2022

Terminal duct lobular units (TDLUs) are the structures in the breast that are the source of most breast cancers. Previous research has shown that typical TDLU metrics can be elevated in the non-cancerous breast tissue of women diagnosed with triple negative (TN) breast cancer as compared to women with other breast cancer subtypes. BWHS data was used to see if this same pattern of elevated TDLU is seen in Black women, who also are more commonly diagnosed with TN breast cancer. Results within the BWHS were found to be consistent with those from prior studies of White and Asian women. link to online article

In the US, the incidence of endometrial cancer is increasing fastest among Black women compared to other racial/ethnic groups. In addition, mortality from endometrial cancer among Black women in the US is almost double that of White women. However, few studies have examined risk factors for this cancer in Black women. We found that the risk associated with two established risk factors, menopausal hormone use and severe obesity, were similar to those observed in studies of White women. Our results suggest that associations of two established risk factors for endometrial cancer are similar in Black and White women. link to online article

Obesity is associated with an increased risk of ovarian cancer, but there is some evidence that the association may differ by race. Using data from the OCWAA Consortium, a group of studies which includes the BWHS, body mass index was assessed in relation to risk of invasive epithelial ovarian cancer (EOC). Results showed a strong association between obesity and risk for non-high-grade serous epithelial ovarian cancer (NHGS EOC) among both Black and White women, but risk across racial groups differed by use of hormone therapy and histotype. link to online article

Black women are at higher risk of lung cancer and lung cancer-related mortality than White women despite having a lower smoking prevalence than White women. Using data from the Black Women’s Health Study, we examined physical activity, including vigorous exercise and walking, in relation to lung cancer risk. Women who engaged in vigorous physical activity for more than one hour each week or were in the highest category of energy expenditure from physical activity had a decreased risk of lung cancer. The reduction was present even among smokers. link to online article

Dental fear and anxiety may cause patients to delay or avoid dental care. However, little is known about dental fear and anxiety among racial and ethnic minority populations, who bear a disproportionate burden of poor oral health. Based on data from 484 BWHS participants from the Greater Boston area, we assessed associations between high dental anxiety, poor oral health outcomes, and experiences of perceived racism. Higher levels of reported exposures to racism were associated with higher dental anxiety, which was in turn associated with poorer oral health outcomes. link to online article

Epidemiologic studies suggest that drinking coffee may be associated with a reduced risk of endometrial cancer, possibly due to antioxidants and other chemopreventive compounds found in coffee. Using data from the Epidemiology of Endometrial Cancer Consortium of 19 studies which includes the BWHS, we examined the association between coffee consumption and endometrial cancer risk while also evaluating how other known risk factors for endometrial cancer might modify this effect. Coffee drinking was associated with a reduced risk of endometrial cancer with a stronger association in participants with a higher body mass index. link to online article

Compared to women of other races who never smoked, Black female who never smoked are at greater risk for lung cancer, and the reasons are not well understood. Using data from the Black Women’s Health Study, we found that neighborhood concentrated disadvantage as well as exposure to secondhand smoke at work were associated with an increased risk of lung cancer among Black women who had never smoked. Further research is necessary to identify and understand the factors responsible for the association with neighborhood. link to online article

Characteristics of a woman’s menstrual cycle, such as age at first period and cycle length, are associated with ovarian cancer risk in White women but have not been well-studied in Black women. Using data from the Ovarian Cancer in Women of African Ancestry Consortium, which includes the Black Women’s Health Study, young age at first period (<11) and irregular cycle length were associated with increased epithelial ovarian cancer for White women but not for Black women. link to online article

Black Americans are twice as likely as non-Hispanic White Americans to be diagnosed with multiple myeloma (MM), and the incidence in both groups has increased in recent years. Monoclonal gammopathy of unknown significance (MGUS) is an asymptomatic precursor condition that occurs in virtually all MM cases. Rates of progression from MGUS to MM do not differ by race; the disparity in incidence of MM by race appears to result from disparity in the incidence of MGUS. The best estimates of the prevalence of MGUS in Black individuals ages 50 and older are based on blood samples collected between 1988-2004. Using International Myeloma Working Group diagnostic criteria and blood samples collected during 2014-2018 from participants in the Black Women’s Health Study, we identified MGUS cases and calculated an age-adjusted prevalence of 9.0%, which is higher than the estimates of prevalence previously reported for Black populations. link to online article

