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African-American Women (african-american + woman)
Selected Abstracts"To the Uplift and Protection of Young Womanhood": African-American Women at Iowa's Private Colleges and the University of Iowa, 1878,1928HISTORY OF EDUCATION QUARTERLY, Issue 2 2010Richard M. Breaux First page of article [source] Longitudinal Study of Changes in Hip Bone Mineral Density in Caucasian and African-American WomenJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2005Jane A. Cauley DrPH Objectives: To determine whether changes in hip bone mineral density (BMD) differ in Caucasian and African American women. Design: Longitudinal study of changes in hip BMD. Setting: Four U.S. clinical centers. Participants: Six thousand seven Caucasian (mean age 73) and 482 African-American (mean age 75) women enrolled in the Study of Osteoporotic Fractures. Measurements: Total hip and femoral neck BMD were measured an average of 3.5 years apart (Caucasian) and 2.0 years apart (African American). Annual absolute and percentage changes in BMD and bone mineral apparent density (BMAD) were calculated. Results: The multivariate adjusted annual percentage change in BMD was greater in Caucasian than African-American women at the total hip (,0.574%/y vs ,0.334%/y) and femoral neck (,0.515%/y vs ,0.203%/y) (both, P<.001). Similar findings were observed for BMAD. The average annualized rate of BMD loss was twice as high in women aged 75 and older as in women younger than 75 in both ethnic groups. The annual percentage loss in femoral neck BMD in nonusers versus hormone therapy users was (,0.57% vs ,0.22%) in Caucasians and (,0.35% vs 0.64%) in African Americans (interaction P=.03). Conclusion: The average rate of hip BMD loss is approximately twice as great in Caucasian as African-American women and increases with age in both groups. The hormonal and biochemical factors that contribute to ethnic differences and the increase in bone loss with advancing age need to be identified. [source] Satisfaction and Use of Prenatal Care: Their Relationship Among African-American Women in a Large Managed Care OrganizationBIRTH, Issue 1 2003Arden Handler DrPH ABSTRACT:Background: Although many more mothers of almost all ethnic groups began prenatal care in the first trimester during the last decade, a significant number of low-income and minority women still fail to obtain adequate care in the United States,a failure that may be related to their dissatisfaction with the prenatal care experience. This study sought to examine the relationship between satisfaction with care and subsequent prenatal care utilization among African-American women using prospective methods. Methods: A sample of 125 Medicaid and 275 non-Medicaid African-American adult women seeking care through a large Midwest managed care organization were interviewed before or at 28 weeks' gestation at one of two prenatal care sites. Women were interviewed about personal characteristics, prenatal care experience, and ratings of care (satisfaction). Information about subsequent use of prenatal care was obtained through retrospective medical record review after delivery. Univariate and multivariable analyses examining the relationship between women's satisfaction and prenatal care use were conducted using a dichotomous measure of satisfaction and a continuous measure of utilization. Results: Women were highly satisfied with prenatal care, with an overall mean satisfaction score of 80.3. Non-Medicaid women were significantly (p < 0.05) less satisfied with their prenatal care (mean score, 79.1) than Medicaid women (mean score, 82.8), and the latter had significantly fewer visits on average than the former subsequent to the interview. Analyses showed no significant difference in subsequent utilization according to whether a woman had a high versus low level of satisfaction at the prenatal care interview. Conclusions: This study challenges the assumption that improving a woman's satisfaction with care will lead to an increase in the adequacy of her prenatal care utilization. Since this study was limited to African-American women and is the first prospective study of women's satisfaction with care and prenatal care utilization, the negative findings do not yet settle this area of inquiry. Monitoring women's satisfaction with prenatal care in both managed care and fee-for-service settings and working to improve those aspects of care associated with decreased satisfaction is warranted. (BIRTH 30:1 March 2003) [source] African-American Developmental Disability Discourses: Implications for Policy DevelopmentJOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 1 2005Peggy S. Terhune Abstract, Formal developmental disabilities services are often underutilized, especially by low-income African-American families. This study examined the basis for interactions and service use preferences of African-American woman who cared for an adult female child with a disability. Diverse African-American perspectives were observed by analyzing the discourse of 11 low-income African-American carers using a direct informant interview technique. Two distinct discourses were identified: a "secular professional" discourse and a "spiritual kin" discourse. Families using the secular professional discourse made use of formal developmental disabilities services in a manner similar to European-American