epidemiology; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Sarah J Nyante
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Gary Bradwin
- Department of Laboratory Medicine, Harvard Medical School and Children's Hospital, Boston, Massachusetts
| | - Adrian S Dobs
- Division of Endocrinology and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Norma Kanarek
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William G Nelson
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Nyante SJ, Sherman ME, Pfeiffer RM, Berrington de Gonzalez A, Brinton LA, Aiello Bowles EJ, Hoover RN, Glass A, Gierach GL. Prognostic significance of mammographic density change after initiation of tamoxifen for ER-positive breast cancer. J Natl Cancer Inst 2015; 107:dju425. [PMID: 25663687 DOI: 10.1093/jnci/dju425] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A prior analysis of postmenopausal breast cancer patients linked a decline in mammographic density (MD) following the initiation of tamoxifen treatment with improved survival, but excluded premenopausal women, for whom tamoxifen is the primary anti-endocrine therapy. Therefore, we evaluated change in MD after tamoxifen and breast cancer death among patients age 32 to 87 years. METHODS This case-control study included 349 estrogen receptor (ER)-positive breast cancer patients who were treated with tamoxifen at Kaiser Permanente Northwest (1990-2008): 97 who died from breast cancer (case patients) and 252 who did not (control patients), matched on age and year at diagnosis and disease stage. Percent MD in the unaffected breast was measured at baseline (mean six months before tamoxifen initiation) and follow-up (mean 12 months after initiation). Associations between change in MD and breast cancer death were estimated using conditional logistic regression. RESULTS Patients in the highest tertile of MD decline had a lower risk of breast cancer death when compared with women in the lowest tertile (odds ratio [OR] = 0.44, 95% confidence interval [CI] = 0.22 to 0.88); results were similar after adjustment for baseline MD (OR = 0.49, 95% CI = 0.23 to 1.02). Reductions in death were observed only among patients in the middle and upper tertiles of baseline MD. Associations did not differ by age, tamoxifen use duration, estrogen and/or progestin use, body mass index, or receipt of chemotherapy or radiotherapy. CONCLUSION These data suggest that younger and older ER-positive breast cancer patients who experience large reductions in MD following tamoxifen initiation have an improved prognosis.
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Affiliation(s)
- Sarah J Nyante
- Division of Cancer Epidemiology and Genetics (SJN, MES, RMP, ABdG, LAB, RNH, GLG) and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Group Health Research Institute, Seattle, WA (EJAB); Kaiser Permanente Northwest Center for Health Research, Portland, OR (AG).Current affiliation: SJN is currently affiliated with the Radiology Department, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics (SJN, MES, RMP, ABdG, LAB, RNH, GLG) and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Group Health Research Institute, Seattle, WA (EJAB); Kaiser Permanente Northwest Center for Health Research, Portland, OR (AG).Current affiliation: SJN is currently affiliated with the Radiology Department, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics (SJN, MES, RMP, ABdG, LAB, RNH, GLG) and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Group Health Research Institute, Seattle, WA (EJAB); Kaiser Permanente Northwest Center for Health Research, Portland, OR (AG).Current affiliation: SJN is currently affiliated with the Radiology Department, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Amy Berrington de Gonzalez
- Division of Cancer Epidemiology and Genetics (SJN, MES, RMP, ABdG, LAB, RNH, GLG) and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Group Health Research Institute, Seattle, WA (EJAB); Kaiser Permanente Northwest Center for Health Research, Portland, OR (AG).Current affiliation: SJN is currently affiliated with the Radiology Department, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics (SJN, MES, RMP, ABdG, LAB, RNH, GLG) and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Group Health Research Institute, Seattle, WA (EJAB); Kaiser Permanente Northwest Center for Health Research, Portland, OR (AG).Current affiliation: SJN is currently affiliated with the Radiology Department, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Erin J Aiello Bowles
- Division of Cancer Epidemiology and Genetics (SJN, MES, RMP, ABdG, LAB, RNH, GLG) and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Group Health Research Institute, Seattle, WA (EJAB); Kaiser Permanente Northwest Center for Health Research, Portland, OR (AG).Current affiliation: SJN is currently affiliated with the Radiology Department, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Robert N Hoover
- Division of Cancer Epidemiology and Genetics (SJN, MES, RMP, ABdG, LAB, RNH, GLG) and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Group Health Research Institute, Seattle, WA (EJAB); Kaiser Permanente Northwest Center for Health Research, Portland, OR (AG).Current affiliation: SJN is currently affiliated with the Radiology Department, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Glass
- Division of Cancer Epidemiology and Genetics (SJN, MES, RMP, ABdG, LAB, RNH, GLG) and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Group Health Research Institute, Seattle, WA (EJAB); Kaiser Permanente Northwest Center for Health Research, Portland, OR (AG).Current affiliation: SJN is currently affiliated with the Radiology Department, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics (SJN, MES, RMP, ABdG, LAB, RNH, GLG) and Division of Cancer Prevention (MES), National Cancer Institute, Bethesda, MD; Group Health Research Institute, Seattle, WA (EJAB); Kaiser Permanente Northwest Center for Health Research, Portland, OR (AG).Current affiliation: SJN is currently affiliated with the Radiology Department, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Nyante SJ, Gammon MD, Kaufman JS, Bensen JT, Lin DY, Barnholtz-Sloan JS, Hu Y, He Q, Luo J, Millikan RC. Genetic variation in estrogen and progesterone pathway genes and breast cancer risk: an exploration of tumor subtype-specific effects. Cancer Causes Control 2014; 26:121-31. [PMID: 25421376 DOI: 10.1007/s10552-014-0491-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 11/04/2014] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine whether associations between estrogen pathway-related single nucleotide polymorphisms (SNPs) and breast cancer risk differ by molecular subtype, we evaluated associations between SNPs in cytochrome P450 family 19 subfamily A polypeptide 1 (CYP19A1), estrogen receptor (ESR1), 3-beta hydroxysteroid dehydrogenase type I (HSD3B1), 17-beta hydroxysteroid dehydrogenase type II (HSD17B2), progesterone receptor (PGR), and sex hormone-binding globulin (SHBG) and breast cancer risk in a case-control study in North Carolina. METHODS Cases (n = 1,972) were women 20-74 years old and diagnosed with breast cancer between 1993 and 2001. Population-based controls (n = 1,776) were frequency matched to cases by age and race. A total of 195 SNPs were genotyped, and linkage disequilibrium was evaluated using the r (2) statistic. Odds ratios (ORs) and 95 % confidence intervals (CIs) for associations with breast cancer overall and by molecular subtype were estimated using logistic regression. Monte Carlo methods were used to control for multiple comparisons; two-sided p values <3.3 × 10(-4) were statistically significant. Heterogeneity tests comparing the two most common subtypes, luminal A (n = 679) and basal-like (n = 200), were based on the Wald statistic. RESULTS ESR1 rs6914211 (AA vs. AT+TT, OR 2.24, 95 % CI 1.51-3.33), ESR1 rs985191 (CC vs. AA, OR 2.11, 95 % CI 1.43-3.13), and PGR rs1824128 (TT+GT vs. GG, OR 1.33, 95 % CI 1.14-1.55) were associated with risk after accounting for multiple comparisons. Rs6914211 and rs985191 were in strong linkage disequilibrium among controls (African-Americans r (2) = 0.70; whites r (2) = 0.95). There was no evidence of heterogeneity between luminal A and basal-like subtypes, and the three SNPs were also associated with elevated risk of the less common luminal B, HER2+/ER-, and unclassified subtypes. CONCLUSIONS ESR1 and PGR SNPs were associated with risk, but lack of heterogeneity between subtypes suggests variants in hormone-related genes may play similar roles in the etiology of breast cancer molecular subtypes.
