2021

The 2021 US Preventive Services Task Force (USPSTF) lung cancer screening guidelines were changed to increase the number of smokers eligible for screening by lowering the age eligibility from 55 to 50 years and reducing the required pack-years of smoking from 30 to 20. While these changes should increase the proportion of Black individuals eligible for screening, many high-risk Black women may continue to be ineligible. Using data from the Black Women’s Health Study, we evaluated lung cancer screening eligibility among American Black women under the 2013 and 2021 USPSTF guidelines. Results show that the proportion of Black women diagnosed with lung cancer who would have been eligible for screening increased by 50% under 2021 USPSTF screening guidelines compared with 2013 guidelines, yet two-thirds of the patients with lung cancer still would have been ineligible for screening. Our findings suggest that removing the screening criteria that former smokers must have quit smoking within the past 15 years may benefit Black women. link to online article

The contribution to invasive lobular carcinoma (ILC) of the breast of pathogenic variants (PVs) in the genes that are included in hereditary cancer testing panels were determined. PVs in some genes (ATM, BRCA2, CDH1, CHEK2, PALB2) were associated with increased risk of ILC; PVs in BRCA1 were not. It may be appropriate for those with ILC to have multigene panel testing, as it is for IDC (invasive ductal carcinoma). link to online article

We examined the association between 10 psychosocial stressors and DNA methylation of four stress-related genes among in Black women. We also examined whether religiosity or spirituality modified the DNA methylation (DNAm) of the same stress-related genes. DNA methylation is a normal biological process that regulates gene expression. Observed associations were not statistically significant and therefore show limited evidence of strong interaction in this population. link to online article

There has been little assessment of the relation of psychosocial stress to risk of breast cancer subtypes in Black women. In the BWHS, we derived scores for level of neighborhood disadvantage and of socioeconomic status, based on U.S. census data on education, employment, income, poverty, female-headed households, and race. We found that both neighborhood disadvantage and lower neighborhood socioeconomic status were associated with increased risk of estrogen receptor negative breast cancer. Future studies are needed to understand these associations, such as whether particular biologic responses to chronic stress are involved. link to online article

Low vitamin D levels have been linked to increased risk of colorectal cancer in studies of White populations. Black Americans have lower levels of vitamin D and experience higher rates of colorectal cancer than other populations. Using a predicted vitamin D score developed and validated in the BWHS, we evaluated predicted vitamin D levels in relation to colorectal cancer risk among BWHS participants. Women with low predicted vitamin D scores had a higher risk of colorectal cancer than those with the higher scores, suggesting that low vitamin D levels may be a factor in the higher rates of colorectal cancer among Black Americans. link to online article

Identifying women at high risk for breast cancer enables appropriate screening for early detection, targeted intervention, and enrollment in preventive trials We developed a new breast cancer prediction tool for Black women, designed for use in primary care settings, that performs as well as breast cancer prediction tools developed for White women. The tool for Black women has better prediction among women under 40 years of age than among older Black women. Breast cancer prediction among young Black women is particularly useful because younger women with an increased risk of breast cancer are below the usual ages at which breast cancer screening typically begins. link to online article

A worldwide increase in colorectal cancer (CRC) incidence at younger ages prompted a look at early and late onset disease in the US. There has been an increase in early-onset colorectal cancer in Whites, which has decreased the disparity in incidence of the disease between Blacks and Whites. There has also been an increase in colorectal neuroendocrine tumors in Blacks. The highest rates of CRC (early- and late- onset) are among Blacks and American Indians/Alaskan Natives. link to online article

This study identified structural deletions in several suspected breast cancer predisposition genes in samples from women of African ancestry. This is the first large-scale study to characterize the deletions, and if future studies confirm the findings it may inform future genetic testing for breast cancer. link to online article

A baseline Spiritual Survey (SS-1) was developed and validated in a racially and ethnically diverse sample. The survey showed construct and predictive validity and was well correlated with other measures. The scales produced by the SS-1 were associated with attitudes about religion and spirituality and with some measures of mental health and physical health. link to online article

