Neuroticism, acculturation and the cortisol awakening response in Mexican American adults

Neuroticism is associated with greater susceptibility to the adverse effects of stress and greater exposure to the stressors associated with acculturation in U.S. born Mexican Americans. Neuroticism and acculturation have been associated with injury to crucial stress response systems and are known risk factors for certain mood and anxiety disorders. The purpose of the current study was to examine the effects of neuroticism, and acculturation on the cortisol awakening response (CAR) in healthy Mexican-American adults. Salivary cortisol samples were collected at awakening and 30, 45, and 60 min thereafter, on two consecutive weekdays from 59 healthy Mexican American adult males (26) and females (33), ages 18 to 38 years. Participants were assessed for level of neuroticism and acculturation. Data were analyzed using a mixed effects regression model with repeated measures at four time points. Results showed a significant Neuroticism×Acculturation×Time interaction. The CAR was virtually eliminated in highly acculturated Mexican Americans with greater Anglo orientation and high neuroticism compared with less acculturated Mexican Americans with greater Mexican orientation and lower neuroticism. Findings suggest that some Mexican Americans with high levels of neuroticism may be particularly susceptible to certain challenges and stressors associated with acculturation leading over time to the development of allostatic load, desensitization of the Hypothalamic CRF system and attenuation of the CAR.     

Sulfotransferase 2B1b in human breast: differences in subcellular localization in African American and Caucasian women

Breast cancer (BC) is the most commonly diagnosed cancer among American women; however, the development of post-menopausal BC is significantly lower in African Americans as compared to Caucasians. Hormonal stimulation is important in BC development and differences in the conversion of dehydroepiandrosterone (DHEA) into estrogens may be involved in the lower incidence of post-menopausal BC in African American women. DHEA sulfation by sulfotransferase 2B1b (SULT2B1b) is important in regulating the conversion of DHEA into estrogens in tissues. SULT2B1b is localized in both cytosol and nuclei of some tissues including cancerous and associated-normal breast tissue. Immunohistochemical staining was used to evaluate the total expression and subcellular localization of SULT2B1b in African American and Caucasian breast tissues. Cell fractionation, immunoblot analysis and sulfation assays were used to characterize the subcellular expression and activity of SULT2B1b in BC tissues and T-47D breast adenocarcinoma cells. Immunohistochemical analysis of SULT2B1b showed that African Americans had a significantly greater amount of SULT2B1b in epithelial cells of associated-normal breast tissue as compared to Caucasians. Also, more SULT2B1b in African American associated-normal breast epithelial cells was localized in the nuclei than in Caucasians. Equivalent levels of SULT2B1b were detected in breast adenocarcinoma tissues from both African American and Caucasian women. Nuclei isolation and immunoblot analysis of both BC tissue and human T-47D breast adenocarcinoma cells demonstrated that SULT2B1b is present in nuclei and cytoplasm.     

Clear differences in ovarian cancer incidence and trends by ethnicity among Asian Americans

BackgroundAcross major races in the United States (U.S.), ovarian cancer incidence is low among Asian American women. However, this observation aggregates Asian Americans as a single group despite their heterogeneity. Disaggregating the ethnic Asian population will produce more useful information to better understand ovarian cancer incidence among Asian women in the U.S.MethodsData from the Surveillance, Epidemiology, and End Results Program from 1990 to 2014 were used to compare age-adjusted incidence rates (AAIRs, per 100,000 women) for ovarian cancer for the six largest U.S. Asian ethnicities (Asian Indian/Pakistani, Chinese, Filipino, Japanese, Korean, Vietnamese) to non-Hispanic whites (NHWs). The race/ethnicity-specific AAIRs were calculated by time period and histotype. We examined the magnitude and direction of AAIR trends using average annual percent change (AAPC) statistics.ResultsAll Asian ethnicities had significantly lower ovarian cancer incidence rates than NHWs. However, among Asian ethnicities, Asian Indians/Pakistanis had the highest rate of ovarian cancer (AAIR = 10.51, 95% CI: 9.65–11.42) while Koreans had the lowest (AAIR = 7.23, 95% CI: 6.62–7.88). Clear cell ovarian cancer had significantly higher incidence rates among Chinese, Filipino, and Japanese women than NHW women (incidence rate ratio (IRR) = 1.49, 95% CI: 1.29–1.72, IRR = 1.30, 95% CI: 1.12–1.51, IRR = 1.64, 95% CI: 1.36–1.97, respectively). Incidence trends also differed by Asian ethnicity with significant decreases only observed for Chinese (AAPC = −1.49, 95% CI: −2.22 to −0.74) and Japanese (AAPC = −1.75, 95% CI: −2.57 to −0.92).ConclusionsExamining Asian Americans as a single group results in missed ethnic-specific disparities in ovarian cancer, hence disaggregating this heterogeneous population in future research is warranted.     

