Breast Cancer In Blacks: Impact of Genomics, Healthcare Use and Lifestyle on Outcomes (BRIGHT)

摘要 与白人相比，年轻黑人女性承担着不成比例的乳腺癌(BC)死亡率负担 在临床研究中的代表性不足。了解导致高油价的因素仍然至关重要。 减少年轻黑人妇女死于不列颠哥伦比亚省的死亡率，以改善结果。卑诗省死亡率较高 在患有BC的年轻黑人中，部分原因是患有BBC的比例过高 侵袭性三阴性(TN)BC亚型。除了生物因素，及时获得护理，以及生活方式 造成这种差距的因素是多方面的。因此，深入研究《黑色》中的细节已成为当务之急 评估造成现有差异的生物和非生物因素之间的相互作用，以及 根据不同的分子更好地描述年轻黑人女性中高度攻击性的TNBC 子类型。归根结底，评估生物和非生物因素对于充分了解 并解决年轻黑人女性现有的健康差距问题。通过利用先前基于人口的 2009-2012年间460名患有侵袭性BC的年轻黑人女性的研究(并招募有代表性的样本 在2013-2014年确诊的另外200名女性中)，我们计划：1)评估生物和 非生物因素在患有BC的年轻黑人女性中观察到的高死亡率并产生风险 评分，以帮助识别预后较差的风险人群，以及2)调查亚组的分子特征 与TNBC合作。我们假设生物因素(包括肿瘤基因表达谱)和非生物因素 这是造成不列颠哥伦比亚省年轻黑人妇女存活率不平等的原因之一。此外，我们假设 黑人有更高比例的攻击性TNBC亚型。据我们所知，这是最大的 以人群为基础的患有乳腺癌的年轻黑人女性队列。最终，我们的研究呈现了一种独特的 量化与特定于BC的生存相关的生物和非生物因素的机会，并进一步 在黑人女性中描述TNBC的特征。鉴于之前的干预过于狭隘地聚焦于 患者作为改变的推动者，在不对BC死亡率差异有意义地影响的情况下，重要的是 同时考虑患者、提供者和系统级别的方法，以推动系统更改并关闭 死亡率差距。

Abstract Young Black women bear a disproportionate burden of breast cancer (BC) mortality compared to Whites and are underrepresented in clinical studies. It remains critical to understand factors that contribute to the high mortality from BC among young Black women in order to improve outcomes. The higher BC mortality rate among young Blacks with BC is partly attributed to the disproportionately higher proportions who develop the aggressive triple-negative (TN) BC subtype. In addition to biologic factors, timely access to care, and lifestyle factors contribute to this disparity. Consequently, it has become imperative to look in detail within the Black population to evaluate the interplay between biologic and non-biologic contributors to existing disparities, and to better characterize the highly aggressive TNBC among young Black women based on distinct molecular subtypes. Ultimately, it is critical to assess both biologic and non-biologic factors in order to fully understand and address existing health disparities in young Black women. Through leveraging a prior population-based study of 460 young Black women with invasive BC in 2009-2012 (and recruitment of a representative sample of an additional 200 women diagnosed in 2013-2014), we plan to: 1) assess the contribution of biologic and non-biologic factors on high mortality rates observed among young Black women with BC and generate a risk score, to help identify those at risk for poorer outcomes, and 2) investigate molecular features of the subgroup with TNBC. We hypothesize that biologic (including tumor gene expression profiling) and non-biologic factors contribute to existing disparities in BC survival among young Black women. Furthermore, we hypothesize that Blacks have a higher proportion of aggressive subtype of TNBC. To our knowledge, this is among the largest population-based cohorts of young Black women with breast cancer. Ultimately, our study presents a unique opportunity to quantify biological and non-biological factors associated with BC-specific survival, and further characterize TNBC among Black women. Given that prior interventions have too narrowly focused on the patient as the agent of change without meaningfully impacting the BC mortality disparity, it is important to consider patient, provider and system level approaches concurrently to drive system change and close the mortality gap.