Mediation analysis of racial disparities in triple-negative breast cancer incidence among postmenopausal women

Juhua Luo, Candyce H. Kroenke, Michael Hendryx, Aladdin H. Shadyab, Nianjun Liu, Xiwei Chen, Fengge Wang, Fridtjof Thomas, Nazmus Saquib, Lihong Qi, Ting Yuan David Cheng, Rhonda Arthur, Jean Wactawski-Wende

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Triple-negative breast cancer (TNBC) is disproportionately higher in Black women relative to White women. The objective of this study was to examine to what extent the association between race/ethnicity and risk of TNBC is mediated by potentially modifiable factors. Methods: A total of 128,623 Black and White women aged 50–79 years from the Women’s Health Initiative were followed for a mean of 15.8 years. 643 incident TNBC cases (92 Black women and 551 White women) were confirmed by medical record review. Mediation analyses were conducted using an approach under a counterfactual framework. Results: Black women had approximately twofold higher risk of TNBC compared with white women (HR = 1.93, 95% CI 1.52–2.45). We observed that 48% of the racial disparity was mediated by metabolic dysfunction defined by having 3 or more cardiometabolic risk factors including elevated waist circumference, having history of diabetes, high cholesterol and hypertension. The racial disparity was not significantly mediated by other factors studied, including socioeconomic, lifestyle or reproductive factors. Conclusion: Our study observed that approximately half of the racial disparity between postmenopausal Black and White women in TNBC incidence was driven by metabolic dysfunction.

Original languageEnglish (US)
JournalBreast Cancer Research and Treatment
StateAccepted/In press - 2021


  • Mediation analysis
  • Modifiable risk factors
  • Racial disparities
  • Triple-negative breast cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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