Commonly used polygenic risk scores (PRSs), which are used to predict breast cancer risk, have relatively low prediction accuracy for women of African ancestry. To improve prediction of breast cancer risk in this population, data from five GWAS (genome-wide association studies) in which women of African ancestry are well-represented was used to create new PRSs. The proposed PRSs were better able to predict overall risk of breast cancer and of estrogen receptor (ER) negative and ER-positive breast cancer for women of African ancestry than existing methods. link to online article

Black women have poorer survival from epithelial ovarian cancer than white women. In the Ovarian Cancer in Women of African Ancestry (OCWAA) consortium of seven U.S. studies, we found that college education, nulliparity, smoking status, body mass index, diabetes, postmenopausal female hormone use, histotype, and stage of ovarian cancer accounted for 48.8% of the disparity, with histotype/stage and postmenopausal female hormone use being most important. The findings suggest that several potentially modifiable factors play a role in the Black/White survival disparity, though further research is needed to identify additional mediators and avenues of intervention. link to online article

Risk of colorectal cancer has known associations with common genetic variants, but these associations explain less than half of its heritability. Nondrinking and heavy consumption of alcohol are both associated with a higher risk of colorectal cancer. Using data from the Colon Cancer Family Registry, Colorectal Transdisciplinary Study, and Genetics and Epidemiology of Colorectal Cancer Consortium, we compared nondrinkers and heavy drinkers with light-to-moderate drinkers in Genotype by Environment (GxE) analyses to search for evidence of interaction between alcohol consumption and genetic variants. Our findings suggest that the previously observed association between colorectal cancer and one of the genetic variants is strongest in nondrinkers. Our study also identified a second variant as the putative causal regulatory variant for the region. link to online article

Twelve genes predisposing to breast cancer have been identified in studies conducted primarily among women with European ancestry, but the roles of these genes have been less well-investigated among women of African ancestry. We conducted a case-control study in African American women to estimate the associations of these genes with breast cancer risk. The study confirmed previously identified genes associated with breast cancer risk (BRCA1, BRCA2, PALB2, ATM, TP53, NF1, and CHEK2) and also provided new evidence to associate risk in Black women with genes RAD51C and RAD51D. link to online article

Black women are at high risk for insomnia disorder, but there has been limited research to investigate the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in treating insomnia in this population. Participants in the BWHS who had been identified as experiencing elevated insomnia symptoms were recruited to participate in a randomized clinical trial to compare the efficacy of a standard version of an internet-delivered CBT-I program (SHUTi), a culturally tailored version (SHUTi-BWHS), and a patient education control program (PE) at improving insomnia symptoms. Findings show that both SHUTi and SHUTi-BWHS decreased insomnia severity and improved sleep outcomes more than PE, and that a higher proportion of SHUTi-BWHS than of SHUTi participants completed the full program, suggesting that the modified program was more effective at keeping participants engaged. Those who completed the program had the greatest improvements in their sleep. link to online article

Black women have a higher risk of developing hypertensive diseases of pregnancy (HDOP) such as preeclampsia and gestational hypertension, and a higher incidence of aggressive breast cancer subtypes. We followed 42,982 parous women in the Black Women’s Health Study to examine the relation of self-reported HDOP to breast cancer incidence overall and by estrogen receptor (ER) status. There was no association between a history of HDOP and breast cancer risk overall. A suggestive inverse association with ER- breast cancer may reflect an anti-tumorigenic hormone profile in HDOP, but this association requires confirmation in other studies. link to online article

Despite a lower smoking prevalence, Black women experience higher lung cancer incidence and mortality than White women. Because physical activity has effects on immune and inflammatory systems and sex hormones and metabolism that might reduce risk, we examined vigorous exercise, walking for exercise, and sitting watching television in relation to lung cancer risk in the BWHS. Based on data among 38,432 participants, there was some evidence of a reduced risk of lung cancer for participants who exercised vigorously and an increased risk for those who sat and watched television. Results from previous studies have been inconsistent. Future research is needed to more clearly establish the effect of exercise on lung cancer risk and understand the biologic mechanisms involved. link to online article

