Cancer Registry Research Articles

Abstract A057: Superfund sites and cancer risk: Cluster analysis in Puerto Rican municipalities between 2010 and 2020

Abstract Introduction: Living within proximity to hazardous waste (superfund) sites can pose an increased risk of exposure to chemicals of concern, including cancerogenic substances. Per- square mile, Puerto Rico has a high density of contaminated sites, including the designation of 19 superfund sites by the Environmental Protection Agency across the archipelago. Understanding how living within proximity to superfund sites can help recognize communities that are at greater health risks, such as increased cancer risks. Objectives: Identify clusters and outliers for all types of cancer, to assess ecological risk, by the presence of superfund sites across Puerto Rico. Methods: All types of cancer were recorded and provided by the Puerto Rico Central Cancer Registry for the period of 2010-2020. This data was summarized by municipalities (n=78). Cancer cases in each county were aggregated and divided by population in 2020 to show prevalence of cases. Using geographical information systems (ArcGIS), a Local Moran’s I was run to identify potential municipalities that have clusters; location with similar high (hot spots) or low values (cold spots) and outliers; locations with dissimilar values from their surrounding neighbors. A layer representing municipalities with superfund sites was also applied to the map to see if there was a relationship between living in a superfund site and cancer risk. This study was approved by UPRCCC IRB Protocol #2023-11-124. Results: Between 2010 and 2020, a total of 114,560 diagnosis occurred for all types of cancer in PR, from which 48.06% accounted for females and 51.93% for males, with breast and prostate as the primary cancer sites, respectively. Our analyses showed one hotspot and three cold spots with statistically significant differences from their neighboring municipalities. One hotspot was in Canovanas (p=0.03) which has a superfund site related to pharmaceutical chemicals. The three coldspots were in Cataño (p=0.04), Trujillo Alto (p=0.04), and Guánica (p=0.03). Additionally, four high and low outliers were identified. Across the municipalities, in the lower outliers Vega Alta (p=0.04), Corozal (p=0.002) are the only ones with current Superfund sites. Cabo Rojo (p=0.002) and San German (p=0.006) are included in the list of higher outliers, which are places with superfund sites. However, Hormigueros (p=0.03), and Arroyo (p=0.03), are also in this category. Conclusion: The results identify the key cancer clusters and outliers across municipalities in comparison to neighboring municipalities on the island. Results show municipalities with and without Superfund sites as part of the higher outliers list, which additional research could help establish other contributing factors. Further analysis is needed to consider what factors affect the clusters such as age range, type of cancer, and presence of other environmental contaminants in the area. Acknowledgements: This research was supported by award 1R25CA240120-01 (Cancer Prevention & Control Research Training Program) from the National Cancer Institute. Citation Format: Sailing JT Tang, Nancy R. Cardona, Ana P. Ortiz. Superfund sites and cancer risk: Cluster analysis in Puerto Rican municipalities between 2010 and 2020 [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 A057.

Abstract PR001: A comparison of modeling approaches to assess the interplay of social, behavioral, and environmental factors on lung cancer racial disparities

Abstract Purpose: While risk factors for lung cancer incidence are well established, our understanding of factors driving an increased risk of lung cancer among Black/African American populations remains incomplete. Methods: We assembled data from five U.S. lung cancer case-control studies matched on race, gender and age: the Southern Community Cohort Study, the Inflammation, Health, Ancestry and Lung Epidemiology study, the Northern California Lung Cancer Study, three Detroit area lung studies, and the NCI-Maryland Lung Cancer Study. Incident lung cancers were ascertained from state and regional cancer registries or National Death Index mortality records. Social, behavioral, and environmental factors were ascertained by in-person interviews or mailed-in questionnaires. Participant's residential addresses were geocoded and area-level area deprivation and environmental justice variables were linked at the census block. We evaluated interactions between known lung cancer risk factors and race using multilevel logistic regression analyses and novel tree-based approaches to identify potential factors contributing to racial disparities. Tree-based approaches included a conditional matched classification tree analysis designed to detect complex interactions, as well as a specialized partially recursively induced structured moderation (PRISM) analysis to study variation in disparity in lung cancer risk across levels of educational status. Results: Among 5,829 lung cancer cases and 10,671 controls (64% self-identified Black/African American and 36% White), the average age was 60 years, 50% were female, and 24% had less than a high school education. Conditional logistic regression models fit after imputation of missing data identified increased risk of lung cancer associated with personal history of cancer, family history of lung cancer, current smoking status, smoking duration, smoking pack-years, and higher neighborhood deprivation; whereas, reduced lung cancer risk was associated with higher education and increased BMI. Similar patterns were observed among Black/African Americans only, with the addition of secondhand smoke exposure. Assessment for interactions with race identified significant interactions between race and body mass index (BMI) (p-value < 0.0001), PM2.5 (p= 0.010) and gender (p=0.001) and lung cancer risk. A conditional matched classification tree analysis identified both increased and decreased risk subgroups defined by multi-way interactions of similar variables that were identified as significant main effects in the conditional logistic regression analysis. Smoking pack-years and BMI were identified as the most important determinants of heterogeneity of disparity in lung cancer risk across educational levels in our study population. Conclusions: The use of both traditional and novel tree-based based approaches provide approaches for identifying factors contributing to racial disparities. Future studies should assess the interplay of lung cancer risk factors to inform development of targeted interventions. Citation Format: Melinda C. Aldrich, Chen Zhao, Christine M Lusk, Lucie McCoy, James Jaworski, Michael Mumma, Catherine Pichardo, Michael Betti, John K Wiencke, Brid Ryan, Ann G Schwartz, Sunil Rao. A comparison of modeling approaches to assess the interplay of social, behavioral, and environmental factors on lung cancer racial 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 PR001.

Abstract A027: Ethnic variations in breast cancer risk factors distribution in Guam, HIPIMR study

