Breast Cancer Survivors Research Articles

Adverse Obstetric Outcomes after Breast Cancer Diagnosis: An Observational Database Study in Germany.

Breast cancer may negatively affect later pregnancy and childbirth. We aimed to analyze the impact of previous breast cancer on obstetric outcomes in postdiagnosis pregnancies. Insurance claims data in Southern Germany were used to identify breast cancer (BC) survivors with at least one subsequent delivery after cancer diagnosis between 2010 and 2020. In total, 74 BC survivors were compared to 222 age-matched controls with frequency matching on their age at their postdiagnosis delivery. Endocrine therapy was associated with a significantly lower probability of birth compared to BC survivors without endocrine therapy (HR 0.36; 95% CI 0.18-0.53; p < 0.0001). The risks of preterm birth, low birth weight (LBW), gestational diabetes, hypertensive disorders, and cesarean section were not significantly increased among BC survivors compared to healthy controls. BC survivors were at an increased risk for a small-for-gestational-age (SGA) fetus (OR 3.24; 95% CI 1.17-8.97, p = 0.03). Delivery in less than 2 years after diagnosis increased the risk for SGA (OR 5.73; 95% CI 1.37-24.02, p = 0.03) and LBW (OR 4.57; 95% CI 1.32-15.87, p = 0.02). Our findings are encouraging regarding the risks of preterm delivery, gestational diabetes, hypertensive disorders, and cesarean section to women who consider pregnancy after BC. Delivery in less than 2 years after diagnosis was associated with an increased risk for SGA and LBW.

Abstract A097: Racial and ethnic disparities in risk of persistent opioid use in a diverse cohort of breast cancer survivors and matched women without cancer

Abstract Background: Persistent opioid use (POU) in breast cancer survivors after they have completed active cancer treatment is an emerging area of concern. Disparities affecting the risk of POU remains understudied in breast cancer survivors. We evaluated disparities in examining the risk with POU in breast cancers survivors in the year after active cancer treatment along with a comparison group. Methods: We assembled a cohort of 14,347 female breast cancer (BC) survivors diagnosed in 2009-2019 treated for early-stage disease (in situ, local, regional), who had at least two opioid prescriptions after one year of survivorship and 51,369 age-matched women without cancer. Data were captured from the tumor registry, electronic health records, and pharmacy databases. The primary outcome was POU defined as continuously receiving at least 90 days supplies of opioids during follow-up. Patients were followed through the date once they met POU criteria, died, disenrolled from health plan, or reached study’s end (12/31/2021), whichever came first. We used the multivariable proportional hazard regression to estimate the association [hazard ratios (HR), 95% confidence interval (CI)] between race ethnicity and POU. Results: Overall, the cohort was diverse: 7% Asian/Pacific Islander (API); 14% Black; 28% Hispanic; and 50% White women. During a median follow-up of 6.4 years, 11134 (17%) women developed POU. Patients who developed POU had longer annualized median opioid duration, especially in Black patients (175 vs. 5 days) and were prescribed stronger opioids [median maximum daily morphine milligram equivalent (62.5 vs 42.9)], compared to those who did not develop POU. In the multivariable analyses adjusted for sociodemographic characteristics, opioid type, and other pain medications, Black, Hispanic and API women were 28%, 42% and 54% less likely to develop POU compared to White women [HR (95%CI): 0.72 (0.68-0.76), 0.58 (0.55-0.61), and 0.46 (0.42-0.52), respectively]. However, Black women were only 19% less likely [HR (95%CI): 0.81(0.72-0.92)] to develop POU compared to White women in BC survivors. Also, patients with older age, Elixhauser Comorbidity Index ≥3; smoking, type of opioid (Oxycodone and hydrocodone), and who used other psychiatric and pain medications had significantly greater POU risk. Conclusion: Findings suggest that women of color were less likely to develop POU. Further studies will include further examining clinical and pharmacological management which might have played a role in the race ethnicity groups. Citation Format: Lie Hong Chen, Rulin C. Hechter, Jiaxiao Shi, Zheng Gu, Moira Brady-Rogers, Rowan T. Chlebowski, Reina Hague. Racial and ethnic disparities in risk of persistent opioid use in a diverse cohort of breast cancer survivors and matched women without 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 A097.

Abstract B052: Exploring supplement utilization patterns among African American prostate and breast cancer survivors

Abstract Introduction: The American Cancer Society (ACS) defines dietary supplements as “vitamins and minerals, herbs and other botanicals, amino acids, enzymes, and more.” ACS advises against supplement use for cancer prevention, with no suggestions for survivors. Regardless, 64-81% of cancer survivors and 14-32% of recently diagnosed cancer patients in the U.S. will begin taking supplements to improve health outcomes. Despite this prevalence, few studies have examined supplement use in African American cancer survivors, and studies that have been done include small samples. This project examines supplement use across two genders and two cancer types within a population group historically underrepresented in research. Given the dearth of research to date, this project adds novel findings to the literature and informs future research.Objectives: This study describes supplement use in African American breast and prostate cancer survivors engaged in lifestyle intervention trials, identifies potential correlates of supplement use; and compares supplement use between the two populations. Methods: Men Moving Forward (MMF) is an ongoing lifestyle intervention study for African American prostate cancer survivors. Moving Forward (MF) is a completed lifestyle intervention study that included African American breast cancer survivors. Both studies examine the efficacy of a community-based intervention that promotes adherence to the American Cancer Society Nutrition and Physical Activity Guidelines. At baseline, study participants completed interviews that included a measure of supplement use including type, dose, frequency, and reason for use. Supplements were then categorized by type (e.g., Vitamin D, Vitamin B12) and descriptive analyses were conducted to examine most common types of supplements used, potential correlates of use, and to compare the two cancer survivor groups. Results: 114 men currently enrolled in the MMF study, and 223 women enrolled in MF completed the supplement use measure. Average ages of participants are 66.2 years (SD=7.5) for MMF and 57.5 years (SD=10.1) for MF. Supplement use was common, with 64.0% of MMF participants and 65.9% of MF participants using at least one supplement at baseline. Mean number of supplements was 1.62 (SD=1.9) for MMF and 1.76 (SD=2.0) for MF. The most used supplements were the same across survivor groups: Vitamin D (37.7% MMF, 38.1% MF), Multivitamins (27.2% MMF, 32.7% MF) and Omega-3 Fatty Acids (8.8% MMF, 19.3% MF). Age, education, and income will be explored as predictors of usage. Conclusions: Supplement use was prevalent among both survivor groups, consistent with national data for adult cancer survivors who report supplement use. However, our sample had higher usage rates compared to Non-Hispanic Black US adults without cancer (39.3% of men, 56.2% of women) from the 2023 National Health Statistics Report. Understanding supplement use in cancer survivors can identify potential risks and benefits of use, enhance patient-provider communication, and improve the quality-of-care patients receive. Citation Format: Carlene Kranjac, Estefania Alonso, Margaret Tovar, Sandra Contreras, Iwalola Awoyinka, Patricia Sheean, Melinda Stolley. Exploring supplement utilization patterns among African American prostate and breast cancer survivors [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 B052.

