Breast Cancer in a Caribbean Population in Transition: Design and Implementation of the Atabey Population-Based Case-Control Study of Women in the San Juan Metropolitan Area in Puerto Rico.

Global breast cancer incidence varies considerably, particularly in comparisons of low- and high-income countries; rates may vary even within regions. Breast cancer rates for Caribbean countries are generally lower than for North America and Europe. Rates in Puerto Rico are in the middle of the range between the highest and the lowest Caribbean countries. Populations in transition, with greater variability in risk factor exposures, provide an important opportunity to better understand breast cancer etiology and as potential sources of variation in rates. Understanding of exposures across the life span can potentially contribute to understanding regional differences in rates. We describe here the design and implementation of a population-based, case-control study in the San Juan Metropolitan Area (SJMA) of Puerto Rico, the Atabey Epidemiology of Breast Cancer Study. We describe steps taken to ensure that the study was culturally appropriate, leveraging the Atabey researchers' understanding of the culture, local health system, and other required resources to effectively recruit participants. A standardized, in-person interview was developed, with attention to life course events customized to the study population. In order to understand variation in global breast cancer rates, studies customized to the populations outside of North America and Europe are required.