Abstract Background: Guam has significant ethnic disparities in breast cancer incidence, with rates varying from 46.7 per 100,000 among Asian women to 137.5 per 100,000 among Micronesian women. Incidence rates for Filipino, CHamoru (indigenous people), and White women are 59.8, 94.0, and 121.9 per 100,000, respectively (2013-2017). The Hawai‘i and Pacific Island Mammography Registry (HIPIMR), a collaborative effort between the University of Hawai‘i Cancer Center and the University of Guam Cancer Research Center, collects health and breast imaging data to enhance early cancer detection tailored to the unique ethnic profiles of women in Hawai‘i and Guam. This study aims to identify the distribution of breast cancer risk factors among different ethnic groups in women undergoing screening in Guam. Differences in the prevalence of risk factors may explain variations in incidence patterns. Methods: This study included 1,413 women undergoing mammography screening at FHP Health Center in Guam, from November 2023 to May 2024. The risk factors were classified as follows: BMI (≥25), age of menarche (≤13), age of first pregnancy (≥30), number of live births (≤1), age of menopause (≥55), and family history of first-degree relatives. The robust Poisson method was used to estimate prevalence ratios (PR) of risk factors among ethnic groups, adjusted for age and education. Asians were used as the reference group due to their lowest incidence rates. Furthermore, the total risk score was calculated by summing all the risk factors. ANOVA was used to test the differences in average risk scores among different ethnic groups. Results: All ethnic groups had significantly higher prevalence of being overweight or obese compared to Asian women. The prevalence ratios were highest for Micronesians (PR=1.73, 95% CI: 1.40, 2.13) and CHamoru (PR=1.55, 95% CI: 1.27, 1.90). CHamoru women had the highest rates of breast cancer family history (PR=1.74, 95% CI: 1.19, 2.54). However, CHamoru women had a lower prevalence of having a small number of live births (PR=0.39, 95% CI: 0.24, 0.65) and an older age at first birth (PR=0.83, 95% CI: 0.71, 0.96) when compared to Asian women. There was a significant difference in average score among ethnic groups (P<.001). CHamoru women had significantly higher score (2.35) than Filipino (2.08) and Asian (2.00) women. Conclusion: Our study reveals disparities in risk factors across ethnic groups, consistent with the Guam Cancer Registry's reports of high breast cancer rates among Micronesian and CHamoru women. This project is ongoing, with the aim of linking our data with the Guam Cancer Registry. This linkage will enable us to identify breast cancer cases among participants and compare risk factors across different ethnic groups for women with and without breast cancer. Acknowledgement: This research was funded by the National Cancer Institute: The University of Guam/University of Hawaii Cancer Center Partnership to Advance Cancer Health Equity, Grant U54CA143728 (University of Guam, YCP)/Grant U54CA143727 (University of Hawaii Cancer Center). Citation Format: Gian Paras, Su Bin Jin, Rose Grino, Cabrini Aguon, John Shepherd, Grazyna Badowski. Ethnic variations in breast cancer risk factors distribution in Guam, HIPIMR study [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 A027.

Abstract B177: Association between ethnicity and ovarian cancer tumor characteristics in Asian Americans in California

Abstract Background: Ovarian cancer is often associated with poor survival given that most patients are diagnosed at advanced stages when treatment is less effective. The disease is also very heterogeneous, consisting of various histologic subtypes that each have distinct epidemiologic and pathologic profiles. Given that some studies have noted ethnic-specific disparities in ovarian cancer survival when the Asian American population is disaggregated and certain tumor characteristics are associated with more favorable outcomes, we examined the relationship between Asian ethnic subgroup and ovarian cancer disease presentation. Methods: We included a total of 31,230 non-Hispanic White and Asian/Pacific Islander ovarian cancer cases diagnosed between 1996 and 2020 from the California Cancer Registry. Multivariable logistic regression with odds ratios (ORs) and 95% confidence intervals (CIs) was used to examine the likelihood of being diagnosed with tumors of a certain stage, grade, and histologic subtype, for each Asian ethnic subgroup compared to non-Hispanic Whites. Demographic and socioeconomic factors were considered in the analyses. Results: Most, but not all, Asian ethnic subgroups were less likely to be diagnosed with advanced stage ovarian cancer and more likely to be diagnosed with clear cell ovarian cancer compared to non-Hispanic Whites. For South East Asians, the odds of having advanced stage tumors were 43% lower than non-Hispanic Whites (OR=0.57, 95% CI 0.41-0.79) and the odds of having clear cell tumors were almost 200% higher than non-Hispanic Whites (OR=2.97, 95% CI 1.92-4.61); only South Asians did not show lower odds of an advanced stage tumor diagnosis (OR=1.06, 95% CI 0.86-1.29) and higher odds of a clear cell tumor diagnosis (OR=0.93, 95% CI 0.63-1.37). Conclusion: There are clear differences in ovarian cancer disease presentation when each Asian ethnic subgroup is examined separately with South Asians constituting the only subgroup who did not show a lower likelihood of an advanced stage diagnosis and a higher likelihood of a clear cell diagnosis when compared to non-Hispanic Whites. Given that tumor stage and histologic subtype are considered important prognostic factors for ovarian cancer, identifying the underlying factors that may contribute to being diagnosed with certain tumor characteristics could provide clues to help us improve the survival of this highly fatal malignancy. Citation Format: Alice W. Lee, Jenny Chang, Sannia Siddiqui, Argyrios Ziogas, Robert E. Bristow. Association between ethnicity and ovarian cancer tumor characteristics in Asian Americans in California [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 B177.

Abstract B148: Prevalence of Multimorbidity Among Patients with Newly Diagnosed Cancer at a Safety-Net Health System

Abstract Background: Multimorbidity (MM) presents challenges for cancer care and may require coordination between oncologists and primary or specialty care providers. Nevertheless, U.S.-based studies of MM among cancer patients have mostly been conducted in non-Hispanic White and insured populations, which limits understanding of strategic care planning and resource allocation among more diverse populations. Therefore, we aimed to assess the prevalence of MM among adults with newly diagnosed cancer at a large, racial/ethnically diverse safety-net health system. Methods: We used electronic health record and cancer registry data from JPS Health Network, an urban safety-net health system in North Texas. Our eligible population included patients ≥18 years of age diagnosed with first primary cancer in 2016 – 2020 (excluding in situ cases), whose diagnosis or first-course cancer treatment was received at JPS. Our outcomes of interest were MM (≥2 chronic conditions) and severe MM (≥3 chronic conditions) based on 30 chronic conditions defined by the Centers for Medicare & Medicaid Services with up to a 2-year lookback period before cancer diagnosis. We assessed overall and sub-group specific (age group, sex, and race/ethnicity) prevalence of MM and severe MM. We estimated prevalence differences (PD) and 95% confidence intervals between groups using pairwise comparisons with Bonferroni correction. Results: Our study population comprised 5,019 newly diagnosed adult cancer patients. The median age was 58 years and the majority were females (51%), racial/ethnic minorities (59%), uninsured (51%), and overweight or obese (69%). The most common cancer types were breast (13%), lung (12%), and colorectal (11%). Nearly half (45%) were diagnosed with advanced stage cancer. A high proportion of cancer patients had MM (79%) and severe MM (62%). The most common conditions were hypertension (55%), anemia (36%), hyperlipidemia (31%), diabetes (27%), and depressive mood disorders (22%). MM increased by age: 56% among patients aged 18 – 39 years, 78% among patients aged 40 – 64 years, and 91% among patients aged ≥65 years. A higher proportion of males had MM (PD: 6.0% [95% CI: 3.8%, 8.3%]) and severe MM (PD: 7.5% [95% CI: 4.9%, 10%]) compared with females. By race/ethnicity, Non-Hispanic Black patients had the highest prevalence of MM (PD: 8.1% [95% CI: 4.3%, 12%]) and severe MM (PD: 11% [95% CI: 6.7%, 16%]) compared with the lowest prevalences among Hispanic patients. Conclusions: We observed a high prevalence of MM and severe MM among adult cancer patients, particularly among patients aged ≥45 years and non-Hispanic Black patients. Our estimates were >15% higher than prior studies that included mostly non-Hispanic White adult cancer survivors with higher socioeconomic status. Our findings provide insight about the burden of MM among racially diverse cancer patients with low socioeconomic status, which may inform resource allocation and care coordination initiatives to manage MM. Citation Format: Anand B. Singh, Yan Lu, Aaron W Gehr, Kalyani Narra, Bhavna Tanna, Jolonda Bullock, Rachel J. Meadows. Prevalence of Multimorbidity Among Patients with Newly Diagnosed Cancer at a Safety-Net Health System [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 B148.

