Cancer Mapping: Making Spatial Models Work for Communities

Institution: Public Health Institute
Investigator(s): Eric Roberts, M.D., Ph.D. -
Award Cycle: 2009 (Cycle 15) Grant #: 15UB-8405 Award: $345,297
Award Type: SRI Request for Proposal (RFP)
Research Priorities
Etiology and Prevention>Prevention and Risk Reduction: ending the danger of breast cancer

Initial Award Abstract (2009)

Diseases such as breast cancer do not strike all members of society equally; for many illnesses, the burdens of disease fall disproportionately on those with the fewest resources. Disease mapping is an effective way to communicate disparities, providing vital information for health and environmental advocates and practitioners. Although public demand is acute for cancer mapping that shows rates for small areas (e.g. census tracts), state and local governments have been unable to meet this need due to statistical issues and confidentiality problems.

Recent developments in statistics and computer power have made possible census tract-level disease maps that provide useful information for communities. In general, methods have been developed by statisticians who have little contact with clinicians, communities, local governments, or advocates. However, input from these stakeholders is essential to adapting these methods for practical use. To create a protocol for mapping breast cancer in a large, diverse state such as California, we will convene an Advisory Group (AG) of collaborators with diverse backgrounds and a multi-disciplinary project team to develop and refine a broadly applicable mapping protocol to help locate vulnerable communities, understand demographic risk factors, target prevention/intervention efforts, and generate hypotheses about breast cancer.

Questions: The research questions for this project fall into three overlapping areas.

  1. THE GEOGRAPHY OF INVASIVE BREAST CANCER IN CALIFORNIA: Can we geographically define communities that face heightened vulnerability to invasive breast cancer? Is risk related to issues of social class or segregation?
  2. IMPLEMENTATION OF STATISTICAL METHODS: How can we adapt the work of statistical researchers to the needs delineated by our AG in order to carry out mapping?
  3. COMMUNICATION AND UTILITY FOR TRANSLATION: How do stakeholders work through issues related to the uncertainty around detecting “clusters” of disease? How should results be communicated? How to use maps in communication, advocacy, and public health action?

Methods: The technical staff will begin by working with “simulated data” to determine what kinds of disease patterns (in terms of geographic size, shape, and degree of risk) the methods can locate. This information will be crucial for the AG to make decisions about how the methods should be used. During this time, the health educator will work with the AG to identify group learning objectives and capacity building necessary for decision-making. Key technical decisions regarding the mapping protocol must be directly informed by AG values and preferences. The AG will also help staff to develop supporting material so that advocates, communities, government, and other stakeholders can interpret breast cancer maps. Finally, we will produce statewide, annualized maps showing areas of California with elevated risk of breast cancer.

Community Involvement and Advocacy Concerns: This project takes advantage of the interdisciplinary teams of the California Environmental Health Tracking Program and the California Cancer Registry to engage scientific, advocacy and other stakeholders together to maximize the potential utility of breast cancer mapping. The AG will be engaged in determining key decisions in developing the maps, interpreting results, and communicating and disseminating the maps and related findings. This process ensures that diverse issues of concern and ideas of breast cancer advocates and a variety of other stakeholders are well represented and guide the project.

Progress Report 1 (2011)

An Advisory Group (AG) consisting of clinicians, community organization representatives, local public health department staff members, and breast cancer advocates have successfully outlined a method for mapping statewide surveillance data for the incidence of invasive breast cancer that best meets their needs. These methods were applied to real data with project staff working closely with AG members to interpret and synthesize results generated and develop effective communication products to share project findings with diverse community stakeholders. To incorporate communication priorities from a diverse AG, project staff has facilitated ongoing meetings and discussions to allow for critical dialogue necessary to address potential challenges and build consensus around an appropriate communication strategy. Through regular evaluation data collected from the AG on the stakeholder engagement process, members have reported that AG input has been effectively integrated into project goals and outcomes.

The 12 AG members consistently participated and (a) reviewed breast cancer mapping protocols with respect to their sensitivity, specificity, and communication potential; (b) reviewed results generated through the application of AG-selected methods to actual Cancer Registry data; and (c) outlined appropriate communication strategies to report project findings to diverse community and public health stakeholders.

Staff employed the AG’s preferred mapping method to temporally and geographically analyze invasive breast cancer incidence statewide. This produced a series of 13 maps (one for each year of available data) depicting areas potentially having elevated disease risk color-coded to indicate degrees of consistency, reliability, and likelihood for representing spurious results related to denominator limitations. The team provided training and capacity building to facilitate the AG’s identification of limitations of mapping methods, interpretation of results, and determination of effective communication strategies. They also facilitated conference calls with AG and Cancer Registry staff to clarify current procedures, protocols and challenges in accessing sub-county breast cancer data to allow the AG to refine their priorities and strategies and to develop products that would both meet communities’ information needs and reflect public agency realities.

The AG reviewed draft communication materials and further refined the communication strategy expected to consist of three companion pieces: o A journal article submitted to peer-reviewed journals on the statewide Scan Statistic analysis and the Advisory Group process

Guidelines for the mapping of cancer registry data: results from a breast cancer expert panel study.
Periodical:Journal of Public Health Management and Practice
Index Medicus: J Public Health Manag Pract
Authors: NA
Yr: 2013 Vol: 19 Nbr: 3 Abs: Pg:E1-E10