4th Conference Research Articles

Abstract PR016: Do U.S. quitsites present information related to providing services for LGBTQ individuals? An audit study

Abstract Introduction: Most U.S. quitlines have quitsites, websites designated to promote their services. However, little is known about the design of the quitsites and if they present information relevant to providing services for LGBTQ individuals. The present study audited quitsites for the presence of information regarding services for LGBTQ individuals. Methods Using an audit checklist consisting of nine criteria, a cross-sectional audit of the U.S. quitsites was conducted between October 16th, 2023, and November 8th, 2023. The audit was divided into two phases: 1) auditors evaluated each quitsite separately, and 2) auditors met to discuss points of disagreement and reach a consensus. The interrater agreement was calculated. Frequencies and percentages were calculated for each criterion. Results The audit evaluated a total of 46 quitsites. Auditors had an interrater agreement of 96.85%. Findings indicated that most quitsites had at least a singular mention of the LGBTQ community somewhere on their website (84.8%). However, only 4.3% of the quitsites mentioned the LGBTQ community on their landing page. Conclusions It is recommended that quitsites explicitly mention services for LGBTQ individuals on their landing page, which has the potential to engage the community into quitline services and reduce tobacco-related disparities. Implications This study represents the first audit to assess whether U.S. quitsites present information relevant to providing services for LGBTQ individuals. This research adds knowledge about how official quitline websites address services for the LGBTQ community. The results suggest that quitsites explicitly mention the provision of services for LGBTQ individuals on their landing page, which has the potential to engage LGBTQ individuals into quitline services and reduce tobacco-related disparities. Citation Format: Jeffrey Wilmer Ramos Santiago, Scott McIntosh, Rafael Orfin, Daimarelys Lara, Skylar Joseph, Manpreet Kaur, Alixida Ramos-Pibernus, Ana Paula Cupertino, Deborah Ossip, Francisco Cartujano-Barrera. Do U.S. quitsites present information related to providing services for LGBTQ individuals? An audit study [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 PR016.

Abstract C040: Racial and ethnic differences in breast cancer prognosis and survival in a multiethnic cohort of Asian American breast cancer patients compared with non-Latina White patients at Kaiser Permanente Northern California

Abstract Background: In the U.S., breast cancer (BC) survival differs significantly by race and ethnicity, with Asian American (AA) patients consistently showing more favorable survival relative to other racial and ethnic groups. Factors contributing to the survival advantage of AA females, a heterogeneous population, are unknown. Methods: We included 5,294 AA female patients diagnosed with incident AJCC stage I-IV BC from 2000-2015 at Kaiser Permanente Northern California, and a random sample of 5,294 non-Latina White (NLW) patients. Follow-up was through 12/31/2020 for recurrence, second primary cancer, BC death, and all-cause death. Survival analysis was conducted using multivariable, cause-specific Cox proportional hazards models. Results: The AA cohort consisted of 41% Filipina, 27% Chinese, 9% Japanese, 9% South Asian, 7% Other Asian, 3% Korean, and 5% Southeast Asian females. AA and NLW females had similar stage (12% III/IV) and ER/PR status (15-18% ER-/PR-), yet more AA females were diagnosed with HER2+ or borderline disease (19% vs. 14%). More AA females had chemotherapy (48% vs. 39%) and mastectomy (47% vs. 36%) with less radiation therapy (38% vs. 46%) than NLW females. Receipt of endocrine therapy was similar between AA and NLW females (72-73%). Compared with NLW females, AA females were younger (mean=56.9 vs. 63.2 years), lived in higher SES neighborhoods (census tract-level education and income), had no comorbidities (45% vs. 36%), lower BMI (mean=25.5 vs. 28.6 kg/m2), and were never smokers (77% vs. 50%) at diagnosis. Fewer AA vs. NLW females met national guidelines of 150 minutes/week of moderate-vigorous exercise (27% vs. 33%). In multivariable Cox models adjusted for diagnosis year, diagnosis age, stage, ER/PR and HER2 status, chemotherapy, radiation therapy, endocrine therapy, and surgery type, AA females had 20% lower risk of BC death and all-cause death compared with NLW females. Similar lower risks were seen across AA ethnicities. Specifically, Japanese and Chinese females had lower risks of BC death (hazard ratio, HR=0.66; 95% confidence interval, CI: 0.47-0.93 and HR=0.78; 95% CI: 0.63-0.97) and all-cause death (HR=0.67; 95% CI: 0.53-0.84 and HR=0.78; 95% CI: 0.67-0.92). South Asian females also had lower risk of all-cause death (HR=0.71; 95% CI: 0.53-0.96). AA females had 17% lower risk of second primary cancer compared with NLW females, specifically for Japanese, South Asian, and Other Asian females (HR range: 0.60-0.66). No difference in risk of recurrence was observed for AA vs. NLW females (HR=1.08; 95% CI: 0.90-1.29), including by Asian ethnicities. Conclusions: In this large, multiethnic cohort in an integrated health care system, clear differences in sociodemographic, clinical, and lifestyle factors exist between AA and NLW BC patients. After accounting for these factors, AA females had a survival advantage over NLW females, mostly in Japanese, South Asian, and Chinese females. These findings identify contributors to outcomes that may be specific to Asian ethnicities and can inform improving survival in all BC patients. Citation Format: Marilyn , Lia D'Addario, Janise Roh, Isaac Ergas, Catherine Lee, Salma Shariff-Marco, Iona Cheng, Valerie McGuire, Julie Von Behren, Katherine Lin, Esperanza Castillo, Mi-Ok Kim, Esther John, Anna Wu, Lenora Woo, Allison Kurian, Angela Omilian, Christine Ambrosone, Song Yao, Scarlett Gomez, Lawrence Kushi. Racial and ethnic differences in breast cancer prognosis and survival in a multiethnic cohort of Asian American breast cancer patients compared with non-Latina White patients at Kaiser Permanente Northern 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 C040.

