Women's Circle Research Articles

Abstract IA-36: Fragmentation of care among Black women who have breast cancer and multiple comorbidities

Abstract Purpose: Black women newly diagnosed with breast cancer and who have multiple comorbidities at the time of cancer diagnosis require greater care coordination to simultaneously manage cancer care and other chronic conditions. Care coordination may be complicated when multiple clinicians from diverse disciplines are involved in managing care and are located in different health systems, defined as care fragmentation. Given that Black women are disproportionately burdened by comorbidities and breast cancer, we examined the degree of care fragmentation and care coordination experienced by this group from a health system and care team perspective using two population-based cohorts. Methods: We analyzed data from two separate cohorts of Black women diagnosed with breast cancer who had diabetes and/or cardiovascular disease. In the first study we used the Women's Circle of Health Follow-Up Study (n=228) to examine types of practice setting for first primary care visit and primary breast surgery, and, through medical chart abstraction, identified whether care visit was within or outside the same health system. In a separate study, we identified women from the SEER-Medicare database (n=3,420) diagnosed with breast cancer and used encounter claims to examine the complexity and composition of the clinical care team. Results: Care fragmentation was experienced by 79% of Black women in the Women's Circle of Health Follow-Up Study, and individual-level factors (age, health insurance, cancer stage, and comorbidity count) were not associated with care fragmentation (p>.05). In the SEER-Medicare cohort, the most common clinical care team composition was oncology with primary care (45%) followed by oncology, primary care, and medical subspecialty (26%). In the adjusted model, Black women were more likely to have a clinical care team of higher complexity if they had cardiopulmonary disease (OR: 1.74; 95% CI: 1.68, 1.81) or diabetes (OR: 1.69; 95% CI: 1.63,1.75) compared with hypertension only. Women were also less likely to have a complex care team if they were dual Medicaid-Medicare covered (OR: 0.56; 95% CI: 0.48, 0.65) compared with Medicare only, rural residents (OR: 0.54; 95% CI: 0.42, 0.65) compared with urban, or diagnosed with stage III cancer (OR: 0.59; 95% CI: 0.47, 0.75) compared with stage I. Conclusion: The majority of Black breast cancer survivors with comorbidities see multiple clinicians from diverse disciplines and in different health systems, illustrating high care coordination demands and care fragmentation. However, the impact of the health system and care team on care outcomes still need to be assessed, and this includes care transitions into survivorship. To address cancer care disparities experienced by Black women, future research should consider examining clinician's perspectives regarding roles and responsibilities for chronic disease management and cancer care, as well as address care fragmentation across diverse healthcare delivery settings. Citation Format: Michelle Doose, Janeth I. Sanchez, Dana Verhoeven, Veronica Chollette, Joel C. Cantor, Jesse J Plascak, Michael Steinberg, Chi-Chen Hong, Kitaw Demissie, Elisa Bandera, Jennifer Tsui, Sallie J. Weaver. Fragmentation of care among Black women who have breast cancer and multiple comorbidities [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-36.

Abstract PO-119: Association of body mass index with pathological complete response after neoadjuvant chemotherapy in a population-based cohort of Black breast cancer patients

Abstract Purpose: Pathologic complete response (pCR) to neoadjuvant chemotherapy is associated with improved event-free and distant recurrence free survival in women with stage II or III breast cancer (BC). While there is strong evidence that obesity is associated with reduced BC survival, its role on pCR after neoadjuvant chemotherapy among BC patients is unclear. Moreover, data regarding the association of pre-treatment BMI with response to neoadjuvant chemotherapy in Black women – who have the highest obesity prevalence than any other racial/ethnic groups and 40% worse survival outcomes compared to White women – are lacking. The purpose of this study was to examine the association of pretreatment BMI and subsequent pCR after neoadjuvant chemotherapy in Black BC patients. Methods: Data were abstracted from medical records of 131 Black BC patients who received neoadjuvant chemotherapy in the Women's Circle of Health Follow-up Study, a population-based cohort study of Black BC survivors in New Jersey. pCR was defined as absence of detectable invasive cancer in the breast and lymph nodes (ypT0/Tisand ypN0) at the time of surgery (noninvasive residual BC, i.e. DCIS was allowed). Tumor subtypes were defined by hormone receptor (HR, i.e., ER, PR) and HER2 status. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs) of the association between pretreatment obesity (BMI ≥30 kg/m2)vs. non-obese (<30 kg/m2), and pCR, after adjusting for covariates. The association with BMI in a continuous scale was also evaluated. Results: Mean age at BC diagnosis was 50±10.7 years, mean BMI was 31.4±7.1 kg/m2, and 69 (52.7%) women were obese. In terms of tumor subtype, 53 (40.5%) were HR+/HER2-, 40 (30.5%) were HER2+, and 38 (29.0%) were triple negative. All patients received standard chemotherapy regimens and 8.4% of patients had dose reductions due to toxicity. Almost one-third achieved pCR (38 [29.0%]). Consistent with prior evidence, our findings were suggestive of decreased odds of pCR among obese (OR 0.88, 95% CI: 0.39-1.99) compared to non-obese women, although the risk estimate was not statistically significant. We observed similar findings with BMI modeled as a continuous variable (OR 0.85, 95% CI: 0.62-1.15 per 5-unit increase in BMI). No substantive differences were observed by tumor subtype (HR+/HER2: OR 0.80, 95% CI: 0.44-1.46; HER2+: OR 0.93, 95% CI: 0.58-1.47; and triple negative BC: OR 0.86, 95% CI: 0.47-1.57 per 5-unit increase in BMI). Conclusion: Our findings suggest that among Black women, higher BMI is inversely associated with achieving pCR. However, risk estimates did not reach statistical significance, possibly due to small sample size. Alternatively, as shown by our and others' prior work, BMI may be an inadequate measure of adiposity, particularly in this population. Future work should evaluate the impact of body fat distribution and body composition on pCR response to neoadjuvant chemotherapy among Black women after a breast cancer diagnosis. Citation Format: Coral Omene, Saber Amin, Nur Zeinomar, Bo Qin, Dhanya Chanumolu, Adana A.M. Llanos, Chi-Chen Hong, Kitaw Demissie, Elisa V. Bandera. Association of body mass index with pathological complete response after neoadjuvant chemotherapy in a population-based cohort of Black breast cancer patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-119.