The physical activity in cancer survivors (PACES) trial: a factorial randomized trial to optimize intervention for breast cancer survivors.

Multiple intervention strategies have been found effective for increasing physical activity among breast cancer survivors, yet most breast cancer survivors fail to meet physical activity recommendations. Optimization of interventions can facilitate real word implementation to ensure effective and efficient intervention delivery. Using a full-factorial design based on the Multiphase Optimization Strategy, 337 breast cancer survivors were randomized to receive a combination of four intervention components: (1) supervised exercise sessions, (2) facility membership, (3) Active Living Every Day (ALED), and (4) Fitbit. Moderate-to vigorous (MVPA) and light-intensity physical activity (LPA) were measured at baseline, 3 months, and 6 months with a hip-worn Actigraph GT3X+. Normal linear mixed models with separate intercepts for each subject were fit in the SAS 9.4 Mixed procedure. Participants who received supervised exercise sessions engaged in more MVPA, 153.58min/week vs. 133.0min/week (F = 3.97, p = 0.048) and LPA, 170.26min/day versus 160.98 light PA minutes/day (F = 4.67, p = 0.032), compared to participants who did not receive supervised exercise. The effects of the three other intervention components on MVPA were not significant; however, those that received ALED engaged in less LPA (F = 6.6, p = 0.011). Supervised exercise sessions resulted in significant increases in MVPA and LPA in a sample of breast cancer survivors. Of note, these sessions were provided only during the first 6 weeks of the intervention and effects remained significant at 6 months. Results of this trial could inform future implementation efforts to ensure effective and efficient delivery of physical activity programs for breast cancer survivors.

Abstract C062: Racial and ethnic disparities in risk of second primary non-breast cancer in breast cancer survivors

Abstract Purpose: Disparities in cancer outcomes are multifactorial and are attributed to differences in access to care, socioeconomic status, tumor characteristics, treatment, family history, and comorbidity burden. Studies evaluating disparities in breast cancer outcomes have mostly been restricted to Black and White patients. Additionally, whether racial and ethnic disparities affect the risk of second primary cancer in breast cancer survivors, remains under-studied. We evaluated disparities in risk of second primary non-breast cancer in a racially and ethnically diverse cohort of breast cancer survivors treated at an integrated healthcare system. Methods: This retrospective cohort study included 37,222 breast cancer patients (aged ≥18 years) diagnosed between 2008-2020 at Kaiser Permanente Southern California (KPSC). Data on tumor characteristics, cancer treatments and sociodemographic variables were extracted from KPSC’s cancer registry and electronic health records. Patients were followed electronically from breast cancer diagnosis until they developed second primary non-breast cancer, died, disenrolled from the health plan, or reached study’s end (12/31/2021), whichever occurred first. Cox proportional hazards regression was used to report the association [Hazard Ratio (95% Confidence Interval)] between race and ethnicity and second primary non-breast cancer. Results: More than half of the study cohort consisted of non-Hispanic White survivors (51.2%), followed by 20.9% Hispanic survivors, 13.9% Asian/Pacific Islander (API) survivors, 12.7% non-Hispanic Black survivors, and 1.3% survivors of other/mixed races. Overall, 55.7% and 23.9% were diagnosed with local and regional breast cancer, respectively. During a median follow-up of 5.2 years, 4.6% survivors developed second primary non-breast cancers. In the multivariable model adjusted for sociodemographic characteristics, breast tumor characteristics, and breast cancer treatments, Hispanic and API survivors were 25% and 28% less likely to develop second primary cancer compared to White survivors [adjusted HR (95%CI): 0.75 (0.65-0.86)] and 0.72 (0.61-0.86), respectively]. We did not find an increased risk in Black survivors compared to White survivors [adjusted HR (95%CI): 0.91 (0.78-1.04)]. However, factors related to higher risk of second primary non-breast cancers were older age at breast cancer diagnosis, smoking, and higher comorbidity burden. Conclusion: Interestingly, risk of second primary non-breast cancer was lower in Hispanic and API survivors compared to White survivors in this insured cohort. Next steps will include examining which lifestyle factors (e.g. less smoking), or if pharmacological management of modifiable comorbidities might have played a role in the decreased risks seen in these two racial and ethnic groups. Citation Format: Amrita Mukherjee, Zheng Gu, Lie H. Chen, Reina Haque. Racial and ethnic disparities in risk of second primary non-breast cancer in breast cancer survivors [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 C062.

Abstract B149: Investigating Disparities in Cost-Associated Barriers to Medication Adherence in Breast Cancer Survivors in the National Institutes of Health All of Us Research Program

Abstract Purpose: Medication adherence (e.g., endocrine therapy, antihypertensives) during survivorship remains suboptimal. Racial disparities in medication adherence continue to persist, yet reasons for this disparity are not fully understood. This study aimed to assess racial differences in cost-associated barriers to medication adherence. Methods: This cross-sectional analysis utilized data from the National Institutes of Health All of Us Research Program. Cohort eligibility included identifying as Black/African American or White, being at least 18 years old, and having a diagnosis of breast cancer. Survivors must have completed the Healthcare Access and Utilization survey, a validated assessment of factors impacting healthcare behaviors. Comparisons between patient characteristics (e.g., age, annual income, marital status, employment, education, etc.) and survey responses were analyzed by race using Pearson’s chi-square tests. Univariable and multivariable logistic regression models were fitted to investigate the unadjusted and adjusted associations of cost-related barriers to medication adherence and race. Results: Among the 1,840 breast cancer survivors included in this cohort, the mean age was 63.8 (standard deviation (sd) = 10.4). The majority of survivors were White (94.3%) (5.7% Black), married (58.9%) and unemployed (57.4%). The mean score for racial discrimination in healthcare was 10.3 (sd = 3.8) (range = 7 - 35). Most survivors did not report any cost-related barriers to adherence (74.9%); however, 19.5% of survivors asked their doctor for lower cost medication to save money. When compared with White survivors, a higher proportion of Black survivors reported that they could not afford prescription medicines (6.5% vs. 12.4%). In the multivariable model, no significant association by race was observed (p=0.387). Survivors who reported annual household income levels above $50k were less likely to report cost-reported barriers when compared to survivors who reported a household income of &amp;lt;$25k (p&amp;lt;0.001). Each one-point increase in perceived discrimination in healthcare increased the odds of reporting a cost-related barrier to adherence by a factor of 1.10 (95% confidence interval: 1.07, 1.13). Conclusions: Although racial differences were not noted for overall cost-related barriers, results highlight a need to understand nuanced differences in perceived cost-related barriers to adherence and how survivors navigate those differences. Further research is needed to understand providers’ roles in encouraging medication adherence and how discrimination in healthcare may serve as a barrier to adherence. Citation Format: Arnethea L. Sutton, Jian He, Lakeshia Cousin, Keesha Powell-Roach, Mandy J. Hill, Wendy Bottinor. Investigating Disparities in Cost-Associated Barriers to Medication Adherence in Breast Cancer Survivors in the National Institutes of Health All of Us Research Program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B149.

