Multilevel Determinants of Breast Cancer: Translating Research into Interventions

描述（由申请人提供）：消除癌症健康差距仍然是国家癌症研究所的高度优先事项，也是减少癌症负担最有希望的途径之一。我们国家在癌症研究方面的投资已经为我们在生物医学和行为风险因素方面的知识取得了许多突破。然而，为了有效地干预这些风险因素，我们还必须了解产生个人风险并导致持续癌症健康差异的社会背景。我寻求这个职业发展奖的目标是成为癌症健康差异领域的独立研究人员，重点关注种族/少数民族和社会经济弱势群体的多层次研究和干预。为了利用我在社会科学研究和癌症流行病学方面的现有培训，我建议在应用中间标记物和生物标记物研究、癌症预防和控制、社区参与干预研究和先进统计方法方面进行额外的培训。一个经验丰富的跨学科导师团队将提供必要和互补的专业知识和指导。我提议的研究将研究社会网络特征（社会整合、社会支持）和代谢综合征（高血糖水平、血脂异常、高血压、腹部肥胖的聚集性）与乳腺癌风险和乳房x光检查乳房密度（乳腺癌风险的一个强有力的生物标志物）之间的关系。我将在两个独立的研究人群中调查这些目标：西班牙裔美国人、非洲裔美国人和白人妇女，他们从纽约市的一个社会经济弱势社区招募。我将建立在广泛的访谈、临床和生物标志物数据的基础上，通过获得以下数据：社区社会环境（来自美国人口普查数据和以前构建的建筑环境数据）、乳房密度（使用有效的计算机辅助方法从常规乳房x光检查中测量）和乳腺癌诊断（通过审查医疗和病理记录）。根据这些结果并与社区代表合作，我将开展定性和定量研究，指导制定降低乳腺癌风险的多层次干预战略。总之，这些研究活动将增加我对与乳腺癌风险相关的社会环境特征、中介行为因素和生物学途径的理解，并提高我在社区参与研究和干预开发方面的技能。最终，这一研究项目将通过以社区为基础的干预措施，在低社会经济、种族/少数民族社区应用于预防乳腺癌风险。

DESCRIPTION (provided by applicant): Eliminating cancer health disparities remains a high priority of the National Cancer Institute, and one of the most promising avenues for reducing the burden of cancer. Our nation's investment in cancer research has contributed to many breakthroughs in our knowledge of biomedical and behavioral risk factors. However, to effectively intervene on these risk factors, we must also understand the social contexts within which individual risks are developed and lead to persistent cancer health disparities. My goal in seeking this career development award is to become an independent researcher in the field of cancer health disparities, with a focus on multilevel research and intervention in racial/ethnic minority and socioeconomically disadvantaged communities. To leverage my existing training in social science research and cancer epidemiology, I propose additional training in applied intermediate marker and biomarker research, cancer prevention and control, community-engaged intervention research, and advanced statistical methods. An experienced interdisciplinary team of mentors will provide the necessary and complementary expertise and mentorship. My proposed research will examine the associations of social network characteristics (social integration, social support) and the metabolic syndrome (clustering of high blood glucose level, dyslipidemia, high blood pressure, abdominal obesity) with breast cancer risk and with mammographic breast density, a strong biomarker of breast cancer risk. I will investigate these aims in two separate study populations of Hispanic, African American, and White women, recruited from a socioeconomically disadvantaged community in New York City. I will build on extensive interview, clinical and biomarker data already available for these studies by obtaining the following data: neighborhood social environment (from U.S. Census data and previously constructed built environment data), breast density (measured from routine mammograms using validated computer-assisted methods) and breast cancer diagnosis (through review of medical and pathology records). Based on these results and in partnership with community representatives, I will conduct formative qualitative and quantitative research to guide the development of multilevel intervention strategies for breast cancer risk reduction. Together, these research activities will increase my understanding of the social environment characteristics, mediating behavioral factors, and biological pathways associated with breast cancer risk and increase my skills in community-engaged research and intervention development. Ultimately, this program of research will be applied to prevention of breast cancer risk through community-based interventions in low socioeconomic, racial/ethnic minority communities.