Risk factors for breast cancer subtypes in racial/ethnic minorities

 描述（由申请人提供）：乳腺癌发病率的种族/民族差异已得到充分记录，但这些差异背后的原因仅部分了解。在种族/少数民族人群中进行的研究相对较少，有些研究得出的风险因素与非西班牙裔白色妇女报告的风险因素不同。此外，大多数针对少数人群的研究都对乳腺癌的风险因素进行了整体评估，尽管越来越多的证据表明乳腺癌是一种异质性疾病，乳腺癌亚型的风险因素不同，由雌激素受体（ER），孕酮受体（PR）和人表皮生长因子受体-2（HER 2）状态定义。目前已知的大多数乳腺癌风险因素适用于激素受体阳性（ER+和/或PR+）或管腔A（ER+和/或PR+，HER 2）肿瘤。很少有研究关注不太常见的亚型的风险因素，如激素受体阴性（ER-PR-）、三阴性（ER-PR-HER 2-）或HER 2过表达（ER-PR-HER 2+）肿瘤。关于不太常见亚型的风险因素的报告，除少数例外，基于小病例数，主要包括非西班牙裔白色女性。鉴于乳腺癌亚型在种族/民族群体中分布不均，少数群体中侵袭性亚型的发生率较高，因此在少数群体中进行病因学研究评估与特定乳腺癌亚型相关的风险因素非常重要。为了解决这一重大的知识差距，我们将汇集现有的采访和癌症登记数据，9,000例乳腺癌病例和7,855例对照，他们参加了五项基于人群的研究。参与者年龄范围广泛（18-79岁），71%的病例和66%的对照组为少数种族/族裔（西班牙裔，亚裔美国人，非洲裔美国人，非西班牙裔白人）。在目标1中，我们将评估乳腺癌亚型的危险因素，并评估年龄和绝经状态的异质性。使用多分类logistic回归，我们将评估亚型与广泛的风险因素的关联，包括乳腺癌家族史，激素因素和可改变的生活方式因素。在目标2中，我们将评估mai亚型的风险因素是否在种族/民族群体中存在差异。利用现有数据，这项研究将提供关于不太常见的乳腺癌亚型的风险因素的急需信息，并将允许直接比较多个种族/族裔群体的亚型特异性风险因素。 这些资料将有助于制定与具体种族/族裔群体直接相关的预防战略。

 DESCRIPTION (provided by applicant): Racial/ethnic differences in breast cancer incidence have been well documented, yet the reasons underlying these differences are only partially understood. Relatively few studies have been conducted in racial/ethnic minority populations and some have produced findings on risk factors that are different from those reported for non-Hispanic White women. Furthermore, most studies in minority populations have assessed risk factors for breast cancer overall, despite growing evidence that breast cancer is a heterogeneous disease, with risk factors that differ for breast cancer subtypes defined by estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) status. Most currently known breast cancer risk factors apply to hormone receptor positive (ER+ and/or PR+) or Luminal A (ER+ and/or PR+, HER2) tumors. Few studies have focused on risk factors for the less common subtypes, such as hormone receptor negative (ER- PR-), triple negative (ER-PR-HER2-), or HER2 over-expressing (ER-PR-HER2+) tumors. Reports on risk factors for the less common subtypes were, with a few exceptions, based on small case numbers and included primarily non-Hispanic white women. Given that breast cancer subtypes are not equally distributed across racial/ethnic groups, with a higher incidence of aggressive subtypes in minority populations, it is important that etiologic studies in minority populations assess risk factors in relation to specific breast cancer subtypes. To address this significant gap in knowledge, we will pool existing interview and cancer registry data for 9,000 breast cancer cases and 7,855 controls who participated in five population-based studies. Participants cover a broad age range (18-79 years) and 71% of cases and 66% of controls are racial/ethnic minorities (Hispanics, Asian Americans, African Americans, non-Hispanic whites). In Aim 1, we will evaluate risk factors for breast cancer subtypes and assess heterogeneity by age and menopausal status. Using polytomous logistic regression, we will assess associations of subtypes with a broad set of risk factors, including family history of breast cancer, hormonal factors and modifiable lifestyle factors. In Aim 2, we will assess whether risk factors for the mai subtypes differ across racial/ethnic groups. Leveraging existing data, this study will provide much needed information about risk factors for the less common breast cancer subtypes and will allow direct comparison of subtype-specific risk factors across multiple racial/ethnic groups. Such information will inform the development of preventive strategies that are directly relevant for specific racial/ethnic groups.