Linking Neighborhood and Individual ACEs to Breast Cancer

Institution: Public Health Institute
Investigator(s): Barbara Cohn, Ph.D., MPH, MCP -
Award Cycle: 2017 (Cycle 23) Grant #: 23UB-9452 Award: $754,299
Award Type: SRI Request for Proposal (RFP)
Research Priorities
Community Impact of Breast Cancer>Disparities: eliminating the unequal burden of breast cancer

Initial Award Abstract (2017)

Overview: This application tests the hypothesis that adverse childhood experiences (ACEs) are associated with 1) early age at menarche, a risk factor for breast cancer and linked to the more aggressive forms of estrogen receptor negative (ER-) breast cancer that is more prevalent in African Americans, 2) greater breast density in midlife, a strong risk factor for breast cancer also associated with more aggressive disease and more prevalent in African Americans, and 3) incident breast cancer before the age of 55, known to be more aggressive and more common in African Americans. This research is made possible by a 58+-year prospective study of 9,300 California women born between 1959 and 1967 in the Child Health and Development Studies (CHDS) cohort. Significantly, follow-up began before birth, when the mothers enrolled in the CHDS during their pregnancies. We will focus on neighborhood indices of income, education, and racial segregation from birth to adolescence as the primary ACEs of interest.

Hypotheses: We hypothesize that neighborhood segregation in childhood is an independent predictor of risk, even after accounting for individual level risk factors.

General methodology: Using existing data on residence history from birth to adolescence, we will link children’s residence to neighborhood segregation indices that are derived from census data. We will test multiple indices in order to addresses limitations of each approach when used alone. We will compare age at menarche, breast density, and breast cancer incidence in relation to childhood residence history according neighborhood segregation, and also according to more standard measures of neighborhood socioeconomic status such as percent residents living in poverty. We will also examine the extensive individual and family data collected from birth to mid-life on these children that might also be linked to neighborhood segregation, such as parental illness and death, divorce, parent and adult behaviors such as alcohol abuse, and childhood growth from infancy through adolescence. Having these data makes it possible to determine whether the neighborhood ACEs are making a direct contribution to risk or whether individual and family ACEs are also important. It has been found that neighborhood segregation may be linked strongly to toxic environmental exposures. We are fortunate to have existing data on maternal prenatal blood levels of persistent environmental chemicals that can help us begin to understand how the environment contributes to risk associated with neighborhood. The data we have on the prenatal period will be used to understand whether childhood is the most important period for the development of risk. The prenatal period might also be involved.

Innovative elements: This would be the very first prospective study to determine if neighborhood segregation in childhood is related to breast cancer. The CHDS data also include important individual ACEs (see above) assessed prospectively, avoiding errors of recall about childhood. ACEs measured at multiple time-points in childhood enable us to find the most relevant risk periods for intervention and to examine the effect of upward and downward changes in ACE status. Finally, existing data on maternal stress during pregnancy, pregnancy complications, and environmental chemical exposures previously assayed in maternal perinatal serum are available to determine their contribution to the childhood adversity associations.

Advocacy involvement and relevance: By focusing on indices of segregation at the neighborhood level as an indicators of childhood adversity, research results can be directly applied to modern-day neighborhoods in California with characteristics that place their children at increased risk for breast cancer. Results will create a unique opportunity to intervene on future risk at the community and policy level. Ms. Karuna Jaggar, Executive Director, Breast Cancer Action (BCAction), is the Community Partner for this project. BCAction is a breast cancer education and activist group devoted to achieving health justice for all women living with and at risk of breast cancer. BCAction will 1) serve as a partner throughout the three-year project to assure relevance of scientific questions, 2) lead dissemination of the research findings to the breast cancer community as well as the wider public, 3) host webinars that have California and national distribution for members and the general public, 4) do media outreach and write op-eds to bring findings to the wider public, and 5) develop policy recommendations based on the research findings and highlight interventions that may help reduce the risk of breast cancer for communities that are disproportionately impacted. These recommendations will be informed by this research project as well as by conversations with community members and community partners, in order to focus on the most actionable and impactful interventions that can make real differences for the most underserved and vulnerable communities.