Cancer Disparities Research Articles

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.

Abstract C002: Investigating racial and ethnic healthcare disparities in screenable gynecologic cancers

Abstract In this systematic scoping literature review, we analyzed peer-reviewed literature to develop a comprehensive understanding of the racial and ethnic healthcare inequity regarding the management and treatment of gynecologic cancers. This approach allows for novel summative data to inform future research and equitable treatment of gynecologic. For the analytical review, PubMed was primarily used to retrieve research articles exploring the impact of race and ethnicity on gynecologic cancer outcomes and screenings, focusing on cervical, ovarian, endometrial, fallopian tube, and vulvar cancers from 2015 to 2023. Non-original studies and studies published prior to 2015 were excluded from being reviewed. To ensure the reliability and relevance of the subsequent analysis, findings were uniformly summarized using a synthesis matrix, highlighting common themes across articles. Based on the articles investigated, there is strong evidence pointing to increased incidence of gynecologic cancers diagnosed at later, more aggressive stages in African American and Hispanic women than in Non-Hispanic White women. Additionally, disparities were found in screenings and treatment management. Women-of-color were less likely to be offered education from their healthcare providers on gynecologic cancers, and less likely to be offered preventative screening or vaccines. The disparities in treatment management were most pronounced in African American women, who were less often offered access to lifesaving treatments, such as brachytherapy. However, utilizing outreach programs and enhancing both provider competency and patient education initiatives has lead to an increase in the likelihood of African American and Hispanic women in vaccine compliance and adherence to regular check-ups. Our ongoing review continues to unveil racial and ethnic healthcare inequities and their impact on preventative care, patient-physician relationships, and patient education. The preliminary findings suggest that racial/ethnic disparities contribute to reduced adherence to recommended obstetric screenings and established effective treatment regimens. Additionally, the data shows that increased utilization of outreach programs and patient education helps mitigate these disparities. Citation Format: Daniela P. Blanco. Investigating racial and ethnic healthcare disparities in screenable gynecologic 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 C002.

Abstract C156: Examining the role of T cell responses in colorectal cancer sex disparities

Abstract Purpose: Persistent sex disparities in colorectal cancer (CRC) incidence and mortality exist and vary by race and ethnicity. The overarching goal of this proposal is to quantify differences in the CRC tumor immune microenvironment by sex in the Latino Colorectal Cancer Consortium (LC3). Methods: The LC3 is a consortium of pooled individual-level data from Latino participants diagnosed with CRC from California, Florida, and Puerto Rico. Biospecimens, epidemiologic data, and clinical outcomes were collected from each contributing study. DNA was extracted from tumor tissue and paired germline or normal tissue samples. Whole exome sequencing was performed using established protocols. Global genetic ancestry was estimated from whole exome sequence data. High-throughput T cell receptor (TCR) sequencing was used to estimate features of the T cell receptor (TCR) repertoire (e.g. abundance, clonality), and tumor-infiltrating lymphocyte (TIL) counts were obtained through pathology review. We evaluated differences in TCR abundance and TILs by sex using linear models for continuous measurements and generalized linear models for binary or count measurements. Primary analyses were unadjusted, and secondary analyses adjusted for age at diagnosis, stage at diagnosis, tumor location (right colon vs. left colorectum), and microsatellite instability (MSI) status. To examine how genetic ancestry modified the relationship between sex and T cell responses, we fit separate models with an interaction term between each genetic ancestry proportion variable (i.e. African, European, Native American) and sex, and assessed effect modification using a likelihood ratio test. Results: To date, 240 participants had TCR repertoire profiling and whole exome sequencing data generated. 52% were male, with a mean age of 58. 17% of participants had rectal tumors. With respect to Hispanic ethnic heritage or country of origin, 49% of participants were of Mexican descent, followed by 13% of Central or South American descent, and 10% were of Puerto Rican descent. Mean T cell abundance was 0.18 (standard deviation (SD): 0.16) and mean clonality was 0.05 (SD: 0.05). Further analysis is underway. Conclusions: This project leverages within-Latino genetic diversity to disentangle the contributions of sex and genetic ancestry to variability in immune function and to understand how this may further sex disparities in CRC. We anticipate that results from this analysis will provide insight on the relationship between the tumor immune microenvironment and sex disparities in CRC. Citation Format: Nicole C. Loroña, Ya-Yu Tsai, Daniel Sobieski, Eric Cockman, Stephanie L. Schmit, Jane C. Figueiredo. Examining the role of T cell responses in colorectal cancer sex 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 C156.

