Dr. Mandelblatt is a geriatrician with health services and epidemiology training. She is currently Director of Cancer Control at Lombardi Cancer Center. Dr. Mandelblatt has a long history of continuous peer-reviewed funding almost $31 million and centered on translational research for individuals 65 years and older (hereinafter referred to as "elderly" or "older"). Dr. Mandelblatt's focus on understanding and eliminating age and race disparities in cancer care miletus national priorities. For instance, the US Department of Health and Human Services (DHHS) has recently renewed its "war on cancer" by declaring the elimination of age (and race) disparities as a key priority. The National Cancer Institute Year 2010 goals echo this priority. The importance of these national cancer control objectives is cast on the backdrop of the changing demographic profile of the US: by the year 2030, one in five will be elderly and 40 percent will be from minority groups. Despite this "demographic imperative" and rising cancer rates with advancing age, there is a shortage of researchers trained to address the needs of diverse older populations. Dr. Mandelblatt is one a small cadre of scientists in the US with this expertise. One important cancer care gap, recently identified by the Institute of Medicine, is under use of chemotherapy. However, we know little about treatment decision making in regional breast cancer, where chemotherapy can have substantial benefits. Moreover, there is a paucity of data on quality of life and clinical outcomes of therapy in older women. Chemotherapy decision making is particularly complex for older women owing to limited age-related data on cancer biology, potential treatment toxicity, interactions of treatment and comorbidity, limitations in physical, social, and economic resources, and possible biases in care delivery. The research and mentoring proposed in this application will address these issues. The specific objectives proposed for this award are threefold: (1) To conduct theory-based research on patient preferences and clinical characteristics affecting decisions about use of systemic non-hormonal chemotherapy in older women with regional breast cancer, (2) To develop a research database infrastructure to conduct new studies about potential race and age-related biases in care, and (3) To develop a training infrastructure to develop young investigators in population sciences, behavioral research, and cancer control for older individuals. With this award, Dr. Mandelblatt will be able to continue her commitment to gero-oncology, have sufficient protected time to train new investigators in this nascent field, and address new research innovations to advance the science of cancer control at the intersection of aging.