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1.  SYK Allelic Loss and the Role of Syk-Regulated Genes in Breast Cancer Survival 
PLoS ONE  2014;9(2):e87610.
Heterozygotic loss of SYK, a non-receptor tyrosine kinase, gives rise to mouse mammary tumor formation where Syk protein levels are reduced by about half; loss of SYK mRNA is correlated with invasive cell behavior in in vitro models; and SYK loss has been correlated with distant metastases in patients. Here, allelic loss of the SYK gene was explored in breast ductal carcinoma in situ (DCIS) using fluorescence in situ hybridization and pyrosequencing, respectively, and in infiltrating ductal carcinoma (IDC) using genomic data from The Cancer Genome Atlas (TCGA). Allelic loss was present in a subset of DCIS cases where adjacent IDC was present. SYK copy number loss was found in about 26% of 1002 total breast cancer cases and 30% of IDC cases. Quantitative immunofluorescence revealed Syk protein to be six-fold higher in infiltrating immune cells compared with epithelial cells. This difference distorted tumor cell mRNA and protein levels in extracts. 20% of 1002 IDC cases contained elevated immune cell infiltration as estimated by elevated immune-specific mRNAs. In cases without immune cell infiltration, loss of SYK copy number was associated with a significant reduction of SYK mRNA. Here we define a 55 Gene Set consisting of Syk interacting, motility- and invasion-related genes. We found that overall survival was significantly reduced in IDC and Luminal A+B cases where copy number and mutations of these 55 genes were affected (Kaplan-Meier, Logrank test p-value 0.007141 and Logrank test p-value 0.001198, respectively). We conclude that reduction in Syk expression and contributions of genomic instability to copy number and mutations in the 55 Syk interacting genes significantly contribute to poorer overall patient survival. A closer examination of the role of Syk interacting motility and invasion genes and their prognostic and/or causative association with metastatic disease and patient outcome is warranted.
doi:10.1371/journal.pone.0087610
PMCID: PMC3921124  PMID: 24523870
2.  Cholesterol, lipoproteins, and breast cancer risk in African-American women 
Ethnicity & disease  2012;22(3):281-287.
Background
Cholesterol levels, including high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides have been reported to be associated with breast cancer risk.
Methods
We studied African-American women (97 breast cancer cases and 102 controls) accrued through a population-based, case-control study in the Washington, DC metropolitan area during 1997 and 1998. Plasma lipid levels were measured using enzymatic methods. Logistic regressions (adjusted for age, age at menarche, parity, previous alcohol consumption, and education) were used to explore the associations between lipid levels and breast cancer.
Results
Through multivariable-adjusted regression, we observed a significant inverse association between breast cancer risk and increasing levels of total cholesterol (OR= 0.46, 95% CI= 0.25-0.85) and LDL (OR=0.41, 95% CI= 0.21-0.81), whereas lower levels of HDL were associated with a significant increase in risk (OR= 1.99, 95% CI= 1.06-3.74).
Conclusions
These data demonstrate significant reductions in breast cancer risk with high levels of total cholesterol and significant increase in risk when HDL levels are low. These data are in support of a protective effect of cholesterol which has been reported in other populations; further, these findings add to the literature in an understudied population, African-American women.
PMCID: PMC3830419  PMID: 22870570
Breast cancer; cholesterol; HDL; LDL; triglycerides; African-Americans
3.  Understanding sleep disturbances in African-American breast cancer survivors: a pilot study 
Psycho-oncology  2011;10.1002/pon.2000.
Objectives
The goals of this study were (i) to report the prevalence and nature of sleep disturbances, as determined by clinically significant insomnia symptoms, in a sample of African-American breast cancer survivors; (ii) to assess the extent to which intrusive thoughts about breast cancer and fear of recurrence contributes to insomnia symptoms; and (iii) to assess the extent to which insomnia symptoms contribute to fatigue.
