Breastfeeding versus formula-feeding and girls' pubertal development.

To examine the association of breastfeeding or its duration with timing of girls' pubertal onset, and the role of BMI as a mediator in these associations. A population of 1,237 socio-economically and ethnically diverse girls, ages 6-8 years, was recruited across three geographic locations (New York City, Cincinnati, and the San Francisco Bay Area) in a prospective study of predictors of pubertal maturation. Breastfeeding practices were assessed using self-administered questionnaire/interview with the primary caregiver. Girls were seen on at least annual basis to assess breast and pubic hair development. The association of breastfeeding with pubertal timing was estimated using parametric survival analysis while adjusting for body mass index, ethnicity, birth-weight, mother's education, mother's menarcheal age, and family income. Compared to formula fed girls, those who were mixed-fed or predominantly breastfed showed later onset of breast development [hazard ratios 0.90 (95 % CI 0.75, 1.09) and 0.74 (95 % CI 0.59, 0.94), respectively]. Duration of breastfeeding was also directly associated with age at onset of breast development (p trend = 0.008). Associations between breastfeeding and pubic hair onset were not significant. In stratified analysis, the association of breastfeeding and later breast onset was seen in Cincinnati girls only. The association between breast feeding and pubertal onset varied by study site. More research is needed about the environments within which breastfeeding takes place in order to better understand whether infant feeding practices are a potentially modifiable risk factor that may influence age at onset of breast development and subsequent risk for disease in adulthood.

Translating and testing breast cancer risk reduction messages for mothers of adolescent girls.

Emerging scientific findings regarding breast cancer science are typically presented only in discipline specific journals in which the general public and those at risk have limited access, creating a development-to-delivery gap between the state of the science and public knowledge. A lack of collaboration between scientists, communication experts, and community partners further compounds this lack of information available to the public. The present study translates recent scientific findings about environmental breast cancer risks into palatable magazine-style messages for mothers of young daughters as a strategy to meet the call for greater translation and dissemination of scientific results to the lay public. Results from focus groups indicate that mothers actually want more science in messages and greater explication of findings that indicate causality. Mothers also expect polished, professional messages that are representative of their daughters and provide a source for further information seeking purposes. Recommendations for future translation and message design endeavors are discussed.

Implications of Exposure to Intimate Partner Violence in Childhood.

The most recent available data show that children were present at 38% of domestic incidents reported throughout Delaware, and analysis of barriers to reporting predict this number to be much higher. Intimate partner violence (IPV) can take numerous forms, such as patterns of physical, sexual, psychological, economic, and reproductive abuse, meaning each situation manifests differently and requires individualized intervention. Children face unique short- and long-term challenges as a result of their witness status within such scenarios. Programming throughout Delaware works to support victims and mitigate the negative ramifications that IPV has on children and their families.

Guidelines for the mapping of cancer registry data: results from a breast cancer expert panel study.

CONTEXT: Small area (eg, subcounty) cancer mapping is one of the analytic services most commonly requested of cancer registries and local public health agencies, and difficulties in providing it have been noted to undermine public confidence. Although a great many statistical protocols have been published to enable this practice, none of them are in common use to generate information for the general public. OBJECTIVES: To evaluate the utility of subcounty breast cancer mapping and articulate guidelines and a possible protocol for its implementation by cancer registries and local public health agencies. METHODS: We convened an Expert Advisory Group of breast cancer stakeholders from around California to elicit values, priorities, and preferred characteristics of protocols for proactive subcounty breast cancer mapping. Upon formulating a protocol, we applied it to 9 years of data (2000-2008) describing invasive breast cancer in California for evaluation by the Expert Advisory Group. RESULTS: Maps with subcounty resolution were seen to provide important information with a wide range of applications. Priorities included the avoidance of false-positive findings, scientific credibility, and the provision of information elucidating social and environmental characteristics. A protocol using Kulldorff's Scan Statistic along with postanalytic steps for refining results was elaborated; when applied to the data, 4 discrete regions with elevated rates of invasive breast cancer were identified and described. CONCLUSIONS: Expert Advisory Group priorities were readily translatable into a scientifically rigorous protocol that protected confidentiality and avoided statistically unstable rate estimates. The resulting maps enabled participants to visualize geographically defined populations falling within and crossing county boundaries. These findings support the enactment of policies for the routine and proactive analysis of breast cancer surveillance data to provide subcounty information.

