High Cancer Research Articles

Abstract C056: Cancer patterns and trends in Costa Rica: A population-based tumor registry study

Abstract Background: Recent economic and social changes in low- and middle-income countries in Latin American have influenced the raise of noncommunicable diseases, including cancer. Data from cancer registries are critical for surveilling disease trends during periods of epidemiologic transition. The aim of this study is to generate population estimates of cancer incidence rates in Costa Rica and to evaluate geographical differences. Methods: The National Tumor Registry in Costa Rica was queried for cancer cases diagnosed between 2009-2014. Population data were used to calculate sex, country and region-specific age standardized rates (ASR) per 100,000 people using the World Health Organization's 2000 standard population. Standardized incidence ratios (SIR) and 95% confidence intervals (CI) were calculated to assess the effect of sex and geographic regions. Results: The overall cancer incidence rate in Costa Rica was 219.24 cases per 100,000. Females had a higher cancer rates relative to males (SIR: 1.1, 95% CI: 1.08-1.11, p < .001). The leading cancers were prostate (ASR: 53.09, 95% CI: 51.75-54.46), female breast (ASR: 48.73; 95% CI: 47.54-49.94), cervical (ASR: 30.78; 95% CI: 29.77-31.62), stomach (ASR: 17.45; 95% CI: 16.93-17.99), colorectal (ASR: 16.49; 95% CI: 15.98-17.00) and thyroid (ASR: 12.96; 95% CI: 12.54-13.40) cancers. San Jose had the highest breast and colon cancers rates whereas, Cartago had the highest rates for gastric and thyroid cancers. Conclusion: Costa Rica has a growing cancer burden involving preventable cancers. Continued monitoring of trends in incidence rates is needed to implement cancer control actions. Further involvement to create cancer prevention strategies and programs aimed to reduce cancer burden is warranted. Citation Format: Omar Picado, Jordan Baeker-Bispo, Layla Bouzoubaa, Raymond R. Balise, Gilberto Lopes, Erin N. Kobetz. Cancer patterns and trends in Costa Rica: A population-based tumor registry study [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 C056.

Abstract C027: Racial variation in umbilical cord blood vitamin D concentrations and telomere length: Implications for cancer risk

Abstract Background: Non-Hispanic Blacks (NHBs) experience a markedly higher cancer burden and cancer mortality compared to non-Hispanic Whites (NHWs). Several factors account for this disparity, including suboptimal or deficient vitamin D status. Vitamin D has an important role in cancer risk, disease/cancer progression and telomere biology. Given the documented cancer disparities between these groups, it is important to examine vitamin D concentrations and leukocyte telomere length in utero, a window of susceptibility for disease and cancer risk later in life. We investigated racial differences in neonate umbilical cord blood vitamin D concentrations, and whether differences in vitamin D concentrations are associated with umbilical cord blood telomere length by race and gender. Methods: In 2006-2007, pregnant women were recruited for the Expanded Hormones in Umbilical Cord Blood Study (EHUB) and followed to postpartum. Venous umbilical cord blood samples, along with maternal and birth characteristics, were collected in 39 NHB and 65 NHW full-term neonates. 25(OH)D and 1,25(OH)2D levels were assayed using an equilibrium radioimmunoassay procedure, and relative telomere length was measured by qPCR in leukocyte DNA. Geometric mean plasma concentrations of 25(OH)D and 1,25(OH)2D were calculated. Linear regression analysis was used to examine associations between neonatal cord blood 25(OH)D and 1,25(OH)2D concentrations and leukocyte telomere length by race and gender. Results: Compared to NHW mothers, NHBs were younger, had higher parity, were more likely to be overweight and obese prepregnancy, and more likely to be exposed to secondhand smoke. NHB neonates had lower birth lengths (19.4 versus 20.2 inches; p<.0001) and lower birth weights (3287 vs. 3425 gm) than NHW neonates. Compared to NHW neonates, NHBs had lower adjusted mean 25(OH)D (6.4, 95% CI: 5.4-7.6 ng/mL versus 16.4, 95% CI: 14.2-18.9 pg./mL; p<.0001) and lower 1,25(OH)2D concentrations (51.1, 95% CI: 43.3-60.4 pg./mL versus 71.7, 95% CI: 62.6-82.0 pg./mL; p<.0003). After adjusting for race and gender, 25(OH)D and 1, 25(OH)2D concentrations were not associated with telomere length. There was an interaction between race and vitamin D, but not gender and vitamin D on telomere length. Compared to NHWs, NHB neonates had shorter telomere lengths per increase in vitamin D concentrations (-0.83 per unit of 25(OH)D and -0.79 per unit of 1,25(OH)2D). The interaction persisted after adjusting for maternal and birth characteristics. Conclusion: We did not find an association between umbilical cord blood vitamin D concentrations and telomere length. Instead, our findings suggest an interaction between race and umbilical cord blood vitamin D on telomere length. Further research is warranted to understand whether the effect of in utero exposure to vitamin D concentration on telomere length can inform the underlying mechanisms that are associated with cancer disparities in adulthood. Citation Format: Tanya Agurs-Collins, John Barber, Jessica Bienstock, Paige Green, Christopher Heaphy, Jiayun Lu, Alan Meeker, Anthony Rizzo, Sabine Rohrmann, Elizabeth Platz. Racial variation in umbilical cord blood vitamin D concentrations and telomere length: Implications for cancer risk [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 C027.

