Breast Cancer Disparities Research Articles

9260 Insulin Receptor Signaling and Racial Disparities in Triple Negative Breast Cancer

Abstract Disclosure: A.J. Engel: None. K. Samuel: None. I.R. Bass: None. S. Lin: None. I. Antoniou: None. R. Yagnik: None. D. LeRoith: None. N.A. Bickell: None. E.J. Gallagher: Consulting Fee; Self; Novartis Pharmaceuticals. Introduction: Obesity and type 2 diabetes are associated with poor breast cancer (BC) prognosis. These disorders, along with hyperinsulinemia are more common in Black than in White women. Black women also have higher rates of triple negative breast cancer (TNBC), and greater breast cancer mortality than White women. We hypothesized that Black women with TNBC have worse outcomes in part due to tumor promoting effects of hyperinsulinemia via the insulin receptor (IR) signaling pathway. Methods: From our IRB-approved, multi-institutional, cross-sectional, NIH-funded, study of women with newly diagnosed BC, we identified women with TNBC. We performed immunohistochemistry (IHC) analysis of formalin-fixed-paraffin-embedded tumor samples from 45 self-identified Black women and 48 self-identified White women. We quantified the BC expression of IR (n=92), IGF1R (n=92), pERK (n=91), FOXO3a (n=90) for intensity (none=0, weak=1, moderate=2, intense=3). In subsequent analysis, 0 and 1 intensity IHC staining were considered negative, and 2 and 3 were considered positive. Quantification was performed with reviewers blinded to clinical information. Clinical information (age, race, body mass index [BMI], waist circumference, fasting insulin, BC Nottingham Prognostic Index [NPI]) was evaluated after IHC scoring. Statistical proportions were compared using Fishers Exact test, and continuous variables were evaluated using parametric or non-parametric tests, as appropriate. Results: Positive IR staining was seen in 64% of samples (n=59), 74% (n=68) for IGF1R, 68% (n=62) for FOXO3a and 43.3% (n=39) for pERK. Positive IR staining was more prevalent in Black women than White women (P=0.003) but was not significantly associated with age or NPI. IGF1R, FOXO3a, pERK positive staining were not associated with race or NPI. Positive IR staining was also associated with higher BMI, waist circumference, and fasting insulin (P<0.05 for all). Positive IGF1R, FOXO3a, pERK staining were not associated with any of these factors. Conclusions: We found that 64% of TNBCs had positive expression of IR, and IR expression was more prevalent in tumors from Black women and associated with higher insulin levels, suggesting that tumors from Black women may be more sensitive to the tumor promoting effects of systemic hyperinsulinemia. Presentation: 6/2/2024

Abstract C011: The Critical Role of Developmental Evaluation in Supporting and Enhancing an Equitable Transdisciplinary Approach to Address Cancer Disparities

Abstract Background: Complex problems such as cancer disparities require deeper integration of social and scientific problem-solving and a broader systems approach. Given the nature of disparities, it also demands that we not just seek equitable outcomes but collaborate in ways that reflect equity in the process. To address breast and lung cancer disparities, we developed a unique transdisciplinary approach that creates teams inclusive of community, clinicians, and researchers and builds capacity to understand at a deep level the factors that underpin disparities and design and implement newer sustainable solutions. Methods: This study focuses on a phase I planning period for a transdisciplinary process with five teams locally embedded where lung and breast cancer disparities are significant. A leadership team that included primary investigators from academic medicine and public health supported community-based facilitators and evaluators responsible for guiding local teams. Deep equity, considerations on the biology to policy spectrum, and systems thinking are grounding principles in our approach. At the end of phase I, an evaluator facilitated After-Action Reviews (AAR) to assess effectiveness in maintaining fidelity to the framework and to identify successful practices and areas for improvement. These data informed changes to our approach to implementation to further root our commitment to equity during implementation. Seven AAR sessions were conducted: individual teams members, facilitators and evaluators, and the leaderships team (n-=50). The evaluator triangulated the data from the different AARs and facilitated a discussion of the integrated findings to the expanded leadership team. Results: The AAR highlighted three primary themes for critical self-reflection including (1) strengthening the understanding and use of our approach, (2) reducing ambiguity while preserving slack (e.g. flexibility with resources) and creativity, and (3) integrating project’s partners intentionally into our wider transdisciplinary network. In examining these themes, we identified several strategies for improving our transdisciplinary approach during implementation and for wider replication of our framework with future integrated science-social problem solving. These areas included improved systems for 360-degree communication, clear expectations of roles, and additional support for transdisciplinary collaboration and application of grounded principles to better self-organize a transdisciplinary system within a wider less resilient system like academic medicine. Discussion: To successfully innovate socially and scientifically within complexities of cancer disparities, we need to push beyond conventional models of research and program intervention. This means incorporating methods across fields and sectors including evaluation. An After-Action Review is an effective evaluation tool for assessing a complex process with numerous contributors to ensure a stronger outcome including more refined and relevant research questions and sustainability program, policy and practice. Citation Format: Tobi Cawthra, Laura Pinsoneault, Jerica Broeckling, Kristen Gardner-Volle, Tim Meister, Kailey Taebel, Jada Proctor, Felicia Fairfield, Kelly Hackett, David Frazer, Staci Young, Melinda Stolley. The Critical Role of Developmental Evaluation in Supporting and Enhancing an Equitable Transdisciplinary Approach to Address Cancer 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 C011.

