The Community Impact of Breast Cancer

The Research Progress and Results section is organized by the CBCRP’s four major Priority Issues:
The Community Impact of Breast Cancer
Etiology and Prevention
Detection, Prognosis, and Treatment
Biology of the Breast Cell

The Community Impact of Breast Cancer

California is comprised of diverse communities differing by interwoven characteristics such as ethnicity, culture, language, sexual identity, immigration history, and socioeconomic status. This diversity offers the unique opportunity to investigate disparities and the unequal burden of breast cancer among underserved groups. Critical questions to be addressed include:

The CBCRP addresses these issues through program-initiated research in addition to the research conducted by community academic partnerships and individual investigators.
Three research topics are represented in this section:

Sociocultural, Behavioral, and Psychological Issues Relevant to Breast Cancer: The Human Side

Research Completed in 2010

California Chemicals Policy & Breast Cancer
A major challenge to investigating the relationship between chemical exposures and breast cancer is a lack of toxicity information for tens of thousands of commonly used chemicals. California’s Green Chemistry Initiative seeks to eliminate or reduce the creation and use of hazardous chemicals. Megan Schwarzman, M.D., M.P.H., at the University of California, Berkeley, and Sarah Janssen, M.D., Ph.D., M.P.H., at the Natural Resources Defense Council, implemented a Breast Cancer and Chemicals Policy project that brought together a panel of biologists, chemical policy experts, toxicologists, epidemiologists, and advocates to develop an approach for identifying which chemicals might contribute to the development or progression of breast cancer. The testing scheme the panel developed, called the Hazard Identification Approach (HIA), evaluates a chemical’s effect on a variety of endpoints in biological processes that could affect breast cancer risk. Drs. Janssen and Schwarzman are currently working with panel members to conduct a virtual pilot test of the HIA. This work has the potential to lead to new environmental and public health policies that could reduce breast cancer risk by identifying and limiting the manufacture and use of implicated chemicals. The report can be downloaded at http://coeh.berkeley.edu/greenchemistry/cbcrpdocs/pathways_report.pdf .
Race & Ethnicity in Stage-specific Breast Cancer Survival
Breast cancer deaths have been steadily decreasing in the U.S. since 1990. However, this decline has not been the same among all racial/ethnic groups—and it is not clear why. To investigate the reasons for this disparity, Anna Wu, Ph.D., and Kristine Monroe, Ph.D., at the University of Southern California, in Los Angeles; Marilyn Kwan, Ph.D., at the Kaiser Foundation Research Institute in Oakland; Leslie Bernstein, Ph.D., and Katherine DeLellis Henderson, Ph.D., at the Beckman Research Institute of the City of Hope, in Duarte, and Esther John, Ph.D., at the Cancer Prevention Institute of California, in Berkeley, worked together to explore the possibility of pooling data from their seven breast cancer case-control and cohort studies. Together they would have more than16,000 breast cancer cases in California, including 2603 African Americans, 2113 Asian Americans, 2582 Latinas, and 9306 non-Latina Whites to analyze for differences that could not be identified in the individual studies. Together, they successfully produced a proposal that was recently funded by the CBCRP to conduct four studies to investigate factors that may impact racial/ethnic disparities in breast cancer survival as the California Breast Cancer Survivorship Consortium. The findings could lead to programs or initiatives that can reduce these disparities.

Breast Cancer Education for Deaf and Hard-of-Hearing Women
Deaf and hard-of-hearing women are invisible in the research that has shaped breast health and breast cancer educational interventions. Cultural, social, and communication barriers often prevent deaf and hard-of-hearing women from accessing public information about breast health and breast cancer, yet there currently are no breast health and breast cancer programs that have been developed specifically for this community. To address this problem, Barbara Berman, Ph.D., at the University of California, Los Angeles, and Heidi Booth, B.S., at the Greater Los Angeles Council on Deafness, Inc., developed a comprehensive, multi-media breast cancer program tailored to meet the needs of deaf and hard-of-hearing women and then tested the program’s effectiveness in a randomized controlled trial that enrolled 200  women 40 years of age and older. Dr. Berman and Ms. Booth have disseminated their findings to the deaf and hard-of-hearing community, health care providers, and others serving these women at meetings and workshops locally, regionally, and nationally. Their work has the potential to improve breast health among deaf and hard-of-hearing  women.

