Improving our understanding of breast cancer mortality disparities through recurrence: a multi-level approach among women in Georgia

项目总结/摘要 意义尽管通过早期检测的进步来改善乳腺癌预后的努力 和治疗导致乳腺癌死亡率下降，乳腺癌死亡率的种族差异， 黑人妇女死于乳腺癌的可能性比白色妇女高40%。原因 这种差异还没有被完全理解。侵略性乳房发育的种族差异 肿瘤可能是造成这种差异的原因之一，但对侵袭性疾病的因果驱动因素知之甚少。社会 而环境因素，如邻里环境，被认为是潜在的贡献者 乳腺癌的差异，但他们在观察到的种族差异的作用并不清楚。拟议研究 旨在通过调查以下因素的影响来确定观察到的乳腺癌种族差异的潜在驱动因素： 社区环境对乳腺癌死亡率和侵袭性肿瘤类型的发展的影响。 创新这项建议是创新的，因为它将审查三个邻里剥夺复合 确定暴露评估差异是否导致先前评估结果不一致的措施 文献，探索邻里剥夺，种族和其他邻里特征的联合影响，如 农村，以确定黑人和白色妇女谁可能特别容易受到穷人乳房 癌症结果，并确定三阴性乳腺癌的因果驱动因素。Approach.利用人口普查数据， 从约30，000名被诊断为浸润性I-IIIA期乳腺癌的女性中获得每项复合指标和数据 在格鲁吉亚的癌症患者中，我们将估计邻里之间的关联， 贫困和乳腺癌死亡率，探索种族和其他地区的特定阶层和联合影响 特色我们还将评估邻里剥夺与三负发展的关系 乳腺癌与其他乳腺癌亚型。冲击这项研究将加深我们对 邻里环境影响乳腺癌的发生，特别是在黑人妇女中， 更有可能生活在贫困的社区，患上三阴性乳腺癌， 任何种族或族裔群体的乳腺癌结局。这项研究还将推进科学战略， 母研究（R 01 CA 259192）通过告知其多水平建模方法来识别近端， 乳腺癌复发率和死亡率差异的中间和远端决定因素， 明确社区在推动乳腺癌差异方面的作用。此外，执行 拟议的研究可以为未来可在社区一级实施的多层次干预提供信息 来缩小这些差距。

PROJECT SUMMARY/ABSTRACT Significance. Although efforts to improve breast cancer prognosis through advancements in early detection and treatment have led to declines in breast cancer mortality rates, racial disparities in breast cancer mortality still exist, where Black women are 40% more likely to die from breast cancer than White women. Reasons for this disparity are not completely understood. Racial differences in the development of aggressive breast tumors likely contribute to the disparity, but little is known about causal drivers of aggressive disease. Social and environmental factors, such as the neighborhood environment, have been posited as potential contributors to breast cancer disparities, but their role in observed racial disparities is not clear. The proposed research seeks to identify potential drivers of the observed breast cancer racial disparities by investigating the impact of neighborhood environment on breast cancer mortality and the development of aggressive tumor types. Innovation. This proposal is innovative in that it will examine three neighborhood deprivation composite measures to determine whether differences in exposure assessment contribute to inconsistent results in prior literature, explore joint effects of neighborhood deprivation, race, and other neighborhood features, such as rurality, to identify subpopulations of Black and White women who may be particularly vulnerable to poor breast cancer outcomes, and identify causal drivers of triple-negative breast cancer. Approach. Using census data to derive each composite measure and data on ~30,000 women diagnosed with invasive stage I-IIIA breast cancer in Georgia and followed for up to 13 years, we will estimate the association between neighborhood deprivation and breast cancer mortality, exploring both stratum-specific and joint effects of race and other area characteristics. We will also assess neighborhood deprivation in relation to the development of triple-negative breast cancer vs. other breast cancer subtypes. Impact. This research will enhance our understanding of how the neighborhood environment influences breast carcinogenesis, particularly among Black women, who are more likely to live in deprived neighborhoods, develop triple-negative breast cancer, and experience worse breast cancer outcomes of any racial or ethnic group. This research will also advance the scientific strategy of the parent study (R01CA259192), by informing its multi-level modeling approach to identify proximal, intermediate, and distal determinants of disparities in breast cancer recurrence and mortality, and ultimately provide clarity on the role of neighborhoods in driving breast cancer disparities. Moreover, execution of the proposed research could inform future multi-level interventions that can be implemented at the community level to reduce these disparities.