Publications by authors named "Lynn Rosenberg"

254 Publications

First- and second-degree family history of ovarian and breast cancer in relation to risk of invasive ovarian cancer in African American and white women.

Int J Cancer 2021 Jan 31. Epub 2021 Jan 31.

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

Family history (FH) of ovarian cancer and breast cancer are well-established risk factors for ovarian cancer, but few studies have examined this association in African American (AA) and white women by histotype. We assessed first- and second-degree FH of ovarian and breast cancer and risk of epithelial ovarian cancer in the Ovarian Cancer in Women of African Ancestry Consortium. Analyses included 1052 AA cases, 2328 AA controls, 2380 white cases and 3982 white controls. Race-specific odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multilevel logistic regression with adjustment for covariates. Analyses were stratified by histotype (high-grade serous vs others). First-degree FH of ovarian cancer was associated with high-grade serous carcinoma in AA (OR = 2.32, 95% CI: 1.50, 3.59) and white women (OR = 2.48, 95% CI: 1.82, 3.38). First-degree FH of breast cancer increased risk irrespective of histotype in AAs, but with high-grade serous carcinoma only in white women. Associations with second-degree FH of ovarian cancer were observed for overall ovarian cancer in white women and with high-grade serous carcinoma in both groups. First-degree FH of ovarian cancer and of breast cancer, and second-degree FH of ovarian cancer is strongly associated with high-grade serous ovarian carcinoma in AA and white women. The association of FH of breast cancer with high-grade serous ovarian carcinoma is similar in white women and AA women, but may differ for other histotypes.
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http://dx.doi.org/10.1002/ijc.33493DOI Listing
January 2021

A Population-Based Study of Genes Previously Implicated in Breast Cancer.

N Engl J Med 2021 02 20;384(5):440-451. Epub 2021 Jan 20.

From Mayo Clinic, Rochester, MN (C. Hu, S.N.H., R.G., K.Y.L., J.N., J.L., S. Yadav, N.J.B., T.L., J.E.O., C.S., C.M.V., E.C.P., F.J.C.); Harvard University T.H. Chan School of Public Health (H.H., C.G., D.J.H., P.K.), Slone Epidemiology Center at Boston University (K.A.B., J.R.P., L.R.), and Brigham and Women's Hospital (H.E.) - all in Boston; Qiagen, Hilden, Germany (R.S., J.K.); Roswell Park Comprehensive Cancer Center, Buffalo (C.B.A., S. Yao), and Weill Cornell Medicine, New York (R.T.) - both in New York; the University of California, Irvine (H.A.-C., A.Z.), Beckman Research Institute of City of Hope, Duarte (L.B., H.M., S.N., J.N.W.), Keck School of Medicine, University of Southern California, Los Angeles (C. Haiman), and Stanford University School of Medicine, Stanford (E.M.J., A.W.K.) - all in California; the University of Wisconsin-Milwaukee Joseph J. Zilber School of Public Health, Milwaukee (P.A.), and the University of Wisconsin-Madison, Madison (E.S.B., I.M.O., A.T.-D.); the Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, State University of New Jersey, New Brunswick (E.V.B.); the Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta (B.D.C., S.M.G., M.G., J.M.H., E.J.J., A.V.P.); the University of Oxford, Oxford, United Kingdom (D.J.H.); the Fred Hutchinson Cancer Research Center (C.K., P.A.N.) and the Department of Epidemiology, University of Washington (S.L.) - both in Seattle; the Epidemiology Program, University of Hawaii Cancer Center, Honolulu (L.L.M.); the National Institute of Environmental Health Sciences, Durham, NC (K.M.O., D.P.S., J.A.T., C.W.); Vanderbilt University, Nashville (T.P., S.R.); the University of Utah, Salt Lake City (D.E.G.); and the Department of Medicine and the Basser Center for BRCA, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (S.M.D., K.L.N.).

Background: Population-based estimates of the risk of breast cancer associated with germline pathogenic variants in cancer-predisposition genes are critically needed for risk assessment and management in women with inherited pathogenic variants.

Methods: In a population-based case-control study, we performed sequencing using a custom multigene amplicon-based panel to identify germline pathogenic variants in 28 cancer-predisposition genes among 32,247 women with breast cancer (case patients) and 32,544 unaffected women (controls) from population-based studies in the Cancer Risk Estimates Related to Susceptibility (CARRIERS) consortium. Associations between pathogenic variants in each gene and the risk of breast cancer were assessed.

Results: Pathogenic variants in 12 established breast cancer-predisposition genes were detected in 5.03% of case patients and in 1.63% of controls. Pathogenic variants in and were associated with a high risk of breast cancer, with odds ratios of 7.62 (95% confidence interval [CI], 5.33 to 11.27) and 5.23 (95% CI, 4.09 to 6.77), respectively. Pathogenic variants in were associated with a moderate risk (odds ratio, 3.83; 95% CI, 2.68 to 5.63). Pathogenic variants in , , and were associated with increased risks of estrogen receptor-negative breast cancer and triple-negative breast cancer, whereas pathogenic variants in , , and were associated with an increased risk of estrogen receptor-positive breast cancer. Pathogenic variants in 16 candidate breast cancer-predisposition genes, including the c.657_661del5 founder pathogenic variant in , were not associated with an increased risk of breast cancer.

Conclusions: This study provides estimates of the prevalence and risk of breast cancer associated with pathogenic variants in known breast cancer-predisposition genes in the U.S. population. These estimates can inform cancer testing and screening and improve clinical management strategies for women in the general population with inherited pathogenic variants in these genes. (Funded by the National Institutes of Health and the Breast Cancer Research Foundation.).
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http://dx.doi.org/10.1056/NEJMoa2005936DOI Listing
February 2021

Racial differences in population attributable risk for epithelial ovarian cancer in the OCWAA Consortium.

J Natl Cancer Inst 2020 Nov 30. Epub 2020 Nov 30.

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

Background: The causes of racial disparities in epithelial ovarian cancer (EOC) incidence remain unclear. Differences in the prevalence of ovarian cancer risk factors may explain disparities in EOC incidence among African American (AA) and White women.

Methods: We used data from four case-control studies and three case-control studies nested within prospective cohorts in the Ovarian Cancer in Women of African Ancestry Consortium to estimate race-specific associations of ten known or suspected EOC risk factors using logistic regression. Using the Bruzzi method, race-specific population attributable risks (PAR) were estimated for each risk factor individually and collectively, including groupings of exposures (reproductive factors and modifiable factors). All statistical tests were two-sided.