All-cause and cancer mortality in a private health plan in Brazil: Ten years retrospective analysis.

e13610 Background: Cancer is the second leading cause of death worldwide. From 2014 to 2015 Brazil estimated more than 500,000 new cases of cancer, which placed the country among those with the highest cancer incidence. This study evaluates the 10-year evolution of mortality rates due to all causes and cancer and to estimate the potential years of life lost (PYLL) in beneficiaries of health plan, according to sex, age and geographic region. Methods: Retrospective cross-sectional, descriptive study evaluated the causes of death, between 2008 and 2017, by sex and age groups, for all causes (AC) and cancer (CA) data from the health insurance system. The information on the death certificates (DC) was coded according to the ICD-10. Age was stratified into groups: up to 49 years, 50–59 years, 60–69 years, 70–79 years and 80 years or more. Data were analyzed by checking the proportions and mortality rates (MR), grouped into two five-year periods, 2008-2012 (P1) e 2013-2017 (P2). Annual MR per 100,000 population was estimated using the direct method and proportional mortality rates (PMR). To calculate the potential years of life lost (PYLL) the upper limit was 76 years old. The avoidable MR was also analyzed for individuals up to 75 years and cancer. Microsoft Excel v2010 and Qlik Sense v13.21 were used to analyze data and statistics. Results: 5,779 deaths were analyzed, 4,447 in men (77.0%, average 70.1 years) and 1,332 women (33%, 75.9 years). Cancer was the second leading cause of death (n = 953, PMR 16.5%), behind cardiovascular disease (n = 1,662 PMR 28.8%). The major crude death rate per 100,000 was due circulatory system diseases (347), followed by cancer (199) and respiratory system diseases (110). The highest cancer MR were in men, elderly and Brazilian regions with the lowest Human Development Index (HDI). Greatest number of deaths in men at P1 were from cancers of lung (CMP 19.8%), prostate (14.2%) and pancreas (8.0%). At P2, prostate (18.2%), lung (16.8%) and stomach (7.6%). In women, during P1, breast (20.2%), lung (13.1%) and pancreas (83%), and during P2, the same order, 22.5%, 14.6% and 9.3%, respectively. Cancer accounted for a total of 6,335 PYLL and 40.9% of causes of death were classified as avoidable. Conclusions: Cancer was one of the leading causes of mortality during the study. High pancreatic cancer MR differs from national statistics, requiring more analysis that involves possible occupational exposure. Although preventive actions for healthy life habits, early screening and diagnosis, Brazil presents high cancer mortality rates as showed in this analysis.

Lipid levels and survival after obesity-related cancer in the Women’s Health Initiative CVD biomarker cohort.

e13618 Background: Previous investigations have demonstrated an inconclusive relationship between lipid biomarkers and mortality after cancer. Methods: We used data from 2,279 postmenopausal women diagnosed with 13 obesity-related cancers, who were part of the Women’s Health Initiative (WHI) lipid biomarkers cohort, to evaluate the relationship between lipid levels measured at study entry prior to cancer diagnosis, and mortality after cancer. Baseline lipid measurements consisted of HDL-Cholesterol, LDL-Cholesterol, and non-HDL-Cholesterol with ranges of measurement listed in the table. Obesity-related cancers included: meningioma, thyroid, adenocarcinoma of esophagus, breast, multiple myeloma, liver, kidney, gallbladder, stomach, uterus, pancreas, ovaries, and colorectal. The age adjusted relationship between baseline lipids and all-cause mortality as well as mortality due to cancer were estimated using Cox proportional hazards models and Fine-Gray models, respectively. Results: The majority of women in the cohort had either desirable or acceptable lipid levels (86% HDL-C, 30% LDL-C and 61% non-HDL-C. Low vs. desirable HDL-C levels were associated with higher risk of all-cause mortality (hazard ratio (HR) 1.54, 95% confidence interval [CI] [1.48, 1.60], p <.001) and higher cancer mortality (sub-distribution hazard ratio (SHR)1.9, 95% CI [1.51, 2.3], p <.001). High non-HDL-C vs desirable, was associated with higher all-cause mortality (HR 1.13, 95% CI [1.06, 1.21], p = .001) however no significant impact on cancer mortality (SHR 1.06, 95% CI [0.87, 1.30], p = 0.563). LDL-C levels demonstrated a more complex relationship with mortality, nevertheless, very high LDL-C levels were associated with higher risk of all-cause mortality (HR 1.63, 95% CI,1.21-2.2, p = ,0.001) and cancer-specific mortality (HR 1.78, 95% CI 1.22-2.63, p = 0.003). Conclusions: Elevated LDL-C and lower HDL-C may be associated with a lower risk of all-cause and cancer specific mortality in women diagnosed with obesity related cancers in the WHI. Results of multivariable adjustment for important predictors of mortality including race/ethnicity, medication use and other socio-demographic and clinical factors will be presented. [Table: see text]