Abstract B043: Improving quality of life for Hispanic breast cancer survivors: A culturally tailored education intervention

Abstract Purpose: To evaluate the effectiveness of the Breast Cancer Education Intervention (BCEI) program in increasing knowledge and awareness of survivorship topics among survivor advocates and survivors, and to assess the impact of survivorship care plans on quality of life. Breast cancer survivorship care is crucial for improving the quality of life among survivors. Hispanic/Latino women face greater challenges and disparities in accessing survivorship care due to cultural, socioeconomic, and systemic barriers. The BCEI program, adapted from the National Cancer Institute’s model, aims to address these disparities through culturally tailored survivorship education and support. Methods: The BCEI program was piloted with a group of 8 Hispanic/Latino breast cancer survivors, in collaboration with Cancer Support Community Arizona (CSCAZ). This six-month program, created and delivered in Spanish, consisted of bi- monthly in-person sessions and phone check-ins. The educational sessions featured topics such as emotional and physical changes, lifestyle behaviors, nutrition, exercise, and psychological distress along with the introduction of a personalized survivorship care plan. These sessions provided a sense of community and emotional support with essential knowledge and understanding of the cancer journey, addressing gaps caused by language barriers in clinical settings, and the lack of Spanish language support groups. Survivor advocates underwent specialized training to effectively support the survivor participants. Data for the BCEI program was collected through pre and post survey evaluations, participant check-ins, and qualitative feedback. Survivors were paired with bilingual Patient Navigators, who connected them to resources in the community. Results: Preliminary results show a significant improvement in survivors’ knowledge and satisfaction with survivorship care. Participants demonstrated an increased awareness of the importance of survivorship care plans and showed positive changes in lifestyle behaviors. The results highlighted the program’s cultural tailoring and sense of community as key success factors. Conclusion: The Breast Cancer Education Intervention program demonstrates potential in addressing health disparities in breast cancer survivorship among Hispanic/Latino women. Building on this success, we are expanding the BCEI program to include a second iteration focused on Black and African American breast cancer survivors, who also face similar challenges and disparities. The program will be implemented in collaboration with the Coalition of Blacks Against Breast Cancer (CBBC). Citation Format: Idali Cuellar, Farhia M. Omar. Improving quality of life for Hispanic breast cancer survivors: A culturally tailored education intervention [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 B043.

Abstract B079: Impact of exercise interventions on mental and physical health outcomes among Black breast cancer survivors: A systematic review

Abstract This review aims to identify and characterize physical activity interventions developed to address mental and physical health outcomes among Black breast cancer (BC) survivors. Over 3.8 million BC survivors in the U.S. may experience physical, psychological, and functional symptoms that alter their ability to engage in physical activity. Physical activity for BC survivors is well recognized for managing these cancer-related symptoms and improving quality of life. However, physical inactivity is a public health problem among Black women with BC. Black women experience a 41% higher mortality rate and worse outcomes across all stages of BC than any other racial/ethnic group due to many factors, including psychosocial stressors and disproportionate socioeconomic disadvantages. More research is needed to understand barriers and facilitators among Black BC survivors to engage in physical activity, specifically posttreatment, and to decrease BC disparities. A systematic review was deemed appropriate, and the keywords “breast cancer AND black women AND exercise” were searched using the following databases: PubMed, Web of Science, CINAHL, and PsycINFO as of May 2024. Studies were selected based on inclusion/exclusion criteria using two reviewers. This review included 19 studies (n=8 descriptive and n=11 experimental) involving 9,691 breast cancer patients, focusing on the mental and physical health outcomes associated with physical activity among Black women. Findings indicate that Black women generally do not meet physical activity guidelines, exhibit lower physical functioning, higher body mass index (BMI), and often live with multimorbidity. Studies were categorized into physical health (BMI, lymphedema, fatigue, muscle strength, physical function, diet, and comorbidities) and mental health (quality of life, emotional well-being, social support, and negative mood). Exercise interventions demonstrated potential for improving physical activity, cardiorespiratory fitness, and muscle strength, with mixed results on quality of life (QOL) and fatigue. Significant associations were found between higher physical activity levels and QOL (n=7). Physical health-related findings included significant associations between physical activity and improved BMI (n=2), decreased lymphedema (n=2), and weight loss (n=1). However, four out of six studies focusing on BMI reported no significant associations with physical activity. An 8-week moderate-intensity exercise intervention led to marginal reductions in fatigue and slight improvements in QOL (P = 0.06) compared to baseline. A high prevalence of obesity, physical inactivity, and suboptimal adherence to physical activity among Black BC survivors from this systematic review highlight the need to develop culturally tailored physical activity interventions to address this public health issue. Specifically, more studies are needed to incorporate more goal setting, motivational techniques, and access to physical/psychosocial resources that address barriers and enhance facilitators to long-term exercise adherence. Citation Format: Sabrina M. Guillen, Lakeshia Cousin. Impact of exercise interventions on mental and physical health outcomes among Black breast cancer survivors: A systematic review [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B079.

