Bridges to the Future Program
Breast cancer is the second leading cause of death for all women (after lung cancer), and the leading overall causes of death in women between the ages of 40-55.1 Figures of breast cancer cases are rapidly growing over the years. In 2001, approximately 192,000 new cases of breast cancer will be diagnosed, and 40,200 women will die from the disease in the United States2. Among the Hispanic population, breast cancer has become the most common form of cancer. One in every 12 Hispanic women will develop breast cancer sometime during her lifetime.3 Statistics have shown that every year about 8,600 Hispanic women develop, breast cancer and 1,800 died from the disease.4
A risk is anything that increases a person’s chance of getting a disease. There are different kinds of risk factors that have been linked to breast cancer. Being a woman and getting older are the most significant risk factors. Women who started menstruating at an early age (before age 12) or who went through menopause at a late age (after age 50) have a slightly higher risk of breast cancer. Women who have had no children or who had their first child after age 30 have a slightly higher breast cancer risk. Breast cancer is higher among women whose closed blood relatives have this disease. Blood relatives can be from either the mother’s or father’s side of the family. Having one first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman’s risk, and having two first-degree relatives increases her risk 5-fold. A recent analysis using data from different studies found that women who use oral contraceptives have a slightly greater risk of breast cancer than those women not using them. Most studies have, also, suggested that long-term use (5 years or more) of hormone replacement therapy (HRT) after menopause may slightly increase your risk of breast cancer.5 Obesity is also associated with an increased risk of developing breast cancer, especially for women after menopause (which usually occurs at age 50).
To understand the significance of statistics related to overweight and obesity, it is important to know how overweight and obesity are defined and measured. Overweight refers to an excess of body weight that may come from muscle, bone, fat, and/or body water.6 The Body Mass Index (BMI) can be used to measure both overweight and obesity in adults. BMI is a direct calculation based on height and weight, and it is not gender specific. BMI is found by diving a person’s weight into kilograms by height squared. The mathematical formula is: weight (kg/height squared (m2). The National Institutes of Health (NIH) identify overweight as BMI of 25-29.9 kg/m2, and obesity as BMI of 30 kg/m or greater.7
In 1998, the most recent year these statistics were available, more than 50% of people in the US were overweight – every other person, or an estimated 97 million adults, and over the 20-year period from 1974 to 1994, the percentage of obese adults aged 20-74 increased from 14.5% to 22.5%. That means that there is approximately one obese person for every 4.5 people in the US.8 The age-adjusted prevalence of combined overweight and obesity in racial/ethnic minorities – especially minority women – is generally higher than in whites in the United States. The statistics are as follows; Black women (20 + years old): 65.8%, White women (20 + years old): 49.2%, and Mexican-American women (20 + years old): 65.9%.9
Breast Cancer and Diet
Eating a healthy diet and maintaining an appropriate weight, are two things a women can do keep her risk of breast cancer as low as possible. It has appeared that American’s embrace of low-fat foods has had an unintended opposite effect. All of this emphasis on decreasing the fat content of food has indirectly contributed to an increase I calories from other sources, such as carbohydrates.8 Current research suggests that there is a possible relationship between eating meat, especially beef and cures meats, and increased in the risk of breast cancer. This relationship is uncertain for eating other meats such as pork and poultry. Some studies have suggests that cancer-causing chemicals, heteracyclic amines, are formed when meat is cooked at high temperatures and for a long-time.10 Other early studies have suggested that high dietary fat intake was associated with a higher incidence of breast cancer – but other studies have failed to show a clear relationship between fat intake and breast cancer risk.10
In the United States Mexican-American comprise 60% of the Hispanic/Latino population.11 For years Hispanics have learned many American traditions - but they have not forgotten about their own. The two drawbacks of the Mexican-American diet are the liberal use of added fat, particularly lard, and a preference for high-fat meats. A contributing factor is stove-top cooking, such as stewing or frying with liberal amounts of oil and lard, instead of baking or broiling. Most foods, including meat, beans, tortillas, rice, and potatoes, are fried.12 With emigration to the United States, major changes occur in the Mexican-American’s diet. The introduction of salads and cooked vegetables has increased the use of fats, such salad dressings, margarine, and butter. Other less healthy changes include a several decline in the consumption of traditional fruit-based beverages in favor of high-sugar drinks.11
The Institutional Review Board (IRB) is responsible for reviewing and approving all purposed research projects involving human subjects. Projects involving data collection in which there is identifiable linkage to the subject or involving physical, social, psychological or privacy risks to the subject must complete a “Research Protocol” and summit it to the IRB through the Office of Research & Sponsored Projects (ORSP) before the research is initiated.13 All new studies are reviewed first by the IRB Subcommittee or the IRB Chairman, both of whom are authorized to classify studies as exempt from formal IRB review and approve studies that qualify for expedited review. The Principal Investigation must complete an IRB – approved application form, a complete description of the activity (complete protocol), and Investigator’s Brochure.14 After the documents have been turned in, the Principal Investigator must wait for an approval and instructions to begin the study.
