Cancer Disparities Research Articles

Abstract B162: Building skills for authentic researcher-community collaborations: A curriculum

Abstract Background: Cancer incidence and mortality rates are declining in the population overall, but certain groups continue to be at increased risk of developing or dying from cancer. Cancer disparities are complex, and the root causes are a mix of genetic, behavioral, and socioeconomic factors. Many different perspectives are needed to understand cancer disparities and create better solutions. Methods: To aid community members and biomedical researchers in building skills for authentic transdisciplinary collaborations, we developed a pilot 9-month curriculum for community members (community scholars) and early/middle career basic science and clinical fellows (research scholars) to learn about cancer disparities, factors influencing disparities, communication with diverse audiences, and how to understand different perspectives. Research and community scholars are grouped to design a project that allows them to practice new skills and apply new learning. This curriculum is offered through the Medical College of Wisconsin and is part of the Community and Cancer Science Network which uses a transdisciplinary approach to address cancer disparities. To assess impact of the curriculum, scholars completed assessments throughout the program. At two points, scholars were asked to reflect upon how the curriculum impacted their understanding of cancer disparities, social determinants of health, cancer research, and if the curriculum influenced their work. Scholars also provided a self- assessment of how they perceived collaboration and their role at the start and completion of the curriculum. At the final assessment scholars answered qualitative questions to reflect on their understanding of disparities, relationships and partnerships, and developing new perspectives. Results: Three cohorts of scholars (n=32 enrolled; n=27 completed) participated in the curriculum which included didactic and experiential learning. Assessment data showed scholars were eager for collaboration but somewhat unprepared for associated challenges. However, they developed an appreciation for the time and skills needed to build partnerships with those whose perspectives differ. Importantly, scholars reported that they became more comfortable with acknowledging general gaps in their knowledge and understanding after participating in the curriculum. Scholars reported a modest increase in applying knowledge outside of the program, sharing the information with others, and identifying ways community and research can collaborate to address cancer disparities. Qualitative responses highlighted scholars’ interest in continued engagement, a willingness to reflect on their own biases, and an eagerness to engage other disciplines. Discussion: The skills required to collaborate with those from different perspectives and disciplines need to be mentored and developed. This program is successful in preparing researchers and community members in understanding the complexities of transdisciplinary collaboration and preparing them to establish authentic partnerships. Citation Format: Tobi Cawthra, Kristen Gardner-Volle, Laura Pinsoneault, Alexis Krause, Jessica Olson, Deborah Thomas, Carol Williams, Melinda Stolley. Building skills for authentic researcher-community collaborations: A curriculum [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 B162.

Abstract B163: Researcher, Clinician, and Community Focus Groups to Inform an Understanding of Cancer Disparities in the Transgender and Gender Diverse

Abstract Background: A growing number of Americans identify as transgender or gender diverse (TGD). This population experiences barriers and challenges across to socio-ecological spectrum including healthcare. Simultaneously, there is limited data on cancer in TGD persons. While advances in data-capture provide promising opportunity for future research, a comprehensive understanding of cancer disparities for the TGD community is needed to inform clinically and socially relevant research questions – particularly on cancer prevention, risk, screening, and treatment. Our study aimed to develop a transdisciplinary (TDS) academic-community team to create a shared understanding of factors associated with cancer disparities in the TGD population with aid from discussion sessions and interviews with researchers, clinicians, and community members. Methods: The TDS team engaged in literature reviews and discussion to ground their collective understanding. The team also conducted focus groups and interviews with researchers, clinicians, and community members (N=55) to enrich the team’s understanding of factors associated with cancer disparities. Data were summarized and thematized and groups were compared. Results: Community organizations/members noted systemic issues such as insufficient training of healthcare providers and staff, individual mistrust, and not believing they would live long enough to worry about cancer development. Providers identified personal uncertainty working with TGD patients, knowledge of appropriate recommendations for cancer screening, and individual risk behaviors (i.e. tobacco and alcohol use) as potential causes for cancer disparities. Researchers indicated they had not considered including TGD individuals as a specific subject population, were unsure how to study given lack of mouse models for early-stage research and acknowledged the opportunity for future study inclusion. Further, community members discussed the persistent stress of existing as a TGD person during a time of increasingly aggressive anti-TNB legislation and social attitudes. Healthcare providers and researchers reflected on the behavioral and physiological impact of stress on an individual’s health and cancer risk. Conclusion: The findings from our focus groups elucidated areas of shared understanding between the three different audiences; however, they also highlighted concepts that were not shared which offer opportunities for further collaboration and learning by key stakeholders. Through our TDS and collaborative approach, we will continue deep learning between team members to identify specific research questions to address the root causes of TGD cancer disparities through TDS collaboration and innovative research. Citation Format: Tobi Cawthra, Chandler Cortina, laura Pinsoneault, Michael Munson, Andrew Petroll, Melinda Stolley. Researcher, Clinician, and Community Focus Groups to Inform an Understanding of Cancer Disparities in the Transgender and Gender Diverse [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 B163.

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

Abstract Background: Complex problems such as cancer disparities require deeper integration of social and scientific problem-solving and a broader systems approach. Given the nature of disparities, it also demands that we not just seek equitable outcomes but collaborate in ways that reflect equity in the process. To address breast and lung cancer disparities, we developed a unique transdisciplinary approach that creates teams inclusive of community, clinicians, and researchers and builds capacity to understand at a deep level the factors that underpin disparities and design and implement newer sustainable solutions. Methods: This study focuses on a phase I planning period for a transdisciplinary process with five teams locally embedded where lung and breast cancer disparities are significant. A leadership team that included primary investigators from academic medicine and public health supported community-based facilitators and evaluators responsible for guiding local teams. Deep equity, considerations on the biology to policy spectrum, and systems thinking are grounding principles in our approach. At the end of phase I, an evaluator facilitated After-Action Reviews (AAR) to assess effectiveness in maintaining fidelity to the framework and to identify successful practices and areas for improvement. These data informed changes to our approach to implementation to further root our commitment to equity during implementation. Seven AAR sessions were conducted: individual teams members, facilitators and evaluators, and the leaderships team (n-=50). The evaluator triangulated the data from the different AARs and facilitated a discussion of the integrated findings to the expanded leadership team. Results: The AAR highlighted three primary themes for critical self-reflection including (1) strengthening the understanding and use of our approach, (2) reducing ambiguity while preserving slack (e.g. flexibility with resources) and creativity, and (3) integrating project’s partners intentionally into our wider transdisciplinary network. In examining these themes, we identified several strategies for improving our transdisciplinary approach during implementation and for wider replication of our framework with future integrated science-social problem solving. These areas included improved systems for 360-degree communication, clear expectations of roles, and additional support for transdisciplinary collaboration and application of grounded principles to better self-organize a transdisciplinary system within a wider less resilient system like academic medicine. Discussion: To successfully innovate socially and scientifically within complexities of cancer disparities, we need to push beyond conventional models of research and program intervention. This means incorporating methods across fields and sectors including evaluation. An After-Action Review is an effective evaluation tool for assessing a complex process with numerous contributors to ensure a stronger outcome including more refined and relevant research questions and sustainability program, policy and practice. Citation Format: Tobi Cawthra, Laura Pinsoneault, Jerica Broeckling, Kristen Gardner-Volle, Tim Meister, Kailey Taebel, Jada Proctor, Felicia Fairfield, Kelly Hackett, David Frazer, Staci Young, Melinda Stolley. The Critical Role of Developmental Evaluation in Supporting and Enhancing an Equitable Transdisciplinary Approach to Address Cancer Disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C011.

