African American Women Breast Research Articles

African American Women Breast Cancer Survivors: Coping with the COVID-19 Pandemic.

African American women breast cancer survivors are among those with the greater burden of cancer. Breast cancer is the second leading cause of death among black women, and this death rate is 40% higher than that of white women. The COVID-19 pandemic increased the burden of morbidity and mortality among this population of cancer survivors. In this report, we explore the ways in which the COVID-19 pandemic was a source of stress for African American women breast cancer survivors and their subsequent responses to these stressors. This is a qualitative descriptive study with content analysis of data from the narratives of 18 African American breast cancer survivors. Participants were interviewed via phone and video conferencing platform and asked questions related to their experiences with the COVID-19 pandemic. The findings suggest stressors associated with (1) potential COVID-19 spreaders in their immediate environments; (2) closures and restricted access to social- and faith-based activities; (3) televised news broadcasts of COVID-19; and (4) disruptions to planned cancer prevention and control healthcare. Three categories emerged that captured the ways in which these women responded to stressors during the early phase of this pandemic: (1) seeking control in their social environments; (2) following the rules; and (3) seeking support from God, family, and friends. These findings can be used to better support breast cancer patients during the early phases of a pandemic.

Intersectionality Impacts Survivorship: Identity-Informed Recommendations to Improve the Quality of Life of African American Breast Cancer Survivors in Health Promotion Programming.

(1) Background: African American women breast cancer survivors face unique experiences that impact their quality of life as they transition beyond treatments. Experiences may be complicated by living at the intersection of systemically oppressed identities, including gender, race, social class, and cancer-related disability. Using the Black Feminist Thought (BFT) framework and the PEN-3 cultural model, this qualitative study sought to: (a) understand African American women breast cancer survivors’ lived experiences; (b) examine how the multiple intersecting factors of race, gender, social class/socioeconomic status, and cancer-related disability impact their quality of life; and (c) inform future health promotion programming that is culturally relevant to AAWBCS to improve their quality of life. (2) Methods: Seven focus groups were conducted with 30 African American breast cancer survivors in a Midwestern metropolitan region. Focus groups were audiotaped and transcribed verbatim. Framework analyses were conducted to identify themes with NVivo qualitative analysis software. (3) Results: Four themes emerged: (a) caregiving roles provide both support and challenges for survivors, (b) the “strong Black woman” is inherent in survivor experiences, (c) intersectionality impacts survivorship, and (d) African American women resist oppression through culturally specific supports and advocacy. (4) Conclusions: The intervention point of entry should be at the peer support group level and centered on family and provide community-based support and services. Future research should move upstream to address social determinants of health, including racism, sexism, and ableism; there is a critical need to discuss how structural racism affects health care and develop interventions to address racial discrimination and racial bias in health care.

Patient Navigation Can Improve Breast Cancer Outcomes among African American Women in Chicago: Insights from a Modeling Study.

African American (AA) women experience much greater mortality due to breast cancer (BC) than non-Latino Whites (NLW). Clinical patient navigation is an evidence-based strategy used by healthcare institutions to improve AA women's breast cancer outcomes. While empirical research has demonstrated the potential effect of navigation interventions for individuals, the population-level impact of navigation on screening, diagnostic completion, and stage at diagnosis has not been assessed. An agent-based model (ABM), representing 50-74-year-old AA women and parameterized with locally sourced data from Chicago, is developed to simulate screening mammography, diagnostic resolution, and stage at diagnosis of cancer. The ABM simulated three counterfactual scenarios: (1) a control setting without any navigation that represents the "standard of care"; (2) a clinical navigation scenario, where agents receive navigation from hospital-affiliated staff; and (3) a setting with network navigation, where agents receive clinical navigation and/or social network navigation (i.e., receiving support from clinically navigated agents for breast cancer care). In the control setting, the mean population-level screening mammography rate was 46.3% (95% CI: 46.2%, 46.4%), the diagnostic completion rate was 80.2% (95% CI: 79.9%, 80.5%), and the mean early cancer diagnosis rate was 65.9% (95% CI: 65.1%, 66.7%). Simulation results suggest that network navigation may lead up to a 13% increase in screening completion rate, 7.8% increase in diagnostic resolution rate, and a 4.9% increase in early-stage diagnoses at the population-level. Results suggest that systems science methods can be useful in the adoption of clinical and network navigation policies to reduce breast cancer disparities.