Are the demographics of recurrent oropharyngeal and oral cavity squamous cell carcinoma changing?

e18537 Background: In the current era of human papillomavirus (HPV)-related oropharyngeal cancer and decreasing alcohol and tobacco use, the demographic factors associated with recurrent head and neck cancer may be evolving. We evaluated clinical and demographic factors in a cohort of patients with recurrent and non-recurrent Oral Cavity (OC) and Oropharyngeal Squamous Cell Carcinoma (OPSCC) in order to evaluate which factors are associated with tumor recurrence and how these factors are modified by HPV status. Methods: From a cohort of 3201 patients diagnosed with OC and OPSCC at Kaiser Permanente Northern California between 1/1/2008 and 6/30/2019, 235 recurrent cases were identified. Clinical and demographic factors were extracted from electronic medical records. We calculated frequencies of demographic and clinical factors stratified by recurrence and HPV status, and reported p-values using the chi-square test for independence. Results: HPV-related cases were more likely to be male (84% vs. 64%), younger (80% ≤70 years old vs. 55%), have fewer comorbidities (61% with non-cancer Charlson index < 1 vs. 47%), and higher cancer stage (88% with a stage > 1 vs. 42%) than HPV-unrelated cases. Recurrent HPV-unrelated cases were more likely to be Asian (14% vs. 8%), and from higher income census tracts (75% from tracts with median household income > $60,000 vs. 66%) than recurrent HPV-related cases. Chi-square p-values of < 0.001. Recurrence and HPV status did not appear to be associated with prior smoking and alcohol abuse. Conclusions: Our cohort verifies that HPV-related OPSCC patients are more likely to be younger, male, and with lower Charlson scores, while recurrent HPV-unrelated OC and OPSCC may be more common among Asians and individuals from higher-income census tracts. This may have important implications for future clinical trial design and surveillance for recurrence. [Table: see text]

Association of geriatric conditions with survival and health care use in older adults with colon cancer living in long-term care facilities.

12045 Background: Older adults with colon cancer residing in nursing homes are at risk for experiencing geriatric conditions such as cognitive decline, limitations in activities of daily living (ADLs), needing pain medications, and incontinence, due to cancer and its treatment. We sought to investigate these factors pre- and post-diagnosis and explored their relationship with health care use and survival. Methods: We identified 483 patients age 65+ with colon cancer from 2011-2015 in SEER-Medicare with linked quarterly nursing home assessments from the Minimum Data Set both pre- and post-cancer diagnosis. We determined the number of geriatric conditions (cognitive functioning, limitation in any ADL, pain medication use, bowel/urinary incontinence) at the pre- and post-cancer diagnosis assessment. We created four groups based on changes in these factors from pre- to post- assessment: improved (n = 105), worsened (n = 25), remained limited (n = 240), never limited (n = 113). Regression models estimated how changes from pre- to post-cancer diagnosis were associated with number of emergency department (ED) visits, hospitalizations, and survival, adjusted for age, sex, race/ethnicity, insurance status, cancer stage, number of pre-cancer comorbidities, urban/rural status, and time from diagnosis. Results: Overall, 55.3% of patients were age > 80 at diagnosis, with 64.8% female; 73.3% non-Hispanic white; and 9.9% Stage IV. Pre- versus post-diagnosis, 20.7% vs. 34.8% of patients were limited in cognitive functioning, and 75.4% vs. 77.8% were limited in ADLs. About a third of patients required pain medication, and about half of patients had urinary incontinence, which did not change pre- and post-diagnosis. Patients who remained limited had higher rates of ED visits (Risk ratio [RR] 1.05, p < .01) compared to those never limited. Those who worsened had higher rate of hospitalization (RR 1.44, p < .01) and ED visits (RR 1.63, p < .01). 12-month and 5-year survival was 46.7% and 6.1%, respectively. Factors associated with worse survival in a multivariable model included: remaining limited at both assessments (OR 1.52, p < .01), worsening from prior (OR 2.00, p = .01), as well as older age and higher cancer stage. Conclusions: Older adults with colon cancer residing in nursing homes have high prevalence of geriatric conditions and differential health care use and survival based on the presence of geriatric conditions, highlighting the need to consider geriatric conditions when providing cancer care to this population.

