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Cancer Causes & Control

, Volume 24, Issue 4, pp 731–739 | Cite as

Estrogen receptor positive tumors: Do reproductive factors explain differences in incidence between black and white women?

  • Erica T. WarnerEmail author
  • Rulla M. Tamimi
  • Deborah A. Boggs
  • Bernard Rosner
  • Lynn Rosenberg
  • Graham A. Colditz
  • Julie R. Palmer
Original paper

Abstract

Purpose

The incidence of estrogen receptor positive (ER+) breast cancer is higher among white women relative to black women. In two large prospective cohorts, the Black Women’s Health Study (BWHS) and the Nurses’ Health Study II (NHSII), we investigated whether reproductive factors explain the difference.

Methods

During 1,582,083 person-years of follow-up of 140,914 women observed from 1995 to 2007, 327 ER+ breast cancers were identified among black women in BWHS and NHSII and 1,179 among white women in NHSII. Cox proportional hazards regression models, stratified by race and pooled, were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for the association of race, parity, age at first birth, and lactation in relation to risk of ER+ cancer with adjustment for age and other breast cancer risk factors.

Results

Age at first birth differed markedly in the two groups, with 66 % of parous black women having their first child before age 25 as compared with 36 % of white women. Each additional year of age at first birth was associated with a 4 % increased risk of ER+ breast cancer among both racial groups. Relative to nulliparous women, parous women were at decreased risk of ER+ breast cancer (HR 0.59, 95 % CI 0.20, 1.77), in black women and (HR 0.63, 95 % CI 0.45, 0.87) in white women. The HR for the association of black race with ER+ cancer was 0.67 (95 % CI 0.53, 0.84) in a model that adjusted for age only, 0.77 (95 % CI 0.61, 0.99) in a model that controlled for parity, age at first birth, and other reproductive/hormonal factors, and 0.83 (95 % CI 0.70, 0.98) in a model that additionally controlled for other breast cancer risk factors such as alcohol consumption and use of hormone supplements. Similar associations were seen among premenopausal women and in an analysis restricted to ER+PR+ tumors.

Conclusions

Reproductive factors explained some of the higher incidence of ER+ tumors among white women as compared to black women.

Keywords

Breast carcinoma Race Estrogen receptor Reproductive factors Incidence Black African American 

