Disparities In Breast Cancer Mortality Research Articles

Young Black Women's Breast Cancer Knowledge and Beliefs: A Sequential Explanatory Mixed MethodsStudy.

Black women under the age of 50 have a 111% higher breast cancer mortality rate than their White counterparts. The breast cancer mortality disparities among young Black women may be due in part to the fact that they are more likely to be diagnosed with late-stage, invasive breast cancer tumors. Psychosocial factors, such as lack of perceived risk for breast cancer, lack of awareness of breast cancer risk factors, and ambiguity about breast cancer screening guidelines are areas that are under investigated among young Black women. The purpose of this study was to identify young Black women's cancer beliefs and level of breast cancer risk knowledge. A sequential explanatory mixed methods study was conducted using quantitative data from the Health Information Trends Survey 6 (HINTS 6) (n = 25) and qualitative data from interviews with young Black female college students (n = 13). The results of the quantitative data analysis were used to guide the development of the qualitative interview guide. Data regarding participants' cancer beliefs, cancer risk factor knowledge, perceived cancer risk, and ambiguity about cancer screening behaviors were analyzed. The findings indicated young Black women have low perceived risk of developing cancer. Most participants were not aware of cancer recommendations that were targeted towards women under the age of 40. In addition, knowledge about lifestyle behavior risk factors for breast cancer was relatively low. Our findings underscore the importance of developing, disseminating, and implementing breast cancer education interventions that are targeted towards young Black women.

Impact of Structural Racism and Social Determinants of Health on Disparities in Breast Cancer Mortality.

The striking ethnic and racial disparities in breast cancer mortality are not explained fully by pathological or clinical features. Structural racism contributes to adverse conditions that promote cancer inequities, but the pathways by which this occurs are not fully understood. Social determinants of health (SDOH), such as economic status and access to care, account for a portion of this variability, yet interventions designed to mitigate these barriers have not consistently led to improved outcomes. Based on the current evidence from multiple disciplines, we describe a conceptual model in which structural racism and racial discrimination contribute to increased mortality risk in diverse groups of patients by promoting adverse SDOH that elevate exposure to environmental hazards and stress; these exposures in turn contribute to epigenetic and immune dysregulation, thereby altering breast cancer outcomes. Based on this model, opportunities and challenges arise for interventions to reduce racial and ethnic disparities in breast cancer mortality.

Abstract A102: Nationwide Racial, Ethnic, Geographic and Stage-Specific Trends in Breast Cancer Incidence among Older US Women, 2001-2019