Abstract C105: Novel cancer-specific hypoxia signature predicts poor prognosis and highlights racial disparities in breast cancer

Abstract Triple-negative breast cancer (TNBC) is the most aggressive subtype of breast cancer. TNBC displays exceptional transcriptional heterogeneity, both between patients and intratumorally, and disproportionately affects underserved women. Hypoxia, a state of low oxygen levels, is often present in the solid tumor microenvironment. In TNBC, hypoxia is a key driver of aggressiveness and therapeutic resistance. Past bulk RNA sequencing (RNAseq) studies in cancer research have lacked spatial resolution, failing to uncover precise transcriptional differences within tumor regions. This spatial limitation has been especially problematic for studying transcriptional heterogeneity of the cellular hypoxia response within tumors. By integrating single-cell RNA sequencing and spatial transcriptomic analyses in a TNBC xenograft tumor model, our research has uncovered a novel hypoxia gene signature, specific to cancer cells. Elevated expression of this hypoxia signature predicts poorer prognosis in breast cancer patients, especially within TNBC patients and those of African ancestry. This suggests that hypoxia may play a role in the racial disparities observed in TNBC prognosis, potentially informing treatment strategies. This workflow introduces a novel framework for translating general spatial transcriptomics data into clinically relevant and accurate gene signatures. Citation Format: Kent Schechter, Long C. Nguyen, Geetha P. Yerradoddi, Rania Bassiouni, John D. Carpten, Marsha R. Rosner. Novel cancer-specific hypoxia signature predicts poor prognosis and highlights racial disparities 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 C105.

Abstract A037: Understanding the role of neighborhood deprivation in racial and urban-rural disparities in triple negative breast cancer

Abstract Background: Triple negative breast cancer (TNBC) accounts for 15% of all breast cancers and is one of the most aggressive disease subtypes. Disparities in TNBC exist, where US Black women and women living in urban environments are more likely to be diagnosed with TNBC than their White or rural counterparts. Reasons for these disparities are not completely understood. Social determinants of health, such as the neighborhood environment, have been implicated as potential contributors to breast cancer disparities. To improve our understanding of disparities in TNBC, we examined neighborhood deprivation in relation to breast cancer subtype, according to race and rurality. Methods: We identified 40,095 non-Hispanic Black and White women diagnosed with invasive breast cancer in 2010-2017 in the Georgia Cancer Registry. Neighborhood deprivation was measured by the Neighborhood Deprivation Index (NDI), a composite measure of neighborhood poverty, income, housing, unemployment, occupation, and education derived through principal component analysis using 2011-2015 block group-level American Community Survey data. Georgia Department of Public Health data were used to measure county-level rurality. We estimated case-only multivariable odds ratios (OR) and 95% confidence intervals (CI) for the separate associations between NDI, in quintiles, and each breast cancer subtype (TNBC, ERBB2+, or luminal B vs. luminal A breast cancer), overall and according to race and rurality. Results: Of the 40,095 non-Hispanic Black (31.5%) and White (68.5%) women, 5,328 were diagnosed with TNBC, 1,926 with ERBB2+, 4,958 with luminal B, and 27,883 with luminal A breast cancer. Compared to living in the least deprived neighborhoods, living in the most deprived neighborhoods was associated with a 33% (OR= 1.33, 95% CI 1.19-1.48) increased odds of TNBC vs. luminal A breast cancer. Race and rurality did not modify the association. However, estimates were less pronounced among non-Hispanic Black (OR=1.18, 95% CI 1.00-1.39) compared to non-Hispanic White (OR=1.40, 95% CI 1.18- 1.65) women and among women living in urban (OR=1.33, 95% CI 1.18-1.50) compared to rural (OR=1.52, 95% CI 1.15-2.03) counties. Neighborhood deprivation was associated with an increase in ERBB2+ breast cancer (OR=1.19, 95% CI 1.00-1.40), which was confined to non- Hispanic White women (OR=1.29, 95% CI 1.00-1.66) and women living in urban counties (OR=1.25, 95% CI 1.04-1.52). The OR for luminal B breast cancer was 1.08 (95% CI 0.96- 1.21). Although race did not modify this relationship, an association was observed only among women living in urban counties (OR=1.14, 95% CI 1.00-1.29). Conclusions: In this population of Georgia breast cancer patients, neighborhood deprivation was associated with an increase in TNBC, regardless of race or rurality. The weaker associations among non-Hispanic Black women and women living in urban counties suggests that other factors, in addition to neighborhood deprivation, may play an important role in TNBC development among Black women and women residing in urban environments. Citation Format: Lauren E. Barber, Jasmine M. Miller-Kleinhenz, Maret L. Maliniak, Leah Moubadder, Jeffrey M. Switchenko, Lauren E. McCullough. Understanding the role of neighborhood deprivation in racial and urban-rural disparities in triple negative 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 A037.

Abstract B131: Disparities in late-stage breast cancer: The impact of socioeconomic status across racial groups by healthcare utilization and community healthcare access

Abstract BACKGROUND: Late-stage breast cancer (LSBC, defined as stage 3 or 4) significantly contributes to breast cancer (BC) mortality, underscoring the importance of early detection and intervention. Understanding the individual and community factors contributing to LSBC is crucial for improving LSBC diagnoses and outcomes. OBJECTIVE: To evaluate the association between LSBC and individual demographic/socioeconomic status (SES) characteristics by race, and describe differences in individual healthcare utilization (IHU) and community healthcare access (CHA). Methods: This population-based retrospective study used demographic and SES data (age at diagnosis, marital status, years of education, income, poverty status, health insurance, and body mass index) from the Carolina BC Study Phase 3, a population-based cohort of women diagnosed with invasive BC from 2008-13. We analyzed all cases of LSBC (n=545) and stage 1 (n=1,225). Age-adjusted relative frequency differences (RFDs) and 95% confidence intervals (CIs) assessed the relationship between LSBC and SES for Black (n=835, 47.2%) and non-Black (n=935, 52.8%) women. Analyses were stratified by IHU status (High vs Low: High: Had regular pre-diagnostic care and were adherent to BC screening guidelines, >0.5 mammograms per year; Low: Lacked one or both forms of care); and stratified by CHA status (High vs Low), a census tract-level measure of cancer-specific healthcare infrastructure (e.g., oncologist density) and utilization (e.g., insurance rates). High CHA had either high or low infrastructure and high use; Low CHA had low infrastructure and low use. Results: Compared to non-Black women, Black women had more LSBC diagnoses (38.7% vs 23.7%), were more likely to be unmarried (59.1% vs 28.7%), have an income of <$50k (71.8% vs 38.2%), and be impoverished (27.0% vs 6.1%). Age at diagnosis, years of education, and income were significantly, positively associated with LSBC for all women, but the age-adjusted RFDs were greater among Blacks. After stratifying by IHU, income remained significantly associated with LSBC for Blacks with low IHU. For those with high IHU, the effects of SES on LSBC were not statistically significant. After stratifying by CHA, income and poverty status were significantly positively associated with LSBC for all women with high CHA; Marital status was significantly associated with LSBC for Blacks. Among the low CHA group, income and poverty were significantly associated for Blacks; RFDs were not estimable for non-Blacks due to small sample size (n=66). Notably, 36.5% of Blacks lived in low CHA areas compared to 7.1% of non-Blacks. Conclusion: Healthcare access exacerbates the effects of IHU but does not mitigate the impact of demographic/SES characteristics on LSBC diagnoses. Enhancing CHA alone is insufficient. Targeted interventions addressing individual and community factors are crucial to reduce LSBC diagnoses and improve outcomes, especially for Black women. Citation Format: Joel A. Begay, Brittney A. Gedeon, Matthew R. Dunn, Melissa A. Troester, Marc A. Emerson. Disparities in late-stage breast cancer: The impact of socioeconomic status across racial groups by healthcare utilization and community healthcare access [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 B131.