Abstract C179: Train the trainer series in Southern California a call to action for cancer prevention and screening

Abstract Background: Alarmed by low rates of cancer screening in disenfranchised communities and medical deserts in Southern California, City of Hope launched a cancer prevention and control training program to broadly disseminate cancer screening and healthy living educational resources to Health Educators who serve the most vulnerable within our Catchment areas. Methods: The project was IRB approved as exempt came internally from City of Hope. To increase cancer prevention and uptake of cancer screening, we focused on training of Community Health Workers (CHW) from Federally Qualified Health Centers (FQHC’s), community hospitals, faith-based organizations. This community co-designed training included Cancer 101 , on best practice for Breast, Cervical, Colorectal, Lung, and Prostate screening, and Clinical and Biospecimen Studies and SB 987. Complete and online redcap enrollment survey, along with 2 brief pre and post surveys per series topic. The presentations and surveys will be facilitated by COE staff. Trainees completed surveys via RedCap. Surveys will be conducted via Redcap. Results: TTT series trained 101 trainees on 8 topics. Trainees included: Asian (14.9%), Black/African-American (6.9%), Latino/Hispanic (73.3%), Pacific Islander (2.0%), White/European American (5, 5.0%), Mix (3.0%). The gender identities trained were Male (10.9%), Female (87.1%), Transgender: Female to Male (2.0%). Facilitators of screening included Someone to talk about worries/fears about cancer (73.0%), Someone to go with and help at the appointment (53.0%), Paid time off from work (63.0%), Clinical provider recommendation/encouragement (57.0%), Free/ Low cost exams (81.0%), Insurance to pay for exams (68.0%), Free transportation (64.0%), Child care services (53.0%), In-language educational materials (62.0%), Language Interpretation services (51.0%), Community education programs (66.0%), Gift Cards or Incentives (4.0%).The participants' education level was mostly college educated (64.0%), high school (33.0%), and less than high school (3.0%). The top 3 cancers affect our community the most are breast, colon, and lung. Conclusion: The conclusion is community partners are ready to be engaged and trained in cancer prevention and screening. Cancer centers, leveraging their COE, can respond to this call to action. Citation Format: Kimlin Ashing, Lauren D'Souza, Brenda Gascon, James Morrison, Veronica Tejada, Alexis Garden, Jose Gomez, Sophia Yeung. Train the trainer series in Southern California a call to action for cancer prevention and screening [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 C179.

Abstract A040: Effects of food environment, income inequality, and racial segregation on obesity- related cancer mortality

Abstract BACKGROUND: Rural areas experience 7-12% higher risk of obesity-related cancer mortality compared to their urban counterparts. Complex interactions between social and structural factors in rural areas, combined with limited access to healthy foods and lower income, warrant further study to understand drivers of this disparity. Methods: County-level rates of age-adjusted obesity-related cancer mortality per 100,000 (2009-2020 were obtained from the Centers for Disease Control and Prevention’s Wide-Ranging ONline Data for Epidemiologic Research database. Based on data from the Food Environment Atlas, we calculated food swamp using the modified Retail Food Environment Index (mRFEI) as the ratio of fast-food restaurants and convenience stores to grocery and specialized food stores, supercenters, and farmers markets. Food swamp scores were then divided into quartiles. Next, we used Global G and local Gi statistics to identify the presence of spatial autocorrelation in food swamp and subsequently calculated a spatial moving average (SMA) across counties. Measures of economic segregation, racial segregation, and racialized economic segregation were calculated using the Index of Concentration at the Extremes (ICE) using population and demographic estimates from the 2005- 2009 American Community Survey. Larger values reflect concentrated extremes of disadvantage. Poisson regression was used to assess the impact of food swamp, urban-rural status, economic segregation, racial segregation, and racialized economic segregation on rates of obesity-related cancer mortality. Results: Among the 3014 counties included, median food swamp score was 3.6 (interquartile range=2.6-4.9), and counties in the 2nd, 3rd, and 4th quartiles for food swamp had 2%, 4%, and 6% higher rates (respectively) of obesity-related cancer mortality than those in the 1st quartile. Incidence rate ratios for the association of food swamp quartile with obesity-related cancer mortality were 1-3% smaller after control for food swamp SMA and for racialized economic Urban-rural differences in obesity-related cancer mortality varied with all ICE measures. Rural counties had 5% higher rates of obesity-related cancer mortality (IRR=1.05, 95%CI=1.04-1.06), even after controlling for food swamp and food swamp SMA, but there was no longer an association after controlling for economic segregation (IRR=0.99, 95%CI=0.98-1.00). Rural counties had 5% higher rates of obesity-related cancer mortality (IRR=1.05, 95%CI=1.04-1.07) when controlling for racial segregation and 2% higher rates when controlling for racialized economic segregation (IRR=1.02, 95%CI=1.01-1.03). Thus, we stratified our models by urban-rural status and found that each ICE measure had larger effects on obesity-related cancer mortality in rural counties than in urban. CONCLUSION: While food swamp is important, the socioeconomic environment of a county has a larger impact on obesity- related cancer mortality. Individuals may have access to healthy food stores, but whether they can afford the healthy food is more important. Citation Format: Elizabeth S. Davis, Sara Myers, Jeffrey A. Franks, Michael R. Poulson, Julie R. Palmer, Kelly M. Kenzik. Effects of food environment, income inequality, and racial segregation on obesity- related cancer mortality [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 A040.

Abstract B082: Design Studios for Health to identify distinct outreach events and interventions to reduce the burden of cancer among Hispanic/Latino and Black adults in a major southwestern metropolitan region

Abstract Introduction: Cancer is the second leading cause of death in Arizona. While there was a 7% decrease in cancer mortality among Arizonans from 2016-2020, more work is needed to decrease cancer incidence and mortality among racial and ethnic minorities, including Black and Hispanic/Latino populations. Further, it is critical to engage community members to identify cancer-related priorities, brainstorm feasible and acceptable community-based interventions, and co-create community-academia-healthcare solutions to reduce cancer disparities. Methods: The team conducted a series of Design Studios for Health (DSH) – guided listening sessions to foster community involvement, facilitate knowledge exchange, and identify the priorities and concerns for cancer prevention and control in the Black and Hispanic/Latino communities. Each DSH session included introductions, information dissemination, and breakout sessions with a moderator and a notetaker. The first DSH sessions were held in February 2024 via Zoom, one for Black community members (n=14) and one for Hispanic/Latino community members (n=14). In March 2024, an in-person DSH aimed to bring together all previous participants from both communities (n=27). This session deepened collaborations and knowledge exchange, building on insights from the initial sessions. The iterative nature of DSH ensured continuous refinement and co-creation of precision health solutions based on feedback and the data collected. Results: DSH participants identified the following cancer priorities: breast, skin, cervical, prostate, colorectal, and stomach cancers. They emphasized the need for community-shared information on survivorship resources, prevention (shared via social media), symptoms, costs, payment options, resource guides for community health workers, and guidance on navigating medical and insurance payments. Recommendations for academic partners included offering workshops and educational seminars on cancer prevention, using university space to host community cancer prevention events, alternating event locations in the metropolitan region to reach multiple underserved communities, hosting community fairs with multiple cancer education and screening opportunities, forming community advisory boards focused on cancer prevention and control, and organizing local forums to share cancer prevention and control resources. To support local organizations and health education outreach, they recommended creating additional training on cancer, e.g. for community health workers, to enhance public dissemination. Future directions: Based on these findings, our team is developing interactive, virtual, games-based cancer education to help dispel myths about cancer prevention and control. We are collaborating with community health workers to increase the accessibility of cancer prevention, screening, and resource education at pop-up cancer screening events (October and November 2024) held in areas of Phoenix serving low-income, racially, and ethnically diverse communities. Citation Format: Alexis M. Koskan, Maricarmen Vizcaino, Maissa Khatib, Tina M. Brown, Dorothy D. Sears. Design Studios for Health to identify distinct outreach events and interventions to reduce the burden of cancer among Hispanic/Latino and Black adults in a major southwestern metropolitan region [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 B082.