Abstract Purpose: Breast Cancer (BC) incidence is increasing among younger women with significant variation by race, ethnicity, and geography. Yet, few studies have described trends and possible social disparities among the oldest women (65+), typically grouping older women into a single age category, despite age-related variation in screening guidelines (e.g., no longer recommending routine screening beyond age 74 or limited life expectancy). We assessed trends in US BC incidence rates among 3 separate age groups of older women (65-74y, 75-84y, 85+) by stage at diagnosis, race, ethnicity, and geography. Methods: To cover all 50 US states, we used the US Cancer Statistics (USCS) public use database, 2022 submission of NCPR and SEER incidence data to obtain annual BC incidence rates from 2001-2019, age adjusted to the 2000 US standard population. We used Joinpoint regression to obtain the average annual percent changes (AAPCs) in BC incidence rates for each age group over the time period stratified by disease stage at diagnosis, race/ethnicity, metropolitan status, and region. Results: From 2001-2019, overall BC incidence rates per 100,000 were 530.4, 515.3, and 376.8 for ages 65-74, 75-84, and 85+, respectively. During this period, incidence increased by 0.4% (95% CI: 0.2 to 0.6) per year in women aged 65-74, remained stable in women aged 75-84 years, and decreased by 1.1% (95% CI: -1.4 to -0.8) per year in women aged 85+ years. In all age groups, there was a decline in regional stage (AAPCs range -0.8 to -0.9) and an increase in distant stage (AAPCs range: 1.1- 1.6). However, in situ and localized stage trends varied by age group (e.g., both increased in 65- 74, but decreased for 85+). For all stages combined, in the 65-74 year-old age group, non- Hispanic Black, American Indian/Alaska Native, Asian/Pacific Islander, and Hispanic women had 7-11 times the rate of average annual percent increase compared to non-Hispanic White women (AAPCs: 1.6, 1.8, 2.2, and 1.4 vs. 0.2, respectively). Rates increased for non-Hispanic Black and Asian/Pacific Islander women (AAPCs: 1.0 and 0.9, respectively) in the 75-84 year old age group and decreased for non-Hispanic White and Hispanic women aged 85+ (AAPCs: -1.0 and -1.3, respectively). Age-specific trends did not vary by metropolitan status, though BC incidence rates were lower in non-metropolitan vs. metropolitan areas across all age groups (non- metropolitan vs. metropolitan rate ratio range: 0.90-0.95). BC incidence in 65-74 year-old women increased from 2001-2019 in the Northeast, Midwest, and South, increased in the Northeast (AAPC: 0.2) and decreased in the West for ages 75-84, (AAPC: -0.6), and decreased in all 4 regions of the US (AAPC range: -0.7 to -1.5) in the 85+ year-old age group. Conclusions: As previously reported for younger women, these findings support racial, geographic, and stage- specific BC variation in trends are also observed for older women. Further research should examine the contribution of screening practices to these trends and their impact on BC mortality disparities among older women. Citation Format: Erica Lee Argov, Anita Karr, Michelle Lui, Parisa Tehranifar, Rebecca Kehm. Nationwide Racial, Ethnic, Geographic and Stage-Specific Trends in Breast Cancer Incidence among Older US Women, 2001-2019 [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 A102.

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

Abstract Background: Disparities in breast cancer morbidity and mortality persist in African Americans. Social determinants and their subsequent effect on stress reactivity may impact the biological mechanisms associated with the onset and progression of cancer. However, stress reactivity has not been examined specifically among African American breast cancer survivors. Objective: To evaluate within-subject variation in stress reactivity among African American breast cancer survivors and determine whether this reactivity is influenced by social stressors, such as financial strain and social isolation, known to be associated with cancer outcomes. Methods: We conducted a laboratory intervention study using the Trier Social Stress Test on African American breast cancer survivors. We measured stress reactivity using salivary cortisol levels; socioeconomic, social, and psychological stressors were estimated by self-report. We performed multi-level random effect repeated-measures linear regression models to estimate within-subject changes in cortisol levels. We tested the moderating effects of social factors and cumulative social stressors on reactivity outcomes. Results: Sixty African American breast cancer survivors were included in the study. There were significant increases in mean cortisol levels at 30 minutes (beta=0.054, 95%CI=0.026, 0.082; p<0.001) and 40 minutes (beta=0.040, 95% CI=0.015, 0.065; p=.002) post-stress during the recovery period. We identified significant interactions between time and social stressors on cortisol levels for financial strain (χ2/df=15.83/4, p=.003), social isolation (χ2/df=9.67/4, p=.04), negative life events (χ2/df=12.75/4, p=.01), perceived stress (χ2/df=11.93/4, p=.02), and cumulative index of social stressors (χ2/df=11.14/4, p=.03). Conclusion: Social risk factors moderate the effects of stressors on cortisol reactivity among African American breast cancer survivors. There is a need to understand the lived experiences of Black women and develop interventions that mitigate the impact of social stressors on stress responses. Citation Format: Dr. Fatimata Sanogo, Dr. Junhan Cho, Dr. Trista Beard, Dr. Chanita Hughes Halbert. Intersecting burdens: The role of social barriers and perceived stress in moderating cortisol reactivity among African American breast cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A089.

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.

A Retrospective Analysis of Breast Cancer Mortality among Jewish and Muslim Arab Women in Israel: The Role of Sociodemographic Factors.