Abstract B161: Has much changed? A scoping review on the nature of racial/ethnic disparities in endometrial cancer research since the release of the Society of Gynecologic Oncology statement

Abstract Introduction: Endometrial cancer is prevalent in the United States and has well documented disparities across race and ethnicity. The Society of Gynecologic Oncology’s (SGO) 2014 review on racial/ethnic disparities in gynecologic cancers, including endometrial, ended with a call to action to increase research on endometrial cancer disparities and to shift focus from identification of disparities to solutions. With a decade passed since the publication, it is unknown how the landscape of research on racial/ethnic disparities in endometrial cancer has changed. Objectives: A scoping review was conducted to identify the nature of research on racial/ethnic disparities in endometrial cancer since the publication of the SGO review in 2014, including summarizing the proportion of studies that focused on disparities across patient, provider and systemic spheres. Secondarily, to understand the proportion and nature of studies that proposed a solution to the identified racial/ethnic disparities. Methods: Scoping review was designed following the PRISM-SCa protocol. MEDLINE, EMBASE and Web of Science were searched to identify relevant studies. Inclusion criteria included: publication following the SGO statement, in English, published in the United States, on human subjects, primary study, specifically mentioned a racial or ethnic disparity in endometrial cancer. Reviews, meta- analyses, and opinion pieces were excluded. Relevant studies were coded for nature of disparity and solutions offered using a standardized data abstraction tool. Results: 182 studies were included, 141 (77.5%) focused on racial disparities, 34 (18.8%) on racial and ethnic, and 7 (3.8%) on ethnic, mainly Hispanic. Of those, 138 (75.8%) focused only on Black or African American disparities. When evaluating the level at which the disparity was identified, 116 (63.7%) were at the patient level, 25 (13.7%) at the provider level, 21 (11.5%) systemic, and 20 (11.5%) identified disparities on multiple levels. Half of the studies included offered solutions (91, 50.0%), however, the majority of the solutions suggested an increase in disparity research (32, 35.2%) and expanding clinical trials (15, 16.5%); many of these were included as further directions of the study itself. Other solutions included expanding access to health care (15, 16.5%), enhancing patient education (12, 13.2%), increasing patient participation in care (4, 4.4%), increasing diversity in the workforce (1, 1.1%), and other (12, 13.2%). Conclusions: Though much research on racial/ethnic disparities in endometrial cancer has been conducted since the SGO statement, many studies focused on patient-level factors instead of challenging provider/systemic level factors. When it came to a call to action, only half of the studies discussed a solution, the majority of which were included as future directions and suggested expansion of research. A small minority of articles outlined tangible solutions to the disparity discussed, leaving a continued need to shift research from identification of the disparity to creating solutions. Citation Format: Sarah Battiston, Victoria Kelley, Molly Wilson, Morolayo Ilori, Katerina Furman, Layla Hak, Madison Miller. Has much changed? A scoping review on the nature of racial/ethnic disparities in endometrial cancer research since the release of the Society of Gynecologic Oncology statement [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 B161.

Abstract C172: Diversifying translational research models to address outcomes disparities in lung cancer

Abstract Introduction: Racial disparities in lung cancer remains a persistent and challenging problem, with African Americans experiencing the highest mortality of any race or ethnic group. Emerging evidence suggests that multiple biological factors affect the development and progression of lung cancer. Three-dimensional organoid culture models have become important instruments to use for biomarker analysis and drug sensitivity screening. Despite this strong rationale and potential, there is a lack of representative preclinical models from African American patients with lung cancer. Furthermore, there are no studies evaluating the ability to create organoids successfully using samples from different races. As such, our goal was to establish a diverse biobank of organoid models and determine the rate of successful development based on race and other factors. Methods: Patients with lung cancer from a large urban medical center were recruited to participate in the study from 2021 to 2024. Specimens were collected from surgical pulmonary resection or endobronchial biopsy. Each tissue specimen was divided into 3 pieces and allocated for genomic, transcriptomic and organoid development. Once collected, specimens allocated for organoid development were processed within 8 hours. Cells were isolated from tissues by mechanical and enzymatic dissociation and plated in Matrigel drops overlayed with optimized organoid media. Patient demographics, tumor characteristics and method of specimen collection were recorded. Results: A total of 29 patients consented to the study and had evaluable specimens collected. Mean age was 67 years. Fifty-five percent of patients (16/29) were female. White patients were 55 percent of cohort (16/29), while Black patients made up 45% (13/29). Approximately 62 (18/29) percent of patients were diagnosed with adenocarcinoma, followed by squamous cell carcinoma in 28 percent (8/29) of patients. Tumor stage was 55%, 28%, 3% and 14% for stages I, II, III and IV respectively. Overall, there was a successful organoid development rate of 69 percent (20/29). There was a strong trend toward higher success rates in Black patients compared to White patients (85% vs. 56%, p = 0.10). There were no significant differences in successful organoid development based on gender (p = 0.43), histology (p = 0.18) or tumor stage (p = 0.84). Conclusions: Establishment of a racially diverse set of organoid models will be an invaluable tool for biomarker discovery and for screening novel therapeutic agents. Black patients appear to have similar to improved propensity for successful organoid development. Future efforts should be focused on creating diverse biobanks to strengthen precision oncology efforts for Black patients, collectively helping to reduce racial outcomes disparities in patients with lung cancer. Citation Format: Amanda Pilling, Hollis Hutchings, Avi Cohen, Shirish Gadgeel, Ikenna Okereke. Diversifying translational research models to address outcomes disparities in lung 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 C172.

