1998 WHRG Grant Program

Faculty

Grant Program
- Application Form
- Application Guidelines
- Grant Recipients

Symposia

Obesity, Race, and Stage of Breast Cancer at Diagnosis
Yadong Cui, M.P.H., M.D.
School of Medicine, University of Maryland, Baltimore

Introduction: Breast cancer is the most common cancer among women in the United States. Breast cancer survival is worse among black women compared with white women. Clinical stage is an explanatory factor for overall differences in survival. There is a well established racial difference in the stage at diagnosis of breast cancer: black women are more likely to be at a later stage at diagnosis relative to white women, which, in part, has been traditionally attributed to social/cultural factors of tumor biology. Black/white differences in the prevalence of obesity have been documented. The tendency for black women to be heavier than white women has also been reported in studies of breast cancer cases. In most studies, obesity is associated with late stage breast cancer at diagnosis. It is important to examine to what extent the racial difference in stage at diagnosis can be explained by the observed racial difference in the prevalence of obesity.

Hypothesis: Obesity may be an important factor in explaining more advanced stage of primary breast cancer at diagnosis in black women compared to white women. This study aims to assess to what extent the race-stage association can be explained by racial differences in obesity.

Study Design and Methods: This preliminary study is a cross-sectional assessment of race, obesity, and stage of breast cancer at diagnosis. Fifty black women as well as 50 white women with breast cancer will be identified from three selected Baltimore metropolitan area hospitals. The outcome variable is breast cancer stage at diagnosis. Main study variables are race and obesity at the time of diagnosis of breast cancer. All patient information including age, race, weight, height, menopausal status, pathology report, and treatments will be obtained from hospital medical records. Statistical analysis will be done to assess the association between race and breast cancer stage, the association between race and obesity, as well as the association between obesity and breast cancer stage. The extent to which obesity acts as an explanatory factor for the black/white difference in stage at diagnosis of breast cancer will be evaluated by bivariate and multiple regression analysis.

Public Health Impact: The proposed study will contribute to the understanding of the role of obesity in explaining the black/white difference in stage of breast cancer at diagnosis. Other hypothesized causes for the later stage at diagnosis in blacks compared to whites have included racial difference in socioeconomic status, differences in access to health care, and the related issue of screening behavior. Given that obesity may be more amenable to intervention than social/cultural influences, it is important for the goal of end points for interventions so that racial differences in disease stage at diagnosis and survival can be reduced or eliminated.