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Principal Investigator: Christine B. Ambrosone
Organization: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
Fiscal Year: 2024
Award: $989,275
Funding agency: National Cancer Institute
Abstract
Asian American women experience more favorable cancer survival than other US racial/ethnic groups, even
after accounting for known prognostic indicators. Breast cancer, which follows this pattern, is a useful model for
understanding factors contributing to this intriguing survival advantage, given that it is the most common
cancer in Asian American women, and has established clinical, biological/genetic, and lifestyle prognostic
factors. Thus, studying the breast cancer survival advantage in Asian American women has the potential to
identify protective factors that may benefit all patients. We propose to investigate multilevel factors (health
behaviors and contextual factors, clinical characteristics, treatment, and tumor immune response) in relation to
overall and breast cancer-specific mortality in Asian American breast cancer cases. However, the Asian
American population is heterogeneous, with lifestyle factors and disease risks (e.g., breast cancer survival
rates) varying by specific ethnicity and by immigration status. Many studies have shown the importance of
population disaggregation to uncovering meaningful differences among Asian American ethnic groups, but no
single study to date includes adequate Asian American ethnic group population samples. To overcome this
limitation, we will conduct the proposed research in integrated data and biospecimens from four established
cohort studies enriched with Asian American breast cancer cases. These studies together include 4,219 Asian
American patients (1,848 Chinese, 602 Japanese, 1,538 Filipinas) and 5,386 non-Latina White women with
breast cancer as a comparison group. In Specific Aim 1, we will assess contributions of individual-level lifestyle
and health behaviors and multilevel neighborhood social context and sociocultural factors to survival
differences among the Asian American ethnic groups relative to non-Latina Whites. In Specific Aim 2, we will
evaluate how specific treatment factors impact survival for 4,373 Asian Americans compared to 4,373 non-
Latina Whites, taking advantage of electronic health record data from an equal-access healthcare system. In
Specific Aim 3, we will characterize the immune infiltrates in the breast tumor microenvironment from 1,200
Asian American (from Aim 1) and 714 non-Latina White (from TCGA) patients using immunogenomic profiling,
and to determine the associations of immune phenotypes with patient survival among Asian Americans and
with exposure factors from Aim 1. Thus, using existing resources, this study will comprehensively assess
factors including health behaviors and neighborhood context, lifestyle, treatment, tumor immuno-biology, and
their contributions to the survival advantage in Asian American women. The proposed study makes efficient
use of data from numerous breast cancer studies to gain insight for strategies that may advance knowledge
about the management of breast cancer for all women.
Terms: <Accounting><Active Follow-up><Adherence><Algorithms><American><Application Context><Asian Americans><Asian group><Asian individual><Asian people><Asian population><Asians><Automobile Driving><Behavior><Biological><Biology><Body Size><Body Tissues><Breast Cancer><Breast Cancer Patient><Breast Neoplasms><Breast Tumor Patient><Breast Tumors><California><Cancer Biology><Cancer Prognosis><Cancers><Caucasian Females><Caucasian Women><Cell Body><Cells><Characteristics><Chinese><Clinical><Cohort Studies><Complementary and alternative medicine><Concurrent Studies><Data><Dietary intake><Disparities><Disparity><Electronic Health Record><Endocrine Therapy><Epidemiology><Ethnic Group><Ethnic Origin><Ethnic People><Ethnic Population><Ethnic individual><Ethnicity><Ethnicity People><Ethnicity Population><Female Groups><General Prognostic Factor><Genetic><Health Care Systems><Health Promotion><Health behavior><Healthcare Systems><Heterogeneity><Hormonal Therapy><Immigration><Immune><Immune infiltrates><Immune response><Immunes><Immunobiology><Immunogenomics><Immunologic Receptors><Immunological Receptors><Immunological response><Immunophysiology><Individual><Japanese><Knowledge><Latina><Life Style><Lifestyle><Maintenance><Malignant Breast Neoplasm><Malignant Neoplasms><Malignant Tumor><Mammary Cancer><Mammary Neoplasms><Modeling><Neighborhoods><Outcome><Pathway interactions><Patient Self-Report><Patients><Pattern><Phenotype><Plants><Population><Population Group><Population Heterogeneity><Prevalence><Prognostic Factor><Prognostic/Survival Factor><RNA Seq><RNA sequencing><RNAseq><Race><Races><Racial Group><Research><Research Resources><Resources><Salutogenesis><Sampling><Self-Report><Site><Social Environment><Social Network><Social support><Socio-economic status><Socioeconomic Status><Survival Rate><TCGA><The Cancer Genome Atlas><Time><Tissue Sample><Tissues><Translating><Treatment Factor><Treatment outcome><Tumor Tissue><United States><White Females><White Women><Woman><Women's Group><access to health care><access to healthcare><accessibility of health care><accessibility to health care><accessibility to healthcare><active followup><anti-cancer immunotherapy><anti-tumor immune response><anticancer immunotherapy><biologic><black female><black women><breast cancer diagnosis><breast cancer family registry><breast cancer survival><cancer disparity><cancer health disparity><cancer immunobiology><cancer immunotherapy><cancer microenvironment><cancer registry><cancer survival><cancer-related health disparity><chemotherapy><cohort><comparator group><comparison group><contextual factors><data integration><data registry><differences due to race><differences in race><differs by race><differs in race><disease risk><disorder risk><disparities in race><disparity due to race><disparity in cancer><disparity in ethnic><diverse populations><driving><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><epidemiologic><epidemiological><ethnic based disparity><ethnic difference><ethnic disadvantage><ethnic disparity><ethnic inequality><ethnic inequity><ethnic subgroup><ethnicity difference><ethnicity disparity><ethnicity group><experience><follow up><follow-up><followed up><followup><health care access><health care availability><health care service access><health care service availability><health related behavior><healthcare access><healthcare accessibility><healthcare availability><healthcare service access><healthcare service availability><heterogeneous population><hormone therapy><host response><immune cell infiltrate><immune receptor><immune system response><immune-based cancer therapies><immunoresponse><immunotherapy for cancer><immunotherapy of cancer><improved><inequality due to race><inequity due to race><insight><life-style factor><lifestyle factors><malignancy><malignant breast tumor><mammary tumor><mortality><multi-ethnic><multiethnic><neoplasm registry><neoplasm/cancer><pathway><population diversity><prognostic><prognostic assays><prognostic indicator><prognostic test><promoting health><protective factors><race based differences><race based disparity><race based inequality><race based inequity><race differences><race disparity><race related differences><race related disparity><race related inequality><race related inequity><racial><racial background><racial difference><racial disparity><racial inequality><racial inequity><racial origin><racial population><racial subgroup><racially different><racially unequal><social climate><social context><social cultural factor><social culture determinant><social support network><socio-economic position><sociocultural determinant><sociocultural factor><socioeconomic position><socioenvironment><socioenvironmental><tissue archive><transcriptome sequencing><transcriptomic sequencing><treatment adherence><treatment compliance><tumor><tumor microenvironment>