Abstract C071: Comprehensive genomics-informed prospective older adult (OA) cancer registry: Initial findings from gastrointestinal (GI) malignancy

Abstract The REACH study (Resilience and Equity in Aging, Cancer, and Health) assesses the impact of geriatric consultation on reducing emergency department and/or unplanned hospitalization visits (EDH) for OA age 70+ diagnosed with GI cancer. We sought to develop an OA GI cancer registry (REACH Registry) within the REACH intervention integrating 1) disease and treatment factors from the PRISSMM cancer taxonomy model with 2) patient reported outcomes and 3) geriatric assessment (GA) measures predictive of function, toxicity, and survival. We reviewed GA measures using the modified Rockwood frailty scale, PROMIS-10 global mental and physical scores, Karnofsky performance status, health-related social needs, and disease/treatment factors using PRISSMM cancer taxonomy for OA consented to REACH in the GI Cancer Center at Dana-Farber Cancer Institute (DFCI) from January 2022–April 2024. OA were eligible if age 70+ at initial DFCI consult visit and diagnosed with any GI cancer. The GA stratifies OA by frailty level on a 0-1 scale: Fit/Robust (score range 0–0.19), Pre-Frail (0.2–0.34), and Frail (0.35–1.0). PRISSMM is a cancer data modeling system developed for the American Association for Cancer Research Project Genomics Evidence Neoplasia Information Exchange (GENIE) Biopharma Collaborative; it includes pathology, radiology/imaging, symptoms, and molecular markers curated by trained research staff from unstructured EHR data. From Jan. 2022–Apr. 2024, 50 OA consented to REACH registry (94 eligible). Of those, 44% (n=22) have PRISSMM data available for analysis. Most OA reported white race (90%, n=45) and female gender (52%, n=26). Pancreatic cancer was the most common diagnosis (n=21), followed by colon (9), biliary (5), and esophageal (4). Most OA completed GA (90%, n=45) with 51% screened Fit/Robust (n=23), 47% Pre-Frail (n=21), and 2% Frail (n=1). Type 2 diabetes mellitus was the most commonly reported comorbid condition (26%, n=13), followed by chronic kidney disease (n=6) and congestive heart failure (n=3). Of the 22 OA with available PRISSMM data, 59% (n=13) were diagnosed with stage IV disease and 100% received cancer-directed therapy; 72% (n=16) received standard care, 27% clinical trial (n=6). Most OA consented for tumor somatic genomic testing (77%, n=17). At the time of data curation 24 months from assessment, 20 patients had died, 30 were alive. Evaluation of the REACH intervention geriatric consultation on EDH outcome is forthcoming. REACH registry is the first GI cancer database inclusive of geriatric specific measures alongside curated disease, treatment and genomic data. We observed a higher rate of genomic testing and treatment initiation than reported in the literature. We anticipate that by September 2024, a larger cohort of REACH Registry participants will have completed PRISSMM data available for analysis. Future study will compare EDH for REACH vs. non-REACH OA as well as treatment patterns of this OA cohort evaluated at a large comprehensive cancer center and associated community sites. Citation Format: Tammy T. Hshieh, Rachel L. Weitzner, Siri Rosenberg, Leila Rostamnjad, Lauren K. Brais, Nora Horick, Tamryn Gray, Jiping Wang, Jeffrey Meyerhardt, Nadine J. McCleary. Comprehensive genomics-informed prospective older adult (OA) cancer registry: Initial findings from gastrointestinal (GI) malignancy [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 C071.

Abstract B088: Decentralizing cancer disparities research: Barbershops as a foundation for community outreach and engagement

Abstract Introduction Addressing cancer disparities by meeting people where they are is a crucial aspect of community-engaged research. The impact of this has been seen through the community outreach and engagement efforts of cancer centers across the country, with many focusing on churches, community events, and other trusted places. In the past four years, Mayo Clinic’s Cancer Health Equity Program (CHERP) has made a specific effort to decentralize clinical trials and community-engaged research by going to the places our community trusts and frequents. As a result, we partnered with a trusted leader in Jacksonville, Florida to engage with barbershops as sites for health information dissemination. We re-engaged a cohort of barbers who had previously worked with our outreach initiatives as part of the Community Engagement Alliance (CEAL) Against COVID-19 Disparities and recruited new ones for this phase of work. Methods Our community partner completed a training hosted by Florida A&M University on working with barbershops for community outreach and engagement research. The community partner then trained each barber on sharing health information, incorporating feedback from the previous cohort. Barbers were also trained to collect engagement and pre/post-test information to measure outcomes. Health information included COVID-19 prevention/ vaccine information and general cancer prevention information used in other community outreach and engagement initiatives. Results A total of 19 barbers engaged in this initiative; 9 were a part of our previous work with barbers and 10 were recruited for the new year of funding. The barbers all identified as Black and engaged with a total of 497 clients. Of the 497 clients, 91% identified as Black, and less than 5% identified as White, Asian, or Native American. 344 clients identified as male (69%), 147 as female (30%), 1 as transgender (0.2%), and 5 did not disclose their gender. The majority of participants were born between the 1960s and 2000s, with most reporting having a high school degree or GED (55%). Post-test information found evidence of knowledge change, including a 3.4% increase in those who responded understanding how COVID-19 is spread and a 4% increase in those who reported vaccines to be safe. Barbers also expressed their appreciation for being included in this initiative. Conclusion CHERP, in partnership with the community, is addressing disparities at different levels. One of the barriers the barbers had to overcome was hesitancy in sharing health-related topics. However, sustained initiatives, such as this one might overcome this barrier. This study’s engagement with barbershops to reach communities most impacted by cancer disparities points to the impact of barbershops as a site for cancer disparities research. Citation Format: Jessica Otero Machuca, Opeyemi Bolajoko, Jocelyn Turner, Folakemi Odedina. Decentralizing cancer disparities research: Barbershops as a foundation for community outreach and engagement [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 B088.

