The Community Impact of Breast Cancer: The Social Context

Overview: The CBCRP supports research into public policy alternatives that would contribute to breast cancer prevention and improve outcome. The CBCRP recognizes the need for reducing inequities in access to prevention, detection, treatment, and survivorship services for underserved populations. We encourage sociocultural, psychological, and behavioral research to reduce the impact of breast cancer on each woman.

Three of CBCRP's Priority Issues are represented in this section:

Funding Data:

    Proportion of Total
Community Impact grants awarded in 2003:

11

22%
Funded amount:

$3,629,388

31%
Supplements Funded:

1 ($10,000)

 

Community Impact Portfolio Summary:

One newly funded CBCRP grant was awarded under the Health Policy and Health Services priority issue to Wendy Max at the University of California, San Francisco. Dr. Max will be studying the economic cost of breast cancer in California; this research will allow policy-makers to understand the impact that breast cancer has on both the entire state and in various counties and regions.

Six new awards were to initiate research projects in our Sociocultural, Behavioral and Psychological Issues priority issue. First, Rebecca Rausch at the University of California, Los Angeles will follow-up on a previous CBCRP award and continue to examine the effects of chemotherapy and/or antiestrogen therapy on the mental functioning of breast cancer patients. The term "chemo brain" has long been an issue of concern among women undergoing cancer therapy, but only fairly recently has there been systematic investigation into this problem. Dr. Rausch's study will measure longterm deficits in memory, attention and concentration among a small group breast cancer patients, and they will use MRI (magnetic resonance imaging) to study specific structural changes in the brain associated with these mental deficits. Next, Beth Glenn also at the University of California, Los Angeles will examine the communication style, structure, and the anticipated impact of BRCA1 and 2 testing on the family. The idea is that the family context in which a woman considers genetic evaluation and testing may represent an important influence on her decision whether to be evaluated and tested. Furthermore, this family context may differ by ethnicity that may explain the low level of minority participation in genetic testing. Next, psychosocial support for women with breast cancer is an innovative and understudied field of research. Kate Collie is a postdoctoral fellow in the Stanford University School of Medicine working with Cheryl Koopman in the Department of Psychiatry and Behavioral Sciences. Dr. Collie's project , 'Art for Recovery', is based at the UCSF Comprehensive Cancer Center, which offers a variety of support services for breast cancer patients that involve visual creative expression. This support does not rely on verbal expression, and Dr. Collie will study how well the program is meeting the emotional, psychological, and social support needs of women, especially underserved women. Next, Janine Giese-Davis also at Stanford University will examine the possible role of guilt in affecting psychological and emotional recovery from breast cancer. Women may feel guilt because they have not been able to spend as much time with their children or families, mistakenly believe that they have caused their cancer, think that their children may be at greater risk for cancer, or fear dying prematurely, thereby abandoning children and family members. Dr. Giese-Davis' team will be the first researchers using recently developed methods (e.g., questionnaires and coding from videotapes of counseling sessions) to measure shame and guilt, as well as embarrassment and pride in women with breast cancer. John Park and Morton Lieberman (co-PIs) at the University of California, San Francisco will study the effectiveness of BreastCancerTrials.org (BCT.org), an Internet-based tool for matching breast cancer patients to clinical trials. This secure and confidential online registry enables comparison of patient self-reported medical histories with clinical trial eligibility requirements. The hypothesis of this study is that BCT.org can shorten the duration of clinical trials and promote participation among underserved women including seniors, racial and ethnic minorities, rural residents, and lower income families. Finally, Celia Kaplan also from the University of California, San Francisco will compare treatment decision-making processes, quality of life issues, and the receipt of follow-up care among 300 Latinas and 300 white women diagnosed with DCIS in diverse regions in California. Women with DCIS have a unique disease profile, since their prognosis is often very good, and many of the discovered lesions would not have resulted in invasive cancer if left untreated. Still, many DCIS patients will undergo treatment essentially the same as women with invasive breast cancer.