Leading Causes of Death among Asian American Subgroups (2003–2011)

Background

Our current understanding of Asian American mortality patterns has been distorted by the historical aggregation of diverse Asian subgroups on death certificates, masking important differences in the leading causes of death across subgroups. In this analysis, we aim to fill an important knowledge gap in Asian American health by reporting leading causes of mortality by disaggregated Asian American subgroups.

Methods and Findings

We examined national mortality records for the six largest Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and non-Hispanic Whites (NHWs) from 2003-2011, and ranked the leading causes of death. We calculated all-cause and cause-specific age-adjusted rates, temporal trends with annual percent changes, and rate ratios by race/ethnicity and sex. Rankings revealed that as an aggregated group, cancer was the leading cause of death for Asian Americans. When disaggregated, there was notable heterogeneity. Among women, cancer was the leading cause of death for every group except Asian Indians. In men, cancer was the leading cause of death among Chinese, Korean, and Vietnamese men, while heart disease was the leading cause of death among Asian Indians, Filipino and Japanese men. The proportion of death due to heart disease for Asian Indian males was nearly double that of cancer (31% vs. 18%). Temporal trends showed increased mortality of cancer and diabetes in Asian Indians and Vietnamese; increased stroke mortality in Asian Indians; increased suicide mortality in Koreans; and increased mortality from Alzheimer’s disease for all racial/ethnic groups from 2003-2011. All-cause rate ratios revealed that overall mortality is lower in Asian Americans compared to NHWs.

Conclusions

Our findings show heterogeneity in the leading causes of death among Asian American subgroups. Additional research should focus on culturally competent and cost-effective approaches to prevent and treat specific diseases among these growing diverse populations.     

Unique features of breast cancer in Asian women—Breast cancer in Taiwan as an example

Breast carcinoma is one of the most common cancers in women and is known to arise from a multifactorial process, the effect of reproductive risk factors strongly supporting a hormonal role in its etiology. Breast cancer in Asia is characterized by a lower incidence than in Western populations, but is still the leading type of cancer in Asian women, and a significant increasing tread indicates that it is an issue of particular public health importance. Asian breast cancer is characterized by early tumor onset, showing a relatively younger median age at diagnosis. Recently, scientists began to explore the tumorigenic mechanisms underlying breast cancer formation at the molecular level. Both a candidate-gene approach and genome-wide association studies have yielded crucial insights into breast cancer susceptibility genes initiating breast tumorigenesis. As expected, ethnic/racial variation in the genotypic frequency of these genes results in differences in breast cancer incidence in different populations. Furthermore, the question of how important these genes are in Asian breast cancer remains to be explored.It has been demonstrated that gene expression profiles and gene sets are prognostic and predictive for patients with breast cancer. Originally, due to its early onset, it was speculated that Asian breast cancer would have a higher frequency of the basal-like subtype of breast cancer, a molecular subtype characterized by poor differentiation, resulting in a relatively poor progression; however, recent findings do not support this speculation. The frequency of the luminal-A subtype of breast cancer, characterized by estrogen receptor expression, is similar to that in breast cancer in Caucasian, supporting the usefulness of hormone-based therapy in Asian breast cancer.     