An Overview of Poverty in Delaware.

Delaware's 2017-2021 five-year average poverty rate was 11.4%, which is lower than the rate of 12.6% throughout the United States as a whole. Poverty rates by race and ethnic background show disparities. Black Delaware residents were more than twice as likely to live in poverty as white Delawareans, with poverty rates of 17.8% and 8.4%, respectively, while Asian individuals had a poverty rate of 10.5%. Hispanic or Latino/x individuals of any race were the most likely to experience poverty and had a five-year average poverty rate of 18.2%. Tracking the overall poverty rate (most commonly through the American Community Survey 5-Year Averages) is valuable when studying trends over time but lacks the power to display the true economic status of individuals and families. Access: work, income supports, shelter, food, and healthcare all complete each whole person. Level of access within each of these sectors of life determines well-being, and varies based on race and ethnic background, geography, and age. A new challenge is now faced as the Public Health Emergency (PHE) has ended, repealing a multitude of supports with the risk of putting individuals and families into a new phase of crisis.

A complex systems model of breast cancer etiology: The Paradigm II Model.

BACKGROUND: Complex systems models of breast cancer have previously focused on prediction of prognosis and clinical events for individual women. There is a need for understanding breast cancer at the population level for public health decision-making, for identifying gaps in epidemiologic knowledge and for the education of the public as to the complexity of this most common of cancers. METHODS AND FINDINGS: We developed an agent-based model of breast cancer for the women of the state of California using data from the U.S. Census, the California Health Interview Survey, the California Cancer Registry, the National Health and Nutrition Examination Survey and the literature. The model was implemented in the Julia programming language and R computing environment. The Paradigm II model development followed a transdisciplinary process with expertise from multiple relevant disciplinary experts from genetics to epidemiology and sociology with the goal of exploring both upstream determinants at the population level and pathophysiologic etiologic factors at the biologic level. The resulting model reproduces in a reasonable manner the overall age-specific incidence curve for the years 2008-2012 and incidence and relative risks due to specific risk factors such as BRCA1, polygenic risk, alcohol consumption, hormone therapy, breastfeeding, oral contraceptive use and scenarios for environmental toxin exposures. CONCLUSIONS: The Paradigm II model illustrates the role of multiple etiologic factors in breast cancer from domains of biology, behavior and the environment. The value of the model is in providing a virtual laboratory to evaluate a wide range of potential interventions into the social, environmental and behavioral determinants of breast cancer at the population level.

The Pathways Study: a prospective study of breast cancer survivorship within Kaiser Permanente Northern California.

OBJECTIVE: With 2.3 million breast cancer survivors in the US today, identification of modifiable factors associated with breast cancer recurrence and survival is increasingly important. Only recently new studies have been designed to examine the impact of lifestyle factors on prognosis, including Pathways, a prospective study of women with breast cancer in Kaiser Permanente Northern California (KPNC). METHODS: Pathways aims to examine the effect on recurrence and survival of (1) lifestyle factors such as diet, physical activity, quality of life, and use of alternative therapies and (2) molecular factors such as genetic polymorphisms involved in metabolism of chemotherapeutic agents. Eligibility includes any woman diagnosed with invasive breast cancer within KPNC, no previous diagnosis of other invasive cancer, age 21 years or older, and ability to speak English, Spanish, Cantonese, or Mandarin. Newly diagnosed patients are identified daily from electronic pathology records and are enrolled within two months of diagnosis. An extensive baseline interview is conducted, blood and saliva samples are collected, and body measurements are taken. Women are followed for lifestyle updates, treatment, and outcomes by self-report and query of KPNC databases. RESULTS: Recruitment began in 9 January, 2006, and as of 16 January, 2008, 1,539 women have been enrolled along with collection of 1,323 blood samples (86%) and 1,398 saliva samples (91%). CONCLUSIONS: The Pathways Study will become a rich resource to examine behavioral and molecular factors and breast cancer prognosis.

