charleshaas69: October 2012

Wednesday, 31 October 2012

Namibia: Teenage Pregnancy Alarming in the Ohangwena Region

Eenhana — Last year about 1 691 learners dropped out of school due to teenage pregnancy, just one of the many challenges adolescents face on a daily basis.

This means on average of 30 children per classroom, Ohangwena region have closed 58 classes in 2011, 57 classes in 2010 and 56 classes in 2009.

According to the Ohangwena Region Health Director, John Hango, the youth pregnancy rate in the region is very high with 25 percent among the 17 year - olds, 35 percent among the 19 - year olds and 57 percent among the of year - olds who have given birth to children.

Hango referred to these statistics as "just the tip of the iceberg" adding that the numbers can be much higher but are simply not documented. Adolescent pregnancy remains very prevalent, particularly in the rural areas of the country, and has a negative impact on the health of the adolescents and their infants. He revealed these statistics at the official inauguration of the Namibia Plant Parenthood Association (NAPPA)'s Youth- Friendly clinic here on Saturday.

Hango said these youth's pregnancies are contributing to a high level of poverty and illiteracy in the region. "Adolescents should be able to manage a life without back street abortions and baby dumping, which usually occur when they do not want a child. Poor access to relevant information and services are especially problematic for the Namibian youths, as sexual education is not taught in schools and it is a taboo discussion topic at home with their parents," said Hango. He also revealed that the Ohangwena Regional Health Directorate received 78 cases of abortion in 2011, and this year from January to June his office received 74 cases. Many cases are suspected to be among the youths who are suspected to be undergoing illegal abortions.

The Deputy Minister of Youth, National Service, Sports and Culture, Pohamba Shifeta, officially opened the clinic and urged the Namibian youths, especially those in the Ohangwena region to respect their parents. "We should all as productive youths respect our parents and guardians irrespective of whether they are educated or not because these parents have travelled in this long journey called life. Whether you might hold a degree or a diploma from a university, but respect your parents because they know the road you are using for your journey to life," he said.

He advised youths especially those frequenting shebeens to stop this rowdy behaviour because it's destroying their future. "The health challenges adolescents face were brought to the forefront at a policy dialogue on Adolescent Health Services. Adolescents are considered boys and girls between the ages of 10 and 19." Shifeta further pointed out that family planning is central to promoting and preserving reproductive health. The 2011 National HIV Sentinel Survey indicates a slight decline in the overall HIV prevalence among the 15 to 19 year-old group of pregnant women, which stands at seven percent in comparison to 2011 when it was 5.1 percent.

Shifeta said rape, passion killings and other forms of sexual gender based violence (SGBV) are common in Namibia. In 2011, the Namibian police and the media reported that there were an estimated 15 000 SGBV cases during the previous year.

"This is likely to be gross underestimate, while SGBV encompasses much more than rape and domestic violence," he said He noted that officials dealing with survivors of abuse often have poor response skills. "They often get laughed at or are told that it was their fault resulting in these victims not reporting the crimes."

Caption: The Deputy Minister of Youth, National Service, Sport and Culture, Pohamba Shifeta, unveiling the plaque of the Eenhana-NAPPA Friendly Clinic on Saturday during the official opening of the clinic.

Source: http://allafrica.com/stories/201210311179.html

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Overweight according to geographical origin and time spent in France: a cross sectional study in the Paris metropolitan area

