4th Conference Research Articles

Settings for planetary health and well-being: Considerations for the conference theme of the 25th Global Conference of IUHPE, Abu Dhabi, 2025

Settings for planetary health and well-being: Considerations for the conference theme of the 25th Global Conference of IUHPE, Abu Dhabi, 2025

Hot Topics at the 18th SDEWES Conference in 2023: A Conference Report

The present paper reviews the hot topics at the 18th Conference on Sustainable Development of Energy, Water, and Environment Systems (SDEWES) held from 24 to 29 September 2023 in Dubrovnik, Croatia. The selected papers, including aspects of biomass energy application, energy saving in building, low-carbon development and climate change adaptation, hybrid application of sustainable energy, energy storage system, and other measures in sustainable development, are published in this Special Issue of Energies. The 12 selected papers in Energies and corresponding literature that relates to the above topics and has been published in the most recent year are reviewed. In particular, diversifying energy applications are trending towards comprehensive integration with more efficient clean energy capacities for global energy procurement, which can also offer increased resilience and sustainability, reduce reliance on fossil fuels, mitigate environmental impacts, and enhance energy security through a mix of renewable sources and innovative technologies. Meanwhile, energy storage has become increasingly important, which can manage the intermittent of renewable energy, stabilize the grid, and improve energy security and resilience against disruptions. In addition to conventional solar energy storage, biomass energy storage, building energy storage, water storage, etc., can also reduce the overall energy costs, deferring investments in additional transmission infrastructure.

Abstract A066: Unmasking differences in adolescent HPV vaccine uptake in six Asian American subgroups: data from the national immunization survey-teen (2015-2019)

Abstract Introduction: The HPV vaccination rates among Asian American adolescents were found to be below optimal levels. Understanding the high-risk demographics and the various factors influencing HPV vaccine acceptance is essential for addressing disparities and enhancing vaccination rates in this population. This study aimed to investigate HPV vaccine uptake in adolescents aged 13 to 17 across six major Asian American ethnic groups using nationally representative data. Methods: The study analyzed data from the National Immunization Survey- Teen (2015-2019), comprising 3,968 Asian American adolescents from Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese backgrounds. Provider and practice characteristics were examined alongside HPV vaccine initiation and completion rates within each subgroup. Results: Findings revealed that while the overall initiation rate among Asian American adolescents was 66.65%, significant variations existed among subgroups, ranging from 57.3% in Asian Indians to 71.22% in Chinese adolescents. Similarly, completion rates ranged from 30.89% in Asian Indians to 48.14% in Chinese adolescents, with an aggregated completion rate of 40.37% for the total Asian American sample. Household survey data generally showed lower initiation and completion rates compared to provider-reported data but still reflected subgroup disparities. Conclusion: Across all ethnic groups, a common barrier to HPV vaccination was the lack of physician recommendation. However, slight variations in this barrier were observed among subgroups. These findings underscore the importance of considering socioeconomic, cultural, and acculturation-related factors in designing effective public health and clinical interventions to promote HPV vaccination among Asian American adolescents. Citation Format: Lin Zhu, Elaine Z. Liu, Philip Siu, Chun Pan, Grace X. Ma. Unmasking differences in adolescent HPV vaccine uptake in six Asian American subgroups: data from the national immunization survey-teen (2015-2019) [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A066.

Abstract A137: Enrolling a diverse sample of community health center patients for a multi-level intervention to increase colorectal cancer screening uptake and follow-up

Abstract Colorectal cancer (CRC) screening is underutilized, especially in community health centers (CHCs) that provide care to marginalized communities, including low-income, uninsured, and racial/ethnic minority populations. Stool-based tests, such as the fecal immunochemical test (FIT) and FIT-DNA, can be effective CRC screening methods if individuals with abnormal results undergo colonoscopy. The Community Collaboration to Advance Racial/Ethnic Equity in CRC Screening (CARES) study aims to enroll a diverse sample of individuals at average risk for CRC for a multi-level intervention to increase CRC screening uptake and colonoscopic follow-up after abnormal FIT or FIT-DNA results in CHCs in 3 U.S. regions. Our overall goal is to conduct a two-arm, pragmatic randomized trial that includes patients in 4 Boston and 4 Los Angeles (LA) CHCs. Two clinics in the Great Plains Tribal Leaders Health Board in South Dakota (SD) will be included in a parallel pilot study. Pre-implementation activities included qualitative interviews with providers and administrators at each CHC to understand barriers to screening and current clinic workflows, development of a central database, and tailoring intervention components for each site: study invitation letters, text message reminders, infographics, instructional videos, QR codes to informational videos, and navigation for patients with abnormal results. In the 63 semi-structured pre-implementation interviews, stakeholders reported patient barriers to screening included lack of motivation due to the absence of symptoms and difficultly understanding test instructions, while provider barriers were lack of electronic health record (EHR) past-due screening reminders, and system-level barriers included challenges referring patients for colonoscopy in outside facilities. For each clinic, we queried EHR data to identify patients ages 45-75 with a recent primary care visit and an indicated preference for English or Spanish language. In the Boston clinics, 38.3% were Non-Hispanic White, 62.1% preferred English, and 65.1% were privately insured. In LA, 91.3% were Hispanic, 86.8% preferred Spanish, and 72.4% were Medicaid insured. The mean baseline CRC screening rate was significantly higher in the Boston clinics than in the LA clinics (69.1% v. 21.2%; p<0.0001). Of those screened, the most common screening modality was colonoscopy in Boston (84.3%) and FIT in LA (92.2%) (p<0.001). Higher baseline screening and colonoscopy rates in Boston may be due to multiple factors, including differences in patient demographics, prevalence of immigrant populations, language barriers, and/or healthcare access and capacity. We randomized each CHC to either mailed FIT or FIT-DNA and enrolled 2429 patients in the FIT-arm (Boston: n=936; LA: n=1493) and 2798 patients in the FIT-DNA arm (Boston: n=1303; LA: n=1495). We intend to enroll 800 patients in a similar manner in SD. To increase CRC screening through targeted interventions among populations with limited resources, it is crucial to consider local systems, barriers and facilitators to care. Citation Format: Folasade P. May, Jessica J. Tuan, Suzanne Brodney, Sapna Syngal, Andrew T. Chan, Beth Glenn, Gina Johnson, Yuchiao Chang, David A. Drew, Beverly Moy, Nicolette J. Rodriguez, Erica T. Warner, Adjoa Anyane-Yeboa, Chinedu Ukaegbu, Anjelica Q Davis, Kimberly Schoolcraft, Samantha Kuney, Kelley Le Beaux, Catherine Jeffries, Jennifer S. Haas. Enrolling a diverse sample of community health center patients for a multi-level intervention to increase colorectal cancer screening uptake and follow-up [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A137.

