Breast Cancer In African American Women Research Articles

Abstract A021: Development of cross-ancestry polygenic risk. scores for breast cancer in women of African ancestry

Abstract Introduction: Polygenic risk scores (PRSs) predict breast cancer (BC) risk and have shown utility for screening in European ancestry women (EUR). However, PRSs developed for non-European ancestry, particularly African American (AA) women, have limited predictive accuracy. Methods: We analyzed data from 17,454 BC cases and 19,093 controls in the African American Breast Cancer Genetics (AABCG) consortium, split into training (70%), tuning (10%), and testing (20%) sets. Genome-wide association analyses for overall BC, ER-positive BC, ER- negative BC and triple-negative BC (TNBC) were performed in the training dataset, controlling for age, genotyping platform, and the top 10 principal components. We built single-ancestry PRS models using forward stepwise selection (FSS), PRSice-2, PLINK C+T, Lassosum2, and LDpred2-auto. These were combined with published EUR 313-SNP models (330-SNP for TNBC) in the tuning set to obtain cross-ancestry models. Genome-wide cross-ancestry PRS methods, including CT-SLEB and PRScsx, were also used. We created an ensemble model by combining different PRS models across subtypes using ensemble-based approaches. All developed PRS models were then evaluated in the independent testing set. Additional validation was performed using the All of Us (AoU) study with 834 BC cases and 29,122 controls from the AA population. Results: The observed-scale SNP-based heritability was estimated at 0.29 (SE: 0.12) for overall BC risk, 0.43 (SE: 0.18) for ER-positive BC, 0.44 (SE: 0.24) for ER-negative BC, and 1.13 (SE: 0.40) for TNBC. The best models showed good discriminating capacity: ensemble-based models for overall (AUC=0.626) and ER-positive BC (AUC=0.626), and combined cross-subtype and cross-ancestry FSS models for ER-negative (AUC=0.647) and TNBC (AUC=0.654). The odds ratio per standard deviation was 1.63 (95% CI: 1.55, 1.71) for the ensemble-based PRS of overall BC risk, with an estimated life risk of 28% for the top 1%. The cross-ancestry model using CT-SLEB combined with the EUR 313-SNP model was validated (AUC=0.61) among AA women in the AoU study. Conclusion: We developed PRSs with improved discriminating ability for BC risk in women with African ancestry. Cross- ancestry and subtype learning enhanced model performance. These findings indicate common variation has a larger role in BC in AA women than previously reported, warranting further validation in external AA populations and clinical evaluation. Citation Format: James L. Li, Haoyu Zhang, Julian C McClellan, Guimin Gao, Kevin Wang, Julie R. Palmer, Olufunmilayo I. Olopade, Christopher A. Haiman, Dezheng Huo. Development of cross-ancestry polygenic risk. scores for breast cancer in women of African ancestry [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 A021.

Population attributable fraction of reproductive factors in triple negative breast cancer by race.

10522 Background: Age-adjusted incidence rates of triple negative breast cancer (TNBC) are higher in African American (AA) women than in non-Hispanic White (White) women. The disproportionate incidence of TNBC in AA women partially drives the 40% higher mortality rate from breast cancer in AA women compared to White women. Several studies have identified lack of breastfeeding and younger age at first birth as risk factors for TNBC. There are large differences in breastfeeding uptake and duration in the US: only 44% of AA women breastfeed for 6 months or longer, compared to 60% of White women. To quantify the contribution of differences in breastfeeding patterns and younger age at first birth to disparities in incidence of TNBC, we calculate the population-attributable fraction (PAF), which is the proportion of the incidence of a disease that may be attributable to a particular exposure. Methods: A systematic review was performed to identify relevant case-control studies. Pooled odds ratios (ORs) for breastfeeding for < 6 months and age at first birth < 25 years were calculated from data extracted from studies using a common effect model. PAF was calculated using the Levin formula. Risk factor population prevalences were extracted from national surveys. Pooled ORs were used as estimates of relative risk (RR). A combined PAF was calculated using the polychoric correlation coefficient between breastfeeding duration and age at first birth to account for contributions of multiple risk factors. Results: Using race specific ORs, the PAF of breastfeeding for < 6 months was 12% (95% confidence interval (CI) 5-20%) among White women and 15% (95% CI 3-26%) among AA women. The PAF of having a child before age 25 was not significantly different from zero for White women (2% (CI -6-11%)) but was significantly different from zero for AA women (21% (CI 5-25%)). The combined PAF was 27% for AA women and 17% for all women in the US. Extrapolating to the US population, we estimated that 4,850 annual cases of TNBC (2,421 among White women and 1,533 among AA women) could be attributed to breastfeeding for < 6 months and age at first birth < 25 years. Conclusions: Given the protective role of breastfeeding against TNBC, policy changes aimed at supporting breastfeeding, addressing structural barriers, and promoting a culture shift could reduce racial disparities in TNBC incidence in the US. [Table: see text]