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

Abstract Parabens are endocrine-disrupting chemicals used as preservatives to extend the shelf life of consumables, pharmaceuticals, and personal care products. Daily use of products containing parabens results in continuous exposure that can negatively impact health. It is known that parabens cause breast cancer cells to grow and express genes linked to cancer and hormone action. Our lab previously showed that parabens increase viability of and regulate estrogen-responsive gene expression in diverse luminal A breast cancer cell lines. In addition, greater effects were seen in a luminal A cell line of West African ancestry compared to one of European ancestry, suggesting that exposure to parabens in personal care products may contribute to breast cancer disparities. Therefore, the purpose of this study was to investigate whether parabens increase cell viability across a variety of cancer cell types, particularly those associated with cancer disparities. To do so, we utilized the National Cancer Institute-60 (NCI-60) Human Tumor Cell Lines screen that includes leukemia, non-small cell lung (NSCL), colon, central nervous system (CNS), melanoma, ovarian, renal, prostate, and breast cancer cell lines, plus a custom panel of pancreatic cancer cell lines. Of these, ovarian, NSCL, prostate, colon, renal, CNS, and pancreatic cancers have known disparities. We treated these cancer cell lines with biologically relevant doses of butylparaben (BP), methylparaben (MP), or propylparaben (PP) (doses ranging from 0.0012 µM – 20 µM) for 72 hours and measured cell viability. Treatment with dimethylsulfoxide or 10 nM estradiol served as negative and positive controls, respectively. In general, we observed a paraben-specific and cell-line specific effect on cell viability. MP exhibited the greatest effect with increased cell viability in 42% of the cell lines, followed by PP (38%), and BP (32%). MP and PP are among the most common parabens found in personal care products and differences in urinary levels based on race/ethnicity (e.g. higher levels in non-Hispanic Blacks/Mexican Americans compared to non-Hispanic Whites) have been reported. Breast, ovarian, and NSCL had the most cell lines (67-83%) that exhibited increased cell viability with any paraben treatment. Increased cell viability was also observed in several leukemia, colon, pancreatic, CNS, and melanoma cell lines (33-50%). Only one renal, and no prostate, cell line exhibited increased cell viability. These data suggest that paraben-mediated protumorigenic effects may promote cancer disparities beyond breast cancer. Studies are currently underway to determine the mechanisms underlying this link. One caveat of this study is that most of the cell lines in this readily available screen are of European ancestry, highlighting a need to develop more genetically diverse in vitro models for understanding the mechanistic link between paraben exposures and cancer risk/outcomes in the context of disparities. Approaching this challenge from an endocrinology and genetic ancestry perspective may help narrow the disparity gap. Citation Format: Jazma L. Tapia, Jillian C. McDonough, Loretta Erhunmwunsee, Lindsey S. Trevino. Parabens promote cell growth in cancer cell lines associated with health disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C113.

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

Abstract Introduction Addressing cancer disparities by meeting people where they are is a crucial aspect of community-engaged research. The impact of this has been seen through the community outreach and engagement efforts of cancer centers across the country, with many focusing on churches, community events, and other trusted places. In the past four years, Mayo Clinic’s Cancer Health Equity Program (CHERP) has made a specific effort to decentralize clinical trials and community-engaged research by going to the places our community trusts and frequents. As a result, we partnered with a trusted leader in Jacksonville, Florida to engage with barbershops as sites for health information dissemination. We re-engaged a cohort of barbers who had previously worked with our outreach initiatives as part of the Community Engagement Alliance (CEAL) Against COVID-19 Disparities and recruited new ones for this phase of work. Methods Our community partner completed a training hosted by Florida A&M University on working with barbershops for community outreach and engagement research. The community partner then trained each barber on sharing health information, incorporating feedback from the previous cohort. Barbers were also trained to collect engagement and pre/post-test information to measure outcomes. Health information included COVID-19 prevention/ vaccine information and general cancer prevention information used in other community outreach and engagement initiatives. Results A total of 19 barbers engaged in this initiative; 9 were a part of our previous work with barbers and 10 were recruited for the new year of funding. The barbers all identified as Black and engaged with a total of 497 clients. Of the 497 clients, 91% identified as Black, and less than 5% identified as White, Asian, or Native American. 344 clients identified as male (69%), 147 as female (30%), 1 as transgender (0.2%), and 5 did not disclose their gender. The majority of participants were born between the 1960s and 2000s, with most reporting having a high school degree or GED (55%). Post-test information found evidence of knowledge change, including a 3.4% increase in those who responded understanding how COVID-19 is spread and a 4% increase in those who reported vaccines to be safe. Barbers also expressed their appreciation for being included in this initiative. Conclusion CHERP, in partnership with the community, is addressing disparities at different levels. One of the barriers the barbers had to overcome was hesitancy in sharing health-related topics. However, sustained initiatives, such as this one might overcome this barrier. This study’s engagement with barbershops to reach communities most impacted by cancer disparities points to the impact of barbershops as a site for cancer disparities research. Citation Format: Jessica Otero Machuca, Opeyemi Bolajoko, Jocelyn Turner, Folakemi Odedina. Decentralizing cancer disparities research: Barbershops as a foundation for community outreach and engagement [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B088.

Abstract B164: Sustaining statewide transdisciplinary collaborations to address cancer disparities

