Florida Cancer Registry Research Articles

Racial/ethnic disparities in curative-intent treatment for early-stage non-small cell lung cancer patients among heterogeneous Black populations: US-born Black, Afro-Haitian, West Indian Black, and Hispanic Black.

Heterogeneous Black populations encounter significant obstacles in accessing cancer care, yet research on lung cancer treatment disparities remains limited. This study investigates whether the disparity in receiving curative-intent treatment (curative-intent surgery and/or stereotactic body radiation therapy [SBRT]) for early-stage non-small cell lung cancer (NSCLC) between non-Hispanic Whites (NHWs) and total Blacks extends to diverse Black populations, including US-born, Afro-Haitian, West Indian Black, and Hispanic Black individuals. This cross-sectional study included all Florida cancer registry early-stage NSCLC cases 2005-2017, linked to individual-level discharge data containing comorbidity and specific treatment details (surgery and/or SBRT). Multivariable logistic regression assessed the association between race/ethnicity and the receipt of curative-intent treatment, while accounting for sociodemographic factors (poverty, age, insurance, and smoking status) and clinical variables. Among 55,655 early-stage NSCLC patients, 71.1% received curative-intent treatment: 72.1% NHW and 59.7% Black (non-Hispanic and Hispanic)individuals. Black patients had 35% lower odds (ORadj, 0.65; 95% CI, 0.59-0.70) of receiving curative-intent treatment compared to NHW patients. ORs varied from 0.57 (95% CI, 0.59-0.70) for Hispanic Black to 0.76 (95% CI, 0.56-1.02) for West Indian Black. Remarkably, Black-White disparities persisted despite the availability of curative treatment options (SBRT) for both high Charlson Comorbidity Index (CCI) observed among US-born Blacks and surgery for low CCI patients among all other Black subgroups. Pronounced disparities in accessing curative-intent treatments for early-stage NSCLC were evident across all Black subgroups, regardless of treatment availability and comorbidity profile. These findings underscore the need to address Black heterogeneity and prompt further research to rectify treatment disparities in early-stage NSCLC.

Comparing the linkage performance of fastLink, Match*Pro and Splink at the Florida Cancer Registry using simulated pseudopeople data

ObjectivesThe objective was to compare the record linkage performance of fastLink, Match*Pro, and Splink using realistic simulated "Rhode Island" data from the Python package pseudopeople. A requirement was no expected wrong matches (false positives, FP) after a limited manual review. ApproachWe incorporated custom noise on (a) Social Security Number (SSN) and (b) address. We first used high-quality data where SSN was available and then low-quality data where SSN was unavailable. Missed matches (false negatives, FN) were acceptable. We used an iterative process of determining the “appropriate” match threshold and the correct matches (true positives, TP). ResultsThe two analysis datasets, df1 and df2, resulted in 660,227 actual matches and 9,987 actual non-matches. The specified match threshold probability was 0.995 for fastLink, 0.999999999 for Splink, and about 0.99 for Match*Pro. When SSN was available, the (rounded) results were: Splink 627,000 TP (4 FP), fastLink 577,000 TP (15 FP), and Match*Pro 436,000 TP (4 FP) in the default frequency-based EpiLink-like option; the EM option crashed. When SSN was unavailable, the results were: Splink 579,000 TP (3 FP), fastLink 582,000 TP (137 FP), and Match*Pro 442,000 TP (3 FP); the EM option had 516,000 TP (442 FP). The fastLink developers are working on adding Active Learning. ConclusionOverall, Splink and fastLink performed better than Match*Pro. A likely explanation is that only Splink and fastLink provide match probability and are open source. Splink (Python) and fastLink (R) require basic user programming skills. The results will be updated once the final report has been approved.

Intra-Ethnic and Geographic Disparities in Stage at Diagnosis for Non-Small Cell Lung Cancer.

Despite the importance of early detection for lung cancer outcomes, staging disparities among the growing US Hispanic population remain underexplored. This population-based study aimed to identify racial-ethnic disparities among non-Hispanic White, non-Hispanic Black, and Hispanic (including specific subgroups) patients in stage at diagnosis for potentially curable non-small cell lung cancer (NSCLC). Incident NSCLC cases (2005-2018) were extracted from the Florida cancer registry. Stage was categorized as early (localized/regional) or advanced (distant). Multivariable logistic regression assessed the association between race/ethnicity and stage at diagnosis, adjusting for socioeconomic status, smoking, and clinical factors. Among 157,034 NSCLC patients, 47.8% were diagnosed at an advanced-stage. Multivariable models showed higher odds of advanced-stage diagnosis for non-Hispanic Blacks (ORadj=1.22; 95%CI: 1.17-1.26) and Hispanics (ORadj=1.03; 95%CI: 1.00-1.08) compared to non-Hispanic Whites. Regional differences were stark for Hispanics compared to non-Hispanic Whites: ORadj 0.96 (95%CI: 0.91-1.01) in South Florida vs 1.12 (95%CI: 1.05-1.19) in the rest of Florida. In South Florida, Central Americans (ORadj=1.49; 95%CI: 1.20-1.85) were the only Hispanic group showing a staging disadvantage compared to non-Hispanic Whites. Pronounced disparities in NSCLC staging among non-Hispanic Black and Hispanic populations, with notable regional variations within Florida's Hispanic communities, indicate that targeted interventions could significantly enhance early detection. The relative advantage observed in nearly all minority groups in multicultural South Florida compared to the rest of Florida underscores the need for future research exploring how specific Hispanic and multiracial sociocultural contexts can positively influence the landscape of cancer early detection across the US.