Mindful Movement Program for Breast Cancer Survivors
Many breast cancer survivors continue to experience psychosocial and physical problems, such as anxiety, depression, fear of recurrence, and pain, long after their treatment is completed. Mindfulness training and movement-dance therapy has the potential to reduce these problems and improve breast cancer survivors’ quality of life, but little if any research has been done in this area. Rebecca Crane-Okada, Ph.D., R.N., at the Beckman Research Institute of the City of Hope, in Duarte, and Holly Kiger, R.N., M.N., at the YWCA Santa Monica/Westside, conducted a randomized controlled trial that investigated the impact of a new and innovative 12-week Mindful Movement Program (MMP) that combined movement and mindfulness techniques on the quality of life of breast cancer survivors who were 50 years of age or older and were 12 months or more past completion of treatment. Their study found that the MMP had a positive effect on both mindfulness and quality of life (reducing fear of recurrence). Dr. Crane-Okada and Ms. Kiger now intend to study the MMP in a larger group of women. This work could result in an MMP becoming widely used to improve quality of life in breast cancer survivors.

Latina Breast Cancer Survivors…Our Experience
Survivorship is a distinct and important phase of the cancer experience, but it has been relatively neglected in education and clinical practice. Research is needed to understand patterns of delivery of survivorship care and to identify areas in need of intervention, particularly for Latinas and other populations at risk for disparities. Diana Tisnado, M.P.A., Ph.D., at the University of California, Los Angeles, and Brian Montano, M.P.H., at Partnered for Progress in Los Angeles, developed and implemented a Community Research Collaboration pilot project to examine issues of breast cancer survivorship care among Latinas in Los Angeles County. Focus groups they conducted with Latinas identified concerns including: quality of care, health insurance coverage, emergency MediCal, provider choice, fatigue, depression, cognitive problems, and family stress. Participant recommendations included support services for family members and caregivers. Dr. Tisnado and Mr. Montano will now develop and assess an intervention that will address the concerns they have identified. This work has the potential to improve the survivorship experience of Latinas with breast cancer.

Breast Cancer Risk Reduction in American Indian Women
Breast cancer incidence and mortality rates have been increasing among American Indian women over the past 20 years, and breast cancer is now their second leading cause of cancer death. American Indians currently have the poorest cancer screening rates of any ethnic group, and those with breast cancer have the lowest five-year survival rate. Marlene von Friederichs-Fitzwater, Ph.D., at the University of California, Davis, and Linda Navarro, at the Turtle Health Foundation, in Sacramento, received a one-year planning grant that allowed their team of academic and community investigators to address weaknesses in the research plan and submit a revised CBCRP grant application. This work allowed them to strengthen their research and obtain a 2010 CBCRP grant for their study, “Increasing Mammography Screening among Native Women.” Results from a CBCRP pilot project leading up to this grant was published in the Journal of Cancer Education. 2010 [E-pub, DOI 10.1007/s13187-010-0111-0]

Reproductive Concerns and Depression among Younger Survivors
Breast cancer can negatively impact a woman’s fertility. Jessica Gorman, M.P.H., at the University of California, San Diego, evaluated whether concerns about reproduction after breast cancer treatment were associated with long-term depression in women diagnosed with early stage breast cancer at age 40 or younger. Her study showed that greater reproductive concerns independently predicted consistent depressive symptoms after taking into account both social support and physical health. In addition, both not having a child at the time of diagnosis and reporting treatment-related ovarian damage were strongly associated with higher reproductive concerns and with depression. These findings suggest that reproductive concerns are associated with depression, and that young survivors would benefit from additional information and support related to reproductive issues. This work provides additional evidence of a need for interventions to improve patient-provider discussions about reproductive issues prior to treatment and later in survivorship. Findings from this research were published in Psycho-oncology 19(2010)517.

