Breast Oncology Program, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, MI, USA.
Ann Surg Oncol. 2017 Oct;24(10):2869-2875. doi: 10.1245/s10434-017-5977-1. Epub 2017 Aug 1.
Disparities in poverty and health care access barriers have a negative impact on the health and wellness of population subsets that bear a disproportionate share of these socioeconomic disadvantages, such as African Americans and Hispanic/Latina Americans. The more advanced stage distribution of breast cancer in these two population subsets is likely related to imbalance in distribution of socioeconomic resources in the United States. However, differences in the breast cancer burden of population subsets defined by racial/ethnic identity are also influenced by race/ethnicity-associated variation in tumor biology and hereditary susceptibility. Compared with white Americans, African-American women have higher population-based breast cancer mortality rates, which are at least partly explained by an increased risk for the biologically aggressive triple-negative phenotype. International studies correlate West African ancestry with predisposition for triple-negative breast cancer. In contrast, Hispanic/Latina Americans have lower population-based incidence and mortality rates for breast cancer despite their increased rates of socioeconomic challenges. Genetic studies suggest that extent of Native American ancestry among Hispanic/Latina women may reduce breast cancer risk. Eradication of disparate access to breast cancer early detection and treatment strategies is a public health imperative, but research to elucidate the genetics of breast cancer related to racial/ethnic identity is equally important as we strive to comprehensively define this complex disease.
贫困和医疗保健获取障碍的差异对那些承担这些社会经济劣势不成比例份额的人群亚组的健康和福利产生负面影响,例如非裔美国人和西班牙裔/拉丁裔美国人。这两个人群亚组中乳腺癌更晚期的分布可能与美国社会经济资源分配的不平衡有关。然而,根据种族/民族身份定义的人群亚组的乳腺癌负担差异也受到与种族/民族相关的肿瘤生物学和遗传性易感性差异的影响。与白人相比,非裔美国女性的基于人群的乳腺癌死亡率更高,这至少部分归因于生物学侵袭性三阴性表型的风险增加。国际研究将西非血统与三阴性乳腺癌的易感性相关联。相比之下,尽管西班牙裔/拉丁裔美国人面临更多的社会经济挑战,但他们的乳腺癌基于人群的发病率和死亡率较低。遗传研究表明,西班牙裔/拉丁裔女性中的美洲原住民血统程度可能会降低乳腺癌的风险。消除乳腺癌早期检测和治疗策略的差异获取是公共卫生的当务之急,但研究阐明与种族/民族身份相关的乳腺癌遗传学同样重要,因为我们努力全面定义这种复杂的疾病。