Abstract C119: Exploring the functional role of LRIG1 and WWOX tumor suppressors in breast cancer disparities

Abstract Breast cancer is the most commonly diagnosed cancer among women in the US. Despite a lower rate of breast cancer incidence, Black women in the US suffer higher rates of mortality compared to White women. This disparity poses a major clinical issue for Black women in the US, and we are particularly interested in understanding how molecular and environmental mechanisms may be contributing to these disproportionate outcomes. Our previous study found that in a cohort of women from Baltimore, Maryland (110 Black, 75 White), higher neighborhood deprivation was associated with decreased gene body methylation and gene expression of two tumor suppressor genes, LRIG1 and WWOX. These findings were unique to the tumor, which potentially points to ancestry-specific somatic mutations that may impact gene and protein expression for LRIG1 and WWOX. The goal of this project is to determine gene and protein differences in LRIG1 and WWOX by population group in women with and without breast cancer as it relates to neighborhood-level socioeconomic deprivation. We hypothesize that LRIG1 and WWOX exhibit decreased gene and protein expression in Black women compared to White women. Using the same diverse cohort from Baltimore, Maryland, we identified and conducted DNA genotyping on clinically relevant mutations of LRIG1 and WWOX using amplification by PCR and detection by fluorescent reporters. We found that the genotype frequencies in two single nucleotide polymorphisms (SNPs) for LRIG1, rs1403626 (P=6.3e-1) and rs2306272 (P=0.005967), differ significantly between population groups in these breast tissue samples, an interesting finding that matches our previous predictions. We also identified a dose-dependent relationship between LRIG1 gene expression and rs1403626 SNP genotypes. Additional patient genotyping will be conducted to determine relationships between LRIG1 and WWOX SNPs, differences in DNA methylation, and correlations with neighborhood deprivation measures. To interrogate the impact on protein expression, we will construct LRIG1 and WWOX knockdown mutants in estrogen receptor (ER)-positive and ER-negative commercially available breast cancer cell lines derived from Black and White patients, and determine the functional consequences of LRIG1 and WWOX loss by immunofluorescence and western blot, including how this may differ by population group. These studies will give us a better understanding of how the expression of tumor suppressor genes may contribute to the higher susceptibility of Black women developing more aggressive breast tumors. Citation Format: Angel H. Pajimola, Brittany Jenkins-Lord. Exploring the functional role of LRIG1 and WWOX tumor suppressors in breast cancer 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 C119.

Abstract C181: Toward breast health equity: Insights into mammography access across Virginia’s social and structural landscape

Abstract Background: Breast cancer (BC) disparities across race, socioeconomic status, and location, stress the need for equitable access to screening. In Virginia (VA), BC is a major concern, with Petersburg City having the highest mortality rate nationwide. Understanding social and structural factors’ impact on mammography accessibility may provide insights on effectively serving screening-eligible women in VA, particularly those facing greater BC burden. Also, analyzing data at the census tract level is vital for accurate accessibility assessment, mitigating county-level data skewing and disparity concealment. Objective: Examine how social and structural factors (e.g., demographics, transportation, area deprivation) influence mammography facility and unit distribution in VA. Methods: We utilized a comprehensive approach to compile and analyze data at the census tract level. We employed Poisson regression models to predict the number of mammography facilities and units within each tract. The predictor variables included the number of bus stops (VA Transit Routes & Stops GTFS), percentage of Black residents (American Community Survey), area deprivation index (ADI) scores (Neighborhood Atlas®), and vehicle ownership rates (American Community Survey), with the logarithm of the population of females aged 40-74 used as an offset to account for population size. Separate models were built for VA, our catchment area, urban areas within our catchment, and rural areas within our catchment. We exponentiated the model coefficients to obtain relative risks, indicating the multiplicative effect of each predictor on the outcome variable. Results: Study findings highlighted statistically significant disparities in the distribution of mammography facilities and units within VA. Higher ADI scores, indicating greater socioeconomic deprivation, were linked to fewer mammography units. This association was notable in our rural catchment areas (RR = 0.5492), indicating a 45.08% reduction in mammography units, in our catchment area overall (RR = 0.8653), a 13.47% decrease, and in urban catchment areas (RR = 0.8800), a 12.00% decline. Similarly, an increase in the percentage of Black residents was consistently associated with a decrease in the number of mammography units, with a relative risk of 0.8828 within our catchment area, indicating a 11.72% decrease, 0.8793 in urban areas within our catchment, signifying a 12.07% decrease, and 0.9391 statewide, showing a 6.09% decrease. Conclusions: These findings stress the need for targeted resource allocation to enhance mammography access. For instance, findings suggest a specific need for increased mammography units in rural areas and areas with higher percentages of Black women, like Petersburg (67.5% to 94.9% Black population depending on the tract), specifically within our catchment. Implications from these findings provide a unique opportunity to leverage the expertise of residents, community leaders and local representatives to identify where additional resources can be allocated. Citation Format: Bianca D. Owens, Jinlei Zhao, Katherine Y. Tossas. Toward breast health equity: Insights into mammography access across Virginia’s social and structural landscape [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 C181.

