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Biological and Psychosocial Predictors of Psychological Functioning among African American Breast Cancer Survivors


California ranked within the top percentile among states that had the highest breast cancer mortality rates among African American women. To that end, the purpose of this dissertation was to gain an understanding of the breast cancer survivorship trajectory for African American women. The first arm utilized a qualitative approach to investigate the meaning of survivorship and utilization of resources among (n=155) African American breast cancer survivors (AABCS). Written responses were analyzed using Contemporary Narrative Inquiry (CNI). Results revealed that through their lived experiences, the participants self-identified with the meaning of survivor, exuded resilience and had a strong sense of spirituality. The Meaning of Survivorship model was developed for AABCS. The study findings revealed the important facets of their survivorship experience. The second arm of the study was comprehensive review of empirical studies of contributors to breast cancer disparities, including histopathological grade, hormone receptors, gene mutations, biological markers, age of diagnosis, parity, anthropometric factors, advanced stage at diagnosis, socioeconomic position, chronic stress burden, difference in breast cancer treatment, quality of care, and patient/physician factors. The review provided substantial evidence for development of the Biopsychosocial Model of Breast Cancer Survivorship (BBCS) for African American women. This conceptual explanatory model identified several key biological and psychosocial risk factors that may contribute to a severe disease trajectory. The final arm of the study examined the relationships between several biological predictors, specifically Estrogen (ER), progesterone (PR), triple negative breast cancer (TNBC), BReast CAncer gene ( BRCA1/2), Tumor Protein 53 (p53) age less than or equal to 45 at diagnosis, Basal Metabolic Index (BMI), age less than or equal to 30 at first pregnancy, and psychosocial risk factors (socioeconomic position [SEP], chronic stress), that may affect the psychological functioning (anxiety, depression) of African American breast cancer survivors. Using general linear modeling (GLM), a modified model was tested with a sample (n = 155) of AABCS from Northern and Southern California. Results revealed that some biological and psychological risk factors were significant predictors for anxiety and depression among AABCS. Overall, the findings from this dissertation may serve as a benchmark for collaboration of various disciplines to develop interventions that address breast cancer disparities among these women.

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