Abstract C036: Prevalence of and racial/ethnic differences in hearing and balance problems in a multiethnic cohort of patients with breast cancer

Abstract Background: Patients with breast cancer face many health issues during the cancer care continuum. Chemotherapy and radiotherapy can cause hearing and balance problems, e.g., tinnitus, hearing loss, and vertigo or persistent dizziness, negatively affecting patients’ health outcomes and quality of life. Hearing loss is more prevalent among cancer survivors than in the general population. However, little attention has been paid to tinnitus, hearing loss, and vertigo specifically among breast cancer patients and survivors, and it is unclear whether these symptoms vary across racial/ethnic groups. Methods: Between July and September 2023, we surveyed patients enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort about whether they experienced tinnitus, hearing loss, and/or vertigo. Racial/ethnic groups included Asian or Pacific Islander (API), Black, Hispanic, and White. To examine racial/ethnic differences in hearing and balance problems, we fit separate multivariable logistic regression models, controlling for sociodemographic and clinicopathologic factors. Adjusted odds ratios (AOR) and 95% CIs were calculated. Results: Of 1,462 patients, the mean age was 54.2 years (SD 11.4), with a median duration from diagnosis to survey of 8.2 years (IQR: 5.0-12.4). Most were White (69.8%), followed by Black (22.7%), API (3.8%), and Hispanic (3.7%); and 46.0% received chemotherapy. Overall, 15.1%, 13.6%, and 7.7% reported experiencing tinnitus, hearing loss, and vertigo, respectively. Similar prevalences of these symptoms were observed among survivors who had received chemotherapy. By race/ethnicity, 16.1% of Black patients reported experiencing tinnitus compared to 15.6% of White, 9.4% of Hispanic, and 3.8% of API patients (P=.050). White patients reported a higher proportion of hearing loss (15.5%) than Hispanic (14.8%), Black (8.0%), and API (7.8%) patients (P=.004). A higher percentage of Black patients (13.2%) reported experiencing vertigo than White (6.5%), Hispanic (5.7%), and API (1.9%) patients (P=.001). After adjusting for demographic and clinical characteristics, Black patients had lower odds of experiencing hearing loss than White patients (AOR 0.39, 95% CI: 0.20-0.75). Compared with White patients, Black patients had greater odds of experiencing vertigo (AOR 1.80, 95% CI: 1.01-3.21). Due to limited power, we did not observe statistically significant differences in vertigo or hearing loss between API or Hispanic survivors and White survivors and in tinnitus across racial/ethnic groups. Older age and longer duration from diagnosis to survey were associated with greater odds of tinnitus or hearing loss. Conclusions: In this multiethnic cohort, hearing and balance problems were prevalent and varied by race/ethnicity among breast cancer patients. Our findings suggest that oncology programs should consider routine screening for these symptoms, encourage patient-provider discussion to identify unmet needs, and address racial/ethnic disparities to improve hearing and balance-related quality of life of breast cancer survivors. Citation Format: Jincong Q. Freeman, Fangyuan Zhao, Wenji Guo, Rita Nanda, Olufunmilayo I. Olopade, Jayant M. Pinto, Megan J. Huisingh-Scheetz, Dezheng Huo. Prevalence of and racial/ethnic differences in hearing and balance problems in a multiethnic cohort of patients with breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C036.

Abstract B143: Associations between the food environment and food insecurity on fruit and vegetable intake among urban-dwelling Latina breast cancer survivors participating in the Mi Vida Saludable trial

Abstract Socioeconomic disparities prevalent in Hispanic populations may cause inequities in cancer outcomes and risk factors. We explored the association of access to healthy foods (AHF) and food insecurity (FI) with changes in fruit and vegetable (FV) intake in Latina breast cancer (BC) survivors living in New York City who participated in the Mi Vida Saludable trial. Mi Vida Saludable was a 2x2 factorial trial (n=167) that tested the effects of an in-person and/or eHealth intervention on FV intake and physical activity (PA). Main study results showed only the in-person intervention had modest increases in FV intake. Eligibility criteria included being female, self-identifying as Latina/Hispanic, ³18 years old, history of stage 0-III BC, &amp;gt;3 months post-treatment, &amp;lt;5 daily serving of FV and/or &amp;lt;150 minutes/week of moderate-vigorous PA. FV intake was assessed via 3 24-hour diet recalls at baseline and 12 months. AHF was from a modified validated Access to Healthy Food scale. FI was assessed via questions about eating less or going hungry due to lack of money. Generalized estimating equations examined whether baseline AHF and FI were associated with change in daily FV intake, adjusting for baseline age, marital status, education, and study arm. Three-way interaction terms (AHF or FI with time and study arm) were included to test if associations of AHF and FI with change in FV intake varied by intervention arms. FV intake was log-transformed due to a non-normal distribution; percent changes from baseline were described. AHF was measured in 86 women with 58% and 42% reporting low-medium and high access, respectively. Women with high AHF were more likely to be older (59 vs. 53 years, p=.002) and scored lower on a 5-point acculturation scale (higher score suggests higher acculturation, 1.8 vs. 2.1, p=.01). FI, measured in 157 participant, was prevalent in 23% of women. Women with FI were more likely to be single (44% vs. 16%, p=.003), renting (100% vs. 86%, p=.02), and have higher mean BMI (31 vs. 29 kg/m2, p=.02). 3-way interactions were not statistically significant, though analyses were likely underpowered. In the control group, the adjusted daily FV intake decreased by 79% (p=.01) from baseline to 12 months for women with low-medium AHF and by 49% (p=.10) for those with high AHF; similarly, daily FV intake decreased by 64% (p=.01) for women with FI and by 58% (p=.01) for women without FI. Most Latina BC survivors in New York City who participated in a 12-month diet and PA intervention trial had low-medium AHF at baseline; nearly 1/4 had FI. Associations of AHF or FI with changes in FV intake did not vary significantly by study arm, although sample sizes across strata were small. In the control arm, women with low-medium AHF and FI had larger decreases in FV intake after 12 months. Future dietary intervention studies in Latina BC survivors, and other underserved or under-resourced populations, should account for AHF and FI in the study design, and develop strategies to connect people to healthy food resources. Citation Format: Zachary O. Kadro, Eileen Rillamas-Sun, Blake Langley, Pam Koch, Isobel Contento, Ann Ogden Gaffney, Allison Meisner, Heather Greenlee. Associations between the food environment and food insecurity on fruit and vegetable intake among urban-dwelling Latina breast cancer survivors participating in the Mi Vida Saludable trial [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 B143.