Methods
African-American breast cancer survivors completed surveys pertaining to demographics, medical history, insomnia symptoms, and intrusive thoughts about breast cancer, fear of cancer recurrence, and fatigue. Hierarchical regression models were performed to investigate the degree to which intrusive thoughts and concerns of cancer recurrence accounted for the severity of insomnia symptoms and insomnia symptom severity's association with fatigue.
Results
Forty-three percent of the sample was classified as having clinically significant sleep disturbances. The most commonly identified sleep complaints among participants were sleep maintenance, dissatisfaction with sleep, difficulty falling asleep, and early morning awakenings. Intrusive thoughts about breast cancer were a significant predictor of insomnia symptoms accounting for 12% of the variance in insomnia symptom severity. After adjusting for covariates, it was found that insomnia symptom severity was independently associated with fatigue accounting for 8% of variance.
Conclusions
A moderate proportion of African-American breast cancer survivors reported significant problems with sleep. Sleep disturbance was influenced by intrusive thoughts about breast cancer, and fatigue was associated with the severity of participants' insomnia symptoms. This study provides new information about sleep-related issues in African-American breast cancer survivors.
doi:10.1002/pon.2000
PMCID: PMC3823716  PMID: 21648016
sleep; African-American; breast; cancer; survivors
4.  An Exploratory Analysis of Fear of Recurrence among African-American Breast Cancer Survivors 
Background
Fear of recurrence (FOR) is a psychological concern that has been studied extensively in cancer survivors but has not been adequately examined in African-American breast cancer survivors.
Purpose
This exploratory study describes the extent and nature of FOR in African-American breast cancer survivors. FOR is examined in relation to socio-demographic characteristics, treatment-related characteristics, psychological distress, and quality of life (QOL).
Methods
Participants completed questionnaires assessing FOR, psychological distress, QOL, and demographic and treatment characteristics. Pearson r correlations, t tests, and ANOVAs were used to determine the association between FOR and demographic and treatment-related characteristics. Hierarchical multiple regression models were performed to investigate the degree to which FOR dimensions account for the variance in QOL and psychological distress.
Results
Fifty-one African-American breast cancer survivors participated in this study. The mean age of participants was 64.24 (SD = 12.3). Overall fears as well as concerns about death and health were rated as low to moderate. Role worries and womanhood worries were very low. Inverse relationships were observed between age and FOR dimensions. FOR was positively correlated with measures of psychological distress and negatively correlated with QOL. FOR significantly accounted for a portion of the variance in QOL and distress after controlling for other variables.
Conclusions
This study suggests that African-American women in this sample demonstrated some degree of FOR. Results indicate that FOR among African-American breast cancer survivors decreases with age and time since diagnosis and co-occurs with psychological distress as well as diminished quality of life.
doi:10.1007/s12529-011-9183-4
PMCID: PMC3760175  PMID: 21915625
Fear of Recurrence; African-American; Breast Cancer Survivors
5.  Breast Cancer Risk Assessments Comparing Gail and CARE Models in African-American Women 
The breast journal  2009;15(0 1):S72-S75.
The Gail model has been used to predict invasive breast cancer risk in women using risk factors of age, age at menarche, age at first live birth, number of first-degree relatives with breast cancer, and number of previous benign breast biopsies. However, this model underestimates breast cancer risk in African-American women. The Contraceptive and Reproductive Experience (CARE) model has been developed to replace the Gail model in predicting breast cancer risk in African-American women. In a sample of 883 women who participated in the breast cancer screening program at Howard University Cancer Center, we compared the breast cancer risk estimates from the Gail model and the CARE model. The mean 5-year breast cancer risk was 0.88% (Range: 0.18–6.60%) for the Gail model and 1.29% (Range: 0.20–4.50%) for the CARE model. Using the usual cutoff-point of 1.67% or above for elevated risk, there is a significant difference in the proportion of women with elevated breast cancer risk between the Gail and the CARE models (McNemar’s test, p < 0.0001). For both models, there was a significant mean risk difference between those with and without a family history of breast cancer (Wilcoxon rank-sum test, p < 0.0001). Our results confirm the need for validation of the Gail model in African-Americans and diversity in research. Although these findings are not perfect and perhaps not definitive, they are additive in the discussions during counseling and risk assessment in African-Americans. Furthermore, these findings will be complemented by new technologies such as genomics in refining our ability to assess risk.
doi:10.1111/j.1524-4741.2009.00824.x
PMCID: PMC3760176  PMID: 19775333
6.  Adipokines in Plasma and Breast Tissues: Associations with Breast Cancer Risk Factors 
Background
Blood adipokines are associated with breast cancer risk; however, blood–breast adipokine correlations and factors that explain variation in adipokines are unknown.