heritage families. Families using the spiritual kin discourse tended to rely on natural or informal supports rather than the developmental disabilities service system, as the system did not exemplify the values that these families profess. It was observed that the discourses result in two distinct worldviews, and two distinct ways of accessing the developmental disabilities system. Recommendations are proffered for changes within the developmental disabilities service system to accommodate diverse cultures and families. A key recommendation involves modifying the system to accommodate worldviews of disability other than the currently used scientific biomedical view. [source] Patient and direct-care staff body mass index in a state mental hospital: implications for managementACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2004W. V. R. Vieweg Objective:, Obesity is a major problem among chronically psychotic patients. Method:, We assessed body mass index (BMI) of chronically psychotic patients on admission to a state mental hospital and in follow-up. We also compared patient BMI to staff BMI. Results:, The initial patient BMI (26.4 ± 5.8 kg/m2) was in the overweight range. The patient BMI (29.1 ± 5.8 kg/m2) increased (P < 0.0001) on follow-up and almost reached the level of obesity. Staff BMI (35.1 ± 8.6 kg/m2) was in the obese range with 64.9% meeting criteria of obesity and 29.9% meeting criteria of morbid obesity. African-American women made up 84.5% of clinical-care staff and constitute the race,sex mix most vulnerable to obesity in the US. Morbid obesity (BMI , 40 kg/m2) was five times more common among these African-American female clinical-care staff than among African-American women in the general US population. Conclusion:, Our findings may have treatment implications for chronically psychotic patients at risk for obesity. [source] Interactions between genetic and reproductive factors in breast cancer risk in a population-based sample of African-American familiesGENETIC EPIDEMIOLOGY, Issue 4 2002Valérie Chaudru Abstract Incidence of breast cancer (BC) varies among ethnic groups, with higher rates in white than in African-American women. Until now, most epidemiological and genetic studies have been carried out in white women. To investigate whether interactions between genetic and reproductive risk factors may explain part of the ethnic disparity in BC incidence, a genetic epidemiology study was conducted, between 1989 and 1994, at the Howard University Cancer Center (Washington, DC), which led to the recruitment of 245 African-American families. Segregation analysis of BC was performed by use of the class D regressive logistic model that allows for censored data to account for a variable age of onset of disease, as implemented in the REGRESS program. Segregation analysis of BC was consistent with a putative dominant gene effect (P < 0.000001) and residual sister-dependence (P < 0.0001). This putative gene was found to interact significantly with age at menarche (P = 0.048), and an interaction with a history of spontaneous abortions was suggested (P = 0.08). A late age at menarche increased BC risk in gene carriers but had a protective effect in non-gene carriers. A history of spontaneous abortions had a protective effect in gene carriers and increased BC risk in non-gene carriers. Our findings agree partially with a similar analysis of French families showing a significant gene × parity interaction and a suggestive gene × age at menarche interaction. Investigating gene × risk factor interactions in different populations may have important implications for further biological investigations and for BC risk assessment. Genet. Epidemiol. 22:285,297, 2002. © 2002 Wiley-Liss, Inc. [source] Triple negative tumours: a critical reviewHISTOPATHOLOGY, Issue 1 2008J S Reis-Filho Breast cancer is a heterogeneous disease that encompasses several distinct entities with remarkably different biological characteristics and clinical behaviour. Currently, breast cancer patients are managed according to algorithms based on a constellation of clinical and histopathological parameters in conjunction with assessment of hormone receptor (oestrogen and progesterone receptor) status and HER2 overexpression/gene amplification. Although effective tailored therapies have been developed for patients with hormone receptor-positive or HER2+ disease, chemotherapy is the only modality of systemic therapy for patients with breast cancers lacking the expression of these markers (triple-negative cancers). Recent microarray expression profiling analyses have demonstrated that breast cancers can be systematically characterized into biologically and clinically meaningful groups. These studies have led to the re-discovery of basal-like breast cancers, which preferentially show a triple-negative phenotype. Both triple-negative and basal-like cancers preferentially affect young and African-American women, are of high histological grade and have more aggressive clinical behaviour. Furthermore, a significant overlap between the biological and clinical characteristics of sporadic triple-negative and basal-like cancers and breast carcinomas arising in BRCA1 mutation carriers has been repeatedly demonstrated. In this review, we critically address the characteristics of basal-like and triple-negative cancers, their similarities and differences, their response to