Results: Among 3,244 White EOC cases and 9,638 controls and 1,052 AA EOC cases and 2,410 controls, AA women had a statistically significantly higher PAR (false discovery rate (FDR) P < .001) for first-degree family history of breast cancer (PAR = 10.1%, 95% CI = 6.5% to 13.7%) compared to White women (PAR = 2.6%, 95% CI = 0.8% to 4.4%). After multiple test correction, AA women had a higher PAR than White women when evaluating all risk factors collectively (PAR = 61.6%, 95% CI = 48.6% to 71.3% vs. PAR = 43.0%, 95% CI = 32.8% to 51.4%, respectively; FDR P = .06) and for modifiable exposures, including BMI, oral contraceptives, aspirin, and body powder (PAR = 36.0%, 95% CI = 21.0% to 48.8% vs. PAR = 13.8%, 95% CI = 4.5% to 21.8%, respectively; FDR P = .04).

Conclusions: Collectively, the selected risk factors accounted for slightly more of the risk among AA than White women, and interventions to reduce EOC incidence that are focused on multiple modifiable risk factors may be slightly more beneficial to AA women than White women at risk for EOC.
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http://dx.doi.org/10.1093/jnci/djaa188DOI Listing
November 2020

A prospective study of reproductive factors in relation to risk of systemic lupus erythematosus among black women.

Lupus 2021 Feb 24;30(2):204-210. Epub 2020 Nov 24.

Slone Epidemiology Center, Boston University, Boston, MA, USA.

Objective: Systemic lupus erythematosus (SLE) occurs most commonly among reproductive age women, compatible with a potential role of reproductive factors, although past studies including women of mainly European ancestry have yielded conflicting results. We assessed relationships of reproductive factors to SLE risk among black women.

Methods: We followed 58,243 participants in the Black Women's Health Study (BWHS) from 1995 - 2015 using biennial health questionnaires, on which participants reported reproductive and other factors. Self-reported incident SLE cases were confirmed as meeting 1997 American College of Rheumatology SLE classification criteria by medical record review. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for SLE for several reproductive factors, controlling for potential confounders.

Results: During 954,476 person-years of follow-up, 125 incident cases of SLE were confirmed. Later age at menarche and longer duration of breast feeding were associated with increased risk of SLE. The multivariable HRs were 2.31 (95% CI, 1.30-4.11) for age at menarche ≥15 relative to age 12, and 1.73 (95% CI, 1.01-2.94) for breast feeding ≥6 months relative to none. There were no clear associations with parity, age at first birth, menopausal status, hysterectomy, age at menopause, or history of endometriosis.

Conclusion: Our results suggest that later menarchal age and breastfeeding of infants for ≥6 months vs. none may be associated with increased SLE risk among black women, while other reproductive factors did not appear related. The biological mechanisms underlying these potential associations should be pursued.
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http://dx.doi.org/10.1177/0961203320973074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854483PMC
February 2021

High Consumption of Red Meat Is Associated with Excess Mortality Among African-American Women.

J Nutr 2020 12;150(12):3249-3258

Slone Epidemiology Center, Boston University School of Medicine , Boston, MA, USA.

Background: Red meat is a rich source of nutrients but is typically high in saturated fats. Carcinogenic chemicals can be formed during cooking and processing. Little is known about the relation of red meat consumption to mortality in African Americans (AAs), a group with excess mortality and high consumption of red meat relative to whites.

Objective: Our objective was to assess the association between red meat consumption and mortality in AA women.

Methods: The Black Women's Health Study (BWHS) is a prospective cohort study of AA women across the USA who completed health questionnaires at enrollment in 1995 (median age 38 y, median BMI 27.9 kg/m2) and every 2 y thereafter. The analyses included 56,314 women who completed a validated FFQ and were free of cardiovascular disease and cancer at baseline in 1995. Exposures were total red meat, processed red meat, and unprocessed red meat consumption. Outcomes were all-cause and cause-specific mortality. Cox proportional hazards models with control for age, socioeconomic status, lifestyle factors, medical history, and dietary factors were used to estimate HRs with 95% CIs.

Results: During 22 y of follow-up through to 2017, we identified 5054 deaths, which included 1354 cardiovascular deaths and 1801 cancer deaths. The HR for all-cause mortality was 1.47 (95% CI: 1.33, 1.62) for the highest quintile of total red meat consumption relative to the lowest. Each 1 serving/d increase in red meat consumption was associated with a 7% (95% CI: 5%, 9%) increased risk of all-cause mortality. Red meat consumption was also associated with increased cardiovascular mortality, but not with cancer mortality. Results were similar for the consumption of processed and unprocessed red meat.

Conclusions: Red meat consumption is associated with increased all-cause and cardiovascular mortality among AA women.
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http://dx.doi.org/10.1093/jn/nxaa282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726124PMC
December 2020

Leisure Time Physical Activity in Relation to Mortality Among African American Women.

Am J Prev Med 2020 11 2;59(5):704-713. Epub 2020 Sep 2.

Slone Epidemiology Center, Boston University, Boston, Massachusetts.

Introduction: African American women have a life expectancy 2.7 years shorter than that of white women and are less likely than white women to meet national physical activity guidelines. Physical activity has been found to reduce mortality, but evidence concerning African American women is limited.

Methods: In the Black Women's Health Study, a prospective cohort study of African American women begun in 1995, a total of 52,993 participants who were free of cardiovascular disease and cancer at enrollment were followed through 2017. Cox proportional hazards models evaluated the associations of repeated measures of physical activity with mortality, adjusting for demographic, medical, and lifestyle factors. Statistical analyses were last performed in September 2019.

Results: During the 22 years of follow-up, 4,719 deaths occurred. Higher levels of physical activity were associated with reduced all-cause, cardiovascular disease, and cancer mortality. Hazard ratios for walking ≥5 hours per week relative to no walking were 0.69 (95% CI=0.62, 0.77), 0.71 (95% CI=0.57, 0.87), and 0.80 (95% CI=0.67, 0.96) for all-cause, cardiovascular disease, and cancer mortality, respectively. The comparable hazard ratios for vigorous exercise for ≥5 hours per week vs none were 0.58 (95% CI=0.50, 0.67), 0.66 (95% CI=0.50, 0.87), and 0.52 (95% CI=0.39, 0.72).

Conclusions: Both walking for exercise and vigorous exercise were associated with reductions in mortality among African American women, including deaths from cardiovascular disease and deaths from cancer, both of which are disproportionately high in the African American population. These findings underline the importance of institutional and individual changes that will lead to increased physical activity.
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http://dx.doi.org/10.1016/j.amepre.2020.05.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577941PMC
November 2020

Aspirin use and risk of breast cancer in African American women.

Breast Cancer Res 2020 09 4;22(1):96. Epub 2020 Sep 4.

