Centers

Parisa Tehranifar - Lance Armstrong Young Investigator Grant Award

In the last several decades, remarkable improvements in cancer survival have been made through advances in early detection and treatment of many cancers. However, all segments of the population have not benefited equally and the burden of cancer is being disproportionately borne by socially disadvantaged racial/ethnic minorities and persons with low socioeconomic status (SES). Numerous investigations have produced important knowledge about specific pathways by which social disparities may occur for a limited number of cancers within specific time periods, but fall short of answering a fundamental question: why do social disparities in cancer vary across cancer sites and time periods?

In this young investigator application, I propose to investigate whether variations in effectiveness of screening and treatment capacities across cancer sites and time periods are associated with socioeconomic, racial and age-related disparities in cancer survival. I will test several hypotheses based on the theory that socially advantaged groups effectively use their greater access to adaptable social resources (e.g., knowledge, power, and beneficial social connections), in different or changing situations, to avoid disease or death. The usefulness of these resources for extending survival from a particular disease depends on the availability of knowledge, technology, and effective tools for treating that disease. Accordingly, we would expect to observe significant social disparities for cancers with greater screening and treatment capacities (e.g., breast, colon) and relatively smaller social disparities for cancers with more limited screening and treatment capacities (e.g., pancreas, lung). Furthermore, social disparities in cancer survival may be larger in young adults (< 40 years) who, similar to low SES and racial minority groups, have fewer adaptable resources relevant to health promotion, and have experienced the slowest improvement in cancer survival. I hypothesize that differences in survival between racial and socioeconomic groups are larger for: 1) cancers with more effective screening and treatment services than for cancers with less effective screening and treatment services; 2) cancers with greater progress in cancer screening and treatment services than cancers with minimal progress over time; and 3) young adults with cancer than middle-aged and elderly cancer patients.

This project will fill a gap in our understanding of why social disparities in cancer emerge, endure or change thereby informing policy and practice to overcome the unequal burden of cancer in our society. Support for the study hypotheses will show that advances in cancer screening and treatment will not only fail to narrow, but will exacerbate social disparities in cancer survival through greater uptake and utilization of these services by socially advantaged groups. These findings will endorse interventions that reduce the relevance of personal resources to obtaining cancer care or target population groups experiencing survival disparities.