RESUMO
PURPOSE: Given the increasing number and diversity of cancer survivors in the USA and persistent racial/ethnic disparities in breast cancer care, we sought to examine the role of acculturation in adherence to recommended surgical treatment and survivorship care recommendations. METHODS: Study participants included 343 Mexican American women with stage I to III breast cancer who participated in the Ella Binational Breast Cancer Study and were treated at The University of Texas MD Anderson Cancer Center in Houston, Texas, between March 2007 and June 2011. Participants completed a questionnaire measuring acculturation, and clinical and demographic variables were obtained from an institutional database. Multivariable logistic regression models were constructed to examine differences in surgical procedures received and adherence to long-term survivorship care by acculturation level. RESULTS: Bilingual (odds ratio [OR] = 1.85; 95% confidence interval [CI] = 0.85-4.02, P = .11) and English-dominant women (OR = 2.39; 95% CI = 1.02-5.61, P = .04) were more likely to receive breast-conserving surgery (versus mastectomy) than were Spanish-dominant women. Among all patients, adherence to surveillance mammography and clinic visits decreased over time; the decline in clinic visit adherence was statistically significant (P = .005). Although no statistically significant association was found between acculturation and adherence to long-term survivorship care, receipt of breast-conserving surgery (versus mastectomy) was significantly associated with higher adherence to surveillance mammograms. CONCLUSION: Acculturation may play a role in decision-making about surgical management of breast cancer, and further studies with larger samples are needed to explore its role in adherence to survivorship care recommendations. Findings from this study may help identify patients requiring additional support while making decisions pertaining to their cancer treatment and survivorship care.
Assuntos
Aculturação , Neoplasias da Mama/terapia , Sobrevivência , Idoso , Neoplasias da Mama/mortalidade , Sobreviventes de Câncer , Feminino , Humanos , Mastectomia/estatística & dados numéricos , Americanos Mexicanos , TexasRESUMO
BACKGROUND: Incidence rates for breast cancer are higher among Mexican-American (MA) women in the United States than women living in Mexico. Studies have shown higher prevalence of breast cancer risk factors in more acculturated than less acculturated Hispanic/Latinas in the United States. We compared the prevalence of behavioral risk factors and family history of breast cancer by level of acculturation and country of residence in women of Mexican descent. METHODS: Data were collected from 1,201 newly diagnosed breast cancer patients living in Mexico (n = 581) and MAs in the United States (n = 620). MA participants were categorized into three acculturation groups (Spanish dominant, bilingual, and English dominant); women living in Mexico were used as the referent group. The prevalence of behavioral risk factors and family history of breast cancer were assessed according to acculturation level, adjusting for age at diagnosis and education. RESULTS: In the adjusted models, bilingual and English-dominant MAs were significantly more likely to have a body mass index of 30 kg/m(2) or greater, consume more than one alcoholic beverage a week, and report having a family history of breast cancer than women living in Mexico. All three U.S. acculturation groups were significantly more likely to have lower total energy expenditure (≤533 kcal/d) than women in Mexico. English-dominant women were significantly less likely to ever smoke cigarettes than the Mexican group. CONCLUSIONS: Our findings add to the limited scientific literature on the relationships among acculturation, health behavior, and family history of breast cancer in Mexican and MA women.
Assuntos
Aculturação , Neoplasias da Mama/prevenção & controle , Comportamentos Relacionados com a Saúde/etnologia , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Adulto , Idoso , Neoplasias da Mama/etnologia , Neoplasias da Mama/psicologia , Família , Feminino , Predisposição Genética para Doença , Inquéritos Epidemiológicos , Humanos , Idioma , Estilo de Vida , Modelos Logísticos , Mamografia/psicologia , Programas de Rastreamento/psicologia , Americanos Mexicanos/psicologia , Americanos Mexicanos/estatística & dados numéricos , México/etnologia , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Fatores de Risco , Identificação Social , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: We compared the distribution of breast cancer reproductive and hormonal risk factors by level of acculturation and country of residence in women of Mexican descent. METHODS: To compare the distribution of breast cancer reproductive and hormonal risk factors by level of acculturation and country of residence in women of Mexican descent, taking into account level of education, we analyzed data on 581 Mexican and 620 Mexican American (MA) women with a history of invasive breast cancer from the Ella Binational Breast Cancer Study. An eight-item language-based acculturation measure was used to classify MA women. Multivariate logistic regression was used to test associations between language acculturation, country of residence, and reproductive and hormonal risk factors. RESULTS: After adjustment for age and education, compared to women residing in Mexico, English-dominant MAs were significantly more likely to have an earlier age at menarche (<12 years; odds ratio [OR]=2.08; 95% confidence interval [CI], 1.30-3.34), less likely to have a late age at first birth (≥30 years; OR=0.49; 95% CI, 0.25-0.97), and less likely to ever breastfeed (OR=0.13; 95% CI, 0.08-0.21). CONCLUSIONS: Differences in reproductive and hormonal risk profile according to language acculturation and country of residence are evident; some of these were explained by education. Results support continued efforts to educate Mexican and MA women on screening and early detection of breast cancer along with promotion of modifiable factors, such as breastfeeding.