Methods
Plasma (n = 155) and breast (n = 85) leptin and adiponectin were assessed by immunoassays in women with no history of cancer. Multivariable-adjusted regression models were used to determine breast adipokine associations.
Results
Through body mass index (BMI)-adjusted analyses, we initially observed positive plasma–breast correlations for leptin (r = 0.41, P = 0.0002) and adiponectin (r = 0.23, P = 0.05). The positive plasma–breast correlation for leptin was strongest among normal weight women (r = 0.62), whereas the correlation for adiponectin was strongest among obese women (r = 0.31). In multivariable models, adjusting for BMI, demographic, reproductive, and lifestyle factors, plasma leptin was not associated with breast leptin, and only the highest quartile of plasma adiponectin was associated with tissue levels. Of the risk factors investigated, those that contributed most to the variation in breast tissue adipokines were BMI and race for leptin, oral contraceptive use and smoking status for adiponectin.
Conclusions
Although we report positive plasma–breast adipokine correlations overall, plasma adipokine concentrations may not be good surrogates for breast concentrations among all women. Predictors of breast adipokines vary, depending on subject characteristics, possibly explaining inconsistent epidemiologic results and they implicate differing pathways toward carcinogenesis.
Impact
A clearer understanding of the relationships between plasma adipokines and their levels within the target organ is necessary to better understand the impact of these hormones on breast cancer risk. Future studies are needed to identify additional factors associated with breast adipokines in target tissues.
doi:10.1158/1055-9965.EPI-12-0016
PMCID: PMC3760187  PMID: 22892282
8.  PHYSICAL ACTIVITY REDUCES BREAST CANCER RISK IN AFRICAN AMERICAN WOMEN 
Ethnicity & disease  2011;21(4):406-411.
Objective
To examine the relationship between physical activity and breast cancer in African American women.
Design
A population-based case-control study was conducted with 199 women (97 cases and 102 controls) from the Washington, DC metro area. A self-report physical activity questionnaire elicited responses on walking for exercise and vigorous physical activity (e.g., running, aerobics, etc.) in the past year. Responses were used to calculate a metabolic equivalent (MET) score [MET-hours/week = hours/week vigorous activity×7+ hours/week walking ×3]. The MET score was categorized into low, medium and high tertiles. Multivariate logistic regression examined the association between physical activity and breast cancer.
Results
African American women who engaged in vigorous physical activity (> 2 hours/week in the past year) had a 64% reduced risk of breast cancer compared to those who did not participate in any vigorous activity (odds ratio, OR = 0.36; 95% confidence interval, CI = 0.17–0.75). We also found a 64% reduced breast cancer risk in women with a high versus low tertile of total activity (OR = 0.36; 95% CI = 0.16–0.79). For postmenopausal women, vigorous physical activity and total activity (high versus low tertile) also had an inverse relationship with breast cancer (p<.05).
Conclusion
Data regarding the association of physical activity and breast cancer has been equivocal and lacking for African American women. This study found that modest levels of physical activity reduced breast cancer risk in this group. Targeted efforts are needed to encourage more African American women to engage in physical activity.