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Affiliation(s)
- Sarah J Nyante
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA,
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Brinton LA, Smith L, Gierach GL, Pfeiffer RM, Nyante SJ, Sherman ME, Park Y, Hollenbeck AR, Dallal CM. Breast cancer risk in older women: results from the NIH-AARP Diet and Health Study. Cancer Causes Control 2014; 25:843-57. [PMID: 24810653 DOI: 10.1007/s10552-014-0385-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 04/09/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Divergent risk factors exist for premenopausal and postmenopausal breast cancers, but it is unclear whether differences by age exist among postmenopausal women. METHODS We examined relationships among 190,872 postmenopausal women, ages 50-71 years recruited during 1995-1996 for the NIH-AARP Diet and Health Study, in whom 7,384 incident invasive breast carcinomas were identified through 2006. Multivariable Cox regression hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for breast cancer risk factors by age (50-59, 60-69, ≥70 years). RESULTS The only factor showing significant statistical heterogeneity by age (p(het) = 0.001) was menopausal hormone therapy duration, but trends were apparent across all ages and the strongest association prevailed among women 60-69 years. Although other risk factors did not show statistically significant heterogeneity by age, we did observe attenuated relations for parity and late age at first birth among older women [e.g., HR for age at first birth ≥30 vs. 20-24 = 1.62 (95% CI 1.23-2.14) for women 50-59 years vs. 1.12 (0.96-1.31) for ≥70 years]. In contrast, risk estimates associated with alcohol consumption and BMI tended to be slightly stronger among the oldest subjects [e.g., HR for BMI ≥35 vs. 18.5-24.9 = 1.24 (95% CI 0.97-1.58) for 50-59 years vs. 1.46 (1.26-1.70) for ≥70 years]. These differences were somewhat more pronounced for estrogen receptor positive and ductal cancers, tumors predominating among older women. Breast cancer family history, physical activity, and previous breast biopsies did not show divergent associations by age. CONCLUSION Although breast cancer risk factor differences among older women were not large, they may merit further consideration with respect to individualized risk prediction.
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Affiliation(s)
- Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892, USA,
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31
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Tsilidis KK, Rohrmann S, McGlynn KA, Nyante SJ, Lopez DS, Bradwin G, Feinleib M, Joshu CE, Kanarek N, Nelson WG, Selvin E, Platz EA. Association between endogenous sex steroid hormones and inflammatory biomarkers in US men. Andrology 2013; 1:919-28. [PMID: 24124163 DOI: 10.1111/j.2047-2927.2013.00129.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 07/10/2013] [Accepted: 08/03/2013] [Indexed: 11/25/2022]
Abstract
Sex steroid hormones and inflammatory biomarkers are both associated with the development and progression of chronic diseases, but their interrelationship is relatively uncharacterized. We examined the association of sex hormones and sex hormone-binding globulin (SHBG) with biomarkers of inflammation, C-reactive protein (CRP) and white blood cell (WBC) count. The study included data from 809 adult men in the National Health and Nutrition Examination Survey 1999-2004. Geometric means and 95% confidence intervals were estimated separately for CRP and WBC concentrations by sex steroid hormones and SHBG using weighted linear regression models. Higher concentrations of total (slope per one quintile in concentration, -0.18; p-trend, 0.001) and calculated free (slope, -0.13; p-trend, 0.03) testosterone were statistically significantly associated with lower concentrations of CRP, but not with WBC count. Men in the bottom quintile of total testosterone (≤3.3 ng/mL), who might be considered to have clinically low testosterone, were more likely to have elevated CRP (≥3 mg/L) compared with men in the top four quintiles (OR, 1.61; 95% CI, 1.00-2.61). Total and calculated free estradiol (E2) were positively associated with both CRP (Total E2: slope, 0.14; p-trend, <0.001; Free E2: slope, 0.15; p-trend, <0.001) and WBC (Total E2: slope, 0.02; p-trend, 0.08; Free E2: slope, 0.02; p-trend, 0.02) concentrations. SHBG concentrations were inversely associated with WBC count (slope, -0.03; p-trend, 0.04), but not with CRP. These cross-sectional findings are consistent with the hypothesis that higher androgen and lower oestrogen concentrations may have an anti-inflammatory effect in men.
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Affiliation(s)
- K K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
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Nyante SJ, Dallal CM, Gierach GL, Park Y, Hollenbeck AR, Brinton LA. Risk factors for specific histopathological types of postmenopausal breast cancer in the NIH-AARP Diet and Health Study. Am J Epidemiol 2013; 178:359-71. [PMID: 23899816 DOI: 10.1093/aje/kws471] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Risk factor associations for rare breast cancer variants are often imprecise, obscuring differences between tumor types. To clarify differences, we examined risk factors for 5 histological types of breast cancer in the National Institutes of Health-AARP Diet and Health Study. Risk factor information was self-reported. We followed 192,076 postmenopausal women aged 50-71 years from 1995-1996 through 2006. During that time period, 5,334 ductal, 836 lobular, 639 mixed ductal-lobular, 216 mucinous, and 132 tubular breast cancers were diagnosed. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards regression. Heterogeneity was evaluated using case-only logistic regression. The strongest differences were for menopausal hormone therapy (Pheterogeneity < 0.01) and age at first birth (Pheterogeneity < 0.01). Risk of tubular cancer in relation to current menopausal hormone therapy (for current use vs. never use, hazard ratio (HR) = 4.39, 95% confidence interval (CI): 2.77, 6.96) was several times stronger than risk of other histological types (range of HRs, 1.39-1.75). Older age at first birth was unassociated with risk of mucinous (for ≥30 years vs. 20-24 years, HR = 0.62, 95% CI: 0.27, 1.42) or tubular (HR = 1.08, 95% CI: 0.51, 2.29) tumors, in contrast to clear positive associations with lobular (HR = 1.82, 95% CI: 1.39, 2.37) and mixed ductal-lobular (HR = 1.87, 95% CI: 1.39, 2.51) tumors. Differing associations for hormonal factors and mucinous and tubular cancers suggest etiologies distinct from those of common breast cancers.
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MESH Headings
- Adenocarcinoma/epidemiology
- Adenocarcinoma/pathology
- Adenocarcinoma, Mucinous/epidemiology
- Adenocarcinoma, Mucinous/pathology
- Aged
- Anthropometry
- Breast Neoplasms/epidemiology
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/pathology
- Cohort Studies
- Confidence Intervals
- Contraceptives, Oral
- Female
- Follow-Up Studies
- Hormone Replacement Therapy/statistics & numerical data
- Humans
- Logistic Models
- Maternal Age
- Middle Aged
- National Institutes of Health (U.S.)
- Neoplasm Grading
- Neoplasm Staging
- Postmenopause/physiology
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Risk Factors
- Surveys and Questionnaires
- United States/epidemiology
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Affiliation(s)
- Sarah J Nyante
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Room 7-E236, MSC 9774, Bethesda, MD 20892-9774, USA.
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33
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Bensen JT, Tse CK, Nyante SJ, Barnholtz-Sloan JS, Cole SR, Millikan RC. Association of germline microRNA SNPs in pre-miRNA flanking region and breast cancer risk and survival: the Carolina Breast Cancer Study. Cancer Causes Control 2013; 24:1099-109. [PMID: 23526039 DOI: 10.1007/s10552-013-0187-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 03/13/2013] [Indexed: 01/03/2023]
Abstract
PURPOSE Common germline variation in the 5' region proximal to precursor (pre-) miRNA gene sequences is evaluated for association with breast cancer risk and survival among African Americans and Caucasians. METHODS We genotyped nine single nucleotide polymorphisms (SNPs) within six miRNA gene regions previously associated with breast cancer, in 1,972 cases and 1,776 controls. In a race-stratified analysis using unconditional logistic regression, odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated to evaluate SNP association with breast cancer risk. Additionally, hazard ratios (HRs) for breast cancer-specific mortality were estimated. RESULTS Two miR-185 SNPs provided suggestive evidence of an inverse association with breast cancer risk (rs2008591, OR = 0.72 (95 % CI = 0.53-0.98, p value = 0.04) and rs887205, OR = 0.71 (95 % CI = 0.52-0.96, p value = 0.03), respectively) among African Americans. Two SNPs, miR-34b/34c (rs4938723, HR = 0.57 (95 % CI = 0.37-0.89, p value = 0.01)) and miR-206 (rs6920648, HR = 0.77 (95 % CI = 0.61-0.97, p value = 0.02)), provided evidence of association with breast cancer survival. Further adjustment for stage resulted in more modest associations with survival (HR = 0.65 [95 % CI = 0.42-1.02, p value = 0.06] and HR = 0.79 [95 % CI = 0.62-1.00, p value = 0.05, respectively]). CONCLUSIONS Our results suggest that germline variation in the 5' region proximal to pre-miRNA gene sequences may be associated with breast cancer risk among African Americans and breast cancer-specific survival generally; however, further validation is needed to confirm these findings.
