Towards a Transdisciplinary Understanding of Breast Cancer Survival Disparities

描述（由申请人提供）：种族和民族在乳腺癌生存方面的差异仍然是美国医疗保健结果差距的最突出和最明显的表现之一，但它们尚未产生易于分析或改善的结果。这一领域的许多研究都是在特定学科的范围内产生的，这些学科只解决了问题的一部分，因此很难看到整体的情况。我们建议通过整合对一系列潜在决定因素的理解来评估新墨西哥州西班牙裔女性持续存在的乳腺癌生存差异，从社区预防/早期检测开始，继续通过诊断和预后指标到临床相关因素。我们将在一项基于人群的病例队列研究中调查1997年至2011年新墨西哥州六个县诊断为浸润性乳腺癌的妇女，与非西班牙裔白人妇女相比，西班牙裔妇女乳腺癌死亡风险增加1.6倍。将包括近1000例死亡病例和20%的队列样本（约1450名妇女）。我们将利用基于人群的乳房x线摄影数据、新墨西哥州SEER登记、医疗图表回顾和肿瘤组织来调查各种不同乳腺癌生存的潜在因素。了解这些领域对乳腺癌生存差异的共同贡献应该解决生存差异研究中的重要空白。相对而言，很少有研究能够测量以上一个领域的变量。那些试图解决生存差异的人一直在与这些学科的孤立发现作斗争，几乎没有办法确定针对特定贡献者的预防策略的相对影响。如果没有这些数据，就很难有效地针对时间序列中的关键环节进行干预。我们的综合办法将使我们能够确定可以干预的因素，以及那些将产生最大影响的因素。消除不平等是一项复杂的任务，可以通过跨学科合作，对各种因素进行综合、全面的评估，从而很容易地应用于消除我们社区中的不平等，从而加强这项任务。

DESCRIPTION (provided by applicant): Racial and ethnic disparities in breast cancer survival remain one of the most prominent and tangible manifestations of the gaps in health care outcomes in the United States, yet they have not yielded to easy analysis or amelioration. Much of the research in this area has arisen from within the confines of specific disciplines that address only a piece of the problem, and as a result it is difficult to perceive the overall picture. We propose to evaluate the persistent breast cancer survival disparity among Hispanic women in New Mexico by integrating the understanding derived across a continuum of potential determinants, beginning with community-based prevention/ early detection and continuing through diagnostic and prognostic indicators to clinically-related contributors. We will investigate the 1.6-fold increased risk of breast cancer death in Hispanic as compared with non-Hispanic white women in a population-based case-cohort study of women diagnosed with invasive breast cancer in six New Mexico counties from 1997 to 2011. Almost 1000 deaths and a 20% sample of the cohort (~1450 women) will be included. We will draw on population-based mammography data, the New Mexico SEER registry, medical chart reviews, and tumor tissue to investigate a full spectrum of potential contributors to the disparate breast cancer survival. Understanding the joint contributions from these areas to breast cancer survival differences should address important gaps in survival disparity research. Relatively few studies measure variables in more than one of these areas. Those attempting to address survival disparities have contended with isolated findings from these disciplines, with few ways to determine the relative impact of prevention strategies directed to a particular contributor. Without that data, it is difficult to effectively target interventions to the crucial link or links in the temporal sequence. Our comprehensive approach will allow us to identify factors amenable to intervention, and those that will have the strongest impact. The task of eradicating disparities is a complex one, and one that may be strengthened by working across disciplines to develop an integrated, comprehensive assessment of factors that then can readily be applied to eliminate disparities in our communities. PUBLIC HEALTH RELEVANCE: Racial and ethnic disparities in breast cancer survival persist as one of the most visible indicators of gaps in health care outcomes in the United States. Many research studies have identified factors that influence differences in survival, but an overall picture is lacking. Our goal is to develop a comprehensive understanding of contributors to the disparity in breast cancer survival in Hispanic women in New Mexico, and to determine the relative contributions of each, so that interventions can be directed most effectively to eradicate disparities.