Purpose: To determine the associations between state-level indicators of structural racism and incidence of triple-negative breast cancer (TNBC) among black and white women diagnosed with breast cancer. Methods: Black and white women diagnosed with breast cancer between 2010 and 2016 were identified from 12 states represented in the Surveillance, Epidemiology, and End Results (SEER18) program. State-level disparities were measured by black to white rate ratios in educational attainment, political participation, incarceration, and unemployment; and dichotomized to “high” or “low” structural racism using the median rate ratio of the 12 states. Logistic regression was used to examine the associations between indicators of structural racism and TNBC among black and white women. Results: Living in states with high levels of structural racism in the domains of educational attainment, judicial treatment, and political participation were generally associated with greater odds of TNBC among black and white women. The increased odds of TNBC was greater for black women living in states with high levels of racial disparities than white women. Among black women diagnosed with breast cancer, the odds ratio (OR) of being diagnosed with TNBC comparing women living in states with high disparities in educational attainment versus those with low disparities was 1.50 (95% confidence interval [CI]: 1.27–1.77). For white women, the OR for educational attainment was 1.17 (95% CI: 1.10–1.23). Conclusion: Results from this study support the notion that racial health disparities need to be contextualized. Further research should address mechanisms through which structural racism influences health disparities.
International research and collaboration has been a part of the National Cancer Institute’s (NCI) mission since its creation in 1937. Early on, efforts were limited to international exchange of information to ensure that U.S. cancer patients could benefit from advances in other countries. As NCI’s research grant portfolio grew in the 1950s, it included a modest number of grants to foreign institutions, primarily in the U.K. and Europe. In the 1960s, the development of geographic pathology, which aimed to study cancer etiology through variations in cancer incidence and risk factors, led to an increase in NCI funded international research, including research in low- and middle-income countries. In this paper, we review key international research programs, focusing particularly on the first fifty years of NCI history. The first NCI-led overseas research programs, established in the 1960s in Ghana and Uganda, generated influential research but also struggled with logistical challenges and political instability. The 1971 National Cancer Act was followed by the creation of a number of bilateral agreements with foreign governments, including China, Japan, and Russia, to support cooperation in technology and medicine. While these agreements were broad without specific scientific goals, they provided an important mechanism for sustained collaborations in specific areas. With the creation of the NCI Center for Global Health in 2011, NCI’s global cancer research efforts gained sustained focus. While the global cancer burden has evolved over time, increasingly impacting low- and middle-income countries, NCI’s role in global cancer research remains more important than ever.
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