Obesity affects multiple points along the breast cancer control continuum from prevention to screening and treatment, often in opposing directions. Obesity is also more prevalent in Blacks than Whites at most ages so it might contribute to observed racial disparities in mortality. We use two established simulation models from the Cancer Intervention and Surveillance Modeling Network (CISNET) to evaluate the impact of obesity on race-specific breast cancer outcomes. The models use common national data to inform parameters for the multiple US birth cohorts of Black and White women, including age- and race-specific incidence, competing mortality, mammography characteristics, and treatment effectiveness. Parameters are modified by obesity (BMI of ≥ 30 kg/m(2)) in conjunction with its age-, race-, cohort- and time-period-specific prevalence. We measure age-standardized breast cancer incidence and mortality and cases and deaths attributable to obesity. Obesity is more prevalent among Blacks than Whites until age 74; after age 74 it is more prevalent in Whites. The models estimate that the fraction of the US breast cancer cases attributable to obesity is 3.9-4.5 % (range across models) for Whites and 2.5-3.6 % for Blacks. Given the protective effects of obesity on risk among women <50 years, elimination of obesity in this age group could increase cases for both the races, but decrease cases for women ≥ 50 years. Overall, obesity accounts for 4.4-9.2 % and 3.1-8.4 % of the total number of breast cancer deaths in Whites and Blacks, respectively, across models. However, variations in obesity prevalence have no net effect on race disparities in breast cancer mortality because of the opposing effects of age on risk and patterns of age- and race-specific prevalence. Despite its modest impact on breast cancer control and race disparities, obesity remains one of the few known modifiable risks for cancer and other diseases, underlining its relevance as a public health target.

译文

肥胖会影响从预防到筛查和治疗的乳腺癌控制连续体的多个点,通常方向相反。在大多数年龄段,肥胖在黑人中也比白人更普遍,因此可能会导致观察到的种族死亡率差异。我们使用癌症干预和监测建模网络 (CISNET) 建立的两个模拟模型来评估肥胖对种族特异性乳腺癌结局的影响。这些模型使用通用的国家数据来告知美国多个黑人和白人女性出生队列的参数,包括特定于年龄和种族的发病率,竞争性死亡率,乳房x线摄影特征和治疗效果。通过肥胖 (BMI ≥ 30千克/m(2)) 及其年龄,种族,队列和时间段特异性患病率来修改参数。我们测量了年龄标准化的乳腺癌发病率和死亡率以及肥胖导致的病例和死亡。直到74岁,肥胖在黑人中比白人更普遍; 74岁以后,在白人中更普遍。这些模型估计,美国乳腺癌病例中肥胖的比例在白人中是3.9-4.5% (模型范围),在黑人中是2.5-3.6%。鉴于肥胖对 <50岁女性风险的保护作用,消除该年龄组的肥胖可以增加两个种族的病例,但减少 ≥ 50岁女性的病例。总体而言,肥胖分别占白人和黑人乳腺癌死亡总数的4.4-9.2% 和3.1-8.4%。然而,肥胖患病率的变化对乳腺癌死亡率的种族差异没有净影响,因为年龄对风险以及年龄和种族特定患病率的模式有相反的影响。尽管肥胖对乳腺癌控制和种族差异的影响不大,但它仍然是癌症和其他疾病的少数已知可改变的风险之一,突显了其作为公共卫生目标的相关性。

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