Abstract PO-205: Association of pre-diagnostic cigarette smoking and alcohol consumption with mortality in Black breast cancer survivors

Abstract Purpose: There is limited data about how lifestyle factors are associated with breast cancer (BC) prognosis in Black women, as the majority of evidence is based on studies conducted in White women. Given the 40% increased risk of death for Black women diagnosed with BC compared to White women, and the differences in prevalence of these modifiable risk factors between racial groups, better understanding how these factors, among others, are associated with survival in Black women is necessary to address existing cancer health disparities. The purpose of this study is to examine the association of pre-diagnostic cigarette smoking and alcohol consumption with survival in a cohort of Black breast cancer survivors. Methods: We studied 1895 women enrolled in the Women's Circle of Health Follow-up Study, a population-based cohort study of Black BC survivors in New Jersey enrolled within 10 months of diagnosis. Smoking and alcohol consumption history, along with information on potential covariates were collected during in-person interviews. We evaluated the association between pre-diagnostic cigarette smoking (status, duration, intensity, pack-years) and alcohol consumption (average number of total drinks/week) and all-cause and BC- specific mortality using Cox Proportional Hazards models and Fine and Gray competing risk models, adjusted for confounders. Results: During 12,019 person years of follow-up (median 5.9, maximum: 14.8 years), we observed 290 deaths, of which 175 were breast-cancer related deaths. Currently smoking, particularly in regular drinkers, was associated with worse survival. Compared to never smokers, current smokers had 56% increased risk for all-cause mortality (hazard ratio (HR):1.56, 95% confidence interval (CI): 1.17-2.07), and this was higher for current smokers with pack years above the median (HR: 1.80, 95% 1.30-2.5). While the multiplicative interaction of smoking and alcohol was not statistically significant, compared to non-regular drinkers who never smoked, current smokers who regularly drank had a 72% increased risk of all-cause mortality (HR:1.72, 95% CI: 1.11-2.67), whereas the association for current smokers that were not regular drinkers was less substantial (HR: 1.41, 95% CI: 0.95-2.09). We observed similar associations for BC-specific mortality, with a 60% increased risk of BC-specific mortality (HR: 1.6, 95% CI: 0.92-2.78) for current smokers who regularly drank, but no association for current smokers who were not regular drinkers. We did not observe an association for smoking and BC-specific mortality or for alcohol consumption and all-cause or BC-specific mortality. However, self-reported alcohol drinking was low in this population (only 12% of women reported consuming >3 drinks/week). Conclusion: In a population based-study of Black BC survivors, smoking prior to a BC diagnosis was associated with worse overall survival, particularly in women who also regularly consumed alcohol. Citation Format: Nur Zeinomar, Saber Amin, Bo Qin, Yong Lin, Baichen Xu, Dhanya Chanumolu, Coral O Omene, Karen S Pawlish, Kitaw Demissie, Christine Ambrosone, Chi-Chen Hong, Elisa V Bandera. Association of pre-diagnostic cigarette smoking and alcohol consumption with mortality in Black breast cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-205.

Motyw winy Heleny w tradycji epickiej i w dyskursie

The paper takes up the issue of Helen’s guilt for the outbreak of the Trojan war present in the Iliad and in the oral epic tradition. It puts forward a thesis that in order to blame others or to free themselves from blame epic heroes employ the typical in oral culture technique of conducting disputes. Like other characters in the Iliad, Helen, is also under constant social pressure which seeks to find her guilty and, in effect, to activate a mechanism of making a scapegoat of her. To defend herself, she risks self-accusations in order to make it impossible for other people to bring a charge against her. Helen cares about her good opinion in the Trojan society and particularly in the circle of women.

