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American Journal of Epidemiology Advance Access originally published online on August 24, 2005
American Journal of Epidemiology 2005 162(8):734-742; doi:10.1093/aje/kwi278
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

ORIGINAL CONTRIBUTIONS

Risk Factors for Fatal Breast Cancer in African-American Women and White Women in a Large US Prospective Cohort

Marjorie L. McCullough, Heather Spencer Feigelson, W. Ryan Diver, Alpa V. Patel, Michael J. Thun and Eugenia E. Calle

From the Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA

Correspondence to Dr. Marjorie McCullough, Department of Epidemiology and Surveillance Research, American Cancer Society, 1599 Clifton Road, NE, Atlanta, GA 30329-4251 (e-mail: marji.mccullough{at}cancer.org).

African-American women have a higher lifetime risk of fatal breast cancer than do White women. Recent studies suggest that breast cancer risk factors may vary by race. The authors examined risk factors for fatal breast cancer in postmenopausal African-American women and White women in a large US prospective cohort. In 1982, 21,143 African-American women and 409,093 White women in the Cancer Prevention Study II completed a questionnaire on reproductive, medical, anthropometric, and demographic factors. During a 20-year follow-up, 257 deaths from breast cancer occurred among African-American women and 4,265 among Whites. Cox proportional hazards modeling was used to calculate multivariate-adjusted rate ratios, stratified by race. Higher body mass index, taller height, and physical inactivity were associated with increased breast cancer mortality rates in both groups. A college education was associated with higher mortality from breast cancer only in Africa-American women (hazard ratio = 1.62, 95% confidence interval: 1.13, 2.30; ptrend = 0.01, vs. less than a high school education). Most other risk factors were associated with breast cancer rates similarly in both groups. With few exceptions, established breast cancer risk factors were similarly associated with risk of death from breast cancer among African-American women and White women.

African Americans; body mass index; breast neoplasms; cohort studies; education; exercise; reproductive behavior; risk factors

Abbreviations: CI, confidence interval; HR, hazard ratio


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