Homeoprotein DLX4 expression is increased in inflammatory breast cancer cases from an urban African-American population

Protein expression of Distal-less homeobox 4 (DLX4) was analyzed in inflammatory breast cancer (IBC) cases from an African-American (AA) population to determine if a) DLX4 gene over expression exists in this cohort and b) if the overexpression is associated with breast cancer clinicopathological characteristics (ER, PR, HER2, triple-negative). Twenty-nine blocks of formalin-fixed paraffin-embedded (FFPE) tissue from well-characterized human IBC cases were used for immunohistochemical staining (IHC). IHC results were assigned an intensity and percentage score. Percentage scores were assigned as 0, 1, 2, 3, or 4 and intensity scores were assigned 0, 1+, 2+ or 3+. For the analysis of the IHC, a percentage score of 3 or 4 and an intensity score of 2+ or 3+ were categorized as high. Chi-square or Fisher's exact tests were used to compare the high and low groups. In this cohort, 89.7% (26 out of 29) of IBC cases showed high percentages of positive cells staining for the DLX4 protein, while 40.0% (12 out of 30) of normal breast tissue from reduction mammoplasty cases demonstrated DLX4 expression (p < 0.01). In IBC patients, 65.5% of cases showed a high level of staining intensity, compared to 20.0% of normal breast tissues (test, p = 0.001). Intensity to DLX4 was higher in the HER2 negative status (78.3%) than the HER2 positive status (16.7%) (test, p = 0.011). DLX4 expression is higher in the IBC cases in this study of an urban AA population than in normal breast tissue cases. HER2 negative status is positively associated with high intensity of DLX4.

PCB exposure and potential future cancer incidence in Slovak children: an assessment from molecular finger printing by Ingenuity Pathway Analysis (IPA®) derived from experimental and epidemiological investigations

The risk of cancer due to PCB exposure in humans is highly debated. In eastern Slovakia, high exposure of the population to organochlorines (especially PCBs) was associated with various disease and disorder pathways, viz., endocrine disruption, metabolic disorder & diabetes, and cancer, thereby disturbing several cellular processes, including protein synthesis, stress response, and apoptosis. We have evaluated a Slovak cohort (45-month children, at lower and higher levels of PCB exposure from the environment) for disease and disorder development to develop early disease cancer biomarkers that could shed new light on possible mechanisms for the genesis of cancers under such chemical exposures, and identify potential avenues for prevention.Microarray studies of global gene expression were conducted from the 45-month-old children on the Affymetrix platform followed by Ingenuity Pathway Analysis (IPA®) to associate the affected genes with their mechanistic pathways. High-throughput qRT-PCR TaqMan low-density array (TLDA) was performed to further validate the selected genes on the whole blood cells of the most highly exposed children from the study cohort (n = 71). TP53, MYC, BCL2, and LRP12 differential gene expressions suggested strong relationships between potential future tumor promotion and PCB exposure in Slovak children. The IPA analysis further detected the most important signaling pathways, including molecular mechanism of cancers, prostate cancer signaling, ovarian cancer signaling, P53 signaling, oncostatin M signaling, and their respective functions (viz., prostate cancer, breast cancer, progression of tumor, growth of tumor, and non-Hodgkin's disease). The results suggest that PCB exposures, even at the early age of these children, may have lifelong consequences for the future development of chronic diseases.

Detection of a lipid peroxidation-induced DNA adduct across liver disease stages

Background

Oxidative stress and chronic inflammation can increase cellular levels of reactive oxygen species and lipid peroxidation (LPO) when associated with the pathogenesis of hepatocellular carcinoma (HCC), which can develop following the progression of steatosis, fibrosis and cirrhosis. Using a monoclonal antibody for cyclic γ-hydroxy-1, N² -propanodeoxyguanosine (γ-OHPdG), a promutagenic DNA adduct formed endogenously by LPO, we examined its formation across liver disease stages to understand it's potential role in HCC development.

Methods

Formalin-fixed paraffin embedded (FFPE) liver tissue samples from 49 patients representing normal, steatosis, fibrosis, cirrhosis and HCC were stained for γ-OHPdG and 8-hydroxydeoxyguanosine (8-oxo-dG), an oxidative damage biomarker. Quantification of immunohistochemical (IHC) staining was performed using histological scoring of intensity and distribution. Using primary human hepatocytes (HH) and a stellate cell (SC) co-culture, immunocytochemical staining of γ-OHPdG and Nile Red was performed to determine if the formation of γ-OHPdG was consistent between the clinical sample disease stages and the in vitro steatotic and fibrotic conditions.

Results

γ-OHPdG levels varied significantly between the stages of normal and steatosis, steatosis and fibrosis, and steatosis and cirrhosis (P≤0.005). There was a trend, although not significant, of increased levels of γ-OHPdG in HCC compared to the other groups. A strong correlation was observed (Pearson's, R² =0.85) between levels of γ-OHPdG and 8-oxo-dG across the disease spectrum. The increase of γ-OHPdG in steatosis and decrease in fibrosis was a pattern confirmed in an in vitro model using primary HH co-cultured with human SCs.

Conclusions

γ-OHPdG was detected in FFPE liver tissues of patients with different stages of liver disease and in vitro studies, demonstrating that its formation is consistent with LPO in early stages of liver disease and suggesting that it may be a source of mutagenic DNA damage in liver disease progression.

Physician Intervention and Chinese Americans' Colorectal Cancer Screening

OBJECTIVE

We conducted a cluster-randomized trial evaluating an intervention that trained Chinese-American primary care physicians to increase their Chinese patients' colorectal cancer (CRC) screening.

METHODS

Twenty-five physicians (13 randomized to the intervention arm and 12 to the control arm) and 479 of their patients (aged 50-75 and nonadherent to CRC screening guidelines) were enrolled. The intervention, guided by Social Cognitive Theory, included a communication guide and 2 in-office training sessions to enhance physicians' efficacy in com- municating CRC screening with patients. Patients' CRC screening rates (trial outcome) and rating of physician communication before intervention and at 12-month follow-up were assessed. Intention-to-treat analysis for outcome evaluation was conducted.

RESULTS

Screening rates were slightly higher in the intervention vs. the control arm (24.4% vs. 17.7%, p = .24). In post hoc analyses, intervention arm patients who perceived better communication were more likely to be screened than those who did not (OR = 1.09, 95% CI: 1.03, 1.15). This relationship was not seen in the control arm.

CONCLUSIONS

This physician-focused intervention had small, non-significant effects in increasing Chinese patients' CRC screening rates. Physician communication appeared to explain intervention efficacy. More intensive interventions are needed to enhance Chinese patients' CRC screening.

Correlates of Triple Negative Breast Cancer and Chemotherapy Patterns in Black and White Women With Breast Cancer

BACKGROUND

Triple negative breast cancer (TNBC) tumors are estrogen receptor-negative, progesterone receptor-negative, and human epidermal growth factor-negative. TNBC is responsive to chemotherapy, but chemotherapy might be underused in some patient subgroups. The goal of the present study was to characterize the patterns of chemotherapy use (uptake and completion) in TNBC patients.

PATIENTS AND METHODS

Women with primary invasive, nonmetastatic breast cancer were recruited in Washington, DC, and Detroit. Data were collected using a standardized telephone survey that captured sociocultural and health care process factors. Clinical data were abstracted from the medical records. We used χ² tests to access the association between the receipt of chemotherapy use (initiation and completion) and categorical variables, and t tests were used for continuous variables. Logistic regression models were used to evaluate the factors associated with chemotherapy uptake.

