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    Research Grants Awarded

    Racial Differences in Adverse Effects of Hormone Deprivation Therapy

    Study Section:
    Population Specific

    Scientific Abstract:
    Adjuvant treatment may cause more symptoms than the disease itself, especially since breast cancer is often detected early before symptoms occur. The goal of hormone deprivation therapy with Aromatase Inhibitors (AI), a common adjuvant treatment for breast cancer, is to profoundly lower estrogen levels and “starve” the cancer of its hormonal stimulus. While there are clear benefits, women taking AI have an increased risk of musculoskeletal symptoms in the short-term and fractures in the long-term. These side effects impact quality of life and may affect treatment adherence. We hypothesize that the resultant estrogen deficiency leads to a decrease in vitamin D levels causing musculoskeletal symptoms. Because African American (AA) women in general have lower levels of vitamin D than Whites (W), we hypothesize that AA women are more likely than W women to suffer musculoskeletal symptoms with AI therapy. Clues to support this theory come from a study that showed replacing hormones in women after menopause increases vitamin D levels, two uncontrolled studies that found low vitamin D levels in patients with musculoskeletal symptoms, and evidence that AA women are more likely than Whites to be vitamin D deficient. To test this hypothesis we propose to conduct a case-control study, comparing frequency and severity of musculoskeletal symptoms and vitamin D concentrations between breast cancer patients and control women, stratifying by race. The first aim is to enroll AA and W breast cancer patients taking adjuvant AI and control women (no history of invasive cancer) matched on age, race and season of blood draw. The second aim is to enroll AA and W women with breast cancer prior to the start of AI therapy along with a comparison group of women to evaluate the change in vitamin D levels in the first 6 months of therapy and correlate this with onset of musculoskeletal symptoms. Many individuals have low levels of vitamin D that worsens with age due to low dietary intake and limited sun exposure. Therapy may exacerbate vitamin D deficiency, cause severe musculoskeletal symptoms and long-term effects on bone health, especially among AA women. There is a paucity of information on the frequency, severity and cause of these symptoms and differences by race. The proposed study will help fill the gaps in knowledge and potentially provide a safe, well tolerated and practical way to improve the health-related quality of life for all patients.

    Lay Abstract:
    Cancer is a disease where the treatment may create more symptoms than the disease itself and can cause long-term health consequences. T his is especially true for breast cancer where early detection with screening catches the disease before symptoms occur. A common form of treatment for breast cancer patients is “hormone deprivation therapy” using Aromatase Inhibitors (AI). The goal of therapy is to lower estrogen levels as much as possible, thereby “starving” the tumors that need these hormones to grow. This treatment has side effects as well as benefits. Women on this therapy have an increased risk of osteoporosis, fractures and musculoskeletal symptoms such as muscle and joint pains. We hypothesize that the low estrogen levels leads to decreases in vitamin D levels, causing musculoskeletal symptoms. Because African American (AA) women in the general population have lower levels of vitamin D than White (W) women, we hypothesize that AA women with breast cancer are more likely to suffer musculoskeletal symptoms than White women. Clues to support this theory come from a study that showed replacing hormones in women after menopause can increase vitamin D levels, two studies that found low vitamin D levels in patients with musculoskeletal symptoms, but these studies did not have a comparison group, and evidence that AA women have significantly lower vitamin D levels than W women. We propose to conduct a case-control study to test our hypothesis. We will compare vitamin D levels and frequency and severity of musculoskeletal symptoms in AA and W women with breast cancer taking AI therapy to women of similar race and age but without cancer. We will also enroll women with breast cancer who are beginning treatment and compare the change in vitamin D levels and frequency and severity of musculoskeletal symptoms over a 6 month period to control women. Many individuals have low levels of vitamin D due to low dietary intake and limited sun exposure that worsens with age. This deficiency may be exacerbated by treatment lead to severe musculoskeletal symptoms and long term effects on bone health (osteoporosis and fractures). There is a paucity of information on the frequency and severity of these symptoms, their cause, and differences by race. The proposed study will help fill the gaps in knowledge and, potentially provide a safe, well tolerated and practical way to improve the health-related quality of life for all breast cancer patients.