Breast Cancer Educational Needs and Concerns of African American Women Below Screening Age.

African American women are disproportionately impacted by breast cancer, including triple-negative disease, at a young age. Yet most public health research in breast cancer focuses on women of screening age. This study identified the specific breast cancer educational needs of African American women below the recommended screening age. Data were collected through 30 key informant interviews with young African American women breast cancer survivors (diagnosed between 18 and 45), family members of African American women diagnosed between 18-45 years, and community organization leaders and healthcare providers who work with young African American women impacted by breast cancer. Data were coded and analyzed by multiple team members using template analysis. The analysis identified four overarching themes reflecting breast cancer educational needs of young African American women. Although most Breast Cancer Knowledge and Perceived Risk educational needs were consistent with those of older women, there were specific needs involving Cultural Reluctance in Health Disclosures and Breast Cancer Risk Reduction. With regard to Healthcare Provider Relationships, participants stated a need for younger women to be particularly proactive in advocating for their health, as providers may be dismissive about cancer concerns due to young age. Though breast cancer in younger women is statistically improbable, there are educational needs specific to young African American women involving self-advocacy and family history. Findings have implications for developing interventions guiding young women to advocate for themselves in medical encounters and in their families, as well as for teaching medical providers how to counsel the young women regarding breast cancer.

Empowered Choices: African-American Women's Breast Reconstruction Decisions.

Objectives: Breast reconstruction (BR) potentially can improve quality of life in postmastectomy breast cancer survivors (BCS); however, African-American women are less likely to undergo BR than Caucasian women. This qualitative study was undertaken to explore individual, sociocultural, and contextual factors influencing African-American women's BR decision-making processes and preferences. Methods: Postmastectomy African-American BCS with and without BR participated in semi-structured interviews. We adopted a grounded theory approach using the constant comparison method to understand the contexts and processes informing participants' BR decision-making. Results: Twenty-three women participated, of whom 17 elected BR and 6 did not. Whereas women's primary reasons for deciding for or against BR differed, our core category, "empowered choices ," describes both groups' decision-making as a process focused on empowering themselves physically and/or psychologically, through self-advocacy, informed and shared decision-making, and giving back/receiving communal and spiritual support from church and African-American survivor groups. Socioeconomic factors influenced women's access to BR. Women preferred autologous BR and expressed the need for greater culturally-matched resources and support to inform treatment and shared BR decision-making. Conclusions: Understanding and supporting African-American women's BR preferences and empowerment is essential to ensuring equal access, and culturally-relevant, high-quality, and informed patient-centered care.

Abstract A018: Using qualitative methods to develop health messages aimed to reduce secondhand smoke exposure among African American breast cancer survivors in a rural state

