Life Course Developmental and Reproductive Predictors of Increased Mammographic Breast Density in Black Women

项目概要/摘要 尽管普通人群中乳腺癌的发病率和死亡率有所改善， 黑人妇女的发病率持续上升，她们的乳腺癌死亡率最高 比其他种族都要多乳腺摄影密度的增加已经被公认为 最强的独立乳腺癌风险因素。然而，到目前为止，很少有研究表明， 我已经将黑人妇女纳入我们对乳房X光检查乳腺密度的理解，这是一个重要的 限制，因为黑人女性更有可能有致密的乳房。乳腺癌的差异很可能 多因素，并由健康的社会决定因素的相关组合驱动， 妇女对乳腺癌的认识导致对乳腺密度对癌症差异的影响了解有限。而 种族是一种社会结构，不太可能直接预测乳房X线摄影密度，它可以作为一个标志， 不同的生活经验，由于不同的文化习俗，环境暴露，和经验， 结构性种族主义儿童期、青春期和妊娠期代表乳房发育增加的时期， 易受此类暴露和宿主因素的影响。事实上，黑人女性的人体测量和 生殖模式-这是已知的贡献者乳房摄影密度在白色妇女-在他们的 生命历程我们假设，在发育过程中， 儿童期和青春期，以及成年期不同的生殖结果可能部分解释了 黑人妇女乳腺X线摄影高密度的发病率增加。利用黑人妇女健康研究， 作为美国最大的黑人女性群体（59，000名女性），我们已经开发了一个大型的 乳房X光照片储存库，由超过10，000名参与者组成。利用这一分析工具，在目标1中，我们将 确定人体测量，体型和性发育特征之间的关联， 乳腺摄影密度的百分比和绝对值。Aim 2将探讨 具体的妊娠相关特征以及乳房X线摄影密度百分比和绝对值。这将是 第一项研究评估从出生到成年的因素作为黑人妇女乳腺摄影密度的预测因素。 这些目标的成功完成将为深入了解乳腺X线摄影密度增加的病因提供帮助。 黑人妇女，有助于更好地了解乳腺癌的发病率和生存差异， 这个弱势群体。该提案还整合了先进的流行病学技术和基本的 生物统计技能与临床培训，准备PI的职业生涯作为一个独立的医生科学家， 癌症健康差异研究的专业知识。

PROJECT SUMMARY/ABSTRACT Despite improvements in breast cancer incidence and mortality rates in the general population, breast cancer incidence rates in Black women have continued to rise and they exhibit the highest breast cancer mortality rate out of any other racial population. Increased mammographic density has been well established as one of the strongest, independent breast cancer risk factors. However, to date, there have been very few studies that have included Black women in our understanding of mammographic breast density, which is a significant limitation given that Black women are more likely to have denser breasts. Breast cancer disparities are likely multifactorial and driven by related combinations of social determinants of health, the paucity of data in Black women has resulted in a limited understanding of the contribution of breast density to cancer disparities. While race, a social construct, is an unlikely direct predictor of mammographic density, it can serve as a marker of differential lived experiences due to various cultural practice, environmental exposures, and experiences of structural racism. Childhood, puberty, and pregnancy represent times of increased breast development and susceptibility to such exposures and host factors. In fact, Black women display differing anthropometric and reproductive patterns – which are known contributors to mammographic density in white women – across their life course. We hypothesize that unique distributions of body and sexual maturation characteristics during childhood and puberty, and varying reproductive outcomes during adulthood may, in part, explain the increased incidence of high mammographic density in Black women. Using the Black Women’s Health Study, the largest cohort of Black women in the United States (59,000 women), we have developed a large mammogram repository consisting of over 10,000 participants. Leveraging this analytic tool, in Aim 1, we will determine the associations of anthropometric, body habitus, and sexual development characteristics across the life course with percent and absolute mammographic density. Aim 2 will explore the association between specific pregnancy-related characteristics and percent and absolute mammographic density. This will be the first study to assess factors from birth to adulthood as predictors of mammographic density in Black women. Successful completion of these aims will offer insight into the etiology of increased mammographic density in Black women and contribute to a better understanding of breast cancer incidence and survival disparities in this vulnerable population. This proposal also integrates advanced epidemiologic techniques and fundamental biostatistical skills with clinical training to prepare the PI for a career as an independent physician scientist with expertise in cancer health disparities research.