Abstract C155: Differential colorectal cancer mortality across racial and ethnic groups: Impact of socioeconomic status, clinicopathology, and treatment-related factors

Abstract Introduction: Non-Hispanic Black colorectal cancer (CRC) patients have a higher risk of mortality compared to most other racial/ethnic groups. Limited studies examine the contribution of socioeconomic (SES), clinicopathologic, or treatment variations toward mortality disparities. This retrospective cohort investigation examined the extent to which SES, clinicopathologic, and treatment factors explain racial/ethnic differences in CRC mortality. Methods: We studied 146,515 individuals ,18+ years old, with a confirmed diagnosis of CRC within 2010-2017 identified from the Surveillance, Epidemiology, and End Results (SEER) database. We performed Cox regression analyses to examine the association of race/ethnicity, surgery type, and tumor site with all-cause mortality and CRC-specific mortality. We then performed mediation analysis to quantify the extent to which mortality differences were mediated by SES, clinicopathologic, and treatment factors. Results: Non-Hispanic Black patients had a significantly higher hazard of all-cause mortality than non-Hispanic White patients. The non- Hispanic White versus non-Hispanic Black patients’ comparison demonstrated that variations in SES and clinicopathologic factors significantly explained 46.63% (indirect effect HR: 0.92, 95% CI 0.91-0.93) and 10.87% (indirect effect HR: 0.98, 95% CI 0.97-99) of the excess all-cause mortality among non-Hispanic Black patients, respectively. The Hispanic vs. non-Hispanic Black comparisons identified SES as the most influential mediator, explaining 19.68% of the excess all-cause mortality. The proportions mediating for CRC-specific mortality showed comparable outcomes to all-cause mortality. Conclusions Non-Hispanic Black patients had greater risk for all-cause mortality and CRC-specific mortality attributed to SES and clinicopathologic variations compared to other racial/ethnic groups. Future studies should investigate equity in healthcare through interventions addressing SES-related disparities. Citation Format: Pierre Fwelo, Toluwani E. Adekunle, Tiwaladeoluwa B. Adekunle, Ella R. Garza, Emily S. Huang, Wayne R. Lawrence, Aldenise P. Ewing. Differential colorectal cancer mortality across racial and ethnic groups: Impact of socioeconomic status, clinicopathology, and treatment-related 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 C155.

Abstract A139: Patient and provider barriers and facilitators to lung cancer screening: I-STEP 2 Study

Abstract Purpose: While lung cancer is a leading cause of death in the U.S., annual lung cancer screening (LCS) rates remain low. After deployment of an implementation intervention to increase lung cancer screening (LCS) and referral, we used a qualitative approach to identify barriers and facilitators, and recommended supports to increase screening. Methods: Semi-structured interviews were conducted with patients (n=66) and providers (n=59) across 15 BJC Consortium hospitals. Interview domains included perceptions and experiences with LCS referral and completion, barriers and facilitators to LCS, and the impact of the COVID-19 pandemic on these processes. Patients were eligible if they had been referred for LCS. Providers were eligible if they were involved in the LCS decision-making and referral process. Interviews were audio-recorded, de-identified, and transcribed. Deductive and inductive codes were developed separately for patients and providers. Coded data were analyzed to determine themes. Results: Patients cited transportation, uncertainty surrounding insurance coverage for screening, and the COVID-19 pandemic as barriers to accessing LCS. Due to the Medicare and Medicaid requirement of a documented shared decision-making visit prior to providing an LCS referral, providers cited time constraints during patient encounters as a barrier to delivering optimal LCS care. Both patients and providers reported low general awareness of LCS (compared to other preventive screening services) as a barrier to utilization. Patients described many facilitators to LCS including fears regarding cancer risk, knowledge of the benefits of early cancer detection in improving cancer outcomes, provider recommendations, ease of LCS process, and receiving educational materials about LCS. Providers also describe access to evidence-based outreach and education materials regarding LCS, and implementation of clinical decision support tools (e.g. pre-screening for LCS eligibility and insurance authorization, integration of EMR prompts centered around LCS and nodule surveillance) as facilitators for screening. Patients and providers highlighted the importance of LCS navigators in facilitating communication and reducing barriers to LCS and surveillance – specifically, patients found one-on-one support and education with navigators to be encouraging as they underwent LCS. Conclusion: While there are some key barriers related to lung cancer screening and follow-up, there are many facilitators to screening that can be leveraged to increase referrals and enable successful follow-up management after screening. Recommended additions to basic lung screening intervention materials include provider education on how lung cancer screening referral processes are unique in comparison to other screenings, how providers can foster patient understanding of lung nodules, and local support and resources to help patients navigate barriers to lung screening. Citation Format: Amy Ayala, Meera Muthukrishnan, Sydney Beache, Michelle Silver, Courtney Harriss, Graham Colditz, Aimee James. Patient and provider barriers and facilitators to lung cancer screening: I-STEP 2 Study [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 A139.

Abstract C168: Developing lung adenocarcinoma cell lines to mitigate lung cancer health disparities

Abstract Lung cancer continues to be the number one cause of cancer-related deaths worldwide and remains a prominent source of cancer health disparities. Black/African American (B/AA) males exhibit a 12% higher lung cancer incidence rate and a 15% higher lung cancer death rate when compared to white males. Lung adenocarcinoma (LUAD) is the most common histological subtype of lung cancer in all ethnic/racial groups, including B/AAs. To further examine this phenomenon, we want to create a collection of lung cancer cell lines that would be useful for molecular studies of lung cancer development, progression, development of new targeted therapies, and pre-clinical drug testing. After reviewing the literature (Leon et al. 2023, Frontiers in Oncology, Vol. 13, p. 1187585, 2023), we identified only 30 unique B/AA cell lines out of ∼800, the majority of which are derived from White and Asian patients. Moreover, only 6 of the 30 cell lines are derived from patients with LUAD. We are in the process of deriving more LUAD cell lines from B/AA patients as well as alveolar epithelial cell lines in order to study the development of LUAD. In addition, we are creating a collection of multiple independent isogenic cell line variants from an existing lung cancer cell line NCI-H23. NCI-H23 was derived from a B/AA male LUAD patient and harbors a KRASG12C heterozygous mutation. G12C is the most common KRAS mutation in LUAD (∼40% of KRAS mutations) followed by G12V (∼20%), G12D (∼15%), G12A (∼10%), and G13C (∼6%). We used CRISPR/Cas-9 genome- based editing to replace the KRASG12C mutation with KRASG12V, KRASG12D, KRASG12A, and KRASG13C. We have derived multiple independent cell lines for most mutations. We are in the process of performing whole genome sequencing of these cell lines to exclude any off-target effects that may have arisen from the CRISPR/Cas-9 engineering. In addition, we will carry out whole genome RNA sequencing to assess the effect of the engineering and/or KRAS mutation switching. As a control, we are also sequencing the genomes and transcriptomes of three monoclonal cell lines we derived from NCI-H23 cells, to determine what variability ensues with the derivation of monoclonal lines, since that is required to obtain the CRISPR/Cas9-edited cells. We will use this collection of cell lines to study the efficacy of polyisoprenylated cysteinyl amide inhibitors (PCAIs) and other drugs on cell lines bearing these KRAS mutations. PCAIs were developed to target cells carrying mutant KRAS. Our efforts will provide new cell lines to study lung adenocarcinoma in B/AA subjects, addressing a key shortcoming and disparity in the lung cancer research toolkit. Citation Format: Sofia A. Lugo, Christopher Leon, Matthew A. Gladstone, Chunli Yan, Daniel J. Mullen, Pablo E. Puente, Kweku Ofosu-Asante, Justin K. Mensah-Mamfo, Kyle R. Phillips, Yong Huang, Nazarius S. Lamango, Ite A. Offringa. Developing lung adenocarcinoma cell lines to mitigate lung cancer health disparities [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 C168.