Comparison of the Menopause and Midlife Transition between Japanese American and European American Women

Cross-cultural differences in the meaning and experience of the universal biologic phenomenon of the menopause have been well documented. Very few studies, however, have focused on the response to the midlife transition among ethnic minority women in the United States, and even fewer exist about Asian American women. This exploratory study compared the perceptions and experiences of the midlife transition among Japanese American and European American women. The midlife transition was viewed as a time of self-assurance, maturity, and taking comfort and satisfaction in oneself. Biologically, it was a marker of mortality. Similar to menses, marriage, and motherhood, menopause was viewed as the final identity transformation, but interpreted quite differently by the two ethnic groups. The findings of this study support the cross-cultural theories that emphasize the interaction of biology, society, age, gender, and acculturation in this universal female experience and suggest additional expansion of these theories to incorporate lifestyle choices that may affect the actual health consequences of female aging. [menopause, midlife transition, Japanese American women, ethnicity]     

Resemblance for Body Mass Index in Families of Obese African American and European American Women

Objective: We determined the levels of resemblance in body mass index (BMI) in large samples of families selected through obese African American and European American women. Research Methods and Procedures: We examined correlations among relatives in 1185 European American and African American families ascertained through age-matched obese women (BMI ≥ 30 kg/m²). A subset of 801 families were ascertained through extremely obese women (BMI ≥ 40 kg/m²). Results: Parent-offspring and sibling correlations ranged from 0.19 to 0.15, suggesting a moderate level of heritability in both groups. Mean BMI values for female relatives were lower for European Americans than for African Americans even though probands were matched, perhaps because the European American relatives regress to a lower population mean. We found significantly higher family correlations for height in European Americans, suggesting greater environmental variability among African Americans for factors affecting growth and physical development. Discussion: Our results suggest a similar level of heritability of BMI in families of obese African American and European American women. Other genetic studies will be needed to determine the extent to which the same or different genes and environmental conditions contribute to an overall similar heritability in the two racial groups.     

Larger Amounts of Visceral Adipose Tissue in Asian Americans

Objective: Excess visceral adipose tissue (VAT) is recognized as an important risk factor for the development of coronary heart disease and type 2 diabetes. Several studies have reported less VAT in African Americans compared with whites. As little is known about the levels of VAT in Asians, we compared whole‐body VAT in Asian Americans with European Americans. Research Methods and Procedures: VAT was measured using whole‐body multislice magnetic resonance imaging in 54 women (18 Asian Americans, 36 European Americans) and 53 men (19 Asian Americans, 34 European Americans) with body mass index (measured in kilograms per square meter) < 30. Data were analyzed by multiple regression modeling. Results: Asian American women had higher log‐transformed VAT compared with European American women (p < 0.05), after adjusting for age and total body fat. There was a significant age by race interaction such that race differences in VAT were most evident over the age of 30 years. No differences in VAT could be detected between Asian American and European American men, even after adjusting for potential covariates, including total adiposity. %Discussion: These data are the first to demonstrate higher amounts of VAT in healthy Asian Americans, a finding that suggests normative VAT values or standards derived from whites may not be applicable to Asians.     

Neoadjuvant tamoxifen and aromatase inhibitors: comparisons and clinical outcomes

Neoadjuvant hormonal therapy for oestrogen receptor (ER) and/or progesterone receptor (PgR) positive large operable or locally advanced breast cancer is effective and a safe alternative to chemotherapy in postmenopausal women. A randomised trial has demonstrated that the response rate and the incidence and degree of downstaging with the aromatase inhibitor letrozole is significantly greater than with tamoxifen [J. Clin. Oncol. 19 (2001) 3808]. Tumours at all levels of ER appear to respond better to letrozole than tamoxifen but at low levels of ER responses are seen only with letrozole and not with tamoxifen. Patients most likely to benefit from neoadjuvant therapy and those who achieve the greatest reduction in tumour volume are those patients with tumours that express very high levels of ER (ALLRED category score 8). Both letrozole and anastrozole appear effective in both erbB2 positive and negative breast cancers. Three months of treatment is adequate to determine if a tumour will respond. Following breast-conserving surgery and radiotherapy, local recurrence rates appear satisfactory.     

