Improving our understanding of breast cancer mortality disparities through recurrence: a multi-level approach among women in Georgia

通过复发提高我们对乳腺癌死亡率差异的理解：格鲁吉亚妇女的多层次方法

• 批准号: 10818726
• 负责人: Lauren E McCullough
• 金额: $ 10.36万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10818726
• 关键词: Area; Automobile Driving; Barbering; Black American; Black race; Breast; Breast Carcinogenesis; Cancer Prognosis; Censuses; Characteristics; Clinical; Communities; Data; Development; Diagnosis; Disease; Disparity; Distal; Early Diagnosis; Early treatment; Environment; Environmental Risk Factor; Epidemiologist; Ethnic Population; Etiology; Future; Goals; Health Insurance; High Prevalence; Intervention; Investigation; Joints; Lead; Literature; Malignant Neoplasms; Mammary Neoplasms; Measures; Mentorship; Modification; Neighborhoods; Outcome; Parents; Predisposition; Public Health; Race; Recording of previous events; Recurrence; Recurrent Malignant Neoplasm; Research; Residential Mobility; Role; Scientific Advances and Accomplishments; Specific qualifier value; Woman; Work; black women; cancer health disparity; cancer recurrence; cancer subtypes; cohort; comorbidity; deprivation; disparity reduction; experience; health equity; improved; innovation; interest; knowledgebase; malignant breast neoplasm; mortality; mortality disparity; multilevel analysis; neighborhood disadvantage; outcome disparities; parent deprivation; programs; racial difference; racial disparity; racial population; rurality; social factors; triple-negative invasive breast carcinoma; tumor

PROJECT SUMMARY/ABSTRACT Significance. Although efforts to improve breast cancer prognosis through advancements in early detection and treatment have led to declines in breast cancer mortality rates, racial disparities in breast cancer mortality still exist, where Black women are 40% more likely to die from breast cancer than White women. Reasons for this disparity are not completely understood. Racial differences in the development of aggressive breast tumors likely contribute to the disparity, but little is known about causal drivers of aggressive disease. Social and environmental factors, such as the neighborhood environment, have been posited as potential contributors to breast cancer disparities, but their role in observed racial disparities is not clear. The proposed research seeks to identify potential drivers of the observed breast cancer racial disparities by investigating the impact of neighborhood environment on breast cancer mortality and the development of aggressive tumor types. Innovation. This proposal is innovative in that it will examine three neighborhood deprivation composite measures to determine whether differences in exposure assessment contribute to inconsistent results in prior literature, explore joint effects of neighborhood deprivation, race, and other neighborhood features, such as rurality, to identify subpopulations of Black and White women who may be particularly vulnerable to poor breast cancer outcomes, and identify causal drivers of triple-negative breast cancer. Approach. Using census data to derive each composite measure and data on ~30,000 women diagnosed with invasive stage I-IIIA breast cancer in Georgia and followed for up to 13 years, we will estimate the association between neighborhood deprivation and breast cancer mortality, exploring both stratum-specific and joint effects of race and other area characteristics. We will also assess neighborhood deprivation in relation to the development of triple-negative breast cancer vs. other breast cancer subtypes. Impact. This research will enhance our understanding of how the neighborhood environment influences breast carcinogenesis, particularly among Black women, who are more likely to live in deprived neighborhoods, develop triple-negative breast cancer, and experience worse breast cancer outcomes of any racial or ethnic group. This research will also advance the scientific strategy of the parent study (R01CA259192), by informing its multi-level modeling approach to identify proximal, intermediate, and distal determinants of disparities in breast cancer recurrence and mortality, and ultimately provide clarity on the role of neighborhoods in driving breast cancer disparities. Moreover, execution of the proposed research could inform future multi-level interventions that can be implemented at the community level to reduce these disparities.

项目概要/摘要 意义。尽管通过早期检测的进步来改善乳腺癌预后的努力 和治疗导致乳腺癌死亡率下降，乳腺癌死亡率存在种族差异 仍然存在，黑人女性死于乳腺癌的可能性比白人女性高 40%。原因 这种差异尚未完全被理解。攻击性乳房发育的种族差异 肿瘤可能是造成这种差异的原因，但人们对侵袭性疾病的驱动因素知之甚少。社会的 环境因素，例如邻里环境，被认为是潜在的影响因素 乳腺癌差异，但它们在观察到的种族差异中的作用尚不清楚。拟议的研究 旨在通过调查以下因素的影响来确定所观察到的乳腺癌种族差异的潜在驱动因素 社区环境对乳腺癌死亡率和侵袭性肿瘤类型发展的影响。 创新。该提案的创新之处在于它将研究三个邻里剥夺组合 确定暴露评估差异是否导致先前结果不一致的措施 文献，探索邻里剥夺、种族和其他邻里特征的联合影响，例如 农村地区，以确定可能特别容易受到不良乳房影响的黑人和白人妇女亚群 癌症结果，并确定三阴性乳腺癌的因果驱动因素。方法。使用人口普查数据 得出约 30,000 名被诊断患有侵入性 I-IIIA 期乳腺的女性的各项综合测量值和数据 佐治亚州的癌症并跟踪长达 13 年，我们将估计邻里之间的关联 剥夺和乳腺癌死亡率，探索种族和其他领域的特定阶层和联合影响 特征。我们还将评估与三阴性发展相关的邻里剥夺 乳腺癌与其他乳腺癌亚型。影响。这项研究将加深我们对如何 社区环境影响乳腺癌的发生，尤其是黑人女性，她们 更有可能生活在贫困社区，患上三阴性乳腺癌，并且经历更糟糕的情况 任何种族或族裔群体的乳腺癌结果。这项研究还将推进科学战略 父研究 (R01CA259192)，通过告知其多级建模方法来识别近端、 乳腺癌复发和死亡率差异的中间和远端决定因素，以及最终 明确社区在推动乳腺癌差异方面的作用。此外，执行 拟议的研究可以为未来可在社区一级实施的多层次干预措施提供信息 以减少这些差距。