Abstract C060: Social isolation and secondary appraisal mediate the association between race and functional well-being among prostate cancer survivors

Abstract Background: Disparities in prostate cancer (PCa) incidence and mortality persist among African Americans. Functional well-being plays a crucial role in the prognosis and survival of PCa patients. Prior studies show the association between African American race and health-related quality of life among PCa patients. However, no studies have examined possible mediational processes linking race to functional well-being in this population. Objective: To assess the association between race and functional well-being and the mediating pathways of clinical, social determinants, and psychological factors in PCa patients. Methods: We used clinic-based cohort data of PCa patients treated with radical prostatectomy from April 2017 through September 2021. We measured functional well-being, socioeconomic factors, social stressors, perceived stress, and primary and secondary appraisal by self-report. We obtained clinical variables such as disease stage, prostate-specific antigen (PSA) levels, and comorbidities through electronic medical records. We first conducted a path analysis based on linear regression to test the direct association between race and functional well-being, adjusting for age, marital status, education level, employment status, and income. We concurrently examined the mediational pathways linking race to functional well-being via mediators, including stage, PSA, primary appraisal, secondary appraisal, perceived stress, and social isolation. Results: A total of 163 participants (48 African American, 115 White) with a mean age of 66.7 years (SD=6.31) were included in the study. Participants' mean score of functional well-being was 20.32 (SD=6.70; Range=0-28). Compared to White individuals, African American participants exhibited significantly lower levels of functional well-being (b [95% CI] = -3.09 [-5.48, -0.72]). Mediation analyses linking race to functional well-being revealed that, compared to Whites, African Americans displayed significantly lower levels of secondary appraisal (b [95% CI] = -1.45 [-2.85, -0.05]), which, in turn, were associated with higher levels of functional well-being (b [95% CI] = 0.27 [0.01, 0.53]). In addition, African Americans also displayed higher levels of social isolation (b [95% CI] = 0.55 [0.14, 0.97]), which were significantly associated with lower levels of functional well-being (b [95% CI] = -0.91 [-1.64, -0.17]). Both indirect effects of race → secondary appraisal → functional well-being (b [95% CI] = -0.39 [-0.88, -0.01]) and race → social isolation → functional well-being (b [95% CI] = -0.50 [-1.06, -0.02]) were significant and explained 12.6% and 16.2%, respectively, of the total relationship between race and functional well-being. Conclusion: Social isolation and secondary appraisal mediate the association between race and functional well-being among prostate cancer survivors. There is a need to understand the lived experiences of Black men and develop interventions that mitigate the impact of social barriers and psychological stressors on functional well-being to advance health equity. Citation Format: Fatimata Sanogo, Junhan Cho, Trista Beard, Chanita Hughes Halbert. Social isolation and secondary appraisal mediate the association between race and functional well-being among prostate 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 C060.

Abstract A039: Joint roles of proteomics and neighborhood-level social determinants of metastatic prostate cancer

