Multilevel Determinants of Breast Cancer: Translating Research into Interventions

描述(申请人提供)：消除癌症健康差距仍然是国家癌症研究所的高度优先事项，也是减轻癌症负担的最有希望的途径之一。我国对癌症研究的投资为我们在生物医学和行为风险因素方面的知识做出了许多突破。然而，为了有效地干预这些风险因素，我们还必须了解个体风险形成的社会背景，并导致持续的癌症健康差异。我寻求这一职业发展奖的目标是成为癌症健康差距领域的独立研究员，专注于对种族/少数民族和社会经济不利社区的多层次研究和干预。为了利用我在社会科学研究和癌症流行病学方面的现有培训，我建议在应用中间标志物和生物标志物研究、癌症预防和控制、社区参与的干预研究和高级统计方法方面进行额外的培训。经验丰富的跨学科导师团队将提供必要和补充的专业知识和导师。我提议的研究将考察社会网络特征(社会融合、社会支持)和代谢综合征(高血糖水平、血脂异常、高血压、腹型肥胖的聚集性)与乳腺癌风险以及乳房X光检查乳房密度的关系，乳房X光检查是乳腺癌风险的强大生物标记物。我将在两个不同的研究人群中调查这些目标，这些研究人群是西班牙裔、非裔美国人和白人女性，她们是从纽约市的一个社会经济弱势社区招募的。我将在这些研究已有的广泛访谈、临床和生物标志物数据的基础上，通过获得以下数据：邻里社会环境(来自美国人口普查数据和之前构建的建筑环境数据)、乳房密度(通过使用经过验证的计算机辅助方法进行常规乳房X光检查来测量)以及乳腺癌诊断(通过回顾医疗和病理记录)。基于这些结果，并与社区代表合作，我将进行形成性的定性和定量研究，以指导为降低乳腺癌风险而制定多层次干预策略。总之，这些研究活动将增加我对与乳腺癌风险相关的社会环境特征、中介行为因素和生物途径的了解，并增加我参与社区参与研究和干预开发的技能。最终，这项研究计划将应用于通过在低社会经济、种族/少数民族社区进行基于社区的干预来预防乳腺癌风险。

DESCRIPTION (provided by applicant): Eliminating cancer health disparities remains a high priority of the National Cancer Institute, and one of the most promising avenues for reducing the burden of cancer. Our nation's investment in cancer research has contributed to many breakthroughs in our knowledge of biomedical and behavioral risk factors. However, to effectively intervene on these risk factors, we must also understand the social contexts within which individual risks are developed and lead to persistent cancer health disparities. My goal in seeking this career development award is to become an independent researcher in the field of cancer health disparities, with a focus on multilevel research and intervention in racial/ethnic minority and socioeconomically disadvantaged communities. To leverage my existing training in social science research and cancer epidemiology, I propose additional training in applied intermediate marker and biomarker research, cancer prevention and control, community-engaged intervention research, and advanced statistical methods. An experienced interdisciplinary team of mentors will provide the necessary and complementary expertise and mentorship. My proposed research will examine the associations of social network characteristics (social integration, social support) and the metabolic syndrome (clustering of high blood glucose level, dyslipidemia, high blood pressure, abdominal obesity) with breast cancer risk and with mammographic breast density, a strong biomarker of breast cancer risk. I will investigate these aims in two separate study populations of Hispanic, African American, and White women, recruited from a socioeconomically disadvantaged community in New York City. I will build on extensive interview, clinical and biomarker data already available for these studies by obtaining the following data: neighborhood social environment (from U.S. Census data and previously constructed built environment data), breast density (measured from routine mammograms using validated computer-assisted methods) and breast cancer diagnosis (through review of medical and pathology records). Based on these results and in partnership with community representatives, I will conduct formative qualitative and quantitative research to guide the development of multilevel intervention strategies for breast cancer risk reduction. Together, these research activities will increase my understanding of the social environment characteristics, mediating behavioral factors, and biological pathways associated with breast cancer risk and increase my skills in community-engaged research and intervention development. Ultimately, this program of research will be applied to prevention of breast cancer risk through community-based interventions in low socioeconomic, racial/ethnic minority communities.