Abstract C126: Disparities in time-to-treat insured patients with newly diagnosed cancer in a vertically integrated healthcare system

Abstract Purpose. After a cancer diagnosis, delays in initiating treatment may impact treatment response, disease progression, adverse health events, and overall survival. Race and socioeconomic status (SES) may be factors in initiating cancer treatment. Complicating this issue is the lack of insurance or underinsurance. Thus, the purpose of this study was to assess the influence of race/ethnicity and SES on time to treatments for insured patients diagnosed with cancer in a vertically integrated healthcare system. Methods. We conducted a cross-sectional nested study within a cohort of patients diagnosed with cancer between 2010 and 2018 from Kaiser Permanente Southern California (KPSC), a vertically integrated healthcare system. Patients of all ages and all cancer anatomical sites were included. Patients with in-situ cancers were excluded, with no other exclusion criteria. The main independent variables are race/ethnicity and SES, and the dependent variable is time to initial treatment. All information was pulled from the KPSC Cancer Registry, including race/ethnicity, and treatments (surgical; radiation; chemotherapy; immunotherapy; hormonal). SES was categorized into quintiles based on geocoded expected income using home addresses from census tract data. For each patient, we calculated days from diagnosis to first treatment. Results. We identified 153,270 patients of all ages with cancers of all anatomical sites diagnosed between 2010 and 2018, of which 125,943 received treatment. When examining racial groups, the mean time to treatment for White, Black, Hispanic, Asian/PI, and other patients was 42.5, 52.6, 44.3, 44.1, and 41.2 days, respectively. For White patients, mean time to treatment was 42.4 days in the lower 20% income quintile and 42.7 days in the top 20% income quintile. For Black patients, mean time to treat was 53.9 days in the lower 20% income quintile and 52.8 days in the top 20% income quintile. For Hispanic patients, mean time to treat was 45.8 days in the lower 20% income quintile and 42.1 days in the top 20% income quintile. For Asian/PI patients, mean time to treat was 44.1 days in the lower 20% income quintile and 43.5 days in the top 20% income quintile. For other patients, mean time to treat was 51.4 days in the lower 20% income quintile and 39.2 days in the top 20% income quintile. Within each SES quintile, Black patients consistently started cancer treatment later than other racial/ethnic groups. Conclusion. We found minimal disparities in time to initial treatment based on SES in this vertically integrated system of care. Within each of the White, Black, and Asian racial groups, the difference in time to treatment between the highest and lowest SES groups was less than 2%. This difference was closer to 7% in Hispanic patients. Additional work is necessary to elucidate reasons why Black patients initiate cancer treatments later than other racial groups and if this affects recurrence or survival. Citation Format: Robert Cooper, Reina Haque, Andrea Young, Zimin Zhuang. Disparities in time-to-treat insured patients with newly diagnosed cancer in a vertically integrated healthcare system [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 C126.

Abstract C127: Patterns of mortality risk in insured patients with cancer by race/ethnicity and socioeconomic status in Southern California

Abstract Purpose. Several factors including, socioeconomic status (SES), access to screening and healthcare coverage, tumor biology, differences in disease management and care delivery in various healthcare settings, and implicit bias among healthcare providers contribute to mortality disparities in individuals with cancer. Further, health insurance is strongly associated with better survival. Previous studies that examined disparities in cancer mortality included patients with and without healthcare coverage, making it difficult to disentangle the effects of health insurance coverage from other SES factors. Thus, we evaluated the influence of race/ethnicity and geocoded SES on all-cause mortality in cancer patients with health insurance. Methods. We identified adults with health insurance coverage diagnosed with eight common cancers from 2009 to 2014 from the California Cancer Registry (stages I-IV) and followed them through 2017 (8 years maximum). Specifically, we identified those who lived in southern California counties. Patients had managed care, preferred provider organization, Medicare, Medicaid, dual Medicare and Medicaid, and other private insurance. We calculated person-year mortality rates by race/ethnicity and geocoded SES quintiles. Adjusted hazard ratios for the association between overall mortality and race/ethnicity and SES were estimated using Cox proportional hazards models accounting for other demographics, stage at diagnosis, and cancer treatments. Results. 164,197 adults were diagnosed with cancer originating from breast, prostate, lung, colon, skin melanoma, uterus, kidney, and bladder. For all racial/ethnic groups combined, the mortality rates from lowest to highest SES groups were 112.1/1000 PY (lowest); 100.2/1000 PY (lower-middle); 91.2/1000 PY (middle); 79.1/1000 PY (upper-middle); and 63.5/1000 PY (upper). These rates suggest that people with the lowest SES have a markedly increased mortality risk after cancer diagnosis even if they have health insurance. In multivariable analyses, those in the lowest SES group had a 40–78% increased risk of all-cause mortality compared to those in the upper SES group across all races/ethnicities. For example, within African Americans, the adjusted mortality risk was up to 61% higher (HR 1.61, 95% CI 1.41–1.83) in the lowest SES group compared to the highest SES group. Conclusion. This study suggests disparities in overall mortality risk after cancer diagnoses persist even in a cohort with health insurance, and that SES is an important driver of this disparity. Issues related to travel distance, access to transportation to cancer care facilities, and access to telemedicine may be magnified among those with lower SES during cancer care where optimal management becomes more complex. To potentially mitigate the effects of these social determinants, healthcare systems must either implement programs to support patients, or have partnerships with local community organizations to do so. All of this requires systems level support through social work, patient navigation, and cancer case management. Citation Format: Reina Haque, Amrita Mukherjee, Robert M. Cooper. Patterns of mortality risk in insured patients with cancer by race/ethnicity and socioeconomic status in Southern California [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 C127.

Abstract A038: Uncovering the role of social determinants of health in racial disparities in cancer incidence in Alabama

