Juhua Luo1, Candyce H Kroenke2, Michael Hendryx3, Aladdin H Shadyab4, Nianjun Liu5, Xiwei Chen5, Fengge Wang5, Fridtjof Thomas6, Nazmus Saquib7, Lihong Qi8, Ting-Yuan David Cheng9, Rhonda Arthur10, Jean Wactawski-Wende11. 1. Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA. juhluo@indiana.edu. 2. Division of Research, Kaiser Permanente Northern California, Oakland, USA. 3. Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN, USA. 4. Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA, USA. 5. Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA. 6. Division of Biostatistics, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. 7. Research unit, College of Medicine, Sulaiman AlRajhi University, Al Bukayriyah, Saudi Arabia. 8. Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA, USA. 9. Department of Epidemiology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA. 10. Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, USA. 11. Public Health and Health Professions, University at Buffalo, Buffalo, USA.
Abstract
BACKGROUND: Triple-negative breast cancer (TNBC) is disproportionately higher in Black women relative to White women. The objective of this study was to examine to what extent the association between race/ethnicity and risk of TNBC is mediated by potentially modifiable factors. METHODS: A total of 128,623 Black and White women aged 50-79 years from the Women's Health Initiative were followed for a mean of 15.8 years. 643 incident TNBC cases (92 Black women and 551 White women) were confirmed by medical record review. Mediation analyses were conducted using an approach under a counterfactual framework. RESULTS: Black women had approximately twofold higher risk of TNBC compared with white women (HR = 1.93, 95% CI 1.52-2.45). We observed that 48% of the racial disparity was mediated by metabolic dysfunction defined by having 3 or more cardiometabolic risk factors including elevated waist circumference, having history of diabetes, high cholesterol and hypertension. The racial disparity was not significantly mediated by other factors studied, including socioeconomic, lifestyle or reproductive factors. CONCLUSION: Our study observed that approximately half of the racial disparity between postmenopausal Black and White women in TNBC incidence was driven by metabolic dysfunction.
BACKGROUND: Triple-negative breast cancer (TNBC) is disproportionately higher in Black women relative to White women. The objective of this study was to examine to what extent the association between race/ethnicity and risk of TNBC is mediated by potentially modifiable factors. METHODS: A total of 128,623 Black and White women aged 50-79 years from the Women's Health Initiative were followed for a mean of 15.8 years. 643 incident TNBC cases (92 Black women and 551 White women) were confirmed by medical record review. Mediation analyses were conducted using an approach under a counterfactual framework. RESULTS: Black women had approximately twofold higher risk of TNBC compared with white women (HR = 1.93, 95% CI 1.52-2.45). We observed that 48% of the racial disparity was mediated by metabolic dysfunction defined by having 3 or more cardiometabolic risk factors including elevated waist circumference, having history of diabetes, high cholesterol and hypertension. The racial disparity was not significantly mediated by other factors studied, including socioeconomic, lifestyle or reproductive factors. CONCLUSION: Our study observed that approximately half of the racial disparity between postmenopausal Black and White women in TNBC incidence was driven by metabolic dysfunction.
Entities:
Keywords:
Mediation analysis; Modifiable risk factors; Racial disparities; Triple-negative breast cancer
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