Abstract 869: Breast tumor gene expression in the mTOR pathway and clinicopathological characteristics in Black women and White women

Abstract Background: Aberrant activation of the mammalian Target of Rapamycin (mTOR) pathway is implicated in breast carcinogenesis and outcomes. Based on protein expression data, the activation could be heterogeneous by race, body fatness, and tumor clinicopathological characteristics. To understand potential impacts of mTOR pathway signaling in breast cancer, we evaluated the association of race and clinicopathological characteristics with gene expression of select mTOR pathway genes in breast tumors. Methods: Study participants were from the Women's Circle of Health Study (WCHS), complemented with samples from the Roswell Park Pathology Network Shared Resource (PNSR). Tumor tissue blocks were collected from 367 newly-diagnosed breast cancer cases (190 Black and 177 White women). Gene expressions of AKT1, EIF4EBP1, MTOR, RPS6KB2, TSC1 were quantitated using NanoString assays. Generalized linear models were performed to relate gene expression levels with demographic and clinicopathological variables. The regression coefficient (β) was converted to percentage difference. Additionally, we conducted an external validation of mTOR gene expression using data from The Cancer Genome Atlas (TCGA; N=332). Results: Study participants were mostly within the ages of 51 to 65 years old. Black women had lower expression levels of AKT1, MTOR, RPS6KB2 and TSC1 compared to White women. Black race vs White race was significantly associated with lower gene expression of AKT1 (-21.34%, 95% CI = -31.61%, -8.61%) and RPS6KB2 (-12.19%, 95% CI = -19.75%, -3.92%). The racial differences in expression levels of these two genes were consistent across luminal A, luminal B, HER2-enriched, and triple-negative subtypes. Higher tumor grade was associated with higher expression levels of EIF4EBP1 and RPS6KB2, but with lower expression of TSC1. In comparison to luminal A tumors, luminal B tumors had higher expression of RPS6KB2 (17.35%, 95% CI = 4.08%, 32.31%); whereas HER2-enriched (-23.66%, 95% CI= -41.73%, -1.00%) and triple-negative (-22.89%, 95% CI= -40.55%, -1.00%) had lower expression of TSC1. All these associations were unchanged after additionally adjusting for body mass index in a subset. Similarly, results from the TCGA data showed that in comparison to luminal A tumors, luminal B tumors had higher expression of RPS6KB2 (53.73%, 95% CI = 27.12%, 87.76%) whereas HER2-enriched had a lower expression of TSC1 (-26.66%, 95% CI = -43.45%, -4.88%) and triple-negative subtype had a lower expression of TSC1 (-17.30%, 95% CI = -50.68%, -3.05%). Conclusions: Variables such as race and breast cancer subtypes should be considered in studying the mTOR pathway genes in breast cancer tumors. Citation Format: Mmadili N. Ilozumba, Song Yao, Adana A. Llanos, Angela Omilian, Weizhou Zhang, Susmita Datta, Chi-Chen Hong, Warren Davis, Thaer Khoury, Christine B. Ambrosone, Ting-Yuan D. Cheng. Breast tumor gene expression in the mTOR pathway and clinicopathological characteristics in Black women and White women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 869.

Multilevel Risk Factors for Weight Change after Breast Cancer Diagnosis Among Black Women

Abstract Background: Weight gain after breast cancer diagnosis increases the risk of mortality. African American/Black breast cancer survivors are more likely to have excess body weight than their White counterparts, which may contribute to their higher mortality rate. Emerging evidence suggests that post-diagnosis weight gain may result from multilevel determinants. However, no study has investigated the multilevel characteristics among Black breast cancer survivors. Objective: To evaluate associations between individual-level factors and neighborhood social and built environment factors with weight change after breast cancer diagnosis among Black women. Methods: We evaluated associations of interest among 785 women enrolled in the Women's Circle of Health Follow-Up Study (WCHFS), a longitudinal study of Black breast cancer survivors in New Jersey. Weight change was primarily based on measurements at baseline and follow-up visits (Median: 10.3 and 23.2 mo. since diagnosis, respectively). Participants were grouped into categories of stable weight (52.4%), ≥3% weight loss (20.0%), and ≥3% weight gain (27.6%). Using multivariate- adjusted multinomial logistic regression and multilevel multinomial logistic regression, we evaluated relative risk ratios (RRRs) for associations between multilevel factors and post-diagnosis weight change category. Results: Black breast cancer survivors who were older at diagnosis, had higher household income, post-menopausal status, and higher baseline BMI were less likely to gain weight compared to women with stable weight. Former smoking, higher tumor stage, and chemotherapy were associated with increased relative risk of weight gain (e.g. RRR-chemo: 1.45, 95% CI: 1.01, 2.08). Black women residing in neighborhoods in the highest tertile for density of walkable destinations had a decreased relative risk of post- diagnosis weight gain (e.g. RRR-T3 highest density vs. T1 lowest: 0.39, 95% CI: 0.20, 0.75), while those residing in neighborhoods with higher density of fast food restaurants had increased relative risk of weight gain (RRR-T3 highest density vs. T1 lowest: 1.94, 95% CI: 1.23, 3.05). Conclusion: Both individual and neighborhood factors may influence the risk of weight gain among Black women after breast cancer diagnosis.