Notes

Acknowledgments

Erica T. Warner was supported by National Cancer Institute grant number 5T32CA009001-36 and National Institute of General Medical Sciences grant number 5R25GM055353-14. Dr. Colditz is supported in part by an American Cancer Society Cissy Hornung Clinical Research Professorship. Black Women’s Health Study is supported by National Cancer Institute grant R01 CA058420. The Nurses’ Health Study II is supported by National Cancer Institute grant number R01 CA50385. We thank the participants of the Black Women’s Health Study and Nurses’ Health Study II. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. Data on breast cancer pathology were obtained from several state cancer registries (AZ, CA, CO, CT, DE, DC, FL, GA, IL, IN, KY, LA, MD, MA, MI, NJ, NY, NC, OK, PA, SC, TN, TX, VA) and results reported do not necessarily represent their views.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Jemal A, Ward E, Thun M (2007) Recent trends in breast cancer incidence rates by age and tumor characteristics among US women. Breast Cancer Res 9:R28PubMedCrossRefGoogle Scholar
  2. 2.
    Anderson WF, Chatterjee N, Ershler WB, Brawley OW (2002) Estrogen receptor breast cancer phenotypes in the surveillance, epidemiology, and end results database. Breast Cancer Res Treat 76:27–36PubMedCrossRefGoogle Scholar
  3. 3.
    Chu KC, Anderson WF, Fritz A, Ries LAG, Brawley OW (2001) Frequency distributions of breast cancer characteristics classified by estrogen receptor and progesterone receptor status for eight racial/ethnic groups. Cancer 92:37–45PubMedCrossRefGoogle Scholar
  4. 4.
    Furberg H, Millikan R, Dressler L, Newman B, Geradts J (2001) Tumor characteristics in African American and white women. Breast Cancer Res Treat 68:33–43PubMedCrossRefGoogle Scholar
  5. 5.
    Kelsey JL, Gammon MD, John EM (1993) Reproductive factors and breast cancer. Epidemiol Rev 15:36PubMedGoogle Scholar
  6. 6.
    Hankinson SE, Colditz GA, Hunter DJ et al (1995) Reproductive factors and family history of breast cancer in relation to plasma estrogen and prolactin levels in postmenopausal women in the Nurses’ Health Study (United States). Cancer Causes Control 6:217–224PubMedCrossRefGoogle Scholar
  7. 7.
    Rosner B, Colditz GA, Willett WC (1994) Reproductive risk factors in a prospective study of breast cancer: the Nurses’ Health Study. Am J Epidemiol 139:819PubMedGoogle Scholar
  8. 8.
    Palmer JR, Boggs DA, Wise LA, Ambrosone CB, Adams-Campbell LL, Rosenberg L (2011) Parity and lactation in relation to estrogen receptor negative breast cancer in African American women. Cancer Epidemiol Biomarkers Prev 20:1883–1891PubMedCrossRefGoogle Scholar
  9. 9.
    Ma H, Bernstein L, Pike MC, Ursin G (2006) Reproductive factors and breast cancer risk according to joint estrogen and progesterone receptor status: a meta-analysis of epidemiological studies. Breast Cancer Res 8:R43PubMedCrossRefGoogle Scholar
  10. 10.
    Colditz GA, Rosner BA, Chen WY, Holmes MD, Hankinson SE (2004) Risk factors for breast cancer according to estrogen and progesterone receptor status. J Natl Cancer Inst 96:218PubMedCrossRefGoogle Scholar
  11. 11.
    Ursin G, Bernstein L, Wang Y et al (2004) Reproductive factors and risk of breast carcinoma in a study of white and African-American women. Cancer 101:353–362PubMedCrossRefGoogle Scholar
  12. 12.
    Furberg H, Newman B, Moorman P, Millikan R (1999) Lactation and breast cancer risk. Int J Epidemiol 28:396–402PubMedCrossRefGoogle Scholar
  13. 13.
    Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Osterman MJK (2010) Births: final data for 2008. National Vital Statistics Reports 59Google Scholar
  14. 14.
    Mathews TJ, Hamilton BE (2009) Delayed childbearing: more women are having their first child later in life. NCHS Data Brief 21Google Scholar
  15. 15.
    Yoo K, Tajima K, Miura S et al (1997) Breast cancer risk factors according to combined estrogen and progesterone receptor status: a case-control analysis. Am J Epidemiol 146:307–314PubMedCrossRefGoogle Scholar
  16. 16.
    Arpino G, Weiss H, Lee AV et al (2005) Estrogen receptor–positive, progesterone receptor–negative breast cancer: association with growth factor receptor expression and tamoxifen resistance. J Natl Cancer Inst 97:1254PubMedCrossRefGoogle Scholar
  17. 17.
    Bardou VJ, Arpino G, Elledge RM, Osborne CK, Clark GM (2003) Progesterone receptor status significantly improves outcome prediction over estrogen receptor status alone for adjuvant endocrine therapy in two large breast cancer databases. J Clin Oncol 21:1973PubMedCrossRefGoogle Scholar
  18. 18.
    Colditz GA, Hankinson SE (2005) The Nurses’ Health Study: lifestyle and health among women. Nat Rev Cancer 5:388–396PubMedCrossRefGoogle Scholar
  19. 19.
    Rosenberg L, Adams-Campbell L, Palmer JR (1995) The Black Women’s Health Study: a follow-up study for causes and preventions of illness. J Am Med Womens Assoc 50:56–58PubMedGoogle Scholar
  20. 20.
    Collins LC, Marotti JD, Baer HJ, Tamimi RM (2008) Comparison of estrogen receptor results from pathology reports with results from central laboratory testing. J Natl Cancer Inst 100:218PubMedCrossRefGoogle Scholar
  21. 21.
    Ghafoor A, Jemal A, Ward E, Cokkinides V, Smith R, Thun M (2003) Trends in breast cancer by race and ethnicity. CA Cancer J Clin 53:342–355PubMedCrossRefGoogle Scholar
  22. 22.
    Chlebowski RT, Chen Z, Anderson GL et al (2005) Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst 97:439–448PubMedCrossRefGoogle Scholar
  23. 23.
    Clarke CA, Keegan TH, Yang J et al (2012) Age-specific incidence of breast cancer subtypes: understanding the black-white crossover. J Natl Cancer Inst 104:1094–1101PubMedCrossRefGoogle Scholar
  24. 24.
    Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277PubMedCrossRefGoogle Scholar
  25. 25.
    Smigal C, Jemal A, Ward E et al (2006) Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin 56:168–183PubMedCrossRefGoogle Scholar
  26. 26.
    Anderson WF, Chu KC, Chang S, Sherman ME (2004) Comparison of age-specific incidence rate patterns for different histopathologic types of breast carcinoma. Cancer Epidemiol Biomark Prev 13:1128Google Scholar
  27. 27.
    Li CI, Malone KE, Daling JR (2002) Differences in breast cancer hormone receptor status and histology by race and ethnicity among women 50 years of age and older. Cancer Epidemiol Biomark Prev 11:601Google Scholar
  28. 28.
    Chu KC, Anderson WF (2002) Rates for breast cancer characteristics by estrogen and progesterone receptor status in the major racial/ethnic groups. Breast Cancer Res Treat 74:199–211Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Erica T. Warner
    • 1
    • 2
    Email author
  • Rulla M. Tamimi
    • 1
    • 2
  • Deborah A. Boggs
    • 3
  • Bernard Rosner
    • 2
    • 4
  • Lynn Rosenberg
    • 3
  • Graham A. Colditz
    • 1
    • 5
  • Julie R. Palmer
    • 3
  1. 1.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  2. 2.Channing Division of Network MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Slone Epidemiology CenterBoston UniversityBostonUSA
  4. 4.Department of BiostatisticsHarvard School of Public HealthBostonUSA
  5. 5.Department of SurgeryWashington University School of MedicineSaint LouisUSA

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