Abstract Introduction: Striking racial disparities in prostate cancer (PCa) outcomes among American Black men warrant significant efforts to identify early predictors of lethal PCa, to avoid over- treatment of clinically favorable disease with minimal risk of progression. Building on prior work, this study examined independent and joint roles of proteomic markers and social determinants of health (SDOHs) in predicting prostate disease aggressiveness in a racially diverse cohort of men undergoing prostate biopsy. Methodology: A retrospective cohort of 300 men biopsied for prostate cancer was assembled at University Hospitals (UH) Seidman Cancer Center in Cleveland, Ohio between January 1, 2005-May 2022. An extensive medical chart review was performed to identify Black and White men undergoing transrectal ultrasound- guided biopsy that resulted in: (i) a negative biopsy in patients with a history of 1+ prior negative biopsy and no PCa history (“NEG”); (ii) a biopsy-detected PCa of Gleason sum 6 (“GL6”); and (iii) biopsy-detected PCa with nodal and/or distant metastases at initial cancer detection (“METS”). Prostate biopsy tissues were obtained on each patient, balancing 100 men per biopsy group, and balanced on race (1:1) within each biopsy group. Informed by findings from an untargeted analysis of the entire proteome of 60 patients (“Discovery cohort”), we conducted a targeted proteomics analysis of 16 protein markers generated from prostate biopsy tissue, using mass spectrometry, on n=240 patients (“Verification cohort”). Chi-square testing and Analysis of Variance (ANOVA) were used to assess associations between protein expression, neighborhood-level SDOHs, and biopsy group. Race-stratified analyses were performed to examine statistical interactions between study associations. Principal components (PC) analysis was used to identify protein markers that predicted the greatest variance in biopsy group. Multivariable logistic regression (MLR) was used to predict METS (vs. NEG and GL6, combined), as a function of PC-selected protein markers and census block-group level area deprivation index (ADI). Bonferroni correction was used to establish the threshold for the decision rule of statistical significance (alpha error 0.05/16 markers: p< 0.0031). Results: Median patient age was 68 years. Protein expression distributions were transformed into quintiles due to non-normality. Of 16 protein markers, 14 were significantly correlated with biopsy group, including PARP 1 and TGFB1, for which METS patients had the highest expression. ADI was strongly correlated with race but not protein expression. ADI was significantly higher in METS patients, followed by GL6 and lowest in NEG group; however no associations were seen for ADI with protein expression. Eight proteins were found to predict METS in PC and MLR analysis. Conclusions: These data support use of proteomics markers to predict a metastatic versus non-metastatic biopsy result. Next steps include deep exploration of proteome findings generated in the Discovery cohort, such as biological pathways. Citation Format: Jennifer Cullen, Tao Liu, Holly Hartman, Fangzhou Liu, Anood Alfahmy, Rini Ghosh, Ayesha Shafi, Julia Payne, Randy Vince, Lee Ponsky, Gregory MacLennan. Joint roles of proteomics and neighborhood-level social determinants of metastatic prostate 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 A039.

Abstract A054 Liver cancer mortality by structural disadvantage and race: An analysis of U.S. area-level factors

Abstract Introduction: Racial/ethnic and sex disparities in liver cancer (LC) mortality are well established; yet little is known about the contributions of county-level social risks on these disparities. Methods: We used U.S. national death certificate data from the National Center for Health Statistics (2018-2022) for LC mortality. County-level estimates of income inequality (ratio of household income at the 80th and 20th percentile), and median household income were obtained using the American Community Survey. Severe housing problems (percentage of households with 1 of 4 housing problems: overcrowding, high housing costs, lack of kitchen facilities, or lack of plumbing facilities) were abstracted from the U.S. Department of Housing and Urban Development (HUD) and U.S. Census Bureau. We estimated age-adjusted mortality rates (MR) and MR rate ratios (aRR) across metrics of county-level social risk grouped in quartiles overall and by race/ethnicity. Results: There were 101,088 liver cancer (LC) deaths from 2018-2022 (MR=6.16 per 100,000). Areas of highest county-level income inequality had 31% higher LC mortality compared to areas within the lowest quartile (aRR=1.31). LC MRs were 45% higher in counties with the lowest vs. highest median household income (aRR=1.45). Men and women in the highest quartile of severe housing problems had 29% and 22% higher LC MR (aRR=1.29 and 1.22, respectively), than those in the lowest quartiles. Men and women in the lowest quartile of median household income had 43% and 49% higher LC mortality than those in the highest median income quartiles (aRR=1.43 and 1.49, respectively). Within the highest quartile of income inequality, American Indian/Alaskan Native (AI/AN) persons had the highest LC mortality rates (MR=7.07), followed by Hispanic (MR=6.75), Black (MR=6.48), and Asian (MR=5.83) individuals. Similarly, in the highest quartile of severe housing problems, AI/AN persons had the highest LC mortality rate (MR 7.74), while Hispanic persons had 58% higher MR (MR 7.01), followed by Black (MR=6.19), Asian (MR=5.85) and White (MR=4.07) individuals. In the lowest median household income quartile, compared to White persons (MR=5.91), AI/AN persons had the highest MR (MR=8.86), and Hispanic persons had a 70% increase in mortality (MR=8.48). Among counties with the highest income inequality, compared to White persons (aRR=1.15), Black persons had an 80% increase in mortality (aRR=1.43). For those in the most concentrated quartile of severe housing problems, compared to White persons (aRR=1.07), AI/AN persons had an 80% increase in mortality (MR=1.34).Conclusion: All county-level indicators of highest social risk were associated with greater liver cancer mortality, but do not appear to fully account for racial and ethnic disparities in mortality. Therefore, place- based interventions are needed to address the role of county-level economic attributes in liver cancer mortality disparities. Citation Format: Jennifer K. McGee-Avila, Wayne R. Lawrence, Natalie Joe, Cameron B. Haas, Meredith S Shiels. Liver cancer mortality by structural disadvantage and race: An analysis of U.S. area-level factors [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 A054.