RESULTS

Women with TNBC (16% of sample) were more likely to be black than white (68% vs. 32%; P < .05). Among women with TNBC, 60% underwent chemotherapy. Chemotherapy uptake was greater for black than for white women (48.3% vs. 11.7%; P = .01) and in women without (vs. with) healthcare discrimination (35% vs. 25%; P = .04). In multivariable models, only race was associated with the receipt of chemotherapy. Black women were more likely to receive chemotherapy than were white women. The odds ratio of receiving chemotherapy by race was 4.1 (95% confidence interval, 1.3-13.1). Each 1-year increase in age was associated with a lower likelihood of chemotherapy completion (odds ratio, 0.9; 95% confidence interval, 0.826-0.981; P = .02). Women with at least some college were less likely to complete chemotherapy than were those with other education levels (P = .02).

CONCLUSION

A substantial number of TNBC patients failed to receive and/or complete chemotherapy. Differences in chemotherapy uptake by race and sociocultural factors diminished in multivariable models but age and stage remained significant. Suboptimal treatment among women with TNBC could contribute to adverse outcomes. Future investigations are necessary to assess whether the noninitiation and/or noncompletion of chemotherapy is clinically warranted.

Associations between genetic variation in one-carbon metabolism and LINE-1 DNA methylation in histologically normal breast tissues

Genome-wide DNA hypomethylation is an early event in the carcinogenic process. Percent methylation of long interspersed nucleotide element-1 (LINE-1) is a biomarker of genome-wide methylation and is a potential biomarker for breast cancer. Understanding factors associated with percent LINE-1 DNA methylation in histologically normal tissues could provide insight into early stages of carcinogenesis. In a cross-sectional study of 121 healthy women with no prior history of cancer who underwent reduction mammoplasty, we examined associations between plasma and breast folate, genetic variation in one-carbon metabolism, and percent LINE-1 methylation using multivariable regression models (adjusting for race, oral contraceptive use, and alcohol use). Results are expressed as the ratio of LINE-1 methylation relative to that of the referent group, with the corresponding 95% confidence intervals (CI). We found no significant associations between plasma or breast folate and percent LINE-1 methylation. Variation in MTHFR, MTR, and MTRR were significantly associated with percent LINE-1 methylation. Variant allele carriers of MTHFR A1289C had 4% lower LINE-1 methylation (Ratio 0.96, 95% CI 0.93-0.98), while variant allele carriers of MTR A2756G (Ratio 1.03, 95% CI 1.01-1.06) and MTRR A66G (Ratio 1.03, 95% CI 1.01-1.06) had 3% higher LINE-1 methylation, compared to those carrying the more common genotypes of these SNPs. DNA methylation of LINE-1 elements in histologically normal breast tissues is influenced by polymorphisms in genes in the one-carbon metabolism pathway. Future studies are needed to investigate the sociodemographic, environmental and additional genetic determinants of DNA methylation in breast tissues and the impact on breast cancer susceptibility.

Macronutrient Composition or Social Determinants? Impact on Infant Outcomes With Gestational Diabetes Mellitus

The purpose of this study was to examine, through a randomized, controlled trial, the effects of a maternal carbohydrate-restricted diet on maternal and infant outcomes in gestational diabetes mellitus (GDM). Women diagnosed with GDM were randomly allocated into one of two groups: an intervention group that was placed on a lower-carbohydrate diet (35-40% of total calories) or a control group that was placed on the usual pregnancy diet (50-55% carbohydrate). A convenience sample of participants diagnosed with GDM (ages 18-45 years) was recruited from two different sites: one urban and low-income and the other suburban and more affluent. Individual face-to-face diet instruction occurred with certified diabetes educators at both sites. Participants tested their blood glucose four times daily. Specific socioeconomic status indicators included enrollment in the Supplemental Nutrition Program for Women, Infants and Children or Medicaid-funded health insurance, as well as cross-sectional census data. All analyses were based on an intention to treat. Although there were no differences found between the lower-carbohydrate and usual-care diets in terms of blood glucose or maternal-infant outcomes, there were significant differences noted between the two sites. There was a lower mean postprandial blood glucose (100.59 ± 7.3 mg/dL) at the suburban site compared to the urban site (116.3 ± 15 mg/dL) (P <0.01), even though there was no difference in carbohydrate intake. There were increased amounts of protein and fat consumed at the suburban site (P <0.01), as well as lower infant complications (P <0.01). Further research is needed to determine whether these disparities in outcomes were the result of macronutrient proportions or environmental conditions.

Factors Associated with Exercise Motivation among African-American Men

OBJECTIVE

The primary aims of this study were to: (1) characterize exercise stages of change among a sample of African-American men, (2) determine if exercise motivation was associated with self-reported exercise behavior, and (3) examine if groups of personal (i.e., age, BMI, income, educational attainment, and perceived health), psycho-social (i.e., exercise self-efficacy, personality type, social influence), and environmental factors (i.e., neighborhood safety) predicted stages of change for physical exercise among African-American men.

METHODS

One hundred seventy African-American male participants were recruited for this study (age: 47.63(10.23) years). Participants completed a self-report questionnaire assessing study variables. Multinomial logistic regression models were used to examine the association of exercise stages of change with an array of personal, psychosocial, and environmental factors.

RESULTS

BMI, exercise self-efficacy, and nighttime neighborhood safety were entered as independent variables in the full model. BMI and exercise self-efficacy continued to be significant predictors of exercise stages of change in the full model. Obese men had a 9.24 greater odds of being in the action stage of change than in the maintenance stage. Also, men reporting greater exercise self-efficacy had lower odds of being in the lower stages of change categories (pre-preparation, preparation, and action) than in the maintenance stage.

CONCLUSION

Our results confirmed that using an ecological framework explained more of the variance in exercise stages of change than any of the individual components alone. Information gleaned from this study could inform interventionists of the best ways to create tailored exercise programs for African-American men.

Abstract 1870: Associations among tissue vitamin D metabolites and breast cancer risk factors in women undergoing reduction mammoplasty

Background: Vitamin D, the precursor to the potent steroid hormone calcitriol (1,25(OH)2D), is mainly obtained through sunlight exposure, diet and supplements. Some basic science and preclinical studies indicate that vitamin D promotes differentiation and apoptosis; inhibits the proliferation and inflammation and therefore decreases the risk of developing cancer. However, most of these studies were done in cell culture and epidemiology studies utilized blood vitamin D assays. This study validates methods for measuring 25(OH)D and 1,25(OH)2D in breast tissues and investigates the relationship between tissue vitamin D, plasma vitamin D and breast cancer risk factors. Methods: To validate the assay, 44 tissue samples from 11 women with no history of breast cancer undergoing reduction mammoplasty were used to investigate the levels of vitamin D across the breast by enzyme immunoassay. Tissue and plasma 25(OH)D and 1,25(OH)2D levels were then determined in 176 subjects who have available epidemiological profiles and among whom we previously determined breast hormone and receptor levels. Correlations between tissue vitamin D metabolites with blood vitamin D metabolites, participants’ characteristics (e.g., age, race and BMI), and other hormone and receptor levels were analyzed using Pearson's correlation coefficient. Non-normally distributed continuous variables were logarithmic transformed. Partial correlation coefficients were also used to examine associations while adjusting for participant characteristics. Results: The average coefficient of variation of 25(OH)D and 1,25(OH)2D among 4 breast sections were 14.81% and 19.13%, respectively. For the entire study set, tissue 25(OH)D levels ranged between 53.24-209.36 nmol/Kg and tissue 1,25(OH)2D range was 2.48-41.91 pmol/Kg. We observed positive correlations between tissue and plasma levels of 25(OH)D (r = 0.55, p&lt;0.0001) and 1,25(OH)2D (r = 0.58, p&lt;0.0001). Tissue 25(OH)D and 1,25(OH)2D levels were also well correlated (r = 0.59, p&lt;0.0001). After adjustment for BMI and age, tissue 1,25(OH)2D was positively correlated with plasma adiponectin to leptin ratio (r = 0.18, p = 0.047), and inversely correlated with tissue IGF to IGFBP3 ratio (r = -0.30, p = 0.025). None of these associations were found when comparing these factors with plasma level vitamin D metabolites. Conclusions: Our data indicate that although plasma and tissue vitamin D metabolites strongly correlate with each other, studying the target organ, namely the breast, provides greater insight into mechanistic carcinogenic relationships and how hormone levels in tissues modulate the microenvironment of the normal breast that may be related to breast cancer risk.