Abstract A068: Association of perceived discrimination on patient-physician communication and quality of life among breast cancer survivors

Abstract Background: Discrimination adversely affects mental and physical health. Using mediation analysis, we explore whether patient-provider communication mediates the relationship between perceived discrimination and health-related quality of life among early-stage breast cancer survivors. Methods: We analyzed surveys from 303 early-stage breast cancer survivors. Discrimination was measured with the Experiences of Everyday Discrimination Scale which assesses the frequency of perceived discrimination (range: 1/almost every day – 6/never). Patient-provider communication was captured with the Patient and Physician Peer Assessment (range: 1/poor-5/excellent). Mental and physical quality of life was captured with the SF-12 health survey (range: 1/poor - 100/excellent). We used descriptive analysis to identify factors associated with perceived discrimination and adjusted regression to examine the association of perceived discrimination on patient-provider communication and quality of life scores. We also performed a mediation analysis to determine the extent to which patient-provider communication mediates the relationship between perceived discrimination and mental and physical health scores. Results: Overall, 58% of participants reported facing some form of discrimination. When they were asked to identify the primary source of discrimination that they encountered, gender and race emerged as the two most common. Stratified by race, White respondents reported feeling most discriminated against due to their gender, followed by education/income, weight, race, and physical appearance. Conversely, Black patients predominantly identified race as the primary reason for discrimination, with physical appearance, gender, weight, national origin, and education/income following in descending order of frequency. Less frequent perceived discrimination was associated with a 2.77 (95%CI: 0.88 to 4.65, p = 0.004) higher average mental health score and 2.18 (95%CI: 0.33 to 4.04, p = 0.02) physical health score, and 0.18 (95%CI: 0.06 to 0.31, p = 0.003) higher patient-provider communication score. In both unadjusted and adjusted mediation analyses, we observed a very small and statistically insignificant “indirect effect”, indicating there is no evidence for the existence of mediation effect. Conclusion: Perceived discrimination among breast cancer survivors was associated with poorer patient-provider communication and lower mental and physical health scores. However, patient-provider communication does not serve as a mediator for the adverse impact of discrimination on self-reported mental and physical health. This suggests that mitigating the effects of discrimination requires collective efforts of all stakeholders within the healthcare system, rather than solely relying on healthcare providers. Citation Format: Freddie Yang, Ilana Graetz, Janeane Anderson, Xin Hu. Association of perceived discrimination on patient-physician communication and quality of life among breast cancer survivors [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 A068.

Abstract C032: Take Charge during Treatment: A randomized exercise trial for breast cancer patients

Abstract Introduction. Breast cancer (BC) is the most frequently diagnosed cancer with over 4 million survivors living in the United States. Recent treatment (Tx) advances such as in targeted (e.g. anti-HER2), systemic (e.g. anthracyclines), or combined therapies have supported the increased survival rates but continue to present adverse effects. Cardiotoxicity, which may be induced during or after Tx, is the second highest cause of mortality in BC survivors and also negatively impacts quality of life (QoL). Black/African American (B/AA) patients have higher rates of this effect along with a higher incidence of aggressive BC types. Limited research has targeted vascular function as an area of focus in the cardio-oncology field. Methods. The Discovery and Elimination of Cardio-Oncology Disparities Toward Equity in the Heartland Center is examining how anti-cancer treatments impact vascular function, the potential mitigating effects of exercise and how socioenvironmental factors moderate these effects. The Take Charge during Treatment randomized trial within this Center is testing the feasibility and acceptability of an exercise during treatment program for B/AA and non-Hispanic White (NHW) women newly diagnosed with BC. The study also examines and compares the effects of exercise on VO2 peak and QoL in participants. The 16-week intervention promotes adherence to the American College of Sports Medicine exercise guidelines for cancer survivors and is guided by a certified exercise trainer. To evaluate the intervention, patient's complete surveys including the FACT-B for QoL, a VO2 peak assessment, physical assessments, and anthropometry measurements at baseline (before BC Tx), after the 16-week program, and at a 12-month timepoint. Socioenvironmental factors are examined using participant addresses. Results. To date, 1330 patients were assessed for eligibility, 60 consented, and 49 enrolled and randomized. Herein, we present data on 45 of the 49 (35 NHW, 10 B/AA). The mean age of participants is 52 years (SD=12), most were diagnosed with Stage I or II BC, and they have varied education and income levels. Baseline (pre-treatment) differences are noted by racial group for QoL (Total score – 88 (SD=9) for NHW vs 74 (SD=29) for B/AA; Physical function – 25 (SD=3) for NHW vs 22 (SD=5) for B/AA; Functional – 21 (SD=4) for NHW vs 18 (SD=8) for B/AA), VO2 peak (22 (SD=5) for NHW vs 17 (SD=6) for B/AA), and obesity (NHW – 30%, B/AA – 70%). Cognitive function, pain interference, social isolation and perceived stress were similar across groups. B/AA women were more likely to report living in a highly redlined area (50%) compared to NHW women (3%), with lower percent tree canopy (13% vs 24%) and lower perceived social cohesion (15 vs 19). Reports of discrimination and resilience were similar across groups. Conclusions. Preliminary baseline results suggest that B/AA women enter BC Tx more vulnerable to developing QoL challenges and cardiotoxicity. Neighborhood environmental factors will be further examined to understand the association with adverse outcomes. Citation Format: Estefania Alonso, Melinda Stolley, Kirsten Beyer, Alison Kriegel, Shane Phillips, Matt Durand, Michael E. Widlansky, Amanda L. Kong, Kent Hoskins, Andreas Beyer. Take Charge during Treatment: A randomized exercise trial for breast cancer patients [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 C032.

Abstract B159: Could cultural adaptation of nutrition education improve survivorship outcomes among African American/black women with reproductive cancers?