Abstract Purpose Black-White racial disparities have long been recognized in cancer incidence. National estimates may not reflect racial disparities in individual states. In Alabama (AL), a primarily rural underserved state, Black Americans are more often diagnosed with breast, prostate and colorectal cancer (CRC), with Black men more often diagnosed with lung cancer. Although rurality and area-level deprivation, as social determinants of health (SDoH), have been associated with cancer, their role in explaining racial disparities in cancer incidence remains unknown. We assessed racial disparities in breast, prostate, CRC and lung cancer incidence in AL. Methods We used the Alabama Statewide Cancer Registry (ASCR) to collect data on incident cases of breast, prostate, CRC and lung cancers diagnosed between January 1, 2010 and December 31, 2019. We categorized cases according to age group (0-14, 15-19, 20-24, 25-34, 35-44, 45-64, 65-84, ≥85 years), racial/ethnic group (non-Hispanic Black/White), rural-urban status (defined by AL Rural Health Association), and national area deprivation index (ADI) quartile (Q1-Q4) of census tract at diagnosis. For each combination of these variables, we calculated age-adjusted incidence per 100,000. We conducted bivariate descriptive analysis of incidence rates by race, and rural-urban status and ADI quartile stratified by race. Results Incidence of breast, prostate and CRC cancer was higher in Black versus White individuals (breast 143 vs 127; prostate 206 vs100; CRC males 57.2 vs 45.4, CRC females 42.7 vs 32.6). Lung cancer incidence was higher in Black males and White females (Black vs White: males 82.7 vs 77.6; females 36.9 vs 49.9). In all cancers, racial differences in incidence existed by rural versus urban status (breast Black 142 vs 144, breast White 131 vs 124; prostate Black 204 vs 207, prostate White 101 vs 99.4; male CRC Black 60 vs 55.3, male CRC White 47.7 vs 43, female CRC Black 43.5 vs 42.3, female CRC White 35.2 vs 30.2; male lung Black 84.5 vs 81.7, male lung White 85.1 vs 70.2, female lung Black 31.4 vs 40.1, female lung White 54.4 vs 45.6). In all cancers, racial differences in incidence also existed by ADI status (reporting Q1 vs Q4) [breast Black 190 vs 130, breast White 144 vs 118; prostate Black 269 vs 189, prostate White 109 vs 101; CRC male Black 64.2 vs 56.7, CRC male White 41.2 vs 49.7, CRC female Black 43.4 vs 43.5, CRC female White 29.5 vs 36.6; lung male Black 73.7 vs 91, lung male White 57.9 vs 97.6, lung female Black 41 vs 37.7, lung female White 40.8 vs 60.7]. Conclusions In AL, racial differences in incidence rates for each of the most common cancers exist overall and by key SDoH. Generally, Black individuals have higher rates of cancer, particularly those in rural and low ADI areas. Next, we will perform a decomposition analysis to decompose the Black/White differences in incidence into a portion explained and unexplained by rural-urban status and ADI. Ultimately, these results may inform interventions in a rural underserved state with a large Black population at higher risk of cancer. Citation Format: Mackenzie E. Fowler, Hayden Reeves, Melissa J. Smith, Geetanjali Saini, Mahak Bhargava, Ritu Aneja. Uncovering the role of social determinants of health in racial disparities in cancer incidence in Alabama [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 A038.

Abstract C019: Peripheral Absolute Lymphocyte Count and Breast Cancer Mortality among Racially Diverse Women

Abstract Background: Among patients with triple-negative breast cancer (TNBC), higher tumor infiltrating lymphocytes (TILs) are associated with increased overall mortality (OM) and breast cancer-specific mortality (BCSM). We previously found that low peripheral absolute lymphocyte count (ALC) is associated with increased OM and BCSM in a sample of mostly non-Hispanic White (NHW) patients with TNBC. Here, we investigated the association between low ALC and mortality (OM and BCSM) across different breast cancer subtypes and whether the association is potentially modified by race and ethnicity. Methods: We used the Oncoshare database, which links electronic medical records (EMRs) data to the California Cancer Registry (CCR), and assessed women diagnosed with stage I-III breast cancer between 2000-2017, who had at least one ALC measurement and treated at two healthcare systems in California. Patient and tumor characteristics were obtained from the CCR and laboratory testing from EMRs. Patients with metastatic disease and chemotherapy receipt after one year of diagnosis were excluded. Multivariable logistic models assessed factors associated with “low ALC” (<1 K/µL, ever vs. never). We applied Cox models to evaluate the association between “min ALC” (lowest ALC value after diagnosis) and OM and BCSM within each breast cancer subtype (Luminal A, HER2-enriched, and TNBC), and further explored the interaction between min ALC and race and ethnicity. All models adjusted for low absolute neutrophil count, demographics, and tumor features. Results: Among 10,750 women analyzed, the risk of “low ALC” was associated with TNBC vs Luminal A (odds ratio (OR) 1.22, p=0.0098), older age (OR 1.01 per year, p<0.001), higher grade (grade 3 vs. 1, OR 1.15, p=0.042), higher stage (stage III vs. I, OR 1.81, p<0.001), and public vs. private health insurance (OR 1.29, p<0.001). Cox models showed that higher min ALC was associated with lower OM across breast cancer subtypes (Luminal A: HR 0.37, HER2-enriched: HR 0.32, TNBC: HR 0.22; all p<0.001) and BCSM (Luminal A: HR 0.29, HER2-enriched: HR 0.23, TNBC: HR 0.19; all p<0.001). Interaction analysis showed that race and ethnicity modified the association between min ALC and OM (interaction-p <0.001) and BCSM (interaction-p < 0.001) in the overall cohort; compared to NHW women (HR 0.38, 95% confidence interval [0.34-0.43]), the association between min ALC and OM was stronger among Hispanic (HR 0.24, [0.18-0.33]), Asian (HR 0.19, [0.14-0.25]), and Black (HR 0.21, [0.13-0.35]) women. Similar results were observed for BCSM. Conclusions: Low peripheral ALC, a routinely measured clinical lab result, strongly predicts higher BCSM and OM across breast cancer subtypes, beyond TNBC. The association between min ALC and BCSM/OM was stronger among Black and Asian women vs. NHW women, suggesting that maintaining normal ALC during breast cancer treatment may reduce BCSM and OM, especially for women from racial and ethnic minoritized groups. Future research should investigate differences in ALC, immune response, and BCSM in diverse populations. Citation Format: Candice N. Thompson, Ingrid Luo, Mina Satoyoshi, Lidia Schapira, Esther M. John, Summer S. Han, Allison W. Kurian. Peripheral Absolute Lymphocyte Count and Breast Cancer Mortality among Racially Diverse Women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C019.

Abstract A046: Disparities in cancer burden and survival rates in persistent poverty communities in Los Angeles County