An Epidemiological Study of Cervical Cancer Trends among Women with Human Immunodeficiency Virus.

The purpose of this study was to examine cervical cancer among women with Human Immunodeficiency Virus (HIV) and to discuss targeted strategies to reduce the risk of developing cervical cancer. This study used retrospective data from surveillance reports collected between January 2001 and December 2012. Women with HIV/Acquired Immunodeficiency Syndrome (AIDS) were linked through a crosswalk file to Florida's cancer registry database to determine which women developed cervical cancer during this period. We examined the cervical cancer trends using age-adjusted cervical cancer rates to examine the changes over time; the geographic variations in cervical cancer and HIV across service areas using a Geographic Information System (GIS); and finally, the cervical cancer rates among women with HIV compared with the cervical cancer rates in the general population. The results show that, over time, the cervical cancer rates in women with HIV/AIDS decreased; however, we detected increases in the cervical cancer rates among women in the general population. The findings of this study show that more work is required to address cervical cancer. This growing burden of cervical cancer implies that targeted interventions are imperative to improving the health status of women with cervical cancer. If properly addressed, the potential to reduce and prevent cervical cancer is achievable.

Hepatocellular carcinoma etiology drives survival outcomes: A population-based analysis.

e16142 Background: Previous studies on survival differences according to etiology of hepatocellular carcinoma (HCC) (5-year observed survival of 23%) are limited to hospital-based series and restricted cohorts. We performed a population-based survival analysis by major HCC etiologies, inclusive of hepatitis-C virus (HCV), hepatitis-B virus (HBV), alcohol-related liver disease (ALD), and non-alcoholic fatty liver disease (NAFLD) as singular causes, in addition to unexplored dual etiological groups, (HCV&HBV, HCV&ALD, and HBV&ALD), and accounting for age at diagnosis, tumor characteristics, and socio-demographics. Methods: All 19,956 cases of HCC diagnosed in Florida during 2005–2018 from the Florida cancer registry were linked for HCC etiology using Agency for Healthcare Administration and Florida Department of Health viral hepatitis data. Survival analysis was performed for the 15,759 linked HCC cases, comparing HCC etiologic groups (4 single and 3 dual). Results included age-adjusted 5-year survival, Kaplan-Meier curves, and adjusted hazard ratios from Cox regression models. Results: The leading single etiology was ‘HCV only’ (n=4,983; 31.6%); the leading dual etiology was ‘HCV&ALD’ (n=2,694; 17.1%). The age-adjusted 5-year survival was low (<22%) across all HCC etiologies; however, non-ALD causes showed higher survival [‘HCV only’ (21.5%; 95%CI:20.2%–22.8%), ‘HBV only’ (20.2%; 95%CI:16.6%–23.9%), ‘NAFLD only’ (19.9%; 95%CI:18.7%–21.2%)] than ALD-related etiologies [‘ALD only’ (14.4%; 95%CI:12.7%–16.0%), ‘HCV&ALD’ (10.4%; 95%CI:9.0%–11.9%), ‘HBV&ALD’ (8.1%; 95%CI:2.2%–14.1%)]. Compared to the reference category ‘HCV only,’ age-adjusted hazard ratios were 1.69 (95%CI: 1.41–2.03; p-value<0.0001) for ‘HBV&ALD,’ 1.33 (95%CI:1.26–1.40; p-value<0.0001) for ‘HCV&ALD,’ and 1.35 (95%CI:1.28–1.43; p-value<0.0001) for ‘ALD only.’ Multivariable analysis including additional factors showed minimal variation from these results. Conclusions: Significant differences in survival based on HCC etiology are important for prevention, surveillance, and targeted treatments based on etiologic-specific biomarkers. Specific pathophysiological mechanisms for ALD in addition to viral hepatitis could be responsible for poorer outcomes for dual etiologies involving alcohol use, compared to viral etiology alone. To increase overall survival, improved screening is needed for patients with multiple HCC risk factors. [Table: see text]

A geospatial analysis of neighborhood hot spots and socioeconomic disparities associated with high lung cancer incidence for targeted intervention in south Florida.

e22525 Background: This study aims to identify the locations as well as specific socioeconomic disparities associated with high lung cancer incidences in South Florida (SF). The information is used to develop strategies for increasing smoking cessation and lung cancer screening rates in underserved communities via community outreach and engagement (COE). Methods: Sylvester Comprehensive Cancer Center’s catchment area in SF was studied and consists of three urbanized counties (Miami-Dade, Broward, and Palm Beach) as well as one rural county (Monroe), with a total population of 6 million. Age-adjusted incidence of lung cancer was calculated (2010-2019 Florida cancer registry data) for every census tract in the study area. Geospatial hot spot analysis was then applied to identify statistically significant clusters of census tracts with high age-adjusted lung cancer incidences. Socioeconomic data (American Community Survey) and smoking rates (CDC Places data) associated with the hot spot census tracts were then analyzed for risk factor identification and potential barriers to screening. Results: Hot spots census tracts for lung cancer in SF are generally associated with lower socioeconomic status, including lower income, higher percent of people living in poverty, more households with no vehicles, lower education levels, and higher percent of active smokers. Such socioeconomic disparities are most pronounced in the two highly populated counties of Miami-Dade and Broward. Palm Beach County’s hot spots include retirement communities, while those in the rural county of Monroe have the highest smoking rates. Conclusions: Using this analysis, our COE team began targeting hot spot communities for intervention with a specific focus on those where smoking rates are high, and no lung cancer screening facilities exist. The results demonstrate the utilities of geospatial data analysis for identifying locations and population segments for which increased cancer prevention efforts are needed. Targeting neighborhoods with the identified disparities for increased intervention in smoking cessation and lung cancer screening can help a COE team reach at-risk populations with limited resources more effectively. [Table: see text]