Abstract C112: Hemp extract attenuates the proliferation of hepatocellular carcinoma cells- derive cells from racially diverse populations by inhibiting the Interferone-1 signaling pathway

Abstract Hepatocellular Carcinoma (HCC) is a highly fatal disease where race/ethnicity plays a vital role in determining incidence, mortality, and survival rates. The incidence of HCC is highest in Asia and Africa. Furthermore, there is a statistically significant increase in incidence and mortality and a decrease in 5-year survival rates in African American (AA)/Black patients compared to non-Hispanic white patients. The HCC patients might benefit from a holistic dietary approach, including hemp extract, along with their clinical treatment. Our bioinformatics analysis of The Cancer Genome Atlas (TCGA) identified the IFN-I signaling genes (ISGs) as the most significantly enriched pathway in AA/Black HCC patients. Consistent with this finding, RNA-seq analysis of archived HCC tumors from white (n=14) and AA/Black (n=18) patients further confirmed the upregulation of ISGs in these cohorts. Due to the severe toxicity of the currently available cancer treatments, there is also a demand for the development of alternative therapies with high efficacy and low side effects. We characterized 16 varieties of hemp for their polyphenols, antioxidation, CBDs, and terpenes contents and determined the effects of hemp extracts on the proliferation of HepG2 (white patients), Hep3B, and O/20 (Black patients), and HuH-7 (Asian Patient) HCC cell lines. Among different hemp varieties, KY-Plume extract showed the highest concentration of polyphenols, antioxidation activity, CBDA, and terpenes. It also most potently inhibited the growth of all HCC cell lines (IC50s 20-25 mg/ml), irrespective of their racial origin. Hemp treatment reduced the phosphorylation of the IFN downstream mediators, Jak-1, Tyk2, STAT1, and STAT2, in all HCC cell lines. In addition, hemp treatment also inhibited phosphorylation/activation of PI3K-Akt-mTOR and MAPK pathways. Currently, research is underway to identify the active chemical agent in hemp and test it on other patient-derived HCC lines and in an in vivo model. In conclusion, our data suggest that hemp can attenuate HCC proliferation by inhibiting multiple cellular signaling pathways, including the IFN-1 pathway. Our data suggest that HCC patients might benefit from a holistic dietary approach, including hemp extract, along with their clinical treatment. (Funded: Even-Allen-USDA and P20 CA264068-01-NIH). Citation Format: Rafat A Siddiqui, Haiwen Li, Ramesh Dhakal, Milton O Faison, Devanand Sarkar.. Hemp extract attenuates the proliferation of hepatocellular carcinoma cells- derive cells from racially diverse populations by inhibiting the Interferone-1 signaling pathway [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C112.

Abstract A052: The association of perceived neighborhood environment with physical and mental health status among cancer survivors in the All of Us Research Program

Abstract Background Neighborhood environment has been recognized as a key determinant of health. Neighborhood disorder refers to physical and social characteristics of neighborhoods that may signal the breakdown of order and social control. Previous studies have reported that neighborhood disorder, such as high levels of noise, vandalism, abandoned buildings, crime, and drug and alcohol use, is associated with poor self-reported health. In contrast, neighborhood social cohesion and the extent of connectedness in society have positive effects on physical and mental health. Little studies, however, have comprehensively examined the association between perceived neighborhood environment and health outcomes among cancer survivors. We examined and found this significant association among cancer survivors. Method We used survey and electronic health records data on cancer survivors aged ≥18 years (N=10,051) from All of Us Controlled Tier Dataset v7 (summer 2017-July 2022), including survey data on 21 items about neighborhood environment, neighborhood order, disorder, and social cohesion. Eleven items were used to measure perceived neighborhood disorder, six items were used to measure perceived neighborhood order, and four items were used to measure perceived social cohesion. Logistic regression models were used to estimate the association between each measure of neighborhood order, disorder, or social cohesion and physical and mental health status (poor/fair versus very good/excellent), adjusted for 1) age and sex; 2) age, sex, race/ethnicity, educational attainment, annual household income, employment, health insurance, marital status, living alone, house ownership, nativity, smoking, and heavy alcohol drinking. Results Cancer survivors living in neighborhoods with high level of order and social cohesion were less likely to report poor or fair physical health. For example, cancer survivors who perceived their neighborhood as sharing the same values were less likely to report poor or fair physical health (OR=0.49; 95% CI=0.39- 0.61). Additionally, cancer survivors who felt their neighborhood was safe were less likely to report poor or fair physical health (OR=0.71; 95% CI=0.55-0.92). In contrast, cancer survivors residing in neighborhood with disorder characteristics were more likely to report poor or fair physical health. Specifically, those living in neighborhood with common vandalism were more likely to report poor or fair physical health (OR=1.40; 95% CI=1.08-1.80). Furthermore, cancer survivors who perceived high level of drug use in their neighborhood were more likely to report poor or fair physical health (OR=1.49; 95% CI=1.19-1.88). Similar associations were observed between 19 neighborhood characteristics and mental health status. Conclusions Most neighborhood characteristics evaluated in this study were associated with self-reported physical and mental health status among cancer survivors. These findings suggest that improving built environment and social support could enhance perceived health and quality of life in this population. Citation Format: Dongjun Lee, Farhad Islami, Ahmedin Jemal, Hyunjung Lee. The association of perceived neighborhood environment with physical and mental health status among cancer survivors in the All of Us Research Program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A052.