"They See Us as Resource": The Role of a Community-Based Youth Center in Supporting the Academic Lives of Low-Income Chinese American Youth

Based on a 15-week ethnographic-based research, this article examines the role of a community-based youth center in supporting the academic lives of Chinese American youth from low-income families in an east coast city I call "Harborview." This study demonstrates the significant role that community-based organizations play for low-income immigrant youth in providing them with social capital. This study also challenges the portrayal of Asian Americans as model minorities who do not face any barriers.  [Asian American education, community-based organizations, out-of-school-time programs, social capital]     

Identification of a Functional Genetic Variant at 16q12.1 for Breast Cancer Risk: Results from the Asia Breast Cancer Consortium

Genetic factors play an important role in the etiology of breast cancer. We carried out a multi-stage genome-wide association (GWA) study in over 28,000 cases and controls recruited from 12 studies conducted in Asian and European American women to identify genetic susceptibility loci for breast cancer. After analyzing 684,457 SNPs in 2,073 cases and 2,084 controls in Chinese women, we evaluated 53 SNPs for fast-track replication in an independent set of 4,425 cases and 1,915 controls of Chinese origin. Four replicated SNPs were further investigated in an independent set of 6,173 cases and 6,340 controls from seven other studies conducted in Asian women. SNP rs4784227 was consistently associated with breast cancer risk across all studies with adjusted odds ratios (95% confidence intervals) of 1.25 (1.20−1.31) per allele (P = 3.2×10⁻²⁵) in the pooled analysis of samples from all Asian samples. This SNP was also associated with breast cancer risk among European Americans (per allele OR  = 1.19, 95% CI  = 1.09−1.31, P = 1.3×10⁻⁴, 2,797 cases and 2,662 controls). SNP rs4784227 is located at 16q12.1, a region identified previously for breast cancer risk among Europeans. The association of this SNP with breast cancer risk remained highly statistically significant in Asians after adjusting for previously-reported SNPs in this region. In vitro experiments using both luciferase reporter and electrophoretic mobility shift assays demonstrated functional significance of this SNP. These results provide strong evidence implicating rs4784227 as a functional causal variant for breast cancer in the locus 16q12.1 and demonstrate the utility of conducting genetic association studies in populations with different genetic architectures.     

The Clinical Breast Care Project: an important resource in investigating environmental and genetic contributions to breast cancer in African American women

Age at diagnosis, pathological characteristics, and tumor behavior differ between African American (AAW) and Caucasian women (CW) with breast cancer, with AAW having more aggressive tumors and higher mortality rates. Although both societal and molecular contributions to these disparities have been suggested, the African American population has traditionally been under-represented in research and clinical protocols, limiting the power of epidemiologic and molecular studies to provide better understanding of disease pathogenesis in this minority population. The Clinical Breast Care Project (CBCP) has developed a large tissue and blood repository from patients undergoing treatment for breast cancer, with previous history of breast cancer, counseled in the Risk Reduction Clinic, screened by routine mammography, or undergoing elective reductive mammoplasty. Recruitment of AAW into the CBCP was successful; 25% of the 2,454 female patients were African American, including 35% disease-free, 3% high-risk, 40% benign, 8% preinvasive and 14% with invasive breast disease. More than 500 data fields regarding lifestyle choices, socioeconomic status, health history and geography were collected from all participants, and all consenting individuals provided blood specimens for genomic and proteomic studies. Tissues were collected from all patients undergoing surgical procedures using protocols that preserve the macromolecules for downstream research applications. In addition, patients were followed after diagnosis, with >85% of patients providing ongoing and updated demographic and clinical information. Thus, recruitment efforts in the CBCP have resulted in collection of well-annotated information and research-quality specimens from a large number of AAW. This unique resource will allow for the identification of biological and environmental factors associated with the identification of genetic and non-genetic factors associated with the occurrence, detection, prognosis, or survival of breast cancer in AAW. The opinion and assertions contained herein are the private views of the authors and are not to be construed as official or as representing the views of the Department of the Army or the Department of Defense.     