chemotherapy as well as strategies for the development of novel therapeutic targets for these aggressive types of breast cancer. In addition, the possible mechanisms are discussed leading to BRCA1 pathway dysfunction in sporadic triple-negative and basal-like cancers and animal models for these tumour types. [source] Promoting breast health: older women's perceptions of an innovative intervention to enhance screeningINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2006Robin Y. Wood EdD Aims and objectives., This study is a continuation of prior funded research in which we tested the use of age and ethnically sensitive video breast health kits to increase knowledge about breast cancer and enhance the screening practices of breast self-examination and mammography among older Caucasian and African-American women. Background., Breast cancer is the most frequent cancer in women worldwide and accounts for 23% of all cancers. Mammography is currently the best procedure available for mass screening of breast cancer. However, underutilization of mammography is a problem among older women in the United States. Elders are at the greatest risk for developing and dying from breast cancer but they are the least likely group to be screened routinely with mammograms or to practice breast self-examination, particularly if they are African-American. Design., Participatory qualitative evaluation focus groups were used to assess the overall impact of the video kit intervention programme and to elucidate the quantitative findings of the original study. Methods., Four focus groups were conducted in two diverse settings with a purposive sample of 23 participants (N = 23). The overall sample was predominantly African-American (87%) with mean age of 71 ± 7.9 years and mean education completed of 12 ± 3.4 years. Results., Five major themes emerged from group discussions: usability and appeal of the intervention, fear and empowerment, personal relevance and intergenerational sharing, impact on screening behaviours, and story telling. Conclusions., Analyses suggest that customized media materials constructed especially for older African-American women empowered participants in this sample to action regarding their own breast health. Relevance to clinical practice., These findings may translate to global populations where risk is increasing but screening programmes are not widely available. Given that older women are historically difficult to access and impact, further design and evaluation of innovative and sensitive educational programmes such as the one described here are recommended. [source] Visual Field Loss and Risk of Fractures in Older WomenJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2009Anne L. Coleman MD OBJECTIVES: To evaluate the associations between visual field loss and nonspine fractures. DESIGN: Prospective cohort study. SETTING: Community. PARTICIPANTS: Four thousand seven hundred seventy-three community-dwelling white and African-American women aged 65 and older with no previous history of hip fracture at the time of recruitment. MEASUREMENTS: Radiographically confirmed hip and nonspine, nonhip fractures identified from September 1997 to April 2008. Visual field loss was measured using a Humphrey Field Analyzer suprathreshold screening test of the peripheral and central vision of each eye and was classified into an ordinal rating of no, mild, moderate, or severe binocular visual field (BVF) loss. RESULTS: For hip and nonspine, nonhip fractures and in unadjusted and covariate-adjusted analyses, the highest incidence of fractures was seen in women with the most-severe BVF loss. In covariate-adjusted analysis, women with mild, moderate, and severe BVF loss had a 49% (hazard ratio (HR)=1.49, 95% confidence interval (CI)=1.18,1.88), 25% (HR=1.25, 95% CI=0.87,1.80), and 66% (HR=1.66, 95% CI=1.19,2.32) greater risk, respectively, for hip fractures than women without BVF loss. Similarly, women with mild visual field loss had a 12% (HR=0.88, 95% CI=0.75,1.04) lower risk for nonspine, nonhip fractures, whereas women with moderate and severe visual field loss had a 18% (HR=1.18, 95% CI=0.92,1.52) and 59% (HR=1.59, 95% CI=1.24,2.03) greater risk of nonspine, nonhip fractures than women without BVF loss. CONCLUSION: BVF loss is independently associated with hip and nonspine, nonhip fractures in older female volunteers. [source] Exploring Chronically Ill Seniors' Attitudes About Discussing Death and Postmortem Medical ProceduresJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2005Henry S. Perkins MD Proxy decisions about postmortem medical procedures must consider the dead patient's likely preferences. Ethnic-and sex-based attitudes surely underlie such preferences but lack sufficient characterization to guide decisions. Therefore, this exploratory study interviewed Mexican-American, Euroamerican, and African-American seniors in San Antonio, Texas, for their attitudes about discussing death before it occurs and about organ donation, autopsy, and practice on cadavers. A rigorous content analysis identified themes. Majority attitudes of an ethnic group or sex subgroup here may characterize the group generally. Attitudes about discussing death differed only by ethnic group. Mexican Americans and Euroamericans favored such discussions, but African Americans did not. Attitudes about the postmortem procedures differed by ethnic group