Citation Format: Renny S. Lan, Adana A. Llanos, Theodore M. Brasky, Catalin Marian, Ramona G. Dumitrescu, Bhaskar V. S. Kallakury, Kepher H. Makambi, Jo L. Freudenheim, Peter G. Shields. Associations among tissue vitamin D metabolites and breast cancer risk factors in women undergoing reduction mammoplasty. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1870. doi:10.1158/1538-7445.AM2015-1870

Social networks and physical activity behaviors among cancer survivors: data from the 2005 Health Information National Trends Survey

The study examined the relation between social networks and physical activity behaviors among cancer survivors. The authors examined 873 cancer survivors (596 women, 277 men) 50 years of age or older who participated in the 2005 Health Information National Trends Survey. Multivariate logistic regression analysis showed that survivors who talked about health with friends/family were more likely to pay attention to new physical activity recommendations (OR = 2.89, CI [1.01, 8.33]). Female survivors were more likely to pay attention to new physical activity recommendations (OR = 2.65, CI [1.55, 4.53]) and more likely to have seen, heard, or read physical activity/exercise and cancer information within the past 12 months (OR = 2.09, CI [1.13, 3.85]) compared with their male counterparts. For male survivors, those who were a member of at least one community organization were more likely to pay attention to new physical activity/exercise recommendations (OR = 5.31, CI [1.32, 21.22]) than the men who were not members. Overall, cancer survivors with a social network (i.e., talking to family/friends about health) were more likely to pay attention to new exercise recommendations compared with those who did not have a social network. Significant differences were also observed by gender with physical activity levels, knowledge, and attitudes. Social networking is an important component in cancer survivorship and further research is needed to encourage social networking strategies that might facilitate in increasing physical activity behaviors among cancer survivors.

Relationships among folate, alcohol consumption, gene variants in one-carbon metabolism and p16INK4a methylation and expression in healthy breast tissues

p16(INK4a) is a tumor suppressor gene, frequently hypermethylated in breast cancer; this epigenetic silencing of p16(INK4a) occurs early in carcinogenesis. The risk factors and functional consequences of p16(INK4a) methylation are unknown. Alcohol consumption, a breast cancer risk factor, impedes folate metabolism and may thereby alter gene methylation since folate plays a pivotal role in DNA methylation. In a cross-sectional study of 138 women with no history of breast cancer who underwent reduction mammoplasty, we studied breast cancer risk factors, plasma and breast folate concentrations, variation in one-carbon metabolism genes, p16(INK4a) promoter methylation and P16 protein expression. Logistic regression was used to estimate multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CI). p16(INK4a) methylation was negatively correlated with P16 expression (r = -0.28; P = 0.002). Alcohol consumption was associated with lower breast folate (P = 0.03), higher p16(INK4a) promoter methylation (P = 0.007) and less P16 expression (P = 0.002). Higher breast folate concentrations were associated with lower p16(INK4a) promoter methylation (P = 0.06). Genetic variation in MTRR (rs1801394) and MTHFD1 (rs1950902) was associated with higher p16 (INK4a) promoter methylation (OR = 2.66, 95% CI: 1.11-6.42 and OR = 2.72, 95% CI: 1.12-6.66, respectively), whereas variation in TYMS (rs502396) was associated with less P16 protein expression (OR = 0.22, 95% CI: 0.05-0.99). Given that this is the first study to indicate that alcohol consumption, breast folate and variation in one-carbon metabolism genes are associated with p16(INK4a) promoter methylation and P16 protein expression in healthy tissues; these findings require replication.

Abstract 4157: Autosome instability and loss of chromosome Y in blood lymphocytes predict lung cancer risk

Background: Cancer cells are characterized by frequent chromosome aberrations (CA), which reflect defects of the underlying mechanisms that maintain genomic stability. Chromosome aberrations in peripheral blood lymphocytes has been shown to be associated with overall cancer risk in previous small studies. However, the relationship between types of chromosome aberrations in blood lymphocytes and lung cancer risk has not been well defined. In a case-control study of non-small cell lung cancer, we evaluated if CA in autosomes and sex chromosomes were predictive of lung cancer risk. Method: Chromosome aberrations were determined by G-banding analysis of metaphase chromosomes from short-term cultured blood lymphocytes. Logistic regression was used to estimate the strength of association between CAs and lung cancer risk. Results: Autosome instability (defined as CA in any of the 22 pairs of autosomes in &gt; 5% of the cells) was significantly associated with lung cancer risk among individuals who were &lt;= 67 years of age; adjusted odds ratio (OR) of 5.0 [95% confidence interval (CI) = 1.6 - 15.3]. There was no significant association between autosome instability and lung cancer risk in individuals who were older than 67 years of age. Loss of chromosome Y was significantly associated with an elevated risk of lung cancer among males; adjusted OR of 3.2 (95% CI = 1.2 - 8.8). This association appeared to be stronger in older males (&gt; 67 years of age) and in African American males. We observed no significant association between loss of chromosome X and lung cancer risk in both males and females. Conclusion: Autosome instability and loss of chromosome Y in blood lymphocytes were significantly associated with lung cancer risk. Analysis of chromosome aberrations in blood lymphocytes may be a promising tool for the identification of sub-population who are at high risk of developing lung cancer.

Citation Format: Bing Sun, Ying Wang, Krishna Kota, Yaru Shi, Kepher H. Makambi, Christopher A. Loffredo, Peter G. Shields, Curtis C. Harris, Yun-Ling Zheng. Autosome instability and loss of chromosome Y in blood lymphocytes predict lung cancer risk. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4157. doi:10.1158/1538-7445.AM2014-4157

A non-iterative extension of the multivariate random effects meta-analysis

Multivariate methods in meta-analysis are becoming popular and more accepted in biomedical research despite computational issues in some of the techniques. A number of approaches, both iterative and non-iterative, have been proposed including the multivariate DerSimonian and Laird method by Jackson et al. (2010), which is non-iterative. In this study, we propose an extension of the method by Hartung and Makambi (2002) and Makambi (2001) to multivariate situations. A comparison of the bias and mean square error from a simulation study indicates that, in some circumstances, the proposed approach perform better than the multivariate DerSimonian-Laird approach. An example is presented to demonstrate the application of the proposed approach.

