Abstract P1-17-03: Impact of a culturally syntonic door-to-door breast cancer early detection intervention

BackgroundLate stage of cancer at diagnosis is an important predictor of cancer mortality. In many areas worldwide, cancer registry systems, available data and mapping technologies can provide information about late stage cancer by geographical regions, offering valuable opportunities to identify areas where further investigation and interventions are needed. The current study examined geographical variation in late stage breast cancer incidence across eight states in the United States with the objective to identify areas that might benefit from targeted interventions.MethodsData from the Surveillance Epidemiology and End Results Program on late stage breast cancer incidence was used as dependent variable in regression analysis and certain factors known to contribute to high rates of late stage cancer (socioeconomic characteristics, health insurance characteristics, and the availability and utilization of cancer screening) as covariates. Geographic information systems were used to map and highlight areas that have any combination of high late stage breast cancer incidence and significantly associated risk factors.ResultsThe differences in mean rates of late stage breast cancer between eight states considered in this analysis are statistically significant. Factors that have statistically negative association with late stage breast cancer incidence across the eight states include: density of mammography facilities, percent population with Bachelor’s degree and English literacy while percent black population has statistically significant positive association with late stage breast cancer incidence.ConclusionsThis study describes geographic disparities in late stage breast cancer incidence and identifies areas that might benefit from targeted interventions. The results suggest that in the eight US states examined, higher rates of late stage breast cancer are more common in areas with predominantly black population, where English literacy, percentage of population with college degree and screening availability are low. The approach described in this work may be utilized both within and outside US, wherever cancer registry systems and technologies offer the same opportunity to identify places where further investigation and interventions for reducing cancer burden are needed.

The COVID-19 pandemic caused unprecedented disruptions in healthcare access, resulting in significant delays in breast and cervical cancer screening and diagnostic services. This study examined whether there were changes in the stage of diagnosis for breast and cervical cancers diagnosed among Utah women during the pandemic compared to years prior to the pandemic. Patients included adult females with a new breast or cervical cancer diagnosis reported to the Utah Cancer Registry, diagnosed from January 2020 to December 2021 (pandemic time period) or between January 2018 and December 2019 (pre-COVID-19). We calculated age-adjusted incidence rates and incidence rate ratios (IRRs) with 95% confidence intervals (CI) to compare stage at diagnosis and sociodemographic factors between time periods. A total of 308 cervical cancer cases and 8215 breast cancer cases were diagnosed throughout the duration of the study. Overall incidence of cervical cancer was higher during the pandemic, driven primarily by distant-stage disease incidence, which was more than three times higher than before the pandemic (IRR, 3.11; 95% CI, 1.67-5.79). Non-Hispanic (NH) White women were significantly more likely to be diagnosed with late-stage cervical cancer (IRR, 1.60; 95% CI, 1.12-2.30) during the pandemic compared to pre-pandemic. Local-stage breast cancer incidence decreased slightly during the pandemic compared to pre-pandemic (IRR, 0.93; 95% CI, 0.88-0.99). Hispanic women saw a slight increase in late-stage breast cancer incidence during the pandemic compared to before the pandemic (IRR, 1.31; 95% CI, 1.03-1.67). We saw a significant increase in the incidence of late-stage cervical cancer during the pandemic compared with pre-pandemic. Conversely, while local-stage breast cancer incidence was slightly lower during COVID-19 compared with pre-COVID-19, no difference was observed among all other stages. More time is needed to assess the full impact of COVID-19 on breast and cervical cancer trends.