The purpose of this study is to test the hypothesis that body mass index, energy and fat intake are higher among women with breast cancer compared to those without breast cancer.
Methods and Materials
In this case-control study of diet and breast cancer, the diet before diagnosis reported by women with breast cancer (cases) is compared with the diet reported by women who have not been diagnosed with breast cancer (controls). A total of 200 females subjects will be collected for the purpose of this study. The study is being conducted at the University Breast Care Center at Texas Tech HSC and the patients are usually 35 years or older. The participants who will be involved in the study will be new, low-income, Hispanic patients. The research assistant will approach the new patients and inform them about the study. The bilingual research assistant will then explain the study with details. If the patient agrees to participate, she will read and sign an informed consent form and will agree to answer a questionnaire. Upon enrollment the participant will also be informed about the 3-day food record she must keep and return.
Dr. Salzstein is the Medical Director and Bertha Ciriza is the Coordinator at the University Breast Care Center at Texas Tech HSC. On a regular basis the clinic receives 160 to 180 patients a week; and out of those patients 25 or less are new patients. The patients are women with low-income and 99% are Hispanic. If the patient qualifies for a discount, their regular office visit ($25) is reduced to 20%, 40%, or 70%. In the years 2001 and 2002, the clinic had diagnosed 258 cases of breast cancer. The youngest victims are two eighteen years old and the oldest victim is a seventy-eight year old. .
The interview is be performed in the waiting room inside the clinic. The research assistant will ask the participant to answer the questionnaire in the language of preference, English or Spanish. The patient is, also, asked to give general information; her name, day of birth, and telephone number in case we need to ask further information or gather more details. The survey has a total of 35 questions, which includes; demographic, health, and reproductive characteristics, lifestyle choices, food preferences, and dietary practices (see appendix). After the interview the patient will receive instructions on how to complete a 3-day food record. The approximate time for the interview and instructions is 20 minutes.
3-Day Food Record
The patient is instructed on how to keep a 3-day food record for food intake information. The participant should write down the exact amount, kind and, if possible, the brand of food they have eaten for three days. In order to enhance standardized date collection, the research assistant will hand out a Serving Size Choices guide to take home. The Serving Size Choices guide provides measurement information, for example; A=1/4 cup of food, B=1/2 cup of food, C=1 cup of food, or D=2 cups of food. The participant will have a chance to choose one of these portions and write it in the 3-day food record sheet. She should include all foods and drinks, for example; juices, sodas, alcohol drinks, candy bars, etc. The patient will be instructed to complete the record during weekdays and avoid weekends. If the patient, by any chance, decides to start on Thursday, she must end her record on Friday and continue the following Monday. After the participant has recorded her meals for three days, she will mail-in her results in a self-addressed postage paid envelope. When the research assistant has received the participant’s 3-day food record, she/he will be entering the data into the Nutritionist Program.
Nutrient data analyses
The Nutritionist software will be used to analyze nutrient intake reported by the participants in the 3-day food record. The record of the foods will be entered under the Database Foods. The nutrient analysis will calculate the total percentage and energy intake of the nutrients the participant has encountered. Weight, protein, carbohydrate, saturated fat, polyunsaturated fat, sodium, calcium, and iron are several nutrients that are calculated, automatically. The Nutritionist Program includes, a variety of foods and brands, for example; fruits, vegetables, meats, breads, juices, candy bars, specific meals, and including, several Mexican food. The research assistant will enter the patient’s general information and keep a file on the patients records. The amount of body mass index is calculated once the current weight and height of the patient is entered. Each patient will be assigned to a identification number, in order to keep their files private. All data will be double check by each research assistant after all participants have been collected. When the patients received their diagnosis, the research assistant will begin separating them into two files; patients with breast cancer and without. The research assistants will then study their questionnaire and 3-day food record. The hypothesis will be then tested to indicate the success or failure of the method used in this research.
The results of the study were unsatisfied, since the gathering of the total 200 females subjects were not accomplished. My results will be presented as descriptive characteristics of the total population that we have so far (29 participants). Data will be presented as: mean ± SD, and n (%). Tables 1 and 2 describe characteristics of participants; Table 3, depicts Lifestyles characteristics; Table 4, shows Food preference of participants; Table 5, displays Dietary practices; and Table 6, describes an example of how results will be presented after statistical analysis is conducted.
This is an ongoing study therefore a conclusion is undetermined, only a small number of females have enrolled in the study. When the total participants have been gathered, we will examine their medical records, 3-day food record, and questionnaire. After we have their diagnoses we will separate them into two groups: Breast cancer and No cancer and will conduct statistical analysis.?