Prior studies have shown an inverse association between dietary vitamin A intake and breast cancer risk among premenopausal women of European descent. In as study of Black women that included BWHS participants, we found similar results–higher dietary intake of vitamin A was associated with lower incidence of ER-positive breast cancer. link to online article

There are conflicting results about whether gestational diabetes mellitus (GDM, diabetes during pregnancy) is associated with the risk of breast cancer before age 55. In an assessment of GDM in relation to breast cancer risk in five studies, including the BWHS, we found that women with at least one birth who had a history of GDM had a risk of breast cancer similar to that of women with at least one birth who did not have a history of GDM. There is a well-established decrease in risk of ER-positive breast cancer among women with at least one birth, and in this study women with a history of GDM also showed a decreased risk of ER-positive breast cancer, suggesting that the protective effect of childbearing is not affected by GDM. link to online article

Limited evidence suggests that higher blood levels of vitamin D may be protective against COVID-19 infection. Black women often have insufficient vitamin D levels, and they are more likely to become infected with COVID-19 than white women. In a study conducted within the BWHS, lower blood vitamin D levels were associated with a higher risk of COVID-19 infection. Studies are needed to confirm this association in other populations and to determine the optimum level of vitamin D needed to prevent infection. link to online article

It has been shown that the risk of estrogen receptor-negative (ER-) breast cancer is higher among those who have given birth; breastfeeding mitigates the increased risk. Exploring the hypothesis that normal suppression of the FOXA1 gene during pregnancy results in cellular changes in the breast that increase risk of ER- tumors, deletion of the FOXA1 gene in mouse mammary glands resulted in cellular changes consistent with this hypothesis. These observations provide a possible mechanism for the observed association of pregnancy and ER- tumors. link to online article

In a study that included women with and without breast cancer from the BWHS and multiple other studies, the goal was to establish the frequency of pathogenic variants (PVs) and remaining risk of breast cancer for each gene linked to breast cancer risk in women 65 and over. Results suggested that all women who are diagnosed with triple-negative breast cancer or with ER-negative breast cancer should receive genetic testing. Those women who test positive for certain breast cancer genes and PVs who are also over age 65 should be considered for magnetic resonance image screening. link to online article

A study of over two million individuals in the U.S. and the United Kingdom has been in progress since March of 2020 to assess factors related to COVID-19 infection. Participants from many studies, including the BWHS, were invited to join the study and to provide information on factors that might be related to COVID-19 infection and on whether they had become infected. There was an increased risk of COVID-19 infection associated with living in communities identified as more deprived (according to the Neighborhood Deprivation Index and the Index of Multiple Deprivation). The higher risk of COVID-19 infection among racial and ethnic minorities demonstrates the critical role of social determinants of health, such as the circumstances in which people live. link to online article

This study examined the association of pathogenic variants (PVs) in genes that are associated with an increased risk of breast cancer and polygenic risk scores (PRS) with breast cancer in the general population. Among those who carry PVs in breast cancer predisposition genes, PRS improved personalization of breast cancer risk. Adding PRS may help to prevent over-screening and may enable a breast cancer risk management plan that is more personalized. link to online article

We assessed dietary intake in relation to risk of systemic lupus erythematosus (SLE), a condition that disproportionately affects Black women. Most prior studies examining dietary intake in relation to SLE risk have been in White populations and have been null. Using self-reported diet information, this analysis suggests an increased risk of SLE among Black women whose diet is high in carbohydrates and low in fats. link to online article

Genetic loci (specific locations on genes) that are associated with height have been identified in populations of European ancestry, but few studies have been conducted among individuals of African ancestry. The present study examined populations with African ancestry based on data from over 50,000 African ancestry individuals as well as published data on European ancestry populations. Many new genetic loci linked to height were found in both the African ancestry and the European ancestry data. link to online article