Abstract C121: Racial differences in expression of the oxygen-sensor BACH1 in breast cancer

Abstract Hypoxia is an important hallmark of aggressive solid tumors and a key driver of metastasis and resistance to therapy. Hypoxic stress induces the activation of various factors, such as hypoxia- inducible factors (HIFs), which facilitate cellular adaptation and promote tumorigenesis. Given the complexity of this mechanism, identifying novel targets that sensitize hypoxic tumors to therapy could have significant clinical impact. We demonstrate HIF-independent induction of BACH1 within multiple TNBC (Triple-Negative Breast Cancer) cell lines and patient-derived organoids under hypoxic conditions. Utilizing ChIP-seq, bulk, single-cell and spatial transcriptomics across diverse BACH1 knockout tumor models, our study revealed that BACH1 selectively and directly modulates the transcriptional response associated with hypoxia and stress in TNBC. TGCA analysis reveals racial disparities in BACH1 mRNA expression in TNBC BACH1 mRNA and activity across all breast cancer subtypes (Basal, Her, LumA, LumB). Our findings suggest that BACH1 is an oxygen-sensitive mediator of hypoxia and a promising therapeutic target for mitigating hypoxia-induced pro-metastatic signaling and treatment resistance. These results also highlight the necessity of accounting for racial differences in BACH1 expression and function as a means of developing targeted therapy that takes into account racial disparities in TNBC. Citation Format: Long C. Nguyen, Christopher Dann, Dongbo Yang, Madeline Henn, Emily Shi, Thomas Li, Kent Schechter, Letícia Stock, Wenchao Liu, Margarite Matossian, Andrea Valdespino, Yoo Jane Han, Jing Zhang, Geetha Priyanka Yerradoddi, Yan Li, Mitsuyo Matsumoto, Olufunmilayo I Olopade, Kazuhiko Igarashi, Marsha R Rosner. Racial differences in expression of the oxygen-sensor BACH1 in 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 C121.

Abstract B112: Empowering cancer advocates: Evaluating the impact of a comprehensive training program

Abstract The Cancer Advocacy Training Program aimed to enhance participants' knowledge, skills, and confidence in cancer advocacy, particularly addressing disparities in cancer health outcomes. This evaluation assesses the program's impact through pre- and post-training survey comparisons. The program included 25 participants from various states and focused on comprehensive training. Surveys measured changes in knowledge, attitudes, self-perceived skills, and confidence. Results showed that accurate identification of cancer's main categories increased from 83% to 96%, and awareness of the NCI's mammogram recommendations rose from 70% to 96%. Recognition of the root causes of health disparities remained at 100%, and belief in the inclusivity of cancer advocacy roles was consistently high. Understanding of trust dynamics in advocacy increased by 50%, and recognition of essential political advocacy components improved by 14%. Specific learning outcomes indicated consistent identification of research advocates, a 23% increase in knowledge of strategic funding sources, a 31% improvement in understanding health communication audiences, a 19% rise in awareness of patient advocacy benefits, and a 13% increase in comprehension of informed consent. Confidence in advocacy skills also saw significant improvements. "Extremely confident" participants increased to 33% in problem-solving, adaptability, and communication with stakeholders. Confidence in fundraising and partnership building rose to 19%, evaluation of advocacy outcomes to 24%, identifying key issues to 29%, presentation skills to 33%, and using digital tools to 29%. Self-efficacy results demonstrated notable gains: confidence in solving difficult problems related to cancer advocacy increased with participants reporting "extremely confident" rising from 11% to 33%. Confidence in adaptability under stress improved significantly, with "extremely confident" participants rising from 11% to 33%. Effective communication with stakeholders saw a significant increase, with "extremely confident" participants rising from 17% to 33%. Fundraising and partnership-building confidence increased from 6% to 19%, and confidence in evaluating advocacy outcomes improved, with "extremely confident" participants rising from 6% to 24%. The program effectively enhanced participants' knowledge, attitudes, and advocacy skills, integrating theoretical and practical learning. Gains in confidence across problem-solving, adaptability, and communication skills underline the program's success in preparing participants for real-world advocacy. Participant feedback confirmed the program's relevance and efficacy, suggesting future iterations should emphasize diversity in advocacy and deepen content on key topics. This program serves as a valuable model for empowering cancer advocates and addresses the critical need for targeted training to reduce cancer health disparities. Citation Format: Manisha Salinas, Monica Albertie. Empowering cancer advocates: Evaluating the impact of a comprehensive training 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 B112.

Abstract B028: Beyond the diagnosis: A town hall event to explore black men’s journey with prostate cancer and sexuality

Abstract Introduction Prostate cancer (CaP) significantly impacts Black men, who face higher morbidity despite lower overall mortality. The disease and its treatments profoundly affect sexuality, relationships, and quality of life (QoL), necessitating robust support systems. Healthcare, spousal support, community involvement, and interactions with other survivors are crucial for enhancing survivors' self-esteem and daily functioning. Virtual town halls offer a platform to share trusted information and foster community support, overcoming geographic and structural barriers. This town hall event will explore Black CaP survivors' experiences, focusing on sexuality post-diagnosis and related medical and psychological needs. MethodsOn June 13, 2024, The University of Oklahoma and Stephenson Cancer Center will host the 5th town hall event (via Microsoft Teams) to address Black CaP survivors' sexual health concerns. Previous town halls averaged 70 attendees and covered various aspects of the CaP journey. This event will include storytelling and panel discussions, with presentations from two CaP survivors and their spouses on personal experiences and coping strategies. A urologic oncologist will discuss treatment advancements and early detection, while a clinical health psychologist will address psychological and emotional aspects of survivorship. Simultaneous watch parties will be held in Milledgeville, Georgia, and Dallas, Texas. Interactive Q&A sessions will allow participant engagement. Attendees will complete a post-event survey to assess the session's impact and collect clinical and sociodemographic data. Quantitative data will be analyzed using SPSS v28, and audio-recorded sessions will be transcribed and thematically analyzed using Nvivo. Results will be available by the end of June and presented at the conference. Expected Results Participants will gain a deeper understanding of the intersection between CaP and sexuality in Black men's health. Discussions will highlight the psychological impact of a cancer diagnosis, challenges in maintaining sexual health during and after treatment, and the role of mental health support. The town hall aims to emphasize the importance of a strong support system, providing valuable coping skills through shared experiences and expert insights. Topics will include the emotional and psychological impact of sexual health challenges, partner support, and the necessity of open communication with healthcare providers. The event seeks to improve CaP survivors' QoL by emphasizing continuous education and integrating sexual health into overall survivorship care. Conclusion This town hall event aims to bridge gaps in understanding and addressing Black CaP survivors' sexual health concerns. By fostering open dialogue and providing expert insights, we hope to improve these men's QoL and survivorship care, emphasizing mental health support, spousal support, and continuous education. Citation Format: Motolani Ogunsanya, Ernie Kaninjing, Parisa Ghasemi, Skyler Danker, Daniel Morton, Kathleen Dwyer, Mary Ellen Young, Folakemi T. Odedina, Yaw Nyame, Amy Siston, Jordan Neil, Adam C Alexander, Perry Cole, Patrick Beckford, Donald Reese, Thomas Mitchell, Everett Montgomery, Roland Odeleye, Darla E. Kendzor. Beyond the diagnosis: A town hall event to explore black men’s journey with prostate cancer and sexuality [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 B028.

