Individual and Neighborhood Socioeconomic Status in Relation to Breast Cancer Incidence in African-American Women

American journal of epidemiology (Impact Factor: 5.23). 11/2012; 176(12). DOI: 10.1093/aje/kws211
Source: PubMed


Socioeconomic status (SES) for both individuals and neighborhoods has been positively associated with incidence of breast
cancer, although not consistently. The authors conducted an assessment of these factors among African-American women, based
on data from the Black Women's Health Study, a prospective cohort study of 59,000 African-American women from all regions
of the United States. Individual SES was defined as the participant's self-reported level of education, and neighborhood SES
was measured by a score based on census block group data for 6 indicators of income and education. Analyses included 1,343
incident breast cancer cases identified during follow-up from 1995 through 2009. In age-adjusted analyses, SES for both individuals
and neighborhoods was associated with an increased incidence of estrogen receptor-positive breast cancer. The associations
were attenuated by control for parity and age at first birth, and there was no association after further control for other
breast cancer risk factors. These findings suggest that the observed associations of breast cancer with SES may be largely
mediated by reproductive factors that are associated with both estrogen receptor-positive breast cancer and SES.

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    • "This association may reflect differences in exposure to breast cancer risk factors. For instance, women of higher SES in general have lower parity, greater use of exogenous hormones, and greater alcohol consumption , all established risk factors for breast cancer (Palmer et al. 2012; Suzuki et al. 2005; Heck and Pamuk 1997). Most of these studies have classified breast cancer as a single disease, although recent genetic and molecular analyses have established the existence of several subtypes of breast cancer, based on ER, PR, and Her status. "
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    ABSTRACT: Recent developments in genetics and molecular biology have classified breast cancer into subtypes based on tumor markers of estrogen (ER), progesterone (PR) and human epidermal growth Factor-2 receptors (Her-2), with the basal-like (ER-, PR-, Her2-) subtype commonly referred to as "triple negative" breast cancer (TNBC) being the most aggressive. Prior studies have provided evidence that higher socio-economic status (SES) is associated with increased breast cancer risk, likely due to hormone related risk factors such as parity and hormonal contraceptive use. However, it is unclear if the relationship between SES and overall breast cancer incidence exists within each subtype, and if this association varies by race/ethnicity. Analysis was based on data obtained from the SEER database linked to 2008-2012 American Community Survey data, and restricted to women diagnosed with breast cancer in 2010. The NCI SES census tract SES index based on measures of income, poverty, unemployment, occupational class, education and house value, was examined and categorized into quintiles. Age-adjusted incidence rate ratios were calculated comparing the lowest to the highest SES groups by subtype, separately for each race/ethnic group. We identified 47,586 women with breast cancer diagnosed in 2010. The majority was diagnosed with Her2-/HR+ tumors (73 %), while 12 % had triple negative tumors (TNBC). There was a significant trend of higher incidence with increasing SES for Her2-/HR+ (IRR Highest vs. Lowest SES: 1.32, 95 % CI 1.27-1.39; p value trend: 0.01) and Her2+/HR+ tumors (IRR Highest vs. Lowest SES: 1.46, 95 % CI 1.27-1.68; p value trend: 0.01) among White cases. There was no association between SES and incidence of HR- subtypes (Her2+/HR- or TNBC). Similar associations were observed among Black, Hispanic and Asian or Pacific Islander cases. The positive association between SES and breast cancer incidence is primarily driven by hormone receptor positive tumors. To the extent that neighborhood SES is a proxy for individual SES, future studies are still needed to identify etiologic risk factors for other breast cancer subtypes.
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