16,898 research outputs found

    High serum estradiol confers no risk for breast cancer: another disparity for sub Saharan Africa women

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    Introduction: There are breast cancer epidemiological and tumor behaviour disparities between black women in sub Saharan Africa and their counter parts in western high resource countries. In Uganda, the incidence of breast cancer has nearly tripled in over a four decades for uncertain reasons. High serum estradiol is a known risk factor for breast cancer among women in high resourced nations. The objective of this study was to establish whether high serum estradiol is an associated risk for breast cancer amongst a group of black Ugandan women. Methods: A case control study, conducted over eight month period with incident breast cancer as cases and the controls were without breast cancer but at risk and representative of the population from which the cases were chosen. Questionnaires were administered, clinical examination was done, serum estradiol level estimation was done using cobase immunoassay analyzer using Electro chemiluminescence Immuno assay (ECLIA). Data was analyzed using logistic regression model, and a p - value of less than 0.05 was considered significant. IRB approval was secured. Results: A total of 140 women participated, 70 cases and 70 controls. The median estrogen levels was 43.2 pg/ml with IQR of 18.48 to 75.8 pg/ml, the value was higher among premenopausal women than those without cancer but with no statistical significance. No association was found between level of estradiol and breast cancer (p 0.647). The median oestrogen levels were significantly higher than normal levels in Caucasian women. Conclusion: There was no association between level of estradiol and breast cancer. This is yet another disparity between women of African origin and the non Africans in high resourced countries. There is need to explore more to explain this disparity. Pan African Medical Journal 2012; 12:2

    Evaluation of the Program Delivery of Every Women\u27s Life in Virginia

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    Introduction: Among women, breast cancer is the most prevalent cancer and the second leading cause of cancer death. Although technology advances have improved survival rates for breast cancer overall, improvements have not been universally experienced by all socioeconomic and racial groups. Known determinants of breast cancer care disparities include socioeconomic status, race, age, and social support. As a part of the Breast and Cervical Cancer Mortality Prevention Act of 1990 and with the help of CDC funding, the Virginia Breast and Cervical Cancer Early Detection Program (BCCEDP) or Every Woman’s Life (EWL) was created. EWL provides breast cancer screening to female VA residents between the ages of 18 and 64 who lack health insurance and fall at or below 200% of the Federal Poverty Level. Objective: The purpose of this study is to determine if delays in the diagnosis and treatment of breast cancer, within the VDH program EWL, differs based on sociodemographic characteristics and/ or regional location. Methods: From its inception to July 2008, 705 women received a breast cancer diagnosis through the EWL program. For these 705 cases prevalence and crude odds ratios were calculated for both diagnosis and treatment delays for all of the demographic variables along with 95% confidence intervals. Adjusted odds ratios were calculated for sociodemographic variables against screening to diagnosis delays and diagnosis to treatment disparities along with 95% confidence intervals. Results: According to the crude odds ratios more women who fall into the other category of race experienced diagnosis delays (OR=2.28 [1.11, 4.67]), but they were more likely to receive treatment in a timely manner (OR=0.29 [0.11, 0.79]). Women living alone were also more likely to experience diagnosis delays (OR=1.49 [1.10, 3.02]). Hispanic women were more likely to receive treatment in a more timely manner than non-Hispanic women (OR=0.21 [0.05, 0.81]). Also, women being treated in any other region than northern VA were more likely to experience treatment delays. However, according to the adjusted odds ratios, the only significant timing delay was the one experienced more often by women in the other race category. Conclusion: The research indicates known indicators of disparities within cancer care as socioeconomic status, race, ethnicity, age, and social support. The findings of this study indicate that the only significant indicator of disparity within the Every Women’s Life program is race. Although, African-American women were just as likely to receive timely diagnosis and treatment as white women in the program, it was the combined groups of Asian, American Indian, and other women that were more likely to experience diagnosis, but not treatment, delays. The fact that no other significant indicators of disparities were found within EWL indicates a success of the program, as EWL is targeting those women that would have otherwise been missed by the system

    Allele-specific disparity in breast cancer

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    Background In a cancer cell the number of copies of a locus may vary due to amplification and deletion and these variations are denoted as copy number alterations (CNAs). We focus on the disparity of CNAs in tumour samples, which were compared to those in blood in order to identify the directional loss of heterozygosity. Methods We propose a numerical algorithm and apply it to data from the Illumina 109K-SNP array on 112 samples from breast cancer patients. B-allele frequency (BAF) and log R ratio (LRR) of Illumina were used to estimate Euclidian distances. For each locus, we compared genotypes in blood and tumour for subset of samples being heterozygous in blood. We identified loci showing preferential disparity from heterozygous toward either the A/B-allele homozygous (allelic disparity). The chi-squared and Cochran-Armitage trend tests were used to examine whether there is an association between high levels of disparity in single nucleotide polymorphisms (SNPs) and molecular, clinical and tumour-related parameters. To identify pathways and network functions over-represented within the resulting gene sets, we used Ingenuity Pathway Analysis (IPA). Results To identify loci with a high level of disparity, we selected SNPs 1) with a substantial degree of disparity and 2) with substantial frequency (at least 50% of the samples heterozygous for the respective locus). We report the overall difference in disparity in high-grade tumours compared to low-grade tumours (p-value < 0.001) and significant associations between disparity in multiple single loci and clinical parameters. The most significantly associated network functions within the genes represented in the loci of disparity were identified, including lipid metabolism, small-molecule biochemistry, and nervous system development and function. No evidence for over-representation of directional disparity in a list of stem cell genes was obtained, however genes appeared to be more often altered by deletion than by amplification. Conclusions Our data suggest that directional loss and amplification exist in breast cancer. These are highly associated with grade, which may indicate that they are enforced with increasing number of cell divisions. Whether there is selective pressure for some loci to be preferentially amplified or deleted remains to be confirmed

    Improving breast cancer services for African-American women living in St. Louis

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    A mixed methods, community-based research study was conducted to understand how provider-level factors contribute to the African-American and white disparity in breast cancer mortality in a lower socioeconomic status area of North St. Louis. This study used mixed methods including: (1) secondary analysis of Missouri Cancer Registry data on all 885 African-American women diagnosed with breast cancer from 2000 to 2008 while living in the geographic area of focus; (2) qualitative interviews with a subset of these women; (3) analysis of data from electronic medical records of the women interviewed; and (4) focus group interviews with community residents, patient navigators, and other health care professionals. 565 women diagnosed with breast cancer from 2000 to 2008 in the geographic area were alive at the time of secondary data analysis; we interviewed (n = 96; 17 %) of these women. Provider-level obstacles to completion of prescribed treatment included fragmented navigation (separate navigators at Federally Qualified Health Centers, surgical oncology, and medical oncology, and no navigation services in surgical oncology). Perhaps related to the latter, women described radiation as optional, often in the same words as they described breast reconstruction. Discontinuous and fragmented patient navigation leads to failure to associate radiation therapy with vital treatment recommendations. Better integrated navigation that continues throughout treatment will increase treatment completion with the potential to improve outcomes in African Americans and decrease the disparity in mortality