PMCID: PMC3760197  PMID: 22428342
Total activity; blacks; postmenopausal; women
9.  Impact of Perceived Racial Discrimination on Health Screening in Black Women 
Perceived discrimination has been shown to be related to health screening behavior. The present study examines the effect of discrimination on cancer screening among women in the Black Women’s Health Study. Five self-report items measured discrimination in everyday life and three items measured experiences of major discrimination. Logistic regression was used to test associations of discrimination with Pap smear, mammography, or colonoscopy utilization. At the start of follow-up, 88.8% had a Pap smear in the previous year, 52.7% had a mammogram, and 20.0% had received a colonoscopy. Both everyday and major discrimination were associated with not having received a Pap smear, even after adjusting for other variables. Discrimination was not associated with mammography or colonoscopy utilization. In conclusion, perceived everyday and major discrimination is associated with poorer utilization of Pap smears for cervical cancer screening among Black women.
doi:10.1353/hpu.0.0273
PMCID: PMC3760200  PMID: 20173270
Racism; cancer screening; Black; women’s health
10.  Plasma IGF-1 and IGFBP-3 may be imprecise surrogates for breast concentrations: an analysis of healthy women 
We investigated insulin-like growth factor (IGF)-1 and IGF binding protein (IGFBP)-3 concentrations in histologically normal breast tissues and assessed their association with plasma concentrations, and breast cancer risk factors. IGF-1 and IGFBP-3 were assessed in plasma and breast tissues of 90 women with no history of any cancer and undergoing reduction mammoplasty. Pearson correlations and ANOVAs were used to describe plasma-breast associations and biomarker differences by breast cancer risk factors, respectively. Multivariable regression models were used to determine associations between risk factors, and breast IGF-1 and IGFBP-3. The mean age of the study sample was 37.3 years, 58 % were white, and generally these women were obese (mean BMI = 30.8 kg/m2). We observed no plasma-breast correlation for IGF-1, IGFBP-3, or IGF-1/IGFBP-3 (r = −0.08, r = 0.14, and r = 0.03, respectively; p-values >0.05). Through age- and BMI-adjusted analysis, BMI and years of oral contraceptive (OC) use were inversely associated with breast IGF-1 (p-values = 0.02 and 0.003, respectively) and age was associated with breast IGFBP-3 (p = 0.01), while breast IGF-1/IGFBP-3 was higher in blacks than whites (1.08 vs. 0.68, p = 0.04) and associated with age and BMI (p-values = 0.03 and 0.002, respectively). In multivariable-adjusted models, some breast cancer risk factors studied herein explained 24, 10, and 15 % of the variation in breast IGF-1, IGFBP-3, and IGF-1/IGFBP-3, respectively. While reasons for the lack of plasma-breast hormone correlations in these cancer-free women are unknown, several factors were shown to be associated with breast concentrations. The lack of correlation between blood and tissue IGF-1 and IGFBP-3 suggests that studies of breast cancer risk assessing blood IGF-1 and IGFBP-3 may have important limitations in understanding their role in breast carcinogenesis.
doi:10.1007/s10549-013-2452-y
PMCID: PMC3736825  PMID: 23456194
IGF-1; IGFBP-3; IGF-1/IGFBP-3; Breast tissues; Plasma; Race; Oral contraceptive use
11.  The Effect of a Supervised Exercise Trial on Exercise Adherence Among African American Men: A Pilot Study 
Objective
The objective of this pilot study was to determine the effect of a supervised short-term exercise trial on exercise adherence in a sample of African American males.
Methods
We observed exercise adherence rates among a group of African American men in response to an exercise intervention. Exercise adherence was determined by dividing the total number of actual sessions attended by the total number of possible sessions (12 sessions). A participant was classified as an adherer if they completed 9 out of 12 exercise sessions (75%).
Results
Seventy-one percent of the study participants (12/17) completed at least 75% of the study sessions and therefore adhered to the study protocol. Among the adherers, 7 out of 12 (58%) had adherence rates of 100%. Five participants withdrew from the exercise group due to lack of time and lack of interest.
Conclusion
Exercise adherence rates among African-American men in this study were favorable during this supervised exercise intervention and were comparable to adherence rates observed in other supervised exercise interventions. Recommendations based on this pilot study are provided to reduce participant withdrawal and to inform future largescale studies.
PMCID: PMC3736827  PMID: 21830631
exercise; adherence; African Americans; men's health
12.  Consumption of dairy and meat in relation to breast cancer risk in the Black Women’s Health Study 
Cancer causes & control : CCC  2013;24(4):675-684.