Introduction: Non-Hispanic (nH) Black and Hispanic women are more likely than their nH White counterparts to be diagnosed at a later stage of breast cancer. Potential explanations for this stage disparity include racial/ethnic differences in biological aggressiveness of breast cancer, differences in utilization of screening, and differences in the quality of the screening process. The purpose of these analyses was to examine whether quality of mammography interpretation as performed by the original reading radiologist varied by patient sociodemographic characteristics. We hypothesized that the proportion of potentially missed cancers at original interpretation would be greater in more disadvantaged patient groups (nH Black and Hispanic patients, lacking private health insurance, with lower income and education), such that it might contribute to disparities in stage at diagnosis. Methods: The “Breast Cancer Care in Chicago” study included 989 recently diagnosed nH Black, Hispanic and nH White breast cancer patients residing in Chicago and diagnosed in 2005–2008. Patients reporting either initial awareness of their breast cancer through screening mammography or initial awareness through symptoms despite a prior mammogram within 2 years of detection were eligible for this substudy (N=597). Of these, 369 (62%) consented to a review of their mammogram and other breast images involved in their screening and diagnosis. Original mammograms and diagnostic follow-up images and corresponding reports were requested from screening and diagnostic facilities. Often, multiple facilities were involved for a single patient. For 185 patients, we were able to obtain the original index mammogram (that detected the breast cancer) and the original prior mammogram (that did not detect the cancer), and these 185 patients are the subject of these analyses. A single breast imaging specialist (EC) performed a blinded review of the prior mammogram (blinded to the original interpretation and all other subsequent screening and diagnostic images and results), followed by an unblinded review of the index mammogram (mammogram at time of diagnosis). All reviews were blinded to patient age, race/ethnicity and other sociodemographic characteristics. If an actionable lesion (BIRADs category 0, 4 or 5) on the prior film was found in the same breast and quadrant as the cancer seen on the index mammogram, it was considered a potentially detectable lesion. Results: Of 185 prior mammograms read as non-malignant by the original radiologist, 44% (N=82) had a potentially detectable lesion. The probability of a potentially detectable lesion was greater among patients lacking health insurance or with public but no private insurance, compared to those with private insurance (63% vs. 39%, respectively, p=0.005). The probability of a potentially detectable lesion was also greater for patients reporting annual household incomes below $30,000 compared to higher income patients (59% vs. 37%, respectively p=0.006) as well as minority compared to nH White patients (52% vs. 38%, p=0.04). Similar though insignificant trends were seen for lower vs. greater education. Conclusions: Disadvantaged socioeconomic status appears to be associated with lower quality mammography interpretation for malignancy, and may be contributing to racial/ethnic disparities in breast cancer stage at diagnosis. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B97.

Breast cancer diagnosis in Inner-City African American and Hispanic women: The importance of early screening

After the introduction of a mammography screening program, the incidence of late-stage breast cancer is expected to decrease. The objective of the current study was to evaluate variations in the total incidence of breast cancer and in the incidence of breast cancers with a pathologic tumor (pT) classification of pT2 through pT4 after the introduction of mammography screening in 6 Italian administrative regions. The study area included 700 municipalities, with a total population of 692,824 women ages 55 to 74 years, that were targeted by organized mammography screening between 1991 and 2005. The year screening started at the municipal level (year 1) was identified. The years of screening were numbered from 1 to 8. The ratio of the observed 2-year, age-standardized (Europe) incidence rate to the expected rate (the incidence rate ratio [IRR]) was calculated. Expected rates were estimated assuming that the incidence of breast cancer was stable and was equivalent to that in the last 3 years before year 1. The study was based on a total of 14,447 incident breast cancers, including 4036 pT2 through pT4 breast cancers. The total IRR was 1.35 (95% confidence interval, 1.03-1.41) in years 1 and 2, 1.16 (95% confidence interval, 1.10-1.21) in years 3 and 4, 1.14 (95% confidence interval, 1.08-1.20) in years 5 and 6, and 1.14 (95% confidence interval, 1.08-1.21) in years 7 and 8. The IRR for pT2 through pT4 breast cancers was 0.97 (95% confidence interval, 0.90-1.04) in years 1 and 2, 0.81 (95% confidence interval, 0.75-0.88) in years 3 and 4, 0.79 (95% confidence interval, 0.73-0.87) in years 5 and 6, and 0.71 (95% confidence interval, 0.64-0.79) in years 7 and 8. A significant and stable decrease in the incidence of late-stage breast cancer was observed from the third year of screening onward, when the IRR varied between 0.81 and 0.71.

