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

从肥胖症的预防到筛查和治疗,肥胖症通常会在相反的方向上影响着乳腺癌控制连续性的多个方面。在大多数年龄段,肥胖症在黑人中也比白人更为普遍,因此它可能导致观察到的种族差异。我们使用来自癌症干预和监视模型网络(CISNET)的两个已建立的仿真模型来评估肥胖对特定种族乳腺癌结果的影响。该模型使用共同的国家数据为美国多个黑人和白人妇女的出生队列提供参数,包括特定年龄和种族的发病率,竞争性死亡率,乳房X线照片特征和治疗效果。肥胖(BMI≥30 kg / m(2))及其特定于年龄,种族,队列和时间段的患病率会改变参数。我们测量年龄标准化的乳腺癌的发病率和死亡率,以及肥胖引起的病例和死亡。直到74岁,肥胖症在黑人中比白人更为普遍。 74岁以后,它在白人中更为普遍。这些模型估计,美国肥胖引起的乳腺癌病例中,白人的比例为3.9-4.5%(黑人),黑人的比例为2.5-3.6%(跨模型)。考虑到肥胖对<50岁女性的风险具有保护作用,在这个年龄段消除肥胖可能会增加两个种族的发病率,但会减少50岁以上女性的发病率。总体而言,在各模型中,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%。但是,由于年龄对风险和年龄和种族特定患病率的模式产生了相反的影响,因此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。尽管肥胖症对乳腺癌的控制和种族差异影响不大,但肥胖症仍然是为数不多的已知可改变的癌症和其他疾病风险之一,突显了肥胖症作为公共卫生目标的重要性。

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