This proposal is to carry out a pilot study of breast cancer survivorship among Hispanic and Anglo women in Colorado who are recent subjects in a population-based case-control study (Southwest Hormone, Insulin, Nutrition, and Exercise - SHINE Women's Health Study; Dr. Tim Byers, Principal Investigator). Hispanics as a group present with an overall less favorable disease stage and experience lower breast cancer survival. A recent study among New Mexico Hispanic, Native American, and non-Hispanic White women suggests that not all of the ethnic differences in survival can be fully explained by stage at diagnosis. Our understanding of ethnic disparities in cancer is further complicated by the fact that most of our knowledge of the factors that contribute to both risk and prognosis is derived from studies of predominantly non-Hispanic White populations. Similarly, very little information is available regarding quality of life (QOL) among minority cancer survivors. This proposal is to develop and demonstrate the methods we intend to use in longitudinal follow-up of the SHINE Study participants (Hispanic and non-Hispanic White breast cancer cases and controls). Lifetime body weight, physical activity, medical history, and nutritional factors are being collected from breast cancer cases and controls in this retrospective study, as well as blood samples for genetic and metabolic factors that might predict outcome. We are therefore in the unique position to be able to document risk-related behaviors as well as evaluate changes in diet and lifestyle after the experience of cancer by re-administering selected portions of the existing SHINE questionnaire. Including control subjects from the same study population in this re-assessment will allow us to also understand whether any of the observed differences are due to the cancer experience or differences in ethnicity. We propose to expand the existing questionnaire to include QOL measurements specific to breast cancer survivors who are 1 to 3 years post-diagnosis, which has been suggested to be a particularly stressful time. In addition to self-reports of perceived stress, we also propose to document diurnal variation in salivary cortisol levels in this pilot study as a physiologic measure of stress. Of critical importance to this proposal is the observation that women with metastatic breast disease who fail to show the normal diurnal decline in salivary cortisol have significantly poorer prognosis than those with typical measurements. A potential interpretation of the flattened diurnal cortisol decline among cancer patients might be analogous to post-traumatic stress disorder, which impacts critical immune system functions. Assessment of both subjective (QOL) and objective (salivary cortisol) measures of stress among cases and controls in this ethnically diverse group will further lay the groundwork for better understanding of the role of perceived and physiologic stress in cancer survivorship. In addition to these specific results, we anticipate that this pilot project will demonstrate the feasibility of future studies of the cancer experience among Hispanic and non-Hispanic White women currently enrolled in the SHINE Women's Health Study. We anticipate enrolling 1300 women in Colorado and 4500 women study-wide (4-Corners states) by the end of 2003. The information collected in follow-up studies with this study population can be used to assess psychosocial and physiologic factors both as outcome of the cancer experience and determinants of recurrence and survival. The rapid increase of the Hispanic population in the United States, particularly in the Southwestern states, makes research such as this on the cancer experience of Hispanics a high priority. Breast cancer is the most common cancer in both Anglo and Hispanic women in the United States, and knowledge gained from studying groups with varying survival rates may benefit all women who suffer from this serious disease.