Slone Epidemiology Center at Boston University, 72 East Concord Street, L-7, Boston, MA, 02118, USA.

Background: Use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) has been hypothesized to be associated with reduced risk of breast cancer; however, results of epidemiological studies have been mixed. Few studies have investigated these associations among African American women.

Methods: To assess the relation of aspirin use to risk of breast cancer in African American women, we conducted a prospective analysis within the Black Women's Health Study, an ongoing nationwide cohort study of 59,000 African American women. On baseline and follow-up questionnaires, women reported regular use of aspirin (defined as use at least 3 days per week) and years of use. During follow-up from 1995 through 2017, 1919 invasive breast cancers occurred, including 1112 ER+, 569 ER-, and 284 triple-negative (TN) tumors. We used age-stratified Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of aspirin use with risk of ER+, ER-, and TN breast cancer, adjusted for established breast cancer risk factors.

Results: Overall, the HR for current regular use of aspirin relative to non-use was 0.92 (95% CI 0.81, 1.04). For ER+, ER-, and TN breast cancer, corresponding HRs were 0.98 (0.84, 1.15), 0.81 (0.64, 1.04), and 0.70 (0.49, 0.99), respectively.

Conclusions: Our findings with regard to ER- and TN breast cancer are consistent with hypothesized inflammatory mechanisms of ER- and TN breast cancer, rather than hormone-dependent pathways. Aspirin may represent a potential opportunity for chemoprevention of ER- and TN breast cancer.
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http://dx.doi.org/10.1186/s13058-020-01335-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7650295PMC
September 2020

Experiences of racism and subjective cognitive function in African American women.

Alzheimers Dement (Amst) 2020 21;12(1):e12067. Epub 2020 Jul 21.

Slone Epidemiology Center at Boston University Boston Massachusetts USA.

Introduction: We hypothesized that frequent experiences of racism among African American women would adversely affect subjective cognitive function (SCF), based on the established association of psychological stress with memory decline.

Methods: We used multinomial logistic regression to quantify the association between experiences of racism and SCF, based on six questions, among 17,320 participants in the prospective Black Women's Health Study.

Results: The multivariable odds ratio (OR, 95% confidence interval [CI]) for poor compared to good SCF among women at the highest versus the lowest level of daily racism (eg, poorer service in stores) was 2.75 (2.34 to 3.23); for the same comparison among women at the highest level of institutional racism (eg, discriminated against in housing) relative to the lowest, the OR was 2.66 (2.24 to 3.15). The associations were mediated, in part, by depression and insomnia.

Discussion: Experiences of racism, a highly prevalent psychosocial stressor among African Americans, were associated with lower SCF.
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http://dx.doi.org/10.1002/dad2.12067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409101PMC
July 2020

A Prospective Analysis of Intake of Red and Processed Meat in Relation to Pancreatic Cancer among African American Women.

Cancer Epidemiol Biomarkers Prev 2020 Sep 1;29(9):1775-1783. Epub 2020 Jul 1.

Slone Epidemiology Center at Boston University, Boston, Massachusetts.

Background: African Americans have the highest incidence of pancreatic cancer of any racial/ethnic group in the United States. There is evidence that consumption of red or processed meat and foods containing saturated fats may increase the risk of pancreatic cancer, but there is limited evidence in African Americans.

Methods: Utilizing the Black Women's Health Study (1995-2018), we prospectively investigated the associations of red and processed meat and saturated fats with incidence of pancreatic adenocarcinoma ( = 168). A food frequency questionnaire was completed by 52,706 participants in 1995 and 2001. Multivariable-adjusted HRs and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression. We observed interactions with age ( = 0.01). Thus, results were stratified at age 50 (<50, ≥50).

Results: Based on 148 cases among women aged ≥50 years, total red meat intake was associated with a 65% increased pancreatic cancer risk (HR = 1.65; 95% CI, 0.98-2.78; = 0.05), primarily due to unprocessed red meat. There was also a nonsignificant association between total saturated fat and pancreatic cancer (HR = 1.85; 95% CI, 0.92-3.72; = 0.08). Red meat and saturated fat intakes were not associated with pancreatic cancer risk in younger women, and there was no association with processed meat in either age group.

Conclusions: Red meat-specifically, unprocessed red meat-and saturated fat intakes were associated with an increased risk of pancreatic cancer in African-American women aged 50 and older, but not among younger women.

Impact: The accumulating evidence-including now in African-American women-suggests that diet, a modifiable factor, plays a role in the etiology of pancreatic cancer, suggesting opportunities for prevention.
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http://dx.doi.org/10.1158/1055-9965.EPI-20-0048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484450PMC
September 2020

Night Shift Work and Fecundability in Late Reproductive-Aged African American Women.

J Womens Health (Larchmt) 2021 Jan 29;30(1):137-144. Epub 2020 Jun 29.

Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.

We estimated the association between night shift work and fecundability among African American women. Black Women's Health Study participants ( = 560) aged 30-45 years reported their history of night shift work in 2005. Time to pregnancy for all pregnancies resulting in a livebirth was reported in 2011. We estimated the fecundability ratio (FR) and 95% confidence interval (CI) using proportional probabilities regression, accounting for multiple observations of individual women using generalized estimating equations. We observed 4,417 months of pregnancy attempt time resulting in 390 births. After adjustment for covariates, women who reported ever working night shifts had 20% lower fecundability compared with those who never reported night shift work (FR = 0.80, 95% CI: 0.59-1.04). The FR for women reporting night shift work with a frequency of ≥1 time per month and a duration of ≥2 years was 0.65 (95% CI: 0.47-0.94) relative to women reporting no shift work. We observed a decrease in fecundability associated with ever working night shifts (FR = 0.74, 95% CI: 0.56-0.96) among women aged ≥35 years, but not among younger women (FR = 1.33, 95% CI: 0.78-2.28). A history of working night shifts was associated with reduced fecundability among older reproductive-aged African American women attempting pregnancy.
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http://dx.doi.org/10.1089/jwh.2019.8166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826436PMC
January 2021

A prospective study of yogurt and other dairy consumption in relation to incidence of type 2 diabetes among black women in the USA.

Am J Clin Nutr 2020 09;112(3):512-518

Slone Epidemiology Center at Boston University, Boston, MA, USA.

Background: Yogurt consumption and low-fat dairy consumption have been associated with reduced incidence of type 2 diabetes (T2D) in some studies.

Objective: We assessed the relation of yogurt and other dairy consumption to incidence of T2D in black women, a population group with a disproportionately high incidence of T2D.