Abstract Purpose. This study aimed to develop health messages that help African American breast cancer survivors reduce exposure to secondhand smoke in the home. African American women are disproportionately impacted by tobacco exposures and cancer mortality. Cigarette smoking decreases functional status (e.g., fatigue, pain) and increases complications related to breast reconstruction and the risk for secondary cancers. Understanding knowledge, attitudes, and beliefs related to tobacco and sociocultural and environmental influences may inform the development of messages that protect breast cancer survivors from the harm of smoke. Methods. We used a sequential design to conduct semi-structured interviews, photovoice interviews, and focus groups that informed message development related to secondhand smoke exposure. African American women breast cancer survivors aged 30-65 years, who smoked cigarettes or cigars in past 30 days or lived with a smoker, and were low income were invited to participate. Interviews assessed knowledge related to breast reconstruction and the prevention of secondary cancers; perceived susceptibility and severity related to the harms of tobacco; subjective norms; attitudes toward using tobacco and implementing smokefree home rules; perceived benefits and complexity of implementing smokefree home rules; and intentions to adopt smokefree home rules. Participants who completed the interviews (n=12) were invited to use photovoice to capture the socio-environmental context of survivorship and women’s motivations for making changes in tobacco exposure (n=9). Data from the interviews and photovoice were used to develop 16 messages related to secondhand smoke exposure. An iterative process was used to obtain feedback on each message (e.g., The smoke from cigarettes, pipes, and cigars of any kind is the same. Keep your home safe from secondhand smoke) from focus group participants (n=12). Results. Forty percent of African American women breast cancer survivors who completed the interviews reported current smoking and 54% had expired CO levels > 7 ppm. Most women felt that cigarettes cause some harm, but also stated that no one knows how each person is affected. Some women felt that occasional smoking was not harmful, that secondhand smoke was as bad as smoking, and that it is a gamble as to whether anything would happen if exposed to tobacco smoke. Some women expressed that smoking did not affect their breast reconstruction surgery while others felt that it slowed the healing process, or were unclear about its effects on surgery. Women who provided feedback on the messages during focus groups stated that people say secondhand smoke causes cancer, but they were unclear of its effects. Women felt that health messages needed to convey the type of cancers caused by secondhand smoke. Conclusions. Our study provided helpful information that informed the development of messages that can be used to increase awareness of the harms of secondhand smoke. Citation Format: Nakita Lovelady, Pebbles Fagan, Camille Hart, Michael Preston, Tiffany Haynes, Ronda Henry-Tillman. Using qualitative methods to develop health messages aimed to reduce secondhand smoke exposure among African American breast cancer survivors in a rural state [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A018.

Engaging young African American women breast cancer survivors: A novel storytelling approach to identify patient-centred research priorities.

BackgroundPatient‐centredness is considered an essential aspiration of a high‐quality health‐care system, and patient engagement is a critical precursor to patient‐centred care.ObjectivesTo engage patients, health‐care providers and stakeholders in identifying recommendations to address research and practice gaps that impact young African American breast cancer survivors.MethodsThis paper reported an approach for research priority setting. This approach applies an engagement process (January‐September 2018) of using patient and stakeholder groups, patient storytelling workshops and a culminating storytelling conference in Wisconsin to generate relevant research topics and recommendations. Topics were prioritized using an iterative engagement process. Research priorities and recommendation were ranked over the conference by counting participants’ anonymous votes.ResultsOne hundred attendees (43 patients/family members, 20 providers/researchers and 37 community members) participated in the conference. Five topics were identified as priorities. The results showed that three priority areas received the most votes, specifically community outreach and education, providing affordable health care and engaging in complementary care practice. Stakeholders also agreed it is critical to ‘include youth in the conversation’ when planning for cancer support and educational programmes for caregivers, friends and family members.ConclusionStorytelling as a patient engagement approach can build trust in the patient‐research partnership, ensure that patients are meaningfully engaged throughout the process and capture the diversity of patient experiences and perspectives.

Risk factors for estrogen receptor positive ductal carcinoma in situ of the breast in African American women