Abstract Objective: Persistent poverty census tracts (PPT) are those with socioeconomic challenges where prolonged economic disadvantages may significantly influence health outcomes. This study examined the cancer burden and survival patterns in PPTs compared to non-PPTs in Los Angeles County (LAC) considering disparities by race/ethnicity and stage at diagnosis. Methods: A comprehensive analysis of 2012-2021 Cancer Registry data examined age-adjusted incidence rates (AAIRs) and survival rates for lung, colorectal, liver, stomach, breast, and prostate cancers, which are the Norris Comprehensive Cancer Center priority cancers. Cancer-specific data were further stratified by racial/ethnic group and stage at diagnosis, and compared across residents in PPTs, non-PPTs, and LAC overall. Survival rates were calculated using the Kaplan-Meier method and differences between groups were assessed by log-rank tests. Results: PPTs in LAC were characterized by a higher proportion of racial/ethnic minorities, lower education levels, and higher unemployment compared to non-PPTs. In all racial/ethnic groups combined, AAIRs for lung, breast, and prostate cancers were lower in PPTs than non-PPTs, whereas AAIRS for liver and stomach cancers were higher in PPTs, with no differences for colorectal cancer. Disparities emerged when considering race and ethnicity, with higher lung cancer AAIRs among Non-Hispanic White (NHW) and Black/African American (B/AA) PPT residents compared to non-PPT, while AAIRs for lung and colorectal cancers were lower among Hispanic/Latino (H/L) PPT residents compared to non-PPTs. Breast and prostate cancer AAIRs remained lower in PPTs than in non-PPTS regardless of racial/ethnic group. Patients in PPTs exhibit significantly lower five-year survival rates across all studied cancers, except stomach, compared to non-PPTs. B/AA patients showed the lowest five-year survival rates for lung and colorectal cancer, with patients in PPTs experiencing significantly lower rates than patients in non-PPTs regardless of disease stage (p < 0.01 for early- or late-stage). Liver cancer survival rates were notably low, especially for H/L and Asian/Pacific Islander patients in PPTs, with five-year survival for late-stage cancer at 4.9% (95%CI: 2.8-8.5) and 5.4% (95%CI: 2.1-14.0), respectively. Patients in PPTs with late-stage breast or prostate cancer exhibited significantly lower 5-year survival (compared to non-PPTs) across all race/ethnicities, with B/AA patients experiencing the lowest survival rates for breast cancer and NHW patients experiencing the lowest survival rates for prostate cancer. Conclusions: Cancer outcomes for patients in PPTs were significantly poorer compared to those in non-PPT communities. The notably lower AAIRs in PPTs versus non-PPTs for more screen-able cancers, such as breast, prostate, and early-stage colorectal cancer, suggest a need for greater efforts to provide access to routine screening in areas affected by persistent poverty, though other causes cannot be ruled out. Citation Format: Miriam L Gorbatov, Joel S. Mendez, Myles Cockburn, Laura K. Thompson, Lihua Liu, Jennifer Tsui, Kali Zhou, V. Wendy Setiawan, Chanita Hughes-Halbert, Mariana C. Stern. Disparities in cancer burden and survival rates in persistent poverty communities in Los Angeles County [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 A046.

Abstract C034: Impact of survivorship care plans on self-reported health and functional well-being

Abstract Introduction: Cancer survivors have varying physical, psychosocial, and informational needs. Organizations such as American Society of Clinical Oncology have developed survivorship care plans (SCP) for cancer screening, treatment side effect management, and care coordination. There is a need to better understand SCP utilization among underserved and diverse patient communities. Methods: Adults ages 18+ years with breast or colorectal cancer diagnosed between 2019 and 2021 were recruited from the Greater Bay Area Cancer Registry. Participants completed a 30-minute survey about their survivorship plans, quality of life, health behaviors, and social support. Analysis: Overall comparisons between groups were evaluated with chi-square tests. Associations between demographic characteristics and receipt of any type of survivorship plan were evaluated with univariate binomial logistic regression models, and associations between receipt of any type of survivorship plan and health/well-being outcomes were assessed using univariate ordinal regression models. Multivariable models will be built using relevant variables. Results: Participants (n=872) were on average 59 years (range=24-95) and mostly female (70.2%). Participants had either breast (41.3%) or colorectal cancer (58.7%). Participants were American Indian/Alaska Native (AIAN) (1.0%), Asian American (18.2%), NH Black (12.8%), NH White (38.0%), LatinX (29.0%), and Native Hawaiian or Pacific Islander (0.8%). Receipt of a SCP was reported by 258 (29.6%) participants, 328 (37.6%) had another type of post-treatment guide provided to them, and 224 (25.7%) were not offered any kind of survivorship plan. There were no differences in race/ethnicity, nativity status, non-English language spoken at home, marital status, or educational attainment between those who received any kind of survivorship plan vs. no plan. Being female was associated with 40% lower odds of receiving any kind of survivorship plan (OR=0.60, 95%CI=0.42-0.87). Being on public insurance was also associated with lower odds of receiving a survivorship plan than being on private insurance (OR=0.59, 95%CI=0.43-0.81). Receipt of a survivorship plan was associated with 52% higher odds of reporting a higher level of overall current health (OR=1.52, 95%CI=1.14-2.02) compared to those who did not receive any plan. Receiving a survivorship plan was also associated with higher odds of reporting a higher level of ability to work (OR=1.58, 95%CI=1.18-2.11), more fulfilling work (OR=1.69, 95%CI=1.27-2.23), ability to enjoy life (OR=1.55, 95%CI=1.17-2.06), ability to sleep well (OR=1.35, 95%CI=1.03-1.79), and contentment with their current quality of life (OR=1.51, 95%CI=1.14-1.99). Conclusion: Receipt of any survivorship plan was associated with higher levels of self-reported current overall health and measures of functional well-being. Women, as well as people on public insurance, are less likely to receive a survivorship plan, highlighting disparities in survivorship care planning for these populations. Citation Format: Aly M. Cortella, Katarina Wang, Debby Oh, Niharika Dixit, Zinnia Loya, Kathie Lau, Michelle Wadhwa, Chris Duffy, Salma Shariff-Marco, Kristan Olazo, Vlad Honcharov, Marika Dy, Urmimala Sarkar, Scarlett Lin Gomez. Impact of survivorship care plans on self-reported health and functional well-being [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 C034.

Abstract A055: Neighborhood Deprivation and Oncotype DX Recurrence Scores among Black and White Women: the interplay between race, place, and tumor biology

Abstract Background: Breast cancer (BC) mortality disparities have persisted between non-Hispanic Black (NHB) and non-Hispanic White (NHW) women, even those diagnosed with prognostically favorable BC. The Oncotype Dx Recurrence score (ODX) test is a gene expression panel that can be used to identify estrogen receptor (ER)-positive BC with aggressive tumor biology. Previous studies have found that Black women are more likely to have higher ODX scores than White women and socioeconomic factors (e.g., area-level income, urbanicity) are associated with higher ODX scores. We explored race-stratified associations of neighborhood deprivation and ODX to help elucidate the interplay between race, place, and tumor biology. Methods: Neighborhood deprivation was examined in relation to ODX scores among 7,100 NHB and NHW women diagnosed with ER-positive BC (stage I–IIIA and ≤3 lymph nodes) between 2010–2017, followed through 2022, and identified by the Georgia Cancer Registry. The neighborhood deprivation index (NDI) was used to characterize neighborhood deprivation. Principal component analysis of block group-level American Community Survey data representing six domains (poverty, income, occupation, housing, employment, and education) was used to derive the NDI composite score. NDI was assessed in quartiles and linked to patient residence at the time of diagnosis. Three cut-points were used for ODX scores (low <18, intermediate 18–30, high ≥31). Prevalence ratios (PR) and 95% confidence intervals (CI) were calculated to determine the prevalence of ODX scores based on NDI by race/ethnicity. Results: This study included 1651 NHB and 5449 NHW women. There were 4152 (58.5%) with a low ODX Score and 514 (7.2%) with a high ODX score; 2773 (39.1%) resided in the least deprived neighborhoods (NDI quartile 1) and 928 (13.1%) resided in the most deprived neighborhood (NDI quartile 4). Living in the most deprived neighborhood was associated with an increased prevalence of high ODX scores in models adjusted for age, race, and stage (PR=1.23, 95% CI 0.97–1.62). Stratification by race showed associations were stronger among NHW women (PR=1.41, 95% CI 1.02–1.95) but null among NHB women (PR= 0.91, 95% CI 0.59-1.39). Overall, NHB women were more likely to have a high ODX compared to NHW women. The highest prevalence of a high ODX was observed among NHB women living in the least deprived neighborhoods (PR=1.92, 95% CI 1.34–2.77). Conclusions: Findings from this study suggest that living in a deprived neighborhood increases the prevalence of high ODX among NHW women but not NHB women. NHB women in the least deprived neighborhoods had the greatest prevalence of high ODX scores. The intersection between race, neighborhood, and tumor biology needs more nuanced investigation of the social-structural drivers of disparate BC outcomes. Citation Format: Jasmine M. Miller-Kleinhenz, Lauren E. Barber, Lindsay J. Collin, Maret L. Maliniak, Demetria J. Smith-Graziani, Lauren E. McCollough. Neighborhood Deprivation and Oncotype DX Recurrence Scores among Black and White Women: the interplay between race, place, and tumor biology [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 A055.