Abstract C074: Patient-provider communication and receipt of definitive prostate cancer treatment by race and rurality

Abstract Background: Patient-provider communication (PPC) is critical in treatment decisions for cancer care, and it is unknown if improved communication may mitigate disparities in prostate cancer (PCa) outcomes by race and rurality. We examined associations between PPC and treatment receipt among Black and White patients diagnosed with incident PCa in the North Carolina Louisiana Prostate Cancer Project. Methods: Near-equal numbers of Black (n=1130) and White (n=1128) participants were recruited by rapid case ascertainment from 2004-2009. PPC was assessed from the baseline survey, where participants rated their cancer provider using three subscales adapted from the Primary Care Assessment Survey for contextual knowledge of the patient (CK: knowledge of patient’s medical history, home/work responsibilities, their worries, and the patient as a person), and communication content (CMN: doctor’s thoroughness of questions, attention, explanations of health problems, instructions about symptoms, and advice/help in making care decisions), and interpersonal treatment (IT: amount of time spent, patience, friendliness, caring, concern, and respect for patient). First-course treatment was ascertained from medical records and defined as definitive (surgery or radiation) compared to non-definitive treatment (all other). We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for receipt of definitive treatment with logistic regression, adjusted for age at diagnosis, cancer aggressiveness, educational attainment, and marital status. Results: Black participants were diagnosed at younger ages (mean 62 vs. 64 years) with more aggressive disease (21% vs. 15%) and received surgery or radiation less often than White participants (73% vs. 77%). Median PPC subscales differed between Black and White participants (CK: 16 vs 15; CMN: 23 vs 24; IT: 22 vs 23), and between rural and urban participants (CK: 16 vs 16; CMN: 22 vs 24; IT: 21 vs 23). The odds of receiving definitive treatment was associated with positive communication content (1.12, 1.06-1.18), and interpersonal treatment (1.08, 1.02-1.14) among Black and White participants. Among urban participants, communication content (1.09, 1.05-1.15), and interpersonal treatment (1.09, 1.04-1.14) were associated with higher odds of definitive treatment. Among rural participants, higher communication content was associated with increased odds of receiving definitive treatment (OR 1.15, 95%CI: 1.04-1.28). We did not observe associations for contextual knowledge with the odds of receipt for definitive treatment subgroups. Conclusions: Positive patient-provider communication was associated with higher odds of receiving surgery/radiation in a historical cohort of PCa patients diagnosed between 2004-2009. Higher communication content and interpersonal treatment could promote uptake of contemporary guideline-based treatment recommendations for PCa. Future research will assess the validity and reliability of the communication subscales via annual follow-up questionnaires and associations with cancer-specific survival. Citation Format: Jeanny H Wang, Bria Carmichael, Shaun Jones, Hung-Jiu Tan, Deshira D. Wallace, Jennifer L. Lund, Lixin Song, Jeannette T. Bensen, Eboneé N. Butler. Patient-provider communication and receipt of definitive prostate cancer treatment by race and rurality [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 C074.

Abstract B127: Providers and survivors’ perspectives on affordability challenges for gastrointestinal cancer Black and White patients living in socioeconomically disadvantaged US states