Genetic variation in adipokine genes and associations with adiponectin and leptin concentrations in plasma and breast tissue

BACKGROUND

Circulating adipokines may be associated with breast cancer risk. Genetic variants governing adipokines and adipokine receptors may also predict risk, but their effect on breast adipokine concentrations is unknown.

METHODS

We conducted a cross-sectional analysis of functional SNPs in 5 adipokine genes [adiponectin, leptin (LEP), and their receptors] among 85 cancer-free women who were undergoing reduction mammoplasty.

RESULTS

In multivariable-adjusted regression models, compared with the common GG genotype, the AA genotype of the LEP A19G SNP was associated with 27% lower plasma adiponectin [ratio, 0.73; 95% confidence interval (CI), 0.54-0.98] and leptin (ratio, 0.73; 95% CI, 0.55-0.96). Women with the AG genotype of LEP A19G had 39% lower breast leptin (ratio, 0.61; 95% CI, 0.39-0.97) compared with those with the GG genotype. No associations were observed for SNPs in the remaining genes.

CONCLUSIONS

Genetic variation in LEP may alter endogenous adipokine concentrations in circulation and in breast tissues.

IMPACT

These preliminary findings may support the hypothesis that genetic variation in adipokine genes modifies circulating adipokine concentrations and possibly leptin concentrations in local breast tissues, which may be associated with breast cancer risk.

SYK Allelic Loss and the Role of Syk-Regulated Genes in Breast Cancer Survival

Heterozygotic loss of SYK, a non-receptor tyrosine kinase, gives rise to mouse mammary tumor formation where Syk protein levels are reduced by about half; loss of SYK mRNA is correlated with invasive cell behavior in in vitro models; and SYK loss has been correlated with distant metastases in patients. Here, allelic loss of the SYK gene was explored in breast ductal carcinoma in situ (DCIS) using fluorescence in situ hybridization and pyrosequencing, respectively, and in infiltrating ductal carcinoma (IDC) using genomic data from The Cancer Genome Atlas (TCGA). Allelic loss was present in a subset of DCIS cases where adjacent IDC was present. SYK copy number loss was found in about 26% of 1002 total breast cancer cases and 30% of IDC cases. Quantitative immunofluorescence revealed Syk protein to be six-fold higher in infiltrating immune cells compared with epithelial cells. This difference distorted tumor cell mRNA and protein levels in extracts. 20% of 1002 IDC cases contained elevated immune cell infiltration as estimated by elevated immune-specific mRNAs. In cases without immune cell infiltration, loss of SYK copy number was associated with a significant reduction of SYK mRNA. Here we define a 55 Gene Set consisting of Syk interacting, motility- and invasion-related genes. We found that overall survival was significantly reduced in IDC and Luminal A+B cases where copy number and mutations of these 55 genes were affected (Kaplan-Meier, Logrank test p-value 0.007141 and Logrank test p-value 0.001198, respectively). We conclude that reduction in Syk expression and contributions of genomic instability to copy number and mutations in the 55 Syk interacting genes significantly contribute to poorer overall patient survival. A closer examination of the role of Syk interacting motility and invasion genes and their prognostic and/or causative association with metastatic disease and patient outcome is warranted.

Abstract 116: Association between variation in LEP A19G and adipokine concentrations in plasma and breast tissues

Introduction: Obesity is a well-established postmenopausal breast cancer risk factor, and an indicator of poor prognosis. The adipokines, adiponectin and leptin, may be essential to our understanding these associations. Plasma concentrations of adiponectin are inversely correlated, while plasma concentrations of leptin are positively correlated with obesity. Epidemiological studies of these adipokines and breast cancer risk are suggestive of a positive association for plasma leptin and an inverse association for plasma adiponectin. We studied whether genetic variation in several adipokine genes, leptin (LEP), leptin receptor (LEPR), adiponectin (ADIPOQ), and adiponectin receptors 1 and 2 (ADIPOR1/2) was associated with adipokine concentrations measured in plasma and breast tissue in a study of healthy women.

Methods: Breast tissues and plasma were collected from 85 women undergoing reduction mammoplasty between 1997 and 2009. Plasma and breast adiponectin and leptin concentrations were measured by commercially-available ELISA kits. DNA was extracted from dissected breast tissues and common, functional SNPs in LEP (rs2167270), LEPR (rs1137101), ADIPOQ (rs1501299), ADIPOR1 (rs2275737), and ADIPOR2 (rs1044471) were genotyped. Differences in least-squares mean concentration of plasma and breast adipokines, adjusted for age, race, and body mass index (kg/m2), were compared using an F test. Associations between genotypes and adipokines measured in plasma and tissue were estimated using adjusted regression models, with log-transformed adipokines as dependent variables. Results for each genotype are given as eβ, representing the ratio of plasma adipokines among those carrying a variant genotype relative to those carrying the wild-type.

Results: Genotype of rs2167270 was significantly associated with plasma adiponectin and leptin, and breast leptin concentrations. Compared to the wild-type, homozygous variant allele carriers of the LEP A19G polymorphism had 27% lower plasma adiponectin (Ratio 0.73, 95% CI: 0.54, 0.98; P=0.03) and plasma leptin (Ratio 0.73, 95% CI: 0.55, 0.96; P=0.02). Additionally, compared to wild-type, heterozygous variant allele carriers of this polymorphism had 39% lower breast leptin (Ratio 0.61, 95% CI: 0.39, 0.97; P=0.03), although there appeared to be higher breast leptin among homozygous variant allele carriers (Ratio 1.67, 95% CI: 0.86, 3.26). No associations were observed for LEPR (rs1137101), ADIPOQ (rs1501299), ADIPOR1 (rs2275737), or ADIPOR2 (rs1044471) and adipokines measured in plasma or tissue.

Conclusion: Variant alleles of rs2167270 were associated with lower plasma adiponectin and leptin concentrations, as well as lower breast leptin concentrations. This study provides evidence for a role of variation in adipokine genes in endogenous adipokine concentrations both in circulation and within local breast tissues.

Citation Format: Adana A. Llanos, Theodore M. Brasky, Kepher H. Makambi, Jo L. Freudenheim, Peter G. Shields. Association between variation in LEP A19G and adipokine concentrations in plasma and breast tissues. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 116. doi:10.1158/1538-7445.AM2013-116

Plasma IGF-1 and IGFBP-3 may be imprecise surrogates for breast concentrations: an analysis of healthy women

We investigated insulin-like growth factor (IGF)-1 and IGF binding protein (IGFBP)-3 concentrations in histologically normal breast tissues and assessed their association with plasma concentrations, and breast cancer risk factors. IGF-1 and IGFBP-3 were assessed in plasma and breast tissues of 90 women with no history of any cancer and undergoing reduction mammoplasty. Pearson correlations and ANOVAs were used to describe plasma-breast associations and biomarker differences by breast cancer risk factors, respectively. Multivariable regression models were used to determine associations between risk factors, and breast IGF-1 and IGFBP-3. The mean age of the study sample was 37.3 years, 58 % were white, and generally these women were obese (mean BMI = 30.8 kg/m(2)). We observed no plasma-breast correlation for IGF-1, IGFBP-3, or IGF-1/IGFBP-3 (r = -0.08, r = 0.14, and r = 0.03, respectively; p-values >0.05). Through age- and BMI-adjusted analysis, BMI and years of oral contraceptive (OC) use were inversely associated with breast IGF-1 (p-values = 0.02 and 0.003, respectively) and age was associated with breast IGFBP-3 (p = 0.01), while breast IGF-1/IGFBP-3 was higher in blacks than whites (1.08 vs. 0.68, p = 0.04) and associated with age and BMI (p-values = 0.03 and 0.002, respectively). In multivariable-adjusted models, some breast cancer risk factors studied herein explained 24, 10, and 15 % of the variation in breast IGF-1, IGFBP-3, and IGF-1/IGFBP-3, respectively. While reasons for the lack of plasma-breast hormone correlations in these cancer-free women are unknown, several factors were shown to be associated with breast concentrations. The lack of correlation between blood and tissue IGF-1 and IGFBP-3 suggests that studies of breast cancer risk assessing blood IGF-1 and IGFBP-3 may have important limitations in understanding their role in breast carcinogenesis.

