目标:虽然乳腺癌研究通常聚集亚洲/太平洋岛民(API)妇女,作为一个群体或排除它们,这个群体在遗传背景上是异质的,环境暴露,和健康相关的行为,可能导致不同的癌症结果。我们的目的是评估API女性乳腺癌亚组中对侧乳腺癌(CBC)的风险。
方法:我们对2000年至2016年间诊断为I-III期乳腺癌的18岁以上女性进行了回顾性队列研究。流行病学和最终结果登记处。API亚组包括中国人,日本人,菲律宾人,夏威夷原住民,韩语,越南人,印度人/巴基斯坦人,和其他API女性。异步CBC被定义为在第一次原发性单侧乳腺癌后12个月在相反的乳房中诊断出的乳腺癌。多变量调整后的子分布风险比(SHR)和95%置信区间(CI)通过API亚组进行估计和分层。
结果:从44,362名患有乳腺癌的API女性队列中,25%是菲律宾人,18%是中国人,14%是日本人,8%是印度/巴基斯坦人。与NHW女性相比,API女性作为总体组的CBC风险增加(SHR1.15,95%CI1.08-1.22),其中中国人(SHR1.23,95%CI1.08-1.40),菲律宾(SHR1.37,95%CI1.23-1.52),和夏威夷原住民(SHR1.69,95%CI1.37-2.08)女性有更大的风险.
结论:将API患者聚集或排除在乳腺癌研究之外,忽略了他们的异质性健康结局。为了促进API女性的癌症健康公平性,未来的研究应检查API人群中的不平等现象,以设计能够充分解决其独特差异的干预措施.
OBJECTIVE: While breast cancer studies often aggregate Asian/Pacific Islander (API) women, as a single group or exclude them, this population is heterogeneous in terms of genetic background, environmental exposures, and health-related behaviors, potentially resulting in different cancer outcomes. Our purpose was to evaluate risks of contralateral breast cancer (CBC) among subgroups of API women with breast cancer.
METHODS: We conducted a retrospective cohort study of women ages 18 + years diagnosed with stage I-III breast cancer between 2000 and 2016 in the Surveillance, Epidemiology and End Results registries. API subgroups included Chinese, Japanese, Filipina, Native Hawaiian, Korean, Vietnamese, Indian/Pakistani, and other API women. Asynchronous CBC was defined as breast cancer diagnosed in the opposite breast 12 + months after first primary unilateral breast cancer. Multivariable-adjusted subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were estimated and stratified by API subgroups.
RESULTS: From a cohort of 44,362 API women with breast cancer, 25% were Filipina, 18% were Chinese, 14% were Japanese, and 8% were Indian/Pakistani. API women as an aggregate group had increased risk of CBC (SHR 1.15, 95% CI 1.08-1.22) compared to NHW women, among whom Chinese (SHR 1.23, 95% CI 1.08-1.40), Filipina (SHR 1.37, 95% CI 1.23-1.52), and Native Hawaiian (SHR 1.69, 95% CI 1.37-2.08) women had greater risks.
CONCLUSIONS: Aggregating or excluding API patients from breast cancer studies ignores their heterogeneous health outcomes. To advance cancer health equity among API women, future research should examine inequities within the API population to design interventions that can adequately address their unique differences.