Methods: The Black Women's Health Study has followed 59,000 US black women since 1995 through biennial questionnaires which update health information. Each questionnaire inquired about doctor-diagnosed diabetes in the previous 2 y. FFQs completed by participants in 1995 and 2001 provided information on yogurt and other dietary intake. HRs with 95% CIs for yogurt (nonfrozen or frozen) and other dairy consumption in relation to incident T2D (n = 8061 cases) were estimated with Cox proportional hazards regression, controlling for risk factors for T2D.

Results: The HR for consumption of ≥1 serving of yogurt/d relative to <1 serving/mo was 0.99 (95% CI: 0.87, 1.13, P trend = 0.65) after control for dietary and nondietary risk factors for T2D. The multivariable HR was 0.97 (95% CI: 0.75, 1.27; P trend = 0.74) for 2 or more servings/d of low-fat dairy other than yogurt relative to <1 serving/mo and 1.06 (95% CI: 0.91, 1.25, P trend = 0.36) for 2 or more servings/d of regular dairy relative to <1 serving/mo.

Conclusion: Results from this study do not support an inverse association of yogurt consumption or other dairy consumption with T2D risk in black women.
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http://dx.doi.org/10.1093/ajcn/nqaa143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458770PMC
September 2020

Exogenous hormone use, reproductive factors and risk of intrahepatic cholangiocarcinoma among women: results from cohort studies in the Liver Cancer Pooling Project and the UK Biobank.

Br J Cancer 2020 07 7;123(2):316-324. Epub 2020 May 7.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.

Background: Intrahepatic cholangiocarcinoma (ICC) arises from cholangiocytes in the intrahepatic bile duct and is the second most common type of liver cancer. Cholangiocytes express both oestrogen receptor-α and -β, and oestrogens positively modulate cholangiocyte proliferation. Studies in women and men have reported higher circulating oestradiol is associated with increased ICC risk, further supporting a hormonal aetiology. However, no observational studies have examined the associations between exogenous hormone use and reproductive factors, as proxies of endogenous hormone levels, and risk of ICC.

Methods: We harmonised data from 1,107,498 women who enroled in 12 North American-based cohort studies (in the Liver Cancer Pooling Project, LCPP) and the UK Biobank between 1980-1998 and 2006-2010, respectively. Cox proportional hazards regression models were used to generate hazard ratios (HR) and 95% confidence internals (CI). Then, meta-analytic techniques were used to combine the estimates from the LCPP (n = 180 cases) and the UK Biobank (n = 57 cases).

Results: Hysterectomy was associated with a doubling of ICC risk (HR = 1.98, 95% CI: 1.27-3.09), compared to women aged 50-54 at natural menopause. Long-term oral contraceptive use (9+ years) was associated with a 62% increased ICC risk (HR = 1.62, 95% CI: 1.03-2.55). There was no association between ICC risk and other exogenous hormone use or reproductive factors.

Conclusions: This study suggests that hysterectomy and long-term oral contraceptive use may be associated with an increased ICC risk.
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http://dx.doi.org/10.1038/s41416-020-0835-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374167PMC
July 2020

The COronavirus Pandemic Epidemiology (COPE) Consortium: A Call to Action.

Cancer Epidemiol Biomarkers Prev 2020 07 5;29(7):1283-1289. Epub 2020 May 5.

Zoe Global Limited, London, United Kingdom.

The rapid pace of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) pandemic presents challenges to the real-time collection of population-scale data to inform near-term public health needs as well as future investigations. We established the COronavirus Pandemic Epidemiology (COPE) consortium to address this unprecedented crisis on behalf of the epidemiology research community. As a central component of this initiative, we have developed a COVID Symptom Study (previously known as the COVID Symptom Tracker) mobile application as a common data collection tool for epidemiologic cohort studies with active study participants. This mobile application collects information on risk factors, daily symptoms, and outcomes through a user-friendly interface that minimizes participant burden. Combined with our efforts within the general population, data collected from nearly 3 million participants in the United States and United Kingdom are being used to address critical needs in the emergency response, including identifying potential hot spots of disease and clinically actionable risk factors. The linkage of symptom data collected in the app with information and biospecimens already collected in epidemiology cohorts will position us to address key questions related to diet, lifestyle, environmental, and socioeconomic factors on susceptibility to COVID-19, clinical outcomes related to infection, and long-term physical, mental health, and financial sequalae. We call upon additional epidemiology cohorts to join this collective effort to strengthen our impact on the current health crisis and generate a new model for a collaborative and nimble research infrastructure that will lead to more rapid translation of our work for the betterment of public health.
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http://dx.doi.org/10.1158/1055-9965.EPI-20-0606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357669PMC
July 2020

Gestational Diabetes and Risk of Breast Cancer in African American Women.

Cancer Epidemiol Biomarkers Prev 2020 07 21;29(7):1509-1511. Epub 2020 Apr 21.

Slone Epidemiology Center at Boston University, Boston, Massachusetts.

Background: Gestational diabetes mellitus (GDM) has been hypothesized to increase breast cancer risk, but results from the few prior epidemiologic studies are conflicting, and no studies have examined the association in African American women.

Methods: We analyzed data from the prospective Black Women's Health Study to evaluate associations of history of GDM with breast cancer risk among 41,767 parous African American women, adjusting for potential confounders. HRs and 95% confidence intervals (CI) were estimated from multivariable Cox proportional hazards regression models.

Results: There was no evidence of an association between history of GDM and risk of invasive breast cancer, overall or by estrogen receptor status.

Conclusions: Results of this study do not support the hypothesis that GDM is an important risk factor for breast cancer in African American women overall.

Impact: On the basis of these data, breast cancer risk is not increased among African American women with a history of GDM compared with parous women without a history of GDM.
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http://dx.doi.org/10.1158/1055-9965.EPI-20-0034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7334052PMC
July 2020

Association of Child Abuse with Systemic Lupus Erythematosus in Black Women During Adulthood.

Arthritis Care Res (Hoboken) 2020 Mar 13. Epub 2020 Mar 13.

Slone Epidemiology Center, Boston University, Boston, MA, United States.

Objective: Exposure to psychosocial stressors may contribute to the onset of systemic lupus erythematosus (SLE) through dysregulation of the adaptive stress response. We assessed the relationship of childhood physical and sexual abuse to SLE risk among Black women.

Methods: Using data from the Black Women's Health Study, we followed 36,152 women from 1995 through 2015 with biennial questionnaires. Women reported on exposure to abuse during childhood (up to age 11) in 2005. Self-reported incident SLE cases were confirmed as meeting American College of Rheumatology SLE classification criteria by medical record review. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for SLE among women exposed to physical or sexual abuse during childhood, controlling for potential confounders.