Black women commonly use hair relaxers and leave-in conditioners and oils. Some of these products contain estrogens or estrogen-disrupting compounds, which might contribute to breast cancer risk. We assessed the use of these products in relation to breast cancer in the BWHS. There was no association between conditioner use and breast cancer. For hair relaxers, there was a possible increased risk of breast cancer associated with frequent use of products containing lye, but there was no association of increased risk with non-lye products More research is needed to firmly establish the relationship between hair relaxers and breast cancer. link to online article

Studies of genital powder use and ovarian cancer risk have been conducted in predominantly White populations, although genital powder use has been more common among Black women. Using data from the Ovarian Cancer in Women of African Ancestry consortium, which includes the BWHS, we found genital powder use to be associated with increased risk of ovarian cancer among both Black and White women. link to online article

Two epidemiologic studies have found positive associations between air pollution exposure and uterine leiomyomata (UL) risk, but neither included large numbers of Black women. UL, also known as uterine fibroids, are a type of benign uterine tumor that occurs more commonly among Black women. Using data from the BWHS, we assessed whether three types of air pollution– particulate matter <2.5 microns (PM2.5), nitrogen dioxide (NO2) and ozone (O3) — are associated with risk of UL. PM2.5 and NO2 were not appreciably associated with UL.O3 concentrations were associated with increased UL risk, with a stronger association among women <35 years and parous women. These findings require confirmation. link to online article

Germline pathogenic variants (PV) are inherited genetic mutations. This large study examined the differences in prevalence of 12 breast cancer susceptibility genes in Black women with breast cancer and non-Hispanic White women with breast cancer in the US. There were no differences between the two populations, suggesting that policy regarding genetic testing recommendations does not need to be changed at this time. Efforts should be made to promote equal access to and uptake of genetic testing. link to online article

Polygenic risk scores (PRS) summarize the estimated effect of many genetic variants on an individual’s predisposition for a given trait or medical condition. PRSs have been demonstrated to identify women of European, Asian, and Latino ancestry at elevated risk of developing breast cancer. In a multi-study analysis, the performance of existing PRSs predicted breasted cancer risk among women of African ancestry less well than among other racial/ethnic groups. More work is needed to improve breast cancer risk prediction among Black women. link to online article

Age at menarche (AAM, or age at first period) is associated with health outcomes over the lifetime and varies by race and ethnicity. Most genome-wide association studies (GWAS) that identify loci (locations on genes) linked to AAM have been conducted in European ancestry populations. By conducting a GWAS study on a large population of women with predominantly non-European ancestry, we were able to identify a new AMM locus that is more frequent in African-ancestry participants. These results support the need to study a wide range of ancestries and ethnicities to better identify genetic variants associated with diseases or traits. link to online article

Results on the relationship between consumption of specific dairy products and calcium and risk of breast cancer have been inconclusive. Combining the data of over 1 million women, including 37,861 with breast cancer, associations were evaluated for dairy product and calcium intake with risk of breast cancer overall and estrogen receptor (ER) status subtypes. Adult dairy and calcium consumption was weakly if at all associated with risk of breast cancer overall or breast cancer subtypes. However, higher intake of yogurt and cottage/ricotta cheese was inversely associated with the risk of ER-negative breast cancer. link to online article

Because medical records for endometriosis are both difficult to obtain and not standardized, epidemiologic studies have relied on self-report. Using data from four different cohort studies including the BWHS, we compared questionnaire-reported endometriosis with medical records. For women’s self-report of endometriosis, the overall confirmation rate was > 70%, while the confirmation rate was >94% for self-report of laparoscopic confirmation. Relying on self-report appears to be valid; however, standardization in clinical and surgical data documentation would be needed to obtain the details for subgrouping patients. link to online article

We assessed the relation of early life physical and sexual abuse to several measures of disrupted sleep, including sleep quality and low sleep duration, in the BWHS. Abuse in childhood or teenage years was associated with sleep disruption in adulthood. link to online article

Family history of ovarian cancer and breast cancer are well-established risk factors for ovarian cancer. Based on data from the Ovarian Cancer in Women of African Ancestry Consortium which includes the BWHS, first-degree family history of ovarian cancer was more strongly associated with high-grade serous carcinoma than with other histotypes in Black and White women. The association of second-degree family history of cancer with risk of ovarian cancer may differ by race. link to online article

