ingest
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b743dd6f-fb31-445f-b2b9-a0aa4f8b7562
modifyDatastreamByValue
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fedoraAdmin
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Setting exclusive relation
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fedoraAdmin
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MD_TECHNICAL
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modifyDatastreamByValue
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cdrApp
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modifyDatastreamByValue
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modifyDatastreamByValue
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modifyDatastreamByValue
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modifyDatastreamByValue
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2018-08-08T16:52:58.190Z
modifyDatastreamByValue
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2018-08-14T21:27:36.872Z
modifyDatastreamByValue
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2018-09-21T14:37:00.688Z
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modifyDatastreamByValue
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modifyDatastreamByValue
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cdrApp
2018-10-11T18:24:04.661Z
modifyDatastreamByValue
MD_DESCRIPTIVE
cdrApp
2019-02-28T01:38:29.269Z
modifyDatastreamByValue
MD_DESCRIPTIVE
cdrApp
2019-03-19T20:56:11.233Z
Lynn
Chollet Hinton
Author
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease.
Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data.
Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm.
Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
Spring 2017
2017
Epidemiology
Public health
Black women, Breast cancer, Longitudinal trends, Risk factors, Tumor biology, Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in
young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly
increased since 1976 among young women <40 years. Young-onset breast cancers tend to be
more aggressive with poorer prognosis than older-onset disease, particularly among black
women. This dissertation sought to clarify the impact of shifting incidence by (1)
characterizing the epidemiology of young black women’s breast cancer, and (2)
investigating temporal shifts in breast cancer biology and diagnostic imaging use as
contributors to rising young-onset distant disease. Methods: We examined tumor
characteristics and breast cancer risk factors associated with premenopausal young
(<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer
Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional
logistic regression. Additionally, we examined longitudinal breast cancer incidence using
joinpoint regression among young women (20-39 years) from 1992-2011 according to breast
tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program.
Temporal patterns in imaging use (positron emission tomography, computed tomography,
magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible
breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women
<40 years had higher frequency of poorer-prognostic tumor characteristics compared to
older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status,
triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity,
family history of breast cancer, and oral contraceptive use were associated with increased
risk for young women while breastfeeding was more strongly protective. In SEER, the
frequency of favorable tumor characteristics significantly increased while less favorable
characteristics declined among young women. Imaging use dramatically increased from
1992-2011 among SEER-Medicare cases and was significantly associated with less favorable
characteristics, including ER/PR negativity, high grade, and tumor size >2cm.
Conclusions: Among premenopausal black women, young age (<40 years) was associated with
more aggressive breast tumor biology. Modifiable risk factors including breastfeeding,
adiposity, and oral contraceptive use may be important targets for mitigating harms of
young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while
imaging use dramatically increased from 1992-2011, suggesting that stage migration rather
than shifting tumor biology has contributed to rising incidence of young-onset distant
breast cancer.
Spring 2017
2017
Epidemiology
Public health
Black women, Breast cancer, Longitudinal trends, Risk
factors, Tumor biology, Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting
institution
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
Spring 2017
2017
Epidemiology
Public health
Black women, Breast cancer, Longitudinal trends, Risk factors, Tumor biology, Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
2017-05
2017
Epidemiology
Public health
Black women, Breast cancer, Longitudinal trends, Risk factors, Tumor biology, Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
2017
Epidemiology
Public health
Black women, Breast cancer, Longitudinal trends, Risk factors, Tumor biology, Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
2017-05
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
2017
Epidemiology
Public health
Black women, Breast cancer, Longitudinal trends, Risk factors, Tumor biology, Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
2017-05
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
2017
Epidemiology
Public health
Black women, Breast cancer, Longitudinal trends, Risk factors, Tumor biology, Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
2017-05
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
2017
Epidemiology
Public health
Black women, Breast cancer, Longitudinal trends, Risk factors, Tumor biology, Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
2017-05
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
2017
Epidemiology
Public health
Black women, Breast cancer, Longitudinal trends, Risk factors, Tumor biology, Young age
eng
Doctor of Philosophy
Dissertation
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
2017-05
University of North Carolina at Chapel Hill
Degree granting institution
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
2017
Epidemiology
Public health
Black women, Breast cancer, Longitudinal trends, Risk factors, Tumor biology, Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
2017-05
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
2017
Epidemiology
Public health
Black women, Breast cancer, Longitudinal trends, Risk factors, Tumor biology, Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
2017-05
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
2017
Epidemiology
Public health
Black women; Breast cancer; Longitudinal trends; Risk factors; Tumor biology; Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
2017-05
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
2017
Epidemiology
Public health
Black women, Breast cancer, Longitudinal trends, Risk factors, Tumor biology, Young age
eng
Doctor of Philosophy
Dissertation
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
2017-05
University of North Carolina at Chapel Hill
Degree granting institution
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
2017
Epidemiology
Public health
Black women, Breast cancer, Longitudinal trends, Risk factors, Tumor biology, Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
2017-05
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
2017
Epidemiology
Public health
Black women; Breast cancer; Longitudinal trends; Risk factors; Tumor biology; Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
2017-05
Lynn
Chollet Hinton
Creator
Department of Epidemiology
Gillings School of Global Public Health
Epidemiology of breast cancer among young black women and the rise in young-onset distant disease in the U.S.
Purpose: Rates of distant (stage IV) breast cancer have significantly increased since 1976 among young women <40 years. Young-onset breast cancers tend to be more aggressive with poorer prognosis than older-onset disease, particularly among black women. This dissertation sought to clarify the impact of shifting incidence by (1) characterizing the epidemiology of young black women’s breast cancer, and (2) investigating temporal shifts in breast cancer biology and diagnostic imaging use as contributors to rising young-onset distant disease. Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) black women’s breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases; 5,144 controls) using unconditional logistic regression. Additionally, we examined longitudinal breast cancer incidence using joinpoint regression among young women (20-39 years) from 1992-2011 according to breast tumor characteristics in the Surveillance, Epidemiology, and End Results (SEER) program. Temporal patterns in imaging use (positron emission tomography, computed tomography, magnetic resonance imaging, bone scans) were examined separately among Medicare-eligible breast cancer cases using SEER-Medicare-linked data. Results: Premenopausal black women <40 years had higher frequency of poorer-prognostic tumor characteristics compared to older (≥40) women, including negative estrogen and progesterone receptor (ER/PR) status, triple-negative subtype, high grade, higher stage, and larger tumor size. Adiposity, family history of breast cancer, and oral contraceptive use were associated with increased risk for young women while breastfeeding was more strongly protective. In SEER, the frequency of favorable tumor characteristics significantly increased while less favorable characteristics declined among young women. Imaging use dramatically increased from 1992-2011 among SEER-Medicare cases and was significantly associated with less favorable characteristics, including ER/PR negativity, high grade, and tumor size >2cm. Conclusions: Among premenopausal black women, young age (<40 years) was associated with more aggressive breast tumor biology. Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. In SEER, the frequency of aggressive disease decreased while imaging use dramatically increased from 1992-2011, suggesting that stage migration rather than shifting tumor biology has contributed to rising incidence of young-onset distant breast cancer.
2017
Epidemiology
Public health
Black women; Breast cancer; Longitudinal trends; Risk factors; Tumor biology; Young age
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Melissa
Troester
Thesis advisor
Carey
Anders
Thesis advisor
Jennifer
Lund
Thesis advisor
Hazel
Nichols
Thesis advisor
Andrew
Olshan
Thesis advisor
text
2017-05
CholletHinton_unc_0153D_16797.pdf
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