Leiomyoma May Explain Racial Differences in ART Outcome Between African American and Caucasian Women

Socioeconomic and racial disparities among infertility patients seeking care

O-82: Economics cannot always explain minority under-utilization of assisted reproductive technologies

To compare surgical approach, operative time, and perioperative morbidity after myomectomy by patient race. In this retrospective cohort study, data were abstracted from the American College of Surgeons National Surgical Quality Improvement Program database on 8,438 women undergoing myomectomy between January 1, 2012, and December 31, 2015. Myoma burden and approach to myomectomy were determined based on Current Procedural Terminology coding. Surgical approach and perioperative morbidity were examined in African American, Asian American, and Hispanic American women using non-Hispanic Caucasian women as the referent population. Adjusted means and odds ratios (ORs) with 95% CI were calculated using propensity score matching accounting for age, ethnicity, body mass index (BMI), myoma burden, preoperative anemia, hypertension, smoking, and operative time. Data were available for 2,533 Caucasian, 3,359 African American, 664 Asian American, and 700 Hispanic American women. Smoking, BMI, hypertension, myoma burden, and anemia varied by race (P<.001, all comparisons). In adjusted analysis, African American women were twice as likely to undergo abdominal myomectomy (adjusted OR 1.9, 95% CI 1.7-2.0), Asian American women were more than twice as likely (adjusted OR 2.3, 95% CI 1.8-2.8), and Hispanic American women were 50% more likely to undergo abdominal myomectomy (adjusted OR 1.5, 95% CI 1.2-1.9) when compared with Caucasian women. African American women were 50% more likely to experience composite morbidity after abdominal myomectomy (adjusted OR 1.5, 95% CI 1.2-1.7) and Asian American women were more than three times as likely to experience composite morbidity after laparoscopic myomectomy (adjusted OR 3.7, 95% CI 1.7-8.1) compared with Caucasian women. There were no differences in composite morbidity in other racial groups. Minority women are substantially more likely to undergo abdominal myomectomy when compared with Caucasian women. African American women had 50% increased odds of morbidity after abdominal myomectomy, and Asian American women were more than three times as likely to experience morbidity after laparoscopic myomectomy. Further examination into the etiology and prevention of these racial disparities is needed.

Breast cancer is the second leading cause of cancer death among American women. African American (AA) women are more likely to die from breast cancer than their Caucasian (CAU), Hispanic, Asian and Native American counterparts revealing a clear disparity between AA women and women of other races and ethnicities. Data collected by The American Cancer Society and others reveal that although AA women have a lower incidence of breast cancer than CAU women, AA women tend to have larger, more aggressive tumors, and have a lower 5-year survival rate. Importantly, AA women are more likely to die from breast cancer than any other ethnic group. While socio-economic, cultural and environmental factors are thought to contribute to these disparities, little is known as to whether biological differences exist between CAU and AA women with breast cancer. To determine the effects of bioactive dietary compounds, (–)-epigallocatechin-3-gallate (EGCG), found in green tea, and sulforaphane (SFN), found in broccoli, were administered to breast cancer cells derived from AA and CAU women. Our results reveal that the AA breast cancer cells showed dissimilarities in response to ECGG and SFN treatments when compared to CAU cell lines. Additionally, differential expression of several cancer related genes, including the human telomerase reverse transcriptase gene (hTERT), was seen in AA cells when compared to CAU cells. These data support the hypothesis that biological differences may contribute to the disparity among AA and CAU women with breast cancer and that these variations may be influenced by diet. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B33.

Impact of race and ethnicity on in vitro fertilization outcomes in infertile women with polycystic ovary syndrome in the United States

Comparison of assisted reproductive technology utilization and outcomes between Caucasian and African American patients in an equal-access-to-care setting

