Potential contribution of obesity to disparate breast cancer outcomes: an ecologic study Público

Abstract

This study was planned with the goal to evaluate the potential contribution of racial disparities in obesity to that in breast cancer specific mortality. Previous studies have found that breast cancer risk is associated with non-modifiable factors such as advancing age (65 years and above), genetic factors (BRCA1,2 etc.), early menarche and family history of breast cancer. Modifiable factors highlighted as increasing risk include alcohol consumption, diet, use of post-menopausal hormone replacement therapy and adiposity/obesity. Non-Hispanic Black women experience consistently worse outcomes and higher recurrence and mortality rates which has been attributed to socio economic status, access to care, genetic and pathologic factors that tend to vary with race. This study aimed to examine this phenomenon at a population level with a focus on obesity and breast cancer specific mortality using an ecologic approach with the US census as a framework (states and Census regions, divisions). SEER-STAT and the CDC BRFSS survey results were tapped as sources for our outcome and exposure data respectively. The Joinpoint Regression Analysis program version 4.9 (National Cancer Institute, 2020) was used to examine trends in overall age-adjusted obesity and mortality rates for the 17 states in the southern US region from 1990-2016. Results: The largest gaps between the races in Obesity Average annual percentage change (AAPC) were in Arkansas (NHW AAPC 4%, NHB 1.9%) and Georgia (NHW AAPC %, NHB -3.2%) with the Non-Hispanic Black women experiencing a slower decline in rates than and Non-Hispanic White women. Non-Hispanic White women experienced a more rapid decline in breast cancer mortality in all states; with the widest gaps in Georgia (NHW AAPC -8.0 %, NHB AAPC -3.2%), Oklahoma (NHW AAPC -6.4 %, -0.5%) and Maryland (NHW AAPC -11.2 %, NHB AAPC -6.7%). Similar findings in many states supported an inference that populations with wide racial disparities in obesity also tended to experience five to ten years later, a wide gap in the pattern of breast cancer mortality with the average annual percentage changes being similarly concurrent.

Table of Contents

CHAPTER I: Background .......................................................................................................6

CHAPTER II .............................................................................................................................4

Title, Author, Abstract .................................................................................................................5

Introduction ................................................................................................................................12

Methods ......................................................................................................................................13

Trend visualization and descriptive analysis .....................................................................17

Results ........................................................................................................................................20

Discussion ..................................................................................................................................21

Tables ........................................................................................................................................23

References ..................................................................................................................................32

CHAPTER III: Summary, Public Health Implications, Possible Future Directions .............34

Appendix: Trend visualizations……………..….......................................................................37

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	Breast Cancer, Obesity, Population health, United states, Ecologic, Joinpoint regression, trend analysis,
Committee Chair / Thesis Advisor	Lash, Timothy L., Emory University

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