BackgroundCompared to U.S. white women, African American women are more likely to die from ductal carcinoma in situ (DCIS). Elucidation of risk factors for DCIS in African American women may provide opportunities for risk reduction. MethodsWe used data from three epidemiologic studies in the African American Breast Cancer Epidemiology and Risk Consortium to study risk factors for estrogen receptor (ER) positive DCIS (488 cases; 13,830 controls). Results were compared to associations observed for ER+ invasive breast cancer (n = 2,099). ResultsFirst degree family history of breast cancer was associated with increased risk of ER+ DCIS [odds ratio (OR): 1.69, 95% confidence interval (CI): 1.31, 2.17]. Oral contraceptive use within the past 10 years (vs. never) was also associated with increased risk (OR: 1.43, 95%CI: 1.03, 1.97), as was late age at first birth (≥25 years vs. <20 years) (OR: 1.26, 95%CI: 0.96, 1.67). Risk was reduced in women with older age at menarche (≥15 years vs. <11 years) (OR: 0.62, 95%CI: 0.42, 0.93) and higher body mass index (BMI) in early adulthood (≥25 vs. <20 kg/m2 at age 18 or 21) (OR: 0.75, 95%CI: 0.55, 1.01). There was a positive association of recent BMI with risk in postmenopausal women only. In general, associations of risk factors for ER+ DCIS were similar in magnitude and direction to those for invasive ER+ breast cancer. ConclusionsOur findings suggest that most risk factors for invasive ER+ breast cancer are also associated with increased risk of ER+ DCIS among African American women.

Culture, identity, strength and spirituality: A qualitative study to understand experiences of African American women breast cancer survivors and recommendations for intervention development.

Despite advancements in cancer treatment, racial disparities in breast cancer survival persist, with African American women experiencing lower survival rates and poorer quality of life than non-Hispanic White women. Using a social cognitive model of restorative well-being as a framework, this qualitative study sought: (a) to examine strength- and culture-related factors associated with African American female breast cancer survivors' cancer coping and post-treatment experiences and (b) to make recommendations for culturally sensitive intervention. Eight focus groups occurred with a total of 40 local African American breast cancer survivors. Focus groups were audiotaped and transcribed verbatim. Framework analyses were used to identify themes. NVivo qualitative analysis software-managed data. Two major themes emerged from the focus group discussions: (a) God enables breast cancer survivorship and works every day in our lives and (b) the healthiest thing about us is that we are strong African American women. Recommendations for intervention planning and implementation were made towards intervention structure, content development and language framing in a local context. Findings suggest a need for community-based participatory survivorship interventions that are culturally and spiritually consonant and peer-based. Such interventions may respond to the cancer-related and personal needs of the target population.

Biology and Etiology of Young-Onset Breast Cancers among Premenopausal African American Women: Results from the AMBER Consortium.

Background: African American (AA) women have higher incidence of aggressive, young-onset (<40 years) breast cancers. Young- and older-onset disease may have distinct tumor biologies and etiologies; however, studies investigating age differences among AA women have been rare and generally underpowered.Methods: We examined tumor characteristics and breast cancer risk factors associated with premenopausal young (<40) vs. older (≥40) AA women's breast cancer in the African American Breast Cancer Epidemiology and Risk Consortium (2,008 cases and 5,144 controls). Unconditional logistic regression models assessed heterogeneity of tumor biology and risk factor associations by age, overall, and by estrogen receptor status.Results: Premenopausal AA women <40 years had higher frequency of poorer-prognosis tumor characteristics compared with older women, including negative estrogen and progesterone receptor status, triple-negative subtype, higher grade, higher stage, and larger tumors. Adiposity (i.e., waist-to-hip ratio) and family history of breast cancer were more strongly associated with young-onset disease [case-control OR = 1.46, 95% confidence interval (CI) = 1.04-2.05; OR = 3.10, 95% CI = 2.08-4.63, respectively] compared with older-onset disease (OR = 1.11, 95% CI = 0.91-1.35; OR = 1.57, 95% CI = 1.26-1.94). Breastfeeding showed a slight inverse risk association among young women (OR = 0.70, 95% CI = 0.43-1.16). Oral contraceptive use was associated with increased risk regardless of age. Considering various cutoff points for young age (<40, <45, <50), age-related heterogeneity was greatest when <40 was used.Conclusions: Among premenopausal AA women, diagnosis before age 40 is associated with more aggressive breast tumor biology and some etiologic differences.Impact: Modifiable risk factors including breastfeeding, adiposity, and oral contraceptive use may be important targets for mitigating harms of young-onset breast cancer. Cancer Epidemiol Biomarkers Prev; 26(12); 1722-9. ©2017 AACR.