Abstract 2160: Utilizing geospatial analytics to identify neighborhood cancer hot spots for recruitment of underserved populations in clinical prevention research

Abstract Background: The term “precision public health” has increasingly been used in literature to describe public health practices that utilize new technologies and big data to precisely target the most vulnerable populations for disease control. Following the principles of precision public health, we used geospatial technologies and population-based health data to identify the locations and socioeconomic status of neighborhoods with high cancer incidences for recruitment of participants in prevention research. Methods: Using Florida cancer registry data, geospatial hot spot analyses were carried out to identify statistically significant clusters of census tracts with high incidences of prostate, gastric, and oral cancers within the catchment area of the Sylvester Comprehensive Cancer Center in South Florida. The locations, social determinants of health (US Census’ American Community Survey), and behavioral risk factor data (CDC’s Behavioral Risk Factor Surveillance System) of these hot spots were analyzed to identify the locations of underserved communities facing high risk for these three cancers. Results: Hot spots with high incidences for each of these three cancers overlap in many neighborhoods with high proportions of Hispanic and Non-Hispanic Black populations and high levels of socioeconomic disparities, such as low income, low education level, rental housing, no vehicles, and no access to health insurance. These neighborhoods also have high rates for behavioral risk factors in smoking, lack of physical activity, obesity, and high incidence of cervical cancer (high risk areas for HPV-associated oral cancers). Mobile screening units called the Game Changer Vehicles have been deployed to the locations to recruit participants who were tested on-site for prostate specific antigen (prostate cancer), H. pylori (gastric cancer), or solCD44 (a soluble tumor marker for squamous cell carcinoma) and total protein levels in oral rinse specimens, which can distinguish individuals with molecular features at risk for oral cancers due to tobacco, alcohol use, and human HPV infection. Conclusions: Geospatial analyses of population health data can be used to produce metrics that precisely target neighborhoods with high cancer risk and health disparities to recruit research participants. The same precision approach can also be applied for cancer screening purposes, such as offering cervical self-sample and fecal blood test kits in disadvantaged communities facing heightened risk for cervical and colorectal cancers. Citation Format: Ming S. Lee, Rebecca Kaiser, Ridhi Vyas, Amando Vera, Daniela Flores Quetant, Nancy Elliott, Valerie Bethel, Amanda Rivera, Shria Kumar, Brandon Mahal, Elizabeth Franzmann, Erin Kobetz. Utilizing geospatial analytics to identify neighborhood cancer hot spots for recruitment of underserved populations in clinical prevention research [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2160.

Trends and Disparities in Curative-Intent Treatment for Early-Stage Non-Small Cell Lung Cancer: A Population-Based Analysis of Surgery and SBRT.

Despite the increasing adoption of stereotactic body radiotherapy (SBRT) as a recommended alternative for early-stage non-small cell lung cancer (NSCLC), population-based research on racial/ethnic disparities in curative-intent treatment accounting for SBRT remains limited. This study investigated trends and disparities in receiving curative-intent surgery and/or SBRT in a diverse, retrospective cohort. Early-stage NSCLC cases (2005-2017) from the Florida cancer registry were linked to individual-level statewide discharge data containing comorbidities and specific treatment information. Joinpoint regression assessed trends in treatment receipt. Multivariable logistic regression examined associations between race/ethnicity and treatment type. Among 64,999 patients with early-stage NSCLC, 71.6% received curative-intent treatment (surgery and/or SBRT): 73.1%, 72.4%, and 60.3% among Hispanic, White, and Black patients, respectively (P < 0.01). SBRT use increased steeply from 2005 to 2007 and then by 7.9% annually from 2007 to 2017 (P < 0.01); curative-intent surgery remained stable from 2005 to 2014 before declining by 6.2% annually during 2014-2017 (P = 0.04). The Black-White disparity in receipt of curative-intent treatment was significant [ORadj, 0.65; 95% confidence interval (CI), 0.60-0.71]. Patients with Charlson comorbidity index (CCI)≥3 had 36% (ORadj, 0.64; 95% CI, 0.60-0.69) lower odds of receiving curative-intent surgery and no significant difference for SBRT (ORadj, 1.06; 95% CI, 0.93-1.20) compared with CCI = 0. Racial disparities in receiving curative-intent treatment for early-stage NSCLC persist despite the availability of SBRT, suggesting the full potential of curative-intent treatment for early-stage NSCLC remains unachieved. Addressing disparities in early-stage NSCLC requires addressing differential treatment patterns and enhancing accessibility to treatments like underutilized SBRT, particularly for high-comorbidity populations such as Black patients.