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]

Abstract PO4-09-12: Academic-community partnership bridges disparities in African American patient representation in accelerated partial breast irradiation clinical trials

Abstract Purpose/Objectives: Clinical outcomes in African American (AA) patients diagnosed with breast cancer continue to lag behind other racial groups. Thus, AA women are 41% more likely to die from breast cancer than White women despite lower incidence of breast cancer in AA women. Some of these disparities are related to barriers in access to standard-of-care treatments such as radiation therapy (RT). The prolonged nature of radiation treatments confers disproportionate higher burden (due to lost wages, transportation costs etc.) on economically disadvantaged groups such as AA women. Accelerated partial breast irradiation (ABPI), which dramatically reduces treatment time in appropriately selected patients, has the potential to mitigate financial toxicity, and improve access and treatment compliance for AA. However, underrepresentation of AA patients in APBI trials may pose a barrier to wide adoption of APBI treatments in this patient population. At our institution, we have established a unique partnership between our University Hospital and a county hospital that serves as a safety-net hospital for many economically disadvantaged groups and treats a large proportion of AA patients. The goal of this study is to determine if our unique academic-community partnership improves disparities in representation of AA patients in APBI trials. Methods: We performed a PUBMED search to identify 197 clinical trials involving ABPI. After excluding international trials and multiple reports from the same trials, we identified 80 unique studies that were based in the United States. A total of 20 studies investigating APBI provided demographics data, comprising 1735 total patients. AA enrollment rate in these trials was compared to APBI trials completed at our institution in partnership with our county hospital partner. Results: Out of 1785 patients enrolled in APBI trials in the United States where demographic information was available, 1488 patients were White (85.7%), 124 were Black (7.1%), 67 were Hispanic (3.9%), and 46 were Asian (2.7%), and 10 patients were classified as multiple or unknown (0.6%). We compared these results to two APBI trials conducted at our institution investigating 5-fraction and single fraction APBI regimens. Out of a total of 104 patients treated, 17 patients (16.3%) were Black. This difference in proportion of AA patient enrollment between our institution (16.3%) versus those reported in APBI trials across the United States (7.1%) was statistically significant (p < 0.05). Conclusion: Reporting and representation of AA patients in APBI trials remains low, which may lead to lower adoption of APBI treatments in AA patients. This may lead to underutilization of APBI, a convenient treatment with lower financial toxicity, among AA patients. Our study shows that effective academic-community partnerships can bridge such disparities in AA patient representation in APBI trials. Expansion of such academic-community partnerships across the country may bridge systemic disparities in AA patient representation in oncology clinical trials. Future studies are needed to determine if improved access to novel and convenient treatments such APBI will bridge existing disparities in clinical outcomes in patients diagnosed with breast cancer. Citation Format: Ev Kakadiaris, Brian Lue, Young Suk Kwon, Prasanna Alluri, D Nathan Kim, Ann Sprangler, Mona Arbab, Robert Timmerman, Asal Rahimi. Academic-community partnership bridges disparities in African American patient representation in accelerated partial breast irradiation clinical trials [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-09-12.

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.

