Immigrant Experience & Breast Cancer Risk in Asians

Institution: Cancer Prevention Institute of California
Investigator(s): Scarlett  Gomez , PhD -
Award Cycle: 2011 (Cycle 17) Grant #: 17UB-8602 Award: $722,098
Award Type: SRI Request for Proposal (RFP)
Research Priorities
Disparities>Disparities: eliminating the unequal burden of breast cancer

Initial Award Abstract (2011)

Non-technical overview of the research topic and relevance to breast cancer: High and rapidly increasing incidence rates of breast cancer among California Asian Americans (AA) have been masked by rates reported for AAs as a single group. Not only do rates vary considerably among AA ethnic groups, we recently showed that they are high among young US-born women, rapidly increasing among some US-born and foreign-born groups, and in some cases, are even higher than among non-Hispanic white women. With these dynamic incidence patterns, we have an unparalleled opportunity for better understanding the critical windows of exposure for risk factors like diet and weight gain, and for identifying new risk factors, including infectious exposures, family and community influences, and social stressors related to the process of immigration, being an immigrant, and to discrimination.

Research question(s) or central hypotheses: We propose to 1) document the extent to which new and established risk factors among AAs vary across over the lifespan and are affected by family and community influences; 2) explore new hypotheses relating to the impact of immigrant exposures across the lifespan on breast cancer risk, and 3) compile pilot data on effective strategies for recruiting AAs for future studies. This study will efficiently leverage our ongoing work with AA breast cancer cases being recruited as part of a currently funded cancer survivorship study called “Equality in Breast Cancer Care” (EBCC). This application also proposes to incorporate existing data on community-level measures from our California Neighborhoods Data System, to relate community factors to individual-level risk factors and breast cancer risk.

General methodology: AA breast cancer cases (N~350), ages 20 or over at diagnosis, and residing in the Bay Area, will be recruited as part of the EBCC study, through the population-based regional cancer registry, and much of their exposure data will be obtained through the EBCC telephone interviews. A second interview will collect the additional information needed for the currently proposed study. Controls (N~700), or women in the general population at risk for breast cancer, will be recruited using one of four methods: 1) an approach based on address directories; 2) the California Cancer Detection Program; 3) the Army of Women; and 4) various community-based approaches. We expect these methods to be considerably more efficient than prior approaches in recruiting AA controls, and pooled together, will result in a representative sample.

Innovative elements: Considerable resources have been devoted to understanding the causes of breast cancer; however, to date, our knowledge of this disease still remains limited. Research in immigrant populations has helped to identify many of the established risk factors for breast cancer. Using a trans-disciplinary approach and integrating prior work and expertise in epidemiology, sociology, anthropology, and community interests, we will be asking new questions, as well as looking at some old questions in more detailed and nuanced ways. Applying this approach to a population with widely varying and unique histories, cultures, and lifestyles, coupled with their dynamic breast cancer rates, this study has the potential to reverse the rapidly increasing incidence rate of breast cancer among many of the AA groups in California, as well as provide valuable insights regarding the etiology of breast cancer that can be targeted towards all women for reducing their risk of breast cancer. An additional innovative element is the evaluation of novel methods for recruiting controls, particularly as traditional methods are increasingly costly and biased.

Advocacy involvement and relevance to the human issues associated with breast cancer: The diversity and unique cultures, particularly across generations, of the AA population present exceptional opportunities for identifying causes and understanding the reasons for the wide variation in breast cancer incidence that we have previously documented. However, most of the prior research has not fully capitalized on the unique aspects of AA history, culture, lifestyles, contextual exposures, etc., that may provide valuable insights into breast cancer etiology. Working in partnership with the Asian Pacific Islander American Health Forum, community input will be central to the design, execution, and dissemination of results from this project. This project addresses a disease that has long been thought not to be a problem in the AA community. Extending our considerable prior work to explore, in more detail, the specific aspects relating to the process and consequences of immigration on breast cancer risk, we will provide valuable data that can start to be used to inform AA women about reducing their own risk of breast cancer.