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

项目摘要/摘要 尽管普通人群的乳腺癌发病率和死亡率有所改善，但乳腺癌 黑人女性的发病率持续上升，她们的乳腺癌死亡率最高 在任何其他种族的人口中。增加乳房X光照相密度已被公认为 最强的、独立的乳腺癌风险因素。然而，到目前为止，很少有研究表明 将黑人女性包括在我们对乳房X光检查乳房密度的理解中，这是一个重要的 考虑到黑人女性更有可能拥有更密集的乳房，这一点是有限制的。乳腺癌的差异很可能 多因素和由健康的社会决定因素的相关组合推动的，黑色数据的匮乏 女性对乳房密度对癌症差异的贡献的了解有限。而当 种族，一种社会结构，不太可能是乳房X光检查密度的直接预测因素，它可以作为 由于不同的文化实践、环境暴露和体验而产生的不同的生活体验 结构性种族主义。童年、青春期和怀孕代表着乳房发育和 对这种暴露和宿主因素的易感性。事实上，黑人女性表现出不同的人体测量和 生殖模式-已知的白人女性乳房X光检查密度的贡献者-在她们的 生命历程。我们假设身体和性成熟特征的独特分布在 童年和青春期，以及成年后不同的生殖结果，可能在一定程度上解释了 黑人女性中高密度乳房X光检查的发生率增加。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)，我们已经发展出了一大批 由10,000多名参与者组成的乳房X光片库。利用这一分析工具，在目标1中，我们将 确定人体测量、身体习性和性发育特征之间的关系 乳房X光摄影密度百分比和绝对密度的生命历程。目标2将探索两者之间的联系 与妊娠相关的特定特征以及乳房X光摄影的百分比和绝对密度。这将是 第一项评估从出生到成年的因素作为黑人女性乳房X光检查密度预测因素的研究。 这些目标的成功完成将有助于深入了解乳房X光检查密度增加的原因。 并有助于更好地了解乳腺癌发病率和生存差距 这些脆弱的人群。该建议还融合了先进的流行病学技术和基本的 生物统计学技能和临床培训，为PI成为一名独立的内科科学家做好准备 在癌症健康差异研究方面的专业知识。

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.