CA Breast Cancer Survivorship Consortium-CPIC
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Overview:
 
 The prognosis of female breast cancer patients varies according to race and ethnicity. Although scientists have tried to determine why these differences exist by studying variations in cancer stage, tumor characteristics, treatment received, and socioeconomic status of the patient, racial/ethnic differences in breast cancer survival still remain. Socioeconomic disparities and lifestyle factors including large body size and recreational physical inactivity, and a history of other diseases, have also been found to decrease survival. However, the impact of these factors on racial/ethnic differences in breast cancer mortality has not been determined.
 
 
 
 Research questions:
 
 The overall aim is to determine whether these four groups of exposures: contextual factors, physical activity, body size, and comorbidities, separately or in combination, explain the differences in stage-specific breast cancer survival by race and ethnicity. These four primary exposures were selected because of their modifiable nature, their documented variability across racial/ethnic groups, their associations with breast cancer mortality in general, their potential for broad impact in reducing disparities in breast cancer survival, and their consistent collection and availability across the studies.
 
 
 
 Methods:
 
 We will create the California Breast Cancer Survivorship Consortium (CBCSC), consisting of seven California-based breast cancer studies with over 16,000 breast cancer cases, including 2603 African Americans, 2113 Asian Americans, 2582 Latinas, and 9306 non-Latina Whites. Consortium members will pool data with the goal of understanding whether four modifiable factors are responsible, in part, for racial/ethnic differences in stage-specific breast cancer survival. These interrelated factors will be investigated among these racially and ethnically diverse breast cancer survivors in four projects:
 
 
 
 -Contextual-level factors:
 
 -the impact of contextual-level socioeconomic status (SES) and the interaction with individual-level education on survival;
 -the impact of the built and obesogenic environment (neighborhood attributes that promote walking and healthy living, such as availability of parks, healthy eating places, mixed land use) and the interaction with individual-level body mass index (BMI) and physical activity on survival;
 - the impact of ethnic enclaves and the interaction with individual-level migration characteristics (nativity, age at migration, language usage) on survival; and
 -the impact of institutional (hospital-level) factors such as ownership status (private, public), academic affiliation, patient composition (SES and race/ethnicity), distance to medical facilities with individual-level education on survival.
 -Physical activity:
 
 -determine whether recreational, pre-diagnosis physical activity is independently associated with death due to breast cancer and death due to any cause;
 -determine whether occupational, pre-diagnosis physical activity is independently associated with death due to breast cancer and death due to any cause;
 -determine whether total (recreational and non-recreational), pre-diagnosis physical activity is independently associated with death due to breast cancer and death due to any cause.
 -Body size: examine the associations between body size measures (body mass index (BMI) around the time of diagnosis; waist and hip circumference around the time of diagnosis; waist-to-hip ratio around the time of diagnosis; and weight gain since age 18 years or since age 20 years until time of diagnosis) and all-cause and breast cancer mortality by race/ethnicity, stage, tumor receptor status, and overall, adjusting for prognostic and lifestyle factors 
 -Comorbidities:
 
 -determine the race/ethnic specific relationship between pre-diagnostic hypertension and risk of overall mortality and breast cancer-specific mortality;
 -determine the race/ethnic specific relationship between pre-diagnostic diabetes and risk of overall mortality and breast cancer-specific mortality;
 -determine the race/ethnic specific relationship between pre-diagnostic heart disease and risk of overall mortality and breast cancer-specific mortality;
 -determine the race/ethnic specific relationship between number of pre-diagnostic comorbid conditions and risk of overall mortality and breast cancer-specific mortality.
 
 These factors were selected because they have been implicated to influence breast cancer mortality and the number of women with varying profiles of these factors differs by race/ethnicity.
 
 
 
 Innovative elements:
 
 This consortium project represents the first study of multiethnic breast cancer patients to study several interrelated factors at the same time using comparable methodologies. Most of the previous studies on prognosis were conducted in non-Latina Whites, with only limited data available for African Americans and almost no data on Latinas and Asian Americans. Most prior studies of breast cancer survival disparities have focused on differences between non-Latina Whites and African Americans. This is also an extremely cost effective study; the available questionnaire data from these seven studies represent a very large financial investment in breast cancer research funded by multiple agencies. We will be able to use this pooled dataset with more than 10 years of follow-up to address important questions in a timely manner so that there is economy of scale in both time and financial costs. Better understanding of these ‘modifiable’ risk factors will allow women of all races/ethnicities to consider lifestyle changes that may favorably influence breast cancer survival.
 
 
 
 Advocacy involvement:
 
 We have the support and commitment of a panel of five advocates and advisors (one additional advisor will be recruited). This panel will be involved at every step of the study and will be involved in our monthly conference calls and our yearly in-person meetings. Their advice will be sought in dissemination and translation of results from this study. Women with breast cancer want to know how they can improve their survival after being diagnosed with the disease and the CBCSC will help answer this important question.