Science of Behavior Change in African American Breast Cancer Survivors

项目摘要 尽管获得早期检测的机会增加，而且有更有效的治疗策略， 美国妇女继续经历乳腺癌的发病率和死亡率过高。一 关于乳腺癌差异的假设是，社会条件和对社会的生理反应 应激源影响对疾病的发生和发展很重要的生物过程。这 这一假设是基于动物研究的数据，这些研究表明，暴露于社会压力源的大鼠 很可能发展出乳腺肿瘤，这些肿瘤在组织学和病因学上与那些在 非裔美国女性HPA轴在生理应激反应中起着重要的调节作用; HPA的失调被认为是社会和生物因素 导致乳腺癌预后的种族差异。许多非裔美国人经历着紧张的生活 事件和情况，包括经济、歧视和其他压力因素。这些社会因素可能 有助于增加晚期疾病的风险，但不是所有接触过的非洲裔美国妇女 不利的社会因素发展到晚期疾病和那些谁有一个有限的压力源 会发展成晚期乳腺癌这可能是因为压力反应是高度个性化的。但是， 应激反应以及这些反应与认知机制和坚持之间的关联 癌症控制行为和治疗依从性的建议尚未在 妇女面临不平等的风险增加。因此，为了响应RFA-RM-17-028，行为科学 改变：优化依从性，行为改变干预和结果的启发性研究 (R21)因此，我们建议研究非裔美国人乳腺癌幸存者的应激反应。具体 本探索性研究的目的是：（1）描述非洲人应激反应的性质和分布， 基于社会经济、临床和社会压力的美国乳腺癌幸存者;（2）检查 应激反应性和认知机制之间的关系（例如，自我效能、时间折扣，以及 执行控制）;和（3）确定压力反应性与遵守 癌症控制行为和治疗依从性的建议。拟议的探索性研究将 研究新人群中行为改变网络科学的核心关键机制， 将确定可用于改善高危人群行为依从性的干预目标， 乳腺癌的治疗方法

PROJECT SUMMARY Despite increased access to early detection and the availability of more effective therapeutic strategies, African American women continue to experience excess rates of morbidity and mortality from breast cancer. One hypothesis about breast cancer disparities is that social conditions and physiological responses to social stressors influence biological processes that are important to the initiation and progression of disease. This hypothesis is based on data from animal studies which have shown that rats that are exposed to social stressors are likely to develop mammary tumors that are histologically and etiologically similar to those that develop among African American women. The HPA axis plays a central role in regulating the physiological stress response; dysregulation of the HPA has been suggested as a mechanism through which social and biological factors contribute to racial disparities in breast cancer outcomes. Many African Americans experience stressful life events and circumstances, including economic, discriminatory, and other stressors. These social factors may contribute to an increased risk of advanced stage disease, but not all African American women who are exposed to adverse social factors develop advanced stage disease and those who have a limited number of stressors can develop advanced stage breast cancer. This may be because stress reactivity is highly individualized. But, stress reactivity and the association between these responses and cognitive mechanisms and adherence to recommendations for cancer control behaviors and treatment compliance have not been examined among women at increased risk for disparities. Therefore, in response to RFA-RM-17-028, Science of Behavior Change: Use-inspired Research to Optimize Adherence, Behavior Change Interventions, and Outcomes (R21), we propose to examine stress reactivity among African American breast cancer survivors. The specific aims of this exploratory study are to: (1) characterize the nature and distribution of stress reactivity among African American breast cancer survivors based on socioeconomic, clinical, and social stressors; (2) examine the relationship between stress reactivity and cognitive mechanisms (e.g., self-efficacy, temporal discounting, and executive control); and (3) determine the extent to which stress reactivity is associated with adherence to recommendations for cancer control behaviors and treatment compliance. The proposed exploratory study will examine key mechanisms that are central to the Science of Behavior Change Network in a novel population and will identify intervention targets that can be used to improve behavioral compliance in a population that is at risk for poor outcomes after being diagnosed with breast cancer.