Breast cancer mortality rates vary across ethnic groups in Israel, where protective factors such as high fertility and breastfeeding rates may be moderated by socioeconomic factors and mammography rates. We aim to investigate disparities in breast cancer mortality between Jewish and Muslim Arab women in Israel and examine how sociodemographic variables and number of children are associated with mortality. Our retrospective follow-up study uses data from the Israeli Central Bureau of Statistics and multivariable Cox regression models, adjusting for age, number of children, country of origin, locality size, and socioeconomic status. Compared to Jewish women, Muslim Arab women exhibited lower breast cancer mortality rates. However, after adjusting for multiple sociodemographic variables, no significant differences persisted between Jewish and Muslim Arab women. Having more than three children was associated with lower mortality among Muslim Arab women but not among Jewish women. European/American origin, larger localities, and medium socioeconomic status were associated with higher mortality. Sociodemographic factors may therefore explain the disparities in breast cancer mortality between Jewish and Muslim Arab women in Israel. Targeted intervention programs that consider the unique characteristics and risk factors of different ethnic groups are needed to reduce disparities and improve outcomes.

Socioecologic Factors and Racial Differences in Breast Cancer Multigene Prognostic Scores in US Women

Disproportionately aggressive tumor biology among non-Hispanic Black women with early-stage, estrogen receptor (ER)-positive breast cancer contributes to racial disparities in breast cancer mortality. It is unclear whether socioecologic factors underlie racial differences in breast tumor biology. To examine individual-level (insurance status) and contextual (area-level socioeconomic position and rural or urban residence) factors as possible mediators of racial and ethnic differences in the prevalence of ER-positive breast tumors with aggressive biology, as indicated by a high-risk gene expression profile. This retrospective cohort study included women 18 years or older diagnosed with stage I to II, ER-positive breast cancer between January 1, 2007, and December 31, 2015. All data analyses were conducted between December 2022 and April 2023. The primary outcome was the likelihood of a high-risk recurrence score (RS) (≥26) on the Oncotype DX 21-gene breast tumor prognostic genomic biomarker. Among 69 139 women (mean [SD] age, 57.7 [10.5] years; 6310 Hispanic [9.1%], 274 non-Hispanic American Indian and Alaskan Native [0.4%], 6017 non-Hispanic Asian and Pacific Islander [8.7%], 5380 non-Hispanic Black [7.8%], and 51 158 non-Hispanic White [74.0%]) included in our analysis, non-Hispanic Black (odds ratio [OR], 1.33; 95% CI, 1.23-1.43) and non-Hispanic American Indian and Alaska Native women (OR, 1.38; 95% CI, 1.01-1.86) had greater likelihood of a high-risk RS compared with non-Hispanic White women. There were no significant differences among other racial and ethnic groups. Compared with non-Hispanic White patients, there were greater odds of a high-risk RS for non-Hispanic Black women residing in urban areas (OR, 1.35; 95% CI, 1.24-1.46), but not among rural residents (OR, 1.05; 95% CI, 0.77-1.41). Mediation analysis demonstrated that lack of insurance, county-level disadvantage, and urban vs rural residence partially explained the greater odds of a high-risk RS among non-Hispanic Black women (proportion mediated, 17%; P < .001). The findings of this cohort study suggest that the consequences of structural racism extend beyond inequities in health care to drive disparities in breast cancer outcome. Additional research is needed with more comprehensive social and environmental measures to better understand the influence of social determinants on aggressive ER-positive tumor biology among racial and ethnic minoritized women from disadvantaged and historically marginalized communities.

A Novel Approach for Conducting a Catchment Area Analysis of Breast Cancer by Age and Stage for a Community Cancer Center.

The U.S. Preventive Services Task Force recently issued an updated draft recommendation statement to initiate breast cancer screening at age 40, reflecting well-documented disparities in breast cancer-related mortality that disproportionately impact younger Black women. This study applied a novel approach to identify hotspots of breast cancer diagnosed before age 50 and/or at an advanced stage to improve breast cancer detection within these communities. Cancer registry data for 3,497 women with invasive breast cancer diagnosed or treated between 2012 and 2020 at the Helen F. Graham Cancer Center and Research Institute (HFGCCRI) and who resided in the HFGCCRI catchment area, defined as New Castle County, Delaware, were geocoded and analyzed with spatial intensity. Standardized incidence ratios stratified by age and race were calculated for each hotspot. Four hotspots were identified, two for breast cancer diagnosed before age 50, one for advanced breast cancer, and one for advanced breast cancer diagnosed before age 50. Younger Black women were overrepresented in these hotspots relative to the full-catchment area. The novel use of spatial methods to analyze a community cancer center catchment area identified geographic areas with higher rates of breast cancer with poor prognostic factors and evidence that these areas made an outsized contribution to racial disparities in breast cancer. Identifying and prioritizing hotspot breast cancer communities for community outreach and engagement activities designed to improve breast cancer detection have the potential to reduce the overall burden of breast cancer and narrow racial disparities in breast cancer.