Artificial Intelligence for Neuroimaging and Musculoskeletal Radiology: Overview of Current Commercial Algorithms

To assess differences in the mammographic and sonographic appearance of breast cancer in African American (AA) and Non-Latina White (NLW) women.We identified AA and NLW women with biopsy proven ductal carcinoma in situ or invasive breast cancer between June 1, 2015 and May 31, 2018. Racial differences in Breast Imaging and Reporting Data System (BI-RADS) imaging features were analyzed by imaging cohorts, i.e. screen detected vs. clinical presentation, using logistic regression adjusted for histology and molecular subtypes.We analyzed 270 AA women with 278 cancers (166 screen detected, 112 clinical) and 586 NLW women with 599 cancers (397 screen detected, 202 clinical). Compared with NLW women, AA women had higher rates of non-dense breast composition (almost entirely fatty 12.0% vs. 4.6%, scattered fibroglandular 50.9% vs. 45.2%; overall P < 0001) in both cohorts and were less likely to have screen detected architectural distortion, (odds ratio (OR) = 0.38, 95% CI 0.18–0.80). AA women were less likely than NLW women to have screen detected irregular than oval/round masses (mammography: OR = 0.36, 95% CI 0.19–0.68; sonography: OR = 0.48, 95% CI 0.24–0.94), and more likely to present clinically with high density masses (OR = 3.03, 95% CI 1.12–8.20) demonstrating posterior enhancement (OR = 3.02, 95% CI 1.11–8.27).There are racial differences in the mammographic and sonographic appearance of breast cancer even after accounting for higher rates of triple negative breast cancer in AA women. Understanding these differences may provide breast imagers with a framework to approach breast cancer diagnosis in the AA population in clinical practice.

A comparison of the imaging appearance of breast cancer in African American women with non-Latina white women

PurposeTo assess differences in the mammographic and sonographic appearance of breast cancer in African American (AA) and Non-Latina White (NLW) women. MethodsWe identified AA and NLW women with biopsy proven ductal carcinoma in situ or invasive breast cancer between June 1, 2015 and May 31, 2018. Racial differences in Breast Imaging and Reporting Data System (BI-RADS) imaging features were analyzed by imaging cohorts, i.e. screen detected vs. clinical presentation, using logistic regression adjusted for histology and molecular subtypes. ResultsWe analyzed 270 AA women with 278 cancers (166 screen detected, 112 clinical) and 586 NLW women with 599 cancers (397 screen detected, 202 clinical). Compared with NLW women, AA women had higher rates of non-dense breast composition (almost entirely fatty 12.0% vs. 4.6%, scattered fibroglandular 50.9% vs. 45.2%; overall P < 0001) in both cohorts and were less likely to have screen detected architectural distortion, (odds ratio (OR) = 0.38, 95% CI 0.18–0.80). AA women were less likely than NLW women to have screen detected irregular than oval/round masses (mammography: OR = 0.36, 95% CI 0.19–0.68; sonography: OR = 0.48, 95% CI 0.24–0.94), and more likely to present clinically with high density masses (OR = 3.03, 95% CI 1.12–8.20) demonstrating posterior enhancement (OR = 3.02, 95% CI 1.11–8.27). ConclusionThere are racial differences in the mammographic and sonographic appearance of breast cancer even after accounting for higher rates of triple negative breast cancer in AA women. Understanding these differences may provide breast imagers with a framework to approach breast cancer diagnosis in the AA population in clinical practice.

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.

Abstract P3-14-12: Distinct and targetable molecular features of breast cancer in African American women