Abstract 5276: Risk factors for ductal carcinoma in situ of the breast in African American women

Abstract Introduction: The clinical significance of a ductal carcinoma in situ (DCIS) diagnosis is uncertain. While overall breast cancer mortality risk from DCIS is very low, a recent analysis showed that African American women diagnosed with DCIS were more than twice as likely to die from breast cancer as U.S. white women. Elucidation of risk factors for DCIS in African American women may provide opportunities for risk reduction. Methods: To assess the relation of reproductive, anthropometric, and other factors to risk of DCIS in African American women, we pooled data from three epidemiologic studies participating in the African American Breast Cancer Epidemiology and Risk (AMBER) Consortium - the Black Women’s Health Study, the Carolina Breast Cancer Study, and the Women’s Circle of Health Study. These studies contributed 805 DCIS cases and 13,830 controls to the analysis. We used unconditional logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk of DCIS in relation to each risk factor of interest. Multivariable models were used to mutually adjust for risk factors as well as matching factors (age, study, geographic region, and questionnaire time period). We also compared results to associations observed for invasive breast cancer (n=3,765). Results: First degree family history of breast cancer was associated with an increased risk of DCIS (OR 1.62, 95% CI 1.32, 1.98). Oral contraceptive use within the past 10 years (vs. never) was also associated with increased risk (OR 1.31, 95% CI 1.01, 1.70), as was late age at first birth (≥25 years vs. &amp;lt;20 years) (OR 1.29, 95% CI 1.04, 1.61). Older age at menarche (≥15 years vs. &amp;lt;11 years) was associated with a reduced risk (OR 0.67, 95% CI 0.49, 0.92). Women with higher body mass index (BMI) in early adulthood (≥25 kg/m2 at ages 18 or 21) had a reduced risk of DCIS compared to those who had a BMI &amp;lt;20 kg/m2 in early adulthood (OR 0.71, 95% CI 0.56, 0.91), but there was no association for current BMI. In general, associations of risk factors for DCIS were similar in magnitude and direction to those for invasive breast cancer. However, high waist-to-hip ratio and absence of breastfeeding, two factors associated with increased risk of invasive breast cancer, and particularly with estrogen receptor negative breast cancer among African American women, were not associated with DCIS, either overall or by estrogen receptor status. Conclusions: Our findings suggest that most risk factors for invasive breast cancer are also risk factors for DCIS among African American women. However, two important modifiable risk factors for invasive breast cancer in this population, higher waist-to-hip ratio and absence of breastfeeding, do not appear to influence DCIS risk. Citation Format: Kimberly A. Bertrand, Traci N. Bethea, Lynn Rosenberg, Elisa V. Bandera, Melissa Troester, Thaer Khoury, Christine B. Ambrosone, Julie R. Palmer. Risk factors for ductal carcinoma in situ of the breast in African American women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5276. doi:10.1158/1538-7445.AM2017-5276

Abstract 1132: Lactate dehydrogenase expression in African American women with triple-negative breast cancer

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

Abstract P4-14-11: National trend in African American women breast cancer research productivity from 1992-2012