Abstract Background: Wisconsin’s cancer disparities are evident when considered by race/ethnicity, geography, and socio-economic status. Addressing these disparities requires deeper integration of social and scientific problem-solving and a systems approach. Given the nature of disparities, it also demands that we not just seek equitable outcomes but collaborate in ways that reflect equity in the process. To achieve this, we developed a transdisciplinary approach inclusive of community, clinicians, and researchers and builds capacity to understand, at a deep level, factors that underpin disparities and design newer sustainable solutions. Methods: The Community and Cancer Science Network (CCSN) Integration Hub was established within the Medical College of Wisconsin Cancer Center to provide leadership and capacity building to eight transdisciplinary teams working to address cancer disparities. The Integration Hub and its teams use a co- leadership structure with a community and academic PI as well as a facilitator and evaluator. The Integration Hub has four primary strategies: identifying and addressing knowledge gaps in cancer disparities, building capacity for transdisciplinary collaboration, cultivating networks and relationships, and disseminating through feedback loops that touch communities, academic medicine, and policy. Our approach is grounded in the principles of deep equity, considerations across the biology to policy spectrum, and systems thinking. Results: In its third year, CCSN adapted and adopted tools to understand its effectiveness in building a collaborative environment for transdisciplinary approaches to problem-solving and to set strategy for sustainability. Results from a partner survey administered to team members (n=73) highlighted that the CCSN model contributes to fostering learning conditions that support a strong transdisciplinary approach including a supportive learning environment, concrete learning practices, leadership that reinforces learning and a reflection of core principles as well as embedding a transdisciplinary orientation in team members. The Integration Hub leadership also completed the Organizational Mapping Tool for Coalitions, Alliances and Networks (OMT-CAN) to assess critical dimensions of network health. The assessment helps identify strengths and identify areas for improvements. CCSN network leaders (n=21) rated the network moderate to strong in culture and relationships; joint action, planning, learning and evaluation; and in purpose, goals and strategy. The team further identified the need to work on refining structure, identity and participation; its capacity for strategic communications; and advocacy and organizing. Discussion: To integrate social and scientific problem-solving and address cancer disparities requires the resourcing of credible capacity building networks that can broker equitable relationships between academic medicine and community members and organizations. The CCSN Integration Hub offers a strong model embedded within a cancer center that accomplishes those goals. Citation Format: Tobi Cawthra, Laura Pinsoneault, Kristen Gardner-Volle, Alexis Krause, Kim Kinner, Melinda Stolley. Sustaining statewide transdisciplinary collaborations to address cancer disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B164.

Abstract A093: Assessing cigarette smoking intensity among California adults and the need for tailored interventions to reduce health disparities

Abstract Background: Smoking causes about 20% of all cancers and about 30% of all cancer deaths in the U.S (ACS, 2024). Smoking increases the risk for cancers of the mouth, larynx, pharynx, esophagus, kidney, cervix, breast, liver, bladder, pancreas, stomach, colon, and acute myeloid leukemia and there is no safe form of tobacco smoke (CDC, 2023; ACS, 2024). This study aims to inform public health strategies that can mitigate smoking related disparities and improve health outcomes for marginalized populations. Methods: This study assessed the prevalence of cigarette smoking by demographic characteristics among California adults. We used secondary data from the 2019 California Health Interview Survey (CHIS) that was collected through a random-digit dial telephone survey. Adults ages 18+ were interviewed. We utilized secondary data comprised of 22,160 participants. We conducted interactions between gender and race/ethnicity, and one's smoking status. Multinomial logistic regression test was conducted to predict the probability of participants' level. This study was approved by the researchers Institutional Review Board. Results: Majority or participants were non-smokers (93.1%), mostly females (51.2%,). Many had a bachelor’s degree (23.9%) or some college, vocational training, or an associate degree (22.8%). Many participants (59.8%) were married/living with a partner, and (25.7%) were single. Most participants spoke English (55.4%) and the largest race/ethnic groups were White (40.2%) followed by Latinos (21.8%). Age distribution was as follows: 18–29 (22.9%), 30–39 (17.6%), and 40–49-year-olds (16.2%). For low-intensity smokers , in terms of race/ethnicity, Latino participants were less likely to be low-intensity smokers relative to non-smokers in comparison to White participants (RRR = .411, p = .043). For moderate-intensity smokers , education was statistically significant, with participants holding a graduate degree being significantly less likely to be moderate-intensity smokers relative to non-smokers in comparison to participants who had a HS degree (RRR = .068, p = .025). For high-intensity smokers , single participants were more likely to be high-intensity smokers compared to those married or living with a partner (RRR = 2.72, p = .011). In terms of age, only participants that were 30 to 39 years old were statistically significant, with this group more likely to be high-intensity smokers relative to non-smokers in comparison to participants who were 20 to 29 years of age (RRR = 3.40, p = .031). Conclusion: Findings suggest that one’s demographics characteristics does play a role in smoking consumption rates. Addressing disparities in smoking and cancer requires a multifaceted approach that includes policy changes, targeted interventions, and improved access to healthcare and smoking cessation resources. Hence, public health efforts should create evidence-based interventions and consider the social, economic, and cultural contexts of target populations to reduce disparities in smoking and cancer. Citation Format: Salome Kapella Mshigeni, Anhthu Nguyen, Julian C Sacdalan, Elizabeth Pinder-McSwain, Felipe Aperador Tarazona. Assessing cigarette smoking intensity among California adults and the need for tailored interventions to reduce health disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A093.

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

Abstract Background: Triple negative breast cancer (TNBC) accounts for 15% of all breast cancers and is one of the most aggressive disease subtypes. Disparities in TNBC exist, where US Black women and women living in urban environments are more likely to be diagnosed with TNBC than their White or rural counterparts. Reasons for these disparities are not completely understood. Social determinants of health, such as the neighborhood environment, have been implicated as potential contributors to breast cancer disparities. To improve our understanding of disparities in TNBC, we examined neighborhood deprivation in relation to breast cancer subtype, according to race and rurality. Methods: We identified 40,095 non-Hispanic Black and White women diagnosed with invasive breast cancer in 2010-2017 in the Georgia Cancer Registry. Neighborhood deprivation was measured by the Neighborhood Deprivation Index (NDI), a composite measure of neighborhood poverty, income, housing, unemployment, occupation, and education derived through principal component analysis using 2011-2015 block group-level American Community Survey data. Georgia Department of Public Health data were used to measure county-level rurality. We estimated case-only multivariable odds ratios (OR) and 95% confidence intervals (CI) for the separate associations between NDI, in quintiles, and each breast cancer subtype (TNBC, ERBB2+, or luminal B vs. luminal A breast cancer), overall and according to race and rurality. Results: Of the 40,095 non-Hispanic Black (31.5%) and White (68.5%) women, 5,328 were diagnosed with TNBC, 1,926 with ERBB2+, 4,958 with luminal B, and 27,883 with luminal A breast cancer. Compared to living in the least deprived neighborhoods, living in the most deprived neighborhoods was associated with a 33% (OR= 1.33, 95% CI 1.19-1.48) increased odds of TNBC vs. luminal A breast cancer. Race and rurality did not modify the association. However, estimates were less pronounced among non-Hispanic Black (OR=1.18, 95% CI 1.00-1.39) compared to non-Hispanic White (OR=1.40, 95% CI 1.18- 1.65) women and among women living in urban (OR=1.33, 95% CI 1.18-1.50) compared to rural (OR=1.52, 95% CI 1.15-2.03) counties. Neighborhood deprivation was associated with an increase in ERBB2+ breast cancer (OR=1.19, 95% CI 1.00-1.40), which was confined to non- Hispanic White women (OR=1.29, 95% CI 1.00-1.66) and women living in urban counties (OR=1.25, 95% CI 1.04-1.52). The OR for luminal B breast cancer was 1.08 (95% CI 0.96- 1.21). Although race did not modify this relationship, an association was observed only among women living in urban counties (OR=1.14, 95% CI 1.00-1.29). Conclusions: In this population of Georgia breast cancer patients, neighborhood deprivation was associated with an increase in TNBC, regardless of race or rurality. The weaker associations among non-Hispanic Black women and women living in urban counties suggests that other factors, in addition to neighborhood deprivation, may play an important role in TNBC development among Black women and women residing in urban environments. Citation Format: Lauren E. Barber, Jasmine M. Miller-Kleinhenz, Maret L. Maliniak, Leah Moubadder, Jeffrey M. Switchenko, Lauren E. McCullough. Understanding the role of neighborhood deprivation in racial and urban-rural disparities in triple negative breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A037.

