REGIONAL VARIATIONS IN BREAST CANCER RATES IN CALIFORNIA

观察到的乳腺癌发病率的地区差异一直是公共卫生问题的来源，也是传统上产生假说的来源，这些因素可能与疾病病因学有关。加州内部的利率差异与全国范围内的差异相似。这项提议旨在探索可能解释加州内部观察到的地区差异的因素。这项研究的具体目的是：使用地理信息系统(GIS)和分组数据源来评估社会人口因素(例如收入、教育)、环境毒物(例如杀虫剂、汽车尾气)和既定的风险因素(例如家族史、生殖风险因素)对加州乳腺癌发病率的地区差异的潜在影响；通过纳入专门为研究乳腺癌风险因素而设计的针对加州教师的大型前瞻性队列研究中的个人风险因素信息，进一步评估目标1中确定的区域关联；并开展一项生物标记物子研究，旨在探索乳腺癌研究中新出现的两种特定暴露(即植物雌激素和多环芳烃)的生物标记在城市/农村的变化。全州范围的分组分析将依赖于多种数据来源，包括世界上最大的癌症登记、两次全州范围的风险因素调查、多个全州范围的环境数据集和人口普查数据。个人层面的风险因素信息将来自加州教师研究(CTS)队列中登记的133,400名女教师，她们分布在全州各地。生物标记物的子研究将嵌套在这个队列中，将在130名城市和130名农村CTS成员中进行，以评估饮食和环境标记物是否可能与乳腺癌的地区差异有关。这些多种多样的数据来源，再加上地理信息系统的使用，提供了一个独特的机会，可以将个人风险因素信息与潜在的重要社区因素结合起来，这是迄今为止其他任何研究都没有做过的。此外，生物标记物子研究将使我们能够在乳腺癌发病率城乡差异的背景下评估关于乳腺癌病因的两个新出现的和有趣的假说。

Observed regional variations in breast cancer incidence have been a source of public health concern as well as traditionally a source of hypothesis generation for factors which might be implicated in disease etiology. Rate differences within California are similar to differences noted on the national scale. This proposal is designed to explore factors that may explain the observed regional variations within California. The specific aims of the study are to: use a geographic information system (GIS) and grouped data sources to evaluate the potential influence of sociodemographic factors (e.g., income, education), environmental toxicants(e.g., pesticides, automobile exhaust), and established risk factors (e.g., family history, reproductive risk factors) on regional differences in breast cancer incidence rates in California; further evaluate regional associations identified in Aim 1 by incorporating individual risk factor information from a large, prospective cohort study of California teachers specifically designed to study risk factors for breast cancer; and conduct a biomarker substudy targeted at exploring urban/rural variations in biological markers of two specific exposures of emerging interest in breast cancer research (i.e, phytoestrogens and polycyclic aromatic hydrocarbons). Statewide grouped analyses will rely on multiple sources of data including the largest cancer registry in the world, two statewide risk factor surveys, multiple statewide environmental datasets, and census data. Individual-level risk factor information will be derived from the 133,400 female teachers enrolled in the California Teacher Studies (CTS) cohort who are geographically dispersed throughout the state. The biomarker substudy will be nested within this cohort and will be conducted on 130 urban and 130 rural CTS members to evaluate both dietary and environmental markers for exposures potentially related to regional variations in breast cancer. These multiple sources of data, coupled with the use of a GIS system, offer a unique opportunity to integrate individual risk factor information with potentially important community-level factors in a way that no other study has done to date. Furthermore, the biomarker substudy will allow us to evaluate two emerging and intriguing hypotheses regarding breast cancer etiology in the context of urban/rural variations in breast cancer rates.