This proposal addresses a central challenge in cancer prevention and control: prioritizing efforts to reduce cancer disparities. Some racial and socioeconomic groups have higher rates of cancer incidence and mortality than others. However, the processes causing these disparities remain unclear. Standard epidemiologic methods describe cancer disparities but do not identify the causes of the disparities. To effectively intervene to reduce disparities, we must identify the mechanisms by which disparities arise. This grant will train the recipient to identify modifiable causes of disparities in cancer incidence and mortality using epidemiologic data. To develop the necessary statistical and substantive expertise, the recipient will receive training in three areas: (1) novel statistical techniques that are specifically suited to dissect health disparities (i.e., econometric decomposition and causal mediation analysis using marginal structural models); (2) mentored application of the statistical techniques in a racially and socioeconomically diverse cohort of U.S. men and women; and (3) biological characteristics of tumors that predict prognosis and treatment efficacy. This training will be achieved via hands-on mentored research, coursework, and limited conference attendance. Using the skills developed through the training, the grant recipient will specifically investigate causes of higher breast cancer burden in Black versus White women in the U.S. Socioeconomic status is believed to account for a large portion of racial disparities in breast cancer risk and mortality, but it is unclear by what specific pathways SES influences these racial disparities. This research will estimate the contribution of one pathway by which low SES contributes to racial cancer disparities in breast cancer risk, biology, and mortality: adult weight gain and obesity. The research uses data from the Carolina Breast Cancer Study, a population-based, case-control study conducted in 24 counties of North Carolina. Women with invasive breast cancer and population controls were enrolled between 1993 and 2011. The data consist of 1,803 cases of invasive breast cancer (787 African- American, 1,016 white) and 1,564 population-based controls (718 African- American, 846 white). A unique strength of the data is novel molecular markers of breast cancer subtypes. These markers will allow the study to quantify a potential causal pathway underlying the higher risk of the basal-like subtype of breast cancer in Black women. The results of this work will help policy-makers and the public health and clinical communities evaluate what interventions will be most effective in reducing cancer disparities.

Public Health Relevance

This grant addresses a central challenge in cancer prevention and control: developing effective and efficient interventions to reduce racial and socioeconomic inequalities in rates of cancer diagnosis and death. Standard epidemiologic analysis describes population inequalities but does not identify the processes that cause the disparities. With this award, I will attain the statistical and subject-matter expertise to identify the causal mechanisms by which cancer inequalities arise and quantify the relative impacts of the different mechanisms, thereby improving efforts to prioritize the most effective interventions to reduce inequalities in cancer outcomes.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Scientist Development Award - Research & Training (K01)
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Study Section
Subcommittee I - Transistion to Independence (NCI)
Program Officer
Soyombo-Shoola, Abigail Adebisi
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University of North Carolina Chapel Hill
Public Health & Prev Medicine
Schools of Public Health
Chapel Hill
United States
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DeBono, Nathan L; Robinson, Whitney R; Lund, Jennifer L et al. (2017) Race, Menopausal Hormone Therapy, and Invasive Breast Cancer in the Carolina Breast Cancer Study. J Womens Health (Larchmt) :
Robinson, Whitney R; Cheng, Mariah M; Howard, Annie Green et al. (2017) For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011-2013. BMC Health Serv Res 17:526
Robinson, Whitney R; Nichols, Hazel B; Tse, Chiu Kit et al. (2016) Associations of Premenopausal Hysterectomy and Oophorectomy With Breast Cancer Among Black and White Women: The Carolina Breast Cancer Study, 1993-2001. Am J Epidemiol 184:388-99
Taber, Daniel R; Robinson, Whitney R; Bleich, Sara N et al. (2016) Deconstructing race and gender differences in adolescent obesity: Oaxaca-blinder decomposition. Obesity (Silver Spring) 24:719-26
Sun, Xuezheng; Nichols, Hazel B; Tse, Chiu-Kit et al. (2016) Association of Parity and Time since Last Birth with Breast Cancer Prognosis by Intrinsic Subtype. Cancer Epidemiol Biomarkers Prev 25:60-7
Gartner, Danielle R; Taber, Daniel R; Hirsch, Jana A et al. (2016) The spatial distribution of gender differences in obesity prevalence differs from overall obesity prevalence among US adults. Ann Epidemiol 26:293-8
Durham, Danielle D; Robinson, Whitney R; Lee, Sheila S et al. (2016) Insurance-Based Differences in Time to Diagnostic Follow-up after Positive Screening Mammography. Cancer Epidemiol Biomarkers Prev 25:1474-1482
Doll, Kemi M; Dusetzina, Stacie B; Robinson, Whitney (2016) Trends in Inpatient and Outpatient Hysterectomy and Oophorectomy Rates Among Commercially Insured Women in the United States, 2000-2014. JAMA Surg 151:876-7
D'Arcy, Monica; Fleming, Jodie; Robinson, Whitney R et al. (2015) Race-associated biological differences among Luminal A breast tumors. Breast Cancer Res Treat 152:437-48
Robinson, Whitney R; Kershaw, Kiarri N; Mezuk, Briana et al. (2015) Coming unmoored: disproportionate increases in obesity prevalence among young, disadvantaged white women. Obesity (Silver Spring) 23:213-9

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