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

Abstract Background: Despite advances in medical knowledge and treatment, disparities in breast cancer outcomes persist along demographic and socioeconomic lines. To quantify these disparities, the Area Deprivation Index (ADI) emerges as a powerful metric. It offers insights into the interplay between neighborhood socioeconomic status and breast cancer outcomes by encompassing factors pertaining to income, education, employment, and housing quality. There have been limited studies to examine the role of race and neighborhood disadvantage on specific breast cancer outcomes. Kentucky also faces a unique burden as it has the third highest breast cancer mortality rate in the United States. This study aims to examine the association between neighborhood socioeconomic disadvantage, and breast cancer outcomes including receipt of surgical treatment, radiation therapy, chemotherapy, and breast cancer-specific survival. While also examining how any associations are modified by race and ethnicity among Kentucky breast cancer patients. Methods: We conducted a retrospective cohort analysis using data from the Kentucky Cancer Registry (KCR) among breast cancer patients diagnosed between 2010 and 2017 with follow-up data through December 31, 2022. The KCR dataset was then linked with census tract data to examine ADI. We conducted consecutive multilevel logistic regression for binary outcomes and Cox Proportional hazard models using SAS (version 9.4, SAS Institute, Inc., Cary, North Carolina, USA) for time-to-event of breast cancer survival. Results: Women in the most disadvantaged quartile (4th quartile) were more likely to be Non-Hispanic Black (NH-Black), Appalachian residents, current tobacco users, divorced and using government insurance. Compared to women in the least disadvantaged neighborhoods (1st quartile) women living in the most disadvantaged neighborhoods (4th quartile) were 50% more likely to die from breast cancer (HR: 1.50, 95 CI: 1.28-1.76). Women in the most disadvantaged neighborhoods (4th quartile) were also more likely to be diagnosed at later stages (aOR:1.26, 95 CI:1.13-1.42). These associations were all observed after adjusting for age, race, tobacco use, marital status, insurance status, family history, and residence in Appalachia. Conclusions: Women living in areas of greater disadvantage had significantly increased odds of late-stage diagnosis and risk of breast cancer death regardless of race suggesting that neighborhood-level factors contribute to breast cancer disparities. Our findings underscore the need for neighborhood-level interventions to improve cancer outcomes. Citation Format: Breyanna E. Walker, Elinita Pollard, Justin Moore, Sydney Howard, Pamela Hull, Kathleen O'Connor, Samantha Jones, Lovoria Williams, Adebola Adegboyega, Veronica Jones, Eric Durban, Xiaoqin Wang, Wendi Owen. Investigating the role of race/ethnicity on the association between neighborhood deprivation and breast cancer outcomes among Kentucky breast cancer patients years 2010-2022 [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A058.

Abstract A012: Motherhood and chemotherapy receipt: a population-based study of young women with breast cancer

Abstract Background: Young women, ages 18–39 years, with breast cancer are disproportionately impacted by pronounced socioeconomic disparities, a burden that is exacerbated among mothers as they face competing demands in managing cancer and caregiving responsibilities. Although previous analyses identified 64% of young women with breast cancer as mothers at diagnosis and qualitative studies have reported conflicting views on chemotherapy receipt among mothers, their treatment patterns are not well-defined. Additionally, whether having multiple or young children influences treatment patterns due to increased demands is also unknown. We aimed to determine the association between motherhood or offspring characteristics and chemotherapy receipt by age, stage, race and ethnicity. Methods: We retrospectively linked the Texas Cancer Registry to live birth certificates from 1995 to 2016. Analyses comprised a multicultural, population-based sample of 1,783 mothers who had delivered at least one live birth at diagnosis and 946 young women without children diagnosed with microscopically confirmed invasive breast cancer, between January 1, 2013, and December 31, 2016, at ages 18–39 years. Chemotherapy receipt was based on first course of treatment. Multivariable logistic regression estimated odds ratios (OR) with 95% confidence intervals (CI): model 1 (motherhood), model 2 (number of children), and model 3 (number of young [ages <13 years] children). Model 1 was adjusted for age, stage, insurance, Yost index, receipt of radiation therapy, and surgery type. Models 2 and 3 were adjusted for these covariates plus age of children, number of young children (model 2) and number of children (model 3). Heterogeneity was assessed using single- referent ORs and relative excess risk due to interaction (RERI), and multiplicative models with stratified ORs and likelihood ratio tests (pLRT). Results: Of the 2,729 women, 1,565 (73%) received chemotherapy. There was no association between motherhood (OR=1.00, 95% CI [0.82,1.21]), number of children (OR=0.94, 95% CI [0.72,1.22]), or number of young children (OR =1.07, 95% CI [0.72,1.54]) and chemotherapy receipt. Decreased odds for chemotherapy receipt were observed by race: Non-Hispanic (NH) Black women without children had an ORstratified of 0.57 (95% CI [0.37,0.89]) and NH White mothers had an ORsingle-referent of 0.71 (95% CI [0.51,0.93] and ORstratified of 0.69 (95% CI [0.53,0.95]) compared to NH White women without children (RERI=-0.63, 95% CI [-1.86,-0.09]; pLRT=0.05). Among mothers, those ages >35 years with 2+ young children had an OR of 0.45 (95% CI 0.21,0.98; pLRT=0.39) compared to those with children ages ≥13 years. Conclusion: We found no differences in overall chemotherapy receipt, but observed decreased receipt by race and age, independent of stage, possibly due to unmeasured systemic and clinical factors. Future studies examining detailed tumor characteristics and treatment information could inform targeted interventions to support young women with breast cancer throughout their cancer trajectories. Citation Format: Quiera S Booker, Caitlin C Murphy, Sarah E Messiah, Folefac D. Atem, Bijal S Balasubramanian. Motherhood and chemotherapy receipt: a population-based study of young women with breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A012.