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

Abstract Triple-negative breast cancer (TNBC) is the most aggressive subtype of breast cancer. TNBC displays exceptional transcriptional heterogeneity, both between patients and intratumorally, and disproportionately affects underserved women. Hypoxia, a state of low oxygen levels, is often present in the solid tumor microenvironment. In TNBC, hypoxia is a key driver of aggressiveness and therapeutic resistance. Past bulk RNA sequencing (RNAseq) studies in cancer research have lacked spatial resolution, failing to uncover precise transcriptional differences within tumor regions. This spatial limitation has been especially problematic for studying transcriptional heterogeneity of the cellular hypoxia response within tumors. By integrating single-cell RNA sequencing and spatial transcriptomic analyses in a TNBC xenograft tumor model, our research has uncovered a novel hypoxia gene signature, specific to cancer cells. Elevated expression of this hypoxia signature predicts poorer prognosis in breast cancer patients, especially within TNBC patients and those of African ancestry. This suggests that hypoxia may play a role in the racial disparities observed in TNBC prognosis, potentially informing treatment strategies. This workflow introduces a novel framework for translating general spatial transcriptomics data into clinically relevant and accurate gene signatures. Citation Format: Kent Schechter, Long C. Nguyen, Geetha P. Yerradoddi, Rania Bassiouni, John D. Carpten, Marsha R. Rosner. Novel cancer-specific hypoxia signature predicts poor prognosis and highlights racial disparities in breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C105.

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

Abstract BACKGROUND: Late-stage breast cancer (LSBC, defined as stage 3 or 4) significantly contributes to breast cancer (BC) mortality, underscoring the importance of early detection and intervention. Understanding the individual and community factors contributing to LSBC is crucial for improving LSBC diagnoses and outcomes. OBJECTIVE: To evaluate the association between LSBC and individual demographic/socioeconomic status (SES) characteristics by race, and describe differences in individual healthcare utilization (IHU) and community healthcare access (CHA). Methods: This population-based retrospective study used demographic and SES data (age at diagnosis, marital status, years of education, income, poverty status, health insurance, and body mass index) from the Carolina BC Study Phase 3, a population-based cohort of women diagnosed with invasive BC from 2008-13. We analyzed all cases of LSBC (n=545) and stage 1 (n=1,225). Age-adjusted relative frequency differences (RFDs) and 95% confidence intervals (CIs) assessed the relationship between LSBC and SES for Black (n=835, 47.2%) and non-Black (n=935, 52.8%) women. Analyses were stratified by IHU status (High vs Low: High: Had regular pre-diagnostic care and were adherent to BC screening guidelines, >0.5 mammograms per year; Low: Lacked one or both forms of care); and stratified by CHA status (High vs Low), a census tract-level measure of cancer-specific healthcare infrastructure (e.g., oncologist density) and utilization (e.g., insurance rates). High CHA had either high or low infrastructure and high use; Low CHA had low infrastructure and low use. Results: Compared to non-Black women, Black women had more LSBC diagnoses (38.7% vs 23.7%), were more likely to be unmarried (59.1% vs 28.7%), have an income of <$50k (71.8% vs 38.2%), and be impoverished (27.0% vs 6.1%). Age at diagnosis, years of education, and income were significantly, positively associated with LSBC for all women, but the age-adjusted RFDs were greater among Blacks. After stratifying by IHU, income remained significantly associated with LSBC for Blacks with low IHU. For those with high IHU, the effects of SES on LSBC were not statistically significant. After stratifying by CHA, income and poverty status were significantly positively associated with LSBC for all women with high CHA; Marital status was significantly associated with LSBC for Blacks. Among the low CHA group, income and poverty were significantly associated for Blacks; RFDs were not estimable for non-Blacks due to small sample size (n=66). Notably, 36.5% of Blacks lived in low CHA areas compared to 7.1% of non-Blacks. Conclusion: Healthcare access exacerbates the effects of IHU but does not mitigate the impact of demographic/SES characteristics on LSBC diagnoses. Enhancing CHA alone is insufficient. Targeted interventions addressing individual and community factors are crucial to reduce LSBC diagnoses and improve outcomes, especially for Black women. Citation Format: Joel A. Begay, Brittney A. Gedeon, Matthew R. Dunn, Melissa A. Troester, Marc A. Emerson. Disparities in late-stage breast cancer: The impact of socioeconomic status across racial groups by healthcare utilization and community healthcare access [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B131.

Abstract C061: Disparities in second breast cancers among women with ductal carcinoma in situ