Abstract B161: Has much changed? A scoping review on the nature of racial/ethnic disparities in endometrial cancer research since the release of the Society of Gynecologic Oncology statement

Abstract Introduction: Endometrial cancer is prevalent in the United States and has well documented disparities across race and ethnicity. The Society of Gynecologic Oncology’s (SGO) 2014 review on racial/ethnic disparities in gynecologic cancers, including endometrial, ended with a call to action to increase research on endometrial cancer disparities and to shift focus from identification of disparities to solutions. With a decade passed since the publication, it is unknown how the landscape of research on racial/ethnic disparities in endometrial cancer has changed. Objectives: A scoping review was conducted to identify the nature of research on racial/ethnic disparities in endometrial cancer since the publication of the SGO review in 2014, including summarizing the proportion of studies that focused on disparities across patient, provider and systemic spheres. Secondarily, to understand the proportion and nature of studies that proposed a solution to the identified racial/ethnic disparities. Methods: Scoping review was designed following the PRISM-SCa protocol. MEDLINE, EMBASE and Web of Science were searched to identify relevant studies. Inclusion criteria included: publication following the SGO statement, in English, published in the United States, on human subjects, primary study, specifically mentioned a racial or ethnic disparity in endometrial cancer. Reviews, meta- analyses, and opinion pieces were excluded. Relevant studies were coded for nature of disparity and solutions offered using a standardized data abstraction tool. Results: 182 studies were included, 141 (77.5%) focused on racial disparities, 34 (18.8%) on racial and ethnic, and 7 (3.8%) on ethnic, mainly Hispanic. Of those, 138 (75.8%) focused only on Black or African American disparities. When evaluating the level at which the disparity was identified, 116 (63.7%) were at the patient level, 25 (13.7%) at the provider level, 21 (11.5%) systemic, and 20 (11.5%) identified disparities on multiple levels. Half of the studies included offered solutions (91, 50.0%), however, the majority of the solutions suggested an increase in disparity research (32, 35.2%) and expanding clinical trials (15, 16.5%); many of these were included as further directions of the study itself. Other solutions included expanding access to health care (15, 16.5%), enhancing patient education (12, 13.2%), increasing patient participation in care (4, 4.4%), increasing diversity in the workforce (1, 1.1%), and other (12, 13.2%). Conclusions: Though much research on racial/ethnic disparities in endometrial cancer has been conducted since the SGO statement, many studies focused on patient-level factors instead of challenging provider/systemic level factors. When it came to a call to action, only half of the studies discussed a solution, the majority of which were included as future directions and suggested expansion of research. A small minority of articles outlined tangible solutions to the disparity discussed, leaving a continued need to shift research from identification of the disparity to creating solutions. Citation Format: Sarah Battiston, Victoria Kelley, Molly Wilson, Morolayo Ilori, Katerina Furman, Layla Hak, Madison Miller. Has much changed? A scoping review on the nature of racial/ethnic disparities in endometrial cancer research since the release of the Society of Gynecologic Oncology statement [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B161.

Abstract B099: Addressing cancer disparities in the United States-Affiliated Pacific Island jurisdictions: Insights from the Scaling What Works program

Abstract Purpose The Scaling What Works (SWW) program aimed to build the capacity of National Comprehensive Cancer Control Program (NCCCP) recipients to scale three CDC-identified cancer control projects through training, mentorship, and technical assistance (TA). The SWW program held a Symposium to provide in-person training on adapting, implementing, evaluating, sustaining, and scaling the three projects. We recruited 100% of US-Affiliated Pacific Island (USAPI) NCCCP programs (n=6), who made up approximately 26% of all programs that attended the Symposium (n=23). The USAPI jurisdictions face high cancer burden due, in part, to the United States nuclear legacy, the effects of climate change, limited medical infrastructure, and lack of culturally competent, centralized care across the almost 4,000 miles that the USAPI spans. Through the SWW program, USAPI recipients are supported in their ongoing efforts to mitigate cancer disparities affecting their communities. MethodsWe applied community-based participatory research methods and health equity principles to ensure the SWW program was relevant and responsive to the USAPI recipients’ contexts and needs. We created a SWW subcommittee to learn about and advocate for the specific needs of the USAPI. The committee spoke with ten clinicians and researchers with experience working in the USAPI, across four informal meetings, to understand the unique cancer prevention and control context of each USAPI jurisdiction. The committee reviewed USAPI cancer plans and extracted data related to SWW activities, including cancer prevention priorities, community partners, demographic characteristics, and healthcare infrastructure. Data were added to a matrix, coded, and summarized by subcommittee team members to develop a USAPI fact sheet. We shared the fact sheet with SWW Symposium facilitators and mentors to provide them with the necessary information to support the USAPI programs. Findings We identified components critical to providing effective training and TA that will support USAPI-led work to address disparities in cancer prevention and control. These components include 1) acknowledging the current and historical power dynamics that establish the USAPI cancer prevention and control program space, 2) adjusting generalized training content to each jurisdiction’s unique context and cancer prevention goals, 3) adapting communication strategies to USAPI programs’ preferences and time zones, 4) facilitating networking opportunities both between NCCCP USAPI jurisdictions and across all NCCCP recipients to build a SWW community of practice, and 5) establishing a sustained, bidirectional partnership between USAPI program leaders and the SWW team to collaborate on future cancer prevention and control projects and to provide training and TA, as needed. ConclusionsThe lessons learned from SWW regarding health equity and capacity-building can inform the efforts of researchers, evaluators, and training and TA providers working with USAPI jurisdictions, states, and territories engaged in cancer prevention and control work. Citation Format: Amy L. Tran, Mary Wangen, Renée M. Ferrari, Jingle Xu, Alison T. Brenner, Stephanie B. Wheeler, Rebecca J. Lee, Elizabeth A. Rohan, Angela R. Moore, Shixiu Wang, Alyssa LaMonica, Mary Puckett, Amy L. Thompson, CK Smith, Katie Jones, Malesa Pereira, Rogelio Robles-Morales, Lori A. Crane, Courtney N. Petagna, Thuy T. Vu, Betsy C Risendal, Rachel Hirschey. Addressing cancer disparities in the United States-Affiliated Pacific Island jurisdictions: Insights from the Scaling What Works program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B099.