Consumption of dairy and meat in relation to breast cancer risk in the Black Women's Health Study

PURPOSE

Dairy and meat consumption may impact breast cancer risk through modification of hormones (e.g., estrogen), through specific nutrients (e.g., vitamin D), or through products formed in processing/cooking (e.g., heterocyclic amines). Results relating meat and dairy intake to breast cancer risk have been conflicting. Thus, we examined the risk of breast cancer in relation to intake of dairy and meat in a large prospective cohort study.

METHODS

In the Black Women's Health Study, 1,268 incident breast cancer cases were identified among 52,062 women during 12 years of follow-up. Multivariable (MV) relative risks (RRs) and 95 % confidence intervals (CIs) were calculated using Cox proportional hazards models.

RESULTS

Null associations were observed for total milk (MV RR = 1.05, 95 % CI 0.74-1.46 comparing ≥1,000-0 g/week) and total meat (MV RR = 1.04, 95 % CI 0.85-1.28 comparing ≥1,000 < 400 g/week) intake and risk of breast cancer. Associations with intakes of specific types of dairy, specific types of meat, and dietary calcium and vitamin D were also null. The associations were not modified by reproductive (e.g., parity) or lifestyle factors (e.g., smoking). Associations with estrogen receptor (ER) positive (+), ER negative (-), progesterone receptor (PR) +, PR-, ER+/PR+, and ER-/PR- breast cancer were generally null.

CONCLUSIONS

This analysis of African-American women provides little support for associations of dairy and meat intake with breast cancer risk.

Combining study outcome measures using dominance adjusted weights

Weighting of studies in meta-analysis is usually implemented by using the estimated inverse variances of treatment effect estimates. However, there is a possibility of one study dominating other studies in the estimation process by taking on a weight that is above some upper limit. We implement an estimator of the heterogeneity variance that takes advantage of dominance adjusted weights. The performance of this estimator is compared with that of the commonly used estimator in meta-analysis, the DerSimonian-Laird estimator. Two test procedures for the overall treatment effect are proposed that are based on the quadratic form associated with the proposed heterogeneity variance estimator. An example is given to illustrate the application of these procedures. Copyright © 2013 John Wiley & Sons, Ltd.

Restaurant foods, sugar-sweetened soft drinks, and obesity risk among young African American women

BACKGROUND

The prevalence of obesity is disproportionately high in African American women, and consumption of fast foods and sugar-sweetened soft drinks is also especially high among African Americans.

OBJECTIVE

We investigated the relation of intakes of sugar-sweetened soft drinks and specific types of restaurant foods to obesity in the Black Women's Health Study.

DESIGN

In this prospective cohort study, 19,479 non-obese women aged 21-39 years at baseline were followed for 14 years (1995-2009). Dietary intake was assessed by validated food frequency questionnaire in 1995 and 2001.

MAIN OUTCOME MEASURES

Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of intakes of restaurant foods and sugar-sweetened soft drinks with incident obesity.

RESULTS

Higher intakes of burgers from restaurants and sugar-sweetened soft drinks were associated with greater risk of becoming obese. The associations were present in models that included both factors and adjusted for overall dietary pattern. The HR of obesity in relation to restaurant burger consumption of > or = 2 times/week compared with < 5 times/year was 1.26 (95% CI: 1.14-1.40; P-trend<.001). For sugar-sweetened soft drink intake, the HR was 1.10 (95% CI: .99-1.23; P-trend = .14) for > or = 2 drinks/day compared with < 1 drink/month. The associations were stronger among women younger than age 30 with normal weight at baseline.

CONCLUSIONS

Frequent consumption of burgers from restaurants and sugar-sweetened soft drinks contribute to obesity among young African American women.

Adipokines in plasma and breast tissues: associations with breast cancer risk factors

BACKGROUND

Blood adipokines are associated with breast cancer risk; however, blood-breast adipokine correlations and factors that explain variation in adipokines are unknown.

METHODS

Plasma (n = 155) and breast (n = 85) leptin and adiponectin were assessed by immunoassays in women with no history of cancer. Multivariable-adjusted regression models were used to determine breast adipokine associations.

RESULTS

Through body mass index (BMI)-adjusted analyses, we initially observed positive plasma-breast correlations for leptin (r = 0.41, P = 0.0002) and adiponectin (r = 0.23, P = 0.05). The positive plasma-breast correlation for leptin was strongest among normal weight women (r = 0.62), whereas the correlation for adiponectin was strongest among obese women (r = 0.31). In multivariable models, adjusting for BMI, demographic, reproductive, and lifestyle factors, plasma leptin was not associated with breast leptin, and only the highest quartile of plasma adiponectin was associated with tissue levels. Of the risk factors investigated, those that contributed most to the variation in breast tissue adipokines were BMI and race for leptin, oral contraceptive use and smoking status for adiponectin.

CONCLUSIONS

Although we report positive plasma-breast adipokine correlations overall, plasma adipokine concentrations may not be good surrogates for breast concentrations among all women. Predictors of breast adipokines vary, depending on subject characteristics, possibly explaining inconsistent epidemiologic results and they implicate differing pathways toward carcinogenesis.

IMPACT

A clearer understanding of the relationships between plasma adipokines and their levels within the target organ is necessary to better understand the impact of these hormones on breast cancer risk. Future studies are needed to identify additional factors associated with breast adipokines in target tissues.

MicroRNA-9 as potential biomarker for breast cancer local recurrence and tumor estrogen receptor status

MicroRNAs (miRs) are small, non-protein coding transcripts involved in many cellular functions. Many miRs have emerged as important cancer biomarkers. In the present study, we investigated whether miR levels in breast tumors are predictive of breast cancer local recurrence (LR). Sixty-eight women who were diagnosed with breast cancer at the Lombardi Comprehensive Cancer Center were included in this study. Breast cancer patients with LR and those without LR were matched on year of surgery, age at diagnosis, and type of surgery. Candidate miRs were identified by screening the expression levels of 754 human miRs using miR arrays in 16 breast tumor samples from 8 cases with LR and 8 cases without LR. Eight candidate miRs that showed significant differences between tumors with and without LR were further verified in 52 tumor samples using real-time PCR. Higher expression of miR-9 was significantly associated with breast cancer LR in all cases as well as the subset of estrogen receptor (ER) positive cases (p = 0.02). The AUCs (Area Under Curve) of receiver operating characteristic (ROC) curves of miR-9 for all tumors and ER positive tumors are 0.68 (p = 0.02) and 0.69 (p = 0.02), respectively. In ER positive cases, Kaplan-Meier analysis showed that patients with lower miR-9 levels had significantly better 10-year LR-free survival (67.9% vs 30.8%, p = 0.02). Expression levels of miR-9 and another miR candidate, miR-375, were also strongly associated with ER status (p<0.001 for both). The potential of miR-9 as a biomarker for LR warrants further investigation with larger sample size.