Introduction: Recent evidence indicates that black women living in highly segregated metropolitan areas when diagnosed with breast cancer may receive their diagnosis at an earlier stage and have reduced cancer-specific and all-mortality rates if their neighborhood has a higher proportion of black residents. We conducted a cross-sectional, multilevel analysis of California Cancer Registry records merged with data from the California Neighborhoods Data System to determine whether the odds of having estrogen and progesterone negative (ER-/PR-) breast cancer are also reduced under similar neighborhood sociodemographic conditions. Methods: A total of 88,205 non-Hispanic white, non-Hispanic black, and Hispanic women, ages 18 to 108 at diagnosis with invasive breast cancer between 1996 and 2004 and lived in a census block group within a California metropolitan statistical area (MSA) were included in the analysis. Block groups were used as the neighborhood-level unit of analysis. Racial residential segregation was assessed at the MSA level and was operationalized using the multigroup entropy index, a measure of “evenness,” or the degree to which all racial groups present in an MSA are evenly distributed across its component parts (i.e., census tracts). Results: Controlling for block group socioeconomic status and individual sociodemographic and tumor characteristics, higher percent of black residents in a neighborhood significantly reduced the odds of having ER-/PR- breast cancer relative to having ER+/PR+ cancer among black women (-3.7% for every 10% increase in black neighborhood residents; p = 0.01). When the analysis was further stratified by multigroup entropy scores, black women residing in highly segregated MSA's had a similar reduction in ER-/PR- risk (-3.8% for every 10% increase in black neighborhood residents; p = 0.02), but the reduction was only marginally significant in less segregated MSA's (-4.1% for every 10% increase in black neighborhood residents; p = 0.10). There was a modest increase in the risk of ER-/PR- subtype among Hispanics not accounting for segregation(+4.6% for every 10% increase in black neighborhood residents; p = 0.053), and among Hispanics living in less segregated MSA's (+7.0% for every 10% increase in black neighborhood residents; p = 0.074), but not among Hispanics living in more segregated metropolitan areas. No associations between neighborhood black composition and ER-/PR- subtype were observed among whites. The neighborhood concentration of Hispanic residents generated a different pattern of ER-/PR- risk. Among Hispanic women, greater percentages of Hispanic neighborhood residents increased the odds of having ER-/PR- versus ER+/PR+ breast cancer (+2.7% for every 10% increase in Hispanic neighborhood residents, p < 0.01). Similar increases in risk were seen among non-Hispanic white women (+1.9% for every 10% increase in Hispanic neighborhood residents, p = 0.01), but there was no association among blacks. Stratifying on MSA-level racial segregation, we found similarly significant increases in ER-/PR- risk among whites and Hispanics within both more and less segregated metropolitan areas. No statistically significant relationship was noted among black women residing in low segregation MSA's, but there was a marginally significant decrease in ER-/PR- risk among black residents of more highly segregated MSA's (-4.1% for every 10% increase in Hispanic block group residents; p = 0.05). Conclusions: The racial/ethnic composition of neighborhoods is associated with the risk of ER-/PR- subtype among Californian women diagnosed with breast cancer. This relationship differs across racial/ethnic groups, and to a lesser extent, by the degree of race-based residential segregation across the broader metropolitan area. Citation Format: Erin Linnenbringer, Scarlett Lin Gomez. Neighborhood racial concentration and hormone receptor status among California women diagnosed with breast cancer. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B27. doi:10.1158/1538-7755.DISP13-B27

To retrospectively determine the influence of comparing current mammograms with prior mammograms on breast cancer detection in screening and to investigate a protocol in which prior mammograms are viewed only when necessary. Institutional review board approval was not required. Participants gave written informed consent. Twelve experienced screening radiologists read 160 soft-copy screening mammograms twice, once with and once without prior mammograms. Eighty mammograms were obtained in women in whom breast cancer was diagnosed later; the other 80 mammograms had been reported as normal or benign. All cancers were visible in retrospect. Readers located potential abnormalities, estimated likelihood of malignancy for each finding, and indicated whether prior mammograms were considered necessary. The effect of prior mammograms on detection was determined by computing the mean lesion localized fraction in a range of low fractions of nonlesion locations corresponding to operating points in screening. Scores for both reading sessions were combined to assess the effect of making prior mammograms available only when requested. Data were analyzed by comparing the number of localized lesions between the two reading conditions with a paired two-tailed Student t test and applying a linear mixed model to test differences in average mean lesion localized fraction between reading conditions. P values less than .05 indicated statistical significance. Without prior mammograms, significantly more annotations were made. When only positive cases were considered, no difference was observed. Reading performance was significantly better when prior screening mammograms were available. At fixed lesion localized fraction, nonlesion localized fraction was reduced by 44% (P<.001) on average when prior mammograms were read. Performance was also increased for combined reading mode (ie, when prior mammograms were available on request only). However, this increase was smaller than that when prior mammograms were always available. Prior mammograms were requested in 24%-33% of all cases and were requested more often in positive cases. Comparison with prior mammograms significantly improves overall performance and can reduce referrals due to nonlesion locations. Limiting the availability of prior mammograms to cases selected by the reader reduces the beneficial effect of prior mammograms.