Abstract B013: Sociodemographic differences and inpatient outcomes of opioid use disorder among patients hospitalized for head and neck cancer in the United States

Abstract Background: Opioid use disorder (OUD) is a rising public health concern in the United States. It poses substantial challenges in the management of head and neck cancers (HNC), given the pain associated with the disease. This study examines the sociodemographic differences in OUD among patients hospitalized for HNC in the United States as well as in-patient outcomes of HNC patients with OUD. Methods: We analyzed weighted retrospective data from the 2016 to 2020 National Inpatient Sample database. We included patients 18 years or older with principal discharge diagnoses of HNC with or without secondary diagnoses of OUD using specific ICD-10 codes. OUD was defined as opioid abuse, dependence, poisoning or adverse effects. Baseline sociodemographic and hospital characteristics of HNC patients with or without OUD were compared using χ2 for categorical variables and Student’s t-test for continuous variables. We examined sociodemographic characteristics associated with OUD using multivariable logistic regression models. We assessed three in-patient outcomes including mortality, length of stay and total hospitalization charge (THC) adjusted for inflation. Further we included interaction terms to explore the combined effects of relevant sociodemographic predictors with depression. Results: There were 117,085 hospitalizations for HNC between 2016 and 2020. Among HNC hospitalizations, 3.2% were opioid users and 2.36% had a secondary diagnosis of OUD. The mean age of HNC pts was 63.3 years (SD 0.08). 78.3% were Non-Hispanic White, 11.8% Non-Hispanic Black, 6.7% Hispanic and 3.2% Asians/Pacific Islanders. HNC patients with OUD had higher odds of being female (aOR 1.32; 95% CI 1.09, 1.59) and having more than one comorbidity (aOR 1.088; 95% CI 1.047, 1.132). There were lower odds of OUD with older age >70 years (aOR: 0.25; 95% CI 0.10, 0.59), private insurance (aOR 0.66; 95% CI 0.50, 0.87), higher income quartiles (aOR 0.66; 95% CI 0.50, 0.87) and with hospital regions in the South compared to the North-East United States (aOR 0.57; 95% CI 0.43, 0.74). There was no statistically significant interaction between MDD and gender (aOR 1.27; 95% CI 0.80, 2.04) among patients with HNC and OUD. OUD was not significantly associated with increased mortality in patients hospitalized for HNC (aOR 1.39, 95% CI 0.83, 2.33), however OUD was associated with a greater LOS by 3.6 days (95% CI 2.52, 4.60) and an increased THC of $26,947 (95% CI 13232, 40662). Conclusion: Our study demonstrates significant sociodemographic disparities in the prevalence of OUD among head and neck cancer hospitalizations in the US. Female patients and those with multiple comorbidities had higher odds of OUD. Additionally, OUD was significantly associated with an increased LOS and THC. These findings highlight the need for targeted interventions that address the unique needs of vulnerable populations with OUD and HNC. Citation Format: Ted O Akhiwu, Inemesit Akpan, Michael Imeh, Nosayaba Osazuwa-Peters. Sociodemographic differences and inpatient outcomes of opioid use disorder among patients hospitalized for head and neck cancer in the United States [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B013.

Abstract A116: Cervical cancer awareness, knowledge, and attitudes in young adult students on a Northern California college campus

Abstract Cervical cancer is the fourth most common gynecological malignancy in women worldwide. Human papillomavirus (HPV) is the primary cause of cervical cancer, with increased risk associated with select serotypes HPV 16 and 18. This study assesses cervical cancer awareness, knowledge of HPV, and attitudes towards vaccination among a convenience sample of San Francisco State University (SFSU) students. Despite the availability of effective HPV vaccines and associated cervical cancer prevention, vaccine uptake remains relatively low which may be due to various factors, including lack of awareness and vaccine knowledge. A convenience sample survey assessing cervical cancer awareness, behaviors and attitudes about HPV vaccine was administered to students on the San Francisco State University campus. The data was collected anonymously, via QR code. Participants received a $10 Target gift card. At completion of the survey, a 5x7 information card about Cervical Cancer and HPV vaccines, developed by and for college students, was distributed to participants. A total of 100 students completed the survey. Participants average age was 23-24 years old; 60% of participants identified as female; 34% as male. The vast majority of participants were aware of cervical cancer. Among 60 female respondents, 25 (42%) reported having had a pap smear, but a larger proportion had not. Of the female participants over age 21 years old, 12 out of 62 had never had a pap smear. 39% of respondents were not aware of the HPV vaccine and its relationship to cervical cancer prevention. There was a large difference in HPV vaccine awareness by gender and age. Of the 60 female respondents, 20 had reported being unaware of the HPV vaccine, while 17 of the 34 male respondents also reported being unaware. At completion of the survey, two-thirds of respondents reported a plan to receive a pap smear as recommended. 16% said they will not, and 21% were unsure. Our survey set out to understand the distribution of knowledge, awareness, attitudes and behaviors about cervical cancer and HPV vaccination on the SF State college campus. We found that most students on our campus are aware of cervical cancer. However, a small proportion of participants eligible for pap smears have yet to undergo the procedure. Our research also revealed that there is a lack of understanding regarding the importance of HPV vaccination, with significant differences in awareness by gender and age. This study underscores the need for targeted educational initiatives on cervical cancer awareness, knowledge, and attitudes towards HPV and its vaccine. To improve awareness and preventive actions, we can; increase the efforts to educate the public about the importance of HPV vaccinations and regular Pap smears and improve access to vaccination and screening services. Addressing gaps in knowledge and negative impressions of HPV vaccine can lead to the ultimate eradication of CC as we know it. Citation Format: Elissa I. Sanders, Kim F. Rhoads, Suzana Beyene. Cervical cancer awareness, knowledge, and attitudes in young adult students on a Northern California college campus [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A116.

Abstract A100: Addressing financial toxicity and associated social determinants among Hispanic cancer patients in Puerto Rico