Cumulative Incidence, Predictors, and Outcomes of Transformation to Diffuse Large B-Cell Lymphoma in a Prospective Cohort of Patients with Marginal Zone Lymphoma

Background: Although marginal zone lymphoma (MZL) typically exhibits an indolent course, transformation to diffuse large B-cell lymphomas (DLBCL) is associated with a poorer outcome and remains a clinical challenge in managing patients with MZL. The limited existing literature reports various cumulative incidence rates, ranging from 2.5% and 4.7% (Finnish Cancer Registry, 1995-2018) to 6.6% and 8.4% (Florida Cancer Registry, 1995-2016) at 5 and 10-years, respectively, likely in part driven by varying study designs, ascertainment, and study population. Similarly, reported outcomes after transformed MZL (tMZL) have been variable. We evaluated the cumulative incidence of histological transformation (HT) to LBCL in a well-characterized prospective cohort of MZL patients from the upper Midwest, USA, and overall survival (OS) after transformation. Methods: Patients ≥ 18 years old with newly diagnosed MZL were prospectively enrolled in the University of Iowa/Mayo Clinic Molecular Epidemiology Resource (MER) cohort from 2002-2015. Clinical and treatment data were abstracted from medical records using a standard protocol. Patients were actively followed for retreatment, transformation, and death through 2022. Pathology was classified according to WHO 4/4R, including all transformations. The cumulative incidence of HT to LBCL was determined using death as a competing risk. Time to HT (TTHT) was defined as time from the date of MZL diagnosis to the date of transformation. We evaluated potential predictors of HT using a stepwise approach, and derived hazard ratios (HR) and 95% confidence intervals (CI) from Cox proportional hazards models. To assess predictors of OS after HT, patients ≥ 18 years old with newly diagnosed tMZL (into DLBCL) at Mayo Clinic between 1995 and 2002 (N=7) were combined with the MER cases. Results: We identified 524 patients with MZL in the MER cohort: 362 extranodal (EMZL; lung 18%, stomach 16%, orbit 13%, parotid 10%, skin 10%), 84 splenic (SMZL), and 78 nodal (NMZL). The median age at diagnosis was 63 years (range 18-92); 56% were female, and 83% were non-Hispanic white. During a median follow-up of 18.8 years (95% CI 16.7, NA), there were 25 HT (including 8 patients under observation) and 158 deaths. Eight Ten-year OS was 67% and 77% in the groups with and without HT, respectively. The overall cumulative incidence of HT was 1.5% at 2 years after diagnosis, 2.9% at 5 years, 4.5% at 10 years, and 5.7% at 15 years (Panel 1). The cumulative incidence of HT varied by subtype (e.g., at 5 years: 2%, 4% and 6%, in EMZL, NMZL and SMZL, respectively; Panel 2). The median time to HT also varied by subtype: 76 months (interquartile range (IQR) 43, 81) for EMZL, 30 months (IQR 16, 52) for SMZL, and 18 months (IQR 14, 23) for NMZL. In univariable analysis, predictors of HT were Stage III/IV (HR=3.4, 95% CI 1.36-8.53, p=0.009), elevated LDH (HR=2.98, 95% CI 1.25-7.12, p=0.014), and presence of ≥2 extranodal sites (HR=2.69, 95% CI 1.22-5.94, p=0.014). In multivariable analysis, elevated LDH was the only non-composite predictor of HT (HR=2.65, 95% CI 1.08-6.52, p=0.034). MALT-IPI score 2-3 (HR=3.61, 95% CI 1.06-12.25, p=0.040) and FLIPI score 3-5 (HR=2.19, 95% CI 1.22-8.22, p=0.018) also predicted HT. We analyzed OS after HT in 32 cases of tMZL (21 tEMZL, 7 tSMZL, 4 tNMZL). At HT, median age was 68 years (range 39-89); 24 (80%) patients presented with stage III/IV disease, 11 (58%) with elevated LDH, 12 (55%) with hemoglobin &amp;lt;12g/dL, 3 (14%) with platelet count &amp;lt;100x10 9/L and 9 (39%) with biopsy-proven bone marrow involvement. Twenty-six (81%) were treated with a systemic therapy, mainly CHOP-backbone therapy (R-CHOP n=13, CHOP n=4, R-EPOCH n=3, lenalidomide-R-CHOP n=1). Among these patients, the overall response rate was 85% (n=22/26). Three of the 4 non-responders died within 1 year. At last follow-up, 18/32 (56%) patients had died, and 6/13 (46%) alive patients had relapsed (MZL 3/6, DLBCL 3/6). After HT, 2-, 4- and 10-year OS were 76%, 55% and 55%, respectively. In univariable analysis, the only predictor of OS at HT was age ≥70 (HR 3.57 ,95% CI 1.34-9.48, p=0.011). Conclusion: In this North American prospective cohort of mainly non-Hispanic White patients, we found a low cumulative incidence of HT in MZL of 2.9% and 4.5% at 5- and 10-year, which was consistent with the Finnish findings (Kalashnikov et al., 2023). At HT, age was associated with OS and there was a high response rate to CHOP-backbone therapies.