and sex. Overall, Mexican Americans viewed the procedures most favorably; Euroamericans, less so; and African Americans, least so. Men and women differed further within ethnic groups. Mexican-American men and women split evenly over organ donation, the men expressed no majority preference about autopsies and the women agreed to them, and the men refused and the women agreed to practice on their cadavers. Euroamerican men expressed no majority preferences, but Euroamerican women agreed to organ donation, had no majority preference about autopsies, and refused practice on their cadavers. African-American men expressed no majority preferences, and African-American women expressed none about organ donation or autopsies but refused practice on their cadavers. If confirmed, these ethnic- and sex-based attitudes can help health professionals tailor postmortem care to individual patients' preferences. [source] Longitudinal Study of Changes in Hip Bone Mineral Density in Caucasian and African-American WomenJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2005Jane A. Cauley DrPH Objectives: To determine whether changes in hip bone mineral density (BMD) differ in Caucasian and African American women. Design: Longitudinal study of changes in hip BMD. Setting: Four U.S. clinical centers. Participants: Six thousand seven Caucasian (mean age 73) and 482 African-American (mean age 75) women enrolled in the Study of Osteoporotic Fractures. Measurements: Total hip and femoral neck BMD were measured an average of 3.5 years apart (Caucasian) and 2.0 years apart (African American). Annual absolute and percentage changes in BMD and bone mineral apparent density (BMAD) were calculated. Results: The multivariate adjusted annual percentage change in BMD was greater in Caucasian than African-American women at the total hip (,0.574%/y vs ,0.334%/y) and femoral neck (,0.515%/y vs ,0.203%/y) (both, P<.001). Similar findings were observed for BMAD. The average annualized rate of BMD loss was twice as high in women aged 75 and older as in women younger than 75 in both ethnic groups. The annual percentage loss in femoral neck BMD in nonusers versus hormone therapy users was (,0.57% vs ,0.22%) in Caucasians and (,0.35% vs 0.64%) in African Americans (interaction P=.03). Conclusion: The average rate of hip BMD loss is approximately twice as great in Caucasian as African-American women and increases with age in both groups. The hormonal and biochemical factors that contribute to ethnic differences and the increase in bone loss with advancing age need to be identified. [source] Liver transplantation for acute liver failure from drug induced liver injury in the United StatesLIVER TRANSPLANTATION, Issue 8 2004Mark W. Russo Studies of acute liver failure from drugs have included cases mostly attributed to acetaminophen (APAP) but have reported limited data on other drugs. We used the United Network for Organ Sharing (UNOS) liver transplant database from 1990 to 2002 to identify recipients and estimate a U.S. population-based rate of liver transplantation due to acute liver failure from drugs. Patients were identified if their diagnosis was acute hepatic necrosis from an implicated drug at the time of transplant. Liver transplantation for drug hepatotoxicity accounted for 15% of liver transplants for acute liver failure over the study period. In our cohort (n = 270), 206 (76%) recipients were female. APAP alone, or in combination with another drug, accounted for 133 (49%) cases. In the non-acetaminophen (non-APAP) group (n = 137), the most frequently implicated drugs were: isoniazid, n = 24 (17.5%); propylthiouracil, n = 13 (9.5%); and phenytoin and valproate in 10 (7.3%) cases each. One-year patient and graft survival for the entire cohort was 77 and 71%, respectively. Among Caucasians (n = 206) and African-Americans (n = 48), APAP only was implicated in 110 (53%) patients and 12 (25%) patients, respectively, and non-APAP drugs were implicated in 96 (47%) patients and 36 (75%) patients, respectively (P = .0004). Among African-Americans in the non-APAP group, 28 (78%) were women. In conclusion four drugs were implicated in 42% of patients undergoing liver transplantation for acute liver failure due to drugs other than APAP. The increased frequency of African-American women undergoing liver transplantation for non-APAP drug induced liver injury warrants further study. (Liver Transpl 2004;10:1018,1023.) [source] The relationship between the neighbourhood environment and adverse birth outcomesPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 3 2006Thomas A. Farley Summary Intrauterine growth retardation and preterm birth are more frequent in African-American women and women of lower socio-economic status, but the reasons for these disparities are not fully understood. The physical and social environments in which these women live may contribute to these disparities. We conducted a multilevel study to explore whether conditions of mothers' neighbourhood of residence contribute to adverse birth outcomes independent of individual-level determinants. We analysed data from 105 111 births in 1015 census tracts in Louisiana during 1997,98, merging it with data from other existing sources on neighbourhood socio-economic status, neighbourhood physical deterioration, and neighbourhood density of retail outlets selling tobacco, alcohol and foods. After controlling