Abstract Introduction: Cancer is one of the most expensive medical conditions to treat due to the cost and duration of treatment. Financial toxicity (FT) describes the problems that a cancer patient has related to the cost of medical care, including subjective financial concerns. Despite the high burden of cancer, significant levels of poverty, and a fragile healthcare system in Puerto Rico (PR), no previous studies have evaluated FT among cancer patients in PR. Thus, we aimed to assess FT and associated social determinants among Hispanic cancer patients in PR. Methods: We are conducting a cross-sectional study through an online survey among cancer patients aged 21+ years who have received active cancer treatment over the last year. We use the COST-FACIT questionnaire, a validated survey composed of 12 questions; to measure low (score ≥ 21) and high (score < 21) FT. We also collect information on social determinants, including demographics, clinical characteristics, access to healthcare services, quality of life, social support, and patient navigation services, among others. Cronbach's alpha was used to assess the internal consistency of the FT score. Univariate (ULRM) and multivariate logistic regression models (MLRM) were used to determine the social determinants associated with FT. MLRM included significant variables in the ULRM (p < 0.10) and predictors supported by scientific literature. Results: As of April 8th, 2024, 387 people accessed the survey, with 294 (80.0%) completing it, including the FT section. The final sample size for this preliminary data analysis included 226 participants due to the exclusion of missing information on important covariates. Most of the participants were 51 to 64 years of age (46.9%), female (72.6%), had annual income < $25,000 (59.7%), and had a bachelor’s degree or higher (51.8%). COST-FACIT demonstrated good internal consistency (alpha=0.83). Approximately 46.0% of the participants had a high FT (overall FT mean score = 21.0±8.9). MLRM show that retired participants (OR: 0.22, 95%CI: 0.22-0.59) had less odds of high FT, while those who have public health insurance (OR: 2.38, 95%CI: 1.02-5.54), have comorbidities (OR: 2.27, 95%CI: 1.08-4.79), and have had a cancer diagnosis for more than 1 year (OR: 1.90, 95%CI: 1.02-3.53) have significantly higher odds of experiencing high FT. Conclusion: FT is higher among cancer patients with public health insurance, comorbidities, and more than one year since cancer diagnosis, but FT is lower in retired cancer patients. More research is needed to identify and evaluate interventions to address the FT of cancer treatment and the social determinants associated among Hispanic/Latino patients. IRB: This project was approved by the Institutional Review Board of the University of Puerto Rico Comprehensive Cancer Center (IRB # 2023-11-123). Citation Format: Marievelisse Soto-Salgado, Sofía Contreras-Fernández, Lorena González-Sepúlveda, Karina Torres-Mojica, Rocío Avilés-Mercado, Juan Paulo González-Mayoral, Nancy Cardona-Cordero. Addressing financial toxicity and associated social determinants among Hispanic cancer patients in Puerto Rico [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A100.

Abstract C175: Implementing cervical cancer screening services in women living with HIV in Trinidad and Tobago

Abstract Background: Women constitute 50% of people living with HIV, and cervical cancer (CCA) is among the top cancers for incidence and mortality, in the Caribbean. Women living with HIV (WLWH) are more susceptible and vulnerable to cancer due to their immune-compromised status. There is a pressing need for clinic-based CCA prevention in WLWH. Objective: A preliminary quality improvement evaluation of pilot CCA screening (Pap smear) targeting WLWH in Trinidad and Tobago from July 2020 to September 2021. Methodology: The electronic health information system from a large clinic was used to abstract Pap testing data. No personal identifiers were collected from the system to protect the privacy of individuals and abide by Trinidad and Tobago’s data protection law. Evaluation of quality improvement of interventions approach was applied. Descriptive analyses were conducted using SPSS. Results: A total of 242 WLWH attended the women's clinic (WHC) from July 2020 to September 2021. The average age was 41.2 (age range: 20-72). Most (78.9%) reported sexual activity initiation between 15-29 years old, and 2 in 3 (66.1%) had sexual activity in the last 12 months. Among our participants, 67.8% were Afro-Caribbean, 20.7% were Mixed, and 5.8% were East Indian. The majority of WLWH completed at least secondary education (69.8%). Almost half were single (49.6%), and 59.5% were employed/self-employed. Additionally, 11.6% of patients reported a family history of CCA. The WHC provided Pap test to 91.7% of WLWH, 69.3% had normal Pap test results, 9.2% had abnormal Pap test results, and 0.4% were diagnosed with CCA in situ. Additionally, 8.6% found infections including Candida Albicans, Actinomyces, and Trichomoniasis. For those with abnormal Pap tests, timely follow-up care was provided to prevent further illnesses and cervical dysplasia. WLWH with cervical cancer in situ were scheduled/referred to treatments to prevent CCA progression. Discussion: A women’s clinic approach to CCA screening was successful in providing Pap tests and promoting timely diagnostic and therapeutic care to prevent CCA. We thus recommend an implementation and dissemination science approach to create strategies for adopting, implementing, sustaining and disseminating clinic-based CCA screening and HPV-related cancer prevention to reduce cancer-related morbidity and mortality among WLWH. Citation Format: Jonathan Edwards, Gaole Song, Selena Todd, Tessa Galindo, Sharon Soyer, Gregory Boyce, Kamilah Thomas-Purcell, Jarrett Sharlene, Diadrey-Ann Sealy, Kathy-Ann Pate-Robinson, Kimlin Ashing, Jeffrey Edwards, Nyla Lyons. Implementing cervical cancer screening services in women living with HIV in Trinidad and Tobago [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C175.

Abstract A006: Disparities, social determinants of health, and ovarian cancer: predicting ovarian cancer using sociodemographic information and comorbidities as risk factors

Abstract Introduction In this study, we aimed to identify associations between ovarian cancer (OC) and patient information, including demographics and comorbidities in order to increase awareness of OC risk factors and the ways in which disparities affect individual risk. Methods Administrative data analysis was performed using Florida state inpatient data collected by the Healthcare Cost and Utilization Project in 2012. Demographic variables included age, race, insurance type, and income level. Comorbidities included hypothyroidism, diabetes, hysterectomy, obesity, alcohol abuse, and drug abuse. For each variable, descriptive and logistic regression analyses were performed using SAS software and confirmed with SPSS software to determine frequencies within binary OC outcomes and calculate associations. Results Descriptive analysis revealed that OC was most frequent in white women (73.47%) over 65 (50.17%), who were Medicare beneficiaries (57.00%) within the second quartile of annual income ($38,000-$48,000) (30.71%). Most OC patients did not have any comorbidities. Logistic regression analysis revealed higher risk of OC in women over 65 compared to younger women (OR= 4.277; 95% CI= 3.585-5.103). Black women had reduced odds of OC compared to White women (OR=0.790; 95% CI= 0.693-0.900). Privately insured women had higher odds of OC compared to women with Medicare (OR= 1.426; 95% CI= 1.245-1.634). The risk of OC was reduced in patients in the first, second, and third quartiles of annual income when compared to the highest quartile of annual income (OR= 0.606; 95% CI= 0.527-0.698, OR= 0.618; 95% CI= 0.537-0.710, OR= 0.644; 95% CI= 0.557-0.743, respectively). The risk of OC was increased in women with hypothyroidism (OR= 1.083; 95% CI= 1.021-1.148), diabetes (OR= 1.134; 95% CI= 0.973-1.331), and women who had a hysterectomy (OR= 18.543; 95% CI= 15.262-22.530), compared to those without. Odds of OC were significantly reduced in women with obesity (OR= 0.574; 95% CI= 0.503-0.654) compared to those without. Women who abused alcohol or drugs had lower odds of OC than those who did not (OR= 0.296; 95% CI= 0.205-0.426, OR= 0.280; 95% CI= 0.205-0.382, respectively). Conclusions This study identifies OC risk factors and highlights differences in the prevalence and risk of OC between women of different sociodemographic groups and between women with and without various comorbidities. Groups with socioeconomic privilege were at higher risk of OC. Financial stability and access to healthcare increase the likelihood of receiving a diagnosis, suggesting potential detection bias. Decreased risk of OC was observed in patients with stigmatized comorbidities such as obesity and substance abuse disorders. Under-investigation of symptoms is common in patients with these conditions, leading to underdiagnosis. Health and socioeconomics are inextricable, so it is necessary to understand the relationship between these aspects of patient health and OC to more accurately assess individual risk. Citation Format: Anna E. Langston, Zahra Bahrani-Mostafavi. Disparities, social determinants of health, and ovarian cancer: predicting ovarian cancer using sociodemographic information and comorbidities as risk factors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A006.