Abstract Introduction: Breast cancer is the leading cause of cancer-related death among women in the United States and Oklahoma. Outcomes from DCIS are generally favorable, however, up to 50% of patients will develop an SBC after DCIS, with approximately 30% diagnosed as invasive SBC. Our research objective was to use a combination of data sources (registry, demographic, clinical, and socioeconomic data) to explore the presence of disparities and treatment outcomes, among women of different racial, ethnic, and socioeconomic groups in Oklahoma. Methods: We conducted a retrospective cohort study comparing the overall incidence of DCIS, invasive breast cancer (IBC), and the development of SBCs in women residing in Oklahoma at the time of diagnosis. We obtained data from the Oklahoma Central Cancer Registry (OCCR) and included women diagnosed with breast cancer from 1997-2021 in our analyses. We restricted analyses to women with DCIS as their first primary cancer. SBC was defined as a second primary cancer diagnosed at least six months after the first DCIS diagnosis. We evaluated demographic and cancer-related characteristics of women diagnosed with DCIS as their first cancer by development of a SBC. Results: In initial analyses, we identified 7,903 women with DCIS as their initial cancer diagnosis. Of the women with DCIS, 80% were over 50 years of age at diagnosis and the majority were non-Hispanic (NH) White (85%). For cancer-related characteristics, 33% of tumors were well or moderately differentiated (44% unknown) and 51% of tumors originated in the left breast. Of these women, 513 were subsequently diagnosed with a SBC, which included both in situ (26%) and invasive breast cancers (74%). Among women with a SBC, a higher percentage of women were <50 years of age at the initial DCIS diagnosis (27% vs. 19%) and NH Black (9.4% vs. 6.7%) compared to those without a SBC. Discussion: As a next step, we will further evaluate the risk of SBC among women in the OCCR and National Cancer Data Base to evaluate disparities at the national level. We are planning to evaluate the risk of an SBC after diagnosis of a DCIS by demographic and cancer-related characteristics using multivariable models. We will also evaluate survival among women with DCIS who develop a subsequent SBC. Citation Format: Amanda Janitz, Bethany Hannafon, Mary L Williams, Elizabeth Wellberg, Chao Xu, William Dooley. Disparities in second breast cancers among women with ductal carcinoma in situ [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 C061.

Abstract C129: Adapting to disruption?: Changes in colorectal cancer screening modalities and disparities during the COVID-19 pandemic

Abstract Research Objective: At-home colorectal cancer screening methods, such as Fecal Immunochemical Tests (FIT), offered a safer, convenient alternative to in-clinic procedures like colonoscopies during the COVID-19 pandemic. Racial and ethnic minorities were more likely to use these tests prior to the pandemic, but it is unclear whether disparities in colorectal cancer screening changed because of the pandemic. We examined rates of colorectal cancer screening before and after shutdown periods across race/ethnicity, age, and income among health plan enrollees in the United States to inform screening catch-up strategies after COVID-19 disruptions. Study Design: We conducted a retrospective analysis of cancer screening claims from Optum Clinformatics Data Mart among enrollees from 2019-2021. Monthly screening volume was calculated for a three-year period, with January 2019-February 2020 as the pre-pandemic period, and July 2020-December 2021 as the post-pandemic period. We conducted an event study to calculate group-level monthly predicted probabilities of screening using a linear probability model with group interactions by month, controlling for demographic variables and comorbidities. Additionally, we used difference-in-difference (DD) regressions including group interacted with a post-pandemic dummy. The pandemic closure period months were excluded from our DD analysis. Eligible enrollees included those ages 40-75 with continuous enrollment 12 months prior to screening index month. Colorectal cancer screening claims included codes for colonoscopies and other endoscopic procedures as well as FIT and FOBT tests. Results: 2,576,760 health plan enrollees were included. Colonoscopy rates did not change significantly between the pre-COVID period and post-COVID period, however FIT test screening rates dropped from an average of 0.66% of age-eligible enrollees screened per month in the pre-pandemic period to 0.58%. Our difference-in-difference results suggested Hispanic-NH White disparities in FIT tests widened. For colonoscopy, Hispanic-NH White and Asian-White disparities widened, while Black-White disparities decreased. Conclusions: Despite the promise that in-home FIT testing would substitute for colonoscopy during the pandemic, we saw a much larger decline in FIT testing rates during the pandemic than for colonoscopy and increasing disparities. This study highlights the need for targeted strategies to address screening disparities exacerbated by the COVID-19 pandemic, particularly among Hispanic and NH-Asian populations. Citation Format: Cameron M. Kaplan, Willow Pastard, John Thacker, Todd Schneberk, Chun Nok Lam, Sarah Axeen, Jennifer Tsui. Adapting to disruption?: Changes in colorectal cancer screening modalities and disparities during the COVID-19 pandemic [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 C129.

Abstract B099: Addressing cancer disparities in the United States-Affiliated Pacific Island jurisdictions: Insights from the Scaling What Works program

Abstract Purpose The Scaling What Works (SWW) program aimed to build the capacity of National Comprehensive Cancer Control Program (NCCCP) recipients to scale three CDC-identified cancer control projects through training, mentorship, and technical assistance (TA). The SWW program held a Symposium to provide in-person training on adapting, implementing, evaluating, sustaining, and scaling the three projects. We recruited 100% of US-Affiliated Pacific Island (USAPI) NCCCP programs (n=6), who made up approximately 26% of all programs that attended the Symposium (n=23). The USAPI jurisdictions face high cancer burden due, in part, to the United States nuclear legacy, the effects of climate change, limited medical infrastructure, and lack of culturally competent, centralized care across the almost 4,000 miles that the USAPI spans. Through the SWW program, USAPI recipients are supported in their ongoing efforts to mitigate cancer disparities affecting their communities. MethodsWe applied community-based participatory research methods and health equity principles to ensure the SWW program was relevant and responsive to the USAPI recipients’ contexts and needs. We created a SWW subcommittee to learn about and advocate for the specific needs of the USAPI. The committee spoke with ten clinicians and researchers with experience working in the USAPI, across four informal meetings, to understand the unique cancer prevention and control context of each USAPI jurisdiction. The committee reviewed USAPI cancer plans and extracted data related to SWW activities, including cancer prevention priorities, community partners, demographic characteristics, and healthcare infrastructure. Data were added to a matrix, coded, and summarized by subcommittee team members to develop a USAPI fact sheet. We shared the fact sheet with SWW Symposium facilitators and mentors to provide them with the necessary information to support the USAPI programs. Findings We identified components critical to providing effective training and TA that will support USAPI-led work to address disparities in cancer prevention and control. These components include 1) acknowledging the current and historical power dynamics that establish the USAPI cancer prevention and control program space, 2) adjusting generalized training content to each jurisdiction’s unique context and cancer prevention goals, 3) adapting communication strategies to USAPI programs’ preferences and time zones, 4) facilitating networking opportunities both between NCCCP USAPI jurisdictions and across all NCCCP recipients to build a SWW community of practice, and 5) establishing a sustained, bidirectional partnership between USAPI program leaders and the SWW team to collaborate on future cancer prevention and control projects and to provide training and TA, as needed. ConclusionsThe lessons learned from SWW regarding health equity and capacity-building can inform the efforts of researchers, evaluators, and training and TA providers working with USAPI jurisdictions, states, and territories engaged in cancer prevention and control work. Citation Format: Amy L. Tran, Mary Wangen, Renée M. Ferrari, Jingle Xu, Alison T. Brenner, Stephanie B. Wheeler, Rebecca J. Lee, Elizabeth A. Rohan, Angela R. Moore, Shixiu Wang, Alyssa LaMonica, Mary Puckett, Amy L. Thompson, CK Smith, Katie Jones, Malesa Pereira, Rogelio Robles-Morales, Lori A. Crane, Courtney N. Petagna, Thuy T. Vu, Betsy C Risendal, Rachel Hirschey. Addressing cancer disparities in the United States-Affiliated Pacific Island jurisdictions: Insights from the Scaling What Works 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 B099.