for individual-level sociodemographic factors, tract-level median household income was positively associated with both birthweight-for-gestational-age and gestational age at birth. Neighbourhood physical deterioration was associated with these birth outcomes in ecological analyses but only inconsistently associated with them after controlling for individual-level factors. Neither gestational age nor birthweight-for-gestational-age was associated with the neighbourhood density of alcohol outlets, tobacco outlets, fast-food restaurants or grocery supermarkets. We conclude that measures of neighbourhood economic conditions are associated with both fetal growth and the length of gestation independent of individual-level factors, but that readily available measures of neighbourhood retail outlets are not. Additional studies are needed to better understand the nature of environmental influences on birth outcomes. [source] Effect of Social Class Disparities on Disease Stage, Quality of Treatment and Survival Outcomes in Breast Cancer Patients from Developing CountriesTHE BREAST JOURNAL, Issue 4 2008Zeba Aziz MD Abstract:, To assess the relationship between social class disparities on disease stage on presentation, quality of treatment, and survival outcome of breast cancer patients in Pakistan and compare our data with SEER (Surveillance, Epidemiology, and End Results) data from US on white and African-American women to evaluate differences in disease stage and survival outcomes. Patients were evaluated for age, tumor size, grade, receptor status, stage, and 5-year survival and were compared with SEER data. Socio-economic status was evaluated with financial income. Patients were divided in poor and middle/high groups. Excellent and comparable 5-year survival with SEER data was observed with localized disease in all groups from different strata. Advanced disease was more common in the disadvantaged group with negligible 5-year survivals. Development and implementation of early detection programs, public awareness, and clinical and breast self examination that are more pragmatic in the settings of countries with limited resources are essential. [source] Experiences with Weight Change in African-American Breast Cancer SurvivorsTHE BREAST JOURNAL, Issue 2 2008Chanita Hughes Halbert PhD Abstract:, Although weight gain is a common side effect of breast cancer treatment, limited empirical data are available on how African-American breast cancer survivors react to changes in their weight following diagnosis and treatment. The purpose of this study was to explore psychological and behavioral reactions to weight change in African-American breast cancer survivors. We conducted a qualitative study to explore reactions to weight change following diagnosis and treatment in 34 African-American breast cancer survivors. Forty-seven percent of women reported gaining weight, 32% reported weight loss, and 21% reported no changes in their weight. Regardless of whether women gained or lost weight, these changes were viewed as stressors that caused psychological distress and health concerns. However, some women had positive reactions to weight loss, especially if they had been heavy prior to diagnosis. Women exercised and changed their dietary behaviors following treatment. Despite this, women reported being frustrated with not being able to control changes in their weight. These results suggest that changes in weight may be a critical component of breast cancer survivorship in African-American women. It may be important to provide African-American breast cancer survivors with information about the causes and implications of weight change and strategies for weight control after treatment as part of their follow-up care. [source] Diagnostic Accuracy of the Gail Model in the Black Women's Health StudyTHE BREAST JOURNAL, Issue 4 2007Lucile L. Adams-Campbell PhD Abstract:, The Gail model is used to predict the risk of breast cancer in women of diverse race/ethnic groups for clinical trial protocols. However, this model has only been validated in US white women. Using a nested case-control study design, we evaluated the diagnostic accuracy of the original Gail model (GM) and that of the revised Gail model algorithm for blacks/African-Americans (GM-B) in the Black Women's Health Study (BWHS). Risk profiles were derived via a self reported questionnaire at the time of enrollment into the BWHS in 1995. Biennial questionnaires were obtained from the participants to determine the incident cases of breast cancer. The study of 725 breast cancer cases and 725 controls revealed that the 5-year risk of breast cancer based on the GM ranged from 0.2% to 15.4% among cases and 0.2% to 13.6% among the controls. Based on the GM-B, the 5-year risk of breast cancer ranged from 0.2% to 8.7% among cases and 0.2% to 7.2% among the controls. The sensitivities of the GM and GM-B model with the standard cutoff of 1.7% were 17.9% (95% CI: 15.9,19.9%) and 4.1% (95% CI: 3.0,5.2), respectively. Both the original and the modified version of the Gail model underestimate the risk of developing breast cancer in African-American women. More importantly, the modified Gail Model (GM-B) does a worse job at predicting the development of breast cancer for blacks than the original model (GM). [source] Satisfaction and Use of Prenatal Care: Their Relationship Among African-American Women in a Large