Specialized Program of Research Excellence (SPORE) in Breast Cancer
Researchers, clinicians and public health specialists are working diligently to find new ways of detecting, treating and preventing breast cancer. Their work begins with the National Cancer Institute- funded Specialized Program of Research Excellence (SPORE) in Breast Cancer, one of six in the country.
"The purpose of this SPORE is the integration of public health, clinical and molecular sciences to better investigate etiology, prevention and early detection in breast cancer and to devise ways to reduce breast cancer mortality," explains Shelton Earp, Lineberger's director and the SPORE's principal investigator.
The SPORE has four components:
- Public Health Intervention: strives to increase the use of mammography in under-served African American populations
- Molecular Epidemiology: seeks to identify the environmental and genetic causes of breast cancer
- Gene Discovery: identifies new molecular markers of breast cancer that can be used for early diagnosis and treatment
- Clinical Developmental: Projects that produce innovative ideas for novel therapies or diagnostics
Breast cancer can be successfully treated with greater than a 90 percent cure rate if it is detected early. But less than half of women age 50 and older in the United States have regular screening mammograms -- and the number is even lower in the African-American community. In all women, breast cancer incidence increases with age, rising rapidly after age 40. Almost 80 percent of all breast cancers occur in women over 50 years of age.
The NC-BCSP is a long-term, comprehensive, multi-level community intervention program designed to increase breast cancer screening among older African-American women in five rural eastern North Carolina counties.
Its primary objectives are to:
- Increase initial and repeat mammography screening by black women ages 50 years and older
- Increase follow-up of positive screening mammograms
- Establish partnerships between health care providers and communities that will maintain increased breast cancer screening and follow-up once the grant ends
These objectives are being pursued through three complementary intervention components: OutReach, InReach and Access. OutReach efforts emphasize providing social support to women within their social networks through 160 “natural helpers” trained as lay health advisors (LHAs); the InReach and Access components are directed at lowering organizational and structural barriers to breast cancer screening. InReach focuses on health care providers and organizations, while Access addresses factors such as cost, referral systems, and transportation.
The LHAs are one of the initiative's most innovative elements.The initiative was most successful with poor women in households with family income under $12,000, and this group is generally the most difficult to reach.
Moving forward, NC-BCSP is developing a brochure on abnormal mammogram results for use by LHAs, recruiting more primary care physicians for practice-based research, organizing support for those undergoing treatment and the first breast cancer survivors group for African-Americans in eastern North Carolina, and continuing to analyze the program's effectiveness and cost-effectiveness.