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Affiliation(s)
- Jeannette T Bensen
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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34
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Siddiq A, Couch FJ, Chen GK, Lindström S, Eccles D, Millikan RC, Michailidou K, Stram DO, Beckmann L, Rhie SK, Ambrosone CB, Aittomäki K, Amiano P, Apicella C, Baglietto L, Bandera EV, Beckmann MW, Berg CD, Bernstein L, Blomqvist C, Brauch H, Brinton L, Bui QM, Buring JE, Buys SS, Campa D, Carpenter JE, Chasman DI, Chang-Claude J, Chen C, Clavel-Chapelon F, Cox A, Cross SS, Czene K, Deming SL, Diasio RB, Diver WR, Dunning AM, Durcan L, Ekici AB, Fasching PA, Feigelson HS, Fejerman L, Figueroa JD, Fletcher O, Flesch-Janys D, Gaudet MM, Gerty SM, Rodriguez-Gil JL, Giles GG, van Gils CH, Godwin AK, Graham N, Greco D, Hall P, Hankinson SE, Hartmann A, Hein R, Heinz J, Hoover RN, Hopper JL, Hu JJ, Huntsman S, Ingles SA, Irwanto A, Isaacs C, Jacobs KB, John EM, Justenhoven C, Kaaks R, Kolonel LN, Coetzee GA, Lathrop M, Le Marchand L, Lee AM, Lee IM, Lesnick T, Lichtner P, Liu J, Lund E, Makalic E, Martin NG, McLean CA, Meijers-Heijboer H, Meindl A, Miron P, Monroe KR, Montgomery GW, Müller-Myhsok B, Nickels S, Nyante SJ, Olswold C, Overvad K, Palli D, Park DJ, Palmer JR, Pathak H, Peto J, Pharoah P, Rahman N, Rivadeneira F, Schmidt DF, Schmutzler RK, Slager S, Southey MC, Stevens KN, Sinn HP, Press MF, Ross E, Riboli E, Ridker PM, Schumacher FR, Severi G, dos Santos Silva I, Stone J, Sund M, Tapper WJ, Thun MJ, Travis RC, Turnbull C, Uitterlinden AG, Waisfisz Q, Wang X, Wang Z, Weaver J, Schulz-Wendtland R, Wilkens LR, Van Den Berg D, Zheng W, Ziegler RG, Ziv E, Nevanlinna H, Easton DF, Hunter DJ, Henderson BE, Chanock SJ, Garcia-Closas M, Kraft P, Haiman CA, Vachon CM. A meta-analysis of genome-wide association studies of breast cancer identifies two novel susceptibility loci at 6q14 and 20q11. Hum Mol Genet 2012; 21:5373-84. [PMID: 22976474 PMCID: PMC3510753 DOI: 10.1093/hmg/dds381] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 09/06/2012] [Indexed: 11/14/2022] Open
Abstract
Genome-wide association studies (GWAS) of breast cancer defined by hormone receptor status have revealed loci contributing to susceptibility of estrogen receptor (ER)-negative subtypes. To identify additional genetic variants for ER-negative breast cancer, we conducted the largest meta-analysis of ER-negative disease to date, comprising 4754 ER-negative cases and 31 663 controls from three GWAS: NCI Breast and Prostate Cancer Cohort Consortium (BPC3) (2188 ER-negative cases; 25 519 controls of European ancestry), Triple Negative Breast Cancer Consortium (TNBCC) (1562 triple negative cases; 3399 controls of European ancestry) and African American Breast Cancer Consortium (AABC) (1004 ER-negative cases; 2745 controls). We performed in silico replication of 86 SNPs at P ≤ 1 × 10(-5) in an additional 11 209 breast cancer cases (946 with ER-negative disease) and 16 057 controls of Japanese, Latino and European ancestry. We identified two novel loci for breast cancer at 20q11 and 6q14. SNP rs2284378 at 20q11 was associated with ER-negative breast cancer (combined two-stage OR = 1.16; P = 1.1 × 10(-8)) but showed a weaker association with overall breast cancer (OR = 1.08, P = 1.3 × 10(-6)) based on 17 869 cases and 43 745 controls and no association with ER-positive disease (OR = 1.01, P = 0.67) based on 9965 cases and 22 902 controls. Similarly, rs17530068 at 6q14 was associated with breast cancer (OR = 1.12; P = 1.1 × 10(-9)), and with both ER-positive (OR = 1.09; P = 1.5 × 10(-5)) and ER-negative (OR = 1.16, P = 2.5 × 10(-7)) disease. We also confirmed three known loci associated with ER-negative (19p13) and both ER-negative and ER-positive breast cancer (6q25 and 12p11). Our results highlight the value of large-scale collaborative studies to identify novel breast cancer risk loci.
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Affiliation(s)
- Afshan Siddiq
- Department of Epidemiology and Biostatistics and
- Department of Genomics of Common Disease, School of Public Health, Imperial College London, London, UK
| | - Fergus J. Couch
- Department of Health Sciences Research
- Department of Laboratory Medicine and Pathology and
| | | | | | - Diana Eccles
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Robert C. Millikan
- Department of Epidemiology, Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care and
| | | | - Lars Beckmann
- Institute for Quality and Efficiency in Health Care, IQWiG, Cologne, Germany
| | | | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Pilar Amiano
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Carmel Apicella
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health and
| | | | - Laura Baglietto
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health and
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
| | | | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, University Breast Center Franconia, Erlangen, Germany
| | | | - Leslie Bernstein
- Division of Cancer Etiology, Department of Population Science, Beckman Research Institute, City of Hope, CA, USA
| | - Carl Blomqvist
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Hiltrud Brauch
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology and
| | - Louise Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Quang M. Bui
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health and
| | - Julie E. Buring
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Saundra S. Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Jane E. Carpenter
- Australian Breast Cancer Tissue Bank, Westmead Millennium Institute and
| | - Daniel I. Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Françoise Clavel-Chapelon
- INSERM UMR 1018, Team 9: Nutrition, Hormones et Santé desfemmes, Centre de Recherche en Epidémiologie et Santé des Populations, Hôpital Paul Brousse, Villejuif, France
| | - Angela Cox
- Institute for Cancer Studies, Department of Oncology and
| | - Simon S. Cross
- Academic Unit of Pathology, Department of Neuroscience, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Kamila Czene
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Sandra L. Deming
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - W. Ryan Diver
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Alison M. Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Lorraine Durcan
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Arif B. Ekici
- Friedrich-Alexander University Erlangen-Nuremberg, Institute of Human Genetics, Erlangen, Germany
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, University Breast Center Franconia, Erlangen, Germany
- David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, University of California at Los Angeles, Los Angeles, CA, USA
| | | | | | - Laura Fejerman
- Division of General Internal Medicine, Department of Medicine, Institute for Human Genetics and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Jonine D. Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Olivia Fletcher
- Institute of Cancer Research, Breakthrough Breast Cancer Research Centre, London, UK
| | - Dieter Flesch-Janys
- Department of Cancer Epidemiology/Clinical Cancer Registry, University Cancer Center Hamburg (UCCH) , Hamburg, Germany
- Department of Medical Biometrics and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mia M. Gaudet
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - The GENICA Consortium
- Gene Environment Interaction and Breast Cancer in Germany (GENICA): Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, University Tübingen, Stuttgart, Germany
- Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
- Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn, Germany
- Institute of Pathology, Medical Faculty of the University of Bonn, Germany
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Bochum, Germany
- Institute and Outpatient Clinic of Occupational Medicine, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Susan M. Gerty
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jorge L. Rodriguez-Gil
- Sylvester Comprehensive Cancer Center and Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Graham G. Giles
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health and
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
| | | | - Andrew K. Godwin
- Department of Pathology and Laboratory Medicine, Kansas University Medical Center, Kansas City, KS, USA
| | - Nikki Graham
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Dario Greco
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland and
| | - Per Hall
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Susan E. Hankinson
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Rebecca Hein
- Division of Cancer Epidemiology, German Cancer Research Center and
- PMV Research Group at the Department of Child and Adolescent Psychiatry and Psychotherapy and
| | - Judith Heinz
- Department of Cancer Epidemiology/Clinical Cancer Registry, University Cancer Center Hamburg (UCCH) , Hamburg, Germany
