Conclusions
This study provides preliminary evidence to suggest that the ICE-Race metric can efficiently identify census tracts with higher odds of TNBC due to both compositional and contextual effects. Preliminary evidence also suggests that the contextual effects may be driven, at least in part, by potentially modifiable metabolic exposures, such as alcohol use and obesity. Krieger and colleagues have called for including ICE metrics in cancer registries to facilitate the monitoring of cancer inequities.[29] Going further, the use of ICE metrics can help to advance the study of racial disparities in breast cancer from a methodology based on traditional risk factors to one grounded in a causal architecture framework. Rather than studying individual risk factors in isolation without considering neighborhood effects, the use of large and representative pooled patient cohorts can be employed to evaluate the multilevel, multifactorial relationships between exposures and TNBC. Such efforts could be complemented by basic and translational research designed to delineate mechanisms of pathophysiology and facilitate biomarker discovery. Together, these lines of research could inform risk stratification approaches to improve early detection, more effectively target risk factor modification interventions to the communities at greatest risk, and advance health equity.[75,76]
Acknowledgements
We would like to acknowledge the HFGCCRI Community Research Advisory Board (CRAB) for consulting with us on the design of our TNBC research projects.
Funding
This project was supported by NIGMS (P20 GM103446) from the NIH and the State of Delaware (to S.D. Siegel).
Availability of data and materials
Datasets generated for this study from the HFGCCRI cancer registry or the Christiana Care Health System EHR are not publicly available because they contain protected health information but may be made available in a deidentified format from the corresponding author on reasonable request. Census tract datasets generated for this study based on publicly available sources, including ICE metrics and the alcohol and fast-food retailer locations, are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study was reviewed and approved by the Christiana Care Health System Institutional Review Board (CCC# 35082), which provided a waiver of informed consent (45 CFR 46.116), and was conducted in accordance with the US Common Rule.
Consent for publication
Not applicable.
Breast Cancer Res. 2022;24(37) © 2022 BioMed Central, Ltd.
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