Assuntos
Aculturação , Neoplasias da Mama/prevenção & controle , Idioma , Americanos Mexicanos/psicologia , Adulto , Distribuição por Idade , Idoso , Arizona/epidemiologia , Neoplasias da Mama/etnologia , Neoplasias da Mama/psicologia , Feminino , Humanos , Entrevistas como Assunto , Modelos Logísticos , Americanos Mexicanos/estatística & dados numéricos , México/etnologia , Pessoa de Meia-Idade , Análise Multivariada , História Reprodutiva , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Texas/epidemiologiaRESUMO
BACKGROUND: Published data support the presence of etiologic heterogeneity by breast tumor subtype, but few studies have assessed this in Hispanic populations. METHODS: We assessed tumor subtype prevalence and associations between reproductive factors and tumor subtypes in 1,041 women of Mexican descent enrolled in a case-only, binational breast cancer study. Multinomial logistic regression comparing HER2(+) tumors and triple-negative breast cancer (TNBC) to luminal A tumors was conducted. RESULTS: Compared with women with luminal A tumors, those with a later age at first pregnancy were less likely to have TNBC [OR, 0.61; 95% confidence interval (CI), 0.39-0.95], whereas those with three or more full-term pregnancies were more likely to have TNBC (OR, 1.68; 95% CI, 1.10-2.55). A lower odds of TNBC was shown for longer menstruation duration, whether before first pregnancy (OR, 0.78; 95% CI, 0.65-0.93 per 10 years) or menopause (OR, 0.79; 95% CI, 0.69-0.91 per 10 years). Patients who reported breastfeeding for more than 12 months were over twice as likely to have TNBC than luminal A tumors (OR, 2.14; 95% CI, 1.24-3.68). Associations comparing HER2(+) with luminal A tumors were weak or nonexistent except for the interval between last full-term pregnancy and breast cancer diagnosis. CONCLUSIONS: Findings show etiologic heterogeneity by tumor subtype in a population of Hispanic women with unique reproductive profiles. IMPACT: Identification of etiologically distinct breast tumor subtypes can further improve our understanding of the disease and help provide personalized prevention and treatment regimens.
Assuntos
Neoplasias da Mama/classificação , Neoplasias da Mama/etnologia , História Reprodutiva , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Feminino , Humanos , Americanos Mexicanos , México/epidemiologia , Pessoa de Meia-Idade , Gravidez , Prevalência , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Obesity at diagnosis of breast cancer is associated with higher all-cause mortality and treatment-associated toxicities. We evaluated the association between parity and obesity in the Ella study, a population of Mexican and Mexican-American breast cancer patients with high parity. Obesity outcomes included body mass index (BMI) ≥30 kg/m(2), waist circumference (WC) ≥35 in (88 cm), and waist-to-hip-ratio (WHR) ≥0.85. Prevalence of obesity ([BMI] ≥ 30 kg/m(2)) was 38.9 %. For WC, the multivariate odds ratio (OR) (95 % confidence interval [CI]) for having WC ≥ 35 inches in women with ≥4 pregnancies relative to those with 1-2 pregnancies was 1.59 (1.01-2.47). Higher parity (≥4 pregnancies) was non-significantly associated with high BMI (OR = 1.10; 95 % CI 0.73-1.67). No positive association was observed for WHR. Our results suggest WC is independently associated with high parity in Hispanic women and may be an optimal target for post-partum weight loss interventions.
Assuntos
Americanos Mexicanos , Obesidade/etnologia , Paridade , Feminino , Humanos , México , Pessoa de Meia-Idade , Gravidez , Estados Unidos , Circunferência da CinturaRESUMO
Breast cancer incidence rates have declined among older but not younger women; the latter are more likely to be diagnosed with breast cancers carrying a poor prognosis. Epidemiological evidence supports an increase in breast cancer incidence following pregnancy with risk elevated as much as 10 years post-partum. We investigated the association between years since last full-term pregnancy at the time of diagnosis (≤10 or >10 years) and breast tumor subtype in a case series of premenopausal Hispanic women (n = 627). Participants were recruited in the United States, Mexico, and Spain. Cases with known estrogen receptor (ER), progesterone receptor (PR), and HER2 status, with one or more full-term pregnancies ≥1 year prior to diagnosis were eligible for this analysis. Cases were classified into three tumor subtypes according to hormone receptor (HR+ = ER+ and/or PR+; HR- = ER- and PR-) expression and HER2 status: HR+/HER2-, HER2+ (regardless of HR), and triple negative breast cancer. Case-only odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for HER2+ tumors in reference to HR+/HER2- tumors. Participants were pooled in a mixed-effects logistic regression model with years since pregnancy as a fixed effect and study site as a random effect. When compared to HR+/HER2- cases, women with HER2+ tumors were more likely be diagnosed in the post-partum period of ≤10 years (OR = 1.68; 95 % CI, 1.12-2.52). The effect was present across all source populations and independent of the HR status of the HER2+ tumor. Adjusting for age at diagnosis (≤45 or >45 years) did not materially alter our results (OR = 1.78; 95 % CI, 1.08-2.93). These findings support the novel hypothesis that factors associated with the post-partum breast, possibly hormonal, are involved in the development of HER2+ tumors.
