PROJECT SUMMARY/ABSTRACT
Despite improvements in breast cancer incidence and mortality rates in the general population, breast cancer
incidence rates in Black women have continued to rise and they exhibit the highest breast cancer mortality rate
out of any other racial population. Increased mammographic density has been well established as one of the
strongest, independent breast cancer risk factors. However, to date, there have been very few studies that
have included Black women in our understanding of mammographic breast density, which is a significant
limitation given that Black women are more likely to have denser breasts. Breast cancer disparities are likely
multifactorial and driven by related combinations of social determinants of health, the paucity of data in Black
women has resulted in a limited understanding of the contribution of breast density to cancer disparities. While
race, a social construct, is an unlikely direct predictor of mammographic density, it can serve as a marker of
differential lived experiences due to various cultural practice, environmental exposures, and experiences of
structural racism. Childhood, puberty, and pregnancy represent times of increased breast development and
susceptibility to such exposures and host factors. In fact, Black women display differing anthropometric and
reproductive patterns – which are known contributors to mammographic density in white women – across their
life course. We hypothesize that unique distributions of body and sexual maturation characteristics during
childhood and puberty, and varying reproductive outcomes during adulthood may, in part, explain the
increased incidence of high mammographic density in Black women. Using the Black Women’s Health Study,
the largest cohort of Black women in the United States (59,000 women), we have developed a large
mammogram repository consisting of over 10,000 participants. Leveraging this analytic tool, in Aim 1, we will
determine the associations of anthropometric, body habitus, and sexual development characteristics across
the life course with percent and absolute mammographic density. Aim 2 will explore the association between
specific pregnancy-related characteristics and percent and absolute mammographic density. This will be the
first study to assess factors from birth to adulthood as predictors of mammographic density in Black women.
Successful completion of these aims will offer insight into the etiology of increased mammographic density in
Black women and contribute to a better understanding of breast cancer incidence and survival disparities in
this vulnerable population. This proposal also integrates advanced epidemiologic techniques and fundamental
biostatistical skills with clinical training to prepare the PI for a career as an independent physician scientist with
expertise in cancer health disparities research.