Meta-analysis of endoscopic versus sublabial pituitary surgery

OBJECTIVES/HYPOTHESIS

To determine whether the endoscopic or sublabial transseptal transsphenoidal approach for pituitary surgery has superior outcomes or decreased complication rates.

STUDY DESIGN

Retrospective meta-analysis of literature.

METHODS

A MEDLINE search was conducted identifying all relevant literature in the English language from 1998 through 2010. Studies explicitly identifying pure sublabial or completely endoscopic approaches were included. Meta-analysis comparing the two techniques was performed for multiple outcome measures utilizing a random effects approach.

RESULTS

A total of 21 endoscopic studies (n = 2,335) and 17 sublabial studies (n = 2,565) met inclusion criteria. Analysis revealed significantly superior rates of gross tumor resection (79% vs. 65%, P < .0001), as well as lower rates of cerebral spinal fluid leak (5% vs. 7%, P < .01), septal perforation (0% vs. 5%), and postoperative epistaxis (1% vs. 4%, P < .0001) for the endoscopic approach compared to the sublabial approach. There was no difference between the two techniques in the incidence of meningitis, diabetes insipidus, or resolution of hormonal abnormality. Hospital stay (P = .01) was shorter for endoscopic surgery compared to sublabial surgery, and there was no significant difference in terms of length of operation.

CONCLUSIONS

The sublabial transsphenoidal approach has been the gold standard for pituitary surgery for many years. However, meta-analysis of the recent literature demonstrates superior outcomes and decreased postoperative complications with the endoscopic approach, potentially justifying a shift toward endoscopic pituitary surgery.

Cholesterol, lipoproteins, and breast cancer risk in African American women

BACKGROUND

Lipid levels, including high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides, have been reported to be associated with breast cancer risk.

METHODS

We studied African American women (97 breast cancer cases and 102 controls) accrued through a population-based, case-control study in the Washington, DC metropolitan area during 1997 and 1998. Plasma lipid levels were measured using enzymatic methods. Logistic regressions (adjusted for age, age at menarche, parity, previous alcohol consumption, and education) were used to explore the associations between lipid levels and breast cancer.

RESULTS

Through multivariable-adjusted regression, we observed a significant inverse association between breast cancer risk and increasing levels of total cholesterol (OR=.46, 95% Cl = .25-.85) and LDL (OR = .41, 95% CI = .21-.81), whereas lower levels of HDL were associated with a significant increase in risk (OR = 1.99, 95% CI = 1.06-3.74).

CONCLUSIONS

Our data demonstrate significant reductions in breast cancer risk with high levels of total cholesterol and significant increase in risk when HDL levels are low. These data are in support of a protective effect of cholesterol which has been reported in other populations; further, these findings add to the literature in an understudied population, African American women.

Telomere length variation in normal epithelial cells adjacent to tumor: potential biomarker for breast cancer local recurrence

A better understanding of the risk of local recurrence (LR) will facilitate therapeutic decision making in the management of early breast cancers. In the present study, we investigated whether telomere length in the normal breast epithelial cells surrounding the tumor is predictive of breast cancer LR; 152 women who were diagnosed with breast cancer at the Lombardi Comprehensive Cancer Center were included in this nested case-control study. Cases (patients had LR) and controls (patients had no LR) were matched on year of surgery, age at diagnosis and type of surgery. Telomere fluorescent in situ hybridization was used to determine the telomere length using formalin fixed paraffin-embedded breast tissues. Small telomere length variation (TLV), defined as the coefficient variation of telomere lengths among examined cells, in normal epithelial cells adjacent to the tumor was significantly associated with a 5-fold (95% confidence interval = 1.2-22.2) increased risk of breast cancer LR. When the subjects were categorized into quartiles, a significant inverse dose-response relationship was observed with lowest versus highest quartile odds ratio of 15.3 (P(trend) = 0.012). Patients who had large TLV had significantly better 10 year recurrence free survival rate compared with patients who had small TLV (80 versus 33%). The present study revealed that TLV in normal epithelial cells adjacent to tumor is a strong predictor of breast cancer LR. If confirmed by future studies, TLV in normal epithelial cells adjacent to tumor has the potential to become a promising biomarker for predicting breast cancer LR after breast conserving surgery.

Abstract B3: Intake of restaurant foods and soft drinks in relation to weight gain and obesity among young African American women

Obesity is an important modifiable risk factor for many cancers. The prevalence of obesity has rapidly increased in the United States, with large disparities by age, sex, and race/ethnicity. In recent decades, increases in body mass index (BMI) have been highest among African American women. Concurrent with the increase in prevalence of obesity, the consumption of foods prepared away from home and of sugar-sweetened beverages has also increased. We prospectively assessed intake of restaurant foods and soft drinks in relation to weight gain and incident obesity in the Black Women's Health Study, an ongoing follow-up study of 59,000 African American women 21–69 years of age at enrollment in 1995. Because the greatest amount of weight gain occurs in young adulthood, we restricted the analysis to 19,172 non-obese women who were younger than age 40 years at baseline. Information on current weight and other lifestyle factors was ascertained every two years through mailed questionnaires, and dietary intake was assessed in 1995 and 2001 using a validated food frequency questionnaire. Participants were asked how often they had eaten the following specific types of foods at restaurants: burgers, fried chicken, fried fish, pizza, Chinese food, and Mexican food. Participants were also asked how often they drank “soft drinks,” a question that specified non-diet soda only. Based on follow-up data from 1995 through 2009, multivariable linear regression models were used to estimate mean weight gain and Cox proportional hazards models were used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for incident obesity according to consumption of restaurant foods and soft drinks. In these analyses, participants were censored when they reached age 40. The multivariable models were adjusted for age, physical activity, other lifestyle factors, and intake of vegetables, fruit, whole grains, and the other exposures of interest. During 14 years of follow-up, intake of burgers from restaurants was associated with increased weight gain and risk of obesity; compared with no consumption, women who ate burgers at restaurants at least once a week gained an additional 2.56 kg (95% CI: 1.60–3.52 kg) and were 30% more likely to become obese (IRR=1.30, 95% CI: 1.16–1.47). Restaurant consumption of fried chicken was associated with increased weight gain and obesity risk after adjustment for physical activity and other non-dietary covariates, but there was no significant association after adjustment for burger intake. Intake of other restaurant foods was not associated with weight gain or risk of obesity. Soft drink intake was not significantly associated with weight gain but was associated with increased risk of obesity (IRR=1.24, 95% CI: 1.10–1.40, for ≥2 drinks per day relative to &lt;1 per month). The associations were stronger among women with BMI &lt;25 than among women with BMI 25–29 at baseline. These results suggest that restaurant burger consumption and soft drink consumption are independently associated with increased risk of obesity among young African American women.

Citation Information: Cancer Prev Res 2011;4(10 Suppl):B3.

Frequent loss of the BLID gene in early-onset breast cancer

The BH3-like motif-containing inducer of cell death (BLID) is an intronless gene localized on 11q24.1. Loss of that region has frequently been reported in early-onset breast cancer and is significantly associated with poor prognosis and reduced survival. Downregulation of BLID is associated with younger age, triple-negative phenotype, and reduced disease-free and overall survival of breast cancer patients. In this study, we investigated allelic loss of BLID in breast tumor specimens from 78 women with invasive breast cancer using 2 dinucleotide polymorphic markers closely linked to the BLID gene (no intragenic marker for BLID is available). Seventy-three cases were informative. Overall, loss of heterozygosity (LOH) at the BLID locus was detected in 32% of the informative cases (23/73). However, in patients 40 years old and younger, LOH was detected in 50% of the cases (9/18). Patients aged 40 years and younger were significantly more likely to experience LOH than those aged 41-55 years (p = 0.04). Specifically, the odds of BLID loss for patients aged 40 years and younger were 3.7 times the odds of loss for patients aged 41-55 years (95% CI, 1.1-13). Our findings suggest a tumor suppressor role of the BLID gene in early-onset breast cancer.