- Department of Medical Biometrics and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert N. Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - John L. Hopper
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health and
| | - Jennifer J. Hu
- Sylvester Comprehensive Cancer Center and Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Scott Huntsman
- Institute for Health Research, Kaiser Permanente, Denver, CO, USA
| | | | - Astrid Irwanto
- Human Genetics Division, Genome Institute of Singapore, Singapore, Singapore
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Kevin B. Jacobs
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- Core Genotyping Facility, SAIC-Frederick Inc., NCI-Frederick, Frederick, MD, USA
- Bioinformed Consulting Services, Gaithersburg, MD, USA
| | - Esther M. John
- Cancer Prevention Institute of California, Fremont, CA, USA
- Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | | | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center and
| | | | - Gerhard A. Coetzee
- Department of Preventive Medicine and
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Mark Lathrop
- Centre National de Genotypage, Evry, France
- Fondation Jean Dausset, CEPH, Paris, France
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Adam M. Lee
- Department of Pharmacology, Mayo Clinic, Rochester, MN, USA
| | - I-Min Lee
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Peter Lichtner
- Institute of Human Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jianjun Liu
- Human Genetics Division, Genome Institute of Singapore, Singapore, Singapore
| | - Eiliv Lund
- Institute of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Enes Makalic
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health and
| | - Nicholas G. Martin
- QIMR GWAS Collective, Queensland Institute of Medical Research, Brisbane, Australia
| | | | - Hanne Meijers-Heijboer
- Department of Clinical Genetics, VU University Medical Center, section Oncogenetics, Amsterdam, The Netherlands
| | - Alfons Meindl
- Clinic of Gynaecology and Obstetrics, Division for Gynaecological Tumor-Genetics, Technische Universität München, München, Germany
| | | | | | - Grant W. Montgomery
- QIMR GWAS Collective, Queensland Institute of Medical Research, Brisbane, Australia
| | | | - Stefan Nickels
- Division of Cancer Epidemiology, German Cancer Research Center and
| | - Sarah J. Nyante
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Kim Overvad
- Department of Cardiology, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, ISPO, Florence, Italy
| | - Daniel J. Park
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Australia
| | - Julie R. Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Harsh Pathak
- Department of Pathology and Laboratory Medicine, Kansas University Medical Center, Kansas City, KS, USA
| | - Julian Peto
- Non-communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | | | - Fernando Rivadeneira
- Department of Internal Medicine and Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Daniel F. Schmidt
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health and
| | - Rita K. Schmutzler
- Division of Molecular Gynaeco-Oncology, Department of Obstetrics and Gynaecology, University of Cologne, Cologne, Germany
| | | | - Melissa C. Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Australia
| | | | - Hans-Peter Sinn
- Department of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael F. Press
- Department of Pathology, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | | | - Elio Riboli
- Department of Epidemiology and Biostatistics and
| | - Paul M. Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Gianluca Severi
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health and
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
| | - Isabel dos Santos Silva
- Non-communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer Stone
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health and
| | - Malin Sund
- Department of Surgery, Umeå University, Umea, Sweden and
| | | | - Michael J. Thun
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Ruth C. Travis
- Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - Andre G. Uitterlinden
- Department of Internal Medicine and Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Quinten Waisfisz
- Department of Clinical Genetics, VU University Medical Center, section Oncogenetics, Amsterdam, The Netherlands
| | - Xianshu Wang
- Department of Laboratory Medicine and Pathology and
| | - Zhaoming Wang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- Core Genotyping Facility, SAIC-Frederick Inc., NCI-Frederick, Frederick, MD, USA
| | - JoEllen Weaver
- Biosample Repository, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Rüdiger Schulz-Wendtland
- Institute of Diagnostic Radiology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | - Lynne R. Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | | | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Regina G. Ziegler
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Elad Ziv
- Division of General Internal Medicine, Department of Medicine, Institute for Human Genetics and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland and
| | - Douglas F. Easton
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - David J. Hunter
- Program in Molecular and Genetic Epidemiology and
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | | | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Peter Kraft
- Program in Molecular and Genetic Epidemiology and
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Nyante SJ, Gierach GL, Dallal CM, Park Y, Hollenbeck AR, Brinton LA. Abstract P3-07-04: Cigarette smoking and postmenopausal breast cancer risk: results from the NIH-AARP Diet and Health Study. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p3-07-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Epidemiologic evidence regarding the relationship between smoking and breast cancer risk is inconsistent. Some studies suggest that the relationship depends on interaction with other factors, such as alcohol use, body mass index (BMI), and menopausal hormone therapy (MHT). We investigated the relationship between smoking and breast cancer risk and interactions with breast cancer risk factors in the NIH-AARP Diet and Health Study, a large prospective cohort. Postmenopausal women ages 50–71 years (N = 192,076) in six US states and two metropolitan areas were followed from 1995–1996 through 2006. Risk factor information was self-reported at baseline. Smoking status was based on whether participants smoked ≥ 100 cigarettes in their lifetime and whether they currently smoked (current −15%, former −40%, never −45%). Alcohol use was estimated from a dietary questionnaire, and categorized based on drinking ≤ 5 or > 5 g/day. BMI was calculated from reported height and weight and categorized as ≥ 30 or < 30 kg/m2. MHT use was categorized as current, former, or never use of any estrogen or progestin preparation. Cancer diagnosis, estrogen receptor (ER), and progesterone receptor (PR) data were reported by state registries. After a mean 9.6 years of follow-up, 7,698 women were diagnosed with primary invasive breast cancer. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression. Multiplicative interactions between smoking and covariates were evaluated using the likelihood ratio test (LRT). Overall, smokers were at an increased risk of breast cancer compared to women who never smoked (current HR 1.19, 95% CI 1.10, 1.28; former HR 1.08, 95% CI 1.02, 1.13). Excess risk diminished as time since quitting increased and was close to null for women who quit smoking ≥ 10 years prior to study enrollment compared to never smokers (HR 1.04, 95% CI 0.98, 1.11). Relative risks differed significantly based on alcohol use (P-LRT < 0.01), but not BMI or MHT use (P-LRT > 0.05). The HR associated with current smoking was 1.15 (95% CI 1.05, 1.25) among women who drank ≤ 5 g/day, but was higher among women who drank > 5 g/day (HR 1.41, 95% CI 1.22, 1.61). The relationship for those who drank > 5 g/day persisted after adjustment for the amount of alcohol (5–10, 10–20, 20–35, >35 g/day) consumed (HR 1.36, 95% CI 1.18, 1.56). Among women who drank > 5 g/day, current smoking was associated with increased risks of hormone receptor-positive tumors (ER+/PR+ HR 1.29, 95% CI 1.01, 1.64; ER+/PR- HR 2.11, 95% CI 1.27, 3.50), but not ER−/PR− tumors (HR 1.07, 95% CI 0.64, 1.79). In summary, we found that smoking was associated with elevated breast cancer risk which was strongest among women who drank > 5 g of alcohol per day. Among these women, smoking-associated increases in breast cancer risk were limited to hormone receptor-positive tumors, consistent with the known relationship between alcohol use and ER+ breast cancer risk. Findings were similar after additional adjustment for the amount of alcohol consumed, suggesting that the increased risks were not due to residual confounding by alcohol dose, although further analyses are needed to fully understand the interaction between these two factors.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-07-04.