Managed Care OrganizationBIRTH, Issue 1 2003Arden Handler DrPH ABSTRACT:Background: Although many more mothers of almost all ethnic groups began prenatal care in the first trimester during the last decade, a significant number of low-income and minority women still fail to obtain adequate care in the United States,a failure that may be related to their dissatisfaction with the prenatal care experience. This study sought to examine the relationship between satisfaction with care and subsequent prenatal care utilization among African-American women using prospective methods. Methods: A sample of 125 Medicaid and 275 non-Medicaid African-American adult women seeking care through a large Midwest managed care organization were interviewed before or at 28 weeks' gestation at one of two prenatal care sites. Women were interviewed about personal characteristics, prenatal care experience, and ratings of care (satisfaction). Information about subsequent use of prenatal care was obtained through retrospective medical record review after delivery. Univariate and multivariable analyses examining the relationship between women's satisfaction and prenatal care use were conducted using a dichotomous measure of satisfaction and a continuous measure of utilization. Results: Women were highly satisfied with prenatal care, with an overall mean satisfaction score of 80.3. Non-Medicaid women were significantly (p < 0.05) less satisfied with their prenatal care (mean score, 79.1) than Medicaid women (mean score, 82.8), and the latter had significantly fewer visits on average than the former subsequent to the interview. Analyses showed no significant difference in subsequent utilization according to whether a woman had a high versus low level of satisfaction at the prenatal care interview. Conclusions: This study challenges the assumption that improving a woman's satisfaction with care will lead to an increase in the adequacy of her prenatal care utilization. Since this study was limited to African-American women and is the first prospective study of women's satisfaction with care and prenatal care utilization, the negative findings do not yet settle this area of inquiry. Monitoring women's satisfaction with prenatal care in both managed care and fee-for-service settings and working to improve those aspects of care associated with decreased satisfaction is warranted. (BIRTH 30:1 March 2003) [source] Disparities in medical care among commercially insured patients with newly diagnosed breast cancerCANCER, Issue 1 2010Opportunities for intervention Abstract BACKGROUND: African-American women have increased breast cancer mortality compared with white women. Diagnostic and treatment gaps may contribute to this disparity. METHODS: In this retrospective, longitudinal cohort study, Southern US health plan claims data and linked medical charts were used to identify racial disparities in the diagnoses, treatment, and mortality of commercially insured women with newly diagnosed breast cancer. White women (n = 476) and African-American women (n = 99) with newly diagnosed breast cancer were identified by breast cancer claims codes (International Classification of Diseases, Ninth Revision, Clinical Modification codes 174, 233.0, 238.3, and 239.3) between January 2000 and December 2004. Race, diagnoses (breast cancer stage, estrogen/progesterone receptor [ER/PR]-positive status), treatment (breast-conserving surgery, antiestrogen therapy, and chemotherapy interruption or reduction), and all-cause mortality were assessed from medical charts. Multivariate regression analyses were adjusted for age, geography, and socioeconomic status to test the association of race with diagnoses/treatment. RESULTS: White women were older (P < .001) and had higher rates of diagnosis at stage 0/I (55.2% vs 38.4%; P < .05) than African-American women. More white women had positive ER/PR status (75% vs 56% African-American; P = .001) and received antiestrogen therapy if they were positive (37.2% vs 27.3% African-American; P < .001). White women received slightly more breast-conserving surgery and chemotherapy dose modification than African-American women (P value nonsignificant). African-American women had a higher mortality rate (8.1%) than white women (3.6%; P = .06). In adjusted analyses, African-American women were diagnosed at later stages (odds ratio, 1.71; P = .02), and white women received more antiestrogen therapy (odds ratio, 2.1; P = .03). CONCLUSIONS: Disparities in medical care among patients with newly diagnosed breast cancer were evident between African-American women and white women despite health plan insurance coverage. Interventions that address the gaps identified are needed. Cancer 2010. © 2010 American Cancer Society. [source] Race modifies the association between breast carcinoma pathologic prognostic indicators and the positive status for HER-2/neuCANCER, Issue 10 2005Azadeh T. Stark Ph.D. Abstract BACKGROUND Inferences about the variations in the biology of breast carcinoma between African-Americans and Caucasians have been reported. The difference in the prevalence of positive HER-2/neu breast carcinoma was evaluated and the race-specific risk was assessed for positive HER-2/neu among a cohort of women diagnosed with their first primary breast carcinoma, given the accepted prognostic pathologic indicators for positive HER-2/neu status. METHODS Demographic, clinical, and