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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): Hispanic /Latino (H/L) women are less likely to be diagnosed with breast cancer than are White (W) women, but more likely to be diagnosed with late stage tumors and to have worse survival. Compared to White and African American women, their self-reported mammography screening rates are lower. The recent demographic shift toward a rapidly growing H/L population throughout the U.S. underscores the need for a proactive approach to cancer control in this relatively understudied population. Because relatively little is known about cancer screening behavior in H/L women living in the Northeast US, particularly among recent immigrants, we propose to establish a cohort of 1,600 H/L women, ages 40-75, living in Connecticut, and to study their screening experience over a 2-4 year period. Employing a prospective design, we will: 1) identify predictors of non-adherence to recommended mammography screening guidelines over the study period; 2) identify predictors of inadequate communication of mammography screening results; and 3) identify predictors of inadequate follow-up of abnormal mammograms in this culturally diverse H/L population. Our hypothesis is that the increased risk of poor adherence to guidelines, poor communication of results, and inadequate follow-up for abnormal mammograms in some H/L women can be explained by their higher risk status with respect to selected constructs of health behavior models. Specifically, adapting the Health Belief Model to our study aims, we will examine established predictors as well as measures that may be of particular relevance to H/L women (e.g., health literacy). We will also determine if the predictors associated with specific mammography screening outcomes differ by birthplace (foreign born vs U.S. born) or other acculturation indicators, as well as age cohort (younger versus older women). In sum, a strategy of studying ethno-regionally distinct subgroups of the larger H/L population is needed to inform effective breast cancer control efforts. As this population is disproportionately poor, less likely to speak English, and is unlikely to be adequately insured, we can anticipate the probable consequences: later stage at diagnosis and decreased survival. This proposal is a critical first step in cancer control for H/L women as they are certain to represent a growing proportion of new breast cancer cases as their numbers increase, as they adopt higher risk reproductive patterns (e.g., later age at first birth), and as they reach the ages in which breast cancer risk increases for all women. PUBLICH HEALTH RELEVANCE: Hispanic /Latino (H/L) women are less likely to be diagnosed with breast cancer than are White (W) women, but more likely to be diagnosed with late stage tumors and to have worse survival. Although relatively few studies have focused on the growing Hispanic/Latino population residing in the Northeast, U.S., it is known that the mammography screening rates are low in this ethno- regionally diverse population, relative to White and African American women. This prospective evaluation of mammography screening adherence and related outcomes in a community-based cohort of 1,600 H/L women represents a critical first step in cancer control for H/L women- as they are certain to represent a growing proportion of new breast cancer cases as their numbers increase, as they adopt higher risk reproductive patterns (e.g., later age at first birth), and as they reach the ages in which breast cancer risk increases for all women.