Purpose
Dairy and meat consumption may impact breast cancer risk through modification of hormones (e.g., estrogen), through specific nutrients (e.g., vitamin D), or through products formed in processing/cooking (e.g., heterocyclic amines). Results relating meat and dairy intake to breast cancer risk have been conflicting. Thus, we examined the risk of breast cancer in relation to intake of dairy and meat in a large prospective cohort study.
Methods
In the Black Women’s Health Study, 1,268 incident breast cancer cases were identified among 52,062 women during 12 years of follow-up. Multivariable (MV) relative risks (RRs) and 95 % confidence intervals (CIs) were calculated using Cox proportional hazards models.
Results
Null associations were observed for total milk (MV RR = 1.05, 95 % CI 0.74–1.46 comparing ≥1,000–0 g/week) and total meat (MV RR = 1.04, 95 % CI 0.85–1.28 comparing ≥1,000 <400 g/week) intake and risk of breast cancer. Associations with intakes of specific types of dairy, specific types of meat, and dietary calcium and vitamin D were also null. The associations were not modified by reproductive (e.g., parity) or lifestyle factors (e.g., smoking). Associations with estrogen receptor (ER) positive (+), ER negative (−), progesterone receptor (PR)+, PR−, ER+/PR+, and ER−/PR− breast cancer were generally null.
Conclusions
This analysis of African-American women provides little support for associations of dairy and meat intake with breast cancer risk.
doi:10.1007/s10552-013-0146-8
PMCID: PMC3695615  PMID: 23329367
Diet; Breast cancer; Epidemiology; Cohort; African-American
13.  Steroid hormone levels associated with passive and active smoking 
Steroids  2011;76(7):653-659.
Context
Cigarette tobacco smoke is a potent environmental contaminant known to adversely affect health including fertility and pregnancy.
Objective
To examine the associations between second-hand cigarette tobacco-smoke exposure, or active smoking and serum concentrations of steroid hormones using tandem mass spectrometry.
Design
Healthy women (18–45 y) from the general community in the Metropolitan Washington, DC were recruited at the follicular stage of their menstrual cycle. Participants were assigned to one of three study groups: active smokers (N= 107), passive smokers (N= 86), or non-smokers (N= 100). Classifications were based on a combination of self-reporting and serum cotinine concentrations.
Methods
Serum androgens, estrogens, progestins, androstenedione, aldosterone, cortisol, corticosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), 11-deoxycortisol and 25-hydroxy-vitamin D3 (25-OHVitD3) and cotinine were measured by isotope dilution tandem mass spectrometry (LC/MS/MS) (API-5000). Kruskal–Wallis tests were used to assess median differences among the three groups, with Dunn’s multiple comparison test for post hoc analysis.
Results
Serum estrone, estradiol, and estriol concentrations were lower in active and passive smokers than in non-smokers. The three study groups differed significantly in serum concentrations of 16-OHE1, aldosterone and 25-OHVitD3, as well as in the ratios of many of the steroids. Pair-wise comparison of the groups demonstrated significant differences in hormone concentrations between (i) smokers and nonsmokers for aldosterone: (ii) passive smokers and non-smokers for aldosterone, progesterone and estriol. Moreover, for smokers and passive smokers, there were no significant differences in these hormone concentrations.
Conclusions
Smoke exposure was associated with lower than normal median steroid hormone concentrations. These processes may be instrumental in explaining some adverse effects of tobacco smoke on female health and fertility.
doi:10.1016/j.steroids.2011.02.042
PMCID: PMC3635532  PMID: 21396948
Environmental toxicants; Cigarette tobacco smoke exposure; Mineralocorticoids; Sex hormones; Stress hormones; Tandem mass spectrometry
14.  Telomere length variation in normal epithelial cells adjacent to tumor: potential biomarker for breast cancer local recurrence 
Carcinogenesis  2011;33(1):113-118.
