Immigration Effects on Breast Cancer Incidence
The effect of immigration on the development of breast cancer in women of African descent
Susan Vadaparampil, PhD, MPH (H. Lee Moffitt Cancer Center)
Vincent DeGennaro MD (University of Florida Health Cancer Center)
Judith Hurley, MD and Sophia George, PhD (University of Miami Sylvester Cancer Center)
Disparities in breast cancer have been reported for race/ethnicity and poverty within a country despite adjusting for known confounders and risks factors. These differences are multifactorial and are related to differences not only in tumor biology but also in screening practices, access to care and overall socioeconomic status. There is nothing in the literature about the short-term effects of immigration on the development of breast cancer. In our recent review of women with breast cancer living in Haiti compared to Haitian women with breast cancer living in Miami who were recent immigrants, we saw lower stage and longer survival in the Miami group. These differences can be readily explained by improved access to care for the Miami cohort. However, there were significant differences in age and estrogen receptor status between women living in Haiti compared to those living in Miami that could not be accounted for by access to care and remain unexplained. These differences persisted when comparing the two Haitian cohorts with African American and Caucasian women with breast cancer from the SEER data. This raises the question as to whether there are short-term effects of immigration on breast cancer incidence and type.
We hypothesize that there are short term effects of immigration on breast cancer incidence and presentation in women of African origin. We postulate that spatial factors of immigration such as diet, lifestyle changes, stressors, (environmental effects) and temporal factors – length of exposure as a result of immigration, determine the contribution of these factors on the increasing incidence of breast cancer in women of African descent with the perspective, that the inherent biology of immigration and country or ethnicity is driving disease etiology, independent of access to care. To determine this, we will evaluate the genetic differences between women of African descent who have breast cancer and are native to Haiti, the USA or who have emigrated from Haiti to the USA.