The Impact of Psychosocial Variables On Breast Cancer Subtype and a Proposed, Multi-Level Intervention
Methods: Participants were 189 African-American women living in the same 15 neighborhood areas of Chicago who were diagnosed with breast cancer between 2005 and 2009. Complete data on tumor biology were available for all participants. Tumor tissue was collected at the time of biopsy or surgical resection of the tumor. Data on women’s psychosocial functioning were collected in their homes or other sites four to six weeks after surgery in face-to-face interviews. Using PASW® Statistics GradPack 18.0, we explored the association between a number of social variables including discrimination and the biological characteristics of breast cancer using a logistic regression model with TNBC status as the outcome variable.
Results: Discrimination was a significant predictor of the triple-negative model (LR=1.19, 95% CI 1.01 to 1.41 and p=0.04), such that as discrimination increased, so did the likelihood of having triple-negative breast cancer.
Conclusions and Implications: Given the impact of discrimination throughout the life course, the investigators have proposed a neighborhood support coordinator (NSC) intervention. The NSC is a novel model of care that aims to address African-American breast cancer disparities in two primary ways. First, rather than being clinic based, this intervention focuses on engaging the women in the neighborhood and community in which they live. This is imperative in that the contextual environment is the critical place where such change must occur. Secondly, the NSC helps the women to navigate overlapping systems rather than limiting the scope to the health care system only. Buffering the effects of discrimination using an intervention that address these issues on multiple levels is key to minimizing health disparities in breast cancer outcomes.