Abstract B023: Incorporating the Patient Voice: An Evaluation of NCI-Designated Cancer Centers and Patient Reported Experiences with Genomic Medicine

Abstract Since the National Cancer Act established the Cancer Centers Program in 1971, NCI-designated cancer centers (NCI-CCs) throughout the country have been mandated to translate state-of-the-art cancer research to communities and enhance clinical care for patients within their catchment areas, including minority and underrepresented populations. Precision oncology, which leverages genetics to optimize personalized treatment plans for patients, has promising potential to address cancer health disparities. In this era of targeted personalized care, though genetics has been incorporated into cancer centers, it is unknown how these innovations are being communicated to the public and communities served. There is particularly limited knowledge surrounding how cancer centers may integrate patient reported experiences with genomics into fulfilling their overall mission and reducing cancer health disparities. The objective of this study was to evaluate how cancer centers are publicly sharing information related to their work in understanding and assessing patient experiences with the use of genetics to guide cancer care. For all NCI-CCs involved in clinical care (n=65), we conducted a review of publicly available and published information, using each cancer center website as a point of origin. While almost all the NCI-CCs discuss providing personalized care and perform genetic testing, we found that the majority (51%) indicate that they assess patient-reported outcomes with genomic medicine, such as symptom monitoring during clinical trials. Fewer (38%) indicated having at least one study or that they assess patient experiences and perspectives with genomic medicine that extended to broader measures, like hereditary testing or pharmacogenomic testing to guide treatment. Forty-five percent of NCI-CCs indicate that any pharmacogenomic testing is performed through standard care, research studies, or otherwise. Finally, about 1 in 3 (35%) indicate that they have departmental resources dedicated to monitoring patient experience at their institutions. Some centers described having an established infrastructure dedicated to measuring and incorporating patient reported experiences into programmatic activities, such as offices and annual events dedicated to patient experience. These centers reflecting a built-in infrastructure were 8 to 12% more likely to publicly communicate and describe targeted activities to assess patient reported outcomes and experiences with genomic medicine and/or provide genetic testing. The use of genomics in research and clinical care continues to expand, yet its impact on the minority and underrepresented communities that cancer centers serve remains uncharacterized. Comprehensive understanding of patient reported experience with genomic medicine is lagging and serves as a key opportunity to potentially address cancer health disparities. As leaders in cancer care, NCI-CCs have the opportunity to enhance communication with communities surrounding genomics and improve the patient-centered care they provide. Citation Format: Amanda S. Andriessen, Loren Saulsberry. Incorporating the Patient Voice: An Evaluation of NCI-Designated Cancer Centers and Patient Reported Experiences with Genomic Medicine [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B023.

Abstract C165: Interrogating the Tumor and Immune Microenvironment of Endometrial Cancers Among a Diverse Cohort of Cases

Abstract Endometrial cancer (EC) is the sixth most common gynecological malignancy, with an increasing incidence worldwide over the last two decades. African American women are more likely to be diagnosed with endometrial cancer than Caucasian women. Unfortunately, African American women are more frequently diagnosed with high-grade EC, which occurs 2-3 times more often compared to their white and Hispanic counterparts. Additionally, African American women have higher mortality rates from EC than Caucasian women, highlighting a significant cancer disparity among these patients. Uterine EC disparities are induced by complex ecosystems composed of cellular niches with distinct genotypes, phenotypes, and spatial transcriptomic landscapes. In estrogen-dependent EC tumorigenesis, the endometrium undergoes uncontrollable proliferation, progressing from normal to atypical hyperplasia and ultimately to carcinoma. The heterogeneity of EC tumors complicates therapeutic targeting, rendering EC a challenging disease to cure. This study aims to investigate the genetic and transcriptomic features found in the tumor microenvironment of African American patients with EC. Previous research has shown that the molecular classification of EC tumors can be categorized as estrogen-driven, hypermutant, microsatellite instable, or lacking a specific molecular profile. Current models do not adequately reflect the oncogenic origin and pathological progression in patients. The cohort of EC cases includes primary, metastatic, and normal tumor tissues classified as Uterine Endometrial Adenocarcinoma, along with two Serous Papillary cases with varying tumor grades (low to high grade). Spatial transcriptomics and whole exome sequencing were performed on these samples. Spatial transcriptomics will identify the alterations in gene expression and the spatial landscape of the cell neighborhoods driving tumor heterogeneity. Whole exome sequencing will provide insight into the germline and somatic variants present in EC, offering a deeper understanding of the potential genetic drivers in African American patients. The genes expressed across the EC tumor landscape are implicated in cell proliferation, epithelial- mesenchymal transition, DNA damage response, and immune response. The analysis will also show the transition of normal to malignant endometrium harboring high tumor mutational burden and microsatellite instability when comparing paired samples. This comprehensive approach aims to elucidate the genetic and transcriptomic underpinnings contributing to the disparities observed in African American patients with EC, ultimately informing better-targeted therapies and improving outcomes. Citation Format: Danyelle Paine, John Carpten. Interrogating the Tumor and Immune Microenvironment of Endometrial Cancers Among a Diverse Cohort of Cases [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C165.