Abstract Background: Affordability challenges for gastrointestinal (GI) cancer care may be numerous and complex in socioeconomically disadvantages states of the southern US, like Alabama (AL) and Mississippi (MS). Given that a large share of the African American US population lives in the southern US, these challenges may be contributing to observed racial disparities in GI cancer. Methods: Semi-structured interviews were conducted with purposefully selected AL and MS GI cancer providers, other staff, and survivors. Interview guides were developed based on access to care conceptual frameworks to identify barriers and facilitators to surgical and overall cancer care along 5 domains: Availability, Accessibility, Affordability, Acceptability, and Accommodation. Transcripts were analyzed by 3 coauthors using an inductive thematic and content analysis qualitative approach with NVivo 12 Plus software. Intercoder agreement was reached at 91%. This analysis focuses on the Affordability domain. Results: Providers (N=27) were 11 surgeons, 4 medical and radiation oncologists, 1 primary care provider, 6 nurses, and 5 patient navigators, 22% practiced in rural areas, 78% in urban areas. Survivors (N=36) were 44-87 years of age, 42% female, 70% white, 30% African-American, 53% colorectal, 19% pancreatic, 28% esophageal cancer. Providers and survivors discussed affordability challenges at the patient and system level. Patient-level challenges were: 1) High cost burden besides payments to providers (e.g., transportation, ostomy bags, nutritional supplements, non-antineoplastic drugs, feeding tubes, deductibles), and 2) Spending priorities outside of health care (e.g., patients prioritizing what to spend limited incomes on, which bills to pay). System-level affordability barriers included: 1) Care impacted by insurance processes (e.g., delays due to preauthorization or hospital out-of-network, surgery scheduled around deductible), and 2) Logistical burdens to access resources to help patients afford care (e.g., applying for grants). Two additional themes emerged from the providers’ interviews only: 1) Added costs due to scarcity of quality medical services (e.g., cost of repeating imaging procedures that were of poor quality), and 2) Poverty making it unfeasible to deliver guideline-concordant care (e.g., providers unable to provide recommended radiation treatment if patients need to travel long distances and have no money for gas). One more theme emerged from the survivors’ interviews only related to the burden of a confusing billing system (e.g., repeat billing for the same doctor). Conclusions: Many affordability-related challenges exist for the care of GI patients from disadvantaged states of the Deep South, and impact survivors and providers’ decision making about treatment and other needs. Future research should quantify the extent of these challenges and determine how they contribute to observed racial disparities in GI cancer surgery and other treatment. Citation Format: Maria Pisu, Nataliya V. Ivankova, Jessica Morgan, Yu-Mei M. Schoenberger, Nathan C. English, Burkely P. Smith, Ivan I. Herbey, Courtney Williams, Bayley A. Jones, Wendelyn M. Oslock, Daniel I. Chu. Providers and survivors’ perspectives on affordability challenges for gastrointestinal cancer Black and White patients living in socioeconomically disadvantaged US states [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 B127.

Abstract C004: Geopolitical and racial-ethnic trends of social vulnerability impact on oropharyngeal cancer mortality in the United States

Abstract Background: Oropharyngeal cancer (OPC) disparities exist across race-ethnicity, socioeconomic status, and sociobehavioral characteristics, as well as across different US regions. However, no investigations have interactively assessed these multilevel factors in the polarizing dynamics of region-specific political leanings and affiliated local policies. Methods: This retrospective ecological analysis used the NPCR-SEER database to evaluate county-area-summarized OPC age-adjusted annual mortality rates from 2000-2020 and the CDC-Social Vulnerability Index to assess 15 country-level SDH-vulnerability factors across all 3143 US counties. OPC-mortality rates for White, Black, and all race-ethnic groups were regionally stratified based on the Presidential and midterm (categorized into Democrat, Republican) electoral results of their counties’ respective states for each biannual cycle. These stratified mortality rates were regressed against socioeconomic status, minority-language status, household composition, housing-transportation SDH-vulnerabilities, as well as their total composite. Results: Across the US, yearly age-adjusted OPC-mortality mean rate was 2.94 deaths/100k patients from 2000 to 2020, with counties in Republican-leaning states having higher mortality rates (3.09/100k) compared to Democratic ones (2.72/100k). Mortality rates for Black patients were substantially higher in Republican-leaning areas (4.02/100k) than Democratic ones (3.08/100k). Non-Hispanic white patients also showed lesser increases in mortality in Republican-areas (3.04/100k) compared to Democratic ones (2.68/100k). With increasing total SDH-vulnerability, white populations in Republican-leaning areas suffered 0.27 age-adjusted added deaths/100k annually & 0.22/100k in Democratic ones, whereas black populations in Republican states suffered 0.51/100k annually & 0.34/100k in Democratic ones. For white patients, vulnerabilities in socioeconomic status primarily contributed to these mortality disparities in Democratic-leaning areas while both socioeconomic status and household composition vulnerabilities influenced disparities in Republican ones. For black patients, household composition primarily contributed in Democratic areas, whereas socioeconomic status, housing-transportation, and household composition-vulnerabilities all contributed equivalently in Republican ones. Conclusions: The results of this study showcase multilevel, population effects of political leanings and racial-ethnic demographic makeup in conferring SDH-derived OPC-mortality disparities over the past two decades. In particular, black OPC patients from Republican-leaning areas suffered exacerbated associations of SDH-vulnerability-related disparities driven by varied SDH-types. Through this nuanced modeling of the interactions between geopolitical and sociodemographic factors, targeted public health resource allocation and policy-lobbying can more specifically address local legislature through this systematic, large-data approach. Citation Format: David J. Fei-Zhang, Mary J. Xu, Jeffrey C. Rastatter, Anthony M. Sheyn, Daniel C. Chelius, Jill N. D'Souza, Sandeep Samant, Urjeet A. Patel, Caryn E. Peterson, Olga Garcia-Bedoya, Patrick D. Smith, Kate Klein, Mamoudou Maiga, Warren A. Kibbe, Lifang Hou. Geopolitical and racial-ethnic trends of social vulnerability impact on oropharyngeal cancer mortality in the United States [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 C004.