In the United States, obesity prevalence has been increasing steadily over the years in all racial/ethnic groups, but is markedly higher in African American (AA) (57.2%) and Hispanic women (46.9%), compared to non-Hispanic white (NHW) (38.2%) and NH Asian (12.4%) women (1). Obesity has been shown to affect cancer risk and progression and can also play a role on disease presentation, treatment efficacy and toxicity, and complicate clinical management of cancer due to obesity-related comorbidities such as hypertension and diabetes (2). Given the high prevalence of obesity in African American and Hispanic women and different metabolic consequences, understanding how it influences cancer risk, detection, disease presentation, clinical management, and progression and possible differences by race/ethnicity is crucial. Breast cancer is the most common cancer among women worldwide, with wide variation in incidence and mortality across geographic regions. In the US, incidence rates have been historically higher in NHW women, but AA and Hispanic women tend to develop the disease at an earlier age and with more aggressive features. In particular, they are more likely to get ER- and triple-negative (TN) tumors, which are more difficult to treat and have worse prognosis. More recent data show that incidence rates in NHW and AA women converged in 2012 due to an increase in incidence in AA women and relatively stable incidence in NHW women3. Death rates are higher in AA than in NHW women, and this mortality difference has been widening over time. Causes of these disparities in risk and survival are likely to be multifactorial, and obesity has been implicated. There is strong evidence, mostly from studies conducted in NHW women, that obesity and weight gain during adulthood are associated with increased risk of postmenopausal breast cancer, particularly among women not using menopausal hormone therapy (4). Obesity during adolescence and young adulthood has been associated with reduced breast cancer risk (4). There is also growing evidence that the association differs by hormone receptor subtype, and that what we have historically known for the association of obesity and breast cancer only applies to ER+ tumors. Few studies have evaluated the association of obesity with the risk of ER- and TN breast cancer and the evidence is inconsistent. In the AMBER Consortium (5), which included four studies in AA women, we found that for ER+ breast cancer, obesity reduced risk for premenopausal women and increased risk for postmenopausal women. However, the risk of TN breast cancer was reduced for postmenopausal women with high BMI, but elevated for those with a high waist-to-hip ratio. One possible explanation for these findings is that TN tumors may be more influenced by components of the metabolic syndrome (central obesity, insulin resistance, dyslipidemia, hypertension) than by estrogens, as suggested by others (6). While more limited, there is growing evidence that obesity is associated with worse breast cancer outcomes, particularly for HR+ tumors (7), with no conclusive evidence on differences by race/ethnicity. Ovarian cancer is the most lethal gynecologic cancer. With difficulties in early detection due to vague symptoms and the lack of effective screening tools, 60% of ovarian malignancies are detected when the disease is already at distant stage when 5-year survival is only 29% (8). Compared to NHW, incidence is lower in AA and Hispanic women, but survival is worse in both groups, after adjusting for age and stage (9) comparable to the incidence and mortality differences observed for breast cancer. Little is known about how the epidemiology of ovarian cancer may differ by race/ethnicity, but there is suggestive evidence that there may be differences in risk profiles, tumor subtype distribution, and clinical management, which may all be affected by obesity. For example, in KP ROCS (Kaiser Permanente Research on Ovarian Cancer Survival), a cohort study of ovarian cancer patients among Kaiser Permanente Northern California members, AA and Hispanic women were more likely to have chemotherapy dose reduction and unfavorable survival compared to NHW, after adjusting for clinical characteristics and detailed treatment information (10). Obesity was the most important predictor of chemotherapy dose reduction (11). There is a general misconception that obesity is not prevalent among ovarian cancer patients. In KP ROCS, 58.5% of AA and 40.7% of Hispanic ovarian cancer patients were obese at diagnosis, compared to 29.5% of NHW (10). Fewer than 1% of Hispanic women and none of the AA women were underweight at diagnosis. In AACES (African American Cancer Epidemiology Study), a multisite case-control study of ovarian cancer in AA women, 61.8% of the cases were obese approximately one year before diagnosis (12). There is growing evidence that obesity increases ovarian cancer risk (13), but most studies were conducted in NHW women. In AACES, we found elevated risk of ovarian cancer with higher BMI and weight gain during adulthood among AA postmenopausal women (12). The impact of body mass index (BMI) on ovarian cancer survival is less clear, but meta-analyses and pooled analyses have suggested that obesity before an ovarian cancer diagnosis might be associated with lower survival, with weaker evidence for BMI at diagnosis. In KP ROCS we found that the association of prediagnosis and at-diagnosis obesity with ovarian cancer varied by stage, with lower survival among obese women with localized disease and better survival among obese women with late-stage disease (14). We found no major differences by race/ethnicity in the impact of obesity on survival, but statistical power was limited as analyses included few AA and Hispanic women. Conclusion: There is growing evidence that higher body fatness is associated with increased breast and ovarian cancer risk and worse outcomes after diagnosis with these cancers, but there are multiple research gaps to fully understand these associations (15). Better methods are needed to measure adiposity, but tools also need to be feasible for use in population-based studies to allow the inclusion of large and multiethnic populations. The role of obesity on cancer risk and survival needs to be evaluated by tumor subtype, menopausal status, use of menopausal hormone therapy, and racial/ethnic subgroup with consideration of country of origin and genetic ancestry. The impact of body fatness during critical exposure windows and the impact of weight changes throughout the cancer continuum are also poorly understood. Cancer survival studies need to take into account prognostic factors, including chemotherapy dosing and obesity-related comorbidities that can have a direct impact on cancer clinical management and survival.

