Current Centers for Population Health and Health Disparities

Fred Hutchinson Cancer Research Center
Understanding and Preventing Breast Cancer Disparities
in Latinas

Contact Information
Jennifer Anderson
Project Coordinator, Thompson Studies
Fred Hutchinson Cancer Research Center
1100 Fairview Ave. N. M3-B232
Seattle, WA 98109-1024
(206) 667-7480
janderso@fhcrc.org
www.fhcrc.org

Beti Thompson, PhD – Contact Principal Investigator

Abstract: Breast cancer is the most common cancer among Hispanic women in the United States. The incidence of breast cancer among Hispanics (83.5 per 100,000) is lower than that among non-Hispanic Whites (147.3 per 100,000); however, as Hispanic women adopt the practices of mainstream U.S. culture, their risk for breast cancer increases. Furthermore, Hispanic women are at increased risk for breast cancers with poor prognosis. The overarching theme of this P50 application is to understand and prevent precursors of breast cancer, and to reduce breast cancer morbidity and mortality among Latinas. This will be done at multiple levels and will engage researchers across several disciplines. Projects have been carefully designed to better understand and prevent breast cancer in Latinas. It is the long-term goal of this P50 application to understand the antecedents of breast cancer in the Latina population, understand the types of breast cancer found in the Latina population, and develop and implement a comprehensive program of screening to increase the opportunities for early breast cancer detection among Latinas. Our short-term objectives are to: (1) increase breast cancer screening among age-eligible Latinas; (2) understand the processes by which ancestry, BMI, inflammation, and breast cancer are related in Latinas; (3) understand aspects of the etiology of poor prognosis breast cancers by identifying risk factors related to triple negative (TN) and human epidermal growth factor receptor-2 (HER-2)-overexpressing (H2E) tumors, which are more commonly found in Latinas compared to non-Hispanic whites; (4) understand the role of ancestry in breast cancer antecedents and incidence among Latinas; and (5) explore expression of genes involved in tumor-related pathway signaling. This Center is committed to a comprehensive multilevel approach to reducing health disparities. Its projects range from the biologic and genetic to the social context within which people live. Through its four projects and cores, the proposed Center will cover myriad aspects of breast cancer–from biological processes and genetic pathways to individual determinants and social determinants.

Center Aims

• Understand the antecedents of breast cancer in the Latina population;
• Understand the types of breast cancer found in the Latina population;
• Develop and implement a comprehensive program of screening to increase the opportunities for early breast cancer detection among Latinas;
• Reduce breast cancer morbidity and mortality among Latinas.

Project 1 seeks to develop and test a culturally appropriate multilevel intervention aimed at increasing screening mammography utilization in a clinic-based sample of Latino women in Western Washington.

Specific Aims

• Develop and implement a culturally-appropriate multilevel randomized intervention to increase use of screening services for breast cancer among age-eligible (40–74) Hispanic women in Western Washington who receive medical care at one of four clinics of Sea Mar Community Health Centers;
• Assess the costs associated with each of the two intervention arms;
• Examine the relationship between neighborhood-level factors (such as the percent Hispanic from U.S. Census data, and self-reported factors such as neighborhood belonging) and mammography uptake, and test whether neighborhood factors modify the effectiveness of the intervention.

Project 2 will test the metabolic response to Western and indigenous Mexican diets in Hispanic women. The study also will investigate whether ancestral genetic variation mediates the response to each diet.

Specific Aims

• Test in a randomized cross-over experimental feeding study the metabolic response to an indigenous Mexican diet versus a Western diet in 50 first- and second-generation Hispanic women living in the greater Seattle area;
• Investigate whether genetic characteristics, as assessed with Ancestry Informative Markers, mediate the metabolic response to each tested diet;
• Compare the experimental indigenous and Western diets regarding measures of hunger and satiety;
• Test whether Ancestry Informative Markers explain variance in adiposity measures in study participants.

Project 3 will evaluate determinants of the incidence and mortality of molecularly defined breast cancer subtypes among women in general and among Latinas specifically. The project will investigate the etiologies and outcomes of two aggressive breast cancer subtypes that disproportionately effect Hispanic women.

Specific Aims

• To better understand how established breast cancer risk factors, including reproductive factors, body mass index, mammographic density, and a family history of breast cancer, relate to TN and H2E breast cancer risks relative luminal breast cancer risk;
• Examine if the associations between established risk factors and the relative risks of TN and H2E breast cancer differ between Hispanics and non-Hispanics;
• To better understand how established breast cancer risk factors influence risk of mortality in women diagnosed with TN and H2E breast cancers.

Project 4 seeks to better understand the biological subtypes of breast cancer in Hispanic women and the relationship of genetics and environmental influences (risk factors) to the development of specific breast tumor subtypes.

Specific Aims

• Determine the relationship between tumor subtype and ancestry in Hispanic women with breast cancer;
• Explore the relationship between specific risk factors and breast tumor subtype in Hispanic women;
• Explore expression of genes involved in tumor-associated pathways (e.g., DNA-repair; growth factor signaling [(EGFR]; PI3K-PTEN-AKT) in the tumors of Hispanic women and the relationship of these pathways with ancestry and risk factors.