TY - JOUR
T1 - Collaborative modeling of the impact of obesity on race-specific breast cancer incidence and mortality
AU - Chang, Yaojen
AU - Schechter, Clyde B.
AU - Van Ravesteyn, Nicolien T.
AU - Near, Aimee M.
AU - Heijnsdijk, Eveline A.M.
AU - Adams-Campbell, Lucile
AU - Levy, David
AU - De Koning, Harry J.
AU - Mandelblatt, Jeanne S.
N1 - Funding Information:
Acknowledgments We thank the Breast Cancer Surveillance Consortium (BCSC) investigators for the data they have provided for this study. A list of the BCSC investigators and procedures for requesting BCSC data for research purposes are provided at http://breastscreen ing.cancer.gov/. The collection of cancer data used in this study was supported in part by several state public health departments and cancer registries throughout the US. For a full description of these sources, please see http://www.breastscreening.cancer.gov/work/ack nowledgement.html. We thank the National Comprehensive Cancer Network investigators for use of their data on treatment dissemination. This work was supported by funding from the National Cancer Institute at the National Institutes of Health (NIH) (Grant Numbers U01CA088283, U01CA152958, and KO5CA96940 to JSM; Grant Number P01CA154292 to JSM and CBS; Grant Number R21CA 149996 to LLA; and Grant Number UO1CA152956 to DL). The views expressed in this article represent those of the authors and not the NIH. Breast Cancer Surveillance Consortium data collection and sharing was supported by the National Cancer Institute (Grant Numbers U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, U01CA70040, and HHSN261201100031C).
PY - 2012/12
Y1 - 2012/12
N2 - Obesity affects multiple points along the breast cancer control continuum from prevention to screening and treatment, often in opposing directions. Obesity is also more prevalent in Blacks than Whites at most ages so it might contribute to observed racial disparities in mortality. We use two established simulation models from the Cancer Intervention and Surveillance Modeling Network (CISNET) to evaluate the impact of obesity on race-specific breast cancer outcomes. The models use common national data to inform parameters for the multiple US birth cohorts of Black and White women, including age- and race-specific incidence, competing mortality, mammography characteristics, and treatment effectiveness. Parameters are modified by obesity (BMI of ≥30 kg/m2) in conjunction with its age-, race-, cohort- and time-period-specific prevalence. We measure age-standardized breast cancer incidence and mortality and cases and deaths attributable to obesity. Obesity is more prevalent among Blacks than Whites until age 74; after age 74 it is more prevalent in Whites. The models estimate that the fraction of the US breast cancer cases attributable to obesity is 3.9-4.5 % (range across models) for Whites and 2.5-3.6 % for Blacks. Given the protective effects of obesity on risk among women <50 years, elimination of obesity in this age group could increase cases for both the races, but decrease cases for women ≥50 years. Overall, obesity accounts for 4.4-9.2 % and 3.1-8.4 % of the total number of breast cancer deaths in Whites and Blacks, respectively, across models. However, variations in obesity prevalence have no net effect on race disparities in breast cancer mortality because of the opposing effects of age on risk and patterns of age- and race-specific prevalence. Despite its modest impact on breast cancer control and race disparities, obesity remains one of the few known modifiable risks for cancer and other diseases, underlining its relevance as a public health target.
AB - Obesity affects multiple points along the breast cancer control continuum from prevention to screening and treatment, often in opposing directions. Obesity is also more prevalent in Blacks than Whites at most ages so it might contribute to observed racial disparities in mortality. We use two established simulation models from the Cancer Intervention and Surveillance Modeling Network (CISNET) to evaluate the impact of obesity on race-specific breast cancer outcomes. The models use common national data to inform parameters for the multiple US birth cohorts of Black and White women, including age- and race-specific incidence, competing mortality, mammography characteristics, and treatment effectiveness. Parameters are modified by obesity (BMI of ≥30 kg/m2) in conjunction with its age-, race-, cohort- and time-period-specific prevalence. We measure age-standardized breast cancer incidence and mortality and cases and deaths attributable to obesity. Obesity is more prevalent among Blacks than Whites until age 74; after age 74 it is more prevalent in Whites. The models estimate that the fraction of the US breast cancer cases attributable to obesity is 3.9-4.5 % (range across models) for Whites and 2.5-3.6 % for Blacks. Given the protective effects of obesity on risk among women <50 years, elimination of obesity in this age group could increase cases for both the races, but decrease cases for women ≥50 years. Overall, obesity accounts for 4.4-9.2 % and 3.1-8.4 % of the total number of breast cancer deaths in Whites and Blacks, respectively, across models. However, variations in obesity prevalence have no net effect on race disparities in breast cancer mortality because of the opposing effects of age on risk and patterns of age- and race-specific prevalence. Despite its modest impact on breast cancer control and race disparities, obesity remains one of the few known modifiable risks for cancer and other diseases, underlining its relevance as a public health target.
KW - Breast cancer
KW - Disparities
KW - Obesity
KW - Simulation modeling
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U2 - 10.1007/s10549-012-2274-3
DO - 10.1007/s10549-012-2274-3
M3 - Article
C2 - 23104221
AN - SCOPUS:84878749197
SN - 0167-6806
VL - 136
SP - 823
EP - 835
JO - Breast Cancer Research and Treatment
JF - Breast Cancer Research and Treatment
IS - 3
ER -