Provider Communication and Health in Breast Cancer Survivors
Breast cancer survivors' perceptions of their communication with health care providers may be associated with their health habits and their physical health. Sara Fernandes-Taylor, B.A., at the University of California, Berkeley, interviewed breast cancer survivors in the San Francisco Bay Area to investigate how they perceived their communication with their doctors. Her study found that patients' perceptions of their communication with providers were not consistently associated with their sense of control over their health, their health behaviors, or health outcomes, and that problems with provider communication were associated with self-esteem and emotional support, rather than with socio-demographic characteristics, such as age, race, and education. In addition, women who were anxious about the future or had problems communicating with physicians during treatment were more likely to express regret five years later. This research suggests that breast cancer treatment could be improved by addressing the psychosocial aspects of cancer care in the survivorship phase; improving study design in physician-patient communication research; and addressing the unique emotional needs of women with recurrent cancers, who may experience an undue burden of regret. Findings from this research were published in Psycho-oncology 2010 Apr 23. [Epub ahead of print]

Research Initiated in 2010

2010 National Latino Cancer Summit
Ysabel Duron
Latinas Contra Cancer

California Breast Cancer Survivorship Consortium
Leslie Bernstein, Scarlett Gomez, Marilyn Kwan, Kristine Monroe, and Anna Wu
Beckman Research Institute of the City of Hope, Cancer Prevention Institute of California, Kaiser Foundation Research Institute, and University of Southern California

Increasing Mammography Screening Among Native Women
Linda Navarro and Marlene von Friederichs-Fitzwater
Turtle Health Foundation and University of California, Davis

Recording Medical Visits for People with Breast Cancer
Sara O’Donnell and Jeffrey Belkora
Mendocino Cancer Resource Center and University of California, San Francisco

Quality of Mammography Facilities Serving Vulnerable Women 
Lauren Goldman
University of California, San Francisco

Research in Progress

Adapting a Breast Cancer Education Program for South Asians
Zul Surani, Roshan Bastani, and Beth Glenn
South Asian Cancer Foundation and University of California, Los Angeles

Breast Cancer Clinical Trials Education Program
Natasha Riley, Vanessa Malcarne, and Georgia Sadler
Vista Community Clinic, San Diego State University Research Foundation, and University of California, San Diego

Demographic Questions for California Breast Cancer Research
Scarlet Lin Gomez
Northern California Cancer Center

Expanding Rural Access: Distance Delivery of Support Groups
Mary Anne Kreshka, Suzanne Ferrier and Cheryl Koopman
The Sierra Fund and Stanford University

Health Anxiety as a Risk for Insomnia in Breast Cancer
Michelle Rissling
University of California, San Diego

Health Literacy in Older Patient's Breast Cancer Treatment
Arash Naeim
University of California, Los Angeles

Increasing Mammography Screening in Latinas with Diabetes
Christine Noguera and Steve Roussos
Golden Valley Health Centers and San Diego State Research Foundation

Macrophages in Breast Cancer Patients of African Descent
Rita Mukhtar
University of California, San Francisco

Neighborhoods and Obesity in Pre-Adolescent Girls: Part II
Irene Yen
University of California, San Francisco

New Methods for Genomic Studies in African American Women
Daniel Stram
University of Southern California

Nuevo Amanecer: Promoting the Psychosocial Health of Latinas
Carmen Ortiz and Anna Napoles-Springer
Circulo de Vida Cancer Support and Resource Center and University of California, San Francisco

Patient and Clinician Knowledge of Breast Cancer Lymphedema
Marilyn Kwan
Kaiser Foundation Research Institute

Quality of Mammography Facilities Serving Vulnerable Women
Lauren Goldman
University of California, San Francisco

Risk Factors and Breast Cancer Survival in Black/White Women
Yani Lu
Beckman Research Institute of the City of Hope

Telephone-Based Decision Support for Rural Patients
Sara O’Donnell and Jeff Belkora
Mendocino Cancer Resource Center and University of California, San Francisco

Underserved Women with Breast Cancer at End of Life
Kendra Stone and Shelley Adler
Charlotte Maxwell Complementary Clinic and University of California, San Francisco