Results: We confirmed 101 cases of incident SLE who had completed the child abuse questions, during 670,822 person-years of follow-up. Both physical and sexual abuse during childhood were associated with statistically significant increases in SLE incidence. The HR for SLE associated with ≥ 2 episodes of severe sexual abuse compared to no abuse was 2.51 (95% CI 1.29-4.85) after adjustment for alcohol consumption, smoking, body mass index, oral contraceptive use, age at menarche, and parental education. The multivariable-adjusted HR for SLE with ≥ 5 episodes of severe physical abuse was 2.37 (1.13-4.99).

Conclusion: Our results suggest that sexual and physical abuse during childhood increase SLE risk during adulthood among Black women. Research is necessary both to confirm this finding and to understand potential mediating mechanisms.
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http://dx.doi.org/10.1002/acr.24188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487019PMC
March 2020

Obesity is an initiator of colon adenomas but not a promoter of colorectal cancer in the Black Women's Health Study.

Cancer Causes Control 2020 Apr 2;31(4):291-302. Epub 2020 Mar 2.

Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.

Purpose: Evidence for the association of anthropometrics with colorectal neoplasms is limited for African Americans.

Methods: We examined anthropometric measures with both colorectal adenoma and colorectal cancer (CRC) risk in the ongoing Black Women's Health Study. In a nested case-control analysis, 954 cases of colorectal adenoma were compared with 3,816 polyp-free controls, matched on age and follow-up time. For the CRC analyses, 413 incident CRC cases were identified over a 16-year follow-up (802,783 person-years). Adenoma cases and CRC were verified by medical record review. We used multivariable conditional logistic regression analyses (for adenoma) and Cox proportional hazards analyses (for CRC) that included anthropometric exposures and selected confounders.

Results: Overall body mass index (BMI) and other anthropometric factors were not associated with colorectal adenoma or cancer risk in Black women. However, increased risk of adenoma (but not CRC) was observed among especially related to adenomas in the proximal colon. Among women ≥ 50 years of age, risk of proximal adenoma increased 14% (95% CI 1.00, 1.31), 35% (95% CI 1.12, 1.63), and 25% (0.93, 1.68) with each standard deviation increase in BMI, waist circumference, and waist-to-hip ratio, respectively. None of the anthropometric factors were associated with young onset CRC or adenoma risk.

Conclusion: Our results suggest that obesity might be an initiator for colon adenomas but not a promoter for colorectal cancer among Black women.
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http://dx.doi.org/10.1007/s10552-020-01283-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144805PMC
April 2020

Predictors of self-reported oral health in the Black Women's Health Study.

J Public Health Dent 2020 01 16;80(1):70-78. Epub 2019 Dec 16.

Slone Epidemiology Center, Boston University, Boston, MA, USA.

Objectives: To describe the self-reported oral health of participants in the Black Women's Health Study (BWHS), a national cohort of 59,000 Black women, and to assess factors associated with this self-report.

Methods: Annual follow-up of the BWHS cohort occurs via surveys. The 2011 questionnaire included oral health self-report items, on which 38,573 respondents had complete data. Sample characteristics were summarized using descriptive statistics. We assessed correlations with several covariates by estimating odds ratios using multivariable-adjusted logistic regression models.

Results: Those who reported fair or poor oral health were more likely to report current smoking, recent tooth loss, diabetes or hypertension diagnoses, lower education levels, obesity, and higher parity. Few factors were related to self-reported gum disease with bone loss.

Conclusions: The oral health of US Black women is poorly understood. Correlates of oral health in the BWHS are largely consistent with what has been observed in other populations.
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http://dx.doi.org/10.1111/jphd.12351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227786PMC
January 2020

Associations Between Prediagnostic Concentrations of Circulating Sex Steroid Hormones and Liver Cancer Among Postmenopausal Women.

Hepatology 2020 Aug;72(2):535-547

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.

Background And Aims: In almost all countries, incidence rates of liver cancer (LC) are 100%-200% higher in males than in females. However, this difference is predominantly driven by hepatocellular carcinoma (HCC), which accounts for 75% of LC cases. Intrahepatic cholangiocarcinoma (ICC) accounts for 12% of cases and has rates only 30% higher in males. Hormones are hypothesized to underlie observed sex differences. We investigated whether prediagnostic circulating hormone and sex hormone binding globulin (SHBG) levels were associated with LC risk, overall and by histology, by leveraging resources from five prospective cohorts.

Approach And Results: Seven sex steroid hormones and SHBG were quantitated using gas chromatography/tandem mass spectrometry and competitive electrochemiluminescence immunoassay, respectively, from baseline serum/plasma samples of 191 postmenopausal female LC cases (HCC, n = 83; ICC, n = 56) and 426 controls, matched on sex, cohort, age, race/ethnicity, and blood collection date. Odds ratios (ORs) and 95% confidence intervals (CIs) for associations between a one-unit increase in log hormone value (approximate doubling of circulating concentration) and LC were calculated using multivariable-adjusted conditional logistic regression. A doubling in the concentration of 4-androstenedione (4-dione) was associated with a 50% decreased LC risk (OR = 0.50; 95% CI = 0.30-0.82), whereas SHBG was associated with a 31% increased risk (OR = 1.31; 95% CI = 1.05-1.63). Examining histology, a doubling of estradiol was associated with a 40% increased risk of ICC (OR = 1.40; 95% CI = 1.05-1.89), but not HCC (OR = 1.12; 95% CI = 0.81-1.54).

Conclusions: This study provides evidence that higher levels of 4-dione may be associated with lower, and SHBG with higher, LC risk in women. However, this study does not support the hypothesis that higher estrogen levels decrease LC risk. Indeed, estradiol may be associated with an increased ICC risk.
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http://dx.doi.org/10.1002/hep.31057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391790PMC
August 2020

Risk factors for estrogen receptor positive ductal carcinoma in situ of the breast in African American women.

Breast 2020 Feb 6;49:108-114. Epub 2019 Nov 6.

Slone Epidemiology Center at Boston University, Boscton, MA, USA.

Background: Compared to U.S. white women, African American women are more likely to die from ductal carcinoma in situ (DCIS). Elucidation of risk factors for DCIS in African American women may provide opportunities for risk reduction.

Methods: We used data from three epidemiologic studies in the African American Breast Cancer Epidemiology and Risk Consortium to study risk factors for estrogen receptor (ER) positive DCIS (488 cases; 13,830 controls). Results were compared to associations observed for ER+ invasive breast cancer (n = 2,099).

