Cancer

The workshop highlighted the multicultural aspects of breast carcinoma etiology among the five racial and ethnic groups in the U.S. defined in the Office of Management and Budget Directive No. 15. It also provided insight into the risk and protective factors that may contribute to the disparities in mortality and survival rates among racial and ethnic minorities.

The diversity of the U.S. population offers great opportunities for understanding the causes of cancer by studying the differences among ethnic groups.

All women, regardless of their racial or ethnic origin or heritage, are at risk of developing breast cancer. Many etiologic factors affect breast cancer development; key among these are genetics, environment, reproductive experience, host vulnerability, and tumor biology of breast carcinoma. Cultural differences, behavioral characteristics, and sociodemographic influences across population subgroups modulate how biologic disease is expressed among different races and ethnic groups. Interactions of these factors contribute to differences in stage at diagnosis among multiracial and multiethnic populations. As knowledge of cancer biology and genetics increases, new mechanisms for identifying etiologic pathways will become available that can be utilized for improved screening, detection, and treatment. Culturally appropriate behavioral change interventions and public health approaches at the community level will be needed to assure that the benefits of research reach all American women.

Migration patterns have previously suggested environmental influences on the observed variation in breast carcinoma incidence from country to country and even within a single country, such as the United States. Studying the migration patterns of American Indians and Alaska Natives may yield new insights into breast carcinoma etiology.

This article provides a very brief overview of urban American Indians and Alaska Natives, culturally specific health care issues, and their related breast carcinoma care issues.

The author is a breast carcinoma survivor and activist who believes that because of the disproportionate rate of incidence of breast carcinoma observed in minority women and other medically underserved populations, research paradigms need to be altered so that these groups are better incorporated into population-based research.

Tragic disparities in cancer incidence and mortality in minority and medically underserved communities continue to be inadequately addressed, in part due to a prevailing “institutionalized racism.” Unless we acknowledge this fact, and until we take the necessary steps to redress it, advances in cancer technology, control, and diagnosis and treatment, as well as improvements in incidence and mortality rates, will continue to bypass this important and growing segment of our society.

Breast carcinoma is a multifactorial disease. Its initiation and progression result from the interaction of 1) the environmental exposures a woman experiences throughout her life; 2) the underlying genetic susceptibilities to environmental agents that a woman inherits; and 3) the timing of critical environmental exposures. Environment includes foods and nutrients; synthetic and naturally occurring chemicals; physical agents such as heat and ionizing and nonionizing radiation; and social, cultural, and economic factors.

The effects of endogenous and exogenous hormones on multiethnic populations are major contributors to breast carcinoma etiology. A proposed hypothesis has offered an insight into the unexplained crossover of breast carcinoma incidence between black and white women.

There is accumulating evidence implicating a role for diet in many cancers and other chronic diseases. However, the extent to which dietary factors are related to the risk of breast carcinoma and may explain, in part, some of the racial/ethnic differences in breast carcinoma incidence rates is not known. Investigations in African-American, Asian-American, and Latino populations present excellent opportunities to investigate the relation between specific micronutrients and food sources and the risk of breast carcinoma. Results from these studies should help to bridge some of the gaps in our understanding of the role of diet in the development of breast carcinoma.

The reliability of statistics regarding dietary/nutritional risk factors for cancer from Asian countries is questioned from a feminist/political perspective.

Women of various racial and ethnic backgrounds who are overweight or sedentary may be at an increased risk for breast carcinoma. Reducing obesity, preventing lifetime weight gain, and increasing physical activity are factors that could have a significant public health impact on reducing the incidence rate of breast carcinoma.

Socioeconomic factors and socioeconomic status (SES) are associated with breast carcinoma incidence, mortality, and survival rates. SES may only partially explain racial disparities in breast carcinoma rates. The limited currently available data and a lack of individual SES data regarding cancer patients prevent a clear understanding of the contributions of these factors to cancer outcomes.

The current state of knowledge regarding breast carcinoma etiology in different ethnic groups was reviewed in plenary sessions that were followed by breakout sessions on specific risk factors. The workshop truly was multidisciplinary with active participation by leaders from the ethnic minority advocacy community including strong representation from basic and clinical research, the community, and policy development sectors. These risk factors then were considered in subsequent breakout sessions from the perspective of each of the five ethnic groups. Summaries are presented in this collation from the workshop.