Delineation of lifestyle and genetic risk factors for breast cancer in women of diverse genetic backgrounds: African aspect of the study

A19

Breast cancer is a disease with a complex etiology that consists of lifestyle and genetic components. When controlling for non-genetic factors, it is clear that African and African American women are more likely to develop aggressive tumors that result in higher mortality compared to Caucasian American women. This suggests that a comprehensive analysis of genetic and lifestyle factors that includes these three demographic groups could provide valuable insights into the complex interactions that result in disease. One aspect of this study involves the development of a correlative, yet culturally relevant questionnaire to identify lifestyle risk factors in African women. Blood, buccal cells, and urine were also collected for the study, in particular, 36 tumor samples and 36 control samples were collected in the Nigerian cohort, but this presentation will focus on questionnaire development, assessment, and study design.
 The initial surveys utilized were conducted at Ile-Ife, Nigeria, and in Nairobi, Kenya. Both surveys are essentially the same except for differences in questions pertaining to diet and nutrition of each country. The survey consisted of questions that identified known risk factors, such as those pertaining to parity, age of first menarche, and family history of cancers, which are of significance to the development of breast cancer. This data will be combined with the genotyping information collected from the tissue samples.
 With more samples and surveys collected this will serve as a robust model to explore the genetic and behavioral differences that may exist. However, there was some consideration necessary for the improvement of the survey. A review of the questions that were consistently left unanswered across the patient population identified points that were not as vital as once thought and indicated cultural stigmas that limited answers from patients. In some cases the questions were confusing, despite being conducted by an interviewer, and this was improved. Changes to the questions will provide a higher yield of information for the study going forward, and this analysis helped to increase the survey's cultural relevance, applicability, and statistical validity. The data collected was organized, coded, and analyzed by the statistical program SPSS, and this model and its data will serve as a valuable tool to explore differences in breast cancers, while also providing a template for the understanding of other diseases.
 The work completed thus far on the survey and the initial preparation of samples for genotyping show promise. It is our hope to expand this work to a larger group of women in order to paint a better picture of how dynamic and destructive breast cancer can be for women of color. In conducting a study of this sort and a survey of this magnitude, it is vital to assure the thorough completion of the survey and appropriate data collection, otherwise holes in the data weaken the results and correlative power to the other demographic groups. The results of this work will help to identify distinct genetics and lifestyle risk factors that may be contributory to the more negative outcomes related to breast cancer and breast disease in African and African American women.