Institution: Kimaw Medical Center
Investigator(s): Emmett  Chase , MD, MPH - Moon  Chen , Ph.D., M.P.H. -
Award Cycle: 2016 (Cycle 22) Grant #: 22AB-1101 Award: $82,500
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Disparities: eliminating the unequal burden of breast cancer

This is a collaboration with: 22AB-1100 -

Initial Award Abstract (2016)

Introduction: American Indian women are considerably more likely to die prematurely and at higher rates of breast cancer than non-Hispanic White women. This is significant not only statistically but also at the individual and societal levels as breast cancer is the most common cancer affecting American Indian women. Cancer-related death rates could be dramatically reduced if current screening recommendations are followed. Furthermore, these unnecessary deaths could be potentially reduced even more if an indigenous, acceptable, American Indian-customized model for breast health that incorporates culturally competent responses to stress, abstinence to tobacco use, reduction in alcohol consumption, and mitigation of other risk factors framed within a supportive family environment, were developed and offered.

Co-led by Emmett Chase, M.D., M.P.H. (Community), the first Californian American Indian physician and the CEO and founder of the K’ima:w Medical Center (KMC) in Hoopa and Moon S. Chen, Jr., Ph.D., M.P.H. (Academic) at the UC Davis Comprehensive Cancer Center (UCDCCC), the Aims of this pilot study, are as follows:

 (1) Engage in collaborative dialogues that would result in the incorporation of joint K’ima:w-centered solutions and UCDCCC expertise in the design, implementation, and evaluation of: a.) Health Circles (an accepted American Indian approach for solving problems); b.) Offering mammography services at KMC rather than sending American Indian women to mammography services more than 1.5 hours away;  

(2) Explore the feasibility and acceptability of offering an array of primary prevention strategies for promoting breast health; and

(3) Evaluate the K’ima:w: Medical Center-UC Davis Comprehensive Cancer Center Partnership in terms of:   a.) Leveraging both partners’ expertise in consensus on solutions to encouraging mammography uptake and resolution of logistical barriers to the actual receipt of mammograms. b.) Satisfaction by both partners as measured by willingness to collaborate in the Full Research Proposal.

Question(s) or hypotheses: Our research questions are: (1) How to encourage mammography uptake in a culturally  competent manner; and (2) How to reduce the logisticalbarriers to actual receipt of a mammogram. The hypothesis associated with (1) is that participants in Health Circles focused on promoting mammography are more likely to obtain mammograms than those in a different breast health topic and (2) is that a
community-centered solution to develop a mammography service at KMC is preferable to American Indian women than referral to a distant facility.

General methodology:  TRIBAL is based on synergistic parity of the Community Co-PI, the first American Indian physician from Humboldt County (where KMC is located) with the Academic Co-PI, a nationally accomplished UC Davis cancer health disparities researcher.  Each will respectively leverage his expertise to achieve TRIBAL’s Aims.  TRIBAL’s team members include American Indian key personnel at KMC and those with expertise in supportive oncology, research, and social services from UCDCC.  TRIBAL’s work will be also overseen by an American Indian/breast cancer survivor Community Advisory Board applying community-based participatory research principles.  Scheduled monthly meetings and quarterly in-person meetings will be used to assure progress and resolve barriers to achievement.  In particular, Health Circles will be tested for effectiveness in promoting mammography uptake and its potential for promoting breast health.  Satisfaction with this pilot will be exemplified by willingness by both KMC and UCDCCC to collaborate in submitting the Full Research Proposal.

Innovative elements:  TRIBAL’s ultimate goal is to develop a novel American Indian model for breast health that goes beyond maintenance of breast cancer screening to incorporate the use of Health Circles to encourage the adoption of modifiable breast health behaviors, e.g., stress management, tobacco and alcohol abstinence, etc.  TRIBAL is perhaps the first CBCRP grant to have an American Indian physician Co-PI lead this CRC which would result in the integration of tribal values and state-of-the science/medicine.

Community involvement: The community and academic partners share equally in budget and complement each other in the achievement of the Aims.  A Community Advisory Board comprised of American Indian and breast cancer advocates will oversee TRIBAL.

Future Plans: Our pilot study findings and lessons learned will be the basis of the indigenous American Indian breast health model that we will propose for the Full Proposal.