Abstract A051: Association of residential economic and racial segregation with pediatric cancer survival

Abstract Purpose: Studies have linked residential segregation to inferior outcomes in adult-onset cancers. However, its association with pediatric cancer outcomes remains poorly understood. Racial and ethnic disparities in pediatric cancer outcomes are well-documented, and residential segregation may contribute, at least in part, to these disparities. This study examines the association between residential economic and racial segregation and survival in a statewide, population-based cohort of pediatric oncology patients. Methods: We studied a cohort of children diagnosed with their initial cancer between 2009 and 2016 at age 21 or younger, who were treated at Children’s Healthcare of Atlanta. The Index of Concentration at the Extremes (ICE) was mapped to the ZIP Codes of patient residence at diagnosis to measure economic and racial segregation. ICE was calculated by the difference between the number of non-Hispanic White people with >80th percentile household income and non-Hispanic Black people with <20th percentile household income, divided by the total number of people in the ZIP Code. ICE tertiles were categorized from the most deprived/segregated (tertile 1) to the most privileged/least segregated (tertile 3). We used the Cox proportional hazards model to estimate 5-, 3-, and 1-year overall survival from diagnosis by ICE tertiles, or by ICE tertiles and patient race. All models adjusted for sociodemographic (age at diagnosis, sex, health insurance, rurality) and clinical factors (cancer type, year of diagnosis). Results: Of our cohort (N=2,790), a higher proportion of non-Hispanic Black patients (50.8% vs. 13.4%) and publicly insured patients (62.3% vs. 30.8%) was found in tertile 1 compared to tertile 3. Patients living in tertile 1 consistently exhibited a higher risk of death at 5 years (adjusted hazard ratio [aHR]=1.32, 95% confidence interval [CI]=1.03-1.69, p=0.026), 3 years (aHR=1.35, 95% CI=1.04-1.75, p=0.026), and 1 year (aHR=1.38, 95% CI=0.94-2.03, p=0.099) post diagnosis, compared to those in tertile 3. In addition, compared to non-Hispanic White patients living in ICE tertiles 2-3 (more privileged areas), no survival difference was found among non-Hispanic Black children living in the same tertiles, while non- Hispanic Black children living in ICE tertile 1 had a significantly higher risk of death at 5 years (aHR=1.46, 95% CI=1.11-1.90, p=0.006), 3 years (aHR=1.56, 95% CI=1.17-2.07, p=0.002), and 1 year (aHR=1.65, 95% CI=1.11-2.45, p=0.014) post diagnosis. Conclusion: Our data indicate that residence in more racially segregated and economically deprived neighborhoods is associated with poorer overall survival among children diagnosed with cancer. Further research should explore the mediation and moderation effects of residential segregation on racial disparities in pediatric cancer-specific survival. Citation Format: Xu Ji, Lu Zhang, Xuesong Han, Heeju Sohn, Kinsey Meggett, Rebecca Williamson Lewis, Sharon M Castellino. Association of residential economic and racial segregation with pediatric cancer survival [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 A051.

Abstract B080: UC Davis Center for Advancing Cancer Health Equity: A framework for community-led cancer health interventions

Abstract Many racial/ethnic groups in the US experience cancer health disparities, contributing to higher cancer incidence and cancer-related deaths compared to other groups. These are driven by a combination of biological and social determinants of health that affect cancer development and care response across the cancer health continuum. Underserved communities in California, many of which are communities of color, experience combinations of these factors that result in a unique landscape of barriers to cancer care. Because of this, interventions to remove these barriers cannot follow a one-fits-all approach. There is a critical need for community-directed interventions that reflect the cultural and social values of the members of a specific community to effectively identify and eliminate barriers to care. Through the UC Davis Center for Advancing Cancer Health Equity (CACHE), we have developed an infrastructure to design and implement community-directed interventions as a partnership between community members and the cancer research community at UC Davis. CACHE was launched in 2022 with the purpose of conducting community-engaged research to implement multi-level interventions for cancer health equity. CACHE is focused on placing underserved communities located in UC Davis’ catchment area at its center through community member ownership and leadership of the center’s research decision-making process. In this initial phase, the center recruited health professionals and community members throughout Northern California to participate in focus groups that inform the development of the center’s mission and vision, and name. Through these focus groups, our center identified community values and terminology that helped to guide and set expectations for its goals, actions and trust-building with underserved communities. The center establishes lasting community relationships through the development of task forces, whose goal is to identify community cancer health priorities to address through research. Given the significant cancer health disparities for American Indian and Alaska Natives in California, the first task force CACHE established is focused on Native and Indigenous cancer health. It consists of both academic researchers and community and Tribal leaders. Our task force began a cancer health needs assessment in partnership with multiple Tribal Nations and non-profit health center Northern Valley Indian Health. Native and Indigenous community conversations have uncovered cancer health and prevention education, transportation, and medical and research communities’ trustworthiness as barriers. We are now working to expand our understanding of these barriers for research interventions leading to improve Native and Indigenous cancer health. Ultimately, the goal of CACHE and its task forces is to develop community-led interventions to eliminate cancer care barriers in partnership with communities, and move towards cancer health equity for all. Citation Format: Nicole B. Halmai, Sophie Barbu, Angelica Rolon, Inigo Verduzco Gallo, Nanci Chavarria Villa, Guadalupe Carvajal, Luis G. Carvajal- Carmona. UC Davis Center for Advancing Cancer Health Equity: A framework for community-led cancer health interventions [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 B080.