Neighborhood Social Environmental Factors and Breast Cancer Subtypes among Black Women.

The disproportionate burden of more aggressive breast cancer subtypes among African American/Black women may stem from multilevel determinants. However, data are limited regarding the impacts of neighborhood social environmental characteristics among Black women. We evaluated the association between neighborhood-level socioeconomic status (nSES) and breast cancer subtypes in the Women's Circle of Health and Women's Circle of Health Follow-up Study, which included 1,220 Black women diagnosed from 2005 to 2017 with invasive breast cancer. nSES at diagnosis was measured using NCI's census tract-level SES index. We used multilevel multinomial logistic regression models to estimate the association of nSES with breast cancer subtypes [triple-negative breast cancer (TNBC), HER2-positive vs. luminal A], adjusting for individual-level SES, body mass index, and reproductive factors. We tested for interactions by neighborhood racial composition. Compared with census tracts characterized as high nSES, the relative risk ratios (RRR) for TNBC were 1.81 [95% confidence interval (CI): 1.20-2.71] and 1.95 (95% CI: 1.27-2.99) for women residing in areas with intermediate and low nSES, respectively (P trend = 0.002). Neighborhood racial composition modified the association between nSES and TNBC; the highest relative risk of TNBC was among women residing in low nSES areas with low proportions of Black residents. Black women residing in socioeconomically disadvantaged neighborhoods may have an increased risk of TNBC, particularly in areas with lower proportions of Black residents. Places people live may influence breast tumor biology. A deeper understanding of multilevel pathways contributing to tumor biology is needed.

Sisterhood and the 4th wave of feminism: An analysis of circles of women in Poland

This article aims at contributing to the discussion on sisterhood in the theoretical framework of the feminist debate. In particular, it advances the discussion on sisterhood with respect to the three waves of feminism, by providing a description of the new approach to sisterhood framed by the categories of the fourth wave of feminism. Drawing on an empirical qualitative study on the circles of women (CW) in Poland, this research explores the changing quality of sisterhood by investigating women’s mutual relationships, and the development of women’s subjectivity. Specifically, the evolution of mutual relationship among women is demonstrated by the increased trust and development of solidarity while the strengthening of subjectivity by the increase of self-acceptance.

Prevalence, risk factors, and trajectories of sleep disturbance in a cohort of African-American breast cancer survivors.

Sleep disturbance may be an overlooked modifiable risk factor for health disparities among African-American breast cancer survivors (AABCS). This study aimed to identify the prevalence of and risk factors for sleep disturbance in a cohort of AABCS. The study was conducted among participants in the Women's Circle of Health Follow-up Study, a longitudinal study of breast cancer in 10 counties in New Jersey. Cases were identified shortly after diagnosis by the New Jersey State Cancer Registry. Self-reported sleep disturbance (Pittsburgh Sleep Quality Index) and other factors (e.g., socioeconomic status, menopausal status) were assessed at pre-diagnosis (n = 637), 10 months post-diagnosis (n = 261), and 24 months post-diagnosis (n = 632). Clinical data were obtained via medical record abstraction, and height and weight were measured by study staff. Most AABCS (57%) reported clinically significant sleep disturbance before diagnosis, and this rate remained largely unchanged at 10 months (53%) and 24 months post-diagnosis (61%). Average sleep disturbance scores indicated clinically significant disturbance at all three assessments (M range = 6.67-7.57). Most reported sleeping fewer than the recommended 7 hours per night at each assessment (range 57-65%). Risk factors for sleep disturbance were identified at each assessment, including pre-diagnosis (less education), 10 months post-diagnosis (lack of insurance, treatment with chemotherapy), and 24 months post-diagnosis (younger age, less education, lower income, obesity, and lymphedema). Treatment with endocrine therapy was a protective factor at 10 months post-diagnosis. Most AABCS report clinically significant sleep disturbance from before diagnosis through 24 months post-diagnosis. These rates appear indicate AABCS experience significant sleep-related disparities.

Comorbidity Management in Black Women Diagnosed with Breast Cancer: the Role of Primary Care in Shared Care.