Abstract C181: Toward breast health equity: Insights into mammography access across Virginia’s social and structural landscape

Abstract Background: Breast cancer (BC) disparities across race, socioeconomic status, and location, stress the need for equitable access to screening. In Virginia (VA), BC is a major concern, with Petersburg City having the highest mortality rate nationwide. Understanding social and structural factors’ impact on mammography accessibility may provide insights on effectively serving screening-eligible women in VA, particularly those facing greater BC burden. Also, analyzing data at the census tract level is vital for accurate accessibility assessment, mitigating county-level data skewing and disparity concealment. Objective: Examine how social and structural factors (e.g., demographics, transportation, area deprivation) influence mammography facility and unit distribution in VA. Methods: We utilized a comprehensive approach to compile and analyze data at the census tract level. We employed Poisson regression models to predict the number of mammography facilities and units within each tract. The predictor variables included the number of bus stops (VA Transit Routes & Stops GTFS), percentage of Black residents (American Community Survey), area deprivation index (ADI) scores (Neighborhood Atlas®), and vehicle ownership rates (American Community Survey), with the logarithm of the population of females aged 40-74 used as an offset to account for population size. Separate models were built for VA, our catchment area, urban areas within our catchment, and rural areas within our catchment. We exponentiated the model coefficients to obtain relative risks, indicating the multiplicative effect of each predictor on the outcome variable. Results: Study findings highlighted statistically significant disparities in the distribution of mammography facilities and units within VA. Higher ADI scores, indicating greater socioeconomic deprivation, were linked to fewer mammography units. This association was notable in our rural catchment areas (RR = 0.5492), indicating a 45.08% reduction in mammography units, in our catchment area overall (RR = 0.8653), a 13.47% decrease, and in urban catchment areas (RR = 0.8800), a 12.00% decline. Similarly, an increase in the percentage of Black residents was consistently associated with a decrease in the number of mammography units, with a relative risk of 0.8828 within our catchment area, indicating a 11.72% decrease, 0.8793 in urban areas within our catchment, signifying a 12.07% decrease, and 0.9391 statewide, showing a 6.09% decrease. Conclusions: These findings stress the need for targeted resource allocation to enhance mammography access. For instance, findings suggest a specific need for increased mammography units in rural areas and areas with higher percentages of Black women, like Petersburg (67.5% to 94.9% Black population depending on the tract), specifically within our catchment. Implications from these findings provide a unique opportunity to leverage the expertise of residents, community leaders and local representatives to identify where additional resources can be allocated. Citation Format: Bianca D. Owens, Jinlei Zhao, Katherine Y. Tossas. Toward breast health equity: Insights into mammography access across Virginia’s social and structural landscape [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 C181.

Abstract B150: Social determinants of health and comorbidities increasing inflammation cytokines related to breast cancer in African American and Latinx women

Abstract Introduction: Comorbidities such as obesity, Type-2 diabetes (T2D), and hypertension (HTN) are highly prevalent among under-resourced African Americans (AA) and Latinx, and they are associated with breast cancer (BC) risks and outcomes. Social determinants of health (SDOH) also have been found related to BC incidence, stage, and survival. In addition, elevated inflammatory cytokines may be an underlying factor in comorbidities that contribute to tumorigenesis and adverse cancer outcomes. Limited research has been conducted to explore the process and associations among SDOH, comorbidities, and inflammation cytokines related to BC. The purpose of this study was to fill this research gap using a sample recruited from AA and Latinx communities. Methods: This was a cross-sectional study conducted in South LA. A total of 570 AA and Latinx women with or without BC were recruited. A panel of 19 cytokines from serum samples were measured by Luminex assay. Demographic information, body mass index, comorbidities, and diagnosis/stage of BC were collected from patients’ medical records. SDOH factors were selected from the social vulnerability index (e.g., percentage of persons in poverty, unemployed, with no high school diploma) obtained through Geographic Information Systems. Chi-square tests, independent sample Mann-Whitney U tests, and Cox regression were employed to examine the associations between BC diagnosis/stages, comorbidities, and cytokines. Path analyses were adopted to further explore the associations between SDOH, comorbidities, and cytokines. Results: Among the 570 women, 45.79% had a diagnosis of BC. Over half (50.97%) had ER/PR+, HER2-, and 27.80% had triple negative BC. Results from Chi-square tests showed that a higher percentage of women with obesity (p=.001), HTN (p<.0001), and T2D (p=.024) had a BC diagnosis than those without the comorbidity. Women with obesity had significantly higher levels of Leptin, VEGFα, and MIP1b; women with HTN had significantly higher levels of VEGFα and MIP1b; and women with T2D had significantly higher levels of Leptin and TGFβ1/β2. Leptin was found significantly higher in ER/PR+ BC (p<.0001) and VEGFα was significantly higher in triple negative BC (p=.001). Increasing VEGFα and TGFβ1/β2 reduced BC disease-free survival significantly. The path model showed community poverty and education level did not affect TGFβ1/β2 directly but were indirectly associated with them through obesity and T2D status (p<.01). Community poverty level was indirectly associated with the level of MIP1b through HTN status (p<.01). Conclusions: To eliminate breast cancer disparities, effective interventions are needed that account for the social and community contexts in which women live and are treated. Interventions that target comorbidities of T2D, HTN, and obesity are important to reduce the disparities. Citation Format: Weizhou Tang, Yanyuan Wu, Jaydutt Vadgama. Social determinants of health and comorbidities increasing inflammation cytokines related to breast cancer in African American and Latinx women [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 B150.

