The influence of the built environment on outcomes after breast cancer

描述（由申请人提供）：对于乳腺癌（BC），美国女性最常见的癌症，诊断后的5年相对生存率现在接近90%，2005年估计有230万美国BC幸存者。然而，由于BC是癌症死亡的第二大原因，幸存者的复发、二次癌症、不良结局和过早死亡的风险增加，确定可以降低这些疾病风险和提高生存率的可改变因素是至关重要的，特别是在预后较差的种族/少数民族人群中。一些流行病学证据表明，体型和体力活动可能是这种可改变的因素，此外，它们与社区“建成环境”特征有关，如可步行目的地的数量、娱乐设施和超市的可用性。鉴于公共卫生努力在减少超重/肥胖和增加体育活动（NIH的两个突出目标）方面的有限成功，考虑对体育活动行为的其他影响是很重要的。这个目标对BC幸存者尤其重要，因为他们体重增加和体力活动减少的风险更大。迄今为止，还没有研究直接评估建筑环境与BC结果之间的关系；因此，本研究旨在考虑体力活动、体型和建筑环境对总体生存、BC特异性生存和BC诊断后第二原发癌症的综合影响。在此过程中，本研究将评估这些变量和结果之间的独立关联，以及这些变量之间的相互关系。利用地理信息系统技术，本研究有效地结合了北加州大旧金山湾区建筑环境的客观特征数据、基于人口的大湾区癌症登记处的癌症诊断和随访数据，以及来自4000多种族(非裔美国人、西班牙裔、亚裔美国人和非西班牙裔白人)BC患者参加了两项基于人群的研究。回归模型将用于评估相关变量之间的关联，多变量调整Cox比例风险模型将用于生存分析。公共卫生相关性：本研究有可能确定如何改变社区环境以改善身体活动，进而改善BC幸存者的预后。如果建筑环境被证明会影响行为和结果，那么这些知识可以被城市和公共卫生规划者用来倡导改变建筑环境，也可以被卫生保健专业人员用来设计诊断后治疗方案和/或建议，以更好地利用现有的建筑环境来改善BC幸存者的健康行为。

DESCRIPTION (provided by applicant): For breast cancer (BC), the most common cancer of US women, the 5-year relative survival after diagnosis is now nearing 90%, resulting in an estimated 2.3 million US BC survivors in 2005. Yet, because BC is the 2nd leading cause of cancer death, and survivors have increased risks of recurrence, second cancers, adverse outcomes, and premature death, it is critical to identify modifiable factors that can reduce the risk for these conditions and improve survival, particularly in racial/ethnic minority populations who have less favorable outcomes. Some epidemiologic evidence suggests that body size and physical activity may be such modifiable factors and, moreover, that they are associated with community "built environment" characteristics such as the number of walkable destinations and the availability of recreation facilities and supermarkets. Given the limited success of public health efforts to reduce overweight/obesity and increase physical activity, two prominent goals of the NIH, it is important to consider alternative influences on physical activity behavior. This goal is particularly important for BC survivors, who are at greater risk of weight gain and decreased physical activity. To date, no studies have directly assessed the relationship between the built environment and BC outcomes; therefore, this study aims to consider the combined effects of physical activity, body size, and a comprehensive set of measures of the built environment on overall survival, BC-specific survival and second primary cancer after BC diagnosis. In doing so, this study will assess the independent associations between each of these variables and outcomes, and the relationships of these variables to each other. Utilizing Geographic Information Systems technology, this study efficiently combines data that objectively characterizes the built environments of the Greater San Francisco Bay Area of northern California, data on cancer diagnosis and follow-up from the population-based Greater Bay Area Cancer Registry, and interview data on individual level risk factors from over 4,000 multiethnic (African-American, Hispanic, Asian-American and non-Hispanic white) BC patients who participated in two population-based studies. Regression models will be used to assess the association between variables of interest and multivariate adjusted Cox proportional hazards modeling will be used in the survival analyses. PUBLIC HEALTH RELEVANCE: This study has the potential to identify how community environments may be changed to improve physical activity that, in turn, may improve outcomes in BC survivors. If the built environment proves to influence behaviors and outcomes, then this knowledge can be used by urban and public health planners to advocate changes to the built environment, and by health care professionals to design post-diagnosis treatment programs and/or recommendations for taking greater advantage of the existing built environment to improve health behaviors among BC survivors.