Abstract"Neighborhoods and health" research has shown that area social factors are associated with the health outcomes that patients with cancer experience across the cancer control continuum. To date, most of this research has been focused on the attributes of urban areas that are associated with residents' poor cancer outcomes with less focused on attributes of rural areas that may be associated with the same. Perhaps because there is not yet a consensus in the United States regarding how to define "rural," there is not yet an accepted analytic convention for studying issues of how patients' cancer outcomes may vary according to "rural" as a contextual attribute. The research that exists reports disparate findings and generally treats rural residence as a patient attribute rather than a contextual factor, making it difficult to understand what factors (e.g., unmeasured individual poverty, area social deprivation, area health care scarcity) may be mediating the poor outcomes associated with rural (or non-rural) residence. Here, we review literature regarding the potential importance of rural residence on cancer patients' outcomes in the United States with an eye towards identifying research conventions (i.e., spatial and analytic) that may be useful for future research in this important area. Cancer Epidemiol Biomarkers Prev; 22(10); 1657-67. Ó2013 AACR.

Computer-administered food frequency questionnaires (FFQs) can address limitations inherent in paper questionnaires, by allowing very complex skip patterns, portion size estimation based on food pictures and real-time error checking. This manuscript evaluates a web-based FFQ, the Graphical Food Frequency System (GraFFS). Participants completed the GraFFS, six, telephone-administered 24-hr dietary recalls over the next 12 weeks, followed by a second GraFFS. Participants were 40 men and 34 women, ages 18–69, living in the Columbus, OH area. Intakes of energy, macronutrients and 17 micronutrients/food components were estimated from the GraFFS and the mean of all recalls. Bias (recalls minus the second GraFFS) was −9%, −5%, +4% and −4% for energy and percentages of energy from fat, carbohydrate and protein. De-attenuated, energy-adjusted correlations (inter-method reliability) between the recalls and the second GraFFS for fat, carbohydrate, protein and alcohol were 0.82, 0.79, 0.67 and 0.90; for micronutrients/food components the median was 0.61 and ranged from 0.40 for zinc to 0.92 for β-carotene. The correlations between the two administrations of the GraFFS (test-retest reliability) for fat, carbohydrate, protein and alcohol were 0.60, 0.63, 0.73 and 0.87; among micronutrients/food components the median was 0.67 and ranged from 0.49 for vitamin B12 to 0.82 for fiber. The measurement characteristics of the GraFFS were at least as good as those reported for most paper FFQs, and its high inter-method reliability suggests that further development of computer-administered FFQs is warranted.

Background: The disproportionate burden of more aggressive breast cancer subtypes among African American/Black women may stem from multilevel determinants. However, data are limited regarding the impacts of neighborhood social environmental characteristics among Black women. Methods: We evaluated the association between neighborhood-level socioeconomic status (nSES) and breast cancer subtypes in the Women's Circle of Health and Women's Circle of Health Follow-up Study, which included 1,220 Black women diagnosed from 2005 to 2017 with invasive breast cancer. nSES at diagnosis was measured using NCI's census tract-level SES index. We used multilevel multinomial logistic regression models to estimate the association of nSES with breast cancer subtypes [triple-negative breast cancer (TNBC), HER2-positive vs. luminal A], adjusting for individual-level SES, body mass index, and reproductive factors. We tested for interactions by neighborhood racial composition. Results: Compared with census tracts characterized as high nSES, the relative risk ratios (RRR) for TNBC were 1.81 [95% confidence interval (CI): 1.20–2.71] and 1.95 (95% CI: 1.27–2.99) for women residing in areas with intermediate and low nSES, respectively (Ptrend = 0.002). Neighborhood racial composition modified the association between nSES and TNBC; the highest relative risk of TNBC was among women residing in low nSES areas with low proportions of Black residents. Conclusions: Black women residing in socioeconomically disadvantaged neighborhoods may have an increased risk of TNBC, particularly in areas with lower proportions of Black residents. Impact: Places people live may influence breast tumor biology. A deeper understanding of multilevel pathways contributing to tumor biology is needed.

Patient navigation (PN) may reduce cancer health disparities. Few studies have investigated the effects of PN on patient-reported satisfaction with care or assessed patients' satisfaction with navigators. The objectives of this study are to test the effects of PN on patient satisfaction with cancer care, assess patients' satisfaction with navigators, and examine the impact of barriers to care on satisfaction for persons with abnormal cancer-related screening tests or symptoms. Study participants included women and men with abnormal breast, cervical, or colorectal cancer screening tests and/or symptoms receiving care at 18 clinics. Navigated (n=416) and non-navigated (n=292) patients completed baseline and end-of-study measures. There was no significant difference between navigated and non-navigated patients in change in patient satisfaction with cancer care from baseline to exit. African-American (p<0.001), single (p=0.03), low income (p<0.01), and uninsured patients (p<0.001) were significantly less likely to report high patient satisfaction at baseline. A significant effect was found for change in satisfaction over time by employment status (p=0.04), with full-time employment showing the most improvement. The interaction between satisfaction with navigators and satisfaction with care over time was marginally significant (p=0.08). Baseline satisfaction was lower for patients who reported a barrier to care (p=0.02). Patients reporting other-focused barriers (p=0.03), including transportation (p=0.02), had significantly lower increases in satisfaction over time. Overall, results suggested that assessing barriers to cancer care and tailoring navigation to barrier type could enhance patients' experiences with health care. PN may have positive effects for healthcare organizations struggling to enhance quality of care.

Background-Few studies have empirically tested the association of allostatic load (AL) with breast cancer clinicopathology. The aim of this study was to examine the association of AL, measured using relevant biomarkers recorded in medical records before breast cancer diagnosis, with unfavorable tumor clinicopathologic features among Black women.Methods-In a sample of 409 Black women with non-metastatic breast cancer, who are enrolled in the Women's Circle of Health Follow-Up Study (WCHFS), we estimated pre-diagnostic AL using two measures: AL measure 1 (lipid profile-based -assessed by systolic and diastolic blood pressure [SBP, DBP], high-density lipoprotein, low-density lipoprotein, total cholesterol, triglycerides and glucose levels, waist circumference, and use of diabetes, hypertension, or hypercholesterolemia medication) and AL measure 2 (inflammatory index-based -assessed by SBP, DBP, glucose and albumin levels, estimated glomerular filtration rate, body mass index, waist circumference, and use of medications described above). We used Cohen's kappa statistic to assess agreement between the two AL measures and multivariable logistic models to assess the associations of interest.

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Key Points Question Is historical mortgage lending discrimination (1930s redlining) associated with recent breast cancer outcomes differently by race and ethnicity? Findings In this cohort study of 14 964 breast cancer cases, we found evidence that residence at diagnosis in areas historically graded “best” (vs residence in redlined areas) was associated with lower odds of late-stage diagnosis, lower odds of high tumor grade, lower odds of triple-negative subtype, and lower hazard of breast cancer–specific death, but only among non-Latina White women. Meaning These findings suggest that historical structural racism may be associated with beneficial cancer outcomes among privileged racial and ethnic groups.