The case for acceleration of prospective multi- stakeholder led community-based research in young Black women with triple negative breast cancer (TNBC).

Abstract

1089 Background: Black women face a three- fold increase in TNBC BRCA1 gene mutations. In TNBC, there is a higher rate of recurrence and metastasis to other organs. Lower access to timely care and more advance stage at diagnosis contribute to poorer outcomes. Black women have the lowest survival rate at each stage of TNBC diagnosis compared to other demographic groups. Research Question: Over the past 10 years, what real world community interventions have been published regarding risk for and diagnosis with TNBC in Black or African American women? Methods: Using the following keywords: TNBC, diversity, health equity, young adults, Black, African American, authors conducted PUBMED and Google Scholar searches for years 2011 to 2022 to summarize publications on community-based interventions with Black or African American women at risk of or diagnosed with TNBC. Results: A validated publication assessment revealed 70 publications: 63 retrospective and 7 prospective studies. Prospective studies were categorized using the NASEM cancer continuum of care domains. The number of studies that addressed the domains included: risk=1, screening =1, diagnosis=3, treatment=2, survivorship=1 end of life=0, outcomes=1. No studies reported the following criteria: A co-creation approach with community-based participatory research principles; interventions led by patients and Black women who are at risk for TNBC; multi stakeholder interventions led by community leaders or patient organizations with long-standing trust of diverse populations; addressing and resolving social drivers of health inequities, mental health, palliative care services or implicit bias; or inclusion in clinical studies. Conclusions: It is critical to address the disproportionate impact of TNBC in partnership with Black women. To achieve equitable health outcomes, we advise public and private sector leaders to make more funding available to support community-engaged approaches in high prevalence geographic areas. 1) Provide CBPR training and opportunities for diverse investigators and patient- and community-based organizations. 2) Build capacity for social needs assessment and interventions. 3) Employ community-based implementation science focused on all care continuum domains including the gaps between domains. 4) Increase public awareness of health issues in Black women and address resistance, access and eligibility for participation in clinical research. 5) Offer RFPs to transform care through collaboration between researchers, providers, patient and community-based organizations, health departments, and payers; engaging clinical and lay navigators and community health workers; design solutions that address barriers; and development and implementation of policy with a focus on standardization, accountability, and enforceability.