Publications

There has been little research examining whether experiences of interpersonal racism are associated with the risk of coronary heart disease (CHD). Based on data from the Black Women’s Health Study, we found a higher risk of CHD among Black women who reported experiences of racism in employment, housing, and with the police than among those who reported no such experiences. We did not find increased risk in relation to perceived racism in everyday life. link to online article

Obesity is one of the known risk factors for multiple myeloma, a blood cancer. In the BWHS, women with high body mass index (BMI>25) in early adulthood have a 57% increased risk of multiple myeloma. Weight control could be a an important in reducing the risk of this disease. link to online article

Adding a polygenic risk score (PRS) to breast cancer risk prediction models created for European-ancestry populations improved the accuracy of the models. We tested the addition of a polygenic risk score developed for African American women (AA-PRS) to the BWHS risk calculator for incident breast cancer in Black Women. The addition of AA-PRS increased the accuracy of the BWHS risk calculator, and it performs similarly to the models in other populations. link to online article

Research has shown that the physiologic response to stress can affect gene expression. Based on breast cancer RNA sequencing data in the Black Women’s Health Study, the top differentially expressed pathways by stress exposure for ER+ cases were related to RNA and protein metabolism, while among ER- cases, they were related to developmental biology, signal transduction, metabolism, and the immune system. Psychosocial stress may affect breast tumor biology through multiple pathways. Changes
in tumor biology and disease progression in relation to stress is an area for further research. link to online article

Physical activity has been shown to be strongly associated with decreased risk of postmenopausal breast cancer, but its association with premenopausal breast cancer is uncertain. In a study of data from 19 cohort studies that included 547,601 premenopausal women, high versus low levels of leisure-time physical activity were associated with reduced risk, suggesting that leisure-time physical activity may lower the risk of premenopausal breast cancer. link to online article

Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic precursor to multiple myeloma. Risk factors for MGUS are largely unknown. Hypothesizing that low vitamin D levels might be associated with risk of MGUS, we examined data from the Black Women’s Health Study to assess the association of vitamin D deficiency (level of 25(OH)D less than 20 ng/mL) with risk of MGUS. MGUS was more prevalent among women with vitamin D deficiency but results were not statistically significant. Further study is required to clarify the possible association between vitamin D deficiency and MGUS. link to online article

The investigative team developed a competing-risk model to estimate 5-year breast cancer risk and 10-year non-breast cancer death from women 55 and older in the Black Women’s Health Study, the Women’s Health Initiative-Extension Study (WHI-ES), and the Multiethnic Cohort (MEC), as well as comparing the model performance to existing models. Results showed that the newly developed model performs at least as well as existing breast cancer prediction models and also predicts non-breast cancer death. link to online article

Sarcoidosis can affect any organ but most commonly affects the lung. It is characterized by granuloma formation. The incidence appears to be greater in women than men and in Black women than other women. Obesity appears to be associated with increased risk and smoking with reduced risk. Several types of infection have been associated with increased risk. Identification of risk factors is needed. link to online article

Strokes, including at younger ages, occur more commonly among Black individuals than other racial groups. In the Black Women’s Health Study, experiences of interpersonal racism reported in 1997 were assessed in relation to the incidence in strokes occurring subsequently during 22 years of follow-up. The incidence of stroke in women who reported experiences of interpersonal racism involving jobs, housing, or interaction with police was estimated to be more than 30% greater than that among women reporting none of these occurrences. These results suggest that racism may contribute to the greater burden of stroke among Black women. link to online article

Use of hair relaxers is common among American Black women. Use has been inconsistently linked to risk of estrogen-dependent cancers and other reproductive health conditions. Using data from the Black Women’s Health Study, we compared the risk of uterine cancer of among women who never or rarely used hair relaxers to that among women who used them frequently. Long-term use of chemical hair relaxers was associated with increased risk of uterine cancer among postmenopausal women, although not among premenopausal women. The findings suggest that hair relaxer use may be a potentially modifiable risk factor for uterine cancer. link to online article

Providing results of genetic testing is an important part of precision medicine, but it is critical that patients receive results in a way that adheres to appropriate principles for conducting health care. For example, providing results should be done with respect for the autonomy of the patient and should cause no harm. We aim to test an alternative way to provide results effectively, ethically, and efficiently to patients who have had genetic testing. We will conduct a randomized controlled trial to compare two methods of providing the opportunity to learn genetic results: a conventional method involving a Board-certified genetic counselor meeting with participants over the telephone, and a self-guided online method with the option for telephone follow-up with a genetic counselor. This study will demonstrate the effectiveness of a model of return of genetic results that could increase access. link to online article

Previous research suggests that aspirin use may reduce the occurrence of colorectal neoplasia. Few studies have investigated this relationship among Black Americans, who are disproportionately diagnosed with the condition. Using data from the Black Women’s Health Study, we assessed aspirin use in relation to the occurrence of colorectal adenoma. Regular aspirin use was associated with decreased risk of colorectal adenoma, suggesting that aspirin use could be part of a prevention strategy among Black women. link to online article

