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[Preprint]. 2024 Mar 19:2024.03.18.24304210.
doi: 10.1101/2024.03.18.24304210.

Risk factors for breast cancer subtypes by race and ethnicity: A scoping review of the literature

Amber N Hurson  1 , Thomas U Ahearn  1 , Hela Koka  1 , Brittany D Jenkins  1   2   3 , Alexandra R Harris  1   3 , Sylvia Roberts  1 , Sharon Fan  1 , Jamirra Franklin  3 , Gisela Butera  4 , Renske Keeman  5 , Audrey Y Jung  6 , Pooja Middha  7 , Gretchen L Gierach  1 , Xiaohong R Yang  1 , Jenny Chang-Claude  6 , Rulla M Tamimi  8 , Melissa A Troester  9 , Elisa V Bandera  10 , Mustapha Abubakar  1 , Marjanka K Schmidt  5   11 , Montserrat Garcia-Closas  1   12
Affiliations

Risk factors for breast cancer subtypes by race and ethnicity: A scoping review of the literature

Amber N Hurson et al. medRxiv. .

Update in

  • Risk factors for breast cancer subtypes by race and ethnicity: A scoping review.
    Hurson AN, Ahearn TU, Koka H, Jenkins BD, Harris AR, Roberts S, Fan S, Franklin J, Butera G, Keeman R, Jung AY, Middha P, Gierach GL, Yang XR, Chang-Claude J, Tamimi RM, Troester MA, Bandera EV, Abubakar M, Schmidt MK, Garcia-Closas M. Hurson AN, et al. J Natl Cancer Inst. 2024 Jul 17:djae172. doi: 10.1093/jnci/djae172. Online ahead of print. J Natl Cancer Inst. 2024. PMID: 39018167

Abstract

Background: Breast cancer is comprised of distinct molecular subtypes. Studies have reported differences in risk factor associations with breast cancer subtypes, especially by tumor estrogen receptor (ER) status, but their consistency across racial and ethnic populations has not been comprehensively evaluated.

Methods: We conducted a qualitative, scoping literature review using the Preferred Reporting Items for Systematic Reviews and Meta-analysis, extension for Scoping Reviews to investigate consistencies in associations between 18 breast cancer risk factors (reproductive, anthropometric, lifestyle, and medical history) and risk of ER-defined subtypes in women who self-identify as Asian, Black or African American, Hispanic or Latina, or White. We reviewed publications between January 1, 1990 and July 1, 2022. Etiologic heterogeneity evidence (convincing, suggestive, none, or inconclusive) was determined by expert consensus.

Results: Publications per risk factor ranged from 14 (benign breast disease history) to 66 (parity). Publications were most abundant for White women, followed by Asian, Black or African American, and Hispanic or Latina women. Etiologic heterogeneity evidence was strongest for parity, followed by age at first birth, post-menopausal BMI, oral contraceptive use, and estrogen-only and combined menopausal hormone therapy. Evidence was limited for other risk factors. Findings were consistent across racial and ethnic groups, although the strength of evidence varied.