Risk factors for breast cancer in a population with high incidence rates.

BACKGROUND: This report examines generally recognized breast cancer risk factors and years of residence in Marin County, California, an area with high breast cancer incidence and mortality rates. METHODS: Eligible women who were residents of Marin County diagnosed with breast cancer in 1997-99 and women without breast cancer obtained through random digit dialing, frequency-matched by cases' age at diagnosis and ethnicity, participated in either full in-person or abbreviated telephone interviews. RESULTS: In multivariate analyses, 285 cases were statistically significantly more likely than 286 controls to report being premenopausal, never to have used birth control pills, a lower highest lifetime body mass index, four or more mammograms in 1990-94, beginning drinking after the age of 21, on average drinking two or more drinks per day, the highest quartile of pack-years of cigarette smoking and having been raised in an organized religion. Cases and controls did not significantly differ with regard to having a first-degree relative with breast cancer, a history of benign breast biopsy, previous radiation treatment, age at menarche, parity, use of hormone replacement therapy, age of first living in Marin County, or total years lived in Marin County. Results for several factors differed for women aged under 50 years or 50 years and over. CONCLUSIONS: Despite similar distributions of several known breast cancer risk factors, case-control differences in alcohol consumption suggest that risk in this high-risk population might be modifiable. Intensive study of this or other areas of similarly high incidence might reveal other important risk factors proximate to diagnosis.

A multilevel model of postmenopausal breast cancer incidence.

BACKGROUND: Breast cancer has a complex etiology that includes genetic, biologic, behavioral, environmental, and social factors. Etiologic factors are frequently studied in isolation with adjustment for confounding, mediating, and moderating effects of other factors. A complex systems model approach may present a more comprehensive picture of the multifactorial etiology of breast cancer. METHODS: We took a transdisciplinary approach with experts from relevant fields to develop a conceptual model of the etiology of postmenopausal breast cancer. The model incorporated evidence of both the strength of association and the quality of the evidence. We operationalized this conceptual model through a mathematical simulation model with a subset of variables, namely, age, race/ethnicity, age at menarche, age at first birth, age at menopause, obesity, alcohol consumption, income, tobacco use, use of hormone therapy (HT), and BRCA1/2 genotype. RESULTS: In simulating incidence for California in 2000, the separate impact of individual variables was modest, but reduction in HT, increase in the age at menarche, and to a lesser extent reduction in excess BMI >30 kg/m(2) were more substantial. CONCLUSIONS: Complex systems models can yield new insights on the etiologic factors involved in postmenopausal breast cancer. Modification of factors at a population level may only modestly affect risk estimates, while still having an important impact on the absolute number of women affected. IMPACT: This novel effort highlighted the complexity of breast cancer etiology, revealed areas of challenge in the methodology of developing complex systems models, and suggested additional areas for further study.

Residential mobility and breast cancer in Marin County, California, USA.

Marin County (California, USA) has among the highest incidences of breast cancer in the U.S. A previously conducted case-control study found eight significant risk factors in participants enrolled from 1997-1999. These included being premenopausal, never using birth control pills, lower highest lifetime body mass index, having four or more mammograms from 1990-1994, beginning drinking alcohol after age 21, drinking an average two or more alcoholic drinks per day, being in the highest quartile of pack-years of cigarette smoking, and being raised in an organized religion. Previously conducted surveys provided residential histories; while statistic accounted for participants' residential mobility, and assessed clustering of breast cancer cases relative to controls based on the known risk factors. These identified specific cases, places, and times of excess breast cancer risk. Analysis found significant global clustering of cases localized to specific residential histories and times. Much of the observed clustering occurred among participants who immigrated to Marin County. However, persistent case-clustering of greater than fifteen years duration was also detected. Significant case-clustering among long-term residents may indicate geographically localized risk factors not accounted for in the study design, as well as uncertainty and incompleteness in the acquired addresses. Other plausible explanations include environmental risk factors and cases tending to settle in specific areas. A biologically plausible exposure or risk factor has yet to be identified.

A historical perspective on breast cancer activism in the United States: from education and support to partnership in scientific research.

