African-American (AA) men have the highest rates of prostate cancer incidence and mortality in the US.
Understanding underlying reasons for this disparity could identify preventive interventions important to AA men.
PURPOSE: To determine whether the association of obesity with prostate cancer risk differs between AA and non-Hispanic white (NHW) men and whether obesity modifies the excess risk associated with AA race.
METHODS: This is a prospective study among 3398 AA and 22673 NHW men who participated in the Selenium and Vitamin E Cancer Prevention Trial (2001-2011). Using Cox regression, we estimated hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) associated with AA and NHW race and body mass index (BMI) [kg/m2] on tjotal, low- (Gleason score < 7), and high-grade (Gleason score ≥7) prostate cancer incidence while adjusting for relevant covariates.
RESULTS: There were 270, 148, and 88 cases of total, low-, and high-grade prostate cancers among AA men and a corresponding 1453, 898, and 441 cases in NHW men (median follow-up of 5.6 years). BMI was not associated with risk of total cancer among NHW men, but was positively associated with risk among AA men (BMI < 25 kg/m2 vs. ≥35 kg/m2, HR = 1.49; 95% CI, 0.95-2.34; Ptrend = 0.03). Consequently, the risk associated with AA race increased from 28% (HR = 1.28; 95% CI, 0.91-1.80) among men with BMI < 25 kg/m2 to 103% (HR = 2.03; 95% CI, 1.38-2.98) among AA men with BMI≥35 kg/m2 (Ptrend = 0.03). BMI was inversely associated with low-grade prostate cancer risk among NHW men (BMI < 25 kg/m2 vs. ≥35 kg/m2, HR = 0.80; 95% CI, 0.58-1.09; Ptrend = 0.02), but positively associated with risk among AA men (BMI < 25 kg/m2 vs. ≥35 kg/m2, HR = 1.77; 95% CI, 1.14-2.76; Ptrend = 0.05). BMI was positively associated with risk of high-grade prostate cancer in both NHW (BMI < 25 kg/m2 vs. ≥35 kg/m2, HR = 1.33; 95% CI, 0.90-1.97; Ptrend = 0.01) and AA men (BMI < 25 kg/m2 vs. ≥35 kg/m2, HR = 1.81; 95% CI, 0.79-4.11; Ptrend = 0.02), but associations were not significantly different.
CONCLUSION: Obesity is more strongly associated with increased prostate cancer risk among AA than NHW men and reducing obesity among AA men could reduce the racial disparity in cancer incidence. Research is needed to test mechanisms underpinning these associations.
Barrington WE, Schenk JM, Etzioni R, Arnold KB, Neuhouser ML, Thompson IM, Lucia MS, Kristal AR. Are you the author?
Reference: Cancer Epidemiol Biomarkers Prev. 2015 Apr;24(4):765.