We, along with staff from nine Michigan tribes, examined Head Start's role in American Indian lives using photovoice methodology, which puts cameras in the hands of community members to document their realities. The use of photovoice as a participatory methodology was purposeful given that it engages participants in the research process, thereby fostering research with rather than on Native peoples. Our collaboration resulted in an Indigenization of the inquiry mode yielding a more culturally relevant and respectful methodology. These adaptations included identifying and presenting Indigenous ways of knowing, both visually and verbally, as well as providing an opportunity for storytelling. The partners shared their story with impact beyond their communities as they relayed findings in multiple venues. The project has not only resulted in improved community facilities and growth and development among our community research partners but an alteration of the method to further empower Native people.
<p class="Pa7"><strong>Background: </strong>Variants of unknown significance (VUSs) have been identified in <em>BRCA1 </em>and <em>BRCA2 </em>and account for the majority of all identified sequence alterations. Notably, VUSs occur disproportionately in people of African descent hampering breast cancer (BCa) management and prevention efforts in the population. Our study sought to identify and characterize mutations associated with increased risk of BCa at young age.</p><p class="Pa7"><strong>Methods: </strong>In our study, the spectrum of mutations in <em>BRCA1 </em>and <em>BRCA2 </em>was enumerated in a cohort of 31 African American women of early age at onset breast cancer, with a family history of breast or cancer in general and/or with triple negative breast cancer. To improve the characterization of the <em>BRCA1 </em>and <em>BRCA2 </em>variants, bioinformatics tools were utilized to predict the potential function of each of the variants.</p><p class="Pa7"><strong>Results: </strong>Using next generation sequencing methods and <em>in silico </em>analysis of variants, a total of 197 <em>BRCA1 </em>and 266 <em>BRCA2 </em>variants comprising 77 unique variants were identified in 31 patients. Of the 77 unique variants, one (1.3%) was a pathogenic frameshift mutation (rs80359304; <em>BRCA2 </em>Met591Ile), 13 (16.9%) were possibly pathogenic, 34 (44.2%) were benign, and 29 (37.7%) were VUSs. Genetic epidemiological approaches were used to determine the association with variant, haplotype, and phenotypes, such as age at diagnosis, family history of cancer and family history of breast cancer. There were 5 BRCA1 SNPs associated with age at diagnosis; rs1799966 (P=.045; Log Additive model), rs16942 (P=.033; Log Additive model), rs1799949 (P=.058; Log Additive model), rs373413425 (P=.040 and .023; Dominant and Log Additive models, respectively) and rs3765640 (P=.033 Log Additive model). Additionally, a haplotype composed of all 5 SNPs was found to be significantly associated with younger age at diagnosis using linear regression modeling (P=.023). Specifically, the haplotype containing all the variant alleles was associated with older age at diagnosis (OR= 5.03 95% CI=.91-9.14).</p><p class="Pa7"><strong>Conclusions: </strong>Knowing a patient's BRCA mutation status is important for prevention and treatment decision-making. Improving the characterization of mutations will lead to better management, treatment, and BCa prevention efforts in African Americans who are disproportionately affected with aggressive BCa and may inform future precision medicine genomic-based clinical studies. <em></em></p><p class="Pa7"><em>Ethn Dis. </em>2017;27(1):169-178; doi:10.18865/ed.27.2.169</p>
