American Journal of Epidemiology Vol. 153, No. 3 : 284-291
Copyright © 2001 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Race, Anthropometric Factors, and Stage at Diagnosis of Breast Cancer
1 Department of Epidemiology and Public Health, School of Medicine, Yale University, New Haven, CT.
2 Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC.
3 Current address: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA.
4 School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia.
A recent study suggested that the greater prevalence of severe obesity among African-American women explained almost one third of the observed differences between African-American and White women in stage at diagnosis of breast cancer. The objective of this investigation was to attempt to replicate these findings in a second, larger population and to expand the analyses by including a measure of body fat distribution, the waist:hip ratio. The authors used data from a population-based study in North Carolina comprising 791 breast cancer cases (302 in African-American women and 489 in White women) diagnosed between 1993 and 1996. African-American women were more likely to have later-stage (TNM stage 
II) breast cancer (odds ratio (OR) = 2.2; 95% confidence interval (CI): 1.6, 2.9). They also were much more likely to be severely obese (body mass index 32.3) (OR = 9.7; 95% CI: 6.5, 14.5) and to be in the highest tertile of waist:hip ratio (OR = 5.7; 95% CI: 3.8, 8.6). In multivariate logistic regression models, adjustment for waist:hip ratio reduced the odds ratio for later-stage disease in African-American women by 20%; adjustment for both waist:hip ratio and severe obesity reduced the odds ratio by 27%. These observations suggest that obesity and body fat distribution, in addition to socioeconomic and medical care factors, contribute to racial differences in stage at breast cancer diagnosis.
anthropometry; blacks; breast neoplasms; mammography; neoplasm staging; obesity
Abbreviations: CI, confidence interval; OR, odds ratio; TNM, tumor-node-metastasis.
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