Introduction: False-positive mammographic screening results are one of the most important harms of breast cancer screening, and their prevalence in the insured population range from 8.7% to 16.3% during the first screening encounter. However, false-positive results have been rarely investigated among uninsured minority women screened through community outreach programs. For this study, we analyzed data from the Breast Screening and Patient Navigation (BSPAN) program participants with an aim to report prevalence and assess correlates of false-positive results in screening mammograms, stratified by age. Methods: BSPAN, created by Moncrief Cancer Institute, contracts with the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and uses a hub-and-spoke model to provide patient navigation and no-cost breast cancer screening and diagnostic services to under- and uninsured predominantly minority women in North Texas. We defined false-positive result as a positive screening mammogram (BI-RADS 0, 3, 4 or 5) followed by a negative diagnostic mammogram (BI-RADS 1, 2 or 3) or a negative biopsy within 9 months of the screen. We used multivariable logistic regression to assess associations of demographic and clinical covariates with false positive results for each age group (40-49 years and 50-64 years, which coincides with age eligibility for NBCCEDP). Results: BSPAN provided screening services to 21,022 women between 2012 and 2019. Prevalence of false-positive results in these women was 11.8% in the 40-49 age group and 9.6% in the 50-64 age group. Multivariable logistic regression demonstrated that, in the 40-49 age group, women who were non-menopausal, did not use hormone replacement therapy, and had prior mammograms had higher odds of false-positive results than those who were menopausal, used hormone replacement therapy and had no prior mammograms, respectively. In the 50-64 age group, women with a prior diagnostic mammogram had higher odds of false-positive results than those without a prior diagnostic mammogram. Discussion: This study establishes contemporary evidence regarding prevalence and correlates of false-positive rates in the unique BSPAN population, where women were predominantly Hispanic, under- and uninsured receiving no-cost screening and diagnostic services through a real-world outreach program. Our findings demonstrate that uninsured women who receive no-cost mammograms are similar to insured women in two aspects: prevalence of false-positive rates in our study is comparable to those among insured population, and we found higher false positive rates among younger women, compared to older women. Impact: Equitable screening outcomes in underserved population emphasizes the need for efforts to reduce false-positive screening rates among uninsured women served through community outreach programs. Citation Format: Rasmi G. Nair, Simon J. Craddock Lee, Hong Zhu, Firouzeh K. Arjmandi, Emily Berry, Keith E. Argenbright, Jasmin A. Tiro, Celette S Skinner. Prevalence and correlates of false-positive results in screening mammography among uninsured women in a community outreach program [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-257.

Background: We examined racial/ethnic differences in Charlson comorbidity index scores (CCI) pre and post breast cancer (BC) diagnosis among Non-Hispanic White (NHW), Hispanic, and African-American (AA) women. Methods: We conducted a retrospective chart review to calculate CCI scores (excluding age and BC) for 387 women diagnosed with BC between December 2013 and June 2017 at the University of Illinois Hospital and Health Sciences System. Using all available electronic records, we used International Chronic Disease 9 and 10 codes to determine presence or absence of a chronic condition pre and post BC diagnosis. Data was collected on race, ethnicity, stage, age at diagnosis, and vital status. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for associations between race/ethnicity and CCI among BC patients. Results: Of the 387 BC patients, 63% were AA, 15% were Hispanic, and 16% were NHW. Mean ages were 56, 56, and 57 years, respectively. 217 women had a CCI of 0 (no comorbidity), 101 women had a CCI ≥1 at their BC diagnosis (mean CCI 4.8), and 69 women developed at least one chronic condition after their BC diagnosis (mean CCI 5.2; with a mean duration of follow-up of 1.9 years). AA women had a higher average CCI score compared to Hispanic and NHW women (CCI= 4.3 versus 3.9 &amp; 3.3, p=0.006). Although not statistically significant, mean CCI scores were higher for Hispanic versus NHW women (CCI= 3.9 vs 3.3, p=0.08). At the time of their BC diagnosis, AA and Hispanic women were 2.2 times more likely to have a CCI ≥ 1 compared to NHW women [(AA vs NHW 95% CI (1.3-3.9), p=0.004); (Hispanic vs NHW 95% CI (1.1-4.3), p=0.02)]. Overall, compared to NHW women, AA women were 3.1 times more likely to have a cancer diagnosis other than breast [95% CI (1.1-8.9), p=0.04] and 5.4 times more likely to suffer from heart failure [95% CI (1.3-23.3), p=0.02]. Compared to NHW women, rates of diabetes were 2.3 times higher among AA women [95% CI (0.95-5.7), p=0.06] and 3.9 times higher among Hispanic women [95% CI (1.4-10.9), p=0.008]. Of the women with a CCI=0 at the time of their BC diagnosis, AA women were 3.3 times more likely [95% CI (1.3-8.1), p=0.01] and Hispanic women were 2.9 times more likely [95% CI (1.0-8.6), p=0.05] to go on to develop at least one chronic condition compared to NHW women. Additionally, of the women who died (n=16), AA and Hispanic women were diagnosed with BC at significantly younger mean ages compared to NHW women [(AA mean age=55 years; Hispanic mean age=64 years; NHW mean age=88 years; p=0.05)]. Conclusion: AA and Hispanic women enter their BC diagnosis with higher mean CCI scores and are more likely to develop ≥1 chronic health condition after their BC diagnosis. Our findings suggest that the burden of chronic disease both before and after BC diagnosis is greater for minority vs. NHW BC survivors. Future studies examining how this impacts survivorship for minority women are warranted. Citation Format: Alpana Kaushiva, Susan Hong. Charlson comorbidity index scores before and after breast cancer diagnosis among a racially diverse cohort of women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4236.

