Prediagnostic allostatic load as a predictor of poorly differentiated and larger sized breast cancers among black women in the Women's Circle of health follow-up study

Cathleen Y. Xing, Michelle Doose, Bo Qin, Yong Lin, Jesse J. Plascak, Coral Omene, Chunyan He, Kitaw Demissie, Chi Chen Hong, Elisa V. Bandera, Adana A.M. Llanos

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32 Scopus citations


Background: Few studies have empirically tested the association of allostatic load (AL) with breast cancer clinicopathology. The aim of this study was to examine the association of AL, measured using relevant biomarkers recorded in medical records before breast cancer diagnosis, with unfavorable tumor clinicopathologic features among Black women. Methods: In a sample of 409 Black women with nonmetastatic breast cancer who are enrolled in the Women's Circle of Health Follow-Up Study, we estimated prediagnostic AL using two measures: AL measure 1 [lipid profile–based—assessed by systolic and diastolic blood pressure (SBP, DBP), high-density lipoprotein, low-density lipoprotein, total cholesterol, triglycerides, and glucose levels; waist circumference; and use of diabetes, hypertension, or hypercholesterolemia medication] and AL measure 2 (inflammatory index–based—assessed by SBP, DBP, glucose, and albumin levels; estimated glomerular filtration rate; body mass index; waist circumference; and use of medications previously described). We used Cohen's statistic to assess agreement between the two AL measures and multivariable logistic models to assess the associations of interest. Results: AL measures 1 and 2 moderately agreed (k = 0.504). Higher prediagnostic AL predicted higher grade (poorly differentiated vs. well/moderately differentiated) using AL measure 1 [OR = 2.16; 95% confidence interval (CI), 1.18–3.94] and AL measure 2 (OR = 1.60; 95% CI, 1.02–2.51), and larger tumor size (≥2 cm vs. <2 cm; OR = 1.58; 95% CI, 1.01–2.46) using AL measure 2 only. Conclusions: Elevated prediagnostic AL might contribute to more unfavorable breast cancer clinicopathology. Impact: Addressing elevated prediagnostic levels of AL has potentially important clinical implications.

Original languageEnglish
Pages (from-to)216-224
Number of pages9
JournalCancer Epidemiology Biomarkers and Prevention
StatePublished - Jan 1 2020

Bibliographical note

Funding Information:
Research reported in this publication was supported by the NCI of the NIH under the following award numbers: P01CA151135 (awarded to C.B. Ambrosone), P30CA072720 (awarded to S. Libutti), R01CA100598 (awarded to C.B. Ambrosone), R01CA185623 (awarded to E.V. Bandera, K. Demissie, and C.C. Hong), K01CA193527 (awarded to A.A.M. Llanos), K07CA222158 (awarded to J.J. Plascak), and K08CA172722 (awarded to C. Omene). Research in this publication was also supported by the U.S. Army Medical Research and Development Command under award number DAMD-17-01-1-0334 (awarded to D.H. Bovbjerg) and by the National Institute on Minority Health and Health Disparities of the NIH under award number K99MD013300 (awarded to B. Qin). Support for this work was also funded by the Breast Cancer Research Foundation (awarded to C.B. Ambrosone) and a gift from the Philip L. Hubbell Family (awarded to K. Demissie). In addition, the New Jersey State Cancer Registry, Cancer Epidemiology Services, New Jersey Department of Health, is funded by the Surveillance, Epidemiology and End Results (SEER) Program of the NCI under contract HHSN261201300021I and control no. N01-PC-2013-00021, the National Program of Cancer Registries (NPCR), Centers for Disease Control and Prevention under grant NU5U58DP006279-02-00 as well as the State of New Jersey and the Rutgers Cancer Institute of New Jersey. We would like to thank the numerous staff at the Rutgers Cancer Institute of New Jersey, Rutgers School of Public Health, the New Jersey State Cancer Registry, and Roswell Park Comprehensive Cancer Center who worked in the different components of the study for their contribution to the study, as well as all the women who agreed to participate in the Women's Circle of Health Follow-Up Study.

Publisher Copyright:
©2019 American Association for Cancer Research.

ASJC Scopus subject areas

  • Medicine (all)


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