Abstract Background/Significance: Cancer epidemiological data suggest African American/Black women experience the lowest relative survival rate for reproductive cancers compared to other racial/ethnic groups, despite these cancers being most prevalent among White women. Findings from recent studies suggest contributors to these adverse outcomes include socio-cultural and lifestyle factors, including diet, physical activity, and smoking. As an intervention strategy, it has been recommended dietary changes may enhance overall health and survival among AA/B women with reproductive cancers. However, inequalities in access to nutritious foods and culturally and linguistically appropriate nutrition information may serve as an impediment to making healthy food choices. Methods: An environmental scan was conducted by reviewing peer reviewed literature and online nutrition information sources to identify available, easily accessible, culturally adapted nutrition education for AA/B reproductive cancer survivors. Focus groups with breast and endometrial cancer survivors will ensure to inform the development of culturally targeted nutritional programs for cancer survivors. Results: Our literature review reveals a growing body of evidence indicating the potential benefits of culturally adapted dietary modifications post-diagnosis for African American/Black women with reproductive cancers, suggesting improved outcomes. Notably, the review underscores the critical role of culturally relevant nutrition information, disseminated by culturally affiliated individuals, with technology playing a pivotal role in accessibility facilitation. This research study aims to clarify the barriers and facilitators encountered by African American/Black women in accessing culturally and linguistically appropriate information, thereby enhancing understanding of factors influencing cancer survivorship outcomes. Conclusion and Implications/Discussion: Seeking to improve the survivorship of reproductive cancers in AA/B women through enhanced dietary patterns, this study merges insights from a systematic literature review and an environmental scan. Offering a comprehensive understanding of available nutritional information for AA/B women. Recognizing both strengths and gaps in existing resources, our research serves as a foundation for developing or adapting culturally specific nutritional programs to improve survivorship outcomes for reproductive cancers. Anticipating that our findings will contribute to understanding barriers and facilitators in accessing culturally and linguistically appropriate information, we aim to enhance cancer survivorship outcomes for AA/B women. Acknowledgement of Funding: The project described was supported by Award Number CHERC-MSI-21-166-01-CHERC-MSI. from the American Cancer Society (ACS). The content is solely the responsibility of the authors and does not necessarily represent the official views of the ACS. Citation Format: Desiree Rivers, Zakirah L Abdul-Hameed. Could cultural adaptation of nutrition education improve survivorship outcomes among African American/black women with reproductive cancers? [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 B159.

Abstract B002: Cancer health equity and research advocacy program among immigrant communities

Abstract Introduction: In an effort to ensure an all-inclusive initiative that would close the disparity gap among the immigrant communities in Florida, we developed a pilot project under the Inclusive Cancer Care Research Equity (iCCaRE) for Black Men Consortium with generous support from the Mayo Clinic Comprehensive Cancer Center (MCCCC). The objective is to train cancer advocates to engage their communities and develop and implement cancer prevention and screening navigation programs. The central hypothesis for this program is that community-driven cancer advocacy will significantly improve cancer awareness, knowledge, prevention, risk reduction, screening uptake, and early detection among Black immigrants. Methods: We collaborated with immigrant communities’ leaders to brainstorm on the current state of healthcare access and disparities experienced by Black immigrants and to set program and research priorities through listening sessions. Cancer advocates were trained to engage their communities to (1) develop and implement cancer risk reduction and education programs using train-the-trainer approach, (2) mobilize the resources within the community for cancer health promotion, prevention, and screening strategies, (3) partner with key stakeholders to accomplish targeted objectives; (4) raise funds to support advocacy activities; and (5) develop and successfully organize community-centered programs. Results: We are currently working with 10 Black immigrant organizations, including immigrant churches across different ethnicities, including Nigeria, Ghana, Cameroon, Liberia, South Africa, Haiti, Jamaica, and across different cities in the United States. Eighteen community cancer advocates, including breast and prostate cancer survivors, caregivers, and community influencers, were trained to engage the immigrant communities in cancer risk reduction and research in Florida using multiple channels, including in-person community programs and online engagement approaches. We have engaged 720 immigrants in cancer risk reduction education and the need to participate in research during advocate-led in-person community outreaches. We currently have 26 immigrants who have volunteered in the Mayo Clinic Community Research Registry. The program is ongoing, and we anticipate that more than 750 will be engaged, and 100 will volunteer to be registered in the Mayo Clinic Community Research Registry. Conclusion: Advocate-led advocacy in immigrant communities will provide evidence for compelling arguments about the feasibility and availability of the Black immigrant population for robust and sustainable research and program engagements to eliminate disparity and advance cancer health equity. Citation Format: Opeyemi O. Bolajoko, Caleb Ramirez, Shannon Pressey, Noreen A. Stephenson, Vinessa A. Gordon, Binta Onyibe, Kingsley Efe, Austin Okaiwele, Mubo Oloruntobo, Brittany M. Norris, Folakemi T. Odedina. Cancer health equity and research advocacy program among immigrant communities [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 B002.

Abstract A124: An examination of trust in biomedical research among the Witness Project’s community health workers

Abstract The Witness Project® (NWP) was established in 1991 and has maintained its status as one of NCI’s Evidence Based Cancer Control Program (EBCCP) for decades. NWP is a self-sustaining, culturally competent, grass roots level community-based intervention program that uses breast and cervical cancer survivors known as Witness Role Models and Community Health Workers (CHW). With many locations in unserved communities throughout the United States, NWP provides relevant cancer related education and navigates minority residents through successful completions of cancer related screenings. Health disparities are a longstanding problem due in part to underrepresentations of historically underserved populations in research. Increasing minority and underserved individuals’ participation in research has great disparity mitigating potential. A team of newly trained Black and Hispanic NWP CHW (n=25) will be created as part of a larger multiphase preliminary pilot study designed to increase diverse individuals’ participations in research within Roswell Park’s catchment area. Design, Measures, Setting, and Participants. The primary objective of this cross-sectional study is to assess Black and Hispanic CHW’s trust in biomedical research. Secondary objectives are to explore the feasibility and acceptability of 1) NWP CHW training, and 2) an informal educational intervention about the importance of minority representations in research and it potential to mitigate health disparities. CMWs will complete the Perceptions of Research Trustworthiness (PoRT) scale to evaluate their trust and distrust in biomedical research before and after viewing the informal educational intervention. Preliminary Results and Planned Analyses At the time of abstract submission nineteen CMWs have completed their NWP and CITI training and PoRT assessments. Fifteen CHWs were Black (78.9%) and four Hispanic (21.1%). When all 25 CMWs are trained we will calculate overall and individual item Trust and Distrust subscale scores. Regarding feasibility and acceptability of the CHW training and the informal education intervention, semi structured interviews will provide qualitative feedback and independent samples t-test will be used to compare pre-and post-informal education intervention PoRT scores. Citation Format: Julia Devonish, Martin Mahoney, Elizabeth Bouchard, Cassy Dauphin, Abshiro Ali, Veronica Meadows, Jomary Colon, Dee Johnson. An examination of trust in biomedical research among the Witness Project’s community health workers [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 A124.