A better understanding of the risk of local recurrence (LR) will facilitate therapeutic decision making in the management of early breast cancers. In the present study, we investigated whether telomere length in the normal breast epithelial cells surrounding the tumor is predictive of breast cancer LR; 152 women who were diagnosed with breast cancer at the Lombardi Comprehensive Cancer Center were included in this nested case–control study. Cases (patients had LR) and controls (patients had no LR) were matched on year of surgery, age at diagnosis and type of surgery. Telomere fluorescent in situ hybridization was used to determine the telomere length using formalin fixed paraffin-embedded breast tissues. Small telomere length variation (TLV), defined as the coefficient variation of telomere lengths among examined cells, in normal epithelial cells adjacent to the tumor was significantly associated with a 5-fold (95% confidence interval = 1.2–22.2) increased risk of breast cancer LR. When the subjects were categorized into quartiles, a significant inverse dose–response relationship was observed with lowest versus highest quartile odds ratio of 15.3 (Ptrend = 0.012). Patients who had large TLV had significantly better 10 year recurrence free survival rate compared with patients who had small TLV (80 versus 33%). The present study revealed that TLV in normal epithelial cells adjacent to tumor is a strong predictor of breast cancer LR. If confirmed by future studies, TLV in normal epithelial cells adjacent to tumor has the potential to become a promising biomarker for predicting breast cancer LR after breast conserving surgery.
doi:10.1093/carcin/bgr248
PMCID: PMC3276329  PMID: 22072619
15.  A six-month crossover chemoprevention clinical trial of tea in smokers and non-smokers: methodological issues in a feasibility study 
Background
Chemoprevention crossover trials of tea can be more efficient than parallel designs but the attrition and compliance rates with such trials are unknown.
Methods
Attrition (dropouts) and compliance with treatment were assessed in a 25-week randomized, placebo controlled, crossover, feasibility clinical trial of four tea treatments to investigate the effect of tea on oral cancer biomarkers. Each treatment lasted 4 weeks with 2 weeks of washout in between. Participants were 32 smokers and 33 non-smokers without any evidence of premalignant oral lesions. The interventions consisted of packets of green tea, black tea, caffeinated water, or placebo. Participants were assigned to each treatment for four weeks, and were instructed to drink five packets per day while on the treatment. Dropout from the trial and compliance (consumption of ≥ 85% of the prescribed treatment packets) are the main outcome measures reported.
Results
There was a high rate of dropout (51%) from the study, and the rates were significantly higher among smokers (64%) than non-smokers (36%). Among participants who completed the study the rate of compliance was 72%. The highest rates of dropouts occurred between the first and second treatment visits in both smokers (38% dropout) and non-smokers (18% dropout). Throughout the study smokers were more likely to dropout than non-smokers. Black tea treatment was associated with the highest rates of dropout among smokers (37%), but was associated with the lowest rate of dropout among non-smokers (4%).
Conclusions
In a study conducted to test the feasibility of a four-treatment crossover tea trial, a high rate of dropout among smokers and non-smokers was observed. Multi-arm crossover tea trials might pose a higher burden on participants and research is needed to improve adherence and treatment compliance in such trials.
Trial registration number
ISRCTN70410203
doi:10.1186/1472-6882-12-96
PMCID: PMC3414766  PMID: 22800470
16.  MicroRNA-9 as Potential Biomarker for Breast Cancer Local Recurrence and Tumor Estrogen Receptor Status 
PLoS ONE  2012;7(6):e39011.
MicroRNAs (miRs) are small, non-protein coding transcripts involved in many cellular functions. Many miRs have emerged as important cancer biomarkers. In the present study, we investigated whether miR levels in breast tumors are predictive of breast cancer local recurrence (LR). Sixty-eight women who were diagnosed with breast cancer at the Lombardi Comprehensive Cancer Center were included in this study. Breast cancer patients with LR and those without LR were matched on year of surgery, age at diagnosis, and type of surgery. Candidate miRs were identified by screening the expression levels of 754 human miRs using miR arrays in 16 breast tumor samples from 8 cases with LR and 8 cases without LR. Eight candidate miRs that showed significant differences between tumors with and without LR were further verified in 52 tumor samples using real-time PCR. Higher expression of miR-9 was significantly associated with breast cancer LR in all cases as well as the subset of estrogen receptor (ER) positive cases (p = 0.02). The AUCs (Area Under Curve) of receiver operating characteristic (ROC) curves of miR-9 for all tumors and ER positive tumors are 0.68 (p = 0.02) and 0.69 (p = 0.02), respectively. In ER positive cases, Kaplan-Meier analysis showed that patients with lower miR-9 levels had significantly better 10-year LR-free survival (67.9% vs 30.8%, p = 0.02). Expression levels of miR-9 and another miR candidate, miR-375, were also strongly associated with ER status (p<0.001 for both). The potential of miR-9 as a biomarker for LR warrants further investigation with larger sample size.