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Background: For the first time in France in a population-based survey, this study sought to investigate the potential impact of migration origin and the proportion of lifetime spent in mainland France on body mass index (BMI) and overweight in adults living in the Paris metropolitan area. Methods: A representative, population-based, random sample of the adult, French speaking population of the Paris metropolitan area was interviewed in 2005. Self-reported BMI (BMI=weight/height2) and overweight (BMI >= 25) were our 2 outcomes of interest. Two variables were constructed to estimate individuals' migration origin: parental nationality and the proportion of lifetime spent in mainland France, as declared by the participants. We performed multilevel regression models among different gender and age groups, adjusted for demographics and socioeconomic status. Results: In women, a parental origin in the Middle East or North Africa (MENA) was associated with a higher risk of being overweight (especially before the age of 55) and a higher BMI (between 35 and 54 years of age), and so were women of Sub-Sahara African parental origin in the middle age category. Only in the youngest men (< 35 years of age) did we observe any association with parental nationality, with a higher BMI when having a MENA parentage. Regarding the association between the proportion of lifetime spent in France and overweight, we observed that, in women, a proportion of 50% to 99% appeared to be associated with overweight, especially after the age of 35. In men, having spent more than half of one's lifetime in France was associated with a higher risk of overweight among oldest men. Conclusions: Our results plea for potential cultural determinants of overweight in the migrant and migrants-born populations in the French context of the capital region. Taking into account the people' family and personal migration histories may be an important issue in public health research and policies on overweight and obesity prevention.

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Source: http://www.biomedcentral.com/1471-2458/12/937

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5 Best Exercises And Stretches Using a Foam Roller

If you've only used foam rollers for muscle rehab, you're missing out. The foam roller can be a really useful device for warm-ups and cool downs, especially for runners. Target your abs, obliques, calves and quads with a few new foam roller exercises.

Foam Roller for Abs: Lay on the floor with the foam roller under your lower abs and your forearms on the floor. Extend your legs and have your feet touch the floor. Using your arms to push, walk backwards to make the roller go over your abs then pull with your arms to reverse the roller's direction.

Foam Roller for Calves: Sit on the floor with your hands slightly behind you, the foam roller underneath the middle of your calf. Press down with most of your weight on your calf muscle, lifting your hips off of the floor. Roll from the knee to the ankle slowly for 10-30 seconds on each leg.

Foam Roller for Hamstrings: Repeat the calf exercise, but place the roller under your hamstring instead of your calf. Relax your hamstrings and roll from hip to above the back of the knee, 10-30 seconds.

Foam Roller for Adductor (Inner Thighs): in modified push-up position, put one leg on the foam roller. Shift as much weight as you can onto the foam roll, and slowly roll over the foam between your hip and knee for 10-30 seconds.

Foam Roll for Biceps: Lay on your side with your upper arm against the roller, aligned with your body. With the outside of the bicep pressed against the foam roller, rise your hips off the floor while supporting your weight on your arm and feet. 10-30 seconds on each side.

When have you used a foam roller? Was it strictly for muscle rehab, or regular workouts? Tell me in the comments—I want to hear your stories!

Get more from Jennifer on Facebook at http://www.Facebook.com/theRealJenniferCohen and follow her on Twitter at http://www.Twitter.com/theRealJenCohen.

Source: http://www.mensfitness.com/training/pro-tips/5-best-exercises-and-stretches-using-a-foam-roller

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Foursquare and Seven Condoms Ago

A new series of PSAs from the AIDS Council (view here) try to engage young people's interest in safe sex by making allusions to Foursquare check-ins. As the couples in the advertisements undress, a little box pops up over one person's genitals saying "NAME and 34 others were here."

My charitable impression is that the ads are based on the notion that when you have sex with someone, you are also sleeping with everyone they've had sex with in the past. Other analysts' less charitable impression seems to be that the ads are engaging in slut shaming and equating promiscuity with STD risk.

Although I agree that it's a problem if the impression young people take away from the ads is that only the promiscuous get or spread STDs, I do think that these PSAs are a catchy, and hopefully effective, way to get young people engaged in talking about the potential risks of sex. However, if we get to the point where people are actually checking in at their partners genitals using Foursquare, I'm going to be really disturbed. The only person who should be Mayor of your body is YOU.

Source: http://std.about.com/b/2012/10/26/foursquare-and-seven-condoms-ago.htm

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Namibia: Teenage Pregnancy Alarming in the Ohangwena Region

Eenhana — Last year about 1 691 learners dropped out of school due to teenage pregnancy, just one of the many challenges adolescents face on a daily basis.

This means on average of 30 children per classroom, Ohangwena region have closed 58 classes in 2011, 57 classes in 2010 and 56 classes in 2009.