Black women are more likely to have comorbidity at breast cancer diagnosis compared with White women, which may account for half of the Black-White survivor disparity. Comprehensive disease management requires a coordinated team of healthcare professionals including primary care practitioners, but few studies have examined shared care in the management of comorbidities during cancer care, especially among racial/ethnic minorities. To examine whether the type of medical team composition is associated with optimal clinical care management of comorbidities. We used the Women's Circle of Health Follow-up Study, a population-based cohort of Black women diagnosed with breast cancer. The likelihood of receiving optimal comorbidity management after breast cancer diagnosis was compared by type of medical team composition (shared care versus cancer specialists only) using binomial regression. Black women with a co-diagnosis of diabetes and/or hypertension at breast cancer diagnosis between 2012 and 2016 (N = 274). Outcome-optimal clinical care management of diabetes (i.e., A1C test, LDL-C test, and medical attention for nephropathy) and hypertension (i.e., lipid screening and prescription for hypertension medication). Main predictor-shared care, whether the patient received care from both a cancer specialist and a primary care provider and/or a medical specialist within the 12months following a breast cancer diagnosis. Primary care providers were the main providers involved in managing comorbidities and 90% of patients received shared care during breast cancer care. Only 54% had optimal comorbidity management. Patients with shared care were five times (aRR: 4.62; 95% CI: 1.66, 12.84) more likely to have optimal comorbidity management compared with patients who only saw cancer specialists. Suboptimal management of comorbidities during breast cancer care exists for Black women. However, our findings suggest that shared care is more beneficial at achieving optimal clinical care management for diabetes and hypertension than cancer specialists alone.

Pre-diagnostic allostatic load and health-related quality of life in a cohort of Black breast cancer survivors.

To determine the association of pre-diagnostic allostatic load (AL) with health-related quality of life (HRQOL) among Black women with breast cancer. In a sample of 409 Black women with non-metastatic breast cancer enrolled in the Women's Circle of Health Follow-Up Study (WCHFS), two pre-diagnostic AL measures were estimated using medical records data from up to 12months prior to breast cancer diagnosis: AL-lipid/metabolic profile-based measure and AL-inflammatory profile-based measure. HRQOL was assessed approximately 24months post diagnosis, using the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) instrument, including 5 subscale scores [presented by physical well-being (PWB), social & family well-being (SFWB), emotional well-being (EWB), functional well-being (FWB), and breast cancer-specific scale (BCS)] and 3 derived total scores [presented by trial outcome index (TOI), Functional Assessment of Cancer Therapy-General (FACT-G) and FACT-B]. We used multivariable logistic regression models, using dichotomized AL scores (lower AL: 0-3 points, higher AL: 4-8 points), to assess the associations between the two pre-diagnostic AL measures and HRQOL. Higher pre-diagnostic AL was associated with poorer FWB and lower FACT-G, but these associations were statistically significant for the AL-inflammatory profile-based measure (FWB: OR 1.63, 95% CI 1.04, 2.56; FACT-G: OR 1.62, 95% CI 1.04, 2.54), but not the AL-lipid/metabolic profile-based measure (FWB: OR 1.45, 95% CI 0.81, 2.59; FACT-G: OR 1.33, 95% CI 0.75, 2.37). These findings suggest that higher AL, particularly when measured using the inflammatory profile-based measure, was associated with poorer HRQOL, namely FWB and FACT-G, among Black breast cancer survivors.

Abstract C046: Dietary calcium and vitamin D and sun exposure with the risk of breast cancer among African American women

Abstract Background: Compared to European American women, African American (AA) women have a higher incidence of breast cancer (BrCa) under age 45, and are more likely to develop estrogen receptor-negative (ER-) tumors, a more aggressive BrCa subtype. Experimental studies drew attention to the potential antitumorigenic properties of calcium and vitamin D. Darker skin color reduces the cutaneous synthesis of vitamin D upon sun exposure. This, together with the tendency of AAs to consume less vitamin D and calcium from food and supplement sources, places AAs at risk for vitamin D and calcium deficiency. However, data are limited regarding the impact of calcium and vitamin D on risk of BrCa and specific subtypes among AA women. Objective: To evaluate calcium intake and vitamin D exposure (through food, supplements and sunlight) with the risk of BrCa and its subtypes among AA women. Methods: We evaluated these associations among 1033 BrCa cases and 391 controls of AA descent recruited since March 2012 in the Women's Circle of Health Study. Cases were identified by rapid case ascertainment in 10 counties in New Jersey. Controls were identified by random-digit-dialing and community-based recruitment, and were frequency matched by age group and county of residence. Dietary information over the year prior to diagnosis (for cases) or the reference date (for controls) was assessed via a validated food frequency questionnaire through in-person interviews. Supplemental intakes including multivitamin sources and daily hours spent outdoors in daylight were also collected. Hormone receptor status was obtained from pathology reports. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusting for relevant sociodemographic, reproductive, and lifestyle risk factors. Results: Vitamin D intake from food was not associated with BrCa risk. However, for supplemental vitamin D intake, we observed a significant decreased overall BrCa risk for users of ≤800 IU/day vs. nonusers (OR=0.73, 95% CI: 0.54, 0.98), which was limited to estrogen receptor-positive (ER+) BrCa (OR=0.69, 95% CI: 0.50, 0.94), but not for ER- or triple-negative BrCa. More daylight hours spent outdoors in a year predicted a lower risk of pre- and postmenopausal BrCa [comparing the highest quartile (Q4) vs. lowest (Q1): OR=0.37, 95% CI: 0.20-0.68, p-trend: 0.002; OR=0.46, 95% CI: 0.30-0.71, p-trend: 0.001, respectively]. The significant inverse associations were observed for both ER+ and ER- BrCa, but not for triple-negative BrCa. Calcium intake was not associated with BrCa risk. Conclusion: Our findings suggest that moderate intake of supplemental vitamin D may decrease the risk of ER+ BrCa. Sun exposure may decrease the risk of BrCa among AA women, which does not appear to differ by menopausal status and ER status. Citation Format: Bo Qin, Baichen Xu, Nan Ji, Karen Pawlish, Song Yao, Christine Ambrosone, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Dietary calcium and vitamin D and sun exposure with the risk of breast cancer among African American women [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C046.

