title: Mediation of Racial and Ethnic Disparities in Estrogen/Progesterone Receptor-Negative Breast Cancer by Socioeconomic Position and Reproductive Factors.
abstract: Hispanic and non-Hispanic black breast cancer patients are more likely than non-Hispanic white patients to be diagnosed with breast cancer that is negative for estrogen and progesterone receptors (ER/PR-negative). This disparity might be transmitted through socioeconomic and reproductive factors. Data on 746 recently diagnosed breast cancer patients (300 non-Hispanic white, 303 non-Hispanic black, 143 Hispanic) were obtained from the population-based Breast Cancer Care in Chicago Study (Chicago, Illinois, 2005-2008). Income, educational level, and census tract measures of concentrated disadvantage and affluence were combined into a single measure of socioeconomic position (SEP). Parity and age at first birth were combined into a single measure of reproductive factors (RPF). We constructed path models to estimate direct and indirect associations of SEP and RPF, and we estimated average marginal controlled direct associations. Compared with non-Hispanic white patients, non-Hispanic black patients and Hispanic patients were more likely to have ER/PR-negative disease (28% and 20% for non-Hispanic black patients and Hispanic patients, respectively, vs. 12% for non-Hispanic white patients; P ≤ 0.001). The ethnic disparity in ER/PR-negative breast cancer (prevalence difference = 0.13, 95% confidence interval: 0.07, 0.18) was reduced by approximately 60% (prevalence difference = 0.05, 95% confidence interval: -0.04, 0.13) after control for SEP and RPF. At least part of the ethnic disparity in the aggressiveness of breast tumors might be transmitted through social influences on tumor biology.
authors.forename: Garth H
authors.initials: GH
authors.lastname: Rauscher
authors.forename: Richard T
authors.initials: RT
authors.lastname: Campbell
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Wiley
authors.forename: Kent
authors.initials: K
authors.lastname: Hoskins
authors.forename: Melinda R
authors.initials: MR
authors.lastname: Stolley
authors.forename: Richard B
authors.initials: RB
authors.lastname: Warnecke
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000208:ethnology; D002641:Chicago / Q000453:epidemiology; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage; D015914:Estrogen Replacement Therapy / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*; D017584:Reproductive History; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data
chemical_list: D003278:Contraceptives, Oral, Hormonal; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
keywords: breast cancer; health status disparities; mediation; reproductive factors; socioeconomic position