Abstract INTRODUCTION: Despite extensive progress in breast cancer prevention, diagnosis and treatment over the past 20 years, African American women suffer disproportionate breast cancer morbidity and mortality. In 1998, breast cancer deaths among African American women were 28% higher than in white women and the five-year survival rate for African American women was 71% compared with 86% for white women. The purpose of this bibliometric study is to assess our national research efforts to combat this racial disparity by analyzing breast cancer research productivity in the United States focusing on African American women from 1992 to 2012. METHODS: This retrospective bibliometric analysis of public data was exempt from Institutional Review Board approval. Articles with "Breast Neoplasm" as a major medical subject heading (MeSH) term published between 1992 and 2012 were identified in the National Library of Medicine MEDLINE database. In addition, articles with "African Continental Ancestry Group" which included African American as a major MeSH term were identified. Country of origin, methodology, journal name, first author specialty and funding sources were recorded. Growth in number of publications was analyzed using linear and nonlinear regression statistical analysis. RESULTS: A total of 113,721 journal articles were identified with "Breast Neoplasm" as a major MeSH term worldwide, of which 34,155 (30.0%) were published from the United States. Among United States publications, 668 (2.0%) were specific to African ancestral populations. From 1992 to 2012, both African ancestral and non-African ancestral specific articles displayed linear growth patterns (p &amp;lt; 0.0001). National Institute of Health (NIH) funded studies displayed an exponential growth pattern (p &amp;lt; 0.0001) for African ancestral specific articles and displayed a linear growth pattern (p &amp;lt; 0.0001) for non-African ancestral articles. The largest specialty contributor of African ancestral specific articles was Epidemiology and Public Health (33.2%), followed by Medicine (internal medicine, family medicine, obstetrics &amp; gynecology, nursing) (24.7%), Basic Sciences (17.4%), Surgery (15%), Medical and Radiation Oncology (4.7%), Pathology (2.9%) and Radiology (2.1%). African ancestral specific articles were most frequently published in Cancer (10.8%). CONCLUSION: Among breast cancer publications from the United States, only 2% of the articles were specific to African ancestral population, which is concerning given recent data indicating the persistent ethnic disparity in survival. However, the trend in research productivity in this population is encouraging, largely due to the exponential growth of NIH-funded studies specific for African American women in the past 20 years. NIH-funded research accounts for 52% of all published African American specific breast cancer studies as compared to 40.5% of studies that are non-specific to this population. Ultimately, improvements in breast cancer incidence, mortality, and survival rates in African American women will undoubtedly result from quality research and should continue to be a priority in our nation’s breast cancer research agenda. Citation Format: Ralph T Wynn, Daniel S Chow, Victoria L Mango, Lauren C Friedlander, Richard Ha. National trend in African American women breast cancer research productivity from 1992-2012 [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-14-11.

Abstract 1472: The differential expression of miRNAs in breast cancer cell lines

Abstract Breast cancer is a heterogenous disease that is the second leading cause of death amongst women in the United States. Triple negative breast cancer (TNBC) is a very aggressive subtype of breast cancer characterized by its loss of estrogen, progesterone and HER2 receptor expression which limits its targets for effective drug therapies. Micro Ribonucleic Acids (miRNAs) are a class of small, endogenous non-coding ribonucleic acids that seem to play an essential role in gene regulation. Changes in the patterns of miRNA expression profiles are serving as potential biomarkers for tumor diagnosis, prognosis of disease-specific outcomes, and the prediction of therapeutic responses in cancer. We analyzed miRNA array (Agilent) expression profiles in triple negative breast cancer cell lines (HCC70, HCC1806, MDA-MB-157) and non-cancerous (AG11132) African American women breast cell lines. We revealed that the TNBC cells exhibited a different miRNA expression pattern when compared to the normal breast cancer cell line. We analyzed the hybridization data files using standard Microsoft Excel techniques and verified our findings using PARTEK Genomics Suite. We combined the data sets from the TNBC cell lines and compared the miRNA array expression profiles to the normal control cell line AG11132. We revealed that there were significant dysregulation of miRNAs including those of the let-7 family, miR-16, miR-31, and miR-25b-1, miR34a, and miR-95 in the triple negative cells as compared to the normal cells. These miRNAs have been described in previous scientific studies to be associated with tumorigenesis in breast cancer. These studies are initial observations that we will follow up with molecular techniques such as real-time PCR and siRNA to validate the results in order to establish more direct correlations to miRNAs and their roles in triple negative breast cancer. Citation Format: Checo J. Rorie, Brianna L. Arrington, Sherette S. Godfrey, Armeshia S. McCoy, Kashenya M. Gurley. The differential expression of miRNAs in breast cancer cell lines. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1472. doi:10.1158/1538-7445.AM2014-1472

African-American Breast Cancer Survivors Participating in a Breast Cancer Support Group: Translating Research into Practice