Abstract PR15: Do segregated neighborhoods buffer the stressful effects of low coping among Black breast cancer survivors?

Abstract Black women diagnosed with breast cancer have worse outcomes compared to White women, and variation in social and psychosocial factors might play a role in this racial disparity. African American (AA) residential segregation is hypothesized to result from racial discrimination, economic inequality, and social network characteristics where the exchange of social capital influences individual mobility patterns. Accordingly, whether segregation exerts a negative or positive influence on psychosocial outcomes, such as perceived stress, might depend on additional intra- (e.g., coping) and interpersonal (e.g., social support) social characteristics. This study investigated whether AA residential segregation, coping and social support were associated with perceived stress among Black breast cancer survivors. Individual-level data were from the Women's Circle of Health Follow-up Study, an ongoing breast cancer survivor cohort of Black women residing in New Jersey (NJ). Perceived stress (Cohen's Perceived Stress Scale, 10-item [PSS-10]), coping (Brief Resilient Coping, 4-item), and social support (Functional Assessment of Chronic Illness Therapy-Breast cancer, 7-item) were measured in follow-up questionnaires (average time since cancer diagnosis = 22.6 months). AA Gini Indices of segregation (0-100) were linked to participants' zip code of residence at baseline questionnaire (average time since cancer diagnosis = 13.0 months). Potential demographic, socioeconomic, and health behavior confounders were from the baseline questionnaire. Multilevel linear regression models were used to estimate relationships between segregation, coping, social support and perceived stress. The follow-up questionnaire was completed by 533 breast cancer survivors, 530 of whom had complete PSS-10 data (sum score mean=15.1, standard deviation [SD]=7.0). The typical participant lived in highly segregated zip codes (median=70.7, range=23.8-92.9). The relationship between coping and perceived stress depended on zip code level AA segregation: among lower segregation zip codes (Gini=62) PSS-10 increased 1.6 points (95% CI: 0.9- 2.3, P <0.001) for each SD decrease in coping ability, but among higher segregation zip codes (Gini=78) PSS-10 increased only 0.7 points (95% CI: 0.02-1.4, P=0.04) for each SD decrease in coping ability. Moreover, adjustment for social support decreased the magnitude of the associations between coping and PSS-10. AA segregation, coping, and social support might act together to influence perceived stress of Black breast cancer survivors in NJ. This abstract is also being presented as Poster C067. Citation Format: Jesse J. Plascak, Laxmi Chavali, Adana A.M. Llanos-Wilson, Bonnie Qin, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Do segregated neighborhoods buffer the stressful effects of low coping among Black breast cancer survivors? [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR15.

Abstract C063: Associations of leptin and leptin receptor protein and gene expression with breast cancer clinicopathologic features