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Affiliation(s)
- SJ Nyante
- National Cancer Institute, Rockville, MD; AARP, Washington, DC
| | - GL Gierach
- National Cancer Institute, Rockville, MD; AARP, Washington, DC
| | - CM Dallal
- National Cancer Institute, Rockville, MD; AARP, Washington, DC
| | - Y Park
- National Cancer Institute, Rockville, MD; AARP, Washington, DC
| | - AR Hollenbeck
- National Cancer Institute, Rockville, MD; AARP, Washington, DC
| | - LA Brinton
- National Cancer Institute, Rockville, MD; AARP, Washington, DC
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Nyante SJ, Dallal CM, Gierach GL, Sherman ME, Park Y, Hollenbeck AR, Brinton LA. P4-10-03: Association between BMI, Physical Activity and Breast Cancer Histologic Types. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-10-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Previous research indicates that certain breast cancer risk factor associations vary by histologic tumor type. However, most studies have been too small to examine risk factors for uncommon histologic types. We examined the association between body mass index (BMI), physical activity, and the relative risk of breast cancer histologic types in a large prospective cohort study to determine whether associations for these risk factors varied by histology.
Methods: This analysis included women in the NIH-AARP Diet and Health Cohort Study who were 50 to 71 years old, postmenopausal at baseline, and not previously diagnosed with cancer (N=190,348). The study cohort was established in 1995–1996 when participants completed a baseline questionnaire regarding health and nutritional information. BMI (kg/m2) was calculated from self-reported height and weight. Daily routine physical activity at work or home was derived from a question asking women what best described their daily routine at work, or throughout the day if they did not work at a job. Choices were mostly sitting with little walking, sitting with a fair amount of walking, mostly standing or walking, light lifting or climbing stairs/hills, or heavy work/carrying heavy loads. Cancer diagnosis and histology were obtained from state cancer registries. This analysis includes participant follow-up through December 31, 2006. After a median 11.2 years of follow-up, 7,631 invasive breast cancers were diagnosed: 5,278 ductal, 831 lobular, 640 mixed ductal-lobular, 214 mucinous, 132 tubular, and 536 other types. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression.
Results: Compared to women with a BMI of 18.5 to 24.9, obese women had increased risks of ductal (HR and 95% CI for BMI 30 to 34.9: 1.24, 1.14 — 1.36; BMI ≥ 35: 1.45, 1.30 — 1.62) and mucinous (HR and 95% CI for BMI 30 to 34.9: 1.58, 1.04 — 2.39; BMI ≥ 35: 1.93, 1.16 — 3.20) cancers. For both histologic types, the relative risk increased with increasing BMI (P-trend: ductal P<0.01; mucinous P<0.01). Women whose daily activity at work or home consisted of mostly standing or walking were at reduced risk of ductal and mixed ductal-lobular cancers compared with women who reported mostly sitting (HR and 95% CI for ductal: 0.86, 77 — 0.96; mixed-ductal lobular: 0.64, 0.48 — 0.86). Women who performed heavy work or carried heavy loads were also at a decreased risk of ductal and mixed ductal-lobular cancers compared with women reporting mostly sitting (HR and 95% CI for ductal: 0.68, 0.52−0.91; mixed ductal-lobular: 0.18, 0.04−0.72), though there were few mixed ductal-lobular cases who reported heavy activity.
Conclusions: High BMI was associated with increased risk of ductal and mucinous breast cancers. Women who spent their daily routine activity mostly standing or walking or doing heavy work had a reduced risk of ductal and mixed ductal-lobular cancers. These differences suggest that associations of BMI and physical activity vary by breast cancer histologic type in postmenopausal women and may have different roles in the etiology of these cancers.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-10-03.
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Affiliation(s)
- SJ Nyante
- 1National Cancer Institute, Rockville, MD; AARP, Washington, DC
| | - CM Dallal
- 1National Cancer Institute, Rockville, MD; AARP, Washington, DC
| | - GL Gierach
- 1National Cancer Institute, Rockville, MD; AARP, Washington, DC
| | - ME Sherman
- 1National Cancer Institute, Rockville, MD; AARP, Washington, DC
| | - Y Park
- 1National Cancer Institute, Rockville, MD; AARP, Washington, DC
| | - AR Hollenbeck
- 1National Cancer Institute, Rockville, MD; AARP, Washington, DC
| | - LA Brinton
- 1National Cancer Institute, Rockville, MD; AARP, Washington, DC
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Nyante SJ, Graubard BI, Li Y, McQuillan GM, Platz EA, Rohrmann S, Bradwin G, McGlynn KA. Trends in sex hormone concentrations in US males: 1988-1991 to 1999-2004. ACTA ACUST UNITED AC 2011; 35:456-66. [PMID: 22150314 DOI: 10.1111/j.1365-2605.2011.01230.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Previous studies suggest that male testosterone concentrations have declined over time. To explore this in a large US population, we examined testosterone and free testosterone concentrations in National Health and Nutrition Examination Surveys (NHANES) from 1988-1991 and 1999-2004. We also examined sex hormone-binding globulin (SHBG), estradiol, and androstanediol glucuronide (3α-diol-G) over the same period. Non-Hispanic white, non-Hispanic black, and Mexican-American men from 1988-1991 and 1999-2004 NHANES surveys who were ≥20 years old and had serum from morning blood draws were included in this analysis (1988-1991: N = 1,413; 1999-2004: N = 902). Testosterone, estradiol and SHBG were measured by competitive electrochemiluminescence immunoassays and 3α-diol-G was measured by enzyme immunoassay. Free testosterone was calculated using testosterone and SHBG values. Adjusted mean hormone concentrations were estimated using linear regression, accounting for NHANES sampling weights and design, age, race/ethnicity, body mass index, waist circumference, alcohol use and smoking. Differences in adjusted mean concentrations (Δ) and two-sided p-values were calculated; p < 0.05 was statistically significant. Overall, 3α-diol-G and estradiol declined between 1988-1991 and 1999-2004, but there was little change in testosterone, free testosterone, or SHBG (Δ: 3α-diol-G = -1.83 ng/mL, p < 0.01; estradiol = -6.07 pg/mL, p < 0.01; testosterone = -0.03 ng/mL, p = 0.75; free testosterone = -0.001 ng/mL, p = 0.67; SHBG = -1.17 nmol/L, p = 0.19). Stratification by age and race revealed that SHBG and 3α-diol-G declined among whites 20-44 years old (Δ: SHBG = -5.14 nmol/L, p < 0.01; 3α-diol-G = -2.89 ng/mL, p < 0.01) and free testosterone increased among blacks 20-44 years old (Δ: 0.014 ng/mL, p = 0.03). Estradiol declined among all ages of whites and Mexican-Americans. In conclusion, there was no evidence for testosterone decline between 1988-1991 and 1999-2004 in the US general population. Subgroup analyses suggest that SHBG and 3α-diol-G declined in young white men, estradiol declined in white and Mexican-American men, and free testosterone increased in young black men. These changes may be related to the increasing prevalence of reproductive disorders in young men.