pathologic data were collected from existing databases. The status of HER-2/neu was considered positive if the immunohistochemistry score was 3+ or if the fluorescent in situ hybridization indicated a ratio greater than 2. Multivariable logistic regression was used to determine the race-specific risk for HER-2/neu positive breast carcinoma. RESULTS The difference in the prevalence of HER-2/neu -positive status between African-American and Caucasian women was not statistically significant (P = 0.46). For Caucasian women the likelihood for positive HER-2/neu was statistically significant and increased almost linearly within each stage with nuclear grade dedifferentiation relative to the reference group, women with Stage 1, Grade 1 carcinomas. For African-American women, this risk was not significantly associated with stage, nuclear grade, their interaction term, or other pathologic prognostic indicators. CONCLUSIONS The findings suggest that race modifies the association between the pathologic prognostic indicators of breast carcinoma and the likelihood of HER-2/neu -positive carcinoma. So far, clinical correlative studies of HER-2/neu have not included race as an independent variable. Concerns about the limited generalizability and the need for validation of the findings across racial lines have been expressed previously. Cancer 2005. © 2005 American Cancer Society. [source] Reproductive factors and risk of breast carcinoma in a study of white and African-American women,,CANCER, Issue 2 2004Giske Ursin M.D., Ph.D. Abstract BACKGROUND Few studies have investigated the association between reproductive factors and the risk of breast carcinoma among African-American women. The authors assessed whether the number of full-term pregnancies, age at first full-term pregnancy, and total duration of breastfeeding were associated with similar relative risk estimates in white and African-American women in a large multicenter, population-based case,control study of breast carcinoma. METHODS Case patients were 4567 women (2950 white women and 1617 African-American women) ages 35,64 years with newly diagnosed invasive breast carcinoma between 1994 and 1998. Control patients were 4668 women (3012 white women and 1656 African-American women) who were identified by random-digit dialing and were frequency matched to case patients according to study center, race, and age. Adjusted odds ratios and 95% confidence intervals were estimated using unconditional logistic regression. RESULTS For white women, the reduction in risk of breast carcinoma per full-term pregnancy was 13% among younger women (ages 35,49 years) and 10% among older women (ages 50,64 years). The corresponding risk reductions for African-American women were 10% and 6%, respectively. Risk decreased significantly with increasing number of full-term pregnancies for both races and both age categories. Duration of lactation was inversely associated with breast carcinoma risk among younger parous white (trend P = 0.0001) and African-American (trend P = 0.01) women. African-American women tended to have more children compared with white women, but parity rates were lower in younger women than in older women in both racial groups. However, breastfeeding was substantially more common in young white women than in young African-American women. CONCLUSIONS Overall, parity and lactation had similar effects on breast carcinoma risk in white and African-American women. If younger African-American women now are giving birth to fewer children than in the past, without a substantial increase in breastfeeding, breast carcinoma rates may continue to increase at a more rapid rate among these women compared with white women. Cancer 2004. Published 2004 by the American Cancer Society. [source] Overview of the summit meeting evaluating research in African-American womenCANCER, Issue S1 2003Lovell A. Jones Ph.D. There is a disparity in the breast cancer survival rate among African-American women compared with the rate among white women. The summit meeting addressed the breast cancer crisis among African-American women by bringing together scientists, breast cancer advocates, and policy makers. The goal of the meeting was to develop a research agenda. For breast cancer research to advance, priority areas must be identified. The current article suggests questions and issues which are addressed in this cancer monograph. Cancer 2003;97(1 Suppl):207,10. © 2003 American Cancer Society. DOI 10.1002/cncr.11028 [source] Histopathology of breast cancer among African-American women,CANCER, Issue S1 2003Lavinia P. Middleton M.D. Abstract Although the overall incidence of breast cancer in African-American women is lower than in white women, African-American women younger than 50 years old have a higher incidence of breast cancer than white women. African-American women with breast cancer have a poorer survival rate than white women and are more likely to die of breast cancer in almost every age group. To explain this disparity, we studied a substantial body of literature that reported a biologic difference in the tumors found in African-American and white women. Specifically, more aggressive histopathologic patterns have been described among African-American patients with breast cancer when compared with white women. In addition, there are data that support an ethnicity-related variation in the expression