Abstract
Obesity and breast cancer are key health issues for American women. Obesity has approximately reached epidemic percentages in the United States and is more widespread among American women. The breast cancer mortality rate persists to mount in Americans. A review of the recent literature was conducted to bring into focus the relationship of these two health problems as they relate to American women. The review is separated into three subjects, obesity prevalence and incidence, breast cancer incidence and mortality and the relationship between obesity and breast cancer. The two studies reviewed are facts of a connection between obesity and breast cancer. The elevated occurrences of obesity among Americans make it probable that they bear an incoherent weight of co-morbidities connected to obesity as well as breast cancer.
Introduction
Americans experience from numerous major health problems connected with high morbidity and mortality. In the precedent decade, much concentration has been accorded to exposing and decreasing the health inequalities that exist between marginal and non-marginal populations. Conversely, an extension of the gap between non-white Americans and whites persists to exist for some health crises. Two health complications, breast cancer and obesity, distress women ordinarily but emerge to inexplicably have an effect on African American women.
Breast Cancer is a widespread form of cancer amongst women in the United States. One third of cancer diagnosis and 15% of cancer deaths are attributed to breast cancer in women. It is approximated that 107,000 new cases of breast cancer is detected yearly in the U.S. According to Lacey, Devesa, & Brinton, (2000:56), there were about 192,000 cases and 40,000 deaths putting at the most regular occurring cancer and the second principal source of cancer death.
The occurrence of breast cancer has been increasing for the last twenty years but the death rates have remained stable. This increase in incidence over the past years is related with increased screening by physical examination and mammography. The incidence of breast cancer is 20 to 40% higher in white women than non-white women. The ultimate chances of having breast cancer are similar for non-white women compared with white women. American women are more likely than White women to develop breast cancer before the age of 50, and less likely to develop breast cancer past the age of 50 years. More particularly American women below the age of 40 have a higher incidence of breast cancer than youthful white women
Death rates are much lower than incidence rates. Even though the incidence of breast cancer is more common in white women, it is more likely to lead to death when it affects American women. The utmost age-adjusted death rate occurs among American women. These women in the age groups 30-54 y and 55 to 69 years have the highest death rate of all ethnic groups. In the older age group, the death rate for white women is higher than that for the non-white American women. The national cancer institute statistics during the years 1973 to 1995 confirmed that death from breast cancer decreased 7.1 percent among white women of all ages and increased 19.4 percent in non-white women in the United States. In 1995, 31.1 American women per 100,000 died from breast cancer, compared with 24.8 white women per 100,000. These high death rates are linked to the fact that a big percentage of non-white women with breast cancer, are diagnosed at a later stage and are less treatable. Other factors that may add to this high death rate may be related to the fact that non-white women are considerably younger at the period of diagnosis than white women. Non-white women are very much more likely to have estrogen receptive negative tumours and progesterone negative tumours, both of which are associated with more insistent tumours.
The root of breast cancer is not entirely recognized, however, it has been revealed that numerous factors increase one's likelihood of budding breast cancer. These possible factors have been considered as modifiable and non-modifiable factors. Age, early age at menarche, late age of menopause, and late age at first pregnancy have been identified as non-modifiable factors. Endogenous hormone levels, obesity, exercise, hormone replacement therapy, alcoholism, breastfeeding, oral contraception, and diet are factors that are considered modifiable. Obesity, one of the modifiable factors, is a major health problem for American women.
Obesity is characterised by an excess of body fat and is a serious and persistent health crisis in America, predominantly among women. Body fat can be deliberated by a number of methods and is normally estimated by the body mass index (BMI). And a person’s BMI is defined as their weight in kilograms divided by the square of their height in meters .Obesity is defined as having a body mass index (BMI) score of 30 or more (normal 18-24). In 2000 a total of 38.8 million American adults met this categorization of obesity. In addition to being obese, a great number of American are overweight, defined as a BMI greater than or equal to 25. Obesity is classified as follows: Pre-obese BMI 25-29.9, the other is Class I obesity BMI 30-34.9 followed by Class II obesity BMI of 35-39.9, and finally Class III 40 and above
The past several years have been characterized by major changes in way of life, hence leading to a steady increase in average body weight and indices of obesity. Genetic also play a major contributing role in this tendency of increasing obesity, however, increase eating of fast food and a more inactive lifestyle or lack of physical activity are also factors to look into. Results from research on trends in the frequency of obesity are accessible for many countries.
Current information point out that obesity in the United States increased by 61% between 1991 and 2000 .Roughly, 97 million adults in the United States are overweight or obese. To be specific, 58 million are overweight and 39 million are obese. The number of adults with overweight and obesity has continued to rise. at the moment 54.9% of United States adults age 22 to 80 are overweight, of which 22.3% are obese (American Obesity Association, 1999). An obesity epidemic within the United States population is clearly portrayed by the fact that in 1991, only 4 of 45 participating states had obesity rates of 15-19% and none had rates greater than 20%. By the year 2000 all of the 50 states apart from Colorado had rates of 15% or greater, with 22 of the states having obesity rates as high as 20% or greater (Centre for Disease Control).
Rates of severe obesity are almost two times greater among non-white women than among white women. Studies trying to gauge the dominance of obesity in weight control practices among middle age American women. Abrahamson ET. Al studied 307 women 30 years of age and older. More than 35 per cent of those who took part were classified as being overweight with a BMI of 25 to 29. And 45 percent were classified as obese having there BMI being greater than or equal to 30. More than 80% of participants were either overweight or obese with a BMI exceeding 25. The results indicated that American women in that population have a higher dominance of obesity.