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Affiliation(s)
- S J Nyante
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
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Pasaniuc B, Zaitlen N, Lettre G, Chen GK, Tandon A, Kao WHL, Ruczinski I, Fornage M, Siscovick DS, Zhu X, Larkin E, Lange LA, Cupples LA, Yang Q, Akylbekova EL, Musani SK, Divers J, Mychaleckyj J, Li M, Papanicolaou GJ, Millikan RC, Ambrosone CB, John EM, Bernstein L, Zheng W, Hu JJ, Ziegler RG, Nyante SJ, Bandera EV, Ingles SA, Press MF, Chanock SJ, Deming SL, Rodriguez-Gil JL, Palmer CD, Buxbaum S, Ekunwe L, Hirschhorn JN, Henderson BE, Myers S, Haiman CA, Reich D, Patterson N, Wilson JG, Price AL. Enhanced statistical tests for GWAS in admixed populations: assessment using African Americans from CARe and a Breast Cancer Consortium. PLoS Genet 2011; 7:e1001371. [PMID: 21541012 PMCID: PMC3080860 DOI: 10.1371/journal.pgen.1001371] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 03/10/2011] [Indexed: 12/24/2022] Open
Abstract
While genome-wide association studies (GWAS) have primarily examined populations of European ancestry, more recent studies often involve additional populations, including admixed populations such as African Americans and Latinos. In admixed populations, linkage disequilibrium (LD) exists both at a fine scale in ancestral populations and at a coarse scale (admixture-LD) due to chromosomal segments of distinct ancestry. Disease association statistics in admixed populations have previously considered SNP association (LD mapping) or admixture association (mapping by admixture-LD), but not both. Here, we introduce a new statistical framework for combining SNP and admixture association in case-control studies, as well as methods for local ancestry-aware imputation. We illustrate the gain in statistical power achieved by these methods by analyzing data of 6,209 unrelated African Americans from the CARe project genotyped on the Affymetrix 6.0 chip, in conjunction with both simulated and real phenotypes, as well as by analyzing the FGFR2 locus using breast cancer GWAS data from 5,761 African-American women. We show that, at typed SNPs, our method yields an 8% increase in statistical power for finding disease risk loci compared to the power achieved by standard methods in case-control studies. At imputed SNPs, we observe an 11% increase in statistical power for mapping disease loci when our local ancestry-aware imputation framework and the new scoring statistic are jointly employed. Finally, we show that our method increases statistical power in regions harboring the causal SNP in the case when the causal SNP is untyped and cannot be imputed. Our methods and our publicly available software are broadly applicable to GWAS in admixed populations.
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Affiliation(s)
- Bogdan Pasaniuc
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Broad Institute of Harvard and Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, United States of America
- * E-mail: (BP); (ALP)
| | - Noah Zaitlen
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Broad Institute of Harvard and Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, United States of America
| | - Guillaume Lettre
- Montreal Heart Institute, Montréal, Canada
- Département de Médecine, Université de Montréal, Montréal, Canada
| | - Gary K. Chen
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, United States of America
| | - Arti Tandon
- Broad Institute of Harvard and Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, United States of America
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - W. H. Linda Kao
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States of America
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ingo Ruczinski
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Myriam Fornage
- Institute of Molecular Medicine and Division of Epidemiology, School of Public Health, University of Texas Health Sciences Center at Houston, Houston, Texas, United States of America
| | - David S. Siscovick
- Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, United States of America
| | - Xiaofeng Zhu
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Emma Larkin
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Leslie A. Lange
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - L. Adrienne Cupples
- Department of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Qiong Yang
- Department of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Ermeg L. Akylbekova
- Jackson Heart Study, Jackson State University, Jackson, Mississippi, United States of America
| | - Solomon K. Musani
- University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Jasmin Divers
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina, United States of America
| | - Joe Mychaleckyj
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, United States of America
| | - Mingyao Li
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - George J. Papanicolaou
- National Heart, Lung, and Blood Institute (NHLBI), Division of Cardiovascular Sciences, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Robert C. Millikan
- Department of Epidemiology, Gillings School of Global Public Health Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York, United States of America
| | - Esther M. John
- Northern California Cancer Center, Fremont, California, United States of America
- Stanford University School of Medicine and Stanford Cancer Center, Stanford, California, United States of America
| | - Leslie Bernstein
- Division of Cancer Etiology, Department of Population Science, Beckman Research Institute, City of Hope, California, United States of America
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Nashville, Tennessee, United States of America
- Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Jennifer J. Hu
- Sylvester Comprehensive Cancer Center and Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Regina G. Ziegler
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Sarah J. Nyante
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Elisa V. Bandera
- The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Sue A. Ingles
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, United States of America
| | - Michael F. Press
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, United States of America
| | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Sandra L. Deming
- Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Nashville, Tennessee, United States of America
| | - Jorge L. Rodriguez-Gil
- Sylvester Comprehensive Cancer Center and Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Cameron D. Palmer
- Broad Institute of Harvard and Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, United States of America
- Divisions of Genetics and Endocrinology and Program in Genomics, Children’s Hospital Boston, Boston, Massachusetts, United States of America
| | - Sarah Buxbaum
- Jackson Heart Study, Jackson State University, Jackson, Mississippi, United States of America
| | - Lynette Ekunwe
- Jackson Heart Study, Jackson State University, Jackson, Mississippi, United States of America
| | - Joel N. Hirschhorn
- Broad Institute of Harvard and Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, United States of America
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
- Divisions of Genetics and Endocrinology and Program in Genomics, Children’s Hospital Boston, Boston, Massachusetts, United States of America
| | - Brian E. Henderson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, United States of America
| | - Simon Myers
- Department of Statistics, University of Oxford, Oxford, United Kingdom
| | - Christopher A. Haiman
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, United States of America
| | - David Reich
- Broad Institute of Harvard and Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, United States of America
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nick Patterson
- Broad Institute of Harvard and Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, United States of America
| | - James G. Wilson
- University of Mississippi Medical Center, Jackson, Mississippi, United States of America
- V. A. Medical Center, Jackson, Mississippi, United States of America
| | - Alkes L. Price
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Broad Institute of Harvard and Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, United States of America
- * E-mail: (BP); (ALP)
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Nyante SJ, Faupel-Badger JM, Sherman ME, Pfeiffer RM, Gaudet MM, Falk RT, Andaya AA, Lissowska J, Brinton LA, Peplonska B, Vonderhaar BK, Chanock S, Garcia-Closas M, Figueroa JD. Genetic variation in PRL and PRLR, and relationships with serum prolactin levels and breast cancer risk: results from a population-based case-control study in Poland. Breast Cancer Res 2011; 13:R42. [PMID: 21470416 PMCID: PMC3219205 DOI: 10.1186/bcr2864] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 03/09/2011] [Accepted: 04/06/2011] [Indexed: 12/27/2022] Open
Abstract
Introduction Studies suggest that high circulating levels of prolactin increase breast cancer risk. It is unclear if genetic variations in prolactin (PRL) or prolactin receptor (PRLR) genes also play a role. Thus, we examined the relationship between single nucleotide polymorphisms (SNPs) in PRL and PRLR, serum prolactin levels and breast cancer risk in a population-based case-control study. Methods We genotyped 8 PRL and 20 PRLR tag SNPs in 1965 breast cancer cases and 2229 matched controls, aged 20-74, and living in Warsaw or Łódź, Poland. Serum prolactin levels were measured by immunoassay in a subset of 773 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) for genotype associations with breast cancer risk were estimated using unconditional logistic regression, adjusted for age and study site. Geometric mean prolactin levels were estimated using linear regression models adjusted for age, study site, blood collection time, and menstrual cycle day (premenopausal women). Results Three SNPs were associated with breast cancer risk: in premenopausal women, PRLR rs249537 (T vs. C per-allele OR 1.39, 95% CI 1.07 - 1.80, P = 0.01); and in postmenopausal women, PRLR rs7718468 (C vs. T per-allele OR 1.16, 95% CI 1.03 - 1.30, P = 0.01) and PRLR rs13436213 (A vs. G per-allele OR 1.13 95% CI 1.01 - 1.26, P = 0.04). However, mean serum prolactin levels for these SNPs did not vary by genotype (P-trend > 0.05). Other SNPs were associated with serum prolactin levels: PRLR rs62355518 (P-trend = 0.01), PRLR rs10941235 (P-trend = 0.01), PRLR rs1610218 (P-trend = 0.01), PRLR rs34024951 (P-trend = 0.02), and PRLR rs9292575 (P-trend = 0.03) in premenopausal controls and PRL rs849872 (P-trend = 0.01) in postmenopausal controls. Conclusions Our data provide limited support for an association between common variations in PRLR and breast cancer risk. Altered serum prolactin levels were not associated with breast cancer risk-associated variants, suggesting that common genetic variation is not a strong predictor of prolactin-associated breast cancer risk in this population.
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Affiliation(s)
- Sarah J Nyante
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Rockville, MD 20852, USA.