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

Abstract Background: Breast cancer (BC) disparities across race, socioeconomic status, and location, stress the need for equitable access to screening. In Virginia (VA), BC is a major concern, with Petersburg City having the highest mortality rate nationwide. Understanding social and structural factors’ impact on mammography accessibility may provide insights on effectively serving screening-eligible women in VA, particularly those facing greater BC burden. Also, analyzing data at the census tract level is vital for accurate accessibility assessment, mitigating county-level data skewing and disparity concealment. Objective: Examine how social and structural factors (e.g., demographics, transportation, area deprivation) influence mammography facility and unit distribution in VA. Methods: We utilized a comprehensive approach to compile and analyze data at the census tract level. We employed Poisson regression models to predict the number of mammography facilities and units within each tract. The predictor variables included the number of bus stops (VA Transit Routes & Stops GTFS), percentage of Black residents (American Community Survey), area deprivation index (ADI) scores (Neighborhood Atlas®), and vehicle ownership rates (American Community Survey), with the logarithm of the population of females aged 40-74 used as an offset to account for population size. Separate models were built for VA, our catchment area, urban areas within our catchment, and rural areas within our catchment. We exponentiated the model coefficients to obtain relative risks, indicating the multiplicative effect of each predictor on the outcome variable. Results: Study findings highlighted statistically significant disparities in the distribution of mammography facilities and units within VA. Higher ADI scores, indicating greater socioeconomic deprivation, were linked to fewer mammography units. This association was notable in our rural catchment areas (RR = 0.5492), indicating a 45.08% reduction in mammography units, in our catchment area overall (RR = 0.8653), a 13.47% decrease, and in urban catchment areas (RR = 0.8800), a 12.00% decline. Similarly, an increase in the percentage of Black residents was consistently associated with a decrease in the number of mammography units, with a relative risk of 0.8828 within our catchment area, indicating a 11.72% decrease, 0.8793 in urban areas within our catchment, signifying a 12.07% decrease, and 0.9391 statewide, showing a 6.09% decrease. Conclusions: These findings stress the need for targeted resource allocation to enhance mammography access. For instance, findings suggest a specific need for increased mammography units in rural areas and areas with higher percentages of Black women, like Petersburg (67.5% to 94.9% Black population depending on the tract), specifically within our catchment. Implications from these findings provide a unique opportunity to leverage the expertise of residents, community leaders and local representatives to identify where additional resources can be allocated. Citation Format: Bianca D. Owens, Jinlei Zhao, Katherine Y. Tossas. Toward breast health equity: Insights into mammography access across Virginia’s social and structural landscape [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C181.