Despite an overall decline in mortality, breast cancer is the most commonly diagnosed cancer and the second most common cause of cancer death among African-American women. As such, clinicians should prepare to address the unique sociocultural and psychological concerns encountered by African-American women breast cancer survivors. The objective of this study is to examine, using qualitative methods, the main coping facilitators used by African-American women as they transition across the cancer continuum. The identification of these facilitators was then aligned with culturally sensitive interventions most useful with women coping with cancer along the cancer continuum. This was a secondary analysis of 20 videotaped stories of African-American breast cancer survivors collected as a part of the Washington University Center for Excellence in Cancer Communications project. The interview began with a discussion of how the survivor first became aware she had breast cancer, followed by a series of open-ended probes used to explore the following themes: coping, relationships, health care system experiences, follow-up care, and quality of life living with breast cancer. Survivors discussed their experiences and advice for targeting needs at each cancer stage from screening to diagnosis, treatment, and then survivorship. Survivor narratives point to key evidence-based clinical intervention strategies at each stage of the cancer trajectory. This study found that survivors see a cyclical cancer course, whereby African-American breast cancer survivors serve an important role in the lives of unscreened women, newly diagnosed women, and women in treatment.

Ductal carcinoma in situ (DCIS) of the breast: Race- and treatment-adjusted specific disease-free probability.

186 Background: Findings of DCIS outcome between African-American (AA) and White-American (WA) women are inconclusive. Methods: We conducted a retrospective longitudinal study with the objective of comparing the risk of any second breast cancer after the first primary DCIS, adjusting for pathologic prognostic indicators, treatment, age, and the established epidemiologic risk factors. Women were diagnosed and treated in one institution between 1990-1999. Diagnostic slides were reviewed and prognostic indicators documented; demographic, clinical and method of detection, screening mammography vs. palpation, were collected from medical records. We applied Accelerated Failure Time Modeling (AFTM) to determine the variables that were best associated with the risk of a second cancer. Results: 335 women, 29.6% (n=100) AA with mean age of 60 (±13) and 70.4% (n=235) WA with mean age of 57 (±12.4), contributed to this study. Distributions of some of the prognostic indicators and final treatment are presented. (Table) During the 10 years of follow-up 12.0% (n=12) of AA and 3.0% (n=7) WA experienced second cancer in ipsilateral breasts; 5.0% (n=5) of AA and 3.8% (n=9) WA in their contralateral breasts and 2 women, 1 AA and 1 WA, in both breasts. Results from the AFTM yielded race as the only variable associated with the risk of a second cancer but only in ipsilateral breasts (HR= 4.11, 95% CI=1.6-10.5 p=0.003). Conclusions: No difference in the risk of a second cancer in contralateral breast between AA and WA women support the notion of equal access and equal treatment in comparable treatment outcome. Reasons for increased risk of a second cancer in ipsilateral breast in AA women are being evaluated. [Table: see text]

Longitudinal analysis of domain-level breast cancer literacy among African-American women

Functional breast cancer literacy was assessed among African-American women and measured at the domain level over time. We used the Kin Keeper(SM) Cancer Prevention Intervention to educate 161 African-American women on three domains of breast cancer literacy: (i) cancer awareness, (ii) knowledge of breast cancer screening modalities and (iii) cancer prevention and control. A breast cancer literacy assessment was administered pre- and post-educational intervention at two time points followed by another assessment 12 months after the second intervention. Generalized estimating equations were specified to predict the probability of correctly answering questions in each domain over time. Domain-level literacy differentials exist; at baseline, women had higher test scores in the breast cancer prevention and control domain than the cancer awareness domain (odds ratio = 1.67, 95% confidence interval 1.19-2.34). After Kin Keeper(SM) Cancer Prevention Intervention, African-American women consistently improved their breast cancer literacy in all domains over the five time stages (P < 0.001) though at different rates for each domain. Differences in domain-level breast cancer literacy highlight the importance of assessing literacy at the domain level. Interventions to improve African-American women's breast cancer literacy should focus on knowledge of breast cancer screening modalities and cancer awareness domains.