Results: First degree family history of breast cancer was associated with increased risk of ER+ DCIS [odds ratio (OR): 1.69, 95% confidence interval (CI): 1.31, 2.17]. Oral contraceptive use within the past 10 years (vs. never) was also associated with increased risk (OR: 1.43, 95%CI: 1.03, 1.97), as was late age at first birth (≥25 years vs. <20 years) (OR: 1.26, 95%CI: 0.96, 1.67). Risk was reduced in women with older age at menarche (≥15 years vs. <11 years) (OR: 0.62, 95%CI: 0.42, 0.93) and higher body mass index (BMI) in early adulthood (≥25 vs. <20 kg/m at age 18 or 21) (OR: 0.75, 95%CI: 0.55, 1.01). There was a positive association of recent BMI with risk in postmenopausal women only. In general, associations of risk factors for ER+ DCIS were similar in magnitude and direction to those for invasive ER+ breast cancer.

Conclusions: Our findings suggest that most risk factors for invasive ER+ breast cancer are also associated with increased risk of ER+ DCIS among African American women.
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http://dx.doi.org/10.1016/j.breast.2019.10.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012668PMC
February 2020

Association of type 2 diabetes with central-scalp hair loss in a large cohort study of African American women.

Int J Womens Dermatol 2019 Sep 6;5(4):261-266. Epub 2019 Jun 6.

Lenzy Dermatology and Hair Loss Center, Chicopee, Massachusetts.

Background: Hair loss on the central scalp commonly occurs among African American (AA) women and can pose substantial psychosocial burdens. The causes of hair loss remain obscure, although type 2 diabetes has been hypothesized to increase the risk of hair loss. The objective of the present study was to prospectively estimate the association between type 2 diabetes and severe central hair loss in AA women.

Methods: The Black Women's Health Study has collected data on medical and lifestyle factors, including diagnosis of type 2 diabetes, biennially since 1995 from AA women across the United States. The present analysis was based on responses from 5389 women to an online hair loss questionnaire in 2015. Respondents indicated severity of central hair loss on a validated six-item photographic scale; the highest levels, levels 3 to 5, were designated as severe. We used Cox proportional hazards models to estimate multivariable hazard ratios and 95% confidence intervals (CIs) for type 2 diabetes in relation to severe central hair loss.

Results: During the follow-up period, 850 cases of severe hair loss occurred. The multivariable hazard ratio for severe hair loss associated with diabetes was 1.68 (95% CI, 1.38-2.06) overall, and 2.05 (95% CI, 1.48-2.85) for diabetes duration of ≥ 10 years.

Conclusion: Type 2 diabetes was associated with an increased risk of severe central scalp hair loss in AA women. Patients with type 2 diabetes should be followed closely for central scalp hair loss so that appropriate treatment can be offered.
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http://dx.doi.org/10.1016/j.ijwd.2019.05.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831789PMC
September 2019

Abdominal and gluteofemoral size and risk of liver cancer: The liver cancer pooling project.

Int J Cancer 2020 08 23;147(3):675-685. Epub 2019 Dec 23.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.

Obesity is known to be associated with primary liver cancer (PLC), but the separate effects of excess abdominal and gluteofemoral size are unclear. Thus, we examined the association between waist and hip circumference with risk of PLC overall and by histologic type-hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). The Liver Cancer Pooling Project is a consortium of prospective cohort studies that include data from 1,167,244 individuals (PLC n = 2,208, HCC n = 1,154, ICC n = 335). Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using proportional hazards regression. Waist circumference, per 5 cm increase, was associated with an 11% increased PLC risk (HR = 1.11, 95%CI: 1.09-1.14), including when adjusted for hip circumference (HR = 1.12, 95%CI: 1.08-1.17) and also when restricted to individuals in a normal body mass index (BMI) range (18.5 to <25 kg/m ; HR = 1.14, 95%CI: 1.07-1.21). Hip circumference, per 5 cm increase, was associated with a 9% increased PLC risk (HR = 1.09, 95%CI: 1.06-1.12), but no association remained after adjustment for waist circumference (HR = 0.99, 95%CI: 0.94-1.03). HCC and ICC results were similar. These findings suggest that excess abdominal size is associated with an increased risk of liver cancer, even among individuals considered to have a normal BMI. However, excess gluteofemoral size alone confers no increased risk. Our findings extend prior analyses, which found an association between excess adiposity and risk of liver cancer, by disentangling the separate effects of excess abdominal and gluteofemoral size through utilization of both waist and hip circumference measurements.
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http://dx.doi.org/10.1002/ijc.32760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391795PMC
August 2020

Perceived racial discrimination and risk of insomnia among middle-aged and elderly Black women.

Sleep 2020 01;43(1)

Slone Epidemiology Center, Boston University, Boston, MA.

Study Objective: To assess whether perceived racial discrimination is associated with insomnia among Black women.

Methods: Data on everyday and lifetime racism and insomnia symptoms were collected from questionnaires administered in the Black Women's Health Study, an ongoing prospective cohort of Black women recruited in 1995 from across the United States. In 2009, participants completed five questions on the frequency of discriminatory practices in daily life (everyday racism) and six questions on ever experiencing unfair treatment in key institutional contexts (lifetime racism). In 2015, the Insomnia Severity Index was used to assess insomnia symptoms. We estimated odds ratios and 95% confidence intervals for associations of racism with insomnia, using multivariable logistic regression models adjusted for potential confounders.

Results: The 26 139 participants in the analytic sample were 40-90 years old (median = 57 years, SD = 9.6 years). Higher levels of everyday racism and lifetime racism were positively associated with subthreshold (ptrend < .01) and clinical insomnia (ptrend < .01). Results remained unchanged after further adjustment for sleep duration and shift work.

Conclusions: Higher levels of perceived racism were associated with increased odds of insomnia among middle-aged and elderly Black women. Thus, perceived racism may contribute to multiple racial health disparities resulting from insomnia. Helping minority populations cope with their experiences of discrimination may decrease the significant public health impact of sleep disruption and subsequent diagnoses.
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http://dx.doi.org/10.1093/sleep/zsz208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955644PMC
January 2020

Perceived racism in relation to telomere length among African American women in the Black Women's Health Study.

Ann Epidemiol 2019 08 21;36:33-39. Epub 2019 Jun 21.

Slone Epidemiology Center at Boston University, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA. Electronic address:

Purpose: Telomere length is considered a biomarker of human aging and premature morbidity and mortality which has been associated with chronic stress.

Methods: We assessed the relation between perceived racism and telomere length in the Black Women's Health Study, a follow-up study of U.S. black women begun in 1995. Participants were asked about frequency of "everyday racism" (e.g., "people act as if they think you are not intelligent") and "institutional racism" (e.g., "ever treated unfairly due to race by police"). Using quantitative real-time polymerase chain reaction assay, relative telomere lengths (RTL) were measured as the copy number ratio of telomere repeat to a single control gene in 997 participants. Associations of racism variables with log-RTL were estimated by multivariable linear regression, with adjustment for age at blood draw and potential confounders.

