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Race/ethnicity, genetic ancestry, and breast cancer-related lymphedema in the Pathways Study

  • Epidemiology
  • Published:
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Abstract

Breast cancer-related lymphedema (BCRL) is a serious chronic condition after breast cancer (BC) surgery and treatment. It is unclear if BCRL risk varies by race/ethnicity. In a multiethnic prospective cohort study of 2953 BC patients, we examined the association of self-reported BCRL status with self-reported race/ethnicity and estimated genetic ancestry. Hazard ratios (HR) and 95 % confidence intervals (CI) were calculated by multivariable Cox proportional hazards models, with follow-up starting 6 months post-BC diagnosis. Estimates were further stratified by body mass index (BMI). By 48 months of follow-up, 342 (11.6 %) women reported having BCRL. Younger age at BC diagnosis, higher BMI at baseline, and lower physical activity were associated with greater BCRL risk. African American (AA) women had a 2-fold increased risk of BCRL compared with White women (HR = 2.04; 95 % CI 1.35–3.08). African genetic ancestry was also associated with an increased risk (HR = 2.50; 95 % CI 1.43, 4.36). Both risks were attenuated but remained elevated after adjusting for known risk factors and became more pronounced when restricted to the nonobese women (adjusted HR = 2.31 for AA and HR = 3.70 for African ancestry, both p < 0.05). There was also evidence of increased BCRL risk with Hispanic ethnicity in the nonobese women. Nonobese AA women had a higher risk of BCRL than White women, which cannot be fully explained by known risk factors. This is the first large-scale, prospective study demonstrating differences in BCRL risk according to race/ethnicity as assessed by both self-report and genetic ancestry data, with a potential ancestry–obesity interaction.

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Abbreviations

AA:

African American

AIM:

Ancestry informative marker

AJCC:

American Joint Committee on Cancer

BC:

Breast cancer

BCRL:

Breast cancer-related lymphedema

BMI:

Body mass index

CI:

Confidence interval

HR:

Hazards ratio

KPNC:

Kaiser Permanente Northern California

MET:

Metabolic equivalent

RPCI:

Roswell Park Cancer Institute

SD:

Standard deviation

SEER:

Surveillance, epidemiology, and end results program

SES:

Socioeconomic status

SLNB:

Sentinel lymph node biopsy

WHR:

Waist-to-hip ratio

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Acknowledgments

The authors thank the office and field staff for data collection, processing, and preparation. The authors thank all the Pathways Study participants for their numerous contributions to this study. This work was supported by the National Cancer Institute at the National Institutes of Health (Grant Number: R01 CA105274 to L.H.K) and the American Cancer Society (Grant Number: RSG-06-209-01-LR to M.L.K). The Roswell Park Cancer Institute Data Bank and Biorepository and Genomics Shared Resource are supported by a National Cancer Institute Cancer Center Support Grant (Grant Number: P30 CA16056). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the funding agencies.

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    Authors and Affiliations

    1. Division of Research, Kaiser Permanente Northern California, Oakland, CA, 94612, USA

      Marilyn L. Kwan, Valerie S. Lee, Janise M. Roh, Isaac J. Ergas, Charles P. Quesenberry Jr. & Lawrence H. Kushi

    2. Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, 14263, NY, USA

      Song Yao, Qianqian Zhu, Qian Liu, Yali Zhang & Christine B. Ambrosone

    3. San Jose Medical Center, Kaiser Permanente Northern California, San Jose, 95119, CA, USA

      Susan E. Kutner

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    1. Marilyn L. Kwan
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    Correspondence to Marilyn L. Kwan.

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    Marilyn L. Kwan and Song Yao contributed equally to this work and are co-first authors.

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    Kwan, M.L., Yao, S., Lee, V.S. et al. Race/ethnicity, genetic ancestry, and breast cancer-related lymphedema in the Pathways Study. Breast Cancer Res Treat 159, 119–129 (2016). https://doi.org/10.1007/s10549-016-3913-x

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