Utilization of imaging in pancreatic adenocarcinoma patients status post Whipple procedure.

e16725 Background: Pancreatic adenocarcinoma (PAC) remains the third leading cause of cancer death in the Western world. The 5-year survival of patients with PAC remains at 4%. Proper utilization of imaging to detect recurrence is necessary in patients who have undergone a Whipple procedure. Currently, Carbohydrate (CA) 19-9 is used for screening and is the only biomarker approved by the Food and Drug Administration (FDA). Sensitivity and specificity range from 79-81% and 82-90%. We intend to evaluate our single institute experience of imaging utilization, CA 19-9, and surgical specimen histopathologic features in the surveillance of PAC patients status post Whipple. Methods: Retrospective analysis of patients with a diagnosis of PAC who underwent imaging status post Whipple from 2008 - 2018 was completed. Cross-sectional imaging and clinical data was obtained from the electronic health record. Results: A total of 197 PAC patients status post Whipple were identified with mean age at diagnosis at 64.4 years and male to female ratio of 1.3. 85 patients were found to have died during treatment. The median survival for these patients was 68 years. Of the patients who died status post Whipple, postoperative CA 19-9 levels within 6 months of the procedure were elevated (p = 0.01). Patients who were found to have stage II to IV PAC at diagnosis were found to have a high CA 19-9 level within 6 months post-Whipple when compared to stage I patients (p < 0.05). Patients who were found to have less than 5 surveillance CTs status post Whipple were found to have higher CA 19-9 levels within 6 months status post Whipple (p < 0.01). There was no difference in number of CT scans between stages. Of those patients who died with stage I or II PAC at diagnosis, a large number were found to have less than 5 surveillance CT studies completed status post Whipple (p < 0.05). Furthermore, a higher cancer stage at diagnosis correlated with worse pathologic differentiation of the cancer (p < 0.001). Conclusions: Post Whipple CA 19-9 correlated with stage, recurrence, number of scans, and survival.

The Evolution of Un Abrazo Para La Familia: Implications for Survivors of Cancer.

Un Abrazo Para La Familia™ (Abrazo) is a 3-h modular preventive intervention designed for low-income caregivers who are co-survivors of cancer. Here we (1) consider the benefit to survivors of cancer, that is, the care recipients who participate in Abrazo; (2) summarize the literature specific to research outreach to low-income, underserved populations when they are faced with cancer; and (3) describe current steps being taken in Southern Arizona to reach these populations via Abrazo. Specific to considering the benefit to care recipients, we analyzed care recipient data derived from three existing cohorts of Abrazo participants. Analyses of the combined cohorts of these data demonstrate that Abrazo is effective with care recipients given statistically significant higher cancer knowledge and self-efficacy scores, pre- vs. post-intervention. We can now report benefit to care recipients who participate in Abrazo. This allows us, with confidence, to expand research recruitment efforts to include care recipients as part of the Abrazo intervention in our efforts to serve low-income, underserved populations when faced with cancer.

Phenome-Wide Scan Finds Potential Orofacial Risk Markers for Cancer

Cancer is a disease caused by a process that drives the transformation of normal cells into malignant cells. The late diagnosis of cancer has a negative impact on the health care system due to high treatment cost and decreased chances of favorable prognosis. Here, we aimed to identify orofacial conditions that can serve as potential risk markers for cancers by performing a phenome-wide scan (PheWAS). From a pool of 6,100 individuals, both genetic and epidemiological data of 1,671 individuals were selected: 350 because they were previously diagnosed with cancer and 1,321 to match to those individuals that had cancer, based on age, sex, and ethnicity serving as a comparison group. Results of this study showed that when analyzing the individuals affected by cancer separately, tooth loss/edentulism is associated with SNPs in AXIN2 (rs11867417 p = 0.02 and rs2240308 p = 0.02), and leukoplakia of oral mucosa is associated with both AXIN2 (rs2240308 p = 0.03) and RHEB (rs2374261 p = 0.03). These phenotypes did not show the same trends in patients that were not diagnosed with cancer, allowing for the conclusion that these phenotypes are unique to cases with higher cancer risk.