Epidemiology of cholangiocarcinoma in Florida, and differences in risk factors between intra- and extra-hepatic cholangiocarcinoma.

e16329 Background: Albeit rare, cholangiocarcinoma (CC) is a poorly understood, highly fatal cancer with an incidence rate of less than 2.5 per 100,000 people. For most cases of CC, causes are not known. Here, we use population-based data from the diverse state of Florida to study the most recent incidence rates and trends for intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC) and measure the prevalence of potential risk factors and preexisting conditions associated with liver cancer including biliary conditions, diabetes, obesity and dyslipidemia, hypertension, smoking, chronic hepatitis C (HCV) and hepatitis B (HBV) infections, alcohol-related disease, and auto-immunes diseases. Methods: We used the Florida Cancer Registry Data on all cases of cholangiocarcinoma (N = 5,096) diagnosed during 2010–2018 (2,930 intra-hepatic, 2,166 extra-hepatic). Data were linked with two other data sources: the Agency for Healthcare Administration and the Department of Viral Hepatitis. Age-adjusted rates by sex were computed, incidence trends using Joinpoint regression and 5-year age-adjusted survival, using lifetable methods, were estimated. Differences in prevalence of risk factors were tested using chi-square tests. Results: Both ICC rates, 1.7 (per 100,000) for males and 1.3 for females, and ECC rates, 1.0 in males and 0.7 in females are relatively low. ICC is currently the fastest increasing cancer at a rate of +7.2% per year in males and +6.5% in females, while ECC trends remain stable. The 5-year survival was 11.0% for ICC (95%CI: 9.2-12.8) and 12.9% (95%CI: 10.5-15.3) for ECC. Overall, conditions such as diabetes type 2 (29%), obesity and dyslipidemia (41%), and hypertension (61%) were highly but equally prevalent in both ICC and ECC. The presence of non-alcohol related cirrhosis (6.0% vs 2.8% for ICC and ECC, respectively), chronic HCV infection (6.6%, 2.0%), and smoking (52.7%, 48.5%) were significantly more prevalent in ICC, while cholangitis of any type (13.5%,26.0%), chronic pancreatitis, auto-immune diseases (all. Conclusions: Currently, ICC is the most rapidly increasing cancer in the US; though, the extent to which better recognition of ICC plays a role in this trend is unknown. ICC and ECC show similarities, but also, differences in the prevalence of specific risk factors and preexisting conditions. The commonly held perception that the increase in metabolic causes (diabetes and obesity), similarly present in both ICC and ECC, are responsible for the current trends is partially challenged by the stable trends in ECC. Given its dismal prognosis, cholangiocarcinoma, especially ICC, requires further research. Funding: This work was supported by Bankhead Coley Grant #20B16 from the Biomedical Research Program of the Department of Health State of Florida.

The prognostic role of cigarette smoking in Kidney Cancer Survival.

The role of cigarette smoking as a prognostic factor for kidney cancer (KC) is unclear. In this population-based study, we analyze cancer-specific survival (CSS) outcomes among KC patients by smoking status at diagnosis in the diverse state of Florida. All primary KC cases from the Florida Cancer Registry diagnosed during 2005-2018 were analyzed. Cox proportional regression was conducted to assess the determinants of KC survival, including age, sex, race/ethnicity, socioeconomic status, histology type, cancer stage, and treatment received with a particular focus on smoking status (smokers at diagnosis referred to as current smokers, former smokers, and never smokers). Among all 36,150 KC patients, 18.3% were smokers at diagnosis (n = 6629), 32.9% were former smokers (n = 11,870), and 48.8% were never smokers (n = 17,651). Age-standardized five-year survival for current, former, and never smokers was 65.3 (95% CI: 64.1-66.5), 70.6 (95% CI: 69.7-71.5), and 75.3 (95% CI: 74.6-76.0) respectively. In multivariable analysis, current and former smokers had an estimated 30% and 14% higher risk of KC death compared to never smokers, respectively, after adjusting for potential confounders (HR: 1.30, 95% CI: 1.23-1.40; HR: 1.14, 95% CI: 1.10-1.20). Smoking independently contributes to poorer survival, across all KC stages. Clinicians should encourage and facilitate participation in cigarette smoking cessation programs targeted at current smokers. Prospective studies are warranted to assess the role of different types of tobacco use and cessation programs on KC survival.

Recruiting African American Prostate Cancer Survivors for a Population-based Biobank Study.

Prostate cancer affects African American men disproportionately compared with men of other racial/ethnic groups. To identify biological bases for this health disparity, we sought to create a state-wide biobank of African American prostate cancer survivors in Florida. African American men diagnosed with prostate cancer between 2013 and 2017 and living in Florida at diagnosis were identified through the State of Florida's cancer registry. Individuals were approached via mail and telephone, assessed for eligibility, and asked for informed consent. χ2 and t tests were conducted to identify differences between eligible and reachable individuals (i.e., had valid contact information) versus consented participants. Of the 5,960 eligible and reachable individuals, 3,904 were eligible and contacted at least once, and 578 consented [overall consent rate = 10% (578/5,960); adjusted consent rate = 15% (578/3,904)]. Statistically significant (Ps < 0.05) but small differences in demographic and clinical variables were observed. Consented participants were less likely to be older than 64 (35% vs. 41%) and less likely to have received radiotherapy (36% vs. 41%) and hormone therapy (16% vs. 21%), but more likely to have regional prostate cancer (13% vs. 11%) and have undergone surgery (44% vs. 39%). Consented participants did not differ from reachable individuals on other demographic and clinical factors (Ps > 0.05). Recruiting African American prostate cancer survivors to biobanking research through a cancer registry is feasible. However, the consent rate was low, and existing challenges limit consent and participation. Strategies for overcoming barriers to informed consent and increasing participation in biospecimen research are needed to address cancer disparities.