e16501 Background: An array-based comparative genomic hybridization (aCGH) analysis was performed to determine if frequent (&gt;40%) copy number aberrations (CNAs) exist in African American (AA) versus Caucasian (C) women with stage I versus stage IIIC/IV endometrioid endometrial cancers (EEC). Methods: Tumor DNA was isolated from 80 frozen primary tumors from the GOG-210 protocol. RPCI 19K BAC arrays were hybridized (GeneTAC HybStation) and scanned (Gene Pix 4200AL Laser Scanner). Spot fluorescence values were quantified using ImaGene, vetted for quality and loess corrected with adjustments for chip-specific spatial effects. The genome was segmented to identify regions with common copy number means (DNAcopy software). Posterior aberration probabilities for the regions were obtained using CGHcall and data was visualized and annotated using iGenomicViewer in R. Validation will be performed by fluorescence in situ hybridization using select BAC probes and endometrial cancer tissue microarrays (TMAs) with either 400 cases linked with clinical, treatment and outcome data or 180 AA versus 120 C women from GOG-136. Results: Recurrent CNAs were identified in all stage and race groups. Distinct genomic losses and gains were observed that appear to segregate Caucasian women with stage I disease from African American women with stage I disease and African American or Caucasian women with stage IIIC/IV disease. Conclusions: The GOG-210 bank yielded high quality DNA for detecting and mapping CNAs in frozen primary tumors with high resolution. Our results would imply that racial disparity for AA EEC has a genetic basis regardless of stage. Validation studies are currently underway in two endometrial cancer TMAs. [Table: see text] No significant financial relationships to disclose.

459: Racial differences in self-reported and biologic measures of chronic stress in pregnancy

Background: Studies have documented lower rates of breast cancer survival for African American versus Caucasian women. Differences in compliance to adjuvant hormone therapy (AHT) may partially explain the survival disparity. The purpose of our study is to examine whether or not a difference in self-reported compliance to AHT exists between African American and Caucasian women and to describe which factors may impact this compliance. Methods: Women who were 2-10 years from diagnosis of estrogen receptor positive, non-metastatic breast cancer at the University of Chicago Hospital were asked to complete a voluntary mail-in survey. All information was self-reported. Compliance to AHT was defined as not missing more than 2 doses of therapy a month and completing 5 years of therapy (or still taking therapy if less than 5 years had passed between initiation of therapy and date of survey completion). Chi square tests and logistic regressions were performed to compare compliance rates by sociodemographic factors, reported perception of AHT importance, and self-perceived risk for breast cancer recurrence. Results: Among the 381 eligible patients, 217 (56.9%) completed the survey. Overall self-reported compliance rate to AHT was 78.5%. African American women (n = 66, 30.8%) reported lower compliance rates compared to Caucasian women (70.0% vs. 82.3%, P = 0.055). For both African American and Caucasian women, perceived importance of AHT (from not important to very important) was correlated with higher rates of reported compliance (OR = 10.65; 95% CI: 3.55-31.94). Patients who weighted their cancer doctor's opinion more when considering taking or stopping AHT were also more likely to report being compliant (OR = 1.99; 95% CI: 0.75-5.25), whereas patients who reported being very worried about side effects were less likely to report being compliant (OR = 0.34; 95% CI: 0.10-1.13). Perceived risk of breast cancer recurrence, however, was not associated with reported compliance. Conclusions: For both African American and Caucasian women, compliance to adjuvant hormone therapy was associated with greater perceived importance of therapy. This study suggests that educating our patients on the importance of hormone therapy may significantly impact their compliance. Citation Format: Christina H. Suh, Sumita Bhatta, Ningqi Hou, Zakiya N. Factors associated with compliance to adjuvant hormone therapy for African American and Caucasian women. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A31.

Psychosocial correlates of binge eating in Hispanic, African American, and Caucasian women presenting for bariatric surgery

The Association of Genetic Polymorphisms in Sex Hormone Biosynthesis and Action with Insulin Sensitivity and Diabetes Mellitus in Women at Midlife

