From Cause to Intervention
U-M researcher leads investigation of breast cancer disparities among Native
American women
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Marilyn Roubidoux
Photo: Martin Vloet |
While developing a presentation on breast cancer several years ago, Marilyn
Roubidoux, M.D., an associate professor of radiology in the U-M Medical School,
found a vast amount of research exploring factors which influence a woman's
propensity for the disease — and little on how these underlying factors affect
racial and ethnic minorities. "There were few articles about breast cancer
risk factors in minority women and nothing at all on Native American women," says
Roubidoux. "I thought we ought to study this in minority populations as well
as Caucasians."
Roubidoux subsequently became the first investigator to review and report
on Native American women's mammogram results. She has researched family history
for breast cancer, breast tissue density and other risk factors among Aleut
and Eskimo women in Alaska, native tribes in the southwest, and Sioux tribes
in South Dakota.
From these data, Roubidoux has attempted to evaluate whether the Gail Model
— a widely used screening tool for assessing breast cancer risk — is appropriate
and effective for Native American women. "We don't know whether the Gail Model
really fits in a native population, because it is based on research which studied
white women," she says. "The same question has been raised regarding African-American
women."
Her research also delves into differences within the native population. Breast
cancer incidence and mortality rates are six times higher among Native American
women in Alaska and the northern plains states, for example, than they are
in the Southwest. Understanding the reasons for these variations — which could
involve diet, smoking, lifestyle, genetics, breastfeeding and childbirth practices,
and the ages at which menstruation begins and menopause occurs — could have
benefits far beyond the Native American population, Roubidoux says. "The disparities
between native groups might give us a clue about the factors contributing to
breast cancer," she says. "Once you understand the causes you can create interventions."
Native American women are less likely than women from other racial groups
to contract breast cancer, but more likely to die within five years when it
is detected — which may suggest that limited access to screening is delaying
diagnosis and treatment. "Findings among the native population can potentially
benefit all rural or underserved women," Roubidoux says.
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