Abstract PR004: Differential gene expression analysis comparing Black and White patients with HPV-positive oropharyngeal squamous cell carcinoma reveals suppressed immune response and higher rates P16/HPV DNA discordance in Black patients

Abstract Background-Human papilloma virus (HPV-positive (+)) oropharynx cancer (OPC) are a distinct neoplastic entity associated with a significant survival advantage compared to HPV- OPCs. The survival advantage is so great that the presence of regional cervical lymph node metastasis is no longer considered an advanced stage III/IV cancer. The survival advantage associated with HPV+ OPC is not the same for Black patients compared to all other races and emerging data now suggests Black patients with HPV+ OPC have survival outcomes similar to White patients with HPV- OPC. We conducted a differential gene expression analysis and high-risk HPV serotyping comparing genomic difference between treatment naïve Black and White patients with HPV+ OPC. Methods: Surgical samples were obtained from Duke, the University of Texas Medical Branch, and the University of Mississippi, through an IRB approved protocol. HPV status determined by p16 immunohistochemistry (IHC). We performed digital spatial profiling and conducted a differential gene expression analysis in 14 Black and 13 White patients using the Nanostring™ Whole Transcriptome Atlas. Morphology markers included CD45, PANCK, and alpha SMA to label lymphocytes, epithelium, and stroma, respectively. A component of the bioinformatics pipeline included conducing a KEGG pathway analysis using pre-ranked test statistics from self-reported Black and White patients HPV+ OPC. The presence of high-risk oncogenic HPV was determined in parallel by RT-PCR (Creative Biogene). P16, CD68 and CD3 expression was measured by IHC using standard techniques. Results: There was a significant decrease in antigen processing and presentation and T-cell receptor signaling pathways in CD45+ lymphocytes (p<0.0002) and B-Cell receptor and chemokine signaling pathways in PANCK+ tumor epithelial cells (p<0.03) in Black patients compared to White patients with HPV+ OPC. There was a significant difference in p16 expression and the absence of HPV DNA in Black patients compared to White patients (p<0.017). 32% of Black patients with p16+ OPC were HPV DNA negative. There was no p16/HPV16 DNA discordance observed in the White patient cohort. Three patients were co-infected with other carcinogenic HPV serotypes (45, 51, and 59) in addition to HPV16 (two Black and one White). CD68 expression, associated with M1-like anti-tumor macrophages, was significantly decreased in Black patients with p16+/HPV16+ OPC, compared to White patients (p<0.017), suggesting alterations in tumor immune response may be important in cancer disparities. Conclusion: The favorable prognosis associated with HPV+ OPC, including recruitment in currently ongoing radiation de-escalation clinical trials cannot be widely applied to all patients with HPV+ OPC and studies addressing racial disparities, HPV/p16 discordance, and predictors of poor response represent a significant health equity gap in the field of OPC disparities. Citation Format: Tammara L. Watts, Katerine Gonzalez, Xiangfeng Shen, Layne Rogers, Nosa Osazuwa-Peters, Gina D. Jefferson, Cecilia G. Clement, Danielle Range, Russel R Kahmke, Walter T Lee, Daniel J. Rocke, Trinitia Y Cannon, Yvonne Mowery, Kouros Owzar. Differential gene expression analysis comparing Black and White patients with HPV-positive oropharyngeal squamous cell carcinoma reveals suppressed immune response and higher rates P16/HPV DNA discordance in Black 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 PR004.

Abstract A031: Methylomic Biomarkers Associated with Prostate Cancer in Black Men

Abstract Introduction: The prostate cancer (PCa) disparity remains the highest cancer disparity in the US, with Black men facing an estimated 78% higher incidence and 230% higher mortality than White men. However, current understanding of risk factors for PCa such as socioeconomic status (SES), diet, and genetics cannot fully explain these disparities. Our objective is to examine DNA methylation (DNAm) markers in a cohort of Black men and assess their associations with PCa status. Methods: We randomly selected 100 Black men for DNAm profiling (50 cases diagnosed with clinically significant (Gleason Grade 3+) prostate cancer and 50 age-matched controls) from two larger cohorts. The cohorts recruited 400 Black men who were newly diagnosed with sporadic PCa as well as 400 controls matched on age and race. All men were 40-79 at recruitment and were enrolled from urology clinics at five Chicago-area medical institutions. All PCa cases underwent a transrectal prostate biopsy for abnormal prostate-specific antigen (PSA) or digital rectal exam and had a histologically confirmed prostate cancer and were not previously diagnosed with PCa. All men in the control group had been recruited from community prostate cancer screening events or were referred to participating urology clinics and had a negative prostate biopsy for a PSA <10ng/ml and were not diagnosed with PCa for 2 years of follow-up. Men with prior PCa diagnosis or conditions known to affect PSA levels were excluded. After enrollment and informed consent, all men provided demographic and lifestyle data via three questionnaires, followed by venipuncture for DNA collection. These specimens were obtained using buffy coat extraction after red blood cell lysis, centrifugation, and pipetting off the overlying plasma and buffy coat for freezing followed by Illumina EPIC arrays for DNAm assays. We examined DNAm markers in gene promoter regions associated with PCa using logistic regression and adjusted for multiple testing using Bonferroni correction. All models controlled for age, BMI, smoking status, first degree family history of PCa, blood cell types, and technical control variables. Results: We found 2,180 CpG sites in gene promoter regions associated with any PCa in this population. The top ten strongest associations identified in our models include loci on genes that have already been associated with prostate cancer progression (MAFG, FAM65B, OSM, PRKAG2), risk (SLC11A1, LAT), and metastasis (S1PR4) as well as immune system functioning (RAP1GAP2). Conclusions: Our initial findings suggest that DNAm markers may be useful predictors of clinically significant PCa status among Black men. Additional research is currently ongoing to expand the sample size of the DNAm profiling and to explore links between these loci and social determinants of health, as well as associations with more advanced (i.e., higher Gleason Grade) PCa. Citation Format: Brian T. Joyce, Yishu Qu, Jun Wang, Kai Zhang, Zequn Sun, Lifang Hou, Adam B. Murphy. Methylomic Biomarkers Associated with Prostate Cancer in Black Men [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 A031.

