Towards a Transdisciplinary Understanding of Breast Cancer Survival Disparities

描述(申请人提供)：乳腺癌存活率的种族和民族差异仍然是美国医疗保健结果差距最突出和最明显的表现之一，但它们并没有屈服于容易的分析或改善。这一领域的许多研究都是在特定学科的范围内进行的，这些学科只解决了问题的一部分，因此很难感知整体情况。我们建议通过整合潜在决定因素的连续体的理解，从基于社区的预防/早期发现开始，通过诊断和预后指标继续到临床相关的贡献者，来评估新墨西哥州拉美裔妇女之间持续的乳腺癌生存差异。我们将在1997年至2011年期间对新墨西哥州六个县被诊断为浸润性乳腺癌的妇女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人女性的1.6倍。近1000例死亡病例和20%的队列样本(约1450名妇女)将包括在内。我们将利用基于人群的乳房X光摄影数据、新墨西哥州SEER登记、病历回顾和肿瘤组织来调查不同乳腺癌存活率的所有潜在因素。了解这些区域对乳腺癌存活率差异的共同贡献，应能解决存活率差异研究中的重要空白。相对较少的研究衡量这些领域中的一个以上的变量。那些试图解决生存差距的人一直在与这些学科的孤立发现作斗争，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，就很难有效地针对时间序列中的一个或多个关键环节进行干预。我们的综合方法将使我们能够确定适合干预的因素，以及那些将产生最强影响的因素。消除差异的任务是一项复杂的任务，通过跨学科合作，对各种因素进行综合、全面的评估，然后可以很容易地应用于消除我们社区中的差异，可以加强这项任务。 公共卫生相关性：乳腺癌存活率的种族和民族差异一直是美国医疗保健结果差距的最明显指标之一。许多研究已经确定了影响存活率差异的因素，但缺乏整体情况。我们的目标是全面了解导致新墨西哥州拉美裔妇女乳腺癌存活率差异的因素，并确定每个因素的相对贡献，以便干预措施能够最有效地指导消除差异。

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. PUBLIC HEALTH RELEVANCE: Racial and ethnic disparities in breast cancer survival persist as one of the most visible indicators of gaps in health care outcomes in the United States. Many research studies have identified factors that influence differences in survival, but an overall picture is lacking. Our goal is to develop a comprehensive understanding of contributors to the disparity in breast cancer survival in Hispanic women in New Mexico, and to determine the relative contributions of each, so that interventions can be directed most effectively to eradicate disparities.