More women that are American are overweight and obese in all categories. This same fact holds true for Hispanic women. The collective occurrence of overweight and obesity for Hispanic and American women (66.5%) is more than 30% greater in percentage to American women. Most American women become overweight with age, majority of these women display a marked excess of obesity compared with women of other origin. Country wide, majority of American women over age 50 are obese. As an outcome, rates are elevated in this set for a number of health outcomes.
Obesity is coupled with increased risk of poor health, mortality, and disability. persons with obesity are at risk for budding one or more serious medical situation, which can lead to poor physical condition and untimely death. Too much weight can result in many grave conditions and potentially deadly health problems including higher incidence of breast cancer. American women are more likely to be obese and being obese is associated with a more complex stage of cancer at diagnosis. In a study of 1,150 American women, those that were severely obese were 2.5 times more likely to have cancer.
The outcome of weight, weight gain, and obesity on breast cancer risks are not obviously understood but have been evident in a number of populations. Most of the studies have examined this relationship in the widely held population. Few studies were found that have examined this correlation in American or Hispanic women, two populations with the highest rate of obesity in the United States. Since very few studies were established that used only an American population, this review will include studies by means of different population groups. The proof that heavier women are at increased risk for breast cancer has been known since the 1970s .Weight gain during adult life has been linked with increased risk of postmenopausal breast cancer. Both studies have revealed a stronger connection between postmenopausal breast cancer risk and BMI in women who have by no means used hormone substitution therapy. The studies have recognized significant differences between postmenopausal and pre-menopausal women.
Prior to menopause, overweight women with breast cancer emerge to have a shorter life span than those with lower BMI. prior to menopause, elevated BMI has been connected to a diminished risk of breast cancer; conversely, a recent study found an augmented risk of the most deadly type of breast cancer, inflammatory breast cancer, in women with BMI as low as 26.7 irrespective of menopausal status.
Women who achieve about 45 pounds or more following the age of 18 are twofold more probable to develop breast cancer after menopause than those without weight gain. After menopause women with obesity have an elevated risk of having breast cancer. Additionally, weight increase after menopause may also augment breast cancer risk. In postmenopausal women, an increase in breast cancer risk of approximately 40% has been accounted for women whose BMI values are in the maximum quartile (35-40). This relationship becomes stronger with mounting age and years behind menopause.
Cleveland et.al premeditated the association between obesity and breast cancer in infantile women aged 21-45. A diminished risk of breast cancer was established for women in the maximum quintile of body mass index as in relation to the minimum quintile. The study results back prior research showing a decreased risk of breast cancer associated with augmented body size among premenopausal or young women Cleveland et.al scrutinized body mass in different life periods and breast cancer risk in postmenopausal women. They established that among women at a minimum 20 years postmenopausal, those who had added 60 pounds or more ever since age 18, had an advanced frequency of breast cancer in relation to those who had upheld their weight unchanged. The outcome of weight increase was unambiguous amid non-users of hormone substitution therapy but not amid clients of hormone substitution therapy.
The augmented risk of health problems connected with obesity depends not merely on the weight added amount but as well, on where the weight is disseminated. Body fat centred on the waist positions an individual at greater risk for metabolic defects, cardiovascular disease, breast cancer, type II diabetes, and death, than from body fat centred in the buttocks.
Biko proposed that the connection linking obesity and breast cancer could be mediate through hyperinsulinemia. Insulin and insulin-like growth factor-1 stimulate mammary cell proliferation in vitro and cell proliferation and is directly linked to the risk of breast cancer (Stoll, 2000).The association of breast cancer incidence with serum levels of insulin and glucose was examined in a co-hort of women aged 45-64.
Breast cancer was positively associated with body mass index but not with waist-hip ratio or serum insulin levels. A higher incidence of breast cancer was observed among women with diabetes compared with women with fasting glucose levels below 100 mg/dl. Insulin resistance has also been suggested to be associated with an increased risk of breast cancer. Insulin sensitivity can be gauged via a marker of insulin secretion, blood C-peptide. In a examination of Blood C-peptide level, and breast cancer risk, women who were at elevated C-peptide levels had an augmented risk of breast cancer. The positive relationship was examined in both pre and postmenopausal women and irrespective of the levels of waist-to hip ratio or body mass index.
Conclusion
Even though both studies were established on the association of obesity and breast cancer in American women, outcomes from the studies re-examined present adequate proof that an association subsists between obesity and breast cancer. The association seems to be more apparent in obese postmenopausal women. Obesity and breast cancer are major health problems for American women. Obesity is more prevalent in American women than in any the men. Non- white American women have the highest mortality rate from breast cancer of all population groups. The incidence of both obesity and breast cancer continue to rise in African American women. Increased risk of breast cancer is one of the consequences of obesity and being obese is associated with a more advanced stage of cancer at diagnosis. If the health disparity gaps are to be reduced between American women and white women in these two areas, intensive efforts to reduce obesity should be directed toward African American women, and future research studies should include African American women.
Bibliography
American Obesity Association. (n.d.) Fact Sheets, Obesity in Minority Populations, Obesity in the US, and Health Effects of Obesity. Washington, D.C.
Bianchini, F., Kaaks, R., & Vainio, H. 2002. Overweight, obesity, and cancer risk. The Lancet Oncology, 3, 565-574.
CDC National Centre for Health Statistics. 2002 (n.d.)fast stats A to Z Retrieved December 2, from http: www.cdc.gov/nchs/fastats/ overwt.htm
Page E. Abrahamson et al., 2006 General and Abdominal Obesity, and Survival among Young Women with Breast Cancer
Rebecca J. Cleveland, 2007Weight Gain Prior to Diagnosis and Survival from Breast Cancer