Breast cancer mortality among ultra-orthodox and non-ultra-orthodox Israeli women: A retrospective cohort study

BackgroundBreast cancer is the leading cause of cancer death in Israeli women. Previous studies found socioeconomic status and other risk factors impact breast cancer outcomes. The ultra-orthodox community is characterized by a longer life expectancy, lower rates of mammography performance, higher fertility rates and other sociodemographic variables that may be related to breast cancer mortality. This study examined disparities in breast cancer mortality between ultra-Orthodox and non-ultra-Orthodox Israeli women. MethodsThis retrospective cohort study for breast cancer mortality included the all Jewish Israeli citizens women born between 1940 and 1960 and lived in communities with over 20,000 residents (n = 628,617). Data was collected from various sources, monitoring a period of 31 years; for each participants, their sociodemographic characteristics were compiled from the population registry, the tax authority, the education registry, and the Central Bureau of Statistics (CBS). Variables included religiosity, age, marital status, children, origin, education, and income. Multivariable Cox models evaluated predictors of mortality. ResultsOf the 628,617 women in the study, 29,611 were ultra-Orthodox. Ultra-Orthodox women had higher marriage rates, more children, and lower secular education and income. Mortality was 108.8/100,000 overall, lower among ultra-Orthodox (83.4/100,000) than non-ultra-Orthodox women (110.1/100,000) despite their risk factors. Using a multivariate model to evaluate the association between ultra-Orthodoxy and breast cancer mortality, the study found higher breast cancer mortality rate among non-ultra-Orthodox women compared to ultra-Orthodox women (HR = 1.491; 99% CI = 1.232, 1.804). Associations with sociodemographic variables were different for each group. ConclusionsAlthough ultra-Orthodox women have socioeconomic risk factors, breast cancer mortality was lower than non-ultra-Orthodox women. Further research on potential cultural and religious factors influencing mortality is warranted. These findings highlight the importance of evaluating predictors within specific populations.

Abstract C118: Racial disparities in insurance coverage for supplemental breast cancer screening