Population of elderly patients with cancer – a growing public health problem in the perspective of national health programmes in Poland

We are witnessing an unprecedented increase in the population of elderly people in Poland and other countries. A large number of these people are at risk of falling ill with cancer. In recent years, medicine has successfully reduced mortality from cardiovascular diseases. Unfortunately, it has been impossible to achieve a significant reduction in cancer mortality, especially in countries with a medium-high human development index, including Poland. The mortality of elderly people due to cancer is particularly difficult to reduce. Screening programmes should be targeted primarily at the older people. The number of people who are unnecessarily tested to diagnose one case of cancer is the lowest in this population. However, screening methods are nonspecific, result in cancer overdiagnosis, extend the lead time, but do not reduce mortality. New screening methods that identify the highest-risk conditions should be developed primarily for the use in the older population. Survivorship care plans for patients who have had cancer are equally important for elderly and younger people. They allow younger patients to resume active life and work. In the elder, they may facilitate control of comorbidities likely to exacerbate after cancer treatment. These exacerbations increase the costs of hospital treatment, reduce the quality of life and increase mortality for reasons not directly related to cancer. The higher cancer mortality rate in elderly patients is partly associated with the fact that treatments with proven effectiveness in younger patients are not used in elderly people because there is no evidence for their clinical benefit but also because they may be overtreated. Relevant studies are currently being carried out by specialized institutions. These challenges should be considered in the debates on the priorities of updated versions of the National Cancer Control Programme and the National Health Programme.

Neutrophil-to-lymphocyte ratio as a predictor of oncologic outcomes in locally advanced non-metastatic clear cell renal carcinoma.

661 Background: An elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with worse oncologic outcomes in several malignancies, its prognostic role in kidney cancer, specifically in the non metastatic setting is controversial. We aimed to evaluate if an elevated NLR in patients with locally advanced non metastatic clear cell renal cell carcinoma (CCRCC) is associated with a worse survival and/or a higher cancer recurrence rate. Methods: We retrospectively identified 880 nephrectomies performed between 01/2009 to 12/2016 in a single center, reviewed data from 478 consecutive radical nephrectomies (RN) for kidney tumors and identified 187 patients with locally advanced non-metastatic CCRCC patients (pT3-T4 N0M0). The cut-off point of NLR = 2.5 was obtained using the receiver operating curve analysis (ROC). NLR was obtained preoperatively and calculated by dividing absolute neutrophil count by absolute lymphocyte count. Overall survival (OS) and recurrence-free survival (RFS) were evaluated using the Kaplan-Meier method. Cox regression models were utilized to evaluate predictors of recurrence and survival. Results: Median follow up was 48.7 months. The 3 year OS was significantly lower for patients with NLR ≥ 2.5 than those with NLR < 2.5 (70% vs 85%, p = 0.049). In patients with a Fuhrman nuclear grade of differentiation of 3-4, the median time to recurrence was significantly shorter for patients with NLR ≥ compared to those with NLR < 4 (24 vs 55 months p 0.045). On multivariable analysis adjusted for NLR ≥ 2.5, microvascular invasion, sarcomatoid differentiation, tumor size and body mass index, only nuclear grade of differentiation was found to be an independent predictor for recurrence (hazard ratio= 2.18; 95% confidence interval [CI]: 1.07 – 4.92, p = 0.03). Conclusions: Patients with non-metastatic CCRCC with higher nuclear grade of differentiation and a high preoperative NLR have shorter RFS and worse OS compared to patients with lower NLR.

Abstract P6-11-10: Patient reported measures of a breast cancer nurse navigator program in a minority, rural, and economically disadvantaged patient population