Abstract Introduction: Despite having a lower incidence of breast cancer, African American (AA) women suffer disproportionately worse outcomes; with more aggressive cancer and higher mortality rates, as well as higher incidence of triple negative breast cancer (TNBC). The cause of these disparities is unclear, but may be driven by different biologic and molecular features. Information about targetable molecular profiles for breast cancer in AAs is limited, and may not be representative of racial minorities. A better understanding of actionable targets is needed to improve treatment and outcomes of breast cancer for AA women. Materials and methods: This study utilized molecular data from three TCGA Breast Invasive Carcinoma studies (Cell 2015, Firehose Legacy, and PanCancer Atlas) on CBioPortal. Data was stratified by C/White and AA/Black to identify the most commonly affected genes, the most significantly differentially affected genes between the two populations, and 35 actionable genes. Genes were compared between racial subgroups (455 AA cases, 2103 C cases) for analysis of mutation types (point mutations, splice site, deletions, and amplifications) mutation load, overall survival, and mRNA expression vs. copy number variation (CNV). Data was assessed for differences, with p-value set at &amp;lt;0.05, and OncoPrints generated using tools in CBioPortal. Results: 2282 genes were differentially altered between white and black subgroups (P&amp;lt;0.05). Of the most commonly altered genes, only three were significantly different between AA and C: TP53, PIK3CA, and CSMD1 (p&amp;lt;0.001). PIK3CA missense mutations were more common in C (36.28% (C) vs 22.47% in AA). TP53 missense mutations were more prevalent in AA (40.09% vs. 28.58% in C). CSMD1 deletions, a tumor suppressor gene, were more prevalent in AA (19.78%) vs. 10.79% in C. We identified a cluster of genes at 8q24.21 (MYC, CASC8, POU51B, CCAT2) showing frequent co amplification in AA and C. For TNBC cases (18 AA cases, 52 C cases), the alteration rate of following genes was significantly between AA and C groups USF3 (27.8% in AA, 0% in C); PIK3C2B (27.8% AA, 1.9% C); SLC41A1 (27.8% AA, 3.85% C); PDHX, PRICKLE4, TOMM6 (all 27.8% AA, 5.8% C); and EHF and PRPF4B (both 27.8% AA, 7.7% C). Some of the genes with highest frequency in both groups include: TP53 (83.3% in AA, 78.9% C); PVT1 (38.9% AA, 46.2% C); CASC8, MYC, and POU51B (33.3% AA, 46.2% C). For actionable targets, PIK3CA, RAD51B, MSH6, KRAS, and NTRK3 were significantly different between AA and C (p&amp;lt;0.05). Of note, FGFR1 and NTRK1 amplifications were common in both AA and C subgroups, 17% AA/13% C and 15% AA/11% C respectively, and are potential targets for emerging therapeutics. Of note, TTN missense mutations were common in both subgroups (15.93% in AA and 18.11% in C), and may be an important marker of tumor mutational burden and predictive for immunotherapy responsiveness. ERBB2 was also commonly amplified in both groups (14% in AA and 12% in C). Survival analysis showed significantly worse outcomes for AA women with PIK3CA alterations (50% disease free for PIK3CA vs. 75% for unaltered at 75 months), while C women with PIK3CA alterations had improved outcomes (85% disease free for PIK3CA vs. 80% for unaltered at 75 months). Conclusion: Significant and diverse molecular differences exist in breast cancer between AA vs. C subgroups. Many of these molecular alterations are linked to specific treatment opportunities. The results indicate that comprehensive molecular profiling may have a major role in assessing treatments for patients with breast cancer, and that AA women may develop breast tumors with unique molecular features requiring novel treatment strategies. Citation Format: Genevra Magliocco, Roy Khalife, Anthony Magliocco. Distinct and targetable molecular features of breast cancer in African American women [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-12.

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.

Mitochondrial A10398G Alteration in Plasma Exosome of Non-small Cell Lung Cancer Patients

This study identifies A10398G alteration of mitochondrial ND3 gene in plasma exosome of 29 non-small cell lung cancer (NSCLC) patients, 31 controls and 13 pairs of tumor tissue and adjacent tissue of NSCLC patients, thereby assessing the relationship between this alteration in plasma exosome and tissue as well as the pathological characteristics of NSCLC patients. Using the PCR-RFLP method, the homoplasmy and heteroplasmy of A10398G were initially identified in mitochondrial DNA from both exosomes and lung tissues. The rate of variant 10398G in plasma exosome was 62.1% in the NSCLC group and 61.3% in the control group. However, there was no statistically significant difference in A10398G between the patient and control groups. The alteration of A10398G in plasma exosome and in tissue correlated with each other (correlation coefficient 0.69; p = 0.009). 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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 &amp;gt; 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.