doi:10.1371/journal.pone.0039011
PMCID: PMC3377597  PMID: 22723919
17.  Dietary patterns and the risk of colorectal adenomas: the Black Women's Health Study 
Background
Colorectal adenomas are benign lesions that may be precursors to colorectal cancer. No studies of African American women have investigated dietary patterns and the risk of colorectal adenomas. We examined data from the Black Women's Health Study (BWHS) to determine whether dietary patterns are associated with the risk of colorectal adenomas.
Methods
This is a prospective cohort study of 59,000 participants followed biennially since 1995. During 155,414 person-years of follow-up from 1997 to 2007 among women who had had at least one screening colonoscopy, 620 incident cases of colorectal adenomas were identified. Using Cox regression models, we obtained incident rate ratios (IRR) for colorectal adenoma in relation to quintiles of each of two dietary patterns, adjusting for other colorectal adenoma risk factors.
Results
Two dietary patterns, Western and prudent, were utilized to assess the association between dietary intake and adenoma risk. The highest quintile of prudent diet, relative to the lowest quintile, was significantly associated with 34% lower colorectal adenoma risk overall (incidence rate ratio, IRR=0.66; 95% CI, 0.50-0.88; p for trend, < 0.01). Higher scores on the Western pattern were associated with higher risk of colorectal adenoma (IRR = 1.42, 95% CI 1.09-1.85 for the highest quintile relative to the lowest; p trend, 0.01).
Conclusion
Our findings suggest that African American women may be able to reduce their risk of developing colorectal adenomas by following a prudent dietary pattern and avoiding a more Western pattern.
Impact Statement
A dietary modification could have a strong impact in colorectal adenoma prevention in African American women.
doi:10.1158/1055-9965.EPI-10-1213
PMCID: PMC3089689  PMID: 21357379
18.  Use of multivitamins, folic acid and herbal supplements among breast cancer survivors: the black women's health study 
Background
Complementary and alternative medicine (CAM) use, including herbals and multivitamin supplements, is quite common in the U.S., and has been shown to be highest in breast cancer survivors. However, limited data are currently available for CAM usage among African Americans. Thus, we sought to determine the prevalence of multivitamins, folic acid and herbal supplement usage in African American breast cancer survivors, and to compare the characteristics of users and nonusers.
Methods
A cohort study of breast cancer survivors, who completed the 1999 Black Women's Health Study questionnaire and self-reported having been diagnosed with breast cancer between 1995 and 1999, comprised the study population. In this study, the intake of natural herbs, multivitamins and folic acid at least three days per week within the past two years was used as a proxy for typical usage of this complimentary alternative medicine (CAM) modality.
Results
A total of 998 breast cancer survivors were identified. Overall, 68.2% had used either herbals or multivitamin supplements or both. The three most frequently used herbals were garlic (21.2%), gingko (12.0%), and echinacea (9.4%). The multivariate analysis determined that single marital status (OR = 1.58; 95%CI: 1.04-2.41), and alcohol consumption of 1-3 drinks per week (OR = 1.86, 95%CI: 1.28-2.68) were significantly associated with increased herbal use. Multivitamin use was significantly lower among obese women (OR = 0.66, 95%CI: 0.46-0.94) and current smokers (OR = 0.53, 95%CI: 0.34-0.82).