Abstract C113: Parabens promote cell growth in cancer cell lines associated with health disparities

Abstract Parabens are endocrine-disrupting chemicals used as preservatives to extend the shelf life of consumables, pharmaceuticals, and personal care products. Daily use of products containing parabens results in continuous exposure that can negatively impact health. It is known that parabens cause breast cancer cells to grow and express genes linked to cancer and hormone action. Our lab previously showed that parabens increase viability of and regulate estrogen-responsive gene expression in diverse luminal A breast cancer cell lines. In addition, greater effects were seen in a luminal A cell line of West African ancestry compared to one of European ancestry, suggesting that exposure to parabens in personal care products may contribute to breast cancer disparities. Therefore, the purpose of this study was to investigate whether parabens increase cell viability across a variety of cancer cell types, particularly those associated with cancer disparities. To do so, we utilized the National Cancer Institute-60 (NCI-60) Human Tumor Cell Lines screen that includes leukemia, non-small cell lung (NSCL), colon, central nervous system (CNS), melanoma, ovarian, renal, prostate, and breast cancer cell lines, plus a custom panel of pancreatic cancer cell lines. Of these, ovarian, NSCL, prostate, colon, renal, CNS, and pancreatic cancers have known disparities. We treated these cancer cell lines with biologically relevant doses of butylparaben (BP), methylparaben (MP), or propylparaben (PP) (doses ranging from 0.0012 µM – 20 µM) for 72 hours and measured cell viability. Treatment with dimethylsulfoxide or 10 nM estradiol served as negative and positive controls, respectively. In general, we observed a paraben-specific and cell-line specific effect on cell viability. MP exhibited the greatest effect with increased cell viability in 42% of the cell lines, followed by PP (38%), and BP (32%). MP and PP are among the most common parabens found in personal care products and differences in urinary levels based on race/ethnicity (e.g. higher levels in non-Hispanic Blacks/Mexican Americans compared to non-Hispanic Whites) have been reported. Breast, ovarian, and NSCL had the most cell lines (67-83%) that exhibited increased cell viability with any paraben treatment. Increased cell viability was also observed in several leukemia, colon, pancreatic, CNS, and melanoma cell lines (33-50%). Only one renal, and no prostate, cell line exhibited increased cell viability. These data suggest that paraben-mediated protumorigenic effects may promote cancer disparities beyond breast cancer. Studies are currently underway to determine the mechanisms underlying this link. One caveat of this study is that most of the cell lines in this readily available screen are of European ancestry, highlighting a need to develop more genetically diverse in vitro models for understanding the mechanistic link between paraben exposures and cancer risk/outcomes in the context of disparities. Approaching this challenge from an endocrinology and genetic ancestry perspective may help narrow the disparity gap. Citation Format: Jazma L. Tapia, Jillian C. McDonough, Loretta Erhunmwunsee, Lindsey S. Trevino. Parabens promote cell growth in cancer cell lines associated with 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 C113.

Abstract A050: The impact of air pollution on aggressive breast cancer prognoses in women of African descent

Abstract Significance. Breast cancer (BC) is the most diagnosed cancer among women in the US. Though highly heterogeneous, different subtypes can be characterized by the expression of membrane receptors on the cell surface: ER+, HER2+, PR+, or basal-like which does not express any of the three receptors. Basal-like triple-negative breast cancer (TNBC) is a highly aggressive subtype of BC that represents about 15% of overall BC cases. Black women disproportionately experience higher rates of early-onset TNBC phenotypes and worse prognoses when compared to White women. Though genetics is a key factor in oncogenesis and cancer progression, it is now widely recognized that differences in cancer outcomes are influenced, also, by various environmental, social, and lifestyle factors known collectively as the social determinants of health (SDOH). For example, air pollution has consistently been shown to be associated with an increased risk of breast cancer, however, little is known about how air pollution alters biological and molecular mechanisms impacting breast cancer progression. Elucidating these influential factors is critical to understanding and addressing disparate outcomes. We are interested in understanding how air pollution impacts immune-oncology related proteins in breast cancer, specifically for Black and White women living in Baltimore City, Maryland. Methods. In a cohort of 217 women (142 Black, 75 White), we performed statistical analyses to determine the correlation between particulate matter 2.5 (PM2.5) with breast cancer subtype and oncogenic molecular drivers within the tumor and its microenvironment. PM2.5 concentration for Census year 2000 was measured using the EPA Downscale Model. Concentrations at the census-tract level were then linked to each participant's geocoded residential address at study baseline. Results. [BJ1] Our data reveal that a higher exposure to PM2.5 is correlated with breast cancer subtypes incidences[BJ2] (p- value[BJ3] =0.051), specifically for hormone receptor positive (ER+ and/or PR+) and TNBC subtypes (p-value=0.035). Elevated air pollution is also associated with estrogen-receptor status overall (p-value=0.002) and in Black (p-value=0.043) and White (p-value=0.008) women in the stratified analysis. Serum protein measurements in this cohort also revealed significant relationships between elevated air pollution and immune-oncology related proteins, including PD-L1, CAIX, CXCL9, and MCP-2.Discussion. Our preliminary evidence reveals an association between air pollution, breast cancer subtypes, and immune-oncology related proteins, with some of these relationships affecting Black and White populations differently. We will continue to interrogate these differences and begin to reveal the underlying mechanisms exacerbating breast cancer disparities. Citation Format: Kayla S. Ingram, Brittany Jenkins-Lord. The impact of air pollution on aggressive breast cancer prognoses in women of African descent [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 A050.