Abstract B076: Qualitative insights into building an effective community advisory board for cancer disparities research

Abstract To address cancer disparities in minority and underserved communities, many organizations and research studies use a community advisory board (CAB) to better understand the needs, preferences, and perceptions of communities experiencing health inequities. Researchers have described a range of problems resulting in less than optional engagement of CAB members. Academic members of an NCI-funded cancer partnership interviewed 15 of the 20 members of their CAB to better understand their perceptions of their roles and expectations, as well as barriers and facilitators of engagement. Two trained team members coded the transcripts and conducted qualitative analysis using an iterative inductive/deductive framework. Deductively, we used principles of community-engaged research, and inductively we used coded quotes to identify details in the CAB members’ perspectives. The research team collaborated in organizing major themes into a conceptual framework to describe context, expectations, barriers and facilitators, and recommended strategies for strengthening involvement and benefit of CAB participation for its members. CAB members identified individual factors associated with their involvement including skills (communication, problem solving, interpersonal, leadership, professional, and advocacy), and motivations (community commitment, personal or family experience with cancer). The interviews indicated that there is a gap between CAB members’ perceptions of their roles and what they expect from participation and attendance in CAB meetings, and those of the academic team as conveyed verbally, in the CAB manual, and during onboarding activities. Barriers to enthusiastic engagement include disruptions associated with the COVID experience, members’ competing priorities, and role ambiguity. The CAB members’ resources and connections to the community were identified as facilitators. All these factors influenced the amount and quality of engagement of members with the academic partners and the community at large. Participants suggested many useful adaptations of the CAB-academic partnership, including enhanced training, improved communication, explicit role definitions, clear expectations around engagement with research, and better onboarding for new members. Scientists using a CAB to enhance community engagement should approach building a robust CAB as a deliberate process involving considerable planning, organization, and attention. Projects using a CAB can use the findings from this project to organize a community-academic partnership that will effectively and efficiently contribute to clinical, translational, and community-engaged work addressing cancer health disparities. Citation Format: Leah Alexander, Jennifer Erves, Rebecca Selove, Ila McDermott, J'la Jenkins, Phillip Morris, David Schlundt. Qualitative insights into building an effective community advisory board for cancer disparities research [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 B076.

Abstract C102: Polyethnic-1000: Advancing cancer genomics by studying ethnically diverse, underserved patient populations in New York

Abstract Prompted by the considerable biases toward European ancestry cases in large cancer genomics repositories, the New York Genome Center initiated an effort to diversify the public datasets that are forming the foundations of current cancer research, in order to optimize the unbiased applications of modern genomically-driven discoveries to a larger population. Our effort was focused on 8 cancer types (breast, prostate, bladder, lung, pancreatic, colon and endometrial cancer, as well as multiple myeloma) and generated Illumina tumor-normal whole-genome sequencing and tumor transcriptome sequencing. The majority of the samples were retrospectively obtained in clinics and hospitals of the New York region and the analyses are conducted with collaborators in these institutions. Our dataset is currently composed of 851 tumor-normal WGS and 471 RNASeq, and is progressively being distributed to the scientific community in partnership with ICGC-ARGO. Overall, 75% of the cohort is predominantly of non-European ancestry, as estimated by genetic ancestry analysis using the 1000Genomes continental references.We analyzed the samples with NYGC’s somatic variant calling pipeline and will present results from the 8 cancer types related to germline and somatic variants (single-nucleotide variants, indels, copy-number alterations, complex structural variants) as well as mutational signatures, neoantigen prediction, fusion genes and expression profiles, in relation to genetic ancestry estimation and clinical features of the patients. We anticipate that the dataset will significantly diversify the genetic ancestry of tumor profiles in public databases, and serve to form hypotheses regarding the contribution of ancestry on cancer disparities. The experience of the Polyethnic-1000 project informs our contribution to the Cancer Grand Challenge SAMBAI, which focuses on breast, prostate and pancreatic cancers in the African Diaspora. SAMBAI will further investigate the causes of cancer disparity by combining genomic data with social determinants of health and exposomics information, deeper immune profiling and new genomics technologies such as long reads sequencing and the use of a pangenome reference. Citation Format: Nicolas Robine, Lara Winterkorn, Tim Chu, Zoe Goldstein, Will Hooper, Ali Oku, Heather M. Geiger, Melissa B. Davis, Onyinye Balogun. Polyethnic-1000: Advancing cancer genomics by studying ethnically diverse, underserved patient populations in New York [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 C102.

Abstract A083 Ethnic disparities in esophageal cancer across New York State

Abstract Introduction Esophageal cancer is one of the most fatal cancers in the United States. Moreover, disparities in mortality, or incidence rates of esophageal cancer have been reported. Here, we conducted a retrospective study to investigate disparities in esophageal cancer in the state of New York. Method Mortality and 5-year survival rate were analyzed through Surveillance, Epidemiology, and End Results (SEER) Stat Database (1969-2022). Mortality and survival data were analyzed by counties in the state of New York. The 5-year survival was analyzed through the Kaplan-Meier curve and SEER combined staging and ethnicity (non-hispanic white; NHW, non-hispanic black; NHB, Asians/Pacific Islanders; API, and Hispanics). Result Bronx County revealed the highest mortality rate among New York City Counties (5.6 per 100,000, 95% CI, 5.4-5.8), and Queens County showed the lowest mortality. (3.9 per 100,000, 95% CI, 3.7-4.0). In localized esophageal cancer, one year survival was highest in the NHW (79.3%, 95% CI, 75.9- 82.2%) in New York, whereas 2-5 year survival rates were highest in the NHB (52.0%, 47.3%, 40.2%, and 38.4%, respectively). Hispanics showed the lowest survival rate in the localized stage. In comparison, API showed the highest survival (1-5 year survival 46.8%, 29.6%, 16.8%, 13.3%, and 12.1% respectively) and NHB revealed the lowest survival outcome in distant metastatic esophageal cancer (1-5 year survival 28.8%, 13.5%, 8.1%, 5.9%, and 5.1% respectively) throughout 5 years. Conclusion Mortality and 5 year survival rates varied across the boroughs of New York City. Early intervention and primary prevention could be especially beneficial in the Bronx, where targeted efforts could help prevent patients from advancing to the distant metastatic stage, considering the unique demographics and healthcare disparities in this area. Citation Format: Inae Park, Sungjae Park, Misuk Lee. Ethnic disparities in esophageal cancer across New York State [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 A083.