Abstract C067: Immune thrombocytopenia induced by PD-1/PD-L1 inhibitors in a patient with non-small cell lung adenocarcinoma: A case report and literature review

Abstract Introduction: The introduction of immunotherapy, particularly programmed cell death protein 1 (PD-1) and programmed cell death-ligand 1 (PD-L1) inhibitors, has transformed the treatment paradigm for non-small cell lung adenocarcinoma (NSCLC), significantly improving patient survival rates. However, alongside their immune-activating effects, these agents can also lead to immune-related adverse events (irAEs), affecting various organ systems. Among these, immune thrombocytopenia (ITP) is a rare but potentially life-threatening complication characterized by the destruction of platelets by autoantibodies, resulting in decreased platelet counts and an increased risk of bleeding. While ITP has been identified as a complication of immunotherapy, particularly PD-1 or PD-L1 inhibitors, its incidence, clinical presentation, and management remain poorly understood. Case Presentation: The 73-year-old female with stage IIIA poorly differentiated NSCLC who received chemotherapy with Taxol/Carboplatin and concurrent radiation therapy followed by a right upper lobectomy, initiated on immunotherapy with durvalumab, a PD-L1 inhibitor, developed severe thrombocytopenia (grade 4) after receiving two cycles of durvalumab. Despite steroid treatment, her condition persisted, indicating immune-related adverse events (irAEs). After confirming the diagnosis through further investigation, including molecular analysis, the patient was treated with intravenous immunoglobulin (IVIG), which significantly increased her platelet counts. Durvalumab was discontinued, and fostamatinib, a spleen tyrosine kinase (SYK) inhibitor, was initiated to manage the irAEs effectively. Discussion: ITP is recognized as an immune-related adverse event (irAE) associated with PD-1 or PD-L1 inhibitors, although it remains rare and poorly understood. Several case reports have highlighted the occurrence of ITP induced by these inhibitors, demonstrating varied clinical presentations and responses to treatment. Mechanisms underlying ITP induction by PD-1/PD-L1 inhibitors are not fully elucidated but may involve immune dysregulation, including CD4+ and CD8+ T cell activation, production of antiplatelet antibodies, and increased expression of PD-L1 on platelets. Management strategies for ITP induced by PD-1/PD-L1 inhibitors include steroids, intravenous immunoglobulin (IVIG) therapy, recombinant human thrombopoietin (TPO), interleukin-6 (IL-6) receptor antagonists, and immunosuppressive agents. However, the effectiveness of these treatments varies among patients, highlighting the need for individualized approaches and further research to optimize management strategies. Conclusion: The prompt recognition and management of ITP induced by PD-1/PD-L1 inhibitors are essential for ensuring favorable patient outcomes. Further research is needed to understand the underlying mechanisms and develop effective prevention and management strategies for this rare but serious immune-related adverse event. Citation Format: Aliya M Khan, Richa Dawar. Immune thrombocytopenia induced by PD-1/PD-L1 inhibitors in a patient with non-small cell lung adenocarcinoma: A case report and literature review [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 C067.

Abstract B060: Bridging gaps in cancer care: Evaluating community health worker presence in Alabama on rates of cancer screening and lifestyle-related outcomes

Abstract Purpose Alabama has the 7th highest cancer mortality in the US. The University of Alabama at Birmingham O’Neal Comprehensive Cancer Center—the only NCI-designated comprehensive cancer center in the state—endeavors to reduce cancer mortality and burden. For 25 years, its Office of Community Outreach and Engagement (OCOE) has applied a community health worker (CHW) outreach and engagement model for cancer awareness, navigation to screening and healthy lifestyle promotion. OCOE hired and trained CHWs to provide services in counties with highest cancer burden. CHW presence fluctuated over time due to grant-funding and other extraneous events. This study evaluates the association of CHW presence with cancer screening and lifestyle-related outcomes. Methods We utilized latest CDC PLACES data (drawn from 2018 and 2020 Behavioral Risk Factor Surveillance System) which provides model-based, population-level age-adjusted prevalence estimates of county-level cancer screening (breast, cervical, colon) and lifestyle outcomes (physical inactivity, obesity, smoking). We evaluated change in rates over time between counties with and without CHW presence using linear mixed effects models. Results Compared to counties without CHW presence, those with CHW presence in 2020 had 0.7% higher mammography rate in 2018 (95% CI: -0.8, 2.3) and 0% difference in mammography rate per year change (95% CI: -0.6, 0.7); counties with CHW presence in both years had 2.8% higher mammography rate (95% CI: 1.1, 4.6) and 0.2% faster increase in mammography rate per year (95% CI: -0.5, 1.0). Counties with CHW presence in both 2018 and 2020 had 1.8% lower rate of colon cancer screening in 2018 (95% CI: -3.6, 0.02) and 1.3% increase in colon cancer screening per year (95% CI: 0.5, 2.1). Counties with CHW presence in 2020 had 1% higher physical inactivity rate in 2018 (95% CI: -2.3, 4.3) and 0.3% faster decrease in physical inactivity rate per year (95% CI: -1.0, 0.4); counties with CHW presence in both years had 3.6% higher physical inactivity rate in 2018 and 0.2% faster decrease in physical inactivity rate per year (95% CI: -0.8, 0.5). Counties with CHW presence in 2020 only had 1.8% higher obesity rate in 2018 (95% CI: -1.7, 5.2) and 0.9% faster decline in obesity rate per year (95% CI: -2.2, 0.4); counties with CHW presence in both years had 5.1% higher obesity rate in 2018 (95% CI: 1.9, 8.3) and 0.3% faster decline in obesity rate per year (95% CI: -1.6, 0.9). There were no statistically significant differences for cervical cancer screening or smoking. Conclusion The OCOE CHW model provided access, education and empowerment for AL residents to obtain cancer screenings and participate in healthy lifestyle behaviors. CHW presence (particularly sustained presence over time) was associated with improved mammography and colon cancer screening, reduced physical inactivity and reduced obesity. Further study of CHW presence and these outcomes during and post COVID-19 is ongoing. Expansion of the CHW model across the entire state is a priority to reduce cancer mortality among Alabamians. Citation Format: Mackenzie E. Fowler, Claudia Hardy, Silvia Gisiger-Camata, Francine Walton, Rochelle Wallace, Tara Bowman, Aldenise P. Ewing, Timiya S. Nolan. Bridging gaps in cancer care: Evaluating community health worker presence in Alabama on rates of cancer screening and lifestyle-related outcomes [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 B060.

Abstract C089: Characterization of the breast tumor immune microenvironment in women of African descent using single-nucleus RNA- and ATAC-sequencing