Abstract A058: Investigating the role of race/ethnicity on the association between neighborhood deprivation and breast cancer outcomes among Kentucky breast cancer patients years 2010-2022

Abstract Background: Despite advances in medical knowledge and treatment, disparities in breast cancer outcomes persist along demographic and socioeconomic lines. To quantify these disparities, the Area Deprivation Index (ADI) emerges as a powerful metric. It offers insights into the interplay between neighborhood socioeconomic status and breast cancer outcomes by encompassing factors pertaining to income, education, employment, and housing quality. There have been limited studies to examine the role of race and neighborhood disadvantage on specific breast cancer outcomes. Kentucky also faces a unique burden as it has the third highest breast cancer mortality rate in the United States. This study aims to examine the association between neighborhood socioeconomic disadvantage, and breast cancer outcomes including receipt of surgical treatment, radiation therapy, chemotherapy, and breast cancer-specific survival. While also examining how any associations are modified by race and ethnicity among Kentucky breast cancer patients. Methods: We conducted a retrospective cohort analysis using data from the Kentucky Cancer Registry (KCR) among breast cancer patients diagnosed between 2010 and 2017 with follow-up data through December 31, 2022. The KCR dataset was then linked with census tract data to examine ADI. We conducted consecutive multilevel logistic regression for binary outcomes and Cox Proportional hazard models using SAS (version 9.4, SAS Institute, Inc., Cary, North Carolina, USA) for time-to-event of breast cancer survival. Results: Women in the most disadvantaged quartile (4th quartile) were more likely to be Non-Hispanic Black (NH-Black), Appalachian residents, current tobacco users, divorced and using government insurance. Compared to women in the least disadvantaged neighborhoods (1st quartile) women living in the most disadvantaged neighborhoods (4th quartile) were 50% more likely to die from breast cancer (HR: 1.50, 95 CI: 1.28-1.76). Women in the most disadvantaged neighborhoods (4th quartile) were also more likely to be diagnosed at later stages (aOR:1.26, 95 CI:1.13-1.42). These associations were all observed after adjusting for age, race, tobacco use, marital status, insurance status, family history, and residence in Appalachia. Conclusions: Women living in areas of greater disadvantage had significantly increased odds of late-stage diagnosis and risk of breast cancer death regardless of race suggesting that neighborhood-level factors contribute to breast cancer disparities. Our findings underscore the need for neighborhood-level interventions to improve cancer outcomes. Citation Format: Breyanna E. Walker, Elinita Pollard, Justin Moore, Sydney Howard, Pamela Hull, Kathleen O'Connor, Samantha Jones, Lovoria Williams, Adebola Adegboyega, Veronica Jones, Eric Durban, Xiaoqin Wang, Wendi Owen. Investigating the role of race/ethnicity on the association between neighborhood deprivation and breast cancer outcomes among Kentucky breast cancer patients years 2010-2022 [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 A058.

The bench to community initiative: community-based participatory research model for translating research discoveries into community solutions.

The BCI program was established to understand sociocultural determinants of personal care product use, evaluate the biological impact of endocrine disrupting chemicals, and develop community interventions. The three pillars of the program include research, outreach and engagement as well as advocacy activities. The research pillar of the BCI includes development of multidisciplinary partnerships to understand the sociocultural and biological determinants of harmful chemical (e.g., endocrine disrupting chemicals) exposures from personal care products and to implement community interventions. The outreach and engagement pillar includes education and translation of research into behavioral practice. The research conducted through the initiative provides the foundation for advocacy engagement with applicable community-based organizations. Essential to the mission of the BCI is the participation of community members and trainees from underrepresented backgrounds who are affected by breast cancer disparities. Two behavioral interventions will be developed building on prior research on environmental exposures with the focus on personal care products including findings from the BCI. In person and virtual education activities include tabling at community events with do-it-yourself product demonstrations, Salon Conversations-a virtual platform used to bring awareness, education, and pilot behavior change interventions, biennial symposiums, and social media engagement. BCI's community advisory board members support activities across the three pillars, while trainees participate in personal and professional activities that enhance their skills in research translation. This paper highlights the three pillars of the BCI, lessons learned, testimonies from community advisory board members and trainees on the impact of the initiative, as well as BCI's mission driven approaches to achieving health equity.

Reducing Breast Cancer Disparities with Precision Public Health: A New Strategy to Improve Prevention and Advance Health Equity in Delaware Hotspots.

While Black and White women are diagnosed with breast cancer (BC) at similar rates, Black women die from BC at a 40% higher rate. This disparity is even more pronounced for younger Black women, who die from BC at nearly twice the rate as younger White women. Black-White differences in BC mortality are largely attributable to health care and tumor biology factors. Black women face greater barriers to accessing BC screening and are twice as likely to be diagnosed with the aggressive triple-negative breast cancer (TNBC) subtype. Delaware leads the US for the incidence of late-stage BC diagnosed among younger women and TNBC. This commentary begins with a discussion of precision public health, an emerging framework that builds on and complements recent advances in precision medicine. Next, a new precision public health initiative designed to reduce BC disparities in Delaware by targeting local hotspots with prevention interventions is presented. Finally, next steps are considered for implementation, evaluation, and new research activities.

Associations Between Perceived Discrimination, Screening Mammography, and Breast Cancer Stage at Diagnosis: A Prospective Cohort Analysis

BackgroundDespite higher breast cancer screening rates, black women still are more likely to have late-stage disease diagnosed. This disparity is influenced in part by structural and interpersonal racism. This prospective study sought to determine how interpersonal factors, including perceived discrimination, influence screening and stage of disease at diagnosis.MethodsA prospective cohort study analyzed adult women with stages I to IV breast cancer from the Miami Breast Cancer Disparities Study. Perceived discrimination and mistrust of providers were assessed using previously validated questionnaires. Multivariable logistic regression was used to evaluate the odds of screening mammography utilization and late-stage breast cancer at diagnosis.ResultsThe study enrolled 342 patients (54.4 % Hispanic, 15.8 % white, and 17.3 % black). Multivariate regression, after control for both individual- and neighborhood-level factors, showed that a higher level of perceived discrimination was associated with greater odds of late-stage disease (adjusted odds ratio [aOR], 1.06; range, 1.01–1.12); p = 0.022) and lower odds of screening mammography (aOR, 0.96; range, 0.92–0.99; p = 0.046). A higher level of perceived discrimination also was negatively correlated with multiple measures of provider trust.DiscussionThis study identified that high perceived level of discrimination is associated with decreased odds of ever having a screening mammogram and increased odds of late-stage disease. Efforts are needed to reach women who experience perceived discrimination and to improve the patient–provider trust relationship because these may be modifiable risk factors for barriers to screening and late-stage disease presentation, which ultimately have an impact on breast cancer survival.