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

Abstract Background: Breast cancer (BC) disparities across race, socioeconomic status, and location, stress the need for equitable access to screening. In Virginia (VA), BC is a major concern, with Petersburg City having the highest mortality rate nationwide. Understanding social and structural factors’ impact on mammography accessibility may provide insights on effectively serving screening-eligible women in VA, particularly those facing greater BC burden. Also, analyzing data at the census tract level is vital for accurate accessibility assessment, mitigating county-level data skewing and disparity concealment. Objective: Examine how social and structural factors (e.g., demographics, transportation, area deprivation) influence mammography facility and unit distribution in VA. Methods: We utilized a comprehensive approach to compile and analyze data at the census tract level. We employed Poisson regression models to predict the number of mammography facilities and units within each tract. The predictor variables included the number of bus stops (VA Transit Routes & Stops GTFS), percentage of Black residents (American Community Survey), area deprivation index (ADI) scores (Neighborhood Atlas®), and vehicle ownership rates (American Community Survey), with the logarithm of the population of females aged 40-74 used as an offset to account for population size. Separate models were built for VA, our catchment area, urban areas within our catchment, and rural areas within our catchment. We exponentiated the model coefficients to obtain relative risks, indicating the multiplicative effect of each predictor on the outcome variable. Results: Study findings highlighted statistically significant disparities in the distribution of mammography facilities and units within VA. Higher ADI scores, indicating greater socioeconomic deprivation, were linked to fewer mammography units. This association was notable in our rural catchment areas (RR = 0.5492), indicating a 45.08% reduction in mammography units, in our catchment area overall (RR = 0.8653), a 13.47% decrease, and in urban catchment areas (RR = 0.8800), a 12.00% decline. Similarly, an increase in the percentage of Black residents was consistently associated with a decrease in the number of mammography units, with a relative risk of 0.8828 within our catchment area, indicating a 11.72% decrease, 0.8793 in urban areas within our catchment, signifying a 12.07% decrease, and 0.9391 statewide, showing a 6.09% decrease. Conclusions: These findings stress the need for targeted resource allocation to enhance mammography access. For instance, findings suggest a specific need for increased mammography units in rural areas and areas with higher percentages of Black women, like Petersburg (67.5% to 94.9% Black population depending on the tract), specifically within our catchment. Implications from these findings provide a unique opportunity to leverage the expertise of residents, community leaders and local representatives to identify where additional resources can be allocated. Citation Format: Bianca D. Owens, Jinlei Zhao, Katherine Y. Tossas. Toward breast health equity: Insights into mammography access across Virginia’s social and structural landscape [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C181.

Abstract C165: Interrogating the Tumor and Immune Microenvironment of Endometrial Cancers Among a Diverse Cohort of Cases

Abstract Endometrial cancer (EC) is the sixth most common gynecological malignancy, with an increasing incidence worldwide over the last two decades. African American women are more likely to be diagnosed with endometrial cancer than Caucasian women. Unfortunately, African American women are more frequently diagnosed with high-grade EC, which occurs 2-3 times more often compared to their white and Hispanic counterparts. Additionally, African American women have higher mortality rates from EC than Caucasian women, highlighting a significant cancer disparity among these patients. Uterine EC disparities are induced by complex ecosystems composed of cellular niches with distinct genotypes, phenotypes, and spatial transcriptomic landscapes. In estrogen-dependent EC tumorigenesis, the endometrium undergoes uncontrollable proliferation, progressing from normal to atypical hyperplasia and ultimately to carcinoma. The heterogeneity of EC tumors complicates therapeutic targeting, rendering EC a challenging disease to cure. This study aims to investigate the genetic and transcriptomic features found in the tumor microenvironment of African American patients with EC. Previous research has shown that the molecular classification of EC tumors can be categorized as estrogen-driven, hypermutant, microsatellite instable, or lacking a specific molecular profile. Current models do not adequately reflect the oncogenic origin and pathological progression in patients. The cohort of EC cases includes primary, metastatic, and normal tumor tissues classified as Uterine Endometrial Adenocarcinoma, along with two Serous Papillary cases with varying tumor grades (low to high grade). Spatial transcriptomics and whole exome sequencing were performed on these samples. Spatial transcriptomics will identify the alterations in gene expression and the spatial landscape of the cell neighborhoods driving tumor heterogeneity. Whole exome sequencing will provide insight into the germline and somatic variants present in EC, offering a deeper understanding of the potential genetic drivers in African American patients. The genes expressed across the EC tumor landscape are implicated in cell proliferation, epithelial- mesenchymal transition, DNA damage response, and immune response. The analysis will also show the transition of normal to malignant endometrium harboring high tumor mutational burden and microsatellite instability when comparing paired samples. This comprehensive approach aims to elucidate the genetic and transcriptomic underpinnings contributing to the disparities observed in African American patients with EC, ultimately informing better-targeted therapies and improving outcomes. Citation Format: Danyelle Paine, John Carpten. Interrogating the Tumor and Immune Microenvironment of Endometrial Cancers Among a Diverse Cohort of Cases [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 C165.