Abstract Introduction and Purpose: Women with dense breasts have increased risk both for developing breast cancer and false-negative mammograms. Supplemental screening with breast MRI has been shown to shown to significantly increase cancer detection among women with dense breasts. In May 2023, Pennsylvania (PA) mandated insurance coverage of one supplemental screening study (breast MRI or ultrasound ) annually for women with dense breasts. Prior research suggests that Black women have lower breast density on average than white women based on subjective grading from the American College of Radiology Breast Imaging and Reporting Data System (BI-RADS), partially due to larger average breast size and higher body mass index (BMI) than white women. The purpose of this study was to estimate the potential impact of this supplemental screening law on different patient populations in a large health system. Methods: Women without prior breast cancer or known BRCA1/2 mutations who underwent mammographic screening at a large PA health system from April 2015-December 2017and completed a risk factor questionnaire were included (N=83,579). Under PA law, women must have either heterogeneously dense breasts plus &amp;gt;20% lifetime risk of breast cancer or extremely dense breasts to be eligible for insurance coverage for supplemental screening, both of which involve subjectively graded breast measurements. Breast cancer risk for each patient was estimated using the Gail model. The cancer detection rate (CDR) for mammographic screening was calculated as the number of cancers diagnosed within one year of a positive mammographic screen; the interval cancer rate was calculated as the number of cancers diagnosed within one year of a non-actionable screening mammogram per 1000 women. Logistic regression was used to calculate the odds of eligibility adjusted for age and BMI. Results: Black women were less likely to have extremely or heterogeneously dense breasts than white women (23.7% vs. 45.0%, p&amp;lt;0.001). Under PA law, 2.5% of Black women and 9.9% of white women would qualify for insurance coverage for supplemental screening (p&amp;lt;0.001). Only 0.2% of Black women and 2.3% of white women had heterogeneously dense breasts and &amp;gt;20% lifetime risk. Black women were more likely to have triple-negative breast cancer (TNBC) than white women (p&amp;lt;0.001). After adjusting for age and BMI, Black women remained 54% less likely to be eligible for supplemental screening than white women (OR=0.46, 95% 0.42-0.51, p&amp;lt;0.001).Conclusions: Black women are less likely to qualify for insurance coverage for supplemental breast cancer screening than white women under PA law. Given that Black women have lower prevalence of subjectively graded dense breasts and higher prevalence of TNBC, the new supplemental screening law is unlikely to meaningfully reduce racial disparities in breast cancer mortality. Methods to better assess breast cancer risk among Black women, particularly the risk of TNBC, are urgently needed to identify Black women that may benefit from supplemental screening. Citation Format: Mattia A. Mahmoud, Sarah Ehsan, Oluwadamilola M. Fayanju, Susan M. Domchek, Katherine L. Nathanson, Despina Kontos, Emily F. Conant, Anne Marie McCarthy. Racial disparities in insurance coverage for supplemental breast cancer screening [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C118.

A catchment and location-allocation analysis of mammography access in Delaware, US: implications for disparities in geographic access to breast cancer screening

BackgroundDespite a 40% reduction in breast cancer mortality over the last 30 years, not all groups have benefited equally from these gains. A consistent link between later stage of diagnosis and disparities in breast cancer mortality has been observed by race, socioeconomic status, and rurality. Therefore, ensuring equitable geographic access to screening mammography represents an important priority for reducing breast cancer disparities. Access to breast cancer screening was evaluated in Delaware, a state that experiences an elevated burden from breast cancer but is otherwise representative of the US in terms of race and urban–rural characteristics. We first conducted a catchment analysis of mammography facilities. Finding evidence of disparities by race and rurality, we next conducted a location-allocation analysis to identify candidate locations for the establishment of new mammography facilities to optimize equitable access.MethodsA catchment analysis using the ArcGIS Pro Service Area analytic tool characterized the geographic distribution of mammography sites and Breast Imaging Centers of Excellence (BICOEs). Poisson regression analyses identified census tract-level correlates of access. Next, the ArcGIS Pro Location-Allocation analytic tool identified candidate locations for the placement of additional mammography sites in Delaware according to several sets of breast cancer screening guidelines.ResultsThe catchment analysis showed that for each standard deviation increase in the number of Black women in a census tract, there were 68% (95% CI 38–85%) fewer mammography units and 89% (95% CI 60–98%) fewer BICOEs. The more rural counties in the state accounted for 41% of the population but only 22% of the BICOEs. The results of the location-allocation analysis depended on which set of screening guidelines were adopted, which included increasing mammography sites in communities with a greater proportion of younger Black women and in rural areas.ConclusionsThe results of this study illustrate how catchment and location-allocation analytic tools can be leveraged to guide the equitable selection of new mammography facility locations as part of a larger strategy to close breast cancer disparities.

Enhancing Mammography and Empowering Solutions for Breast Cancer Disparities.

Mammography enables early detection of breast cancer, a critical factor in improving treatment outcomes and breast cancer mortality. Yet, not all women benefit equally, and striking racial disparities in breast cancer mortality persist, with Black women 40% more likely to die from breast cancer compared with non-Hispanic White women. The current issue of Cancer Epidemiology, Biomarkers & Prevention presents three informative reports revealing racial and ethnic variations in mammography's performance in risk stratification, detection, and surveillance. The performance dynamics of mammography across different racial and ethnic groups highlight the urgency for additional research and innovative interventions to ensure equitable breast cancer control. We emphasize a pressing need for a comprehensive evaluation of multilevel influences on the performance and implementation of mammography in racially and ethnically diverse populations, complemented by equally urgent efforts to address factors influencing the risk of aggressive tumor subtypes and timely and effective treatment delivery. See related articles by Kerlikowske et al., p. 1524, Hubbard et al., p. 1531, Nyante et al., p. 1542.