Breast cancer remained a hidden disease among women in the United States until the 20th century. It was initially brought into the open with public revelations from individual women, which was followed by the development of support groups and ultimately the formation of political activist groups with various priorities. Those concerned with toxic environmental exposures as a potential cause of breast cancer organized, demonstrated, and lobbied for research funding and eventually became partners in the research that arose from their efforts. One representative example was the Breast Cancer and Environment Research Centers (BCERC) Project (2003-2010), supported by the National Institute of Environmental Health Sciences (NIEHS) and the National Cancer Institute (NCI). The BCERC embedded a Community Outreach and Translational Core into its formal organizational infrastructure to ensure advocate involvement in the standing scientific subcommittees of BCERC, the first project funded by NIEHS and NCI to do so. The formal integration of advocates as partners in scientific studies focused on breast cancer is embedded in a rich history of action on the part of many courageous women. This article describes the historical evolution of breast cancer activism in the United States, which provided a critical foundation for the formation of BCERC. This description is followed by a discussion of BCERC as an example of the transdisciplinary research model, a paradigm that strives for inclusion of multiple stakeholders and increased interaction between scientists from a wide spectrum of disciplines, advocates, and lay audiences in order to more effectively conduct critical research and to translate and disseminate its findings.

Evaluation of a partnership approach to translating research on breast cancer and the environment.

BACKGROUND: The growing literature on community-based participatory research (CBPR) suggests that a participatory approach benefits science in important ways. However there have been few formal evaluations of a CBPR approach itself, and few standards developed to assist in such efforts. OBJECTIVES: This evaluation used CBPR guidelines developed by Green and colleagues to evaluate the participatory approach of the Community Outreach and Translation Core (COTC) of the Bay Area Breast Cancer and the Environment Research Center (BABCERC) in translating scientific findings from two key projects to the public. METHOD: To assess key stakeholders' perceptions of alignment between the projects and the guidelines, four COTC members, four researchers, and four community members rated the projects on each of the 26 guidelines. These data were triangulated with transcripts from interviews with the same participants and a focus group with a subset of the participants. RESULTS: The participatory approach by the COTC resulted in many important benefits including improved relationships among diverse stakeholders, knowledge generation, increased sensitivity and propriety of the research, and increased community support of research. However, several atypical features of this collaboration-for example, the basic and etiological nature of the science being undertaken, and the multiple communities (lay and activist/advocate) involved-resulted in different levels and qualities of participation among stakeholders. CONCLUSIONS: Further research should focus on the adaptation of participatory research principles for different kinds of community partners and on the development and refinement of standards and tools to assist in evaluating the process and outcome of participatory research.

Breast cancer incidence and mortality trends in an affluent population: Marin County, California, USA, 1990-1999.

BACKGROUND: Elevated rates of breast cancer in affluent Marin County, California, were first reported in the early 1990s. These rates have since been related to higher regional prevalence of known breast cancer risk factors, including low parity, education, and income. Close surveillance of Marin County breast cancer trends has nevertheless continued, in part because distinctive breast cancer patterns in well-defined populations may inform understanding of breast cancer etiology. METHODS: Using the most recent incidence and mortality data available from the California Cancer Registry, we examined rates and trends for 1990-1999 for invasive breast cancer among non-Hispanic, white women in Marin County, in other San Francisco Bay Area counties, and in other urban California counties. Rates were age adjusted to the 2000 US standard, and temporal changes were evaluated with weighted linear regression. RESULTS: Marin County breast cancer incidence rates between 1990 and 1999 increased 3.6% per year (95% confidence interval, 1.8-5.5), six times more rapidly than in comparison areas. The increase was limited to women aged 45-64 years, in whom rates increased at 6.7% per year (95% confidence interval, 3.8-9.6). Mortality rates did not change significantly in Marin County despite 3-5% yearly declines elsewhere. CONCLUSION: Patterns of breast cancer incidence and mortality in Marin County are unlike those in other California counties, and they are probably explained by Marin County's unique sociodemographic characteristics. Similar trends may have occurred in other affluent populations for which available data do not permit annual monitoring of cancer occurrence.