Elisa V. Bandera, MD, PhD

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1 Elisa V. Bandera, MD, PhD Associate Professor of Epidemiology Rutgers Cancer Institute of New Jersey Rutgers School of Public Health American Institute for Cancer Research Annual Conference on Food, Nutrition, Physical Activity and the Prevention of Cancer. October 2014

2

3 Breast Cancer Incidence

4 Breast Cancer Mortality

5 Breast Cancer Incidence and Mortality by Race and Ethnicity, US, American Cancer Society, Breast Cancer Facts and Figures

6 Non-Hispanic White African American Asian American/Pacific Islander American Indian/Alaska Native Hispanic/Latina DeSantis et al. Breast Cancer Statistics CA Cancer J Clin 2014; 64:52-62.

7 Why is the burden of breast cancer not the same for all women? Risk factors Early Menarche Late Menopause No full term pregnancies Late age at first birth No breastfeeding Hormone Therapy Hormones Biomarkers Body composition Obesity Prognostic factors Subtypes Presentation Suboptimal Treatment Comorbidities Treatment/control of comorbidities Chemotoxicities Access to care Risk and prognostic factors are different in minority populations and most are affected by obesity

8 Prevalence of overweight or obese* by age and race/hispanic origin, Girls, United States, Age group 2-5 y 6-11 y y 42.5% 43.6% 32.7% 31.0% 36.9% 28.1% 36.5% 19.9% 21.6% 14.9% 15.0% 9.7% NH White NH Black NH Asian Hispanic (*BMI for age 85 th percentile of the CDC growth charts) (Ogden et al., JAMA 2014; 311: )

9 Age-adjusted prevalence of overweight or obese by race/hispanic origin, Females, United States, Race/Ethnic group NH White NH Black NH Asian Hispanic 82.0% 77.2% 63.2% 56.6% 44.4% 34.7% 32.8% 11.4% Overweight or Obese (BMI>25) Obese (BMI>30) (Ogden et al., JAMA 2014; 311: )

10 Age-adjusted prevalence (%) Age-adjusted prevalence of abdominal obesity by race/hispanic origin, Females, United States, Abdominal obesity: waist circumference>88 cm NH Whites NH Black Mexican American 50 (Ford et al., JAMA 2014; 312: )

11 Obesity Obesity Diet (Uauy and Solomons, J Nutr 2005)

12 Weight/BMI Birth weight Childhood/Adolescence Young adult (18-20 y) Pre-menopause Post-menopause Breast cancer risk Current evidence mostly based on studies conducted in white women

13 Subgroup Premenopausal Postmenopausal No. studies RR (95% CI) I-Square P value (heterogeneity) ( ) 59.7 < ( ) (Munsell et al, Epidemiol Rev 2014; 36: )

14 Premenopausal breast cancer Subgroup No. studies No. cases RR (95% CI) I- Square P value (heterogeneity) All (premenopausal) ( ) 59.7 <0.001 White 11 5, ( ) Black 7 1, ( ) Hispanic ( ) (Munsell et al, Epidemiol Rev 2014; 36: )

15 Postmenopausal breast cancer Subgroup No. studies No. cases RR (95% CI) I- Square P value (heterogeneity) All (postmenopausal) ( ) White 21 23, ( ) 74 <0.001 Black 7 2, ( ) Hispanic ( ) (Munsell et al, Epidemiol Rev 2014; 36: )

16 Breast Cancer: A heterogeneous disease ER+ ER- IHC Subtype % ER/PR (HR) Luminal A 73% + - Luminal B 10% + +/- HER2 Positive Triple Negative 5% % - - HER-2 Ki-67 Intrinsic Subtype Low (<14%) low/ high Not needed Luminal A Luminal B HER2 overexpressing Not needed Basal-like ER: Estrogen Receptor, PR: Progesterone Receptor; HER2: Human Epidermal Growth Factor Receptor 2 Anderson et al., JNCI 2014; 106: 1-11.

17 Percent 66.8 HR+/HER2- (Luminal A) HR+/HER2+ (Luminal B) HR-/HER2+ (HER2-enriched) HR-/HER2- (Triple Negative) Non-Hispanic White African American Asian American/Pacific Islander Hispanic/Latina Other

18 Postmenopausal breast cancer Subgroup No. studies No. cases RR (95% CI) I- Square P value (heterogeneity) All (postmenopausal) ( ) White 21 23, ( ) 74 <0.001 ER+/PR+ 4 4, ( ) 88 <0.001 ER-/PR- 4 1, ( ) Black 7 2, ( ) ER+/PR ( ) ER-/PR ( ) Hispanic ( ) HR status Not evaluated (Munsell et al, Epidemiol Rev 2014; 36: )

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20 WCRF/AICR Continuous Update Project Report: Diet, Nutrition, Physical Activity, and Breast Cancer Survivors Available at:

21 Odds Ratio Odds Ratio Pre-dx BMI (Obese vs. normal) and mortality in the California Breast Cancer Survivorship Consortium 3 Breast Cancer-Specific Mortality 2.5 All-Cause Mortality NH White African American Asian American Latinas 0 NH White African American Asian American Latinas Kwan et al. American Journal of Epidemiology 2014; 179:

22 Odds Ratio Odds Ratio Pre-dx Waist to Hip Ratio (Q4 vs. Q1) and mortality in the California Breast Cancer Survivorship Consortium 4.5 Breast Cancer-Specific Mortality 4.5 All-Cause Mortality NH White African American Asian American Latinas 0 NH White African American Asian American Latinas Kwan et al. American Journal of Epidemiology 2014; 179:

23 WCRF CUP Report: Norat et al. SLR on diet, nutrition, physical activity and survival and second cancers in breast cancer survivors. June 2014.

24 Obesity and breast cancer subtypes in African Americans Dr. Elisa Bandera Rutgers Cancer Institute of NJ Obesity and breast cancer risk in Hispanics Dr. Esther John Cancer Prevention Institute of California Obesity and breast cancer in a multi-ethnic population Dr. Gertraud Maskarinec U. of Hawaii Cancer Center Breast cancer in low and middle income countries Dr. Isabelle Romieu International Agency for Research on Cancer Panel discussion

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