Racial disparities in cancer outcomes: quantifying modifiable mechanisms

描述(由申请人提供)：本提案解决了癌症预防和控制中的一个核心挑战：优先考虑减少癌症差异的努力。一些种族和社会经济群体的癌症发病率和死亡率比其他群体更高。然而，造成这些差异的过程仍然不清楚。标准的流行病学方法描述了癌症的差异，但没有确定差异的原因。为了有效地干预以缩小差距，我们必须确定差距产生的机制。这笔赠款将培训受赠者利用流行病学数据确定癌症发病率和死亡率差异的可修改原因。为了培养必要的统计和实质性专业知识，受助者将接受三个领域的培训：(1)特别适合剖析健康差异的新统计技术(即，使用边际结构模型进行计量经济学分解和因果调解分析)；(2)在不同种族和社会经济背景的美国男性和女性队列中指导统计技术的应用；(3)预测预后和治疗效果的肿瘤的生物学特征。这种培训将通过实践指导的研究、课程作业和有限的会议出席人数来实现。利用通过培训培养出来的技能，赠款接受者将专门调查美国黑人女性与白人女性乳腺癌负担较高的原因。社会经济地位被认为是乳腺癌风险和死亡率种族差异的主要原因，但尚不清楚具体途径是什么 社会性别差异影响着这些种族差异。这项研究将评估低SES在乳腺癌风险、生物学和死亡率方面导致种族癌症差异的一个途径的贡献：成人体重增加和肥胖。这项研究使用了卡罗莱纳乳腺癌研究的数据，这是一项基于人群的病例对照研究，在北卡罗来纳州的24个县进行。患有浸润性乳腺癌和人口控制的女性在1993至2011年间入选。数据包括1803例浸润性乳腺癌(787例非裔美国人，1016名白人)和1564名以人群为基础的对照(718名非洲裔美国人，846名白人)。这些数据的一个独特优势是乳腺癌亚型的新分子标记。这些标记物将使这项研究能够量化黑人女性基底细胞样亚型乳腺癌风险较高的潜在原因。这项工作的结果将帮助政策制定者以及公共卫生和临床社区评估哪些干预措施将在减少癌症差异方面最有效。

DESCRIPTION (provided by applicant): This proposal addresses a central challenge in cancer prevention and control: prioritizing efforts to reduce cancer disparities. Some racial and socioeconomic groups have higher rates of cancer incidence and mortality than others. However, the processes causing these disparities remain unclear. Standard epidemiologic methods describe cancer disparities but do not identify the causes of the disparities. To effectively intervene to reduce disparities, we must identify the mechanisms by which disparities arise. This grant will train the recipient to identify modifiable causes of disparities in cancer incidence and mortality using epidemiologic data. To develop the necessary statistical and substantive expertise, the recipient will receive training in three areas: (1) novel statistical techniques that are specifically suited to dissect health disparities (i.e., econometric decomposition and causal mediation analysis using marginal structural models); (2) mentored application of the statistical techniques in a racially and socioeconomically diverse cohort of U.S. men and women; and (3) biological characteristics of tumors that predict prognosis and treatment efficacy. This training will be achieved via hands-on mentored research, coursework, and limited conference attendance. Using the skills developed through the training, the grant recipient will specifically investigate causes of higher breast cancer burden in Black versus White women in the U.S. Socioeconomic status is believed to account for a large portion of racial disparities in breast cancer risk and mortality, but it is unclear by what specific pathways SES influences these racial disparities. This research will estimate the contribution of one pathway by which low SES contributes to racial cancer disparities in breast cancer risk, biology, and mortality: adult weight gain and obesity. The research uses data from the Carolina Breast Cancer Study, a population-based, case-control study conducted in 24 counties of North Carolina. Women with invasive breast cancer and population controls were enrolled between 1993 and 2011. The data consist of 1,803 cases of invasive breast cancer (787 African- American, 1,016 white) and 1,564 population-based controls (718 African- American, 846 white). A unique strength of the data is novel molecular markers of breast cancer subtypes. These markers will allow the study to quantify a potential causal pathway underlying the higher risk of the basal-like subtype of breast cancer in Black women. The results of this work will help policy-makers and the public health and clinical communities evaluate what interventions will be most effective in reducing cancer disparities.