Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
Slone Epidemiology Center at Boston University, 72 East Concord Street, L-7, Boston, MA, 02118, USA.
Breast Cancer Res. 2021 Nov 22;23(1):108. doi: 10.1186/s13058-021-01483-y.
Research on psychosocial stress and risk of breast cancer has produced conflicting results. Few studies have assessed this relation by breast cancer subtype or specifically among Black women, who experience unique chronic stressors.
We used prospective data from the Black Women's Health Study, an ongoing cohort study of 59,000 US Black women, to assess neighborhood- and individual-level psychosocial factors in relation to risk of breast cancer. We used factor analysis to derive two neighborhood score variables after linking participant addresses to US Census data (2000 and 2010) on education, employment, income and poverty, female-headed households, and Black race for all households in each residential block group. We used Cox proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) adjusted for established breast cancer risk factors.
During follow-up from 1995 to 2017, there were 2167 incident invasive breast cancer cases (1259 estrogen receptor positive (ER +); 687 ER negative (ER-)). For ER- breast cancer, HRs were 1.26 (95% CI 1.00-1.58) for women living in the highest quartile of neighborhood disadvantage relative to women in the lowest quartile, and 1.24 (95% CI 0.98-1.57) for lowest versus highest quartile of neighborhood socioeconomic status (SES). For ER+ breast cancer, living in the lowest quartile of neighborhood SES was associated with a reduced risk of ER+ breast cancer (HR = 0.83, 95% CI 0.70-0.98). With respect to individual-level factors, childhood sexual abuse (sexual assault ≥ 4 times vs. no abuse: HR = 1.35, 95% CI 1.01-1.79) and marital status (married/living together vs. single: HR = 1.29, 95% CI 1.08-1.53) were associated with higher risk of ER+, but not ER- breast cancer.
Neighborhood disadvantage and lower neighborhood SES were associated with an approximately 25% increased risk of ER- breast cancer in this large cohort of Black women, even after control for multiple behaviors and lifestyle factors. Further research is need to understand the underlying reasons for these associations. Possible contributing factors are biologic responses to the chronic stress/distress experienced by individuals who reside in neighborhoods characterized by high levels of noise, crime and unemployment or the direct effects of environmental toxins.
关于心理社会压力与乳腺癌风险的研究结果相互矛盾。很少有研究通过乳腺癌亚型或专门针对经历独特慢性压力源的黑人女性来评估这种关系。
我们使用正在进行的黑人女性健康研究的前瞻性数据，该研究是一项针对 59,000 名美国黑人女性的队列研究，评估了邻里和个人层面的心理社会因素与乳腺癌风险的关系。我们使用因素分析将参与者的地址与美国人口普查数据（2000 年和 2010 年）联系起来，这些数据涉及每个住宅街区组中所有家庭的教育、就业、收入和贫困、女性户主家庭和黑人种族，得出两个邻里评分变量。我们使用 Cox 比例风险回归来估计风险比 (HR) 和 95%置信区间 (CI)，这些风险比和置信区间经过了既定乳腺癌风险因素的调整。
在 1995 年至 2017 年的随访期间，共有 2167 例浸润性乳腺癌病例（1259 例雌激素受体阳性 (ER+)；687 例 ER 阴性 (ER-)）。对于 ER-乳腺癌，与最低四分位的女性相比，生活在邻里劣势最高四分位的女性的 HR 为 1.26（95%CI 1.00-1.58），与最低四分位相比，生活在邻里社会经济地位 (SES) 最高四分位的女性的 HR 为 1.24（95%CI 0.98-1.57）。对于 ER+乳腺癌，生活在邻里 SES 最低四分位与 ER+乳腺癌的风险降低相关（HR=0.83，95%CI 0.70-0.98）。就个体层面的因素而言，童年性虐待（性侵犯≥4 次与无虐待：HR=1.35，95%CI 1.01-1.79）和婚姻状况（已婚/同居与单身：HR=1.29，95%CI 1.08-1.53）与 ER+乳腺癌的风险增加相关，但与 ER-乳腺癌无关。
在这项针对大量黑人女性的大型队列研究中，即使考虑了多种行为和生活方式因素，邻里劣势和较低的邻里 SES 与 ER-乳腺癌的风险增加约 25%相关。需要进一步研究以了解这些关联的根本原因。可能的促成因素是个体居住在以噪音、犯罪和失业水平高为特征的邻里环境中所经历的慢性压力/压力的生物反应，或者是环境毒素的直接影响。