Results: Participants were aged 40-70 years (mean = 55.6 years), and mean telomere length was 0.77 (range 0.21-1.38). In stratified analyses, there was an inverse association between everyday racism and log-RTL among women who did not discuss their experiences of racism with others (β = -0.1104; 95% CI = -0.2140 to -0.0067; P = .045).

Conclusions: Everyday racism was associated with shorter telomere length among women who reported not discussing those experiences with others.
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http://dx.doi.org/10.1016/j.annepidem.2019.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048405PMC
August 2019

Ovarian Cancer in Women of African Ancestry (OCWAA) consortium: a resource of harmonized data from eight epidemiologic studies of African American and white women.

Cancer Causes Control 2019 Sep 24;30(9):967-978. Epub 2019 Jun 24.

Slone Epidemiology Center, Boston University, Boston, MA, USA.

Purpose: Although the incidence rate of epithelial ovarian cancer (EOC) is somewhat lower in African American (AA) than white women, survival is worse. The Ovarian Cancer in Women of African Ancestry (OCWAA) consortium will overcome small, study-specific sample sizes to better understand racial differences in EOC risk and outcomes.

Methods: We harmonized risk factors and prognostic characteristics from eight U.S.

Studies: the North Carolina Ovarian Cancer Study (NCOCS), the Los Angeles County Ovarian Cancer Study (LACOCS), the African American Cancer Epidemiology Study (AACES), the Cook County Case-Control Study (CCCCS), the Black Women's Health Study (BWHS), the Women's Health Initiative (WHI), the Multiethnic Cohort Study (MEC), and the Southern Community Cohort Study (SCCS).

Results: Determinants of disparities for risk and survival in 1,146 AA EOC cases and 2,922 AA controls will be compared to 3,368 white EOC cases and 10,270 white controls. Analyses include estimation of population-attributable risk percent (PAR%) by race.

Conclusion: OCWAA is uniquely positioned to study the epidemiology of EOC in AA women compared with white women to address disparities. Studies of EOC have been underpowered to address factors that may explain AA-white differences in the incidence and survival. OCWAA promises to provide novel insight into disparities in ovarian cancer.
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http://dx.doi.org/10.1007/s10552-019-01199-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325484PMC
September 2019

Prepregnancy Diabetes and Breastfeeding Cessation Among Black Women in the United States.

Breastfeed Med 2019 05 6;14(4):249-255. Epub 2019 Mar 6.

4 Slone Epidemiology Center, Boston University, Boston, Massachusetts.

The incidence of diabetes is rising, and with it, the number of pregnancies affected by diabetes. U.S. black women have a disproportionately high prevalence of diabetes and lower rates of breastfeeding. The objective of this study was to quantify the relationship between diabetes before pregnancy and breastfeeding duration among black women in the United States. We analyzed women from the Black Women's Health Study ( = 59,000) to assess the relationship between prepregnancy diabetes and time to breastfeeding cessation occurring up to 24 months postdelivery using Kaplan-Meier survival curves, log rank tests, and Cox proportional hazards models. The study population included primiparous women with births between 1995 and 2009 ( = 3,404). Obesity, hypertension before pregnancy, and family history of diabetes were examined for effect modification. Survival curves demonstrated a markedly reduced duration of breastfeeding in women who had been diagnosed with prepregnancy diabetes ( < 0.01). The hazard ratio for breastfeeding cessation for women with prepregnancy diabetes was 1.5 (95% confidence interval 1.1-2.0) compared with women without prepregnancy diabetes after control for age, body mass index (BMI) at age 18, prepregnancy BMI, other metabolic factors, demographics, and health behaviors. Our results suggest that prepregnancy diabetes is a strong predictor of curtailed breastfeeding duration, even after control for BMI. This underscores the need for targeted lactation support for diabetic women.
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http://dx.doi.org/10.1089/bfm.2018.0074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532327PMC
May 2019

Pre- and perinatal factors and incidence of breast cancer in the Black Women's Health Study.

Cancer Causes Control 2019 Jan 29;30(1):87-95. Epub 2018 Nov 29.

Slone Epidemiology Center at Boston University, 72 East Concord Street, L-7, Boston, MA, 02118, USA.

Purpose: The purpose of the study was to investigate the association between pre- or perinatal factors and breast cancer risk among African American women.

Methods: Participants in the Black Women's Health Study, a prospective cohort of 59,000 African American women, reported birth weight, preterm birth, twin or triplet status, maternal age at birth, birth order, and having been breastfed during infancy at various times during follow-up from 1997 to 2015. Numbers of incident cases ranged from 312 for breastfed analyses to 1,583 for twin or triplet analyses. Using multivariable Cox proportional hazards regression, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between each factor and breast cancer risk overall and by estrogen receptor (ER) status.

Results: Compared to birth weights of 5 lbs. 8 oz.-8 lbs. 13 oz., low (< 5 lbs. 8 oz.) and high (> 8 lbs. 13 oz.) birth weights were associated with increased breast cancer risk; HRs (95% CI) were 1.19 (0.98-1.44) and 1.26 (0.97-1.63), respectively. Associations were similar by ER status. Having been born to a mother aged ≥ 35 years versus < 20 years was associated with risk of ER+ (HR 1.59, 95% CI 1.10-2.29), but not ER- breast cancer. Other perinatal factors were not associated with breast cancer.

Conclusion: African American women with a low or high birth weight or born to older mothers may have increased breast cancer risk. Trends towards delayed child birth and higher birth weights, coupled with disproportionately high rates of low birth weight among African Americans, may contribute to increases in breast cancer incidence.
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http://dx.doi.org/10.1007/s10552-018-1103-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521832PMC
January 2019

A prospective study of obesity and risk of systemic lupus erythematosus (SLE) among Black women.

Semin Arthritis Rheum 2019 06 11;48(6):1030-1034. Epub 2018 Oct 11.

Slone Epidemiology Center at Boston University, 72 East Concord St, Boston, MA 02118, United States.

Background: Obesity may influence systemic lupus erythematous (SLE) pathogenesis via stimulation of systemic inflammation, but the relationship between obesity and SLE risk is unclear. Past studies have predominantly assessed White women, while Black women have higher prevalence of both obesity and SLE.