Abstract C157: Unraveling Early Onset Disparities and Determinants: A Two-decade Analysis of Colorectal Cancer Trends in Texas

Abstract Background: Colorectal cancer (CRC) remains a significant public health concern in the United States, with substantial disparities observed in survival rates and age at diagnosis among different racial and ethnic groups. In Texas counties bordering Mexico, which have predominantly Hispanic populations, show higher CRC diagnoses. Hispanic patients generally exhibit lower screening rates, higher mortality, and late-stage diagnosis compared to non- Hispanic counterparts. Understanding the factors behind these disparities is crucial for developing targeted interventions to improve outcomes and reduce the burden of CRC. Methods: Using data from the Texas Cancer Registry, a retrospective study examined CRC survival rates and age at diagnosis among 235,076 patients of various racial and ethnic groups in Texas from 1995 to 2016. The association between Race and ethnicity and survival time over two periods (1995-2005 and 2006-2016) was analyzed using Kaplan-Meier survival analysis and pairwise comparisons. Additionally, the effects of Race and ethnicity on age at diagnosis were examined for the same periods using Welch ANOVA and posthoc comparisons. Results: Persistent survival disparities were observed, with Black patients facing the lowest median survival times across both periods (1995-2005 and 2006-2016). Hispanic patients showed significantly lower median survival rates compared to their non-Hispanic counterparts. Comparisons between races showed significant differences in median survival time between the two periods (1995-2005 and 2006-2016). Black: Hispanic patients showed no significant improvement in survival time between the periods. Significant improvements in survival time were observed in Black: non-Hispanic, White: Hispanic, and White: non-Hispanic patients. Lastly, the mean age at diagnosis depended on the ethnicity of the patient, with Hispanic patients displaying an earlier onset of CRC compared to non-Hispanic equivalents. Hispanic ethnicity was associated with an earlier onset of CRC compared to non-Hispanic counterparts. Conclusion: Geographic and ethnic disparities significantly influence CRC outcomes in Texas. Hispanic populations in border counties face increased risks due to lower screening and socioeconomic challenges. The rising incidence of early-onset CRC, particularly among younger, socioeconomically disadvantaged, and minority populations, necessitates targeted public health interventions to improve screening, early detection, and treatment access. Addressing these disparities is crucial to enhancing CRC survival rates and reducing mortality across diverse demographic groups. Citation Format: Tyler J Torres, Elias Arellano Villanueva, Yossef Alsabawi, Manish Tripathi. Unraveling Early Onset Disparities and Determinants: A Two-decade Analysis of Colorectal Cancer Trends in Texas [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 C157.

Abstract A019: Dietary polyphenols and the risk of lung cancer in the prospective Southern Community Cohort Study

Abstract Objective: We examined total polyphenol intake and intake of polyphenol classes and subclasses with risk of lung cancer in the Southern Community Cohort Study (SCCS). Background: In the US, lung cancer incidence is highest in the south and among underrepresented and underserved populations. Diet is strongly associated with the risk of developing cancer, including lung cancer. Polyphenols, commonly found in plant-based foods, are biologically active compounds with antioxidant and other properties. Several population-based studies have found that higher intakes of some polyphenols were associated with a decreased risk of lung cancer, but this has not been studied in predominantly Black or low-income populations, nor have polyphenol classes and subclasses been studied extensively. Methods: The SCCS is a large, prospective cohort study established in 2002-2009 to study the causes of cancer disparities in 12 southern states. Two-thirds of the cohort are Black and over 50% have an annual household income less than $15,000. Diagnosis of lung cancer was obtained from state cancer registries and death records. Polyphenol intakes derived from a food frequency questionnaire assessing diet in the previous year were adjusted for total energy intake and grouped into quintiles. Cox proportional hazard models adjusted for potential confounders were used to estimate hazard ratios and 95% confidence intervals to determine associations between polyphenol intakes and lung cancer risk. Multiple imputation was performed to account for participants with incomplete information. After exclusions, analyses included 71,569 participants, including 1,484 incident lung cancer cases. Results: Total polyphenols were associated with a statistically significant increased risk of lung cancer (HR, 1.25; 95% CI, 1.04-1.51; P=0.01, comparing the highest to lowest intake quintile). Additionally, three subclasses (phenolic acids, hydroxycinnamic acids, alkylmethoxyphenols) were associated with a similarly statistically significant increased risk of lung cancer. Most associations were similar between Black and White individuals but were largely only statistically significant among Black participants and there was no significant interaction by race. In stratified analysis by smoking status, the associations were primarily present among current and former smokers. Caffeinated or decaffeinated coffee consumption was a major contributor to intake of total polyphenols, phenolic acids, hydroxycinnamic acids, and alkylmethoxyphenols for SCCS participants overall. Conclusions: Total polyphenols and three subclasses of polyphenols were unexpectedly associated with increased lung cancer risk. Further studies should be conducted to evaluate whether some polyphenols may have an adverse effect on lung carcinogenesis, particularly among individuals who smoke. Citation Format: Grace Xu, Heather Munro, Danxia Yu, Qi Dai, Martha Shrubsole. Dietary polyphenols and the risk of lung cancer in the prospective Southern Community Cohort Study [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 A019.

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 A132: Missed Opportunities? Regional availability of Low Dose CT lung cancer screening facility locations in the year prior to diagnoses: A descriptive comparison of American Indian and Non-Hispanic White lung cancer patients in North Carolina

Abstract INTRODUCTION American Indians (AI) have much higher incidence rates of lung cancer (LC) compared with non-Hispanic Whites (NHW) in the US. While low-dose computed tomography (LDCT) screening facilitates early detection of lung cancer, it is unknown how available LDCT screenings are to racially and geographically diverse populations in North Carolina (NC). To address this gap in knowledge, we conducted a descriptive study to characterize incident LC cases among AIs and NHWs, the distance from their location at diagnosis to the nearest LDCT screening facility and explored whether distance was associated with late-stage LC diagnoses. Methods Data were obtained from the Cancer Information and Population Health Resource (CIPHR), which comprise data from NC Central Cancer Registry (CCR) as well as public and private health insurance claims for the state. We identified ZIP codes and dates of rendered service for facilities providing LDCT by searching through claims from 2015-20. In addition, we identified incident LC cases among AIs and NHWs aged ≥18 years, from 2015-19. We assembled lists of LDCT facilities that existed in the year prior to each incident LC case. We calculated the minimum centroid to centroid distance to all facilities. Clinical attributes included age at diagnosis, sex, histology, stage at diagnosis, and rurality as measured by Rural Urban Commuting Area. Risk ratios were calculated for late-stage LC diagnoses across a range of thresholds for patient’s distance to nearest LDCT screening facility for AIs and NHWs. Results We identified 388 AI and 26,867 NHW incident LC cases in NC between 2015-20. Compared to NHWs, the median age at diagnosis for AIs was 5 years younger (AI: 65 vs. NHW: 69); more frequently male (AI: 54% vs NHW: 51%); and almost twice as likely to reside in rural areas (AI: 52% vs. NHW: 28%). There were no differences in late-stage LC diagnoses (AI: 54% vs. NHW: 52%). For distance (in miles) to the nearest LDCT screening facility, the median [Interquartile range] was twice as high for AIs (9.9 miles [0.8, 16.30]) compared to NHWs (5.3 miles [0, 12.1]). Among NHWs, there were statistically significant associations between distance and late-stage LC diagnosis at the shortest distance threshold of 5 miles (RR=1.04; 95%CL: 1.02, 1.07) through the threshold of 30 miles (RR=1.10 95%CL: 1.05, 1.15). There was no association across any distance threshold among AI lung cancer patients. Conclusions The large difference in accessibility of LDCT screening was not strongly associated with metastatic lung cancer diagnoses, possibly because so many patients were diagnosed late, reflecting poor early detection across all populations. We found that 80% of AIs with LC lived more than 10 miles away from LDCT screening facilities. This geographic distance may increase difficulty accessing cancer care geographically, and contribute to suboptimal LC screening rates. If efforts are to be made to increase early detection and improve survival, accessibility needs to be addressed on different dimensions. Citation Format: Bradford E. Jackson, Marc Emerson, Daniel Carrizosa, Chris Baggett, Lisa Spees, Joel Begay, Ana Salas, Yadurshirni Raveendran, Tomi Akinyemiju, Rachel Denlinger-Apte, Stephanie Wheeler, Ronny Bell. Missed Opportunities? Regional availability of Low Dose CT lung cancer screening facility locations in the year prior to diagnoses: A descriptive comparison of American Indian and Non-Hispanic White lung cancer patients in North Carolina [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 A132.