Source: http://allafrica.com/stories/201210311179.html

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Arthritis Patients' Lives Improved By Complementary And Alternative Therapy

Main Category: Arthritis / Rheumatology
Also Included In: Complementary Medicine / Alternative Medicine
Article Date: 31 Oct 2012 - 3:00 PDT

Nearly a quarter of patients with rheumatoid arthritis and osteoarthritis used complementary and alternative therapy (CAT) to help manage their condition, according to a study in the November issue of the Journal of Clinical Nursing.

Researchers interviewed 250 patients aged between 20 and 90 years of age. More than two-thirds (67%) had rheumatoid arthritis and the remainder had osteoarthritis.

They found that 23% used CAT in addition to prescribed drugs and that just under two-thirds of those (64%) felt that the therapy was beneficial, reporting improvements in pain intensity, sleeping patterns and activity levels. "Our study underlines the importance of healthcare professionals being knowledgeable about the potential use of CAT when providing medical care to patients with arthritis" says lead author Professor Nada Alaaeddine, Head of the Regenerative and Inflammation Lab in the Faculty of Medicine, University of St Joseph, Beirut, Lebanon.

"Although CAT might have beneficial effects in rheumatoid arthritis and osteoarthritis, patients should be cautious about their use and should tell their healthcare providers that they are using them to make sure they don't conflict with their existing treatment."

Key findings of the survey included:

CAT users had an average age of 45 years, significantly younger than the average non CAT user, who was aged 57 years.
CAT use was higher in patients with osteoarthritis (29%) than rheumatoid arthritis (20%).
The most common CAT used was herbal therapy (83%), followed by exercise (22%), massage (12%), acupuncture (3%), yoga and meditation (3%) and dietary supplements (3%).
Just under a quarter of the patients using CAT (24%) sought medical care because of possible side effects, but they were not serious and were reversible. The most common side effects included skin problems (16%) and gastrointestinal problems (9%).
The majority did not tell their healthcare provider about their CAT use (59%).
CAT users were asked to rate the amount of pain they felt and the percentage who said that they experienced no pain rose from 12% to 43% after CAT use. The number who slept all night rose from 9% to 66%.
CAT users also reported an improvement in daily activities. The percentage who said that their pain did not limit them at all rose from 3% to 12% and the percentage who said they could do everything, but with pain, rose from 26% to 52%.

"CAT use is increasing and this study shows that it provided self-reported benefits for patient with rheumatoid arthritis and osteoarthritis" says Professor Alaaeddine.

"It is, however, important that patients discuss CAT use with their healthcare practitioner and that they are made aware of possible side effects, in particular the possible interactions between herbal and prescribed drugs."

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Africa: Lethal Salmonella Strain Targets HIV Positive Africans

Nairobi — Fears are growing over an emerging form of intestinal disease in Africa, to which HIV positive people are particularly vulnerable. Medical experts have expressed concerns that health infrastructures across the continent lack the capacity to detect or cope with the dangerous bacterium.

The scientists say that invasive non-Typhoidal Salmonella (iNTS) thrives in the blood systems of people in Sub-Saharan Africa whose body immunity is weakened by HIV/AIDS. This revelation adds yet another dangerous disease to the list of opportunistic infections plaguing HIV positive people in Africa.

According to a study by the Wellcome Trust Sanger Institute, a genomics research centre in the United Kingdom, the relatively new disease causes death in up to 45 per cent of those infected. It has spread from two focal points in Southern and Central Africa to the rest of the continent, reports the study, published in Nature Genetics last month (30 September).

The study found that iNTS also targets people whose immunity is weakened by other conditions such as malaria and malnutrition, both common in Sub-Saharan Africa.

The iNTS-causing bacteria, Salmonella typhimurium, has become resistant to the frontline antibiotics used to treat related blood-borne intestinal diseases.

"In many places in Africa, the basic microbiological facilities are not available, which makes diagnosis of iNTS difficult, as blood culture is the only definitive diagnostic for the disease," the Sanger Institute's Robert Kingsley, one of the authors of the study, told SciDev.Net.