Abstract Background: A Breast Cancer Nurse Navigator (BCNN) is a designated nurse specially trained to follow and support patients and their loved ones through their cancer treatment. BCNNs have been shown to improve patient experience, improve quality of life, and reduce delays in care. In 2017, the University of New Mexico Comprehensive Cancer Center (UNMCCC) instituted a Nurse Navigator program aimed at improving the treatment experience of the unique patient population the institution is intended to serve, primarily minority, rural, and economically disadvantaged patients. Approximately 22% of New Mexicans live in rural areas, and New Mexico ranks 49thin the nation in terms of poverty, with 19.7% of the population living below the poverty line. Both of these predispose to across the board poorer health outcomes and poorer cancer outcomes, including a link between poverty and higher cancer mortality. New Mexico is home to over 200,000 Native Americans, making up 10.4% of the state population, and 1 million Hispanics, making up 48% of the state population. Both groups suffer worse outcomes, increased barriers to care, and overall measurably lower quality of life. UNMCCC’s BCNN program aligns with the American Society of Clinical Oncology’s new task force to address the rural cancer care gap. Methods: Surveys to assess patient satisfaction and services utilized were administered anonymously during regularly scheduled appointments at UNMCCC between April 29 and June 7, 2019 to breast cancer patients, both those under the care of the BCNN and those whose care began prior to the beginning of the program. There were 32 “non-navigated” patients responding, and 54 “navigated” patients. Yes/no questions were converted to binary and Likert Scale questions were converted to scores ranging from 1-5, 1 signifying “Strongly Agree” with 5 signifying “Strongly Disagree.” Results were assessed using two sample T-Tests assuming unequal variances. Results: Navigated patients more strongly agreed that they were prepared for the beginning of treatment when compared to their non-navigated peers (1.558 vs 2.103, p=.020), and showed a decreased desire for an after treatment summary (.918 vs 1.0, p=.044). They also reported that calls were returned promptly when compared to their non-navigated peers (1.33 vs 1.8, p=.003). Navigated patients were subjectively more likely to agree that office staff were knowledgeable about their treatment plan than the non-navigated patients (1.509 vs 1.806, p=.134). Navigated patients were more likely to agree that the BCNN helped them understand treatment plans (1.549 vs 1.710, p=.437), took their concerns seriously (1.434 vs 1.516, p=.579), and helped manage side effects (1.689 vs 1.923, p=.356). Conclusions: The navigated patients perceived that their calls were returned more quickly, which improves patient satisfaction and confidence in the treatment plan and care team. Navigated patients also displayed stronger agreement that they were prepared for the beginning of their treatment, which was supported with a decreased desire for an after treatment summary, suggesting that patients felt overall more knowledgeable about their care. There were subjective improvements in all other treatment related metrics that were not statistically significant though likely limited by the small sample size. This study shows that patients in a unique minority, rural, and economically disadvantaged population subjectively report better understanding of and engagement with the health care system when assisted by a BCNN during the treatment of curative breast cancer, an effect which has not been well demonstrated before. Acknowledgements: Special thanks to Patricia Kuhne and Susan Martinez for their assistance, without which this project would not have been possible. Citation Format: Michael Williams, Dianne Nielson, Zoneddy Dayao, Ursa Brown-Glabberman, Bernard Tawfik. Patient reported measures of a breast cancer nurse navigator program in a minority, rural, and economically disadvantaged patient population [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-10.

A Comparative Study: Has MRI-guided Fusion Prostate Biopsy Changed the Prostate-specific Antigen Gray-zone Range?

ObjectiveThe gray-zone prostate-specific antigen (PSA) range is accepted to be 4-10 ng/ml and is considered to vary according to age. We aimed to investigate whether fusion prostate biopsy (FPB), which has been reported to have relatively higher cancer detection rates, has an effect on gray-zone PSA cut-off value.Material and methodsThis retrospective study included patients that underwent standard prostate biopsy (SPB) or multiparametric magnetic resonance imaging (MpMRI)-guided FPB (SPB+ targeted biopsy). All the patients included in the study were detected with a Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesion on MpMRI (the FPB group only). The demographics, clinical characteristics, and histopathological diagnoses were recorded for each patient.ResultsA total of 1,628 patients comprising 1,208 patients in the SPB group and 420 patients in the FPB group were included in the study. The mean PSA level was 9.75±6.68 ng/ml in the FBP group and 10.46±6.46 ng/ml in the SPB group (p=0.053). Prostate cancer (PCa) detection rate was significantly higher in the FPB group as compared to the SPB group (42.4% vs. 36.4%). The PSA cut-off value for PCa was 9.75 ng/ml (sensitivity and specificity, 81%) in the SPB group and was 7.55 ng/ml (sensitivity and specificity, 81% and 84%, respectively) in the FPB group. In the FPB group, the cancer detection rate among the patients with a PSA level of 7.55-10.00 ng/ml was 56.1%.ConclusionThe results indicated that the introduction of FPB into clinical practice, which has relatively higher cancer detection rates, has further lowered the upper limit for gray-zone PSA.

ZFP161 regulates replication fork stability and maintenance of genomic stability by recruiting the ATR/ATRIP complex

DNA replication stress-mediated activation of the ATR kinase pathway is important for maintaining genomic stability. In this study, we identified a zinc finger protein, ZFP161 that functions as a replication stress response factor in ATR activation. Mechanistically, ZFP161 acts as a scaffolding protein to facilitate the interaction between RPA and ATR/ATRIP. ZFP161 binds to RPA and ATR/ATRIP through distinct regions and stabilizes the RPA–ATR–ATRIP complex at stalled replication forks. This function of ZFP161 is important to the ATR signaling cascade and genome stability maintenance. In addition, ZFP161 knockout mice showed a defect in ATR activation and genomic instability. Furthermore, low expression of ZFP161 is associated with higher cancer risk and chromosomal instability. Overall, these findings suggest that ZFP161 coordinates ATR/Chk1 pathway activation and helps maintain genomic stability.