Abstract B152: Joint Associations of Neighborhood Socioeconomic Status and Education on the Incidence of Colorectal Cancer: The Multiethnic Cohort Study

Abstract Background: Colorectal cancer (CRC) is the 3rd most diagnosed cancer worldwide. When considered separately, both neighborhood- and individual-level SES exposures have been associated with CRC incidence. However, the joint associations of neighborhood- and individual-level SES on CRC incidence have not been examined. Methods: In a prospective study of 153,725 Multiethnic Cohort (MEC) participants (24,764 African American, 44,447 Japanese American, 34,974 Latino, 11,511 Native Hawaiian, and 38,029 White participants) recruited from predominantly Los Angeles County, California (CA), and Hawaii (HI), we examined the joint association of neighborhood SES (nSES) and individual-level education with CRC incidence (CA: 2,519, HI: 2,210 cases). Education, other demographics, and health behaviors were self-reported in the baseline questionnaire (1993-1996). CRC diagnosis was determined via linkages with state cancer registries. nSES was derived using a composite score based on 1990 US Census block group data and assigned to geocoded baseline addresses. Our joint SES measure included four categories: high nSES (quintiles 4-5) and high education (> high school), high nSES and low education (≤ high school), low nSES (quintiles 1-3) and high education, and low nSES and low education. State-specific hazards ratios (HR) for CRC incidence were estimated for joint SES categories. Cox regression adjusted for age at cohort entry, CRC family history, polyp history, obesity, diabetes, diet, alcohol, smoking, physical activity, and NSAID, multivitamin, and hormone therapy use. Subgroup analyses were conducted by sex, race, and ethnicity. Results: For HI MEC participants, compared to individuals with high nSES and high education, risk for CRC was highest among those with low nSES and low education (HR=1.27; 95% CI:1.11-1.45) followed by high nSES and low education (HR=1.25; 95% CI:1.12-1.41), and low nSES and high education (HR=1.17; 95% CI: 1.03-1.31). This pattern of association was observed across sex but differed across race and ethnicity (p-heterogeneity=0.04). The overall pattern of association was observed among White participants in HI. However, for Japanese American individuals in HI, compared to those with high nSES and high education, risk for CRC was highest for low nSES and high education (HR=1.29; 95% CI:1.09-1.53) and high nSES and low education (HR= 1.28; 95% CI; 1.10-1.50). For Native Hawaiian individuals, compared to those with high nSES and high education, CRC risk was highest for those with low nSES and low education (HR=1.70; 95% CI: 1.20-2.42). Associations were not statistically significant between the joint SES measure and CRC risk in CA (HRs: 0.92-0.97). Conclusion: Among MEC participants in HI, CRC risk varied with the joint measure of nSES and education across racial and ethnic groups. These findings emphasize the importance of considering the joint associations of neighborhood- and individual-level SES in understanding racial and ethnic disparities in CRC. Citation Format: Catherine Walsh, Meera Sangaramoorthy, Songyi Park, Sung-shim (Lani) Park, Gertraud Maskarinec, Lynne Wilkens, Christopher Haiman, Anna Wu, Salma Shariff-Marco, Loic Le Marchand, Iona Cheng. Joint Associations of Neighborhood Socioeconomic Status and Education on the Incidence of Colorectal Cancer: The Multiethnic Cohort Study [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 B152.

Abstract A010: Evaluating the aftermath of two major hurricanes and the COVID-19 pandemic on lung cancer Incidence in Puerto Rico: An interrupted time-series analysis

Abstract Background - In recent years, events like hurricanes and the COVID-19 pandemic have significantly impacted the daily lives and the healthcare system in Puerto Rico (PR). We aimed to evaluate the effect of these disruptions on lung cancer incidence. Methods - An interrupted time-series analysis (ITSA) was conducted to assess the impact of hurricanes and the COVID-19 pandemic on lung cancer incidence trends. To achieve this, the data was modeled using first-order autoregression through Prais-Winsten AR(1) regression. Monthly lung cancer cases from 2012 to 2021 were obtained from the PR Central Cancer Registry database. The analysis was divided into three periods: 1) pre-hurricanes (January 2012-August 2017), 2) post-hurricanes (September 2017-March 2020), and 3) onset of COVID-19 lockdown restrictions (April 2020-December 2021). Additionally, we measured the impact of the events by comparing the change in cases with the expected cases in the absence of the disruptions. Results - A steady trend was observed in monthly overall lung cancer cases during the pre-hurricane period. Immediately after the two major hurricanes, there was an immediate decrease of 10.2 cases, representing a 16.1% decline compared to the expected lung cancer cases. During the post-hurricanes period, lung cancer cases exhibited a significant upward trend, eventually surpassing the expected number. However, another decline in lung cancer cases was observed with the onset of the COVID-19 lockdown restrictions, representing a 22.9% decline compared to the expected cases. This decline was followed by a significant upward trend of 0.67 cases per month until the end of 2021, once again surpassing the expected number of cases. Similar patterns were observed by age group and for late-stage cases. However, early-stage lung cancer showed a higher percentage difference at the start of the COVID-19 lockdown restrictions compared to the other groups and did not surpass the expected number of cases by the end of the study. Conclusion - Our results demonstrate the impact of hurricanes and the COVID-19 lockdown on lung cancer incidence in PR. These disruptions led to limited access to healthcare, particularly diagnostic and screening services, as evidenced by the decrease in lung cancer cases. Although lung cancer cases gradually returned to the expected levels in the absence of disruptions, the long-term effects of delayed diagnoses due to these events should be closely monitored. Citation Format: Tonatiuh Suárez-Ramos, Carlos Torres-Cintrón, Yisel Pagán-Santana. Evaluating the aftermath of two major hurricanes and the COVID-19 pandemic on lung cancer Incidence in Puerto Rico: An interrupted time-series analysis [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 A010.