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Nyante SJ, Faupel-Badger JM, Sherman ME, Gaudet MM, Falk RT, Andaya AA, Pfeiffer RM, Lissowska J, Brinton LA, Peplonska B, Vonderhaar BK, Chanock SJ, Garcia-Closas M, Figueroa JD. Abstract P3-12-05: Genetic Variation in Prolactin and Prolactin Receptor, and Relationships with Serum Prolactin Levels and Breast Cancer Risk. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p3-12-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Studies support the hypothesis that high circulating levels of the hormone prolactin increase breast cancer risk. It remains unclear if genetic factors are associated with interindividual variation in circulating prolactin and subsequent breast cancer risk. We examined the relationship between single nucleotide polymorphisms (SNPs) in prolactin (PRL) and prolactin receptor (PRLR), serum prolactin levels and breast cancer risk in a population based case-control study.
Methods: We genotyped 8 PRL and 20 PRLR tag SNPs in 1943 cases and 2229 controls (82% and 89% of enrolled, respectively). Cases were women 20-74 years old, diagnosed with in situ or invasive breast cancer between 2000 and 2003, and living in Warsaw or Lodz, Poland. Controls were cancer-free women selected from a population registry, matched to cases on age and city. Blood samples were provided at the study interview. Serum prolactin levels were measured in a subset of 773 controls using the Bayer Advia Centaur immunoassay. Odds ratios and 95% CIs for genotype-breast cancer associations were estimated using unconditional logistic regression, adjusting for age and city. Geometric mean prolactin levels and 95% confidence intervals (CI) were estimated using linear regression, adjusting for age, city, blood collection time, and day of menstrual cycle (premenopausal). Log-additive model Wald P-values were used to test for linear trends. Analyses were stratified by menopausal status, and all statistical tests were 2-sided (alpha=0.05). To account for multiple comparisons, P-values were adjusted using the Benjamini and Hochberg method.
Results: Three PRLR SNPs were nominally associated with breast cancer: in premenopausal women, rs249537 (per-allele OR 1.39, 95% CI 1.07 - 1.82, P=0.0140); and in postmenopausal women, rs7718468 (per-allele OR 1.16, 95% CI 1.03 — 1.30, P=0.0137) and rs13436213 (per-allele OR 1.13 95% CI 1.01 — 1.26, P=0.0397). We examined serum prolactin levels by genotype for these three SNPs to determine whether the potential risk alleles were associated with increased circulating prolactin, but mean serum prolactin levels were similar by genotype in controls: rs249537 TT=3.83 ng/ml, CT=5.51 ng/ml, CC=5.50 ng/ml, P-trend=0.8381; rs7718468 CC=6.41 ng/ml, CT=6.86 ng/ml, TT=6.47 ng/ml, P-trend=0.5643; and rs13436213 AA=6.48 ng/ml, AG=6.52 ng/ml, GG=6.29 ng/ml, P-trend=0.4766. None of the nominal associations between PRLR genotypes and breast cancer risk were significant after adjusting for multiple comparisons (multiple comparison adjusted P-values: rs249537 P=0.4340; rs7718468 P=0.4340; rs13436213 P=0.8205). PRL SNPs were not associated with breast cancer risk in premenopausal or postmenopausal women. Discussion: Our data do not support an association between PRL or PRLR tag SNPs and breast cancer. Though some associations were nominally significant, these results may be due to random error and require further study. Furthermore, data do not support a relationship between riskassociated SNPs and differences in prolactin levels. Future research should focus on non-genetic factors that affect circulating prolactin levels.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-12-05.
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Affiliation(s)
- SJ Nyante
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
| | - JM Faupel-Badger
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
| | - ME Sherman
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
| | - MM Gaudet
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
| | - RT Falk
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
| | - AA Andaya
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
| | - RM Pfeiffer
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
| | - J Lissowska
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
| | - LA Brinton
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
| | - B Peplonska
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
| | - BK Vonderhaar
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
| | - SJ Chanock
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
| | - M Garcia-Closas
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
| | - JD. Figueroa
- National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, New York, NY; Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland; Nofer Institute of Occupational Medicine, Lódz, Poland
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Nyante SJ, Black A, Kreimer AR, Duggan MA, Carreon JD, Kessel B, Buys SS, Ragard LR, Johnson KA, Dunn BK, Lamerato L, Commins JM, Berg CD, Sherman ME. Pathologic findings following false-positive screening tests for ovarian cancer in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial. Gynecol Oncol 2010; 120:474-9. [PMID: 21144559 DOI: 10.1016/j.ygyno.2010.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 11/02/2010] [Accepted: 11/09/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), ovarian cancer screening with transvaginal ultrasound (TVU) and CA-125 produced a large number of false-positive tests. We examined relationships between histopathologic diagnoses, false-positive test group, and participant and screening test characteristics. METHODS The PLCO ovarian cancer screening arm included 39,105 women aged 55-74 years assigned to annual CA-125 and TVU. Histopathologic diagnoses from women with false-positive tests and subsequent surgery were reviewed in this analysis: all CA125+ (n=121); all CA125+/TVU+ (n=46); and a random sample of TVU+ (n=373). Demographic and ovarian cancer risk factor data were self-reported. Pathologic diagnoses were abstracted from surgical pathology reports. We compared participant characteristics and pathologic diagnoses by category of false-positive using Pearson χ2, Fisher's exact, or Wilcoxon-Mann-Whitney tests. RESULTS Women with a false-positive TVU were younger (P<0.001), heavier (P<0.001), and reported a higher frequency of prior hysterectomy (P<0.001). Serous cystadenoma, the most common benign ovarian diagnosis, was more frequent among women with TVU+ compared to CA-125+ and CA-125+/TVU+ (P<0.001). Benign non-ovarian findings were commonly associated with all false-positives, although more frequently with CA-125+ than TVU+ or CA-125+/TVU+ groups (P=0.019). Non-ovarian cancers were diagnosed most frequently among CA-125+ (P<0.001). CONCLUSIONS False-positive ovarian cancer screening tests were associated with a range of histopathologic diagnoses, some of which may be related to patient and screening test characteristics. Further research into the predictors of false-positive ovarian cancer screening tests may aid efforts to reduce false-positive results.
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Affiliation(s)
- Sarah J Nyante
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Blvd., Rockville, MD 20852, USA.
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Barnholtz-Sloan JS, Shetty PB, Guan X, Nyante SJ, Luo J, Brennan DJ, Millikan RC. FGFR2 and other loci identified in genome-wide association studies are associated with breast cancer in African-American and younger women. Carcinogenesis 2010; 31:1417-23. [PMID: 20554749 DOI: 10.1093/carcin/bgq128] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Twenty-nine single-nucleotide polymorphisms (SNPs) from previously published genome-wide association studies (GWAS) and multiple ancestry informative markers were genotyped in the Carolina Breast Cancer Study (CBCS) (742 African-American (AA) cases, 1230 White cases; 658 AA controls, 1118 White controls). In the entire study population, 9/10 SNPs in fibroblast growth factor receptor 2 (FGFR2) were significantly associated with breast cancer after adjusting for age, race and European ancestry [odds ratios (OR) range 1.17-1.81]. Associations were observed for SNPs in FGFR2, LSP1, H19, TLR1/TLR6 and RELN for AA; FGFR2, TNRC9, H19 and MAP3K1 for Whites; FGFR2, TNRC9, Msc5A1 and chromosome 8q for women > or =50 years old and FGFR2 and TNRC9 for women <50 years old. FGFR2 haplotypes based upon rs11200014, rs2981579, rs1219648 and rs2420946 were associated with increased risk of breast cancer, including the GTGT haplotype in AAs [OR = 1.27, 95% confidence interval (CI) 1.04-1.56] and younger women of either race [OR = 1.35, 95% CI 1.02-1.78) and the ATGT haplotype in Whites (OR = 1.30, 95% CI 1.15-1.46). Recent GWAS hits for breast cancer in Europeans and Whites (i.e. women of European descent) thus showed evidence of replication among AAs and Whites in the CBCS. Several new haplotypes were associated with breast cancer in AA and younger women, particularly the FGFR2 GTGT haplotype. These results highlight the need to conduct GWAS among younger women and in a variety of racial-ethnic populations.
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Affiliation(s)
- Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106-5065, USA.
