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Breast Cancer In Hispanic Women
Hispanic women in the United States experience a lower incidence of breast cancer than do non-Hispanic blacks or whites. On the other hand, Hispanic women with breast cancer experience delays in diagnosis compared to non-Hispanic whites, which contributes to poorer survival. Our preliminary data show that both phenomena (lower incidence and delays in diagnosis) are a function of neighborhood context. Hispanics living in neighborhoods with high percentages of Hispanic residents have lower breast cancer incidence than do Hispanic women in neighborhoods with low percentages of Hispanics. This suggests that cultural factors (diet and other behaviors) are at least partly responsible for the lower breast cancer risk in Hispanic women vs non-Hispanic blacks and whites. It also suggests that breast cancer risks will increase in Hispanics as the Hispanic population becomes more assimilated in to the majority culture. Similarly, the association of delays in diagnosis in Hispanics with neighborhoods with high percentages of Hispanics suggest that cultural factors along with factors affecting access to care might influence breast cancer screening behaviors. The purpose of this proposal is to explore the mechanisms responsible for the relationship of breast cancer risk and also stage at diagnosis in Hispanics to the neighborhood percentage of Hispanics. We will use NHANES data and data from the Dartmouth Health Atlas merged with census data to examine how specific health behaviors and other factors in Hispanic women vary by Hispanic neighborhood density. Information obtained will then be used to inform ongoing community-based participatory research at our institution aimed at primary, secondary and tertiary prevention of breast cancer in Hispanic women.
Background. Hispanic women in the United States are diagnosed with breast cancer at a lower rate than either non-Hispanic black or white women. On the other hand, those Hispanic women who do get breast cancer are diagnosed at a later stage in the disease, and so are more likely to die from breast cancer. According to our previous research, both these facts – that Hispanic women are less likely to get breast cancer but more likely to die from it – are a function of where they live. Hispanic women who live in predominantly Hispanic neighborhoods are less likely to get breast cancer than those in more ethnically diverse neighborhoods. This difference suggests that a person’s culture (type of diet, health beliefs, number of daily interactions with family or friends) is at least partly responsible for the lower breast cancer risk in Hispanic women vs non-Hispanic blacks and whites. It also suggests that more Hispanic women will get breast cancer as the Hispanic population becomes more like the dominant culture. We also know that Hispanic women who live in predominantly Hispanic neighborhoods get diagnosed with breast cancer at a later stage (their cancer is more advanced when it is detected). In a similar way, this fact suggests that cultural factors, -- in addition to whether they can get to the doctor – might change how regularly Hispanic women go in for breast cancer screening. Objective/Aims. We will look at factors that might help explain this relationship of breast cancer risk and stage at diagnosis in Hispanic women to the type of neighborhood they live in. Study design. We will use data from the CDC, the US Census Bureau, and the Dartmouth Health Atlas. Putting these datasets together and analyzing them, we will look at how specific health behaviors and other factors in Hispanic women vary by where they live. Outcomes/benefits. From what we learn, we can then improve the design of research projects in the community to help prevent breast cancer in Hispanic women.