Jones BA, Kasi SV, Curnen MG, Owens PH, Dubrow R.
Severe obesity as an explanatory factor for the black/white difference in stage of diagnosis breast cancer.
Am J Epidemiol 1997;146(5):394-404.

“The study was undertaken to determine the extent to which the observed racial difference in stage at diagnosis of breast cancer could be explained by racial differences in obesity, specifically severe obesity…. Adjustment for severe obesity in a logistic regression model reduced the risk of later stage at diagnosis in blacks relative to white by 33%, from an odds ratio of 1.98 (95% CI 1.22-3.19) to one of 1.66 (95% CI 1.10-2.73).”

“As we have reported previously, black women had more advanced breast cancer than white women, as measured by TNM stage at diagnosis. A black woman’s risk of a diagnosis of TNM stage II or greater was twice that of her white counterpart (age-adjusted odds ratio (OR) = 2.01, 95% CI 1.24-3.24). Examination of individual components of TNM stage revealed that black women were both more likely than white women to be diagnosed with larger tumors (age-adjusted OR = 1.85, 95% CI 1.17-2.93) and more likely to have cancerous lymph nodes (age-adjusted OR = 1.72, 95% CI 1.07-2.75).”

“Historically, hypothesized causes for the later stage at diagnosis in blacks relative to whites have included racial differences in socioeconomic status, differences in access to health care, and the related issue of screening behavior… It is encouraging to note that this physical characteristic is potentially more amenable to intervention than some of the more intractable social/cultural influences to which the racial difference in stage of diagnosis has traditionally been attributed.”