Ethnic differences in anthropometric characteristics of young children and their parents

The distribution of body fat, or fat patterning, is an important risk factor for cardiovascular disease and diabetes, independent of obesity. Furthermore, the incidence of cardiovascular disease and diabetes varies by ethnicity. We documented ethnic differences in anthropometric characteristics and body fat distribution between Anglo, Black, and Mexican American men (n = 101), women (n = 245), boys (n = 111), and girls (n = 111). We used aggregates of skinfold measures to examine ethnic differences in the deposition of fat in body compartments (body, trunk, leg, and arm) and analyzed trunk-extremity skinfold ratios to determine which best reflected ethnic differences in fat distribution. The results show that Mexican American mothers have larger skinfold ratios and more body fat (as determined by skinfold aggregates) than either Anglo or Black American mothers, whereas Black American mothers have larger ratios than Anglo American mothers. Mexican American fathers also have larger skinfold ratios but not more body fat (skinfold aggregates) than Anglo American fathers. Mexican American fathers have more body fat than Black American fathers, but we found no differences between skinfold ratios. The ethnic differences among children in skinfold ratios and aggregates are similar to those found among fathers, with more differences among girls than boys. Fat patterning differences do exist among the three ethnicities, with greater trunk fat among Mexican and Black Americans. Those ethnicities are known to be at higher risk for cardiovascular disease and diabetes.     

Explaining Asian American achievement

ABSTRACT

Jennifer Lee and Min Zhou’s The Asian American Achievement Paradox is a remarkable analysis of the educational upward mobility of Chinese and Vietnamese Americans in Los Angeles. It also provides important insights about the status of contemporary Asian Americans more generally. While critical of the ‘model minority’ thesis, the authors take seriously the role of culture in fostering educational attainment. However, their emphasis on immigrant selectivity and individual psychology may be misplaced when it comes to understanding the achievement of second-generation groups.     

The reigning misperception about culture and Asian American achievement

ABSTRACT

Asian Americans graduate from college at higher rates than other groups, and evince educational outcomes that match or exceed those of their parents. They comprise about 25 per cent of the student body in Ivy League institutions, despite making up only 6 per cent of the U.S. population. While it may be tempting to reduce Asian American academic achievement to Asian culture, and Confucian values more specifically, we provide disconfirming evidence, both within the United States and beyond, to show the fallacy of this logic. Contemporary U.S. Asian immigrants are “hyper-selected”: they are more likely to have graduated from college than their non-migrant counterparts, and also more likely to be college-educated than the U.S. mean. Hyper-selectivity and its spillover effects explain the exceptional educational outcomes of Asian Americans. It is time that we laid to rest the reigning misperception that Asian American academic achievement can be reduced to Asian culture or Confucian values.     

Early-Life Socioeconomic Status and the Prevalence of Breast Cancer in Later Life

Knowledge of mechanisms linking early-life social environment and breast cancer remains limited. We explore direct and indirect effects of early-life socioeconomic status (SES) on breast cancer prevalence in later life. Using 50-year data from the Wisconsin Longitudinal Study (N = 4,275) and structural equation modeling, we found a negative direct effect of early-life SES, indicating that women from higher-SES family background had lower breast cancer prevalence than women from lower-SES families. Additionally, early-life SES has a positive indirect effect on breast cancer via women's adult SES and age at first birth. Were it not for their higher SES in adulthood and delayed childbearing, women from higher-SES families of origin would have had lower breast cancer prevalence than women from lower-SES families. Yet, early-life SES is associated positively with adult SES and age at first birth, and women's higher adult SES and delayed childbearing are related to higher breast cancer prevalence.     

Obesity and Awareness of Obesity as Risk Factors for Breast Cancer in Six Ethnic Groups

Objective: To document BMI and knowledge regarding obesity as a risk factor for breast cancer among subpopulations of African‐, Caribbean‐, and European‐American women and to consider the variables predicting obesity in these diverse groups. Research Methods and Procedures: A stratified cluster‐sampling plan was used to recruit 1364 older women from Brooklyn, NY, during 2000–2002. Two groups were born in the United States (African Americans and European Americans), whereas others were from the English‐speaking Caribbean, Haiti, the Dominican Republic, and Eastern Europe. Participants provided demographics, height and weight measures, and estimates of the risk obesity posed for breast cancer. Results: Women from all groups were significantly overweight (BMI > 25 kg/m²), although European Americans were lowest, followed by Dominicans and Haitians; African‐American and English‐speaking Caribbean women fell into the obese range, even when background variables were controlled. Knowledge of obesity as a breast cancer risk factor was also poor across groups, but Dominicans and Haitians had the lowest scores on knowledge. Importantly, knowledge was not associated with BMI in the overall sample, even when controlling for demographics and ethnicity, although logistic regressions comparing normal weight women with overweight and obese groupings suggested some knowledge of breast cancer risk in the overweight, but not the obese, group. Discussion: The findings remind health professionals of the need to consider more specific ethnic groupings than has hitherto been the case, as well as consider how ethnic and cultural variables may influence perceptions of obesity and its relation to cancer risk.     