Abstract C137: Exploring cardiotoxicity risk factors among patients diagnosed with breast cancer

Abstract Introduction Heart disease is the second most common cause of death for cancer survivors after their cancer diagnosis. Patients diagnosed with cancer, especially those with left-side breast cancer are at higher risk for treatment related toxicity. This burden is exacerbated for vulnerable patients that experience structural and chronic risk factors such as language barriers and disability which contribute to poorer survival. This study compared multi-level factors and their effect on age of diagnosis. Methods We explored a diverse population of N=1795 patient electronic medical records for patients diagnosed with left-side breast cancer and compared characteristics of patients by age, race, ethnicity, history of heart disease, disability status. Descriptive and Kruskal-Wallis ANOVA models were used to compare groups. Results The mostly female cohort of language diverse patients had an average of 66 years, most were White (64.5%), retired (52.1%), and on Medicare (43.2%). Approximately 17.8% were Latine and 13.3% needed an interpreter. Disability status was 9.7% and 8.8% had a history of heart disease. Patients diagnosed with breast cancer who were disabled were younger compared to those without a disability (60 yrs vs 67, p<.0001). When we compared language proficiency, we found this difference persisted as patients with a disability and were limited English were younger compared to patients that experienced neither (61yrs vs 67, p<.0001). Discussion This exploratory analysis is one of the first to explore the role of disability among minoritized and limited English proficient patients with breast cancer. More research is necessary to understand how to best plan and support diverse and disabled patients diagnosed with cancer to minimize their risk and improve outcomes. Citation Format: Melody K Schiaffino, Van "Vannie" K. Nguyen, Dominique Rash, Alicia Fernandez. Exploring cardiotoxicity risk factors among patients diagnosed with breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C137.

Abstract A117: Cervical cancer screening rates among older Hispanic women living in Texas: results using the BRFSS 2018, 2020, and 2022 survey data

Abstract Background: Despite cancer risk increasing with age, older women are less likely to be up-to- date with cervical cancer screening (CCS). CCS is recommended up-to 65 years, absent history of abnormal results. CCS rates are significantly lower among Hispanic women, despite higher cervical cancer incidence and mortality rates compared to non-Hispanic white women. In Texas, women older than 50 years have lower odds of timely pap testing. We examined CCS rates among older Hispanic women in Texas using data from the Behavioral Risk Factor Surveillance System. Methods: Our sample included 5,291 self-identified Hispanic women, ages 50-64. Outcome: receipt of pap smear within the last 3 years following the U.S. Preventive Services Task Force guidelines at the time each survey was conducted (years: 2018, 2020 and 2022). Descriptive analysis and chi-square tests were used to examine the proportion of women who reported receiving CCS within the recommended timeframe. Results: Only 63.75% (mean age = 56.4) reported getting a pap smear. Significant decreases were found among women who had a pap smear from 87.03% in 2018, 71.95% in 2020, and 43.24% in 2022 (p=0.00). Additional analyses will be conducted to test relationships with sociodemographic and healthcare variables. Conclusion: Older Hispanic women in Texas represented in this dataset are far from the 2030 Healthy People goal of 79% CCS. Decreases in CCS rates are possibly due to the COVID-19 pandemic impact on healthcare access. As the US population ages, research is needed to identify the potential systemic barriers this group is confronting to access preventive cancer care. Citation Format: Coralia Vázquez-Otero, Bilikisu Elewonibi, Adaobi Ankwe, Rhonda BeLue. Cervical cancer screening rates among older Hispanic women living in Texas: results using the BRFSS 2018, 2020, and 2022 survey data [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A117.

Abstract C111: Characterization of kisspeptin receptor signaling pathways in cervical cancer: Unveiling novel mechanisms and therapeutic potentials

Abstract Introduction: This study delves into the complex signaling mechanisms of the kisspeptin system in cervical cancer, aiming to unravel the intricate interactions between kisspeptin and its receptor, as well as their roles in modulating cancer progression. Given the emerging significance of the kisspeptin system in tumor biology, our research seeks to illuminate how kisspeptin signaling influences cellular behaviors critical to cancer development, such as proliferation and migration. By exploring the nuanced effects of kisspeptin receptor activation, this study contributes to a deeper understanding of its therapeutic potential and underscores the importance of kisspeptin pathways in the broader context of cancer research. Methods: Was employed Bioluminiscence Resonance Energy Transfer (BRET) assays to explore the activation of the kisspeptin receptor in cervical cancer cell lines, using synthesized analogs of kisspeptin-10 for detailed signaling analysis. Functional effects were assessed through proliferation and migration assays. Additionally, we evaluated the activation or reduction in phosphorylation of specific kinases involved in tumoral processes, providing a nuanced understanding of the signaling mechanisms at play. Results: Our data demonstrate that activation of the kisspeptin receptor substantially modulates cellular proliferation and motility in cervical cancer cell lines. We uncovered novel activation of the Gz protein by kisspeptin-10, which is integral to the kisspeptin receptor function, and identified an upregulation of signaling pathways critical for cell survival and metastasis. Importantly, we observed activation of kinases such as Chk2, c-Jun, p70 S6 kinase, and RSK 1/2/3, as well as members of the STAT family, following kisspeptin-10 stimulation. This kinase activation underscores the multifaceted role of kisspeptin in tumor progression, suggesting its involvement in both pro-oncogenic and tumor-suppressive pathways, and provides direct insights into the mechanistic underpinnings of kisspeptin effect on cancer cell behavior. Conclusion: In conclusion, our study elucidates the complex role of kisspeptin-10 in cervical cancer, demonstrating its ability to modulate cellular proliferation and motility through activation of the kisspeptin receptor. The novel activation of the Gz protein and subsequent upregulation of signaling pathways associated with cell survival and metastasis highlight the intricate involvement of kisspeptin in cancer progression. Furthermore, the activation of key kinases such as Chk2, c-Jun, p70 S6 kinase, RSK 1/2/3, and STAT family members upon kisspeptin-10 stimulation reveals a dual-faceted influence on tumor dynamics, promoting both pro-oncogenic and tumor-suppressive mechanisms. These findings provide significant insights into the molecular actions of kisspeptin in cervical cancer, offering potential targets for therapeutic intervention and a deeper understanding of its role in tumor biology. Citation Format: Deisy Y. Rodríguez-Sarmiento, Pedro H. Scarpelli-Pereira, Michel Bouvier. Characterization of kisspeptin receptor signaling pathways in cervical cancer: Unveiling novel mechanisms and therapeutic potentials [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C111.