Abstract The adipokine, leptin (LEP) and its receptor (leptin receptor, LEPR), are hypothesized to play a role in breast cancer (BrCa) outcomes disparities. The objective of this study was to address the gaps in knowledge regarding the epidemiologic associations of LEP and LEPR protein and gene expression with breast cancer clinicopathologic features (namely, estrogen receptor [ER] status, and tumor grade, stage, size, and subtype). In the Women's Circle of Health Study, we used immunohistochemistry to assess protein expression in breast tumor tissue microarrays among a sample of 711 early stage BrCa cases. LEP and LEPR protein expression was scored semiquantitatively by a board-certified pathologist and we used NanoString digital, multiplexed assays to quantitatively assess gene expression of these biomarkers. Multivariable-adjusted logistic regression models were used to examine the associations of interest. Compared to ER+, LEP protein expression was lower (OR 0.54, 95% CI 0.30, 1.00), and LEPR protein (OR 3.95, 95% CI 2.02, 7.71) and gene expression (OR 1.003, 95% CI 1.001, 1.005) were higher among ER- BrCa cases. Compared to well/moderately differentiated tumors, LEPR protein (OR 2.46, 95% CI 1.40, 4.31) and gene expression (OR 1.002, 95% CI 1.000, 1.003) were higher among poorly differentiated tumors. Compared to luminal A, LEP protein expression was higher among non-luminal HER2-expressing (OR 3.34, 95% CI 1.20, 9.32) and TNBC subtypes (OR 2.02, 95% CI 1.00, 4.08), LEPR protein expression was lower among non-luminal HER2-expressing (OR 0.39, 95% CI 0.16, 0.94) and TNBC (OR 0.28, 95% CI 0.13, 0.57), and LEPR gene expression was lower in TNBC (OR 0.997, 95% CI 0.995, 0.999). LEP gene expression and LEPR protein and gene expression were inversely associated with tumor size (P-values <0.05). No major associations were observed between LEP and LEPR expression profiles and tumor stage. These findings suggest that LEP and LEPR protein and gene expression in the breast tumor microenvironment may serve as biomarkers contributing to interindividual differences in BrCa prognostic indicators and are important for understanding tumor heterogeneity and outcomes disparities. Funding: This study was supported by grants from the National Cancer Institute (K01CA193527, P01CA151135, R01CA100598, R01CA185623). Tumor samples were received, processed and tracked under the auspices of the Roswell Park Comprehensive Cancer Center DataBank and BioRepository Shared Resource, supported by P30CA16056 with support from the Breast Cancer Research Foundation to CBA. This work was also supported by the Biomedical Informatics and the Biospecimen Repository and Histopathology Service shared resources of Rutgers Cancer Institute of New Jersey, supported by P30CA072720. Citation Format: Adana A.M. Llanos, Baichen Xu, Bo Qin, Wenjin Chen, Marina A. Chekmareva, Lei Cong, Chi-Chen Hong, Song Yao, Christine B. Ambrosone, Elisa V. Bandera, Kitaw Demissie. Associations of leptin and leptin receptor protein and gene expression with breast cancer clinicopathologic features [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C063.

FOXA1 Protein Expression in ER+ and ER- Breast Cancer in Relation to Parity and Breastfeeding in Black and White Women.

Forkhead box protein A1 (FOXA1) promotes luminal differentiation, and hypermethylation of the gene can be a mechanism of developing estrogen receptor-negative (ER-) breast cancer. We examined FOXA1 in breast tumor and adjacent normal tissue in relation to reproductive factors, particularly higher parity and no breastfeeding, that are associated with ER- tumors. We performed IHC for FOXA1 in breast tumors (n = 1,329) and adjacent normal tissues (n = 298) in the Women's Circle of Health Study (949 Blacks and 380 Whites). Protein expression levels were summarized by histology (H) scores. Generalized linear models were used to assess FOXA1 protein expression in relation to reproductive factors by ER status. ER-positive (ER+) versus ER- tumors had higher FOXA1 protein expression (P < 0.001). FOXA1 expression was higher in tumor versus paired adjacent normal tissue in women with ER+ or non-triple-negative cancer (both P < 0.001), but not in those with ER- or triple-negative cancer. Higher number of births (1, 2, and 3+) was associated with lower FOXA1 protein expression in ER+ tumors [differences in H score, or β = -8.5; 95% confidence interval (CI), -15.1 to -2.0], particularly among parous women who never breastfed (β = -10.4; 95% CI, -19.7 to -1.0), but not among those who breastfed (β = -7.5; 95% CI, -16.9 to 1.8). The associations for ER- tumors were similar, although they were not statistically significant. In this tumor-based study, higher parity was associated with lower FOXA1 expression in ER+ tumors, and breastfeeding may ameliorate the influence. These findings contribute to our understanding of FOXA1 methylation and breast cancer etiology.

Intake of vitamin D and calcium, sun exposure, and risk of breast cancer subtypes among black women

ABSTRACTBackgroundThe randomized placebo-controlled Vitamin D and Omega-3 Trial suggested a possible benefit of vitamin D on cancer incidence among black individuals. However, data are limited regarding the impact of vitamin D on breast cancer subtypes among African-American/black women, who tend to develop more aggressive forms of breast cancer.ObjectivesWe hypothesize that more vitamin D exposure (through diet, supplements, and sunlight) and higher intake of calcium are associated with decreased risk of estrogen receptor (ER)+ and ER− breast cancer, and of triple-negative breast cancer (TNBC) among black women.MethodsThis study was conducted among 1724 black cases and 1233 controls in the Women's Circle of Health Study (WCHS) and WCHS2. Polytomous logistic regressions were used to estimate ORs and 95% CIs of ER+ and ER− breast cancer; logistic regressions were used for TNBC. The ORs from each study were pooled using an inverse-variance-weighted random-effects model.ResultsDietary vitamin D and calcium intake were not associated with risk of breast cancer subtypes in the pooled analysis. For supplemental vitamin D, we observed possible inverse associations between intake of ≤800 IU/d (compared with nonuse) and risk of several subtypes, with effects that appeared strongest for TNBC (OR: 0.58; 95% CI: 0.35, 0.94); no association was found for >800 IU/d. More daylight hours spent outdoors in a year was associated with lower risk of ER+, ER−, and TNBC (e.g., highest compared with lowest quartile: TNBC OR: 0.53; 95% CI: 0.31, 0.91; P-trend = 0.02).ConclusionsModerate supplemental vitamin D intake was associated with decreased risk of TNBC, and increased sun exposure was associated with reduced risk of ER+, ER−, and TNBC among black women.

