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Principal Investigator: Lauren E McCullough
Organization: EMORY UNIVERSITY
Fiscal Year: 2024
Award: $127,147
Funding agency: National Cancer Institute
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.
Terms: <Accounting><Adopted><Affect><Area><Black><Black Populations><Black group><Black individual><Black people><Black race><Blacks><Breast Cancer><Breast Cancer Patient><Breast Cancer survivor><Breast Tumor Patient><Cancer Prognosis><Caring><Cell Body><Cells><Censuses><Characteristics><Clinical><Clinical Data><Clinical Research><Clinical Study><Communities><Data><Death Rate><Decrease disparity><Diagnosis><Disease><Disorder><Disparate><Disparities><Disparity><Distal><Distant><Early Diagnosis><Economically Deprived><Epidemiologic Methods><Epidemiological Methods><Epidemiological Techniques><Ethnic Origin><Ethnicity><Event><Funding Opportunities><Guidelines><Hospitals><Individual><Inequity><Institution><Intervention><Intervention Strategies><Investigation><Low income><Lower disparity><Malignant Breast Neoplasm><Mediating><Mediator><Methods Epidemiology><Minority><Non-Hispanic><Non-metastatic><Nonhispanic><Nonmetastatic><Not Hispanic or Latino><Outcome><Outcomes Research><Pathway interactions><Pattern><Policies><Population><Population Heterogeneity><Population-Based Registry><Position><Positioning Attribute><Prevalence><Prognosis><Public Health><Race><Races><Recurrence><Recurrent><Recurrent Malignant Neoplasm><Recurrent Malignant Tumor><Research><Risk Estimate><Role><Rural><Social Environment><Societies><Source><Statistical Methods><Survivors><Time><Tumor Biology><United States><Woman><Women's mortality><Work><breast cancer diagnosis><cancer disparity><cancer health disparity><cancer recurrence><cancer registry><cancer survival><cancer-related health disparity><data registry><data streams><death among females><death among women><death in females><death in women><death rate among women><death rate in women><demographic disparity><demographics><diagnosis among females><diagnosis among women><diagnosis in females><diagnosis in women><diagnosis within females><diagnosis within women><disparate effect><disparate impact><disparate result><disparities in mortality><disparities in race><disparity due to race><disparity in cancer><disparity in ethnic><disparity reduction><diverse populations><early detection><economic disparity><economically disadvantaged><ethnic based disparity><ethnic disadvantage><ethnic disparity><ethnic inequality><ethnic inequity><ethnicity disparity><evidence base><experience><female death><female diagnosis><female mortality><heterogeneous population><high risk><improved><inequality due to race><inequitable effect><inequitable impact><inequitable outcome><inequity due to race><innovate><innovation><innovative><intersectionalities><intersectionality><interventional strategy><life-time risk><lifetime risk><low SES><low socio-economic position><low socio-economic status><low socioeconomic position><low socioeconomic status><malignant breast tumor><methods to study multiple-level influences><mitigate disparity><mortality><mortality among females><mortality among women><mortality disparity><mortality in females><mortality in women><mortality rate><mortality ratio><multi-level analysis><multi-level model><multidisciplinary><multilevel analysis><multilevel model><multilevel modeling><neoplasm registry><outcome disparities><outcome inequality><outcome inequity><pathway><population based><population diversity><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial determinant><racial disparity><racial inequality><racial inequity><racial origin><racially unequal><reduce disparity><reduction in disparity><rural disparities><rural dwelling><rural households><rural residence><social climate><social context><social epidemiology><social role><socioenvironment><socioenvironmental><statistic methods><survival disparity><unequal effect><unequal impact><unequal outcome><women's death><women's death rate><women's diagnosis>