A natural history of gastroenteropancreatic neuroendocrine tumors evaluated at a tertiary cancer center: An observational study of 2,067 cases.

508 Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are the second most prevalent digestive cancer and are increasing in incidence. With relatively indolent tumor growth, survival is often long, even for patients with metastatic disease. However, few studies have assessed long-term survival. Therefore, we analyzed the overall survival (OS) of a cohort of GEP-NET patients at a tertiary cancer center from 2000-2015. Methods: 2,707 patients with a pathologic diagnosis of GEP-NET were identified. 640 patients presented for second-opinion visits and were excluded, leaving 2,067 patients, of whom, 2,053 had vital status data for analysis. Primary sites included jejunum/ileum (small bowel), pancreas, gastric, colorectum, appendix, duodenum, and unknown. OS time was calculated from the date of pathologic diagnosis to the date of last follow-up or death. The reverse Kaplan-Meier method was used to calculate follow-up time. Vital status was identified through linkage to the Florida Cancer Registry. Kaplan-Meier (KM) curves and log-rank test were used for OS analyses. Results: The median age of the cohort was 60.7 years. The median follow-up time was 148.9 months (12.4 years). 1,431 (69.2%) patients presented with distant metastatic disease. Most patients, 1,351 (65.5%), underwent treatment at another facility before presentation. The median OS was 132.2 months (11.0 years) for the cohort and was 108.0 and 245.5 months for patients presenting with and without metastasis, respectively (p &lt; 0.001). For metastatic patients, unknown primary tumor site was associated with the worst median OS (55 months), followed by rectal (77 months), gastric (84 months) and pancreatic (85 months; p &lt; 0.001). Duodenal and small bowel had the longest median OS at 147 and 143 months, respectively. Surgery for metastatic disease had an OS benefit (155.7 months) compared to no surgery (98.3 months). Conclusions: In a large cohort of predominantly metastatic GEP-NET patients with extended follow-up time, median OS was over 11 years and 9 years for patients with metastatic disease. These results suggest that OS at a tertiary cancer center may be greater than historical national administrative analyses when given adequate follow-up time, which is important to avoid bias in survival estimates.[Table: see text]

Survival for endometrial cancer as a second primary malignancy.

BackgroundEndometrial cancer (EC) often occurs subsequently to a primary cancer arising from a different site. However, little is known regarding the survival experience of EC as a second primary (ECSP) malignancy, specifically in relation to the original primary site and prior treatment.MethodsUsing Florida's cancer registry, all EC cases (first, second, or higher‐order) diagnosed from 2005–2016 were analyzed. Kaplan–Meier methods and Cox Regression were used in a cause‐specific survival analysis.ResultsA total of 2879 clinically independent ECSPs and 42,714 first primary ECs were analyzed. The most common first primary sites for ECSPs were breast cancer (BC) (n = 1422) and colorectal cancer (CRC) (n = 359). Five‐year cause‐specific survival was 84.0% (95% CI: 83.6–84.3) for first primary ECs and 81.8% (95% CI: 80.0–83.4) for ECSPs. After adjusting for age, race/ethnicity, histology, and stage at diagnosis, ECSPs had a lower risk of EC mortality than first primary ECs (hazard ratios [HR] 0.88, 95% CI: 0.79–0.97). ECSPs with a first primary CRC had a higher risk of EC‐specific death (HR 1.47, 95% CI: 1.04–2.06) compared to ECSPs that followed BC in multivariable analysis. Finally, women who had chemotherapy for ECSP and preceding BC did not have a higher risk of death (HR 0.80, 95% CI: 0.49–1.31) compared to those who only received chemotherapy for first primary EC.ConclusionsECSPs present a complex clinical profile. ECSP survival is superior to that of first primary EC. However, ECSPs following CRC may constitute a population of interest for their worse prognosis. Chemotherapy for a previous BC does not seem to impact the effectiveness of chemotherapy for ECs.

Finding incident cancer cases through outpatient oncology clinic claims data and integration into a state cancer registry.

Cancer data from population-based cancer registries under-report cancer cases, especially for cancers primarily diagnosed and treated in outpatient clinical settings, away from hospital-based cancer registrars. Previously, we developed alternative methods of cancer case capture including a claims-based method, which identified a large proportion of cancer cases missed by traditional population-based cancer registries. In this study, we adapted aclaims-based method for statewide implementation of cancer surveillance in Florida. Between 2010 and 2017 the claims-based method identified 143,083 cancer abstracts, of which 42% were new and 58% were previously registered. The claims-based method led to the creation of 53,419 new cancer cases in the state cancer registry, which made up 9.3% of all cancer cases registered between 2010 and 2017. The types of cancers identified by the claims-based method were typical of the kinds primarily diagnosed and treated in outpatient oncology clinic settings, such as hematological malignancies, prostate cancer, melanoma, breast cancer, and bladder cancer. These cases were added to the Florida cancer registry and may produce an artefactual increase in cancer incidence, which is believed to be closer to the actual burden of cancer in the state.

The role of histology on endometrial cancer survival disparities in diverse Florida.