Background/Purpose. Breast Cancer (BC) is the most commonly diagnosed cancer and the second leading cause of cancer related deaths for women in Texas (TX). In the border county of El Paso, TX, the breast cancer incidence and mortality rates are higher for Hispanic women relative to all races combined. Evidence indicates that breastfeeding can be protective against BC by (1) limiting breast cells’ ability to act abnormally, (2) lowering estrogen levels, and (3) promoting healthier lifestyle choices. Research also indicates that the longer a woman breastfeeds, the lower her risk of developing BC. Unfortunately, among all infants born in TX in 2015, only 48% were exclusively breastfed for up to 3 months and only 24.1% were exclusively breastfed for up to 6 months. The goal of the Breastfeeding Breast Cancer Connection Program (BFBCCP) is to increase intent to breastfeed among Hispanic women of childbearing age (18-44 years) by providing a brief education intervention focused on the importance of breastfeeding and BC prevention. Methods. Study participants included 50 Hispanic women of childbearing age living at the El Paso Housing Authority in El Paso, TX. The study consisted of an intervention group (n=25) and a control group (n=25). The control group received only educational brochures about breastfeeding, whereas, the intervention group received an educational presentation about the importance of breastfeeding and BC prevention. Measures assessed in this study included: 1) knowledge of breastfeeding and BC 2) attitudes towards breastfeeding in the workplace, and 3) behavioral intentions to breastfeed. All measures were assessed via a pre and post self-report survey in the participants preferred language. Results/Findings. Overall, Hispanic women participating in the BFBCCP learned more about the importance of breastfeeding, particularly as it relates to BC prevention, reported greater levels of intent to breastfeed, and reported more positive attitudes towards breastfeeding in the workplace compared to the control group. Given their high BC incidence and mortality rates, Hispanic women in the TX border region would benefit from interventions like BFCCP that promote exclusive breastfeeding for a duration of six mos. to one year as a means of reducing their BC risk. The next step is to assess the efficacy of the BFCCP in increasing breastfeeding completion and duration among pregnant Hispanic women. Citation Format: Karoline Sondgeroth, Rosalba Ruiz-Holguin, Joe Padilla, Rebeca Ramos, Rebecca Palacios. Making the link between breastfeeding and breast cancer risk reduction among Hispanic women of childbearing age [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3345.

