Despite increased access to early detection and the availability of more effective therapeutic strategies, African
American women continue to experience excess rates of morbidity and mortality from breast cancer. One
hypothesis about breast cancer disparities is that social conditions and physiological responses to social
stressors influence biological processes that are important to the initiation and progression of disease. This
hypothesis is based on data from animal studies which have shown that rats that are exposed to social stressors
are likely to develop mammary tumors that are histologically and etiologically similar to those that develop among
African American women. The HPA axis plays a central role in regulating the physiological stress response;
dysregulation of the HPA has been suggested as a mechanism through which social and biological factors
contribute to racial disparities in breast cancer outcomes. Many African Americans experience stressful life
events and circumstances, including economic, discriminatory, and other stressors. These social factors may
contribute to an increased risk of advanced stage disease, but not all African American women who are exposed
to adverse social factors develop advanced stage disease and those who have a limited number of stressors
can develop advanced stage breast cancer. This may be because stress reactivity is highly individualized. But,
stress reactivity and the association between these responses and cognitive mechanisms and adherence to
recommendations for cancer control behaviors and treatment compliance have not been examined among
women at increased risk for disparities. Therefore, in response to RFA-RM-17-028, Science of Behavior
Change: Use-inspired Research to Optimize Adherence, Behavior Change Interventions, and Outcomes
(R21), we propose to examine stress reactivity among African American breast cancer survivors. The specific
aims of this exploratory study are to: (1) characterize the nature and distribution of stress reactivity among African
American breast cancer survivors based on socioeconomic, clinical, and social stressors; (2) examine the
relationship between stress reactivity and cognitive mechanisms (e.g., self-efficacy, temporal discounting, and
executive control); and (3) determine the extent to which stress reactivity is associated with adherence to
recommendations for cancer control behaviors and treatment compliance. The proposed exploratory study will
examine key mechanisms that are central to the Science of Behavior Change Network in a novel population and
will identify intervention targets that can be used to improve behavioral compliance in a population that is at risk
for poor outcomes after being diagnosed with breast cancer.
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