Prediagnostic Allostatic Load as a Predictor of Poorly Differentiated and Larger Sized Breast Cancers among Black Women in the Women's Circle of Health Follow-Up Study.

Few studies have empirically tested the association of allostatic load (AL) with breast cancer clinicopathology. The aim of this study was to examine the association of AL, measured using relevant biomarkers recorded in medical records before breast cancer diagnosis, with unfavorable tumor clinicopathologic features among Black women. In a sample of 409 Black women with nonmetastatic breast cancer who are enrolled in the Women's Circle of Health Follow-Up Study, we estimated prediagnostic AL using two measures: AL measure 1 [lipid profile-based-assessed by systolic and diastolic blood pressure (SBP, DBP), high-density lipoprotein, low-density lipoprotein, total cholesterol, triglycerides, and glucose levels; waist circumference; and use of diabetes, hypertension, or hypercholesterolemia medication] and AL measure 2 (inflammatory index-based-assessed by SBP, DBP, glucose, and albumin levels; estimated glomerular filtration rate; body mass index; waist circumference; and use of medications previously described). We used Cohen's statistic to assess agreement between the two AL measures and multivariable logistic models to assess the associations of interest. AL measures 1 and 2 moderately agreed (κ = 0.504). Higher prediagnostic AL predicted higher grade (poorly differentiated vs. well/moderately differentiated) using AL measure 1 [OR = 2.16; 95% confidence interval (CI), 1.18-3.94] and AL measure 2 (OR = 1.60; 95% CI, 1.02-2.51), and larger tumor size (≥2 cm vs. <2 cm; OR = 1.58; 95% CI, 1.01-2.46) using AL measure 2 only. Elevated prediagnostic AL might contribute to more unfavorable breast cancer clinicopathology. Addressing elevated prediagnostic levels of AL has potentially important clinical implications.

Hole

Hole Madeleine Owen-Dunow (bio) lucy choked on a sharp piece of bone last summer. we took her to theemergency vet & now she breathes through a hole in her throat. when i thinkabout it i think about black holes, how physical laws cease to exist at theircore. here is what i'm trying not to think about: pills hidden in an emptycontainer of nivea chapstick, the bruise on my hip, and where i will be when ifinally stop loving you. this is what i don't know. these are things i do know:cigarettes are the most traded item in the world. oenophobia is an intensefear or hatred of wine. in the french language there are 17 words that meansurrender. the summer of the hole i collapsed on red ground in a circle ofwomen & said i don't want to be alive anymore. when i think about lucy ithink about how 93% of our bodies are stardust & years after the fact thenurses at my doctor's office still know to make me stand backwards on thescale so i can't see the number. 3 weeks before the hole sophia told me if youkill yourself i will still love you. when i think about last summer i think abouthow easy it was, to try to leave this earth unblinking, split second. here iswhat i'm trying not to think about: space & loss & the Vermont air in winter,the colonial houses white and green. no one accepts i just want there to beless of me as an answer. this is something i know: to clean the hole, you need2 sheets of gauze, saline spray, a q-tip. when i think about lucy, i think abouthow she is never afraid. i think about galaxies, vast oceans contained in herlittle body. i bring her into bed with me & put my face next to hers lucy lucywe are both still here and we are the only ones who know what a strangething it is, to be back, willing, amongst the living. [End Page 248] Madeleine Owen-Dunow Madeleine Owen-Dunow is a writer and a student at The New School in New York City. Copyright © 2020 Pleiades and Pleiades Press

Woman in art: a breath of beauty in the men’s world

Woman in art: a breath of beauty in the men’s world

La importancia del círculo. Las tecnologías de la información y la comunicación en la conformación del clan de las mujeres

Faced with the dynamics of today's life, which encourages competition instead of empathy and collaboration, as well as the patriarchal tendency that has historically underestimated female support and knowledge circles, groups have emerged that promote the formation of new circles inspired by a mythical ancestral past, where the clan of women can become agents of cultural change. This paper analyzes the reflectivity of the coordinators of these groups and how communication technologies are integrated into their projects and practices, which play the role of medium and mediator in this contemporary redefinition of women's circles.