PROJECT SUMMARY Psychological distress is an important component of cancer care, and can adversely affect treatment compliance, quality of life and survival. Data about psychological distress in Black breast cancer survivors are sparse. This is an important gap given the racial disparities in breast cancer for Black women and the adverse impact of psychological distress on breast cancer outcomes. The purpose of the proposed research, “An In-depth Examination of Psychological Distress in Black Breast Cancer Survivors,” is to gain a detailed understanding of the unique role of multilevel factors on the psychological distress experience of Black breast cancer survivors, and how Black women cope with breast cancer related psychological distress. This is essential to identify potentially modifiable factors for distress management interventions in Black breast cancer survivors. A highly qualified multi-disciplinary team has been assembled to support my research and training goals. The predoctoral (F99) research project is a mixed methods study guided by the model of cancer related worries, study aims are to: 1a) leveraging an existing longitudinal cohort study compare longitudinal levels of psychological distress, and associations of sociodemographic and clinical factors and psychological distress by race in Black and White breast cancer survivors; 1b) leveraging an existing longitudinal cohort study evaluate the contribution of healthcare related (patient provider communication), and psychosocial factors (medical mistrust) on psychological distress among Black and White breast cancer survivors; 1c) Determine if healthcare related and psychosocial factors identified in aim 1b mediate and/or moderate the association between race and psychological distress; 1d) using primary qualitative focus group data describe the healthcare and psychosocial factors that contribute to distress among Black and White survivors. The postdoctoral (K00) research project’s goal is to understand Black breast cancer survivors’ strategies to cope with psychological distress. Utilizing Strauss and Corbin’s grounded theory methodology and a community engaged approach, study aim is to 2) describe Black breast cancer survivors’ strategies for coping with psychological distress using in-depth interviews. The proposed research aligns with NCI’s key research area of cancer survivorship, which among other issues prioritizes addressing psychological concerns in cancer survivors.