Screening mammography and magnetic resonance imaging (MRI) are recommended for women with ATM, CHEK2, and PALB2 pathogenic variants, but there is little data to guide screening regimens for these women. Using two established breast cancer microsimulation models from the Cancer Intervention and Surveillance Modeling Network (CISNET), benefits and harms of breast cancer screening strategies involving mammography and MRI at various start ages were compared. Results suggest that annual MRI screening starting at age 30 to 35 followed by annual MRI and mammography at age 40 may reduce breast cancer mortality by more than 50% for women with pathogenic variants. Results also suggest that if a patient is already receiving annual MRI screening, there may be little benefit to mammography prior to age 40. link to online article

Black Women and Public Health discusses issues of race, gender, and health. Grounded in the lived experiences and expertise of Black women, this collection bridges gaps between researchers, practitioners, educators, and advocates. The three dozen authors offer analysis, critique, and recommendations for overcoming longstanding and contemporary challenges to equity in public health practices. link to book

In the U.S., obesity, type 2 diabetes, and low birth weight are all more prevalent among Black women than White women, and the reasons why are not well understood. Using data from the Black Women’s Health Study, we conducted admixture mapping of body mass index (BMI) at age 18, adult BMI, and adult waist circumference, and waist-to-hip ratio adjusted for BMI. We searched for evidence of shared African genetic ancestry components among the four anthropometric traits and among birth weight and type 2 diabetes. Findings show that global percent African ancestry was associated with higher adult BMI, and shared ancestry analysis identified local African ancestry regions associated with multiple traits. Findings for one genomic region are consistent with the fetal insulin hypothesis, which suggests that low birth weight and type 2 diabetes have a common genetic basis. Further research is needed to identify the actual genetic variants responsible for the clustering of these conditions in African Americans. link to online article

Black Americans are at higher risk from colorectal cancer (CRC) than any other racial/ethnic group in the United States. Consumption of red and processed meats is associated with an increased risk of CRC in White populations, but three prior studies in Black populations reported no association. Using data from the Black Women’s Health Study, we assessed intakes of processed and unprocessed red meat, saturated fatty acids (SFAs) and monounsaturated fatty acids (MUFAs) in relation to CRC risk. Results show that unprocessed red meat intake was associated with a 2-fold increase in CRC risk. These findings are the first positive evidence that red meat plays a role in the etiology of CRC in Black women, and they also suggest opportunities for prevention. link to online article

Recent reports indicate that the prevalence of sarcoidosis is rising and mortality in chronic sarcoidosis patients is increasing. There is a need for clinicians to have a working knowledge of the clinical manifestations and multi-system involvement of sarcoidosis. This Monograph provides a comprehensive overview of sarcoidosis, including history, epidemiology and pathobiology, specific organ manifestations, traditional and innovative treatment strategies, and patient quality-of-life assessment. link to monograph

The Ovarian Cancer Cohort Consortium (OC3), an international collaboration that includes deidentified data from 21 cohort studies, enables research on risk factors, biomarkers, outcomes and risk prediction of ovarian cancer and its subtypes. With data on a wide variety of exposure and outcomes from 1.3 million women, the consortium is a powerful tool for advancing knowledge. The BWHS is included in this Consortium. link to online article

Black Americans have the highest incidence of pancreatic cancer of any racial/ethnic group in the US. The oral microbiome has been associated with increased risk of pancreatic cancer in a recent study. In a study that included BWHS participants in which we assessed the oral microbiome to risk of pancreatic cancer, there was no association between the microbiome and risk. link to online article

Excess weight is a known risk factor for postmenopausal breast cancer. We evaluated maximum body mass index (BMI, a weight-for-height measurement) and BMI at several timepoints prior to breast cancer diagnosis to evaluate whether the increased risk was related to excess weight (BMI ≥ 35) at a particular point in time. Maximum BMI and time-dependent BMI ≥ 35 were both strongly associated with postmenopausal ER+ breast cancer risk, suggesting that risk is increased regardless of timing. link to online article

The Insomnia Severity Index (ISI) is a commonly used tool to identify sleep disruption. However, its validity has not been tested in Black women and there has been little testing in cancer survivors. The ISI was included on the BWHS health questionnaire in 2015. Based on the data of 29,500 BWHS participants who completed the ISI, we found that internal consistency reliability was high in participants with and without a history of cancer. We found a one-factor model had the best fit to the data but the model was not robust. Assessment in other large studies is needed. link to online article