Using a cross-ancestry genome-wide association study (GWAS) approach, we identified six new gene loci [locations on genes] that are associated with risk of breast cancer overall or of estrogen receptor-negative breast cancer in populations with African or European ancestry. The methods used and the loci identified may contribute to better understanding of the genetics of breast cancer. link to online article

Using data from the Cancer Risk Estimates Related to Susceptibility (CARRIERS) consortium of many breast cancer studies, risks associated with pathogenic variants in known breast cancer-predisposition genes were estimated. Testing for these variants can inform cancer screening and improve clinical strategies. link to online article

Previous research of the relationship between air pollution and breast cancer risk has been predominantly focused on White women. Black women may have higher air pollution exposure due to geographic and residential factors. Using data from the BWHS, we assessed the association between air pollution and breast cancer risk. Overall, there was no association of PM2.5, NO2, or O3 with breast cancer risk. However, there were some associations in specific areas of the U.S. that require confirmation. link to online article

Telomeres are nucleotide strands at the ends of chromosomes. Telomere length gets shorter with age. Prospective studies of the association between depression and telomere length, conducted in primarily European ancestry populations, have had mixed results. We examined telomere length in relation to depression in four race/ethnic population cohorts. We found no statistically significant association in the overall cohort or the specific race/ethnic populations, but did see some evidence of a modifying effect of religiosity or spirituality, religious congregation membership, and group prayer. Further research is needed to explore the potential modifying impact of religion and spirituality in diverse populations. link to online article

Systemic lupus erythematosus (SLE) is an autoimmune disease in which the immune system attacks its own tissues, causing inflammation and tissue damage. It occurs most commonly among women of reproductive age. Using data from the BWHS, we assessed the relationships of reproductive factors to SLE risk. Later age at menarche and longer duration of breastfeeding were both associated with increased risk of SLE. These findings require confirmation in other studies of Black women. link to online article

Causes of racial disparities in the incidence of epithelial ovarian cancer (EOC) are not well-understood, but the prevalence of certain risk factors may explain these disparities. With data from four case-control studies and three case-control studies, including the BWHS, in the Ovarian Cancer in Women of African Ancestry Consortium, we estimated race-specific associations of ten known or suspected EOC risk factors. The selected risk factors accounted for slightly more of the risk among Black women than White women, and interventions focused on modifiable risk factors may be slightly more beneficial to Black women than White women at risk for EOC. link to online article

There are different ways of classifying breast cancers, one of which is the so-called six-marker IHC (ImmunoHistoChemistry) classification. One reason to classify breast cancers is that different types may have different causes, and analyzing risk factors for the different classifications can reveal this. In data from the AMBER consortium, a group of studies that includes the BWHS, breast cancer subtypes had distinct etiologic profiles; that is, different risk factors were associated with different types. In case-control analyses, increased body mass index and waist-to-hip ratio were associated with increased risk of luminal A subtype, while older age at menarche and parity (childbirth) were associated with a reduced risk. For basal-like cancers, parity without breastfeeding and increased waist-to-hip ratio were associated with increased risk, while breastfeeding was associated with reduced risk. link to online article

Full-term pregnancy is associated with reduced risk of endometrial cancer, but it has been unclear whether the effect of additional pregnancies is independent of age at last pregnancy. In data from the Epidemiology of Endometrial Cancer Consortium (E2C2), which includes BWHS data, a full-term pregnancy was associated with greater reduction in risk than an incomplete pregnancy, and each additional pregnancy was associated with further reduction in endometrial cancer risk independent of age at last full-term pregnancy. This suggests the very high progesterone level of the last trimester of pregnancy is not the only explanation for the protective effect. link to online article

Several well-established disparities in cancer incidence and outcomes according to race and ethnicity are reviewed. Although substantial progress has been made in understanding underlying factors, inequities persist. More effort needs to be made to increase diversity in cancer research. Structural racism and barriers to healthcare access need to be eliminated in order to eliminate disparities. link to online article