Considerations in Narrowing the Breast Cancer Mortality Gap Between Black and White Women

This Viewpoint discusses 3 key measures of population-based surveillance along with areas for future investigation to reduce racial disparities in breast cancer mortality.

Effects of social comparison framing of racial health disparities and behaviors

Abstract Messages that feature intergroup comparisons (social comparison frames) regularly communicate the relative prevalence of health problems and preventive behaviors. While prior studies find that comparing disease risks between racial groups are met with resistance from the disadvantaged group, we extended existing research by investigating if behavioral comparisons which show that the higher-risk group also excels in disease prevention efforts could mitigate negative impacts of disease risk comparisons. We conducted two preregistered experiments to examine the effects of comparing cancer risks and the prevalence of screening behaviors between Black and White Americans. Communicating racial disparities in breast cancer mortality reduced perceived risks and fear among White Americans (the less-at-risk group) and decreased cancer screening intention among Black Americans (the disadvantaged group). Adding cancer screening prevalence comparisons did not shift screening intentions among Black Americans but changed their support for disparity-reducing policies, though the effects depended on the disease in question.

Breast health equity along the cancer care continuum: Acollaborative grant initiative.

A competitive grants program developed by the American Cancer Society and Pfizer Global Medical Grants funded nine community‐engaged projects with innovative interventions aimed at reducing breast cancer mortality disparities between Black and White women. This introduction details the purpose and scope of this program and addresses the potential of community‐driven projects along the cancer care continuum.

Disparities in breast cancer mortality among Latin American women: trends and predictions for 2030

BackgroundBreast cancer is among the leading cause of cancer-related mortality among Latin American and Caribbean (LAC) women, but a comprehensive and updated analysis of mortality trends is lacking. The objective of this study was to determine the breast cancer mortality rates between 1997 and 2017 for LAC countries and predict mortality until 2030.MethodsWe retrieved breast cancer deaths across 17 LAC countries from the World Health Organization mortality database. Age-standardized mortality rates per 100,000 women-years were estimated. Mortality trends were evaluated with Joinpoint regression analyses by country and age group (all ages, < 50 years, and ≥ 50 years). By 2030, we predict number of deaths, mortality rates, changes in population structure and size, and the risk of death from breast cancer.ResultsArgentina, Uruguay, and Venezuela reported the highest mortality rates throughout the study period. Guatemala, El Salvador, and Nicaragua reported the largest increases (from 2.4 to 2.8% annually), whereas Argentina, Chile, and Uruguay reported downward trends (from − 1.0 to − 1.6% annually). In women < 50y, six countries presented downward trends and five countries showed increasing trends. In women ≥ 50y, three countries had decreased trends and ten showed increased trends. In 2030, increases in mortality are expected in the LAC region, mainly in Guatemala (+ 63.0%), Nicaragua (+ 47.3), El Salvador (+ 46.2%), Ecuador (+ 38.5%) and Venezuela (+ 29.9%).ConclusionOur findings suggest considerable differences in breast cancer mortality across LAC countries by age group. To achieve the 2030 sustainable developmental goals, LAC countries should implement public health strategies to reduce mortality by breast cancer.

Mobile Web App Intervention to Promote Breast Cancer Screening Among American Indian Women in the Northern Plains: Feasibility and Efficacy Study.