Francis Nyamiobo, a research physician at the Kenya Aids Control Project, said that iNTS could be a major cause of death in HIV positive patients, but could go unrecognised due to "diagnosis challenges".

"Our greatest problem is making the diagnosis," Nyamiobo told SciDev.Net.

Scientists used whole genome sequencing to define a novel lineage of Salmonella Typhimurium, which is causing a previously unidentified epidemic across the region. They discovered that its genetic makeup was evolving into a more typhoid-like bacterium, able to spread efficiently around the human body.

From sequenced samples, the team created a phylogenetic or 'family tree', depicting the pathogen's evolution. This enabled them to date when each sample first emerged and overlay this with geographical information about where samples came from.

The scientists found that this invasive disease comprises two very closely related waves: the first wave originating 52 years ago from a possible south-eastern hub; and the second around 35 years ago, possibly from the Congo Basin.

Kingsley recommended further studies to establish whether the pathogen was being transmitted exclusively through humans or whether a zoonotic (animal) reservoir existed as well.

"We need to understand the transmission routes to address the hypothesis that this pathogen is behaving in a different mode from that we normally associate with NTS," he explained.

Link to full study

This article has been produced by SciDev.Net's Sub-Saharan Africa desk.

References

Nature doi:10.1038/ng.2423 (2012)

Source: http://allafrica.com/stories/201210310368.html

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Prime and Pull

Scientists from the Yale University School of Medicine recently published an article in Nature describing a fascinating new way of approaching the development of a herpes vaccine. In additional to the traditional goal of vaccination - developing a robust immune response against the pathogen in question - they added a second step. They used a topical application of cytokines to recruit protective immune cells into the vaginal tract. The hope was that the cells would permanently set up shop there to prevent herpes infections from spreading into the local neurons.

It seems to have worked, but I want to include a cautionary note. The paper describes a series of early experiments in a mouse model, and it would be years before any human product based on this technique could reach the market. However, "prime and pull" does seem like a potentially promising way to address a longstanding problem in herpes vaccine development -- making sure that any stimulated immune response is present where and when it's needed.

October Content Roundup

My Partner Has HPV - Now What?
One of the most difficult things when teaching about sexual risk behaviors is trying to explain that even though many STDs are particularly devastating, they're also not something you want to get. HPV is a great example of this paradox. Although the virus is incredibly common, and can cause serious health problems, most people will never have any idea that they're infected with it.
Understanding Herd Immunity
In light of the ongoing controversies surrounding the HPV vaccine, I thought it was important that people learn about why widespread vaccination is so important. If enough people get vaccinated, the benefits of vaccination spread to even those who can't receive a vaccine for health or other reasons.

