"There is a disparity in the biological aggressiveness of breast cancer," said Garth H. Rauscher, Ph.D., associate professor of epidemiology at the University of Illinois at Chicago. "We tend to think about biological differences being due to differences in genes, but tumor biology can be affected by social or behavioral factors that are associated with socioeconomic status. Our study highlights the importance of the social environment in influencing tumor biology and ultimately influencing disparities."
Rauscher and colleagues examined data from a population-based sample of 989 patients with a recent diagnosis of breast cancer (397 non-Hispanic whites, 411 non-Hispanic blacks and 181 Hispanics) from the Breast Cancer Care in Chicago Study. Patients were aged 30 to 79 years and had primary in situ or invasive breast cancer. A total of 742 patients consented to medical record abstraction and had medical record data available for estrogen receptor (ER) and progesterone receptor (PR) status.
Researchers established socioeconomic disadvantage using four measurements: individual income, individual education and two census tract measures of socioeconomic status ¡ª concentrated disadvantage and concentrated affluence.
Compared with 12 percent of non-Hispanic white patients, 29 percent of non-Hispanic black patients and 20 percent of Hispanic patients had ER- and PR-negative tumors. Non-Hispanic black and Hispanic patients were also more likely to have lower income and less education and to reside in more disadvantaged and less affluent neighborhoods. In addition, all four measures of socioeconomic disadvantage used in the study were strongly associated with ER/PR-negative status.
"It was interesting to see that the main finding remained unchanged regardless of the measure of socioeconomic status we used," Rauscher said. "Patient levels of income and education, as well as neighborhood-level measures of socioeconomic status, were each associated with tumor biology. In each instance, lower socioeconomic status was associated with more aggressive breast cancers that lacked these hormone receptors."
The study was funded by the National Institutes of Health Centers for Population Health and Health Disparities.
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Socioeconomic disadvantage predicts more aggressive estrogen/progesterone receptor negative breast cancer and mediates racial and ethnic disparities in breast cancer aggressiveness.. Garth H. Rauscher1, Elizabeth L. Wiley2, Richard T. Campbell1. 1Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, 2Department of Pathology, University of Illinois at Chicago, Chicago, IL.Purpose: Racial and ethnic disparities in breast cancer stage at diagnosis are often attributed to social and behavioral factors (e.g., socioeconomic disadvantage, cultural beliefs, health care access and utilization). However, few studies have directly examined their potential role in generating a disparity in the biological aggressiveness of tumors. It is well established that Hispanic and non-Hispanic (nH) Black breast cancer patients are more likely than their non-Hispanic White counterparts to be diagnosed with more aggressive tumors that are negative for estrogen and progesterone receptors (ER/PR negative). Tumor aggressiveness disparities are important because they contribute not only to disparities in stage at diagnosis, but also to disparities in prognosis more generally. We sought to investigate whether the disparity in ER/PR negative disease might be transmitted through the socioeconomic environment.
Conclusions: A substantial portion of the racial/ethnic disparity in breast tumor aggressiveness may be transmitted through social influences that impact the biology of the developing tumor, predisposing disadvantaged groups to more aggressive breast cancer. Socioeconomic disadvantage could lead to higher levels of chronic stress, as well as to differences in dietary or hormonal and reproductive histories, any of which might contribute to disparities in tumor biology.
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