Racial disparities in cancer outcomes: quantifying modifiable mechanisms

描述（由申请人提供）：该提案解决了癌症预防和控制的核心挑战：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高于其他群体。然而，造成这些差异的过程仍然不清楚。标准流行病学方法描述了癌症差异，但没有确定差异的原因。为了有效地进行干预以减少差距，我们必须查明产生差距的机制。该补助金将培训接受者使用流行病学数据确定癌症发病率和死亡率差异的可改变原因。为了发展必要的统计和实质性专门知识，接受者将接受三个领域的培训：（1）专门适用于剖析健康差距的新的统计技术（即，使用边际结构模型的计量经济学分解和因果中介分析）;（2）在种族和社会经济多样化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生物学特征。这项培训将通过实践指导研究、课程作业和有限的会议出席来实现。利用通过培训开发的技能，赠款接受者将专门调查美国黑人女性与白色女性相比乳腺癌负担更高的原因。社会经济地位被认为是乳腺癌风险和死亡率种族差异的很大一部分，但尚不清楚具体途径 社会经济地位影响这些种族差异。这项研究将评估一种途径的贡献，通过这种途径，低SES导致乳腺癌风险，生物学和死亡率的种族癌症差异：成年体重增加和肥胖。这项研究使用了来自卡罗莱纳乳腺癌研究的数据，这是一项在北卡罗来纳州24个县进行的基于人群的病例对照研究。在1993年至2011年期间招募了患有浸润性乳腺癌和人口控制的妇女。数据包括1，803例浸润性乳腺癌（787例非裔美国人，1，016例白色）和1，564例基于人群的对照（718例非裔美国人，846例白色）。数据的一个独特优势是乳腺癌亚型的新分子标志物。这些标志物将使研究能够量化潜在的因果途径，这些途径是黑人女性乳腺癌基底样亚型风险较高的基础。这项工作的结果将有助于政策制定者和公共卫生和临床社区评估哪些干预措施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.