Source: http://std.about.com/b/2012/10/29/prime-and-pull.htm

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Tuesday, 30 October 2012

Hypnosis Halts Hot Flashes for Some Women

By Salynn Boyles
WebMD Health News

Reviewed by Louise Chang, MD

Oct. 26, 2012 -- Hypnosis is an effective treatment for menopause-related hot flashes and night sweats, new research finds.
The alternative therapy reduced hot flashes by as much as 74% in the study conducted by researchers at Baylor University's Mind-Body Medicine Research Laboratory and funded by the National Institutes of Health.
Only hormone therapy, which many women can't take or want to avoid, is more effective for treating the most common symptom of menopause, says researcher Gary R. Elkins, PhD.
"If you compare this treatment with off-label use of antidepressants or other non-hormonal therapies, it works as well or better," he says.
Hot Flashes, Night Sweats
Hot flashes are a sudden rush of heat, followed by facial flushing and sweating, often followed by chills and clamminess. The progression is familiar to most women of a certain age.
Hot flashes and night sweats are the most common symptoms of menopause, affecting some 80% of women.
They are linked to declining estrogen levels, but it remains unclear just why the sudden lack of estrogen sends the body into thermal mayhem, and why some women are more affected than others.
Hormone therapy is a very effective treatment for menopause-related hot flashes, but concerns about risks have limited its use among women.
"There is certainly a need for non-pharmacologic treatments for hot flashes and night sweats," says North American Menopause Society (NAMS) Executive Director Margery Gass, MD.
Hypnosis and Hot Flashes
In an earlier study, Elkins and his Baylor colleagues showed that hypnosis dramatically reduced hot flash and night sweat frequency in breast cancer patients with treatment-related symptoms.
In the newly published study, they set out to determine if the alternative treatment would do the same in women whose symptoms were related to menopause.
A total of 187 postmenopausal women who reported having at least seven hot flashes a day, or 50 a week, were recruited for the trial.
Half the women were given self-hypnosis training that consisted of five, 45-minute weekly sessions.
During the sessions they received suggestions for mental imagery designed to minimize the intensity of their hot flashes, such as images of a cool place. The women were also given a recording of the hypnotic induction, and they were asked to practice self-hypnosis at home daily.
The rest of the women had an equal number of sessions with a clinician, but hypnosis training was not given.
Instead, clinicians talked to the women about their symptoms and gave them encouragement about how to deal with them. These women were also asked to listen to a recording each day at home, but their recording simply had information about hot flashes.
The study participants kept "hot flash frequency" diaries, and they also wore small sensors on their bodies that recorded their hot flashes.
Hot Flashes Less Frequent and Intense
After 12 weeks:
Women in the hypnosis group reported 74% fewer hot flashes on average, compared with 17% fewer among the other women.
The skin sensors showed a 57% reduction in hot flashes among the hypnosis group, compared to a 10% reduction in the non-hypnosis group.
The women treated with hypnosis were far less likely than the other women to report that their hot flashes interfered with their daily lives and sleep.
"Many women do not want to take hormone therapy or any drug for hot flashes," Elkins says. "This study shows that an alternative, non-drug treatment can be highly effective."
Elkins recommends that women who want to try the treatment seek out a qualified practitioner affiliated with either the American Society of Clinical Hypnosis or the Society for Clinical and Experimental Hypnosis.
Gass says she would like to see Elkins' findings duplicated, but she adds that hypnosis could prove to be a badly needed new treatment for hot flashes.
"This will certainly appeal to women who want to avoid drugs and who want a treatment that has few, if any, side effects," she says.
The study, which was published this week in the journal Menopause, was funded by the NIH's National Center for Complementary and Alternative Medicine.
SOURCES: Elkins, G.R. Menopause, Oct. 25, 2012. Gary R. Elkins, PhD, Mind-Body Medicine Research Laboratory, Baylor University, Waco, Texas. Margery Gass, MD, executive director, North American Menopause Society; professor, Case Western Reserve University; consultant OBGYN, Cleveland Clinic, Cleveland, Ohio. News release, North American Membrane Society.
©2012 WebMD, LLC. All Rights Reserved.

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New Strategy To Prevent Ear Infections From Recurring

Editor's Choice
Main Category: Ear, Nose and Throat
Also Included In: Infectious Diseases / Bacteria / Viruses
Article Date: 30 Oct 2012 - 13:00 PDT

Recurrence of middle ear infection can be prevented by boosting levels of antimicrobial proteins that are already there, as well as eliminating bacteria's DNA

The finding came from a team in The Research Institute at Nationwide Children's Hospital who set out to observe how an immune defense protein commonly found in the middle ear communicates with a structure that secures a community of bacteria.

The bacterium is called nontypeable Haemophilus influenza (NTHI) and is responsible for a variety of diseases of both the lower and upper airways, such as middle ear infection.

Similar to other microorganisms, NTHI can create a strong colony of bacteria, known as a biofilm. This permits the bacteria to avoid the person's immune system, while keeping safe from antibiotics and other treatments that try to destroy them.

Gram-positive and Gram-negative bacteria can be killed by an antimicrobial defense protein, called human beta-defensin-3, that is expressed in the middle ear of humans and other mammals. According to prior studies, the host's ability to control the bacteria in the upper airway changes if the expression of beta-defensis is disrupted, and the infection gets even worse.

