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Breast Cancer Res Treat. 2016 Aug;159(1):119-29. doi: 10.1007/s10549-016-3913-x. Epub 2016 Jul 22.

Race/ethnicity, genetic ancestry, and breast cancer-related lymphedema in the Pathways Study.

Author information

1
Division of Research, Kaiser Permanente Northern California, Oakland, CA, 94612, USA. Marilyn.L.Kwan@kp.org.
2
Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, 14263, NY, USA.
3
Division of Research, Kaiser Permanente Northern California, Oakland, CA, 94612, USA.
4
San Jose Medical Center, Kaiser Permanente Northern California, San Jose, 95119, CA, USA.

Abstract

Breast cancer-related lymphedema (BCRL) is a serious chronic condition after breast cancer (BC) surgery and treatment. It is unclear if BCRL risk varies by race/ethnicity. In a multiethnic prospective cohort study of 2953 BC patients, we examined the association of self-reported BCRL status with self-reported race/ethnicity and estimated genetic ancestry. Hazard ratios (HR) and 95 % confidence intervals (CI) were calculated by multivariable Cox proportional hazards models, with follow-up starting 6 months post-BC diagnosis. Estimates were further stratified by body mass index (BMI). By 48 months of follow-up, 342 (11.6 %) women reported having BCRL. Younger age at BC diagnosis, higher BMI at baseline, and lower physical activity were associated with greater BCRL risk. African American (AA) women had a 2-fold increased risk of BCRL compared with White women (HR = 2.04; 95 % CI 1.35-3.08). African genetic ancestry was also associated with an increased risk (HR = 2.50; 95 % CI 1.43, 4.36). Both risks were attenuated but remained elevated after adjusting for known risk factors and became more pronounced when restricted to the nonobese women (adjusted HR = 2.31 for AA and HR = 3.70 for African ancestry, both p < 0.05). There was also evidence of increased BCRL risk with Hispanic ethnicity in the nonobese women. Nonobese AA women had a higher risk of BCRL than White women, which cannot be fully explained by known risk factors. This is the first large-scale, prospective study demonstrating differences in BCRL risk according to race/ethnicity as assessed by both self-report and genetic ancestry data, with a potential ancestry-obesity interaction.

KEYWORDS:

Ancestry; Breast cancer-related lymphedema; Genetics; Interaction; Obesity; Racial disparity

PMID:
27449493
PMCID:
PMC5010992
DOI:
10.1007/s10549-016-3913-x
[Indexed for MEDLINE]
Free PMC Article

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