Background: To identify molecular factors associated with survival disparities, multiple studies have identified differentially expressed genes in tumors from African American women (AAW) compared to Caucasian women (CW), however, it is not clear whether these changes, such as increased expression of PHSPL, SOS1 and CRYBB2P1 in tumors from AAW, are clinically meaningful or represent population artifact. Gene expression data were thus evaluated in breast tumors with defined intrinsic subtypes, non-malignant breast tissue and blood from patients without breast disease. Methods: Gene expression data was generated using U133 2.0 microarrays for 184 breast tumors from AAW and CW matched by subtype, grade, age and presence of local or distant metastases, from 44 benign biopsy specimens, and from 143 peripheral blood samples from patients without current or past invasive breast disease. Principal component analysis (PCA) was performed using Partek Genomics Suite 6.6 and differentially expressed genes were detected using ANOVA with FDR&amp;lt;0.05, 2-fold difference defining significance. Results: When all tumors were analyzed together, only PSPHL, CRYBB2P1 and SOS1 were differentially expressed, each at significantly higher levels in tumors from AAW. When analyzed by subtype, PSPHL, CRYBB2P1, SOS1 and AMFR were expressed at higher levels in luminal A tumors (n=86) and SOS1 at higher levels in basal-like tumors (n=66) from AAW; no differentially expressed genes were detected in HER2-enriched (n=18) or luminal B (n=14) tumors. AMFR, CRYBB2P1, PSPHL and SOS1 were also expressed at significantly higher levels in both non-malignant breast tissue from AAW patients, and in blood specimens from disease-free AAW patients compared to non-malignant and blood specimens from CW. Conclusions: PCA demonstrates that molecular profiles of tumors from AAW are highly similar to those from CW; the few genes that are differentially expressed in tumor specimens are not associated with breast cancer as the same changes are also found in disease-free breast tissues as well as blood from patients without breast disease. Lack of meaningful genetic differences, even within specific tumor subtypes, suggests that disparity differences between AAW and CW with breast cancer are not attributable to molecular differences inherent to the tumors, but likely stem from other factors such as genetic predisposition to the development of basal-like tumors or altered provision of or response to treatment. Citation Format: Allyson L. Valente, Craig D. Shriver, Rachel E. Ellsworth. Gene expression profiling of breast tumors from African American and Caucasian women: Are molecular differences meaningful. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3270. doi:10.1158/1538-7445.AM2014-3270

The incidence of breast cancer in African American women (AAW) is much lower than those of their Caucasian counterparts. However, the age adjusted mortality rates are much greater for AAW compared to Caucasian American women (CAW). These differences in survival between AAW and CAW were attributed to socioeconomic factors and access to health care. Yet, after adjusting these differences, AAW still had lower survival rates than CAW. Genetic and immunohistochemical studies have revealed that biological variations may account for this disparity. These studies have suggested as a causative: a higher prevalence of basal-like tumors in premenopausal AAW and low prevalence of luminal tumor. These are characterized by being high-grade aggressive tumors that are estrogen receptor negative (ER-), progesterone receptor negative (PR-), human epidermal growth factor receptor-2 (HER-2) +/-; with high rate of lymph node involvement. Despite this understanding, there is little evidence to indicate which genetic or non-genetic factors contribute to causing aggressive breast cancer thereby limiting the development of prevention and treatment option. We proposed that the phenotypic diversity of breast cancer might be accompanied by a corresponding diversity in protein expression patterns that can be reveal using proteomic technologies. We hypothesized that in addition to ER- and PR-, and the absence in expression of HER-2, the protein composition of triple-negative tumors varies among African-American and Caucasian. Two-dimensional gel electrophoresis, mass spectrophotometry and data analysis of protein from breast cancer tissues were used to identify differentially expressed proteins from African American and Caucasian women. Western blot of luminal and TNBC cell lines were used to confirm the expression of identified proteins. We have found that many proteins were differentially expressed in AAW breast cancer tissues compared to CAW. One of these is lactate dehydrogenase which was found to be overexpressed in tissues from AAW. Western blot analysis confirmed expression. Citation Format: Odalys J. Torres-Luquis, Sulma Mohammed. Lactate dehydrogenase expression in African American women with triple-negative breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1132. doi:10.1158/1538-7445.AM2017-1132

Purpose: To evaluate cardiovascular risk factors in Caucasian and African American HIV+ women undergoing treatment with HAART including a protease inhibitor (PI). Method: Anthropometric measures and fasting blood samples were obtained from 32 Caucasian and 10 African American women. Serum was analyzed for glucose, insulin, and lipid levels. Results: The African American women were significantly older than the Caucasian women. Body mass index (BMI) was higher in the African American women, and 80% of the African American women and 47% of the Caucasian women were overweight. There were no significant differences in fasting insulin, fasting glucose, or HOMA-IR. However, African American women had significantly higher HDL levels, whereas Caucasian women had higher triglycerides and LDL. When age-matched women were compared, total as well as LDL cholesterol was significantly higher in the Caucasian women. The ratio of total cholesterol/HDL cholesterol was 3.4 ± 1.1 in the African American women and 5.5 ± 1.6 (p = .021) in the age-matched Caucasian women. Conclusion: The differences in lipid levels in HIV+ African American and Caucasian women were greater than those reported in the literature for normal women. Although the sample size is small, the data suggest that the effect of HIV infection and/or HAART on lipid levels may be different in Caucasian and African American women. Large-scale studies will be necessary to confirm these results and clarify the mechanisms involved.

Aromatase gene expression in uterine leiomyoma from African-American women is dramatically higher compared with other races