Abstract Women of African descent are at an increased risk of developing and dying from aggressive subtypes of breast cancer. A connection between aggressive disease and Western Sub-Saharan African ancestry has been postulated, but it remains largely unknown to what extent breast cancer in Africa is reminiscent of breast cancer in U.S. African American (AA) women who experience disproportionately high mortality rates. We performed ATAC- and RNA-sequencing on 9 human triple-negative breast cancer cell lines of U.S. origin and discovered that African ancestry influences the chromatin landscape, leading to disparate transcription factor (TF) activity and downstream gene expression patterns indicative of an aggressive tumor biology. Here, we describe an ambitious study that employs single-nucleus (sn) ATAC- and RNA-sequencing (snMultiome) of frozen breast tumors to characterize chromatin accessibility and gene expression patterns with single-cell resolution in AA (n=33), Kenyan (n=25), and European American (EA, n=24) women in relation to genetic ancestry, risk factor exposures, clinical characteristics, and 5-year survival. To achieve this, we successfully isolated intact, high-quality single nuclei from archival frozen breast tumor tissue through an optimized combination of enzymatic digestion and automated tissue homogenization. We performed snMultiome sequencing of 82 tumors using the 10x Genomics platform. Following filtering, normalization (SCT for snRNA; LSI for snATAC), peak calling (MACS2), and integration (Harmony), our dataset includes a total of 296,557 nuclei. Cancerous (163,419 nuclei) and non-cancerous (133,138 nuclei) cells were distinguished based on DNA copy number (CopyKat). Within the microenvironment, 11 major immune, epithelial, and stromal cell types were successfully annotated, exhibiting distinct patterns by population group (e.g. AA tumors showed markedly increased abundance of myeloid and T-cells, while Kenyan tumors showed increased abundance of pericytes and fibroblasts, relative to EA). A large number of enriched TFs within each cell type varied significantly by population group, suggesting distinct chromatin accessibility patterns related to genetic ancestry. CD45+, EPCAM- cells were further extracted, clustered, and manually annotated for subpopulations based on known marker genes. We detected 26 distinct immune subpopulations across our samples, including 2 inflammatory macrophage, 6 immunosuppressive macrophage, 1 fibronectin+/thrombospondin+ monocyte, 6 T-cell, 1 natural killer cell, 2 B-cell, 1 mast cell, and 4 dendritic cell subpopulations. Differential gene expression analyses of each immune cell subpopulation, adjusted for age, BMI, and tumor subtype, revealed ancestry-specific gene expression patterns, which could provide novel insights into functional differences that may impact tumor immune response. Current efforts focus on in-depth molecular characterization of ancestry-related differences in the tumor immune environment and distinct signatures present in lethal disease. Citation Format: Alexandra R. Harris, Huaitian Liu, Brittany D. Jenkins, Tiffany H. Dorsey, Francis Makokha, Shahin Sayed, Gretchen Gierach, Stefan Ambs. Characterization of the breast tumor immune microenvironment in women of African descent using single-nucleus RNA- and ATAC-sequencing [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 C089.

Abstract PR012: Social and Structural Influences of Preventive Cancer Screenings for Native Hawaiian and Pacific Islander Adults in Hawaiʻi

Abstract Background: Native Hawaiians and Pacific Islanders (NHPI) are hindered by sociocultural, geographic, and environmental factors that contribute to cancer health disparities, often masked by aggregated data with Asian Americans. An average of 7,393 Hawai‘i residents are diagnosed with invasive cancer yearly, and rates are disproportionate ethnically; . Native Hawaiians and Micronesians suffer higher mortality rates for breast cancer (24.9 and 21.6 per 100,000) than White women (17.0). This study aims to investigate social drivers of health behaviors among NHPI in Hawaiʻi by examining social factors that influence cancer screenings through mixed methods. Methods: This mixed methods study is a follow-up to a cross-sectional survey administered in 2018 to 3 Pacific Islander ethnic subgroups: Native Hawaiians, Chuukese, and Marshallese in Hawaiʻi using Respondent Driven Sampling within public housing (N=1,010 NHPI). Disparate cancer screening practices were uncovered within these groups when compared to Hawaiʻi state data. Logistic regression was used to analyze predictors of colon, breast, and cervical cancer screenings. The Gelberg Behavioral Model for Vulnerable Populations and socio-ecological model served as the theoretical models. To triangulate the findings, 16 semi-structured interviews with adults living within the communities first surveyed were conducted in 2023 to uncover any additional drivers of health behaviors that the regression missed. Results: Quantitative findings include cultural/linguistic misunderstandings between NHPI and healthcare providers. Participants who indicated difficulty understanding a provider’s instructions because of language were 51% less likely to be screened for cervical cancer (p = .04). Individuals who hold neutral acculturation to both their ethnic and American culture are less likely to be screened for cancer. Those whose responses fell in a neutral category were 40% less likely than those with a high ethnic identity to have had a colon cancer screening (p = .02). Qualitative findings demonstrate differing views among Pacific Islander groups including competition for resources between groups within public housing. All of the interviewees highlight the role of God and faith in decision making. Informational exchanges take place mainly within the family and cohabitants. From triangulating the findings, there is a lack of strong social ties/networks that could facilitate health-based resources and knowledge. Families are not discussing self-care or family histories of disease, which are instrumental in the early detection of cancers and missed within the regression. Conclusion: This study provides insight into the social drivers of cancer screenings for NHPI communities in Hawaiʻi. Novel insights for the fields of medical sociology and public health are highlighted by influential social processes to NHPI cancer screening behaviors. Recommendations include further research and programs that focus on and foster social dynamics of these communities in relation to cancer screenings. Citation Format: Mark L. Willingham Jr., Kevin Cassel, Wei Zhang, Tressa P. Diaz, Angela Sy, Ian Pagano, Munirih R. Ta'afaki, Angelina G. Mummert. Social and Structural Influences of Preventive Cancer Screenings for Native Hawaiian and Pacific Islander Adults in Hawaiʻi [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 PR012.

Abstract A142: A qualitative assessment of the acceptability of Human Papillomavirus (HPV) self-sampling and informational materials among diverse populations

Abstract Background: Disparities in cervical cancer screening rates among marginalized groups is a driver of inequalities in cervical cancer. Self-sampling for human papillomavirus (HPV) testing is a newly emerging alternative to clinician-performed testing to screen for cervical cancer, and has high potential to reduce screening barriers in under-screened and marginalized groups. We study the acceptability in of HPV self-sampling and informational materials among Black/African American, Hispanic/Spanish speaking, American Indian/Alaska Native and transgender/nonbinary populations. Methods: We conducted qualitative interviews with patients, ages 30-65, who were female at birth, Black/African American, Hispanic, American Indian, and/or transgender/nonbinary. Telephone interviews were conducted in English or Spanish. Patients did not complete the test, rather were asked about the attractiveness, comprehensibility, and acceptability of the HPV self-test, instructions, and messaging. Results: Among 23 completed interviews (5 American Indian/Alaska Native, 7 Hispanic (2 bilingual, 5 Spanish-speaking), 5 Black/African American, and 6 transgender/nonbinary), patients from all groups thought the test was straightforward and convenient, and they would complete the test at home or in clinic. The transgender/nonbinary patients preferred at home testing. American Indian and transgender/nonbinary patients liked that the test might avoid pain, discomfort, and invasiveness. All patients liked the letter and instructions. All groups had specific suggestions for making the materials more culturally acceptable. Conclusions: The HPV self-test and the instructions and materials for use were acceptable for a diverse group of patients. Tailored outreach and messaging should be considered to reduce screening disparities among groups that have been historically underserved by the medical system. Citation Format: Amanda Petrik, Jennifer Rivelli, Allison Firemark, Cheryl Johnson, Blake Locher, Sara Gille, Jennifer Schneider. A qualitative assessment of the acceptability of Human Papillomavirus (HPV) self-sampling and informational materials among diverse populations [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 A142.