Breast cancer patients' quality of care: Does racial concordance matter or is it just a matter of trust?

6537 Background: As insurers consider paying for performance and quality measures grow in importance, factors that affect patients' perceived quality of cancer care matter. Concordance by race in physician-patient relationships has been associated with patient satisfaction and use of health care, however how that is mediated is unclear. Methods: 210 of 300 eligible women stage I or II breast cancer at 1 of 8 participating NYC hospitals responded to our survey (70% response rate): 20% were African-American (AA), 40% were white, and 30% were Hispanic and 9% were other races. Trust is based on a validated scale and calibrated to a 100 point scale (Cronbach α = 0.76). Bivariate analyses and logistic models were used to identify factors associated with patient ratings of quality of care. Results: Only 55% of women rated the quality of their cancer care as excellent. AA women breast cancer patients were less likely to rate their care as excellent (p=0.004). Compared to women who didn't rate their care as excellent, those who rated it excellent had greater trust in their physician (p &lt; 0.0001) and indicated that were treated well by their physicians' office staff (p = 0.01). Of note, AA patients had lower levels of trust (p = 0.004). Women who were of the same race as their physician did not perceive better quality of care as compared to those who were not racially concordant (p = 0.18); nor did they have higher trust in their physician (p = 0.59). Multivariate models evaluating the role of patient race, education, income, knowing which physician to talk to, how well the staff treated the patient, and racial concordance with physician, found that trust in physician was significantly associated with patient perception of excellent quality care (aRR = 1.38; 95%CI: 1.03–1.65) and being AA was associated with worse perceived quality (aRR = 0.47; 95%CI: 0.21–0.88) (model c = 0.79; p &lt; 0.0001). Conclusions: Racial concordance between physicians and patients does not directly affect patients' perceived quality of care. However, women's trust in their physician and their perceived treatment by office staff are associated with excellent cancer care quality ratings. Efforts should be made to increase effective intercultural communication particularly among AA women in order to improve ratings of cancer care quality. No significant financial relationships to disclose.

Quality of Life of African American Breast Cancer Survivors

Women affected by breast cancer experience an array of quality-of-life issues that affect their daily living in both short-term and long-term survivorship. Because African American women experience disparities in breast cancer survival, their quality-of-life concerns may paint a different picture from those of other racial and ethnic groups. To gain a better understanding of quality of life in African American women breast cancer survivors, we conducted a review, using an adaptation of Brenner's quality-of-life proximal-distal continuum, of studies that have investigated these women's experiences and associated variables. Twenty-six studies, qualitative and quantitative, were reviewed that identified both deficits and positive outcomes of breast cancer treatment and sequelae, including physical, emotional, social, and patient-provider problems as well as heightened spirituality and positive growth. Although overall global quality of life was favorable in both African American and white survivors, differences existed in the nature and extent of deficits between these 2 survivor groups. Nursing implications of this review point to the need for further rigorous research and wide dissemination of results. Recommendations for practice include tailoring assessments and interventions within the context of the lives of African American women breast cancer survivors.

“I've Been Through Something”

This article describes common experiences of African American women breast cancer survivors through poetic analysis. Group-as-a-whole theory and empirical and interpretive phenomenology guided analysis of transcripts from three focus groups (n = 21) of African American breast cancer survivors. Familiarity with transcripts and themes led to awareness of poetic ways in which African American women described experiences. Black feminist literature and African American historical references contextualized survivors' experiences. Poetic interpretations of African American women's breast cancer experiences, from diagnosis to survivorship, were created from transcript dialogues. Verbatim words were used to construct the poems, as often as possible. Eleven poems describe the journey from diagnosis to survivorship as experienced by African American women. The poetry may raise levels of awareness of African American women's breast cancer survivorship experiences. Attention to subtleties that underpin culture within the context of health care environments may help health care providers to improve cultural competence.