Abstract IA053: Grateful strides toward spiritual well-being and exercise self-efficacy for Black breast cancer survivors

Abstract Background: Breast cancer (BC) survivorship care poses significant psychosocial and physical challenges, with survivors experiencing stress, inflammation, and poor lifestyle behaviors that impact their well-being and health-related quality of life. Black women with BC, who often experience higher rates of metabolic syndrome and related health complications, are particularly vulnerable. Black women with BC face unique health disparities, including a higher prevalence of metabolic syndrome, contributing to poorer prognoses. Spiritual well-being, particularly through practices such as gratitude journaling, has shown potential in improving psychological and physiological outcomes, but its effectiveness in Black BC survivors remains underexplored. Purpose: This pilot study aimed to assess the feasibility, acceptability, and preliminary efficacy of a gratitude journaling intervention tailored for Black BC survivors to enhance spiritual well-being, exercise self-efficacy, and mitigate inflammatory biomarkers. Methods: A two-group parallel random-assignment experimental design was used to compare a gratitude journaling intervention group with a general memory journaling control group over eight weeks. Twenty-six Black women with a history of BC in the community were enrolled and randomized. Surveys and biospecimen collections were conducted at baseline and post-intervention. Psychosocial measures included dispositional gratitude, spiritual well-being, perceived stress, Superwoman Schema dimensions, and exercise self-efficacy. Inflammatory biomarkers (TNF-α, IL-6, GDF15, CRP) were also measured. Results: Feasibility analysis indicated high recruitment (95%) and baseline assessment completion (100%), with 73% completing baseline and post-intervention assessments. Participants reported high satisfaction with the intervention. Significant improvement in spiritual well-being (p=0.014, ES=0.57) was observed in the intervention group, alongside large effect sizes in exercise self-efficacy (p=0.10, ES=0.391). Changes in dispositional gratitude, perceived stress, and Superwoman Schema dimensions were not statistically significant, although trends suggested positive impacts. Inflammatory biomarkers showed mixed results, with some indicating potential improvements but no significant differences overall. Discussion: The study highlighted the importance of culturally tailored interventions for Black BC survivors, demonstrating significant benefits in spiritual well-being and potential improvements in exercise self-efficacy. While changes in dispositional gratitude and perceived stress were not significant, the intervention group showed positive trends, suggesting potential benefits. Although the impact on inflammatory biomarkers was inconclusive, the study underscores the holistic approach of gratitude interventions in promoting overall well-being among Black BC survivors. Future research should focus on larger, randomized controlled trials to further elucidate the efficacy of gratitude-based interventions in this population. Citation Format: Lakeshia Cousin, Dejana Braithwaite, Stephen Anton, Zhongyue Zhang, Ji-Hyun Lee, Christiaan Leeuwenburgh, Debra Lyon. Grateful strides toward spiritual well-being and exercise self-efficacy for Black breast cancer survivors [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 IA053.

Abstract A120: Cancer screening uptake among Hispanic survivors of adolescent and young adult cancer

Abstract Introduction: Advances in treatment have significantly improved the survival rates of adolescent and young adult (AYA) cancer patients, with a five-year survival rate reaching 86%. However, these survivors remain at increased risk for developing secondary cancers later in life. Racial and ethnic minority groups, such as Hispanics, often experience significant healthcare disparities, including lower cancer screening rates. Cancer survivors, particularly those who are Hispanic and diagnosed as AYAs, may face unique barriers in adhering to recommended cancer screening guidelines. This study examines the uptake rates of colon, breast, and cervical cancer screenings among Hispanic survivors of AYA cancer compared to their age- and sex-matched Hispanic non-cancer controls. Methods: The National Health Interview Survey data (years 2000 - 2021) [R1] were analyzed to identify Hispanic survivors of AYA cancer and Hispanic age- and sex-matched non-cancer controls. Data on cancer screening, including whether patients were up- to-date and ever screened for colon, breast, and cervical cancers, were assessed. The US Preventive Services Task Force recommendations were used to determine whether survivors were up-to-date for the cancer screening tests. The sample included 92 colon cancer survivors, 113 breast cancer survivors, and 313 cervical cancer survivors, matched with 920, 1130, and 3130 controls, respectively. Weighted percentages and odds ratios (OR) were calculated, adjusting for age at survey, sex, marital status, education, poverty status, and insurance. Results: Colon cancer screening uptake was significantly higher among survivors, with 26.1% up-to-date versus 11.5% of controls (OR=2.49, 95% CI=1.17-5.30, p=0.019). For breast cancer, 14.6% of survivors were up-to-date compared to 5.1% of controls [R2] (OR=2.51, 95% CI=1.33-4.72, p=0.005), and 82.6% of survivors were ever screened versus 38.7% of controls (OR=7.41, 95% CI=4.43-12.41, p&amp;lt;0.001). Cervical cancer screening showed the most pronounced difference, with 40.6% of survivors up-to-date compared to 19.0% of controls (OR=3.36, 95% CI=2.43- 4.65, p&amp;lt;0.001), and 71.2% of survivors ever screened compared to 28.6% of controls (OR=14.16, 95% CI=8.56-23.40, p&amp;lt;0.001). Conclusion: Hispanic AYA cancer survivors exhibit significantly higher cancer screening rates compared to matched controls. Despite these positive findings, the overall low screening rates highlight the need for targeted interventions to ensure that all survivors adhere to recommended screening guidelines. Enhancing access to healthcare and ensuring continuity of care are critical steps toward reducing disparities and improving health outcomes for this vulnerable population. Citation Format: Eunju Choi, Amy M. Berkman, Clark R Andersen, Michael E. Roth. Cancer screening uptake among Hispanic survivors of adolescent and young adult 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 A120.

Abstract B134: Socioeconomic, social, and clinical factors associated with loneliness among African American breast cancer survivors

Abstract Importance: Social connections are an important driver of cancer risk and outcomes and animal studies have shown that social isolation is important to breast cancer initiation and progression. However, limited empirical data are available on perceived loneliness among patient groups who are at increased risk for breast cancer morbidity and mortality. Objectives: The purpose of this study was to characterize the nature and distribution of loneliness in a sample of African American breast cancer patients and identify clinical and social factors having significant independent associations with perceived loneliness among these survivors. Methods: The study included African American breast cancer patients (n=110) who provided self-reported data on loneliness as part of a participating in a prospective observational study and randomized trial that examined stress reactivity using the Trier Social Stress Test. Loneliness was measured using a short form of the Loneliness Scale; scores were dichotomized using the median split to characterize patients as experiencing high versus low levels of loneliness. Multivariate logistic regression analysis was used to identify factors having significant associations with loneliness. Results: Over half (51.82%) of patients reported experiencing high levels of loneliness. Clinical and social factors that had significant independent associations with loneliness included marital status (OR=2.853, CI=1.066, 7.635, p=0.037), financial strain (OR=3.240, CI=1.114, 9.422, p=0.031), and the number of co-morbidities. Compared to patients who did not have any co- morbidities, those who had one, two, or three or more comorbidities had seven (CI=1.066, 40.645; p=0.029), eleven (CI=1.858, 66.716, p=0.008), and eleven (CI=1.757, 65.244; p=0.010) times the odds, respectively, of experiencing loneliness. Conclusions and Relevance: Many African American breast cancer patients in this study reported high levels of loneliness. Greater efforts are needed to identify patients who may benefit from interventions that enhance social connections, especially if they are married, experiencing financial strain, and have co-morbid conditions. Citation Format: Kelsie Campbell, Fatimata Sanogo, Trista Beard, Melanie Jefferson, Bodhour Sahlia, Chanita Hughes Halbert. Socioeconomic, social, and clinical factors associated with loneliness among African American breast cancer survivors [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 B134.