Abstract DP-010: INTRAPERITONEAL CHEMOTHERAPY USE AND OUTCOMES: EXPLORATION OF UPMC OVARIAN CANCER REGISTRY DATA

Abstract BACKGROUND: Ovarian cancer (OC) is the deadliest gynecologic cancer. Despite randomized clinical trials showing improved survival for patients receiving intraperitoneal chemotherapy (IP), IP has not received a wide use outside of specialty hospitals. The aim of this study was to explore the impact of IP on OC patient survival and to evaluate whether treatment facility type impacted the outcomes. METHODS: Detailed demographic and clinical information on OC patients (N=2924) who underwent treatment in UPMC facilities between 2000-2016 was obtained from the UPMC Cancer Registry. Duplicate records, rare, grade 1, and non-epithelial tumors were excluded. Kaplan-Meier plots were constructed to compare 10-year survival rates based on the chemotherapy type (IP vs. no-IP), cancer grade, cancer stage, surgery type, neoadjuvant and treatment facility (specialized vs. community). Multivariable Gray's models and logistic regression model were fitted to evaluate the effect of different factors on survival and tumor recurrence respectively. Two tailed P-values <0.05 were considered significant. R software package was used to analyze the data. RESULTS: The final sample consisted from 1840 patients (250 IP and 1590 no-IP). IP chemotherapy was used only in 14% of OC patients and was associated with improved long-term survival. Similarly, cases reported by specialty treatment facilities (Magee and Passavant) had better survival compared to other hospitals. Multivariable Gray's model showed that IP and younger age were significantly associated with lower hazard of death, whereas higher cancer stage is significantly associated with higher hazard of death. Multivariable logistic regression showed that IP is not significantly associated with recurrence after adjusting for median income in the zip code of patient residence and cancer stage. CONCLUSIONS: These findings demonstrate enhanced long-term survival of patients treated with IP therapy at specialty centers. Increasing IP therapy use in clinical practice for OC patient treatment may be important strategy to improve OC outcomes. Citation Format: Adambekov S, Wang S, Taylor S, Buckanovich R, Coffman L, Edwards RP, Linkov F. INTRAPERITONEAL CHEMOTHERAPY USE AND OUTCOMES: EXPLORATION OF UPMC OVARIAN CANCER REGISTRY DATA [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr DP-010.

Spatial trends, health risk assessment and ozone formation potential linked to BTEX

The current study set out to examine BTEX species comprehensively in order to assess their spatiotemporal distribution, carcinogenic and non-carcinogenic health risk assessment, and ozone formation potential (OFP), source identification, and sensitivity and uncertainty analysis in the capital city of Qom, Iran. Data were gathered from 16 sampling stations in the winter and spring seasons. The average BTEX levels of both sampling periods were 22.49 for toluene, 15.2 for benzene, 12.38 for xylene, and 5.69 for ethylbenzene. Higher concentrations were observed in the city center and in the proximity of a power plant. Pollution source identification was carried out using principal component analysis (PCA). PCA and the T/B ratio both indicated that industrial sources are the primary pollution source in the spring, while, in the winter, BTEX levels were driven by traffic sources. The highest OFP was determined to be from xylene, followed by toluene, ethylbenzene, and benzene. Among the BTEX species, benzene had the highest cancer and non-cancer risk above and under the United States Environmental Protection Agency’s standard, respectively. Pollutant concentration was the most sensitive parameter followed by body weight, inhalation rate, and exposure frequency.

LENGTH OF STAY IN U.S. AN ANOMALY: PREVENTIVE HEALTHCARE UTILIZATION AMONG FAITH-BASED FIRST-GENERATION CHINESE

Limited knowledge exists on preventive healthcare services utilization (PHSU) among Chinese immigrants. This study examined factors related to PHSU among faith-based first-generation Chinese. A self-administered survey was conducted in five Chinese churches in southeastern US.(n=184). Mean age was 43 (SD=14) and 50% were males. Comparing with recent immigrants (<10 years), those who lived in the US for more than 10 years were more likely to be married (94.6% vs. 50.0%), have annual exams (74.5% vs. 39.6%), report doctors recommending cancer screenings (35.3% vs. 12.5%), have talked to doctors about screenings (25.5% vs. 4.2%), and perceive higher cancer knowledge (20.0% vs. 2.1%) (all p<.05). Considering all factors together, regressions showed perceived knowledge was the only significant predictor on having talked to doctors (OR=3.11) and doctor recommending screening (OR=2.15). Married status was the only strong predictor on annual exam (OR=29.13). Our findings highlight the urgent need for promoting PHSU in this population.

The association of the decline in glomerular filtration rate with aggressive endometrial cancers.

