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

摘要 与白人相比，年轻黑人女性承受着不成比例的乳腺癌（BC）死亡负担 并且在临床研究中代表性不足。了解导致高风险的因素仍然至关重要。 为了改善结果，我们在年轻黑人妇女中开展了一项关于BC死亡率的研究。BC省死亡率较高 在年轻的黑人与BC的部分原因是不成比例的高比例谁开发的 侵袭性三阴性（TN）BC亚型。除了生物因素，及时获得护理和生活方式 一些因素造成了这种差异。因此，必须详细了解黑人内部的情况。 评估造成现有差距的生物和非生物因素之间的相互作用， 为了更好地描述年轻黑人女性中高度侵袭性的TNBC， 亚型最终，评估生物和非生物因素以充分了解 并解决年轻黑人妇女现有的健康差距。通过利用先前基于人口的 2009-2012年对460名患有侵袭性BC的年轻黑人女性进行的研究（并招募代表性样本 在2013-2014年诊断的另外200名妇女中，我们计划：1）评估生物和 在患有BC的年轻黑人妇女中观察到的高死亡率的非生物因素， 评分，以帮助识别那些有较差结局风险的患者，以及2）研究亚组的分子特征 关于TNBC我们假设生物学（包括肿瘤基因表达谱）和非生物学因素 这也导致了不列颠哥伦比亚省年轻黑人妇女生存率的现有差距。此外，我们假设， 黑人具有较高比例的侵袭性TNBC亚型。据我们所知，这是最大的 以人群为基础的年轻黑人女性乳腺癌患者队列。最终，我们的研究提出了一个独特的 有机会量化与BC特异性存活相关的生物和非生物因素，并进一步 TNBC在黑人女性中的特点。鉴于先前的干预措施过于狭隘地侧重于 患者作为变革的推动者，而不会对BC死亡率差异产生有意义的影响， 同时考虑患者、提供者和系统层面的方法，以推动系统变革， 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.