Abstract C046: Second primary cancer risks among Asian American, Native Hawaiian, and other Pacific Islander breast cancer survivors in the United States by race and ethnogeographic region

Abstract Background: Second primary cancer (SPC) risk differs by race and ethnicity among breast cancer survivors, yet Asian American (AA), Native Hawaiian, and other Pacific Islander (NHPI) women are often aggregated into a singular group despite being distinct races with varying cancer burden. Evaluation of SPC risk among breast cancer survivors disaggregated by race (AA, NHPI) and ethnogeographic region (East AA, South AA, Southeast AA) is needed. Methods: We identified 55,028 AA and 5,455 NHPI women diagnosed with a first local/regional unilateral breast cancer between 2000-2019 (followed through 2020) and survived ≥1 year in the Surveillance, Epidemiology, and End Results (SEER) database. SPC was defined as an invasive primary cancer diagnosed ≥12 months after the first primary breast cancer and grouped as 1) all second primary cancer sites combined (excluding ipsilateral breast), 2) all second primary non-breast cancer sites combined, and 3) site-specific second cancers. Risk of SPC was examined by race and ethnogeographic regions categorized as East AA (Chinese, Japanese, Korean), South AA (Asian Indian, Pakistani), Southeast AA (Filipina, Hmong, Kampuchean, Laotian, Thai, Vietnamese), and NHPI (Micronesian including Chamoru and Guamanian; Melanesian including New Guinean, Fijian; Polynesian including Native Hawaiian, Tongan, Sāmoan, Tahitian). We used a competing risk approach for cumulative incidence and subdistribution hazard ratios (SHRs) adjusted for age, year, and clinical characteristics of the index breast cancer (stage, histology, estrogen receptor status, radiation, and chemotherapy). Results: Over a median follow-up of 6.13 years, 3,813 AA women (East AA=1,922, South AA=312, Southeast AA=1,579) and 498 NHPI women developed a SPC. Overall, NHPI women had an increased risk of developing a SPC compared with East AA women (SHR=1.33, 95%CI=1.21-1.47), which was largely driven by a higher risk of contralateral breast, uterine, and ovarian cancer. While South AA women had a lower risk of overall SPC (SHR=0.85, 95%CI=0.75-0.95) compared with East AA women, this was driven by a decreased risk for lung/bronchus (SHR=0.50, 95%CI=0.32-0.80) and colorectal cancer (SHR=0.36, 95%CI=0.21-0.62). Risk of SPC was similar among Southeast AA women compared with East AA women (SHR=0.99, 95%CI=0.93-1.06), but Southeast AA women had a lower risk of digestive system cancer (SHR=0.76, 95%CI=0.65-0.88), and higher risk of uterine (SHR=1.29, 95%CI=1.02-1.63) and thyroid cancer (SHR=1.97, 95%CI=1.47-2.65). NHPI breast cancer survivors had the highest absolute burden of SPC risk with approximately 1 in 10 NHPI women developing a SPC within 10-years of the index breast cancer (10-year cumulative incidence: 7.66% for East AA, 6.25% for South AA, 7.26% for Southeast AA women). Conclusion: Second cancer risks differed between AA and NHPI breast cancer survivors with the greatest risks among NHPI women. Future research is needed to identify factors associated with higher second cancer risks and tailored interventions to promote health equity. Citation Format: Cody Ramin, Jessica P Li, Kekoa Taparra, Geetanjali D Datta, Lene HS Veiga, Gretchen L Gierach, Robert Haile, Amy Berrington de Gonzalez, Jacqueline B Vo. Second primary cancer risks among Asian American, Native Hawaiian, and other Pacific Islander breast cancer survivors in the United States by race and ethnogeographic region [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C046.

Abstract A089: Intersecting burdens: The role of social barriers and perceived stress in moderating cortisol reactivity among African American breast cancer survivors

Abstract Background: Disparities in breast cancer morbidity and mortality persist in African Americans. Social determinants and their subsequent effect on stress reactivity may impact the biological mechanisms associated with the onset and progression of cancer. However, stress reactivity has not been examined specifically among African American breast cancer survivors. Objective: To evaluate within-subject variation in stress reactivity among African American breast cancer survivors and determine whether this reactivity is influenced by social stressors, such as financial strain and social isolation, known to be associated with cancer outcomes. Methods: We conducted a laboratory intervention study using the Trier Social Stress Test on African American breast cancer survivors. We measured stress reactivity using salivary cortisol levels; socioeconomic, social, and psychological stressors were estimated by self-report. We performed multi-level random effect repeated-measures linear regression models to estimate within-subject changes in cortisol levels. We tested the moderating effects of social factors and cumulative social stressors on reactivity outcomes. Results: Sixty African American breast cancer survivors were included in the study. There were significant increases in mean cortisol levels at 30 minutes (beta=0.054, 95%CI=0.026, 0.082; p&amp;lt;0.001) and 40 minutes (beta=0.040, 95% CI=0.015, 0.065; p=.002) post-stress during the recovery period. We identified significant interactions between time and social stressors on cortisol levels for financial strain (χ2/df=15.83/4, p=.003), social isolation (χ2/df=9.67/4, p=.04), negative life events (χ2/df=12.75/4, p=.01), perceived stress (χ2/df=11.93/4, p=.02), and cumulative index of social stressors (χ2/df=11.14/4, p=.03). Conclusion: Social risk factors moderate the effects of stressors on cortisol reactivity among African American breast cancer survivors. There is a need to understand the lived experiences of Black women and develop interventions that mitigate the impact of social stressors on stress responses. Citation Format: Dr. Fatimata Sanogo, Dr. Junhan Cho, Dr. Trista Beard, Dr. Chanita Hughes Halbert. Intersecting burdens: The role of social barriers and perceived stress in moderating cortisol reactivity among African American breast cancer survivors [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 A089.