Most site-specific cancer incidence is increased with the decrease of glomerular filtration rate (GFR). We analyzed endometrial cancers depending on different type, staging, and histology grades. We hypothesized that patients with lower GFR levels have an increased risk for higher staging and histology grades of endometrial cancers. Patients were divided into two subgroups regarding GFR; the first group with GFR < 60ml/min and the second group with GFR > 60ml/min and regarding different histology grades and cancer stages. Cancers were also divided by stages (1-4). Patients were followed up during 1 year through regular controls in the outpatient clinic and during that time cancer recurrence was recorded. GFR was the strongest predictor for higher cancer histology grade and higher cancer staging. Patients with reduced GFR had OR for higher histology grade and higher staging of 1.06 and 1.06. Traditional risk factors for endometrial cancer development were not associated with higher histology grade or higher cancer staging. Higher staging and histology grades in patients with endometrial cancers are associated with reduced GFR. Patients with mild-to-moderate CKD had significantly higher number of cancers with higher histology grades and higher stages than patients with mild or normal GFR category. Decline in GFR was independently associated with more aggressive cancers without other well-known risk factors for endometrial cancer development like age, menopause, diabetes, and obesity.

Geographic distribution and risk of upper urothelial carcinomas in Croatia, 2001\u20132011

BackgroundStrong associations exist between Balkan endemic nephropathy (BEN) and upper urothelial carcinomas (UUCs). However, the common etiology between the two remains unclear and there are no studies to date that visualize UUC risks in Croatia. In Croatia, 14 villages in the southwestern part of Brod-Posavina County are considered endemic for BEN. The aim of this ecological study is to map cancer risks and describe the case distribution of UUCs in Croatia at the county level during 2001–2011.MethodsA total of 608 incident cases from the Croatian National Cancer Registry were identified. Indirect standardization was employed to compute standardized incidence ratios (SIRs).ResultsCounties with SIRs greater than 1 were concentrated around the agricultural region of Slavonia and the coastal region of Dalmatia. However, only Brod-Posavina County and Vukovar-Srijem County had a statistically significant risk of UUC development, where there were 390 and 210% more UUC cases observed than expected, respectively. Only unique to Brod-Posavina County, females were at higher risk (SIR 4.96; 95% CI 3.59–6.34) of developing UUCs than males (SIR 3.03; 95% CI 2.04–4.01) when compared to their Croatian counterparts. Although Brod-Posavina County only made up 3.7% of the total Croatian population (as of 2011), it had the highest frequency of incident UUC cases after the capital City of Zagreb. No elevated cancer risks were noted in the City of Zagreb, even after stratifying by sex.ConclusionOur findings suggest that Brod-Posavina County had the highest cancer risk for UUCs, especially among females, when compared to Croatia as a whole during 2001–2011. Given that a majority of BEN patients develop associated UUCs, concurrent screening programs for UUCs and BEN should be considered not only in endemic areas of BEN but also the surrounding rural areas and amongst at-risk groups such as those undergoing hemodialysis, who frequently develop UUCs, to help clarify BEN-UUC associations by identifying common risk factors while standardizing disease estimates across endemic regions for BEN.

Geographic distribution of clinical trials for breast cancer across the United States, 2011-2015.

140 Background: Access to clinical trials is paramount for delivery of high quality cancer care. We aim to study the geographical distribution of phase 3 &amp; 4 clinical trials for females with breast cancer across 51 states between 2011 &amp; 2015. Methods: We searched Clinicaltrials.gov registry for phase 3 &amp; 4 clinical trials in US for females with breast cancer &amp; those first posted from 01/01/2011 to 12/31/2015. New cases of female breast cancer from 2011 to 2015 were estimated with U.S. Cancer Statistics Data Visualizations Tool (www.cdc.gov/cancer/dataviz). Results: We found 88 phase 3 &amp; 4 clinical trials over 51 states. The average number (no.) of new cancer cases and no. of trials per state were 22,985 and 34.4 (range: 16 - 57) respectively. On average, each state had 0.003 (SD: 0.002) trials per case. States with maximum number of cases and trials were California, New York, Texas and Florida. These accounted for 30.7% of total cases, but only 12.5% of total trials. Also, these four states had the lowest no. of clinical trials per case while District of Columbia had the highest (0.0123). The states with the lowest no. of clinical trials included Rhode Island, Vermont, Wyoming &amp; Alaska (3.7% of total trials). Table with data regarding states with lowest and highest cancer burden is attached. Conclusions: For breast cancer in females during the years 2011 to 2015, the ratio of available phase 3 &amp; 4 clinical trials to new cancer cases was quite low when examined state-wise. The gap widened as the cancer burden increased resulting in the lowest no. of clinical trials per case in the states with maximum cancer burden. This highlights the need of better allocation of resources and efforts across the nation when conducting clinical trials. [Table: see text]