Race & Breast Cancer Estrogen Receptor Status: Impact of Class and Missing Data

种族

• 批准号: 7214238
• 负责人: NANCY KRIEGER
• 金额: $ 8.2万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-21 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7214238
• 关键词: aging; bias; breast neoplasms; clinical research; estrogen receptors; neoplasm /cancer

DESCRIPTION (provided by applicant): Despite an apparent scientific consensus that US racial/ethnic groups have disparate distributions of breast cancer estrogen receptor (ER) status, previous studies of this topic are limited by: (1) the sizable proportion of cases with unknown ER status (typically 15-40%). (2) the paucity of socioeconomic data. limiting ability to control for confounding by socioeconomic position, and (3) the near exclusive focus on black/white differences. Suggesting, however, that estimates of racial/ethnic disparities in ER status based on such data might be biased, evidence indicates: (a) ER status is more frequently missing among women of color and/or less affluent women, and (b) risk factors for ER status may themselves be socially patterned, e.g., exposure to hormone replacement therapy, for the last 40 years more common among white and more affluent women, may increase likelihood of developing an ER-positive tumor. Because ER status is a key tumor biomarker relevant to both breast cancer treatment and survival, it is important to gauge accurately the extent to which estimates of racial/ethnic disparities in ER status are real or biased. Accordingly, to assess whether estimates of racial/ethnic disparities in breast cancer ER status and incidence of breast cancer by ER status are biased by missing data on ER status and lack of control for socioeconomic position, we will employ multivariate and sensitivity analysis techniques to analyze a multi- racial/ethnic population-based data set consisting of all incident cases of invasive primary breast cancer among women (n = 42,240 including 26,491 white non-Hispanic; 4,102 black; 4,961 Hispanic, and 4,970 Asian and Pacific Islander cases) occurring between 1998 and 2002 and included in the records of two US population-based cancer registries: the Los Angeles Cancer Surveillance Program and the Northern California Cancer Center. Records include data on race/ethnicity, age at diagnosis, and tumor characteristics and are linked to 2000 census tract socioeconomic data. Analyses will: (1) assess the distribution of ER status (positive, negative, or missing) by race/ethnicity, socioeconomic position, age at diagnosis, and tumor size and tumor stage, to estimate probabilities for the distribution of ER status among those within unknown status; and (2) using multivariate and sensitivity analysis, assess whether missing ER data and lack of control for socioeconomic position bias estimates of racial/ethnic disparities in breast cancer ER status and breast cancer incidence by ER status. Results will provide the first evidence whether estimates of racial/ethnic disparities in ER status are biased due to missing data on ER status and lack of inclusion of socioeconomic data, and will do so in a large multi-racial/ethnic cohort. Findings will provide knowledge needed to address health disparities, a key objective of the National Cancer Institute, the National Institutes of Health, and Healthy People 2010, while also addressing the objectives of PAR- 04-159, by using "existing data" to determine "applicability of biomarkers of tumor initiation and progression for epidemiologic studies."

描述（由申请人提供）：尽管有明显的科学共识，即美国种族/民族的乳腺癌雌激素受体（ER）状态分布不同，但先前对该主题的研究受到以下限制：(1)相当大比例的未知ER状态病例（通常为15-40%）。(2)社会经济数据的缺乏。限制控制社会经济地位混淆的能力，以及(3)几乎只关注黑人/白人差异。然而，基于这些数据对内质网状态的种族/民族差异的估计可能存在偏见，证据表明：(a)内质网状态在有色人种和/或不太富裕的女性中更经常缺失，(b)内质网状态的风险因素本身可能是社会模式的，例如，在过去40年里，接受激素替代疗法的白人和较富裕的女性中更常见，这可能会增加发生内质网阳性肿瘤的可能性。由于雌激素受体状态是与乳腺癌治疗和生存相关的关键肿瘤生物标志物，因此准确衡量雌激素受体状态的种族/民族差异的程度是真实的还是有偏见的是很重要的。因此，为了评估乳腺癌ER状态和乳腺癌发病率的种族/民族差异是否因ER状态数据缺失和缺乏对社会经济地位的控制而存在偏差，我们将采用多变量和敏感性分析技术来分析基于多种族/民族人群的数据集，该数据集包括所有浸润性原发性乳腺癌女性病例(n = 42,240，其中包括26,491名非西班牙裔白人；1998年至2002年间发生的4961例西班牙裔病例，4970例亚洲和太平洋岛民病例，并包括在两个美国人口癌症登记处的记录中：洛杉矶癌症监测项目和北加州癌症中心。记录包括种族/民族、诊断年龄和肿瘤特征的数据，并与2000年人口普查区的社会经济数据相关联。分析将：(1)根据种族/民族、社会经济地位、诊断时年龄、肿瘤大小和肿瘤分期评估ER状态（阳性、阴性或缺失）的分布，以估计未知状态者ER状态分布的概率；(2)使用多变量和敏感性分析，评估是否缺少ER数据和缺乏社会经济地位的控制偏差估计乳腺癌ER状态和乳腺癌发病率的种族/民族差异。结果将提供第一个证据，证明由于缺乏关于急诊状态的数据和缺乏纳入社会经济数据，对急诊状态的种族/民族差异的估计是否有偏见，并将在一个大型的多种族/民族队列中进行。研究结果将提供解决健康差异所需的知识，这是美国国家癌症研究所、美国国家卫生研究院和健康人2010年的一个关键目标，同时也解决了PAR- 04-159的目标，通过使用“现有数据”来确定“肿瘤发生和发展的生物标志物在流行病学研究中的适用性”。