Steroid hormone levels associated with passive and active smoking

CONTEXT

Cigarette tobacco smoke is a potent environmental contaminant known to adversely affect health including fertility and pregnancy.

OBJECTIVE

To examine the associations between second-hand cigarette tobacco-smoke exposure, or active smoking and serum concentrations of steroid hormones using tandem mass spectrometry.

DESIGN

Healthy women (18-45 y) from the general community in the Metropolitan Washington, DC were recruited at the follicular stage of their menstrual cycle. Participants were assigned to one of three study groups: active smokers (N=107), passive smokers (N=86), or non-smokers (N=100). Classifications were based on a combination of self-reporting and serum cotinine concentrations.

METHODS

Serum androgens, estrogens, progestins, androstenedione, aldosterone, cortisol, corticosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), 11-deoxycortisol and 25-hydroxy-vitamin D3 (25-OHVitD3) and cotinine were measured by isotope dilution tandem mass spectrometry (LC/MS/MS) (API-5000). Kruskal-Wallis tests were used to assess median differences among the three groups, with Dunn's multiple comparison test for post hoc analysis.

RESULTS

Serum estrone, estradiol, and estriol concentrations were lower in active and passive smokers than in non-smokers. The three study groups differed significantly in serum concentrations of 16-OHE1, aldosterone and 25-OHVitD3, as well as in the ratios of many of the steroids. Pair-wise comparison of the groups demonstrated significant differences in hormone concentrations between (i) smokers and non-smokers for aldosterone: (ii) passive smokers and non-smokers for aldosterone, progesterone and estriol. Moreover, for smokers and passive smokers, there were no significant differences in these hormone concentrations.

CONCLUSIONS

Smoke exposure was associated with lower than normal median steroid hormone concentrations. These processes may be instrumental in explaining some adverse effects of tobacco smoke on female health and fertility.

Use of multivitamins, folic acid and herbal supplements among breast cancer survivors: the black women's health study

BACKGROUND

Complementary and alternative medicine (CAM) use, including herbals and multivitamin supplements, is quite common in the U.S., and has been shown to be highest in breast cancer survivors. However, limited data are currently available for CAM usage among African Americans. Thus, we sought to determine the prevalence of multivitamins, folic acid and herbal supplement usage in African American breast cancer survivors, and to compare the characteristics of users and nonusers.

METHODS

A cohort study of breast cancer survivors, who completed the 1999 Black Women's Health Study questionnaire and self-reported having been diagnosed with breast cancer between 1995 and 1999, comprised the study population. In this study, the intake of natural herbs, multivitamins and folic acid at least three days per week within the past two years was used as a proxy for typical usage of this complimentary alternative medicine (CAM) modality.

RESULTS

A total of 998 breast cancer survivors were identified. Overall, 68.2% had used either herbals or multivitamin supplements or both. The three most frequently used herbals were garlic (21.2%), gingko (12.0%), and echinacea (9.4%). The multivariate analysis determined that single marital status (OR=1.58; 95%CI: 1.04-2.41), and alcohol consumption of 1-3 drinks per week (OR=1.86, 95%CI: 1.28-2.68) were significantly associated with increased herbal use. Multivitamin use was significantly lower among obese women (OR=0.66, 95%CI: 0.46-0.94) and current smokers (OR=0.53, 95%CI: 0.34-0.82).

CONCLUSIONS

A significant number of African American breast cancer survivors are using herbals and multivitamins as CAM modality. Additional research is needed to understand the impact of herbals and multivitamins in African American breast cancer survivors.

Abstract 1925: Dietary patterns and the risk of colorectal adenomas: The Black Women's Health Study

Background: Colorectal adenomas are benign lesions that may be precursors to colorectal cancer. No studies of African American women have investigated dietary patterns and the risk of colorectal adenomas. Objective: We examined data from the Black Women's Health Study (BWHS) to determine whether dietary patterns are associated with the risk of colorectal adenomas. Methods: This is a prospective cohort study of 59,000 participants followed biennially since 1995. During 155,414 person-years of follow-up from 1997 to 2007 among women who had had at least one screening colonoscopy, 620 incident cases of colorectal adenomas were identified. Using Cox regression models, we obtained incident rate ratios (IRR) for colorectal adenoma in relation to quintiles of each of two dietary patterns, adjusting for other colorectal adenoma risk factors. Results: Two dietary patterns, Western and prudent, were utilized to assess the association between dietary intake and adenoma risk. The highest quintile of prudent diet, relative to the lowest quintile, was significantly associated with 34% reduced colorectal adenoma risk overall (incidence rate ratio, IRR=0.66; 95% CI, 0.50-0.87; p for trend, &lt; 0.01). Higher scores on the Western pattern were associated with higher risk of colorectal adenoma (IRR = 1.42, 95% CI 1.09-1.85 for the highest quintile relative to the lowest; p trend, 0.01). Conclusion: Our findings suggest that African American women may be able to reduce their risk of developing colorectal adenomas by following a prudent dietary pattern and avoiding a more Western pattern.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1925. doi:10.1158/1538-7445.AM2011-1925

Dietary patterns and the risk of colorectal adenomas: the Black Women's Health Study

BACKGROUND

Colorectal adenomas are benign lesions that may be precursors to colorectal cancer. No studies of African American women have investigated dietary patterns and the risk of developing colorectal adenomas. We examined data from the Black Women's Health Study to determine whether dietary patterns are associated with the risk of developing colorectal adenomas.

METHODS

This is a prospective cohort study of 59,000 participants followed biennially since 1995. During 155,414 person-years of follow-up from 1997 to 2007 among women who had had at least one screening colonoscopy, 620 incident cases of colorectal adenomas were identified. By using Cox regression models, we obtained incidence rate ratios (IRR) for colorectal adenoma in relation to quintiles of each of two dietary patterns, adjusting for other colorectal adenoma risk factors.

RESULTS

Two dietary patterns, Western and prudent, were utilized to assess the association between dietary intake and adenoma risk. The highest quintile of prudent diet, relative to the lowest quintile, was significantly associated with 34% lower colorectal adenoma risk overall (IRR = 0.66; 95% CI, 0.50-0.88; P(trend) < 0.01). Higher scores on the Western pattern were associated with a higher risk of developing colorectal adenoma (IRR = 1.42; 95% CI, 1.09-1.85 for the highest quintile relative to the lowest; P(trend) = 0.01).

CONCLUSION

Our findings suggest that African American women may be able to reduce their risk of developing colorectal adenomas by following a prudent dietary pattern and avoiding a more Western pattern.

IMPACT

A dietary modification could have a strong impact in colorectal adenoma prevention in African American women.