The CBCRP awarded four new grants in our Racial/Ethnic Differences priority issue. Two of these projects are for Community Research Collaboration (CRC) Pilot awards to support teams of community organizations and university researchers. First, Soo-Young Chin at the Korean Health, Education, Information & Research Center (KHEIR) and Annette Maxwell from the University of California, Los Angeles will explore misconceptions and barriers to regular mammographic screening among Korean-American women. The aims are to address cultural barriers to encourage these women to be screened on a regular basis and to learn how best to disseminate this information to Korean-American women. Using information obtained in focus groups, they will develop one or more interventions and pilot test them in women who are due for re-screening. Next, Diane Estrin at the Women's Cancer Resource Center, Linda Wardlaw from the Charlotte Maxwell Complementary Clinic, and Rani Eversley at the University of California, San Francisco will study the problems of lymphedema among breast cancer surgery patients. This university-community team will test the feasibility issues surrounding the development, testing and standardization of a low-cost intervention to prevent or reduce the severity of secondary arm lymphedema among breast cancer patients. They anticipate developing a full-scale intervention to test the efficacy of this approach in the future.

Two of the Racial/Ethnic Differences grants are epidemiology-based. First, Rebecca Smith-Bindman at University of California, San Francisco will investigate the basis for different rates of breast cancer death between women from different racial and ethnic groups. Dr. Smith-Bindman will use two large, population-based sources with data on 5,880 African Americans, 3,240 Hispanics, and 2,573 Asian women diagnosed with breast cancer from 1992 through 2001. In addition, they will augment this information with person-to-person interviews. Next, Anna H. Wu at the University of Southern California will examine whether pre-and post-diagnostic dietary (especially green tea and soy) and other lifestyle factors (e.g., physical activity, body size) are associated with breast cancer outcome in Asian American women. The data will be gathered from 1,200 Asian-American women diagnosed from 1995 through 2000.

The CBCRP also awarded a supplement to an existing Community Research Collaboration grant. This funding will enable a community based organization, the Chamorro Community Council of California, to gain experience in participatory research with a mentor organization, the Guam Communications Network. The aim is to develop and evaluate a culturally tailored, lay health advocate intervention to increase breast cancer screening rates among Chamorro women aged 50 years and older in Los Angeles and Orange counties.

Community Impact Grants Funded in 2003:

Health Policy and Health Services Priority Issue

The Cost of Breast Cancer in California
Wendy Max
University of California, San Francisco
Request for Applications Award
2 years; $315,198

Racial/Ethnic Differences Priority Issue

Reducing Disparities Among Korean Women
Soo-Young Chin (co-PIs)
Korean Health, Education, Information and Research Center
Annette Maxwell (co-PIs)
University of California, Los Angeles
Community Research Collaboration—Pilot Award
1.5 years, $107,264

Correlates of Lymphedema Severity and Access to Intervention
Diane Estrin (co-PIs)
Women's Cancer Resource Center
Linda Wardlaw (co-PIs)
Charlotte Maxwell Complementary Clinic
Rani Eversley (co-PIs)
University of California, San Francisco
Community Research Collaboration—Pilot Award
1.5 years; $125,000

Racial Disparity in Breast Cancer Mortality
Rebecca Smith-Bindman
University of California, San Francisco
Request for Applications Award
3 years; $583,287

Lifestyle Factors & Breast Cancer Prognosis in Asian Americans
Anna Wu
University of Southern California
Request for Applications Award
3 years; $1,050,751

Sociocultural, Behavioral, and Psychological Priority Issue

'Art for Recovery': Expanding Access for the Underserved
Kate Collie
Stanford University
Postdoctoral Fellowship Award
2 years; $86,138

Assessing the Impact of Shame and Guilt in Recovery
Janine Giese-Davis
Stanford University
IDEA
1.5 years; $157,576


Interplay of Family Context and Ethnicity in BRCA1/2 Testing
Beth Glenn
University of California, Los Angeles
Postdoctoral Fellowship Award
2 years; $80,000

Latinas and DCIS: Treatment Decisions and Quality of Life
Celia Kaplan
University of California, San Francisco
Request for Applications award
3 years; $774,174

BCT.org: Feasibility of a Clinical Trial Matching Tool
Morton Lieberman and John Park (co-PIs)
University of California, San Francisco
Translational Research Collaboration—Pilot Award
1year; $100,000

Late Cognitive and Brain Changes After Breast Cancer Therapy
Helen Rebecca Rausch
University of California, Los Angeles
STEP Award
2 years; $250,000

Community Research Collaboration Supplement Award (CRCAS)

A Network Based Intervention for Chamorros in Southern California
Mentor Group: Guam Communications Network
Trainee Group: Chamorro Community Council of California
1 year; $10,000