Towards a Transdisciplinary Understanding of Breast Cancer Survival Disparities

University Of New Mexico Health Scis Ctr, Albuquerque NM

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Abstract

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.