of breast tumor hormonal markers. The objective of this study was to critically evaluate the existing published data on the histologic features of breast cancer to determine whether breast cancer in African-American women is a histologically more aggressive disease than in white women. We conclude that the aggressive tumor histology reported in African-American women has not been analyzed carefully with respect to the age of the patient at the time of diagnosis and the stage of disease at presentation. Furthermore, there is a need for central pathology review using accepted, published criteria for diagnosis of uncommon and controversial histologic subtypes of breast cancer. Cancer 2003;97(1 Suppl):253,7. Published 2003 by the American Cancer Society. DOI 10.1002/cncr.11021 [source] The perspective of African-American breast cancer survivor-advocatesCANCER, Issue S1 2003Ngina Lythcott Dr.P.H. Abstract BACKGROUND This article discusses the sometimes unique presentation and course of breast cancer in African-American women and the impact these differences have on the perception of breast disease among African-American women. METHODS The project described represents the thoughts of many African-American breast cancer survivors, as summarized by three breast cancer survivor-advocates who work through very different national organizations, each of whom has vast experience working directly with African-American breast cancer survivors and their families. RESULTS In addition to discussions of compelling considerations that have an impact on survivor access, such as agency, culture, and class, other important access questions are raised for research scientists and clinicians that have an impact on the prevention, screening, and detection and treatment of breast cancer in African-American women as well as their accrual to clinical trials. CONCLUSIONS To eradicate ethnicity-related disparities in breast cancer outcomes for African-American women, it is important for the medical community (clinicians and research scientists) to develop active partnerships with African-American and other breast cancer survivor-advocates in order to establish effective breast health awareness and breast cancer treatment programs and to develop meaningful breast cancer research programs. Cancer 2003;97(1 Suppl):324,8. © 2003 American Cancer Society. DOI 10.1002/cncr.11013 [source] Increasing the pool of academically oriented African-American medical and surgical oncologists,,§CANCER, Issue S1 2003Lisa A. Newman M.D., M.P.H. Abstract BACKGROUND In the United States, breast cancer mortality rates are significantly higher among African-American women than among women of other ethnic backgrounds. Research efforts to evaluate the socioeconomic, environmental, biologic, and genetic mechanisms explaining this disparity are needed. METHODS Data regarding patterns in the ethnic distribution of physicians and oncologists were accumulated from a review of the literature and by contacting cancer-oriented professional societies. This information was evaluated by participants in a national meeting, "Summit Meeting Evaluating Research on Breast Cancer in African American Women." Results of the data collection and the conference discussion are summarized. RESULTS Ethnic minority specialists are underrepresented in academic medicine in general, and in the field of oncology in particular. This fact is unfortunate because ethnic minority students are more likely to express a commitment to providing care to medically underserved communities and, thus, they need to be better represented in these professions. Correcting these patterns of underrepresentation may favorably influence the design and implementation of culturally and ethnically sensitive research. CONCLUSIONS Efforts to improve the ethnic diversity of oncology specialists should begin at the level of recruiting an ethnically diverse premed and medical student population. These recruitment efforts should place an emphasis on the value of mentoring. Cancer 2003;97(1 Suppl):329,34. Published 2003 by the American Cancer Society. DOI 10.1002/cncr.11027 [source] Metabolic syndrome in African Americans: Implications for preventing coronary heart diseaseCLINICAL CARDIOLOGY, Issue 4 2007F.A.C.C., Luther T. Clark M.D. Abstract The metabolic syndrome represents a specific clustering of cardiovascular risk factors in the same individual (abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, insulin resistance, a prothrombotic state, and a proinflammatory state). Almost 50 million American adults (about one in four) have the metabolic syndrome, which puts them at increased risk for the development of diabetes mellitus and cardiovascular disease. African Americans, especially African-American women, have a high prevalence of the metabolic syndrome. This is attributable mainly to the disproportionate occurrence in African Americans of elevated blood pressure, obesity, and diabetes. Management of the metabolic syndrome consists primarily of modification or reversal of the root causes (overweight/obesity and physical inactivity) and therapy to reduce or control the risk factors. Although all components of the metabolic syndrome should be addressed, optimal control of atherogenic dyslipidemia and elevated blood pressure may reduce cardiovascular risk by more than 80%. Copyright © 2007 Wiley Periodicals, Inc. [source] | |||||||||||||