BackgroundEndometrial cancer (EC) mortality is particularly high among non-Hispanic Blacks and is twice that of non-Hispanic Whites. However, comparisons of EC survival outcomes by race/ethnicity are often confounded by histology and grade. Here, we analyze EC survival disparities in multiracial Florida with a focus on EC types (1 and 2) and subtypes, defined according to histology and grade.MethodsAll 27,809 cases of EC diagnosed during 2005–2016 were obtained from the Florida Cancer Registry. Age-standardized, 5-year cause-specific survival by race/ethnicity and histological type were calculated. Fine and Gray competing risk regression was used to estimate sub-distribution hazard ratios (sHRs) for associations between risk of death due to EC and potential predictive factors such as histology/grade, age, stage at diagnosis, and insurance.ResultsType 2 EC accounted for only 38.7% of all incident EC-cases but 74.6% of all EC-deaths. Blacks were disproportionately affected by type 2 EC (57.6%) compared to Whites, Hispanics, and Asians (35.6%, 37.7%, and 43.0%, respectively). Age-adjusted 5-year survival for types 1 and 2 were 85.3% and 51.6%, respectively; however, there was wide variation within type 2 subtypes, ranging from 60.2% for mixed cell EC to as low as 30.1% for carcinosarcoma. In the multivariable model, Blacks with type 2 EC had a 23% higher risk of death due to EC (sHR: 1.23, 95%CI: 1.12–1.36) compared to Whites.ConclusionsPopulation-based analyses should consider the histological heterogeneity of EC because the less common type 2 EC drives racial/ethnic survival disparities in EC. Black women have a higher proportion of more aggressive histological types and an overall higher risk of death due to EC than Whites. To the extent that some of these histological types may be considered different diseases and require specific treatment approaches, further research on etiology and prognosis for detailed type 2 EC subtypes is warranted.

Disparities in BRCA counseling across providers in a diverse population of young breast cancer survivors

PurposeAll women diagnosed with breast cancer (BC) ≤age 50 should be referred for genetic counseling (GC) and testing. We sought to compare differences in provider practices and access across a racially and ethnically diverse population of young BC survivors. MethodsA registry-based sample of women diagnosed with invasive BC ≤age 50 from 2009 to 2012 was recruited through the Florida Cancer Registry, and completed a questionnaire and medical record release. Differences were compared across those tested with or without the involvement of a board-certified or credentialed genetics health professional (GHP) in (1) clinical and demographic variables and (2) pretest GC elements. ResultsOf 1622 participants, there were 440 Blacks, 285 Hispanics, and 897 Non-Hispanic Whites. Of 831 participants with medical record verification of testing provider, 170 (20%) had documentation of GHP involvement. Among the 613 who recalled a pretest discussion and had GC elements collected, those with GHP involvement were significantly more likely to recall the seven recognized GC elements. ConclusionGHP involvement was associated with adherence to nationally recommended best practices. With the expanding importance of identifying inherited cancers, it is critical to ensure equitable access to best practices across all populations.

Radiotherapy for the treatment of primary intraocular lymphoma and orbital (ocular adnexa) lymphomas

AbstractPrimary intraocular lymphoma (PIOL) is a lymphomatous proliferation seen in the eye and can be subdivided into two groups: (1) those which occur in the vitreous and /or retina and (2) those which occur in the uvea [1]. The histology is usually diffuse large B‐cell lymphoma (DLBCL) and diagnosis is made by vitrectomy, vitreal biopsy, or choroidal sampling. Vitreoretinal lymphomas are lymphomas that arise primarily in the vitreous and/or the retina and are considered as a part of the primary central nervous system lymphomas (PCNSL). Primary uveal lymphomas start as a primary disease in the uveal tract. Because brain was the most common site of relapse, some old data recommended in the past to treat as for PCNSL [2]. Modern data suggest that in case of brain relapse, salvage tratements remain effective [3]. Most patients with PIOL present a high risk of bilateral involvement, even when pathologic results have been obtained from only one eye. Ocular irradiation should include both eyes. However, when there is no suspicion of disease in the contralateral eeye, it is reasonable to treat onlym the involved eye. The volume of irradiation has to include the globe of the eye (s), optic nerves (s) to the level of the chiasm. Low dose of 30‐36 Gy is recommended [4]. Primary lymphoma of the ocular adnexa (orbital lymphoma) is a very rare tumor entity and accounts less than 1% of all non‐Hodgkin lymphomas (NHL) and 8% of all extranodal NHL [5]. Most cases of extraocular orbital lymphoma are marginal zone lymphoma (MZL) and involve the conjunctiva, lacrimal gland, eyelid, or retrobulbar soft tissues. Less common are follicular lymphoma (FL) and DLBCL. Primary radiation therapy (RT) is the curative option in patients with indolent lymphoma with high response rate and acceptable toxicity [6]. RT may be indicated to consolidate systemic therapy for DLBCL. For most cases of indolent NHL, the entire bony orbit has to be included. When the disease is limited to the conjunctiva, the irradiation has to include the entire conjunctival sac and local extensions to eyelid. A standard dose of 24 to 25 Gy in 1.5 to 2 Gy per fraction is prescribed. Since indolent lymphomas are highly radiosensitive, low dose irradiation (4 Gy in 2 fractions of 2 Gy) has been used in order to minimize the toxicity. A randomized non‐inferiority trial (FORT) compared conventional radiation scheme (24 Gy) to low dose RT (4Gy) in patients with FL. Low dose RT showed inferior results in term of local progression free survival [7].REFERENCES Venkatesh R, Bavaharan B, Mahendradas P, Yadav NK. Primary vitreoretinal lymphoma: prevalence, impact, and management challenges. Clin Ophthalmol. 2019;13:353‐64. Akpek EK, Ahmed I, Hochberg FH, Soheilian M, Dryja TP, Jakobiec FA, et al. Intraocular‐central nervous system lymphoma: clinical features, diagnosis, and outcomes. Ophthalmology. 1999;106:1805‐10. Teckie S, Yahalom J. Primary intraocular lymphoma: treatment outcomes with ocular radiation therapy alone. Leuk Lymphoma. 2014;55:795‐801. Yahalom J, Illidge T, Specht L, Hoppe RT, Li YX, Tsang R, et al. Modern radiation therapy for extranodal lymphomas: field and dose guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys. 2015;92:11‐31. Margo CE, Mulla ZD. Malignant tumors of the orbit. Analysis of the Florida Cancer Registry. Ophthalmology. 1998;105:185‐90. Fakhrian K, Klemm S, Keller U, Bayer C, Riedl W, Molls M, et al. Radiotherapy in stage I‐III follicular non‐Hodgkin lymphoma. Retrospective analysis of a series of 50 patients. Strahlenther Onkol. 2012;188:464‐70. Hoskin PJ, Kirkwood AA, Popova B, Smith P, Robinson M, Gallop‐Evans E, et al. 4 Gy versus 24 Gy radiotherapy for patients with indolent lymphoma (FORT): a randomised phase 3 non‐inferiority trial. Lancet Oncol. 2014;15:457‐63.