Breast cancer is the most common cancer in the United States and the second leading cause of death for American Indian women. American Indian women have lower rates of breast cancer screening than other racial groups, and disparities in breast cancer mortality and survival rates persist among them. To address this critical need, a culturally appropriate, accessible, and personalized intervention is necessary to promote breast cancer screening among American Indian women. This study used mobile health principles to develop a mobile web app-based mammogram intervention (wMammogram) for American Indian women in a remote, rural community in the Northern Plains. This study aimed to assess the feasibility and efficacy of the wMammogram intervention, which was designed to motivate American Indian women to undergo breast cancer screening, as compared with the control group, who received an educational brochure. Using community-based participatory research (CBPR) principles and a multipronged recruitment strategy in a randomized controlled trial design, we developed the wMammogram intervention. This study involved 122 American Indian women aged between 40 and 70 years, who were randomly assigned to either the intervention group (n=62) or the control group (n=60). Those in the intervention group received personalized and culturally appropriate messages through a mobile web app, while those in the control group received an educational brochure. We measured outcomes such as mammogram receipt, intention to receive breast cancer screening after the intervention, and participants' satisfaction with and acceptance of the intervention. A significantly higher proportion of women who received the wMammogram intervention (26/62, 42%; P=.009) completed mammograms by the 6-month follow-up than the control group (12/60, 20%). The wMammogram intervention group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=-5.22; P<.001), increase in knowledge (t120=-4.75; P<.001), and satisfaction with the intervention (t120=-3.61; P<.001). Moreover, compared with the brochure group, the intervention group expressed greater intention to receive a mammogram in the future when it is due (62/62, 100% vs 51/60, 85%) and were more willing to recommend the intervention they received to their friends (61/62, 98.4% vs 54/60, 90%) with statistically significant differences. This study shows the feasibility and efficacy of the wMammogram intervention to promote breast cancer screening for American Indian women in a remote, rural community-based setting. Findings suggest that, with advancements in technology and the ubiquity of mobile devices, mobile web apps could serve as a valuable health intervention tool that builds upon low-cost technology and enhances accessibility and sustainability of preventive care to help reduce breast health disparities experienced in hard-to-reach American Indian populations. ClinicalTrials.gov NCT05530603; https://clinicaltrials.gov/ct2/show/NCT05530603.

Increasing Clinical Trial Participation of Black Women Diagnosed with Breast Cancer

Despite racial disparities in breast cancer mortality, Black women remain underrepresented in clinical trials. In this mixed methods research, 48 Black women were engaged via focus group discussions and in-depth interviews to better understand the lived experience of women with breast cancer. The results of this qualitative study informed the development of a subsequent online survey to identify barriers, motivators, and other factors that influence decision-making by Black women diagnosed with breast cancer when considering clinical trial participation. Among the 257 Black survey participants, most (95%) were aware of clinical trials; of those, most viewed them as lifesaving (81%) and/or benefiting others (90%). Negative perceptions such as serious side effects (58%), not receiving real treatment (52%), or risk of potential harm (62%) were indicated. Barriers included financial expenses (49%), concerns that their condition could be made worse (29%), that they would receive a placebo (28%), or that treatment was unapproved (28%). Participants were more likely than their health care providers (HCPs) to initiate discussions of clinical trials (53% versus 33%), and 29% of participants indicated a need for more information about risks and benefits, even after having those conversations. The most trustworthy sources of information on clinical trials were HCPs (66%) and breast cancer support groups (64%). These results suggest that trusted communities are key for providing education on clinical trials. However, there is also a need for HCPs to proactively discuss clinical trials with patients to ensure that they are adequately informed about all aspects of participation.

Racial/ethnic and socioeconomic differences in breast cancer surgery performed and delayed surgical treatment: Mediating impact on mortality.