Human beta-defensin-3 might lose its strength to destroy NTHI if it gets stuck within the extracellular DNA that makes up a biofilm's outer layer, stopping its connection with bacteria within the biofilm, the team hypothesized.

Lauren O. Bakaletz, Ph.D., director of the Center for Microbial Pathogenesis, explained:

"Antimicrobial host defense proteins, like human beta-defensin-3, have been shown to bind to non-host DNA. This interaction has an impact on the defense protein's ability to function."

While analyzing the animal model of middle ear infection, Dr. Bakaletz and his colleagues discovered that in the biofilms that were created during infection, the animal's defense peptides and bacterial DNA were found together. The team also realized that the defense peptide was mainly co-localized with the extracellular DNA of the biofilm.

When a concentration of human-beta defensin-3, which is normally found in a child's middle ear with an active infection, was released to the bacteria that cause ear infections, the peptide destroyed 100% of the NTHI. However, the destruction ended when extracellular DNA was presented to the response.

"These data support the conclusion that the killing activity of the antimicrobial defense protein was decreased in an NTHI-induced biofilm due to its interaction with eDNA," said Dr. Bakaletz, leading author and professor of Pediatrics and Otolaryngology at The Ohio State University College of Medicine.

After taking away the extracellular DNA from the biofilm, the team found that it recovered the killing activity of the defense peptide.

"The ability to restore antimicrobial defense protein activity is encouraging, since biofilms are resistant to most treatments, including traditional antibiotics," Dr. Bakaletz said.

This research should encourage scientists to create a new treatment regimen that can aim for biofilms created by NTHI during middle ear infection.

One strategy may be to disrupt bacertial DNA by administering a therapeutic agent along with human beta-defensin-3 to the middle ear of a child with chronic, recurrent infection. The same pathway could be used that doctors use to target the middle ear during ear tube surgery (a therapy for chronic ear infections).

Dr. Bakaletz concluded:

"This approach would likely bolster the ability of the innate immune system to manage NTHI-induced biofilms, avoiding the need for antibiotics or empowering the use of antibiotics we already have in our arsena. Doing so could help diminish the recurrent nature of middle ear infection."

Written by Sarah Glynn
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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6 Non-Boring Ways to Eat Your Steel-Cut Oats

Sure, oats can be a bit bland, but think of them as a blank slate: they absorb the flavor of whatever you mix in. Plus, they pack a ton of health benefits—especially the steel-cut variety “The grain’s nutrients, like fiber, are fully intact. Plus, they’re sodium-free, which is rare when it comes to breakfast foods,” says Elisa Zied, R.D., a nutritionist based in New York City.

Ready to dig in? Skip the sugar-heavy insta oatmeal packets and go for the real deal. Leftovers keep in the fridge for a week, so make a big batch over the weekend and reheat before you dash out the door. Here’s how to do it: Bring about three cups of water or milk to a boil, then mix in one cup of steel cut oats and a pinch of salt. Simmer, uncovered, for 20–30 minutes, stirring every few minutes so that the bottom doesn’t burn.

Once that’s done, it’s time to take your bowl from “ho-hum” to “holy crap!” Amp up the flavor—and nutritional content—with these six add-ins.

Source: http://www.mensfitness.com/nutrition/what-to-eat/6-ways-to-eat-your-steel-cut-oats

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Breast Cancer Tumor Disparity And Socioeconomic Disadvantage Linked

Main Category: Breast Cancer
Article Date: 30 Oct 2012 - 4:00 PDT

Racial and ethnic disparities in breast tumor aggressiveness might be explained by social factors that influence the developing tumor and place those in disadvantaged groups at higher risk for aggressive breast cancer, according to data presented at the Fifth AACR Conference on The Science of Cancer Health Disparities, held here Oct. 27-30, 2012.