In the U.S., women of European ancestry have historically had the highest incidence of breast cancer compared to other major race/ethnicity groups. In recent years, the incidence rate for black women has approached that of white women, while rates for Asian and Hispanic women are about 25% lower than for white or black women. However, once diagnosed with breast cancer, black women have poorer survival rates than white women. The most recent “Annual Report to the Nation on the Status of Cancer” using nationwide cancer-registry data from 2006-2013 (Jemal et al., JNCI, 2017) reported a higher age- and stage-adjusted relative mortality risk after breast cancer of 1.71 (95% confidence interval (CI), 1.66-1.76) for non-Hispanic blacks compared to non-Hispanic whites. Hispanic women also experienced a slightly increased relative mortality risk of 1.14 (95% CI, 1.10-1.18) compared to white women, while Asians experienced a lower relative mortality risk of 0.84 (95% CI, 0.80-0.88). The reasons for such disparities in outcomes after breast cancer are complex. One suggested contributing factor is differences in access to care, as blacks and Hispanics tend to be of lower socioeconomic status than whites or Asians. It is possible to minimize the effects of access to health care by examining outcomes after breast cancer diagnosis in an integrated health care setting such as Kaiser Permanente Northern California (KPNC), in which all patients have health insurance coverage with access to the same health care providers. We are currently conducting the Pathways Study, a prospective cohort study of 4,505 women diagnosed with breast cancer with enrollment from 2006-2013. This diverse cohort includes 557 Hispanics, 578 Asians, and 358 blacks. Preliminary analyses in the larger population of 11,176 women who were diagnosed with invasive breast cancer in KPNC and eligible for the Pathways Study found that, despite the uniform health care access, racial disparities in mortality after breast cancer were qualitatively similar to those observed nationally. With 1,738 total deaths as of September 20, 2016, and adjusted for age and stage at diagnosis, compared to white women, black women had an increased relative mortality risk of 1.59 (95% CI, 1.24-2.03). For Hispanic women, the relative risk was 0.92 (95% CI, 0.72-1.19), and for Asians it was 0.70 (95% CI, 0.51-0.97). Among the subset of women enrolled in the Pathways Study (n=538 total deaths), comparable relative risks were 1.74 (95% CI, 1.35-2.24) for black women, 0.99 (95% CI, 0.75-1.29) for Hispanic women, and 0.73 (95% CI, 0.52-1.02) for Asians. Similar black-white differences were also seen for breast cancer-specific mortality and recurrence in the Pathways Study cohort in which recurrences are being documented. These observations indicate that health care access is unlikely to explain racial/ethnic disparities in breast cancer outcomes. As the Pathways Study, we will be able to explore aspects of health care utilization, such as treatment-related factors such as treatment delay, adherence, and early discontinuation. We will also be able to explore presence of comorbid conditions or use of non-cancer medications that may influence mortality and breast cancer outcomes. In the Pathways Study, we are collecting data on lifestyle and psychosocial factors (e.g., food intake, physical activity, social support, doctor-patient communications, and quality of life); linking to geospatial databases to characterize the social and built environment of cohort members; and conducting genome-wide assays. For example, in preliminary analyses that adjusted additionally for estrogen receptor status, body mass index, educational attainment, and physical activity, black-white differences in mortality persisted even though they were somewhat attenuated (relative risk of 1.43; 95% CI, 1.09-1.86). Along with other studies that are examining breast cancer outcomes in different populations, the Pathways Study is poised to contribute to better understanding of the persistent black-white differences in mortality after breast cancer, and thus identify avenues to improve outcomes for all women with breast cancer. Citation Format: Lawrence H. Kushi, Isaac J. Ergas, Janise M. Roh, Scarlett Lin Gomez, Marilyn L. Kwan, Catherine Thomsen, Song Yao, Christine B. Ambrosone. Disparities in breast cancer survivorship and outcomes [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA27.

Background: A family history of breast cancer in a first-degree relative is an established risk factor for breast cancer; however, little is known about the profile of breast and ovarian family history in Hispanic/Latina women. Importance of this relates to recent reports showing a high prevalence of BRCA mutations in Hispanic/Latina women and a pattern of multiple recurrent mutations. In addition, less is known about the association of family history and tumor subtype in this growing ethnic group in the U.S. Methods: Study participants included breast cancer patients of Mexican descent enrolled in the Ella Binational Breast Cancer Study. We first assessed the self-reported breast and ovarian family history profile in 1,150 women. Second, we compared differences in family history of breast and ovarian cancer prevalence between triple negative breast cancer (TNBC) and non-TNBC in 914 patients with available tumor subtype data. Logistic regression was conducted to compare odds of TNBC to non-TNBC according to family history of breast and ovarian cancer. Results: Prevalence of breast cancer family history in a first- and first- or second-degree relative was 13.1% and 24.1%, respectively. A history of breast or ovarian cancer in first-degree relatives was reported in 14.9% of the women. After adjustment for age and country of residence, women with a first-degree relative with breast cancer were more likely to be diagnosed with TNBC compared to non-TNBC (OR=1.98; 95% CI, 1.26-3.11). The odds of TNBC compared to non-TNBC was 1.93 (95% CI, 1.26–2.97) for women with first-degree relatives with breast or ovarian cancer. There was a suggestion of stronger associations between family history and TNBC among women diagnosed at age &amp;lt;50 compared to those &amp;gt;50 years for breast cancer history in first-degree (P-interaction=0.14) and first- or second-degree relatives (P-interaction=0.07). Conclusion: Findings suggest that familial cancers are associated with triple negative subtype, possibly related to the prevalence of BRCA mutations in Hispanic women, which are strongly associated with TNBC. Improvement in collection of family history through new tools and instruments targeting English- and Spanish-speaking Hispanic women should be a priority for future research. Identification of a strong family history can ultimately affect treatment plans, screening practices, and prevention options both for patients and their relatives. Citation Format: Maria Elena Martinez, Kristin Anderson, Patricia Thompson, Betsy C. Wertheim, Lorena Martin, Ian Komenaka, Melissa Bondy, Adrian Daneri-Navarro, Maria Mercedes Meza-Montenegro, Luis Enrique Gutierrez-Millan, Abenaa Brewster, Lisa Madlensky, Malaika Tobias, Loki Natarajan. Family history of breast and ovarian cancer prevalence and its association with triple-negative subtype in Hispanic women. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B17.