Abstract 4183: Recruiting African-American prostate cancer patients for biobank research

Abstract Significant racial disparities exist in prostate cancer (PCa) incidence and mortality rates. Exploration of the basis for disparities would be enhanced by access to data and biological specimens on men of African Ancestry (AA). Unfortunately, AA men remain underrepresented in cancer biorepositories. To address this gap, we have embarked on an effort to create a state-wide biospecimen bank focused on AA men with PCa in Florida. The objective is to collect and manage patients’ data, outcome information, and biospecimens (i.e., tumor tissue samples and saliva) from diverse AA men for research. The objective is to collect and manage patients’ data, outcome information, and biospecimens who have been diagnosed with PCa in Florida. Self-identified AA PCa patients, diagnosed between 2013 and 2017, who were living in Florida at the time of diagnosis were identified through the Florida State cancer registry. Potential participants were mailed packets describing the study, with follow-up by telephone to answer questions and obtain informed consent. Interested patients were screened for eligibility and asked to complete a questionnaire, provide a saliva sample, and provide permission to obtain their tumor tissue sample. Patients were offered up to $30 for participating in the study. The Florida Cancer Registry reported a total of 7,960 AA PCa cases during the ascertainment period. Information packets were sent to 4,898 AA. A total of 116 were found to be ineligible mainly due to deceased or non-English speaking patients. To date, 796 have consented to participate, 1,175 declined ether by mail (n=185) or phone (=985), 740 could not be located, and 2,033 have not responded to the initial information packet/phone after total of 5 attempts. This yields a participation rate of 16.3% (796/4,898). The adjusted participation rate, or the percentage of participants who consented to participate out of those who had communication with the research team, is 41% (796/1,959). Primary reasons for declining include patients stating that they are not interested (72%), too sick (8%), or too busy (5%). A significant inverse association was found between current age and participation rate (p&amp;lt;0.0001) but not insurance status. Older AA PCa patients were found to be less likely to participate in the study. A significant association was also found between Gleason score and participation rate. AA men who had a more aggressive form of PCa (higher Gleason score) were more likely to participate in the study (p&amp;lt;0.01). Our results demonstrate that recruiting Blacks/African-American PCa patients in the biobank study using a cancer registry is feasible, yet difficult. Despite prevailing recruitment challenges, we implemented a diverse of recruitment methods to increase reach. These recruitment methods helped identify additional avenues for targeting this population to increase participation and, ultimately, address cancer disparities among this population. Citation Format: Jennifer Damonte, Siddhartha Roy, Carmen Benson, Kala Jamison, Hyun Park, Allan Pollack, Shahla Masood, Changdong Yeo, Young-chul Kim, Jasreman Dhillon, Kosj Yamoah, Julio Pow-Sang, Thomas A. Sellers, Clement K. Gwede, Jong Y. Park. Recruiting African-American prostate cancer patients for biobank research [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4183.

Psychosocial impact of BRCA testing in young Black breast cancer survivors.

Prior studies demonstrating minimal psychological consequences for women receiving genetic counseling/genetic testing (GC/GT) for hereditary breast and ovarian cancer rely on predominantly Caucasian women. We conducted a prospective follow-up of a subset of participants from a population-based study of Black breast cancer (BC) survivors receiving GC/GT for BRCA1 and BRCA2 mutations. Black women with invasive BC at age≤50years diagnosed between 2009 and 2012 were recruited through the Florida Cancer Registry. Participants (n=215, age M=44.7, SD=6.2) were offered telephone pre- and post-test GC, a subset completed questionnaires assessing sociodemographic, clinical, and psychosocial variables. There were no baseline differences in cancer-related distress, psychological distress, or quality of life between test result groups. Social well-being improved in women receiving negative results (P=.01), but no other outcomes demonstrated significant changes over time between groups. Our study is among the first to demonstrate minimal negative psychosocial outcomes following GC/GT among young Black BC survivors, irrespective of test results.