The environment is an underutilized pathway to breast cancer prevention. Current research approaches and funding streams related to breast cancer and the environment are unequal to the task at hand. We undertook the California Breast Cancer Prevention Initiatives, a four-year comprehensive effort to set a research agenda related to breast cancer, the environment, disparities and prevention. We identified 20 topics for Concept Proposals reflecting a life-course approach and the complex etiology of breast cancer; considering the environment as chemical, physical and socially constructed exposures that are experienced concurrently: at home, in the community and at work; and addressing how we should be modifying the world around us to promote a less carcinogenic environment. Redirecting breast cancer research toward prevention-oriented discovery could significantly reduce the incidence and associated disparities of the disease among future generations.

Breast Cancer Prevention Partners (BCPP) is leading the development of a first-ever, comprehensive breast cancer primary prevention plan for California. With a strong foundation of science and input from stakeholders, including academics, government regulators, nonprofit organizations, and impacted communities, we will create a policy agenda to reduce breast cancer in California. Most women who are diagnosed with breast cancer do not have any of the risk factors commonly associated with the disease. This raises questions about how we reduce risk for breast cancer at the individual, community, and societal levels. Our project seeks to explore the full range of prevention opportunities that can contribute to a statewide effort to reduce the incidence of breast cancer. Topics under exploration include individual and environmental exposures to toxic chemicals; exposure to ionizing radiation and other physical factors; structural barriers to a healthy diet and activity levels, such as food deserts and the built environment; workplace exposures and risk factors; impact of alcohol consumption and tobacco use; and the impact of racism and poverty on breast cancer risk. While all states have cancer plans, this project offers a unique approach. It turns the focus from the individual to societal changes. The interventions recommended will address systemic, society-level issues that increase risks for breast cancer. For instance, physical activity is protective against breast cancer. However, recommending to individuals that they become more active may be less effective than creating safe, walkable neighborhoods with recreational opportunities. It incorporates the important perspectives of communities affected by breast cancer into the recommended interventions. California’s numerous and diverse communities hold valuable information about the issues relevant to their local context and have an intimate understanding of their community’s strengths and barriers to effective change. BCPP engaged community advisors and conducted listening sessions across the state as part of a multistep process to include community knowledge. We have a strong commitment to ensure that social and environmental justice permeates the entire policy agenda. The process is guided by a multistakeholder advisory committee that includes some of California’s leading breast cancer, public health, social and environmental justice, and disease prevention experts. The project will generate a California policy agenda to reduce the incidence of breast cancer in the state. BCPP will work with stakeholders to implement the agenda in the coming years. While the focus of this groundbreaking approach will be squarely on breast cancer, the recommended interventions will undoubtedly impact numerous other cancers and adverse health impacts, and while the focus will be squarely on California, it will provide a road map for other states to prioritize primary prevention of breast cancer. Citation Format: Nancy Buermeyer, Connie L. Engel, Heather Sarantis, Ashley Babcock, Josie Daaboul, Janet Young, Janet Nudelman, M. Sharima Rasanayagam. A breast cancer primary prevention plan for the state of California [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr A38.

Training and technical assistance efforts for community based participatory research (CBPR) partnerships have the potential to improve outcomes in both scientific rigor and collaboration. Successful competition for regional or national funding for CBPR represents a critical step in this trajectory. To this end, a collaboration funded through this NIEHS award has developed and implemented an intensive training program (Community Based Research Infrastructure to Better Science [CRIBS]) to build capacity among community-academic teams to conduct CBPR into disparities in breast cancer and/or environmental causes of breast cancer. The program includes face-to-face training; online training; mock grant review; and technical assistance (TA); and skill-building in creating CBPR partnerships; understanding the science of the environmental causes of and disparities in breast cancer; creating a pathway from vision to project; and writing successful grant applications. Participants in the training included 31 individuals in 12 partnerships with at least one community and one academic member in each. Fifty-five percent of participants identified as belonging to an ethnic or racial minority group; 81% identified as female; 58% identified as community partners; the mean age was 49.76 years old (median = 52; range = 23 to 71). Partnerships came from twelve locations across California. TA efforts began in the second month of F2F trainings and included: a) four, monthly, tailored, in-person consultations of up to 1.5 hrs in length; b) review of an 8-page concept paper prepared by each team; c) four, monthly, tailored one-hour phone consultations. TA was provided by CRIBS staff and representatives from national funding organizations with expertise in scientific and collaborative aspects of breast cancer research, as well as by experts in the field of CBPR, disparities, and the environment. Over time, improved clarity and specificity were evident in the research questions formulated across partnerships. Implications of tailored, technical assistance for partnerships embarking on CBPR in disparities are discussed. Citation Format: Senaida Fernandez, Marj Plumb, Catherine Thomsen, Braun Susan, Heather Sarantis, Juliana van Olphen, Emily Galpern, Marion Kavanaugh-Lynch. Technical assistance as part of capacity building for collaborative research in breast cancer, the environment, and/or disparities. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B05.

This paper describes the development and feasibility of the Community Based Research Infrastructure to Better Science (CRIBS) training. The goal of this training program was to help new or existing community-academic teams to build strong partnerships and successfully develop together fundable research projects focused on breast cancer environmental causes and disparities. A comprehensive mixed-methods participatory approach was utilized to assess the training. Twenty-two community-academic teams applied for the training program; twelve teams were enrolled. All teams completed the training and subsequently submitted research applications for funding. All components of the training received high ratings and positive qualitative comments. Self-rated competency in all of the learning domains increased during the training. Four (33%) of teams were successful in their first attempt to garner research funding, and six (50%) were eventually successful. The evaluation of CRIBS found it to have successfully achieved all four goals of the training: (1) Twelve new CBPR (community-based participatory research) teams, (2) improved knowledge about CBPR and science, (3) twelve submitted grant proposals in the first year, and (4) six (50%) successfully funded research projects.