Ethnic disparities in breast cancer: A comprehensive analysis of socio-demographic and clinical characteristics among African American, Hispanic, and Caucasian women.

e13698 Background: Despite advancements in breast cancer therapy leading to a decline in mortality rates within certain ethnic populations, there exists a concerning trend of increasing cancer incidence among African American (AA) and Hispanic women. This persistent rise highlights the urgent need to explore and comprehend the socio-demographic and breast cancer characteristics specific to these populations. Methods: We assembled a 10-year database of women diagnosed with breast cancer in the community hospital in Chicago. After excluding minority ethnic groups, specifically AA, Hispanic, and Caucasian cohorts were included in this study, comprising 786 patient records analyzed. Results: The distribution revealed a predominance of AA patients at 49.7%, Hispanics at 42.1%, and Caucasians at 8.14%. Noteworthy differences across the three ethnic groups were observed in age categories at cancer diagnosis, BMI categories, family history of first-degree relatives with breast cancer, marital status, smoking habits, menopausal status, and alcohol use at the time of diagnosis (p < 0.05). Within the molecular subtypes, 14.5% were identified as triple-negative breast cancer (TNBC), with a higher prevalence of 18.7% among the AA subgroups. 19.6% of patients had advanced disease, proportion was higher in AA ethnic group (22.8%; p = 0.83) compared to other ethnicities. Breast conservative procedures were prevalent in almost half of the patient population on average (52.1 %), with a slightly higher frequency of mastectomies noted in the Hispanic patient group (44.1%, p < 0.05). In logistic regression analysis, compared to the reference AA ethnicity, Hispanics exhibited higher odds of having HER-2 positive breast cancer (OR 1.74; CI 1.04 – 2.94; p < 0.05), as did Caucasians (OR 2.35; CI 1.05 – 5.04; p < 0.05). Conclusions: In summary, our study underscores substantial socio-demographic and breast cancer characteristic differences among AA and Hispanic populations compared to Caucasians, revealing notable ethnic disparities in breast cancer. Despite these variations, our findings highlight promising healthcare equity, with comparable access to surgical and chemotherapy interventions across ethnicities. TNBC demonstrates molecular heterogeneity and a higher prevalence among AA women, contributing to significant racial disparities.

A systematic review of racial disparity in pivotal poly (ADP-ribose) polymerase (PARP) inhibitor trials.

e13737 Background: Breast cancer is the most common cancer diagnosed worldwide. Breast cancer related mortality has decreased in the US, however this did not extend equally to African American women (AAW). According to CDC mortality rate from breast cancer in AAW is 20% higher than other ethnic groups. Younger age at diagnosis in AAW, higher incidence of triple negative breast cancer (TNBC), and higher incidence of AA males with breast cancer suggest genetic predisposition plays an important role in the disparate outcomes based on race. In an unbiased analysis of TNBC cases, the prevalence of pathogenic germline BRCA 1 & 2 mutations are twice as high as in breast cancer overall. Poly (ADP-ribose) polymerase (PARP) inhibitors have proven to be effective in germline BRCA 1 and BRCA 2 mutation associated breast cancer. However, data regarding the enrollment of racial and ethnic minorities in these pivotal trials that lead to the approval of these drugs is limited. Methods: We examined the demographic data reporting in Phase II/ III clinical trials of PARP inhibitors in breast cancer from 2016 to 2023. In order to highlight the disparities in the enrollment of minority groups we calculated an enrollment percentage of various racial groups in these trials. We conducted a systematic review of Phase II/III clinical trials of PARP inhibitors in BRCA 1 & 2 mutated breast cancer reported studies with sources from PubMed, Embase, Scopus, Clinicaltrials.gov, CENTRAL and Cochrane. 56 full text studies were identified, out of which 14 met inclusion criteria. The total number of patients included was N=5,067. Five trials did not include racial data. Results: Among trials that reported race and ethnicity (N=4004), the enrollment percentage was lowest for racial and ethnic minorities. AA: 3.4%, N=136. Non- Hispanic Whites were the most common to be enrolled: 71.05%, N=2845, Asians were 16.53% N= 662, Hispanics 2.03 %; N=83 and other 6.17%, N=247. Conclusions: Racial minorities are consistently underrepresented in all the pivotal PARP inhibitor trials and contributing to the race-based disparities in breast cancer. [Table: see text]

Patient experience and pain outcomes among Black women with early-stage breast cancer after mastectomy.

e13751 Background: Racial pain disparities in breast cancer (BC) are well-described and persist despite prior trials to improve disparate pain outcomes. We previously found Black women (BW) reported more pain severity (PS) and interference with life (PI) after breast surgery compared to White women. Pain expression is multifactorial, and structural factors affect the ability to report and control pain. Perceived discrimination is associated with mistrust of medical providers, which affects clinical outcomes. Their impact on pain is understudied. We evaluated the association between discrimination, trust, and pain among BW with early-stage BC after mastectomy. Methods: BW with stage 0-III BC who had mastectomy ≤2 years of enrollment at academic and safety net hospitals in Houston, TX and Atlanta, GA, completed a demographic survey, Brief Pain Inventory (BPI), Discrimination in Medical Settings Scale (DMS), and Trust in Physician Scale (TPS). In BPI, worst, least, and average PS were reported from 0-10. PI from 0-10, pain treatments, and % relief were reported. DMS and TPS questions were on a 5-point Likert scale. We performed chart review to obtain baseline clinical data related to BC diagnosis, treatment and comorbidities. PI and DMS were scored as a mean of the total items of each survey. Mean Trust and Mistrust scores used means of TPS questions related to each category. Higher scores mean more PS, PI, discrimination, trust, or mistrust. We used ANOVA to examine associations between categorical variables and Pearson correlation coefficient for continuous variables. We performed univariate linear regression and multi-linear regression between specific variables and outcomes, accounting for collinearity. Results: Of the 77 BW surveyed, 66.2% received chemotherapy. 47.2% had a household income < $25,000, and 40.3% had private health insurance. PS, PI, DMS, and trust scores are shown (Table). Univariate analysis showed an association between DMS and mistrust (p=0.01), lower income and higher PS (p=0.01) and PI (p=0.04), and insurance status and PS (p=0.02) and PI (p=0.02). Associations between mistrust or DMS and pain were not statistically significant. A multivariate analysis with DMS as outcome showed an association with mistrust (p=0.04). Multivariate analysis also showed receipt of chemotherapy was associated with higher PS (p=0.02) and PI (p=0.03). Conclusions: BW have moderate pain up to 2 years following mastectomy. Participants reported low levels of discrimination and high trust. More discrimination was associated with more physician mistrust, but not PS or PI. Lower income and lack of private health insurance were associated with higher PS and PI. Future studies should address discrimination and trust in clinical settings and financial barriers to pain control. [Table: see text]