Methods: We prospectively assessed the relationship between Body Mass Index (BMI, kg/m) and incident SLE within the Black Women's Health Study (median age 38 at entry in 1995). Height and weight at age 18 and during follow-up were self-reported. We confirmed incident SLE cases by updated American College of Rheumatology criteria and collected covariates prospectively. Cox proportional hazards regression models, adjusted for potential confounders, estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for categories of updated BMI and risk of SLE, relative to BMI 20-24.9 ("normal" BMI). Secondary analyses investigated BMI at age 18, BMI in 1995 at cohort entry, cumulative updated BMI and "lagged" BMI (≥4 years prior to outcome window to address possible reverse causation).

Results: Adult obesity was not related to SLE risk: HR for BMI ≥30 ("obesity") relative to normal BMI at ≥4 years prior to SLE diagnosis was 0.90 (95% CI 0.53-1.54). However, obesity at age 18 was associated with increased risk: HR 2.38 (95% CI 1.26-4.51) for ≥30 vs. normal BMI.

Conclusions: Among these Black women, obesity as a teenager was associated with increased SLE risk in adulthood. Further studies are necessary to understand the biologic mechanisms and windows of exposure for the relationship of obesity to SLE pathogenesis.
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http://dx.doi.org/10.1016/j.semarthrit.2018.10.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459733PMC
June 2019

Religious and Spiritual Coping and Risk of Incident Hypertension in the Black Women's Health Study.

Ann Behav Med 2018 11;52(12):989-998

National Consortium on Psychosocial Stress, Spirituality, and Health, Massachusetts General Hospital, Department of Medicine, Boston, MA, USA.

Background: The few studies of the relationship between religion and/or spirituality (R/S) and hypertension are conflicting. We hypothesized that R/S may reduce the risk of hypertension by buffering adverse physiological effects of stress.

Methods: We prospectively assessed the association of R/S with hypertension within the Black Women's Health Study (BWHS), a cohort study initiated in 1995 that follows participants through biennial questionnaires. The 2005 questionnaire included four R/S questions: (i) extent to which one's R/S is involved in coping with stressful situations, (ii) self-identification as a religious/spiritual person, (iii) frequency of attending religious services, and (iv) frequency of prayer. Incidence rate ratios (IRRs) and 95% confidence intervals were calculated for each R/S variable in relation to incident hypertension using Cox proportional hazards regression models, controlling for demographics, known hypertension risk factors, psychosocial factors, and other R/S variables.

Results: During 2005-2013, 5,194 incident cases of hypertension were identified. High involvement of R/S in coping with stressful events compared with no involvement was associated with reduced risk of hypertension (IRR: 0.87; 95% CI: 0.75, 1.00). The association was strongest among women reporting greater levels of perceived stress (IRR: 0.77; 95% CI: 0.61, 0.98; p interaction = .01). More frequent prayer was associated with increased risk of hypertension (IRR: 1.12; 95% CI: 0.99, 1.27). No association was observed for the other R/S measures.

Conclusion: R/S coping was associated with decreased risk of hypertension in African American women, especially among those reporting higher levels of stress. Further research is needed to understand the mechanistic pathways through which R/S coping may affect health.
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http://dx.doi.org/10.1093/abm/kay001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230974PMC
November 2018

Fruit and VegeTable Intake and Lung Cancer Incidence Among Black Women According to Cigarette Smoking Status.

Nutr Cancer 2018 Aug-Sep;70(6):904-912. Epub 2018 Sep 10.

a Department of Oncology , Georgetown University , Washington , DC , USA.

This project evaluated associations between fruit and vegetable intake, cigarette smoking and lung cancer incidence among U.S. Black women. The Black Women's Health Study is a prospective cohort study (analytic cohort = 46,889) among Black women between the ages 21 and 69 at baseline (1995). Fruit and vegetable intake and smoking history were ascertained via questionnaires at baseline and during follow-up. Associations between fruit and vegetable intake, smoking and lung cancer incidence (N = 306 incident cases through 2013) were evaluated using Cox proportional hazards regression. Among women in this cohort, 6.1% and 5.6% reported consuming at least three servings/d of fruit or vegetables, respectively. Smoking history was associated with increased lung cancer incidence. Being a current smoker of ≥15 cigarettes/d was associated with higher lung cancer incidence compared to never smokers (HR = 17.4, 95% CI: 11.5, 26.4). Fruit and vegetable was not associated with lung cancer incidence intake (≥5 vs. <3 servings/d, adjusted HR: 0.86, 95% CI: 0.54, 1.36). Associations between fruit and vegetable intake and lung cancer incidence did not differ by smoking history. Fruit and vegetable intake was low in this study population, but results do not support an association between fruit and vegetable intake and lung cancer incidence, regardless of smoking history.
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http://dx.doi.org/10.1080/01635581.2018.1491608DOI Listing
June 2019

Body Mass Index, Diabetes and Intrahepatic Cholangiocarcinoma Risk: The Liver Cancer Pooling Project and Meta-analysis.

Am J Gastroenterol 2018 10 3;113(10):1494-1505. Epub 2018 Sep 3.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Objective: Obesity and diabetes are associated with an increased liver cancer risk. However, most studies have examined all primary liver cancers or hepatocellular carcinoma, with few studies evaluating intrahepatic cholangiocarcinoma (ICC), the second most common type of liver cancer. Thus, we examined the association between obesity and diabetes and ICC risk in a pooled analysis and conducted a systematic review/meta-analysis of the literature.

Design: For the pooled analysis, we utilized the Liver Cancer Pooling Project, a consortium of 13 US-based, prospective cohort studies with data from 1,541,143 individuals (ICC cases n = 414). In our systematic review, we identified 14 additional studies. We then conducted a meta-analysis, combining the results from LCPP with results from the 5 prospective studies identified through September 2017.

Results: In the LCPP, obesity and diabetes were associated with a 62% [Hazard Ratio (HR) = 1.62, 95% Confidence Interval (CI): 1.24-2.12] and an 81% (HR = 1.81, 95% CI: 1.33-2.46) increased ICC risk, respectively. In the meta-analysis of prospectively ascertained cohorts and nested case-control studies, obesity was associated with a 49% increased ICC risk [Relative Risk (RR) = 1.49, 95% CI: 1.32-1.70; n = 4 studies; I = 0%]. Diabetes was associated with a 53% increased ICC risk (RR = 1.53, 95% CI: 1.31-1.78; n = 6 studies). While we noted heterogeneity between studies (I = 67%) for diabetes, results were consistent in subgroup analyses. Results from hospital-based case-control studies (n = 9) were mostly consistent, but these studies are potentially subject to reverse causation.

Conclusions: These findings suggest that obesity and diabetes are associated with increased ICC risk, highlighting similar etiologies of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. However, additional prospective studies are needed to verify these associations.
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http://dx.doi.org/10.1038/s41395-018-0207-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521884PMC
October 2018