Abstract IA43: Breast cancer and African ancestry

Abstract Variation in cancer incidence and outcome has well-documented correlations with racial-ethnic identity. In the United States, the possible genetic/ancestral hereditary explanations for these associations are confounded by socioeconomic, cultural, and lifestyle patterns. Differences in the breast cancer burden of African American (AA) compared to European/Caucasian (White) American (WA) women represent one of the most notable examples of disparities in oncology related to racial-ethnic identity. Elucidating the etiology of these associations is imperative in achieving the promise of the precision medicine initiatives. Population-based breast cancer mortality rates have been higher for AA compared to WA women since the early 1980s, likely reflecting declines in mortality among WA related to the advent of endocrine therapy, which is less effective in AA women because of the higher prevalence of estrogen receptor-negative disease. The increased risk of triple-negative breast cancer in AA women as well as western, sub-Saharan African women compared to WA, European, and east African women furthermore suggests that selected components of African ancestry are associated with hereditary susceptibility for specific patterns of mammary carcinogenesis. Oncologic anthropology represents a transdisciplinary field of research that can combine the expertise of population geneticists, translational oncologists, and behavioral scientists to elucidate breast cancer disparities related to racial-ethnic identity and to advance knowledge related to the pathogenesis of triple-negative breast cancer. This presentation will review associations between triple-negative/basal-like breast cancer and African ancestry, with a proposed mechanism based upon hereditary and population migration patterns. Citation Format: Lisa A. Newman. Breast cancer and African ancestry [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA43.

Black Feminist Thought: A Paradigm to Examine Breast Cancer Disparities.

African American women (AAW) are diagnosed with more aggressive forms of breast cancer when compared to White women and are more likely to die before the age of 45 years. Researchers have suggested that psychological stress could be a precursor to breast cancer. AAW experience a unique form of stress that is a result of living at the intersection of socially constructed roles of race, gender, and class (intersectionality). No studies have used the paradigm of Black Feminist Thought to examine breast cancer disparities among AAW. The purpose of this study was to examine how the intersection of race, gender, and class influences mental and physiological well-being among AAW with breast cancer. A phenomenological design was used. Ten AAW ages 45-60 years were recruited from across the United States. Semistructured interviews were conducted and analyzed using a modified Husserlian approach of descriptive phenomenology. The interviews were audiotaped and transcribed verbatim, and themes were identified using Giorgi's method. Four themes emerged: (a) altruism (selfless giving and caring for others), (b) silent strength (strength in silence while enduring life in the intersection), (c) existential invisibility (an essential, obscured presence in society), and (d) marginalization (living at the margins of society). Marginalization manifested in two forms: (a) passive marginalization (circumstances in which women removed themselves mentally or physically from societal adversity) and (b) active marginalization (circumstances in which women were overlooked, devalued, or ostracized by others). This study supports the use of Black Feminist Thought to garner knowledge that adds to the discussion of breast cancer disparities. The themes identified suggest other upstream psychosocial risk factors for the development of breast cancer in AAW that stem from life within the societal intersection.

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.

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.

Racial Disparity and Triple-Negative Breast Cancer in African-American Women: A Multifaceted Affair between Obesity, Biology, and Socioeconomic Determinants.

Triple negative breast cancer (TNBC) is a molecularly heterogeneous disease whose incidence is disproportionately higher in African American (AA) women compared to European American (EA) women. Earlier onset, more advanced stage at diagnosis, and aggressive tumor phenotype are some of the characteristic features of TNBC in women with African ethnicity in comparison to EA women, denoting one of the most significant examples of racial disparity in oncology. It is still contentious whether health disparities result in aggressive behavior of TNBC in AA women or it is indeed a molecularly distinct disease. Given the “gaps-in-knowledge” surrounding racial disparity in TNBC, this review discusses various socioeconomic factors and the genetic predispositions contributing to poor prognosis of TNBC in AA women. While socioeconomic factors may contribute to poorer survival, multiple preclinical and clinical studies suggest inherent genetic risk factors and aberrant activation of oncogenic pathways in AA TNBC. Additionally, AA women are more likely to be obese and obesity is known to drive a molecular circuitry resulting in aggressive tumor progression indicating a potential obesity-TNBC axis at work in AA women. Given the multifactorial nature of AA TNBC, a transdisciplinary approach may help bridge the disparity that exists between AA and EA TNBC.

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 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