Abstract B100: Improving access to hereditary cancer genetic testing in diverse populations: Outcomes in over 33,000 patients tested by genetics and non-genetics providers in Kaiser Permanente Southern California

Abstract Kaiser Permanente Southern California is an integrated health care organization serving over 4.7 million members in 14 medical centers. KPSC members are 42% Hispanic/Latino, 28 % Non-Hispanic White, 11% Asian/Pacific Islander, 8% Black/African American, and 12% Other/Unk. To facilitate detection of hereditary cancer syndromes among patients with personal and/or family histories of breast, colorectal, ovarian, pancreas and other cancers, we offered a 48-gene hereditary cancer multigene-panel test designed to detect all the most common hereditary cancer conditions. Patients seen by genetic counselors or geneticists (Gen providers) receive pre-test genetic counseling and include those with a family history of cancer with or without personal history of cancer. Our mainstreaming program allows non-genetics (non-Gen) providers including medical and surgical oncologists, gastroenterologists, and other specialists to order the test at the point of care (based on NCCN criteria) on their patients with cancer without pre-test genetic counseling. Providers place the order in the EMR system and patients receive an email/text message with information about the test, potential results, links to educational videos and a Genetics phone number for questions. When results are ready patients receive an automatic email/text notifying them and providing a link to their test report. Those with a positive test result receive post-test genetic counseling. Patients with negative or uncertain significance (VUS) results receive a message with a link to their test report, information about their result and the option to schedule a visit with genetics. From April 2021 to May 2024, we completed 33,173 tests: 13,076 (39%) ordered by non-Gen and 20,097 (61%) by Gen providers. The results distribution was similar in both groups: pathogenic/likely pathogenic (PV/LPV): 15% for Gen orders, 12% for non-Gen; VUS: 28% Gen, 30% non-Gen, and negative: 56% Gen, 58% Non-Gen. The patients tested closely reflected the diversity of our population, except for under-representation of Hisp/Latino patients and over-representation of Non-Hisp Whites: 14,400 (42%); Hisp/Latino 9,863 (29%); Asian/PI 4,279 (13%); AA/Black 3,209 (9%); and Oth/Unk 2,415 (7%). Eliminating single MUTYH variants the top 5 genes with the highest number and percentage of PV/LPV results for each of the race/ethnicity categories were as follows: AA/Black: BRCA2=60, BRCA1=38, ATM=36, MUTYH=18; Asian/PI: BRCA2=101, ATM=40, BRCA1=37, PMS2=24; Hisp/Latino: BRCA2=250, BRCA1=171, ATM=127, CHEK2=125; CDKN2A=113; Non Hisp White: CHEK2=346; BRCA2=304; ATM=200, BRCA1=196, FH=100; Oth/Unk: BRCA2=50, BRCA1=41, CHEK2=40, PALB2=30, ATM=20. Our results represent one of the largest and most diverse patient cohorts completing hereditary cancer testing from a single institution. They indicate that mainstreaming hereditary cancer testing can improve access for patients from under-represented groups and suggest differences in the frequency of deleterious variants in different hereditary cancer genes across race/ethnic groups. Citation Format: Monica Alvarado, Trevor Hoffman, Reina Haque, Hilary Kershberg, John Goff. Improving access to hereditary cancer genetic testing in diverse populations: Outcomes in over 33,000 patients tested by genetics and non-genetics providers in Kaiser Permanente Southern California [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B100.

Abstract B117: HT Helper Study: A phone application + patient navigation to improve medication adherence among Latina breast cancer patients experiencing social determinants of health

Abstract Background: Hormone therapy (HT) is highly effective for nearly all breast cancer patients with hormone receptor-positive tumors, which are about 80% of all breast cancer diagnoses. Long-term use of HT reduces cancer recurrence rates and cuts the risk of mortality nearly in half during the second decade after diagnosis. Despite proven benefits, 33% of women who are prescribed HT do not take it as prescribed by their doctor (<80% take their daily dosage). Latina patients are disproportionately affected by Social Determinants of Health (SDoH) that keep them from adhering to HT and are at higher risk of breast cancer recurrence and mortality. Objective: The goal of this 4-year randomized controlled study is to assess the effectiveness of the existing bilingual, culturally tailored, interactive HT Helper App, in combination with patient navigation (PN), on improving adherence to HT among Latina breast cancer patients experiencing SDoH barriers, i.e., income, health insurance, education, health literacy, and language, that impacts their medication adherence. This theory-based intervention will increase patient education, enhance self-efficacy, facilitate communication with the medical team and coordination of resources to address SDoH barriers and help patients develop self-care skills for optimal adherence to HT, ensuring patients the most equitable treatment outcomes possible, including improvement in quality of life, survival, and life expectancy. Study Design. The proposed study involves a parallel 3-group randomized controlled trial with 5-time assessments (baseline, 3, 6, 12, and 18 months) and will enroll 159 breast cancer patients who are prescribed HT and are attending the breast clinic at the Mays Cancer Center at UT Health San Antonio. Intervention components are based on Social Cognitive Theory and elements of Motivational Interviewing. Methods: We will compare the effectiveness of 3 groups on HT adherence: 1) the HT Helper App + PN group vs. the PN alone group vs. the usual care group, and will assess the effect of each study condition on patient self-efficacy to identify side effects, use self-care to manage side effects, and communicate with the medical team. We hypothesize that the HT Helper App + PN and the PN alone groups will have greater rates of HT adherence and higher patient self-efficacy than the usual care group, with the HT Helper App + PN achieving better results than both PN alone and the usual care groups. Conclusion: This proposed multi-level intervention involving a unique combination of mHealth technology + PN has the potential to improve adherence to HT by addressing SDoH and promote equitable breast cancer outcomes, including reduced recurrence and improved quality of life, overall survival and life expectancy among underserved Latina patients. The anticipated outcome is a scalable, evidence-based, and easily disseminated intervention with potentially broad use to patients using oral anticancer medications. Citation Format: Patricia Chalela, Vivian Cortez, Sandra Sivak, Armida Flores, Martha De La Mora, Zully Garcia, Byeongyeob Choi, Edgar Muñoz, Qurathul Ahmed, Audrey Cordova, Maria I Sung-Cuadrado, Asra Aslam, Cliff Despres, Alyssa Gonzales, Virginia G Kaklamani, Kate I. Lathrop, Marcela Mazo Canola, Devasena Inupakutika, David Akopian, Amelie G. Ramirez. HT Helper Study: A phone application + patient navigation to improve medication adherence among Latina breast cancer patients experiencing social determinants of health [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B117.