Racial and ethnic disparities in hospital outcomes following hospitalizations for mastectomy for breast cancer.

e13691 Background: Racial and ethnic disparities in breast cancer (BC) treatment and survival have been well documented. White (W) and Asian (A) women are more likely to have localized BC (BC) than Black (B) or Hispanic (H) women. Furthermore, the incidence of triple negative BC is higher in B women who also have the highest death rates from BC. In this study, we aimed to identify an association between race/ethnicity and outcomes following hospitalization for mastectomy using a large national database. Methods: This study isa retrospective analysis of the National Inpatient Sample database, the largest all-payer inpatient database in the United States, of hospitalizations between 2016-2019. Patients (pts) ≥18 years of age, admitted for mastectomy for BC were included and stratified by race/ethnicity. The outcomes of the study were in-hospital mortality rate, prolonged hospital length of stay, surgical site infection, bleeding complication, cardiac complication, respiratory complication, acute kidney injury, urinary tract infection, and wound dehiscence. Hospitalizations and outcomes were identified using ICD-10 diagnosis and procedure codes. Logistic regression analysis was done to identify an association between race and outcomes. Results: A total of 302,208 pts who were hospitalized for mastectomy were included. Of these 218,092 (72.2%) pts were W, 36,242 (12.0%) were B, 25,130 (8.3%) were Hispanics, and 22,744 (7.5%) were of another race. Among B pts, adverse outcomes were significantly higher (p<0.001), including in-hospital mortality rate (0.2%), prolonged hospital length of stay (64.1%), surgical site infection (0.8%), bleeding complication (4.2%), cardiac complication (0.8%), respiratory complication (0.3%), and acute kidney injury (1.4%). After adjusting for various factors including age, insurance, hospital region, hypertension, diabetes, obesity, peripheral vascular disease, alcohol use, Elixhauser comorbidity index, whether pts underwent axillary lymph node dissection and others, logistic regression was performed. This analysis identified that B pts had significantly higher odds for mortality (adjusted odds ratio [aOR], 2.99, 95% CI: 1.62-5.73), prolonged hospital length of stay (aOR, 1.32, 95% CI: 1.18-1.49), and bleeding complication (aOR, 1.28, 95% CI: 1.13-1.48). Conclusions: Results of our study show that adverse hospital outcomes following mastectomy for BC were significantly higher among Black patients. These outcomes remained significant after adjusting for clinical covariates, raising the possibility of other contributing factors to these differences in outcomes. Study limitations include the lack of information on stage at diagnosis, receptor status, and that Hispanics were categorized under race. Further studies are needed to develop effective interventions to reduce these disparities.

Breast cancer disparities among Hispanics in the US: Insights into healthcare access.

e13734 Background: Breast cancer (BC) is the most prevalent cancer and the second leading cause of cancer-related death in women in the US. Hispanics account for 19.1% of the US population, ranking as the second-largest racial/ethnic group, following the Non-Hispanics White (NHW) population. We aimed to assess the current BC characteristics and treatment patterns among Hispanics in the US. Methods: We conducted a retrospective cohort analysis utilizing the Surveillance, Epidemiology, and End Results Registry (SEER). Women newly diagnosed with breast cancer stages 1-3 between 2018 and 2020 were included. Bivariable analyses were conducted using two-sample Wilcoxon rank-sum and Chi2 square to evaluate delay in treatment, defined as a lapse of 3+ months between diagnosis and the initiation of treatment. Treatment encompassed neoadjuvant chemotherapy, radiation, or upfront surgery. Results: The study included 135,690 participants, among whom 16.5% (22,346) were Hispanic. Hispanic women were notably younger than their NHW counterparts (58 vs 65 years old). Most Hispanic and NHW patients resided in metropolitan areas and counties with an MHI exceeding $75,000. While both groups were predominantly diagnosed with Stage 1 IDC, it is noteworthy that a higher proportion of Hispanics tended to be diagnosed at more advanced stages (25.3% vs 17.9%). Additionally, Hispanic and NHW women were mostly diagnosed with HR+/HER2- BC (70.1% vs. 77.7%). Moreover, Hispanics had a higher percentage of HER2+ (15.2% vs. 11.5%) and TNBC (11.4% vs. 8.5%). Hispanics and NHW patients received mostly upfront surgery (74.3% vs. 83.1%), although a larger percentage of Hispanics were treated with NACT (20.8% vs 12.4%). Hispanic patients had a median time to treatment of 1.5 ± 1.34 months, while NHW patients had a shorter time of 1.22 ± 1.07 months, p-value <0.001. After adjusting for all variables, Hispanic women had 2.47 times the odds of experiencing a treatment delay compared to NHW women. Conclusions: This study reveals healthcare access disparities for Hispanic BC patients, emphasizing the need for targeted interventions. Personalized strategies in clinical practice and health policy are crucial for ensuring equitable outcomes for all. [Table: see text]