Conclusions
A significant number of African American breast cancer survivors are using herbals and multivitamins as CAM modality. Additional research is needed to understand the impact of herbals and multivitamins in African American breast cancer survivors.
doi:10.1186/1472-6882-11-30
PMCID: PMC3095573  PMID: 21496245
19.  Colonoscopy Utilization in the Black Women’s Health Study 
Cancer screening is important for health promotion and is a key element in reducing the disparities in cancer morbidity and mortality. Mortality rates for colorectal cancer are more than 40% higher among African Americans than among other ethnic populations in the United States. The primary objective of the present study is to determine correlates of colonoscopy utilization in the Black Women’s Health Study. Our study sample comprised 10992 black women from the Black Women’s Health Study whose ages ranged from 50 to 72 years at baseline in 1997; colonoscopy use in the subsequent 8 years was ascertained. The strongest correlate of colonoscopy use was mammography use: women who utilized mammography had 2.5 times the odds of having a colonoscopy, compared with those who never screened for breast cancer. Women who reported having health insurance had 2 times the odds of having a colonoscopy compared with women who did not have health insurance. Higher level of education was also associated with colonoscopy screening. Concurrent promotion of cancer screenings, ie, mammography and colonoscopy, may be a good approach to increasing colonoscopy utilization among women.
PMCID: PMC2895509  PMID: 20355353
colonoscopy; screening; African Americans; women’s health
20.  An assessment of the CES-D scale factor structure in black women: The Black Women's Health Study 
Psychiatry research  2009;168(2):163-170.
This study investigates the dimensional structure of the Center for Epidemiologic Studies Depression (CES-D) scale in U.S. Black women with and without history of cancer via single-group and multi-group analyses. The CES-D questionnaire was administered in 1999 to 50,774 black women who are participants in the Black Women's Health Study (BWHS). For our analysis, we utilized a group of 690 women with a history of at least one of the three types of cancer (breast cancer, colon cancer or lung cancer) and an age-matched group of 1,380 healthy women with no history of any cancer or other chronic conditions including myocardial infarctions, stroke, angina, diabetes, lupus, and sarcoidosis. Three a priori hypothesized models were tested via confirmatory factor analysis: single-, three- and four-factor structures. The four-factor model provided the best fit and remained largely invariant across the groups when tested via multi-group comparisons. Two internal consistency measures of the scale (Cronbach's α coefficient and split-half coefficient) were also shown to be satisfactory. We concluded that the CES-D scale is appropriate for use in black women regardless of their cancer status.
doi:10.1016/j.psychres.2008.04.022
PMCID: PMC2704501  PMID: 19501414
Depression; confirmatory factor analysis; single- and multi-group analyses
21.  Bone mass in physicians: a Howard University Hospital pilot study. 
PURPOSE: This observational cross-sectional study was done to determine bone mass in physicians and to determine if variables, such as calcium intake and exercise, were related to their bone mass. METHODS: One-hundred physicians of different ethnicities (African, African American, Asian, Caribbean, and Hispanic) were studied. Using dual-energy x-ray absorptiometry (DEXA), bone mass (BMD) of the lumbar spine and hips was measured. A validated questionnaire was used to determine the daily calcium intake and exercise. Student t-test, logistic regression, and Pearson chi-square were used to analyze the data. RESULTS: The study population consisted of 52% men and 48% women, with a mean age of 42 years old and a body mass index of 18.5 to 39.9 kg/m2. Low BMD occurred in 68% of the physicians (osteoporosis in 12%, osteopenia in 56%). Low calcium intake was found in 71%-14% of whom had osteoporosis and 49% osteopenia. Two-thirds of the physicians had inadequate exercise; 57% of this group had decreased BMD (osteoporosis in 9%, osteopenia in 38%). There was no statistical significance between BMD and calcium intake or exercise. CONCLUSION: A high percentage of the physicians in this unique study had a reduced BMD. Most of the physicians with low BMD were less than 45 years of age. This study indicates the need to define BMD in a larger cohort of young, ethnically diverse clinicians, and other health workers.
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PMCID: PMC2594894  PMID: 15040511

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