Conclusion: The literature supports etiologic heterogeneity by ER for some established risk factors that are consistent across race and ethnicity groups. However, in non-White populations evidence is limited. Larger, more comparable data in diverse populations is needed to better characterize breast cancer etiologic heterogeneity.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Summary of evidence for heterogeneity of associations with risk for breast cancer by estrogen receptor (ER) tumor status* among diverse racial and ethnic populations * ER-positive includes subtypes defined as hormone receptor positive, luminal, luminal A, or ER-positive & PR-positive. ER-negative includes subtypes defined as triple negative or basal-like, and hormone receptor negative or ER-negative & PR-negative. ** Fewer than three published studies for either estrogen receptor positive or negative subtype BMI = Body mass index, MHT = menopausal hormone therapy
Figure 2.
Figure 2.
Published estimates for the effect of parity on breast cancer risk by tumor subtype and racial and ethnic group *Pooled studies Estimates for triple negative subtype (ER-, PR-, HER2-) and basal-like subtype are plotted with an open circle. I. Case-control estimates, stratified by tumor subtype, grouped by risk factor definition (A, B, C, D) and colored by racial and ethnic group. II. Case-control estimates pooled within risk factor definition categories (A, B, C, D), stratified by tumor subtype, and colored by racial and ethnic group. III. Case-only estimates comparing risk of ER negative subtype to ER positive, grouped by risk factor definition (A, B, C, D) and colored by racial and ethnic group. A: Per birth, Per 1.6 births; B: ≥1 vs. 0 births, ≥2 vs. (0, <2) births; C: ≥3 vs. (0, 1, <3) births, ≥4 vs. (0, 1) births; D: ≥5 vs. (0, <3) births, ≥6 vs. (0, <2) births, ≥7 vs. 0 births.
Figure 3.
Figure 3.
Published estimates for the effect of age at first birth on breast cancer risk by tumor subtype and racial and ethnic group *Pooled studies Estimates for triple negative subtype (ER-, PR-, HER2-) and basal-like subtype are plotted with an open circle. I. Case-control estimates, stratified by tumor subtype, grouped by risk factor definition (A, B, C, D) and colored by racial and ethnic group. II. Case-control estimates pooled within risk factor definition categories (A, B, C, D), stratified by tumor subtype, and colored by racial and ethnic group. III. Case-only estimates comparing risk of ER negative subtype to ER positive, grouped by risk factor definition (A, B, C, D) and colored by racial and ethnic group. A: Per 1 year, per 5 years; B: ≥20 vs. <20 years, ≥22 vs. <19 years, >24.3 vs. ≤24.3, ≥25 vs. (<19, 20, 21, 25) years, ≥26 vs. <(19, 23, 25, 26) years, ≥28 vs. <(23, 24) years, ≥29 vs. <25 years; C: Nulliparous/≥30 vs. <20 years, ≥30 vs. Nulliparous, ≥30 vs. <(18, 19, 20, 21, 24, 25, 30) years; D: ≥31 vs. <(21, 23, 31) years, ≥32 vs. <22 years, ≥35 vs. <(20, 21) years.
Figure 4.
Figure 4.
Published estimates for the effect of premenopausal BMI on breast cancer risk by tumor subtype and racial and ethnic group *Pooled studies Estimates for triple negative subtype (ER-, PR-, HER2-) and basal-like subtype are plotted with an open circle. I. Case-control estimates, stratified by tumor subtype, grouped by risk factor definition (A, B, C) and colored by racial and ethnic group. II. Case-control estimates pooled within risk factor definition categories (A, B, C), stratified by tumor subtype, and colored by racial and ethnic group. III. Case-only estimates comparing risk of ER negative subtype to ER positive, grouped by risk factor definition (A, B, C) and colored by racial and ethnic group. A: Per 1 unit, per 5 units, per standard deviation, per WHO BMI category; B: ≥25 vs. <25, >25.1 vs. ≤21.4, >27 vs. ≤25, ≥28 vs. ≤24, >28 vs. <23, ≥28.3 vs. <22.2; C: ≥30 vs. <(18.5, 20, 22.5, 25, 30), ≥30.7 vs. ≤22.89, ≥35 vs. <(18.5, 25).
Figure 5.
Figure 5.
Published estimates for the effect of postmenopausal BMI on breast cancer risk by tumor subtype and racial and ethnic group *Pooled studies Estimates for triple negative subtype (ER-, PR-, HER2-) and basal-like subtype are plotted with an open circle. I. Case-control estimates, stratified by tumor subtype, grouped by risk factor definition (A, B, C) and colored by racial and ethnic group. II. Case-control estimates pooled within risk factor definition categories (A, B, C), stratified by tumor subtype, and colored by racial and ethnic group. III. Case-only estimates comparing risk of ER negative subtype to ER positive, grouped by risk factor definition (A, B, C) and colored by racial and ethnic group. A: Per 1 unit, per 5 units, per standard deviation, per WHO BMI category; B: >24 vs. ≤24, ≥25 vs. <25, >25.1 vs. ≤21.4, >27 vs. ≤25, ≥28 vs. ≤24, >28 vs. <23, ≥28.3 vs. <22.2; C: ≥30 vs. <(18.5, 20, 22.5, 25, 30), ≥30.7 vs. ≤22.89, ≥35 vs. <(18.5, 25).
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References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. May 2021;71(3):209–249. doi:10.3322/caac.21660 - DOI - PubMed
    1. Giaquinto AN, Sung H, Miller KD, et al. Breast Cancer Statistics, 2022. CA Cancer J Clin. Nov 2022;72(6):524–541. doi:10.3322/caac.21754 - DOI - PubMed
    1. Kong X, Liu Z, Cheng R, Sun L, Huang S, Fang Y, Wang J. Variation in Breast Cancer Subtype Incidence and Distribution by Race/Ethnicity in the United States From 2010 to 2015. JAMA Netw Open. Oct 1 2020;3(10):e2020303. doi:10.1001/jamanetworkopen.2020.20303 - DOI - PMC - PubMed
    1. Davis Lynn BC, Chernyavskiy P, Gierach GL, Rosenberg PS. Decreasing Incidence of Estrogen Receptor-Negative Breast Cancer in the United States: Trends by Race and Region. J Natl Cancer Inst. Feb 7 2022;114(2):263–270. doi:10.1093/jnci/djab186 - DOI - PMC - PubMed
    1. Gaudet MM, Gierach GL, Carter BD, et al. Pooled Analysis of Nine Cohorts Reveals Breast Cancer Risk Factors by Tumor Molecular Subtype. Cancer Res. Oct 15 2018;78(20):6011–6021. doi:10.1158/0008-5472.CAN-18-0502 - DOI - PMC - PubMed

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Grants and funding

This work was supported by Intramural Funds of the National Cancer Institute, USA. MGC is supported by Breast Cancer Now and the Institute of Cancer Research, UK. RK and MKS were supported by the European Union’s Horizon 2020 Research and Innovation Program B-CAST (grant number: 633784). BDJ and ARH are supported by the Cancer Prevention Fellowship Program.

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