Background: In the United States, Hispanic women are less likely to be screened for cervical and breast cancer than non-Hispanic women. Asian women report lower cervical cancer screening use than other races. Previous studies have not differentiated between Hispanic or Asian subgroups or taken into account the heterogeneous nature of these diverse populations. This study aims to better describe variations of mammography and Pap test use across subpopulations of Hispanic and Asian women in the United States. Methods: Using data from the National Health Interview Survey (2008, 2010, and 2013), we calculated weighted proportions for subgroups of Hispanic and Asian women reporting screening for breast and cervical cancer. We produced cross-tabulations with variables of interest (length of residency, usual source of care, and health insurance), using chi-square tests. Result: The proportion of Hispanic women age 50-74 years who reported a mammogram within the past 2 years did not differ significantly across subgroups. When stratified by insurance status, proportions of breast cancer screening varied by Hispanic subgroup, among publically insured (p = 0.011) and uninsured (p = 0.001) women. The proportion of women age 21-65 years who received a Pap test within the past 3 years differed significantly across Hispanic subgroups (p = 0.005) as follows: Puerto Rican [82.5%, 95%CI (77.9-86.4)], Mexican [75.6%, 95%CI (73.1-77.9)], Mexican American [81.7%, 95%CI (79.1-84.0)], Cuban/Cuban American [75.1%, 95%CI (68.1-80.9)], Dominican [83.0%, 95%CI (75.8-88.4)], Central or South American [79.9%, 95%CI (76.2-83.1)], and Other Hispanic women [82.7%, 95%CI (74.2-88.8)]. Cervical cancer screening use varied across Hispanic subgroups among recent immigrants (p = 0.002) and publicly insured women (p = 0.041). Among Asian women, the proportion who reported breast cancer screening did not differ significantly by subgroup. For cervical cancer screening, the proportion of Asian women who received a Pap test varied across subgroups (p &amp;lt; 0.001). Filipinas [82.7%, 95%CI (78.0-86.7)] were more likely to be screened for cervical cancer than Asian Indian [66.8%, 95% (60.9-72.2)], Chinese [68.7%, 95%CI (62.5-74.4)], and Other Asian [68.1, 95%CI (63.6-72.2)] women. When stratified for length of residency, Pap test use differed significantly across subgroups of Asian immigrants in the US more than 10 years (p = 0.005) and less than 10 years (p &amp;lt; 0.001). Proportions of cervical cancer screening varied across subgroups of Asian women, among those with a usual source of care (p &amp;lt; 0.001), and with private/military (p = 0.005), public (p &amp;lt; 0.001), or no health insurance (p = 0.006). Conclusions: Among Hispanic women, mammography use was comparable across subgroups while Pap test use varied. Among Asian women, Pap test use differed by subgroup and mammography use did not. These data suggest certain ethnic and racial subgroups may have different barriers to screening that vary by usual source of care, insurance status, length of residency, and screening type. These findings offer insights that may be valuable for culturally tailored efforts to promote cancer screening within subgroups of Hispanic and Asian women. Citation Format: Meredith L. Shoemaker, Mary C. White. Breast and cervical cancer screening among Hispanic and Asian subgroups in the United States: Estimates from the National Health Interview Survey, 2008, 2010 and 2013. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B85.

6051 Background: Women of minority races have lower levels of mammography screening and have lower mammography return rates compared to Caucasians. To better understand this problem, we conducted a study of African American, Hispanic, and Asian women’s experiences with mammography. Methods: Six focus groups were conducted with a total of 49 women (19 Asian, 16 African American, and 14 Hispanic) recruited from community medical clinics in Boston. Eligible women had at least one prior mammogram and no personal history of cancer. Focus groups were guided by the attitude-social influence-efficacy model. Cultural barriers to repeat mammography were explored. Discussions were recorded and transcribed, and thematic content analyses were performed. Results: All groups expressed that older generations considered breast health a taboo topic. African American and Hispanic women felt that lack of insurance was not a barrier to mammography since they were savvy about free care options. A prominent reason that African Americans avoided mammograms was a fatalistic belief that a breast cancer diagnosis would inevitably lead to death. African Americans felt that ongoing cancer screening was not a priority because other diseases, such as HIV, were of greater concern. African Americans also felt that dominant social issues, such as drug and domestic abuse, made adherence to preventive health care less important. In contrast, Asians felt that mammogram return rates were poor because appointments took time away from work. Asian and Hispanic women identified discourteous behavior by hospital staff as a barrier. Most Asians were bothered by the staff’s insensitivity to their embarrassment of having to undress for mammograms. Many Hispanics were bothered by a language barrier and perceived indifference of the hospital staff. Conclusions: Cultural barriers to repeat mammography appear to vary among different racial groups. Interventions to improve screening among minority populations may be more successful if they address group-specific concerns. No significant financial relationships to disclose.