Assuntos
Neoplasias da Mama/metabolismo , Receptor ErbB-2/metabolismo , Adulto , Neoplasias da Mama/epidemiologia , Feminino , Hormônios Esteroides Gonadais/fisiologia , Hispânico ou Latino , Humanos , Incidência , Modelos Logísticos , México/epidemiologia , Pessoa de Meia-Idade , Hormônios Placentários/fisiologia , Gravidez , Pré-Menopausa , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Espanha/epidemiologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: This study examined factors that influence mammography use and breast cancer detection, including education, health insurance, and acculturation, among Mexican-American (MA) and African-American (AA) women. METHODS: The study included 670 breast cancer cases (388 MAs and 282 AAs), aged 40-86 years at diagnosis. Data on mammography use, detection, and delay in seeking care were collected via questionnaires and medical records. Using a language-based bidimensional acculturation measure, MAs were classified as English-dominant (n = 67), bilingual (n = 173), and Spanish-dominant (n = 148). Mammography prior to diagnosis was assessed by racial/ethnic acculturation subgroup using logistic regression. RESULTS: In age-adjusted models, mammography use was non-significantly lower among English-dominant (OR = 0.84; 95% CI: 0.45-1.59) and bilingual (OR = 0.86; 95% CI: 0.55-1.35) MAs and significantly lower among Spanish-dominant MAs (OR = 0.53; 95% CI: 0.34-0.83) than among AA women. After adjustment for education or insurance, there was no difference in mammography use by race/ethnicity and acculturation subgroup. Despite high self-reported mammography use (75%), a large proportion of cases reported self-detection (59%) and delay in seeking care >90 days (17%). CONCLUSIONS: These findings favor promoting culturally appropriate messaging about the benefits and limitations of mammography, education about breast awareness, and prompt reporting of findings to a health professional.
Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etnologia , Mamografia/métodos , Americanos Mexicanos/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Overall, Latinas are more likely to be diagnosed with a more advanced stage of breast cancer and are 20% more likely to die of breast cancer than non-Hispanic white women. It is estimated that from 2003 to 2006, $82.0 billion in direct medical care expenditures, in addition to 100,000 lives annually, could be saved by eliminating health disparities experienced by Latinos and increasing the use of up to 5 preventive services in the United States. An additional 3700 lives could be saved if 90% of women aged ≥40 years were recently screened for breast cancer. METHODS: The authors examined the risk for breast cancer in a case-control, population-based sample of Mexican-origin women in Harris County, Texas (n=714), where the rates of breast cancer mortality for Latina women have doubled since 1990. RESULTS: Half of breast cancer cases (n=119) were diagnosed in women aged <50 years. In a multivariate model, women who had a family history of breast cancer (odds ratio [OR], 4.3), who were born in Mexico and had high levels of language acculturation (OR, 2.5), and who did not have health insurance (OR, 1.6) had the highest risk for breast cancer. CONCLUSIONS: Because the current results indicated that Mexican-origin women are at high-risk for early onset, premenopausal breast cancer, the authors recommended policies that target screening, education, and treatment to prevent increased disparities in mortality. The authors concluded that the inclusion of community members and policymakers as partners in these endeavors would further safeguard against an increase in cancer health disparities and aid in formulating a policy agenda congruent with scientifically based, community-driven policy efforts that address breast cancer screening, education, and treatment in this vulnerable population.
Assuntos
Neoplasias da Mama/prevenção & controle , Comportamentos Relacionados com a Saúde , Política de Saúde , Disparidades em Assistência à Saúde , Americanos Mexicanos , Fatores Socioeconômicos , Adulto , Detecção Precoce de Câncer , Saúde da Família , Feminino , Educação em Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Pré-Menopausa , Medicina Preventiva , Risco , Estados UnidosRESUMO
Optimal athletic performance requires adequate nutritional support. This mean getting enough food to meet increased energy needs and a wide variety to ensure adequate nutrient intake. The main energy source should be carbohydrate. Dietary guidelines for healthy eating apply to athletes and diabetics alike. This study evaluated the diets of young athletes for nutritional adequacy and determined the effect on their performance. Sample selection was based on convenience and included normal and diabetic athletes, mainly swimmers and footballers. Attitudes and practices were determined by questionnaire and a 24-hour recall provided data on nutrient intake. BMI and body fat were calculated. Results showed that the nutritional factor most likely to be low was energy. in many cases, this correlated with the athlete's perception of performance. Vitamin and mineral intakes were generally adequate but fibre intake tended to be low. This may be related to the sparsity of fruits and vegetables for many. The main sources of carbohydrate were refined cereals and sugars. Carbohydrate intake ranged from 50-60 percent of calories. Fat intake was relatively high and protein substantial. Most had BMIs above average, with a few underweight and two marginally overweight. Performance was related to quality of diet and importance placed on nutrition. Also critical was the level of training and self-esteem score.(AU)