Breast cancer risk increases with moderate to heavy alcohol consumption. Genes involved in the metabolism of ethanol may influence this risk but have not been well studied. Our analysis assessed variants in four genetic regions related to ethanol metabolism in a large sample of Black women in the US. Two genetic variants had significant associations with breast cancer risk, one with both ER- and triple negative breast cancer and the other with triple negative breast cancer. Additional research is needed to confirm these associations. link to online article

Most research examining post-menopausal menopausal hormone therapy (MHT) use in relation to risk of ovarian cancer has focused on White women. Using data from the Ovarian Cancer in Women of African Ancestry consortium, we evaluated MHT use and ovarian cancer risk in Black and White women. We found that long-term (≥10 years) use of MHT was associated with increased risk of ovarian cancer in both Black and White women. link to online article

Blacks Americans experience poorer oral health than White Americans. Stress has been associated with both poor oral health and exposure to racism. In a follow-up study of women participating in the Black Women’s Health Study, higher levels of perceived racism reported in 2009 were associated with declines in self-rated oral health in the subsequent 10 years. link to online article

We evaluated associations of endometriosis and uterine leiomyomas (fibroids) with risk of ovarian cancer by race. We also examined the effect of hysterectomy on these associations. In both Black and White women, a diagnosis of endometriosis was associated with an increased risk of endometrioid and clear-cell ovarian cancer. Among White participants, the association was stronger in those without hysterectomy; no difference in association was observed in Black participants with and without hysterectomy. Among Black and White participants, leiomyomas were associated with an increased risk of ovarian cancer only in those without hysterectomy. Understanding how racial differences affect access to health care and treatment options, such as hysterectomy, may help guide risk reduction strategies. link to online article

The incidence of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, is increasing in minority populations, but little is known about the epidemiology and disease characteristics in Black women. We assessed the reported incidence of IBD and evaluated the accuracy of self-reported diagnosis among 59,000 Black women enrolled in the Black Women’s Health Study in 1995 and followed through 2021.The incidence of IBD was highest in Black women younger than 30 years of age and similar to previously published estimates in US White women. Among respondents to a supplementary questionnaire, the confirmation rate for the reported diagnosis was estimated to be 57%. link to online article

Prior research has suggested a lower risk of breast cancer among women with preeclampsia (high blood pressure during pregnancy), and a higher risk of breast cancer among women with preterm birth. In this study of premenopausal women, preterm birth was inversely associated with premenopausal breast cancer among women with preeclampsia or gestational hypertension. This suggests that conditions of a pregnancy affect breast cancer risk among women with preterm birth. link to online article

Mammography guidelines recommend that providers consult with women ages 75 and older and those with a life expectancy of less than 10 years to make decisions regarding undergoing mammography. However, there is no modeling tool that incorporates breast cancer risk and life expectancy to help with this decision making. Using a breast cancer risk prediction model that was developed in the Nurses’ Health Study and in the Black Women’s Health Study, a model was developed to predict 10 year risk of death due to causes other than breast cancer and 5 year risk of breast cancer death. This tool can help with decision making around mammography screening. link to online article

Kidney stones are a common medical condition. Black women are more likely to experience metabolic conditions, such as obesity and diabetes, that are related to higher risk of kidney stones. In the BWHS, women who reported a history of kidney stones were more likely to be older, overweight, have conditions such as type 2 diabetes or gallstones, drink little or no alcohol, and consume a Western diet. The association of these factors with a kidney stone diagnosis is consistent with other studies. link to online article

Prior studies have suggested that higher vitamin D levels in the blood are associated with lower risk of hypertension. Black women are more likely to have vitamin D deficiency than women in other racial groups. In the BWHS, using a validated predicted vitamin D score and controlling for confounders, a higher score was weakly associated with lower risk of hypertension. link to online article

Some studies suggest that circadian disruption—disturbance in natural sleeping and waking cycles—increases colorectal cancer risk among animals, but data from human research is limited. Using data from the BWHS, we examined night shift work, chronotype, and residential position within a time zone, proxies for circadian disruption, in relation to colorectal cancer risk. Compared with never having worked night shifts, working a night shift for more than 10 years was associated with increased risk of colorectal cancer, while shorter durations were not associated with increased colorectal cancer risk. These results require confirmation in larger studies. link to online article

Limited data suggest that higher consumption of long-chain omega-3 polyunsaturated fatty acids (LCn3PUFA) may reduce risk of endometrial cancer. Fatty acid intakes from 12 studies participating in the Epidemiology of Endometrial Cancer Consortium, which includes the BWHS, were assessed in relation to endometrial cancer risk. Diets higher in LCn3PUFA were associated with higher risk of endometrial cancer among overweight women but there was no increase among women of normal weight. These results suggest that higher dietary intakes of LCn3PUFA are unlikely to reduce risk of endometrial cancer, but rather might be associated with increases in some subgroups of women. link to online article