Mammography screening and breast self-examination among minority women in public housing projects: the impact of physician recommendation.

This exploratory study examined the impact of physician recommendations and other factors on mammography screening and breast-self examination (BSE) among African American and Hispanic women in public housing communities. We surveyed a randomly selected sample of low-income households from three low-income communities (n = 291), which included both African Americans and Hispanic women. Data for this paper are reported only on women who were 40 years and older head of the households (n = 120 women, including 74 Hispanics and 46 African Americans), since they meet the age criterion for mammography screening. Our analyses indicated that only 46% of women obtained mammography in the previous 12 months, with no significant differences between the Hispanic and African American women in mammography rates. Physicians' recommendations were among the most significant and substantial predictors of obtaining a mammogram or performing BSE. Further, odds were also higher for those who had insurance coverage. In addition, our data also indicated that almost one out of four women, aged 40 and older participants in this study, claimed that their health care providers never told them they needed a mammogram or never told them that they should perform BSE, with no significant differences between Hispanic and African Americans. Our analyses points to an urgent need for intervention to inform and motivate the service providers in underserved communities to motivate breast cancer screening (BCS) among minority women. Additionally, our examination points to the need for urgent interventions targeting minority women, particularly women with no medical insurance for breast cancer screening.     

保乳手术联合放射治疗84例乳腺癌患者临床疗效观察

目的:观察保乳手术联合放射治疗乳腺癌患者临床疗效。方法:选取我院收治的乳腺癌患者84例,均采取保乳手术联合放射治疗,观察临床疗效。结果:所有患者手术均获得成功,84例乳腺癌患者均在出院后进行随访,平均随访时间(2.1±0.4)年,各项检查未发现复发迹象。在放疗的期间内,乳房出现刺痛、发痒的不适患者20例,皮肤色素沉着、红斑的患者37例,在治疗后发生湿性脱皮患者10例,放射性食管炎患者8例;在放疗结束1个月,出现反射性肺炎患者2例。手术及放疗后,患者乳房的美容效果中优秀患者49例,良好患者29例,较差患者6例;行肿瘤扩大切除术患者优秀率高于行象限切除术患者,差异有统计学意义(P0.05)。结论:保乳手术联合放疗可保证治疗效果,同时降低并发症的发生,有利于美观,是一种优秀的乳腺癌治疗方法。     

Should symptomatic menopausal women be offered hormone therapy?

Many physicians remain uncertain about prescribing hormone therapy for symptomatic women at the onset of menopause. The American Society for Reproductive Medicine (ASRM) convened a multidisciplinary group of healthcare providers to discuss the efficacy and risks of hormone therapy for symptomatic women, and to determine whether it would be appropriate to treat women at the onset of menopause who were complaining of menopausal symptoms. MAJOR FINDINGS: Numerous controlled clinical trials consistently demonstrate that hormone therapy, administered via oral, transdermal, or vaginal routes, is the most effective treatment for vasomotor symptoms. Topical vaginal formulations of hormone therapy should be preferred when prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy. Data from the Women's Health Initiative indicate that the overall attributable risk of invasive breast cancer in women receiving estrogen plus progestin was 8 more cases per 10,000 women-years. No increased risk for invasive breast cancer was detected for women who never used hormone therapy in the past or for those receiving estrogen only. Hormone therapy is not effective for the treatment of cardiovascular disease and that the risk of cardiovascular disease with hormone therapy is principally in older women who are considerably postmenopause. CONCLUSIONS: Healthy symptomatic women should be offered the option of hormone therapy for menopausal symptoms. Symptom relief with hormone therapy for many younger women (at the onset of menopause) with menopausal symptoms outweighs the risks and may provide an overall improvement in quality of life. Hormone therapy should be individualized for symptomatic women. This involves tailoring the regimen and dose to individual needs.