Grant Details
Grant Number: |
3R01CA259192-03S1 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: |
2023 |
Abstract
PROJECT SUMMARY/ABSTRACT
Significance. Although efforts to improve breast cancer prognosis through advancements in early detection
and treatment have led to declines in breast cancer mortality rates, racial disparities in breast cancer mortality
still exist, where Black women are 40% more likely to die from breast cancer than White women. Reasons for
this disparity are not completely understood. Racial differences in the development of aggressive breast
tumors likely contribute to the disparity, but little is known about causal drivers of aggressive disease. Social
and environmental factors, such as the neighborhood environment, have been posited as potential contributors
to breast cancer disparities, but their role in observed racial disparities is not clear. The proposed research
seeks to identify potential drivers of the observed breast cancer racial disparities by investigating the impact of
neighborhood environment on breast cancer mortality and the development of aggressive tumor types.
Innovation. This proposal is innovative in that it will examine three neighborhood deprivation composite
measures to determine whether differences in exposure assessment contribute to inconsistent results in prior
literature, explore joint effects of neighborhood deprivation, race, and other neighborhood features, such as
rurality, to identify subpopulations of Black and White women who may be particularly vulnerable to poor breast
cancer outcomes, and identify causal drivers of triple-negative breast cancer. Approach. Using census data to
derive each composite measure and data on ~30,000 women diagnosed with invasive stage I-IIIA breast
cancer in Georgia and followed for up to 13 years, we will estimate the association between neighborhood
deprivation and breast cancer mortality, exploring both stratum-specific and joint effects of race and other area
characteristics. We will also assess neighborhood deprivation in relation to the development of triple-negative
breast cancer vs. other breast cancer subtypes. Impact. This research will enhance our understanding of how
the neighborhood environment influences breast carcinogenesis, particularly among Black women, who are
more likely to live in deprived neighborhoods, develop triple-negative breast cancer, and experience worse
breast cancer outcomes of any racial or ethnic group. This research will also advance the scientific strategy of
the parent study (R01CA259192), by informing its multi-level modeling approach to identify proximal,
intermediate, and distal determinants of disparities in breast cancer recurrence and mortality, and ultimately
provide clarity on the role of neighborhoods in driving breast cancer disparities. Moreover, execution of the
proposed research could inform future multi-level interventions that can be implemented at the community level
to reduce these disparities.
Publications
None. See parent grant details.