585 Background: Breast cancer is the most common malignancy affecting women of all racial and ethnic backgrounds in the United States (US). Although Socioeconomic status (SES), race/ethnicity, and surgical type/delays are associated with breast cancer mortality outcomes, studies on these associations have been contrasting. This study examined the racial/ethnic and SES differences in surgical treatment types and delays. Also, we quantified the extent to which these differences explained the racial/ethnic disparities in breast cancer mortality. Methods: We studied 290,066 women 40+ years old diagnosed with breast cancer between 2010 and 2017 identified from the Surveillance, Epidemiology, and End Results database. We performed logistic regression models to examine the association of SES and race/ethnicity with surgical treatment type and delays. We performed mediation analysis models to quantify the extent to which mortality differences were mediated by treatment, sociodemographic, and clinicopathologic factors. The study subjects were de-identified, and there was no patient contact; thus, the study was exempted from an Institutional Review Board's (IRB) approval. A p-value less than 0.05 indicated significant associations for the descriptive statistics, logistic and Cox proportional hazard regressions, and mediation analysis. We used Stata 17 to perform the analyses. Results: Non-Hispanic (NH) Black [Odds ratio (OR) = 1.16, 95% CI: 1.13-1.19] and Hispanic women [OR = 1.27, 95% CI: 1.24-1.31] were significantly more likely to undergo mastectomy compared to NH White women. Similarly, NH Black and Hispanic women had higher odds of delayed surgical treatment than NH Whites. Patients in the highest SES quintile, compared to those in lowest the lowest, were less likely to experience breast cancer-specific mortality (BCSM). Variations in treatment, SES, and clinicopathological factors significantly explained 70% of the excess BCSM among NH Blacks compared to their NH White counterparts. Conclusions: In conclusion, health disparity continues to be a major societal concern in the US. It affects people of all ages, socioeconomic classes, and ethnic/racial backgrounds. The findings of this study showed that racial and ethnic minorities, the majority of whom have a lower socioeconomic position, are significantly disadvantaged regarding the evaluation, quality, cost, and duration of medical care. Future studies can assess the multifactorial effects of sociodemographic factors like SES, access to health care assessment, and educational background amidst other variables as a multidimensional predictor of treatment delay and overall survival of breast cancer and other health issues among minoritized populations.

Disease outcomes by race in patients with high-risk triple negative breast cancer with residual disease after neoadjuvant chemotherapy: A post-hoc analysis of the EA1131 randomized clinical trial.

586 Background: Black women with breast cancer have the highest breast cancer mortality (BCM) rates of any racial and ethnic group. The higher burden of triple negative breast cancer (TNBC) in Black women contributes to disparities in BCM, but the extent to which disparate outcomes exist in patients with similar tumor biology is uncertain. The objective of this study was to examine racial differences in disease outcomes and BCM between Black and White patients in a clinical trial population of high-risk TNBC with residual disease after neoadjuvant chemotherapy (NAC). Methods: From 2015-2021, the ECOG-ACRIN EA1131 clinical trial randomized 415 clinical stage II-III TNBC patients with residual disease after NAC to either adjuvant capecitabine or platinum. For this analysis, 366 patients with known self-reported Black or White race and follow-up data were included. The aim of this unplanned exploratory analysis was to examine locoregional recurrence (LRR), distant recurrence (DR), and BCM by race using Kaplan-Meier curves for unadjusted estimates and Cox modeling for adjusted analyses. Results: Racial distribution of the analysis population included 66 (18.0%) Black and 300 (82.0%) White patients. 239 (65.3%) patients presented with clinical stage II and 127 (34.7%) with stage III disease. All patients had residual pathological disease after NAC: 86 (23.5%) stage I, 176 (48.1%) stage II, and 102 (27.9%) stage III (n=2 unknown). Median age was 49 years in Black and 54 years in White patients, p=0.003. Disease presentation, response to chemotherapy, and treatment arm were similar by race. Median follow up was 20 months. 2-year estimated LRR occurred in 31.6% of Black and 18.6% of White patients although this was not statistically significant (p=0.387), and 2-year estimated DR and BCM were similar by race. Estimated 2-year outcomes are outlined. Models adjusted for race, age, stage, grade, treatment arm, and locoregional therapy did not identify race as an independent predictor of LRR, DR, or BCM. Higher pathologic stage was the only consistent independent predictor of recurrent disease or BCM (stage III with HR 6.14 for LRR; HR 5.16 for DR; HR 6.84 for BCM; all p&lt;0.001). Conclusions: In this population of high-risk patients with residual TNBC after NAC with similar tumor biology treated on a clinical trial, there was a trend towards increased LRR in Black patients and similar DR and BCM between Black and White patients at 2 years of follow-up. This suggests that differences in BCM in other breast cancer populations may be at least partially driven by differences in tumor biology. Clinical trial information: NCT02445391 . [Table: see text]