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Shetty PB, Barnholtz-Sloan JS, Guan X, Nyante SJ, Millikan RC. Abstract 4827: A novel FGFR2 haplotype is associated with increased risk of breast cancer in African American women. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-4827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objectives: The objective of this study was to identify new and validate known SNPs and haplotypes in FGFR2 associated with risk of breast cancer in African American women.
Methods: Study participants were from the Carolina Breast Cancer Study, a population-based case-control study conducted in North Carolina. Cases and controls were frequency-matched on age and race. 1536 SNPs and 158 AIMs (ancestry informative markers) were genotyped with the Illumina GoldenGate assay. 89% of the SNP panel and 91% of the AIMs passed quality control. Associations between single SNPs and breast cancer were examined using logistic regression in SAS 9.2, and linkage disequilibrium (LD) between SNPs was tested with SAS/Genetics. Haplotypes were constructed and evaluated for association with breast cancer using generalized linear models as implemented in Haplo. stats. Statistical analyses were conducted on the whole dataset and stratified by race and age at diagnosis. 10 single SNPs in FGFR2 were analyzed. Of these 10 SNPs, rs11200014, rs2981579, rs1219648 and rs2420946 were further analyzed in haplotype analysis in order to compare our results with previous studies. As African Americans were over-sampled, all analyses were adjusted to account for study design.
Results: There were 3748 participants in the study; 742 cases (37.6% of cases) and 658 controls (37.0% of controls) were African American, and 1230 cases and 1118 controls were non-African American. 9 SNPs in all women, 9 SNPs in older women (> 50 years at diagnosis), 7 SNPs in younger women (< 50 years at diagnosis), 8 SNPs in African Americans and 9 SNPs in non-African Americans were associated with increased risk of breast cancer after adjusting for European ancestry and/or race and age. In all subjects, the ATGT, GTGT and GTAT haplotypes were associated with increased odds of breast cancer after adjusting for age, race and ancestry. In African American women, the GTGT haplotype was associated with significant increased risk of breast cancer while the ATGT haplotype was associated with increased risk in non-African American women. Interestingly, the GTGT haplotype was also found to be associated with increased risk of breast cancer among women aged <50 years old at diagnosis.
Conclusions: The GTGT haplotype in FGFR2 is a newly discovered haplotype that is associated with increased risk of breast cancer in African American and younger women. Previous studies have primarily focused on post-menopausal, European American women, and these results highlight the need to conduct genetic epidemiology studies in a variety of racial/ethnic populations.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4827.
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Affiliation(s)
- Priya B. Shetty
- 1Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jill S. Barnholtz-Sloan
- 1Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Xiaowei Guan
- 1Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sarah J. Nyante
- 2Epidemiology Department, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Robert C. Millikan
- 2Epidemiology Department, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Cohen SS, Palmieri RT, Nyante SJ, Koralek DO, Kim S, Bradshaw P, Olshan AF. Obesity and screening for breast, cervical, and colorectal cancer in women: a review. Cancer 2008; 112:1892-904. [PMID: 18361400 DOI: 10.1002/cncr.23408] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The literature examining obesity as a barrier to screening for breast, cervical, and colorectal cancer has not been evaluated systematically. With the increasing prevalence of obesity and its impact on cancer incidence and mortality, it is important to determine whether obesity is a barrier to screening so that cancers among women at increased risk because of their body size can be detected early or prevented entirely. On the basis of 32 relevant published studies (10 breast cancer studies, 14 cervical cancer studies, and 8 colorectal cancer studies), the authors reviewed the literature regarding associations between obesity and recommended screening tests for these cancer sites among women in the U.S. The most consistent associations between obesity and screening behavior were observed for cervical cancer. Most studies reported an inverse relation between decreased cervical cancer screening and increasing body size, and several studies reported that the association was more consistent among white women than among black women. For breast cancer, obesity was associated with decreased screening behavior among white women but not among black women. The literature regarding obesity and colorectal cancer screening adherence was mixed, with some studies reporting an inverse effect of body size on screening behavior and others reporting no effect. Overall, the results indicated that obesity most likely is a barrier to screening for breast and cervical cancers, particularly among white women; the evidence for colorectal cancer screening was inconclusive. Thus, efforts to identify barriers and increase screening for breast and cervical cancers may be targeted toward obese women, whereas outreach to all women should remain the objective for colorectal cancer screening programs.
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Affiliation(s)
- Sarah S Cohen
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA.
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Nyante SJ, Gammon MD, Malone KE, Daling JR, Brinton LA. The association between oral contraceptive use and lobular and ductal breast cancer in young women. Int J Cancer 2008; 122:936-41. [PMID: 17957781 DOI: 10.1002/ijc.23163] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent reports indicate that the incidence of lobular breast cancer is increasing at a faster rate than ductal breast cancer, which may be due to the differential effects of exogenous hormones by histology. To address this issue, we examined whether the relationship between oral contraceptive use and incident breast cancer differs between lobular and ductal subtypes in young women. A population-based sample of in situ and invasive breast cancer cases between ages 20 and 44 were recruited from Atlanta, GA; Seattle-Puget Sound, WA and central New Jersey. Controls were sampled from the same areas by random-digit dialing, and were frequency matched to the expected case age distribution. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using polytomous logistic regression. Among the 100 lobular cancers, 1,164 ductal cancers, and 1,501 controls, the odds ratios for oral contraceptive ever use were 1.10 (95% CI = 0.68-1.78) for lobular cancers and 1.21 (95% CI = 1.01-1.45) for ductal cancers, adjusted for study site, age at diagnosis, and pap screening history. Our results suggest that the magnitude of the association between ever use of oral contraceptives and breast cancer in young women does not vary strongly by histologic subtype. These results are similar to previous studies that report little difference in the effect of oral contraceptive use on breast cancer by histology.
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Affiliation(s)
- Sarah J Nyante
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Abstract
It has been increasingly recognized that ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS) and invasive cancer of the breast are often closely associated with one another. However, the genomic relationship between these histologically distinct entities has not been well characterized. Refinements in high-resolution comparative genomic hybridization (CGH) techniques allow for a detailed comparison of genomic alterations in synchronously occurring tumors. The following case illustrates how array CGH may be used to better understand whether synchronous neoplasms share a common origin.
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Affiliation(s)
- Sarah J Nyante
- Department of Surgery, University of California San Francisco, 94115, USA
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Hwang ES, Nyante SJ, Yi Chen Y, Moore D, DeVries S, Korkola JE, Esserman LJ, Waldman FM. Clonality of lobular carcinoma in situ and synchronous invasive lobular carcinoma. Cancer 2004; 100:2562-72. [PMID: 15197797 DOI: 10.1002/cncr.20273] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Lobular carcinoma in situ (LCIS) of the breast is considered a marker for an increased risk of carcinoma in both breasts. However, the frequent association of LCIS with invasive lobular carcinoma (ILC) suggests a precursor-product relation. The possible genomic relation between synchronous LCIS and ILC was analyzed using the technique of array-based comparative genomic hybridization (CGH). METHODS Twenty-four samples from the University of California-San Francisco pathology archives that contained synchronous LCIS and ILC were identified. Array CGH was performed using random primer-amplified microdissected DNA. Samples were hybridized onto bacterial artificial chromosome arrays composed of approximately 2400 clones. Patterns of alterations within synchronous LCIS and ILC were compared. RESULTS A substantial proportion of the genome was altered in samples of both LCIS and ILC. The most frequent alterations were gain of 1q and loss of 16q, both of which usually occurred as whole-arm changes. Smaller regions of gain and loss were seen on other chromosome arms. Fourteen samples of LCIS were related more to their paired samples of ILC than to any other ILC, as demonstrated by a weighted similarity score. CONCLUSIONS LCIS and ILC are neoplastic lesions that demonstrate a range of genomic alterations. In the current study, the genetic relation between synchronous LCIS and ILC suggested clonality in a majority of the paired specimens. These data were consistent with a progression pathway from LCIS to ILC. The authors conclude that LCIS, which is known to be a marker for an environment that is permissive of neoplasia, may itself represent a precursor to invasive carcinoma.
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Affiliation(s)
- E Shelley Hwang
- Department of Surgery, University of California-San Francisco, San Francisco, California 94115, USA.
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