"There is a disparity in the biological aggressiveness of breast cancer," said Garth H. Rauscher, Ph.D., associate professor of epidemiology at the University of Illinois at Chicago. "We tend to think about biological differences being due to differences in genes, but tumor biology can be affected by social or behavioral factors that are associated with socioeconomic status. Our study highlights the importance of the social environment in influencing tumor biology and ultimately influencing disparities."

Rauscher and colleagues examined data from a population-based sample of 989 patients with a recent diagnosis of breast cancer (397 non-Hispanic whites, 411 non-Hispanic blacks and 181 Hispanics) from the Breast Cancer Care in Chicago Study. Patients were aged 30 to 79 years and had primary in situ or invasive breast cancer. A total of 742 patients consented to medical record abstraction and had medical record data available for estrogen receptor (ER) and progesterone receptor (PR) status.

Researchers established socioeconomic disadvantage using four measurements: individual income, individual education and two census tract measures of socioeconomic status - concentrated disadvantage and concentrated affluence.

Compared with 12 percent of non-Hispanic white patients, 29 percent of non-Hispanic black patients and 20 percent of Hispanic patients had ER- and PR-negative tumors. Non-Hispanic black and Hispanic patients were also more likely to have lower income and less education and to reside in more disadvantaged and less affluent neighborhoods. In addition, all four measures of socioeconomic disadvantage used in the study were strongly associated with ER/PR-negative status.

"It was interesting to see that the main finding remained unchanged regardless of the measure of socioeconomic status we used," Rauscher said. "Patient levels of income and education, as well as neighborhood-level measures of socioeconomic status, were each associated with tumor biology. In each instance, lower socioeconomic status was associated with more aggressive breast cancers that lacked these hormone receptors."

Socioeconomic disadvantage predicts more aggressive estrogen/progesterone receptor negative breast cancer and mediates racial and ethnic disparities in breast cancer aggressiveness

Purpose: Racial and ethnic disparities in breast cancer stage at diagnosis are often attributed to social and behavioral factors (e.g., socioeconomic disadvantage, cultural beliefs, health care access and utilization). However, few studies have directly examined their potential role in generating a disparity in the biological aggressiveness of tumors. It is well established that Hispanic and non-Hispanic (nH) Black breast cancer patients are more likely than their non-Hispanic White counterparts to be diagnosed with more aggressive tumors that are negative for estrogen and progesterone receptors (ER/PR negative). Tumor aggressiveness disparities are important because they contribute not only to disparities in stage at diagnosis, but also to disparities in prognosis more generally. We sought to investigate whether the disparity in ER/PR negative disease might be transmitted through the socioeconomic environment.

Methods: Data were obtained from a population-based sample of 989 recently diagnosed breast cancer patients (397 nH White, 411 nH Black, 181 Hispanic) recruited as part of the Breast Cancer Care in Chicago study, aged 30-79 who had been diagnosed with a primary in situ or invasive breast cancer. Of these, 742 patients consented to medical record abstraction and had available medical record data on ER/PR status. Patients were defined as ER/PR negative if their tumor lacked both ER and PR receptors. Four measures of socioeconomic disadvantage were defined: individual income and education were reported at interview, and census tract measures of socioeconomic status (concentrated disadvantage and concentrated affluence) were derived. In order to assess potential mediation, in age-adjusted logistic regression models we used the method of Karlson, Holm and Breen (2010) to compare rescaled coefficients for the disparity in ER/PR negative status before and after adding all four socioeconomic disadvantage variables to the model.

Results: Compared to nH-Whites, nH-Black and Hispanic patients were more likely to have hormone receptor negative tumors (29% and 20% vs. 12%, respectively, p≤0.001); more likely to have less income and education, and more likely to live in more disadvantaged and less affluent neighborhoods (p

Conclusions: A substantial portion of the racial/ethnic disparity in breast tumor aggressiveness may be transmitted through social influences that impact the biology of the developing tumor, predisposing disadvantaged groups to more aggressive breast cancer. Socioeconomic disadvantage could lead to higher levels of chronic stress, as well as to differences in dietary or hormonal and reproductive histories, any of which might contribute to disparities in tumor biology.

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