Grant Details
Grant Number: |
5R01CA259192-04 Interpret this number |
Primary Investigator: |
Mccullough, Lauren |
Organization: |
Emory University |
Project Title: |
Improving Our Understanding of Breast Cancer Mortality Disparities Through Recurrence: a Multi-Level Approach Among Women in Georgia |
Fiscal Year: |
2024 |
Abstract
PROJECT SUMMARY/ABSTRACT
Significance. Although national and philanthropic efforts have sought to reduce and eliminate breast cancer
(BC) mortality disparities over the past few decades, they have not only persisted—but widened. Additionally,
due to incomplete capture of recurrence data, no previous investigation has identified drivers of disparities in BC
recurrence following a diagnosis of early-stage (I–IIIA) disease. In Georgia, where economic and racial/ethnic
disparities are among the greatest in the United States, the sources of BC outcome disparities are unresolved,
and likely arise from the interplay of causal and contributing factors at multiple levels—from cell to society.
Approximately 40% of all BC survivors will suffer a recurrence during their lifetime, and clinical data suggest a
higher risk of recurrence in minority and low-income women. Given the high lifetime risk of recurrence, posited
race/ethnic disparities in recurrent BC, and documented mortality disparities across demographic domains, now
is the pivotal time to characterize underlying pathways contributing to inequities in BC prognosis. Innovation.
Our proposal is innovative in that it will be the first to estimate risks and rates of BC recurrence by demographic
characteristics, consider intersectionality in BC outcome disparities, and use a multilevel decomposition
approach to identify potential targets for intervention. Approach. Integrating multiple data streams (e.g.,
discharge, administrative claims, hospital, and census data) with cancer registry data from a large, diverse
population, we will identify proximal, intermediate, and distal determinants of race/ethnic, SES, and urban/rural
disparities in both recurrence and BC-specific mortality, as well as examine recurrence and its treatments as
mediators of disparities in mortality rates by race, SES, and urban/rural characteristics. Data will be from
approximately 30,000 women diagnosed with a first primary stage I–IIIA BC in Georgia (2013–2017) and followed
for up to 12 years. Impact. Previous research in this area has had consistent shortcomings including (1)
insufficient ascertainment of recurrence at the population level; (2) examining one or few factors without
accounting for shared contributions across multiple levels; and (3) inadequate power to explore intersections of
identity. Our study, for the first time, will examine multi-level contributors to race/ethnic, SES, and urban/rural
disparities in both BC recurrence and mortality among women with early-stage disease. Our innovative multi-
level decomposition approach will move us beyond merely documenting disparities, to identifying modifiable
targets within the social contexts of affected communities, facilitating prioritization of interventions.
Publications
Increasing access, equitability, and rigor in the assessment of Neighborhood Mortgage Discrimination.
Authors: Moubadder L.
, Bliss M.
, Maliniak M.
, Waddel H.
, Switchenko J.
, Chang H.
, Kramer M.
, McCullough L.
.
Source: Research Square, 2024-05-23 00:00:00.0; , .
EPub date: 2024-05-23 00:00:00.0.
PMID: 38826384
Related Citations
Eyes Wide Open: Sleep as a Potential Contributor to Racial and Ethnic Disparities in Cancer.
Authors: Barber L.E.
, McCullough L.E.
, Johnson D.A.
.
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2024-04-03 00:00:00.0; 33(4), p. 471-479.
PMID: 38270540
Related Citations
A Comparison of Three Area-Level Indices of Neighborhood Deprivation and Socioeconomic Status and their Applicability to Breast Cancer Mortality.
Authors: Barber L.E.
, Maliniak M.L.
, Nash R.
, Moubadder L.
, Haynes D.
, Ward K.C.
, McCullough L.E.
.
Source: Journal Of Urban Health : Bulletin Of The New York Academy Of Medicine, 2023-12-29 00:00:00.0; , .
EPub date: 2023-12-29 00:00:00.0.
PMID: 38158547
Related Citations
Considerations in Narrowing the Breast Cancer Mortality Gap Between Black and White Women.
Authors: McCullough L.E.
, Maliniak M.L.
, Moubadder L.
.
Source: Jama Oncology, 2023-12-01 00:00:00.0; 9(12), p. 1613-1615.
PMID: 37856137
Related Citations