ABSTRACT This application will provide the candidate, Dr. Qin, with needed training and research experiences for her to grow into an independent investigator in cancer health disparities. Dr. Qin’s long-term career goal is to integrate multilevel and transdisciplinary components into cancer epidemiology research that will increase the understanding of multilevel modifiable factors affecting cancer health, especially in minority cancer populations, and will ultimately reduce cancer health disparities. African American (AA) breast cancer (BrCa) survivors have worse cardiovascular health (CVH, e.g., obesity, diabetes, unhealthy diet) compared to their white counterparts, which contributes to sizable racial disparities in BrCa mortality. Although the disproportionate burden of poor CVH among AA BrCa survivors is hypothesized to result from multilevel determinants ranging from neighborhood social and built environments to biological and molecular pathways, most studies have examined either biological or behavioral factors, neglecting the influence from neighborhood social and built environments, and cross-level associations and mechanisms. Thus, conceptualized on the NIMHD research framework, the goal of the proposed study is to investigate multilevel modifiable factors affecting BrCa survivorship (with a targeted focus on CVH) and survival among AA women. To achieve this goal, Dr. Qin will utilize the Women’s Circle of Health Follow-Up Study (WCHFS), an existing and ongoing population-based longitudinal study of AA breast cancer survivors, for four specific aims. In Aim 1, she will integrate neighborhood environment measures with WCHFS to enrich this individual-level survey and medical record data. In Aims 2 and 3, she will investigate specific modifiable neighborhood factors influencing CVH and survival of AA BrCa patients. In Aim 4, she will examine the underlying biological mechanisms between CVH and both BrCa-specific and overall survival through serum metabolomic profiling. Results from the proposed study may improve BrCa outcomes among AA women in two ways. First, in addition to a much better risk stratification of the BrCa population, investigating potentially modifiable neighborhood factors can inform stakeholder efforts in developing evidence-based, wide-reaching strategies such as land use regulations, zoning, and street design. Second, evaluating metabolomic signatures that medicate CVH and BrCa survival will have great potential to advance the use of biomarkers to monitor CVH and to guide pharmacologic interventions that will improve BrCa survival. Dr. Qin will develop additional expertise in multilevel and geospatial methods, cancer health disparities in survivorship and survival, and cancer metabolism and metabolomics through structured training and career development activities and didactic mentoring from an interdisciplinary team. The proposed training and research together with protected time are crucial to facilitate Dr. Qin’s transition into an independent investigator in cancer health disparities with expertise in conducting multilevel epidemiological studies.

PROJECT NARRATIVE Given the lowest prevalence of ideal cardiovascular health profiles in African American breast cancer survivors and their excess mortality, understanding the multilevel determinants of poor cardiovascular health is imperative to improve the breast cancer outcomes in this minority cancer population. The proposed study will identify upstream neighborhood barriers to optimal cardiovascular health in African American breast cancer survivors and downstream metabolomic signatures and mechanisms to breast cancer survival. The proposed study will provide translational insights into evidence-based neighborhood interventions, and clinical strategies on metabolic alterations among African American breast cancer survivors to collectively reduce poor cancer outcomes in this understudied population.