CBCRP Researcher Spotlight: Addressing Disparities in Breast Cancer Risk Reduction
Larry Fitzgerald, Ph.D., Manager, Core Funding
In 2009 it is estimated that America will spend almost 18% of its GDP for health care, yet we have among the worst health outcomes of any industrialized nation and the greatest health inequities. Research has demonstrated that some disparity can be explained by variations in access to quality medical care, lifestyles, and genes across various cultural, ethnic, and racial groups. Recently, a PBS documentary series, Unnatural Causes, presented other health disparity determinants: namely the social conditions in which we are born, live, and work. Some of these determinants include unemployment, unsafe workplaces, urban blight, globalization, and racial prejudice.
Since 1993 the University of California, San Francisco, has housed a program called Medical Effectiveness Research Center for Diverse Populations (MERC), which has additional facilities in Fresno. MERC’s mission is to promote health and prevent disease in racially/ethnically diverse populations by (1) discovering mechanisms that explain health disparities, (2) developing and evaluating interventions to eliminate disparities, and (3) training investigators to conduct research on health disparities. A key MERC approach in this effort has been to build a network of relationships with diverse community-based organizations (CBOs) and strive to incorporate the community perspective in training and research.
Dr. Celia Kaplan is a CBCRP-funded, public health researcher with a faculty appointment both in MERC and UCSF’s Division of General Internal Medicine. Dr. Kaplan is from Argentina, but moved to the United States to complete her graduate work at UCLA. For 10 years she was at the UCLA School of Public Health, and for the past 13 years she has been at UCSF. Throughout her career, she has focused on women’s health, with an emphasis on breast cancer screening and abnormal mammogram follow-up, risk reduction, participation in clinical trials, quality of life after cancer diagnosis, and dissemination of information among Latino cancer patients. Her personal experience with breast cancer has helped inform her research, giving her an understanding of the needs of breast cancer patients and raising awareness of the disparities that exist. Dr. Kaplan has received three CBCRP grants to explore a range of topics impacting minority health associated with breast cancer.
In 2000, she was funded to study factors influencing decision making in high-risk women from different ethnic backgrounds. The first part involved a survey of over 1,700 women in San Francisco, all of whom were Asian/Pacific Islander, African American, Latina, or White, 40 to 75 years old, and had no personal history of breast cancer.1 In parallel, Dr. Kaplan’s team surveyed over 800 physicians to assess factors related to their breast cancer risk reduction practices. Results from these studies give insight into patterns of counseling, genetic testing, and chemoprevention treatments in various populations.
2Her second CBCRP grant, in 2003, followed Latinas diagnosed with DCIS for their treatment decisions and subsequent quality of life.3 This study gave key insights into both differences and similarities across ethnicity for DCIS treatment decisions, including breast conservation surgery, radiation therapy, mastectomy, or no treatment. There is much debate on how aggressively DCIS and other cancers diagnosed at early stages should be treated.
Currently, Dr. Kaplan is funded by the CBCRP for a three-year, translational research intervention to maximize patient-doctor communication of breast cancer risk information at the point-of-contact in the doctor’s office. For this, Dr. Kaplan’s team will employ a tablet-PC where the patient can enter her personal information, receive a score, and the physician can utilize this information to provide the most appropriate follow-up tests or counseling. The focus is on the Latina community with the intervention designed in both English and Spanish. The success of the project is enhanced through collaboration with local community groups, including Círculo de Vida (Circle of Life) in San Francisco.
The culmination of Dr. Kaplan’s research is a tool to better disseminate cancer information to minorities for effective prevention, provider communication, and treatment decision-making. Her future goal is to devise ways to increase minority participation in clinical trials, a topic to which she brings her experience in recruiting low-income, healthy women into research projects.
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1 Prev Med., 41(3-4):720-7 (2005)
2 Prev Med., 41(1):7-15 (2004)
3 J Psychosoc Oncol., 25(4):19-36 (2007)
4 Ethn Health., 2(5):497-519 (2007)
