Towards a Transdisciplinary Understanding of Breast Cancer Survival Disparities

描述（由申请人提供）：乳腺癌生存率的种族和民族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，但它们尚未得到简单的分析或改善。这一领域的许多研究都是在特定学科的范围内进行的，只涉及问题的一部分，因此很难看到全貌。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妇女中持续存在的乳腺癌生存差异，从基于社区的预防/早期发现开始，并通过诊断和预后指标继续到临床相关的贡献者。我们将在1997年至2011年对新墨西哥州6个县诊断为浸润性乳腺癌的女性进行基于人群的病例队列研究，调查西班牙裔乳腺癌死亡风险是非西班牙裔白色女性的1.6倍。将纳入近1000例死亡病例和20%的队列样本（约1450例女性）。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、病历审查和肿瘤组织来调查不同乳腺癌生存率的全方位潜在贡献者。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，很少有研究测量这些领域中一个以上的变量。那些试图解决生存差距的人一直在与这些学科的孤立研究结果争论，几乎没有办法确定针对特定贡献者的预防战略的相对影响。没有这些数据，就难以有效地针对时间顺序中的关键环节采取干预措施。我们的全面方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。消除差距的任务是一项复杂的任务，可以通过跨学科的工作来加强这项任务，以便对各种因素进行综合全面的评估，然后可以随时用于消除我们社区的差距。

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.