Breast cancer risk assessments comparing Gail and CARE models in African-American women

The Gail model has been used to predict invasive breast cancer risk in women using risk factors of age, age at menarche, age at first live birth, number of first-degree relatives with breast cancer, and number of previous benign breast biopsies. However, this model underestimates breast cancer risk in African-American women. The Contraceptive and Reproductive Experience (CARE) model has been developed to replace the Gail model in predicting breast cancer risk in African-American women. In a sample of 883 women who participated in the breast cancer screening program at Howard University Cancer Center, we compared the breast cancer risk estimates from the Gail model and the CARE model. The mean 5-year breast cancer risk was 0.88% (Range: 0.18-6.60%) for the Gail model and 1.29% (Range: 0.20-4.50%) for the CARE model. Using the usual cutoff-point of 1.67% or above for elevated risk, there is a significant difference in the proportion of women with elevated breast cancer risk between the Gail and the CARE models (McNemar's test, p < 0.0001). For both models, there was a significant mean risk difference between those with and without a family history of breast cancer (Wilcoxon rank-sum test, p < 0.0001). Our results confirm the need for validation of the Gail model in African-Americans and diversity in research. Although these findings are not perfect and perhaps not definitive, they are additive in the discussions during counseling and risk assessment in African-Americans. Furthermore, these findings will be complemented by new technologies such as genomics in refining our ability to assess risk.

Diagnostic accuracy of the Gail model in the Black Women's Health Study

The Gail model is used to predict the risk of breast cancer in women of diverse race/ethnic groups for clinical trial protocols. However, this model has only been validated in US white women. Using a nested case-control study design, we evaluated the diagnostic accuracy of the original Gail model (GM) and that of the revised Gail model algorithm for blacks/African-Americans (GM-B) in the Black Women's Health Study (BWHS). Risk profiles were derived via a self reported questionnaire at the time of enrollment into the BWHS in 1995. Biennial questionnaires were obtained from the participants to determine the incident cases of breast cancer. The study of 725 breast cancer cases and 725 controls revealed that the 5-year risk of breast cancer based on the GM ranged from 0.2% to 15.4% among cases and 0.2% to 13.6% among the controls. Based on the GM-B, the 5-year risk of breast cancer ranged from 0.2% to 8.7% among cases and 0.2% to 7.2% among the controls. The sensitivities of the GM and GM-B model with the standard cutoff of 1.7% were 17.9% (95% CI: 15.9-19.9%) and 4.1% (95% CI: 3.0-5.2), respectively. Both the original and the modified version of the Gail model underestimate the risk of developing breast cancer in African-American women. More importantly, the modified Gail Model (GM-B) does a worse job at predicting the development of breast cancer for blacks than the original model (GM).

Molecular Breast Cancer Subtypes in Premenopausal African-American Women, Tumor Biologic Factors and Clinical Outcome

INTRODUCTION

Breast cancer is currently viewed as a heterogeneous disease made up of various subtypes, with distinct differences in prognosis. Our goal was to study the distribution and to characterize the clinical and biological factors that influence the behavior and clinical management of the different molecular breast cancer subtypes in premenopausal African-American women.

METHODS

A retrospective analysis of Howard University Hospital tumor registry, for all premenopausal African-American women aged less than 50 years, diagnosed with breast cancer from 1998-2005, was performed.

RESULTS

The luminal A subtype was the most prevalent (50.0%), vs basal-cell-like (23.2%), luminal B (14.1%), and HER-2/neu (12.7%). However when stratified by age groups, results showed that in the age group <35 years the basal-cell-like subtype was the most prevalent (55.6%), vs 25.9%, 14.8%, and 5.6% for luminal A, luminal B, and HER-2/neu subtypes, respectively (P < .000). P53 mutation was more prevalent in the basal-cell-like subtype compared to luminal A (48.0% vs 18.6%, P < .01). The expression of the Bcl-2 gene differed by subtype, with the luminal A and luminal B subtypes more likely to overexpress the Bcl-2 gene (89.1% luminal A, 80.0% luminal B vs 47.6% basal-cell-like and 40.0% HER-2/neu, P < .000). Though not statistically significant, HER-2/neu and basal-cell-like subtypes had the shortest survival time (P < .31).

CONCLUSION

The high prevalence of the basal-cell-like subtype in young premenopausal African-American women aged <35 years may contribute to the poorer prognosis observed in this cohort of African-American women.

Racial discrimination and breast cancer incidence in US Black women: the Black Women's Health Study

Perceived discrimination may contribute to somatic disease. The association between perceived discrimination and breast cancer incidence was assessed in the Black Women's Health Study. In 1997, participants completed questions on perceived discrimination in two domains: "everyday" discrimination (e.g., being treated as dishonest) and major experiences of unfair treatment due to race (job, housing, and police). Cox proportional hazards models were used to estimate incidence rate ratios, controlling for breast cancer risk factors. From 1997 to 2003, 593 incident cases of breast cancer were ascertained. In the total sample, there were weak positive associations between cancer incidence and everyday and major discrimination. These associations were stronger among the younger women. Among women aged less than 50 years, those who reported frequent everyday discrimination were at higher risk than were women who reported infrequent experiences. In addition, the incidence rate ratio was 1.32 (95% confidence interval: 1.03, 1.70) for those who reported discrimination on the job and 1.48 (95% confidence interval: 1.01, 2.16) for those who reported discrimination in all three situations - housing, job, and police - relative to those who reported none. These findings suggest that perceived experiences of racism are associated with increased incidence of breast cancer among US Black women, particularly younger women.

A Follow-up Study of Physical Activity and Incidence of Colorectal Polyps in African-American Women

BACKGROUND

Physical activity is associated with a reduced risk of colon cancer, but the effect of activity on colorectal adenomas, which are precursors to colon cancer, is uncertain. The influence of physical activity on colorectal adenomas among African-American women is of particular interest because African-American women have an increased risk of colon cancer relative to other U.S. women.

METHODS

We prospectively assessed the relation of physical activity to the incidence of colorectal polyps among African-American women. We followed 45,400 women in the Black Women's Health Study from 1997 to 2003. Data were obtained by biennial mailed questionnaires. During 287,029 person-years of follow-up, 1,390 women reported having been diagnosed with colorectal polyps. A review of medical records of 58 women who reported colorectal polyps indicated that 59% had adenomas and 41% had hyperplastic polyps. We converted hours per week of vigorous exercise and hours per week of walking to metabolic equivalent (MET)-hours. We estimated incidence rate ratios with Cox proportional hazard models, controlling for age, body mass index, smoking, family history of colorectal cancer, and education.

RESULTS

For total MET-hours/wk spent in walking and vigorous exercise, the incidence rate ratio decreased from 0.94 for <5 MET-hours/wk to 0.72 for >or=40 MET-hours/wk (P(trend) = 0.01). The inverse association was apparent among most subgroups examined, including women who may be at higher risk of colorectal adenomas because of being obese.

CONCLUSIONS

Increased physical activity is associated with a reduced incidence of colorectal polyps among African-American women.

The effect of the heterogeneity variance estimator on some tests of treatment efficacy

The effect of two noniterative heterogeneity variance estimators on two test procedures for the overall treatment effect using the log odds ratio as the outcome measure is investigated. Using simulated significance levels, it is shown that in addition to being sensitive to changes in the magnitude of the heterogeneity variance, the standard test procedure in meta-analysis (or multicenter clinical trials) is also sensitive to the heterogeneity variance estimator used and attains significance levels that are far from the prescribed level. A second test procedure by Hartung [Hartung, J. (1999). An alternative method for meta-analysis. Biometrical J. 41:901-916], is shown to exhibit good control of type I error probability regardless of changes in the magnitude of the heterogeneity variance and the heterogeneity variance estimator used.