High Rates Of Breast Cancer Research Articles

Exploring Neighborhood-Level Environmental Justice to Tackle County-Level Disparities in Breast Cancer Outcomes

Breast cancer is a disease in which cells, originating from the breast epithelium, grow out of control and form tumors. The progression of breast cancer can vary, and its severity is often categorized by stages ranging from early, localized forms to more advanced stages involving widespread dissemination. Breast cancer cases can be hereditary or non-hereditary; Hereditary cases are caused by a penetrant gene mutation: one that is pathogenic and has the potential to promote the development of cancer whereas non-hereditary cases can be caused by a variety of day-to-day exposures affected by socioeconomic disparities and health literacy rates. Despite scientific and technological advancements, researchers and health officials still do not know enough about the disease and breast cancer incidence rates in the United States have steadily increased. This literature review aims to synthesize the relationship between breast cancer health outcomes and environmental justice, health literacy, and socioeconomic disparities. This relationship was first examined from a county-level in the state of Florida. We first examined three Florida counties with varying socioeconomic profiles (Broward, Miami-Dade, and Palm Beach) and then examined neighborhoods within the county of Miami-Dade (selected because it has the highest breast cancer rates out of all Florida counties). This examination revealed higher incidences of breast cancer in Latinx and African American communities with high environmental exposures and lower socioeconomic statuses. The identification of specific neighborhoods primarily affected by environmental exposures and low socioeconomic statuses emphasizes the need for neighborhood level modeling to inform future breast cancer research and intervention strategies.

Abstract A128: Adherence to mammography screening guidelines by family history of breast cancer in Guam: Preliminary results of HIPIMR study

Abstract Background: In Guam, breast cancer is the most common cancer affecting women, accounting for approximately 34% of all cancer cases. The risk of developing breast cancer is higher for women with a first-degree relative diagnosed with the disease (FHBC). The American Cancer Society recommends annual mammograms for women aged 45-54, with the option to start screening at 40-44. For women aged 55 and older, biennial or annual screenings are advised. Our study aims to investigate the relationship between having a first-degree relative with breast cancer (FHBC) and adherence to these screening guidelines. Methods: This research utilizes preliminary data from the Hawai‘i and Pacific Island Mammography Registry (HIPIMR), a collaborative effort between the University of Hawai‘i Cancer Center and the University of Guam Cancer Research Center, which collects health and breast imaging data in Hawai‘i and Guam. Logistic regression was used to assess the association between having a first-degree relative with breast cancer (FHBC) and adherence to breast cancer screening guidelines. The analysis was conducted across different ethnic groups and adjusted for education and age. Results: The study included 1,017 women who filled out a risk factor questionnaire, including questions about FHBC, before undergoing screening mammography at a clinic in Guam from November 2023 to May 2024. Among the participants, almost 40% were CHamoru, 41% Filipino, 5% Micronesian, 7.4% Asian, and 4.4% White. Of the 1,017 participants, 18.3% reported having a FHBC, and 37.1% did not meet the screening guidelines. Women with FHBC were more likely to meet screening recommendations than those without FHBC (OR=1.63, 95% CI: 1.12, 2.38, adjusted for age and education). Micronesian women (OR=0.54, 95% CI: 0.30, 0.97) and Asian women (OR=0.50, 95% CI: 0.31, 0.82) were less likely to follow screening guidelines compared to Filipino women, after adjusting for age and education. Conclusion: Women with a FHBC were more likely to follow screening guidelines. However, a significant percentage of women in Guam do not adhere to these recommendations, particularly Micronesian women, who also have the highest rates of breast cancer in Guam. Therefore, more outreach and education efforts are needed to improve breast cancer screening adherence in this population. Acknowledgement: This research was funded by the National Cancer Institute: The University of Guam/University of Hawaii Cancer Center Partnership to Advance Cancer Health Equity, Grant U54CA143728 (University of Guam)/Grant U54CA143727 (University of Hawaii Cancer Center). Citation Format: Reina Evangelista, Su Bin Jin, John Shepherd, Grazyna Badowski. Adherence to mammography screening guidelines by family history of breast cancer in Guam: Preliminary results of HIPIMR study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A128.

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

Abstract Background: Guam has significant ethnic disparities in breast cancer incidence, with rates varying from 46.7 per 100,000 among Asian women to 137.5 per 100,000 among Micronesian women. Incidence rates for Filipino, CHamoru (indigenous people), and White women are 59.8, 94.0, and 121.9 per 100,000, respectively (2013-2017). The Hawai‘i and Pacific Island Mammography Registry (HIPIMR), a collaborative effort between the University of Hawai‘i Cancer Center and the University of Guam Cancer Research Center, collects health and breast imaging data to enhance early cancer detection tailored to the unique ethnic profiles of women in Hawai‘i and Guam. This study aims to identify the distribution of breast cancer risk factors among different ethnic groups in women undergoing screening in Guam. Differences in the prevalence of risk factors may explain variations in incidence patterns. Methods: This study included 1,413 women undergoing mammography screening at FHP Health Center in Guam, from November 2023 to May 2024. The risk factors were classified as follows: BMI (≥25), age of menarche (≤13), age of first pregnancy (≥30), number of live births (≤1), age of menopause (≥55), and family history of first-degree relatives. The robust Poisson method was used to estimate prevalence ratios (PR) of risk factors among ethnic groups, adjusted for age and education. Asians were used as the reference group due to their lowest incidence rates. Furthermore, the total risk score was calculated by summing all the risk factors. ANOVA was used to test the differences in average risk scores among different ethnic groups. Results: All ethnic groups had significantly higher prevalence of being overweight or obese compared to Asian women. The prevalence ratios were highest for Micronesians (PR=1.73, 95% CI: 1.40, 2.13) and CHamoru (PR=1.55, 95% CI: 1.27, 1.90). CHamoru women had the highest rates of breast cancer family history (PR=1.74, 95% CI: 1.19, 2.54). However, CHamoru women had a lower prevalence of having a small number of live births (PR=0.39, 95% CI: 0.24, 0.65) and an older age at first birth (PR=0.83, 95% CI: 0.71, 0.96) when compared to Asian women. There was a significant difference in average score among ethnic groups (P<.001). CHamoru women had significantly higher score (2.35) than Filipino (2.08) and Asian (2.00) women. Conclusion: Our study reveals disparities in risk factors across ethnic groups, consistent with the Guam Cancer Registry's reports of high breast cancer rates among Micronesian and CHamoru women. This project is ongoing, with the aim of linking our data with the Guam Cancer Registry. This linkage will enable us to identify breast cancer cases among participants and compare risk factors across different ethnic groups for women with and without breast cancer. Acknowledgement: This research was funded by the National Cancer Institute: The University of Guam/University of Hawaii Cancer Center Partnership to Advance Cancer Health Equity, Grant U54CA143728 (University of Guam, YCP)/Grant U54CA143727 (University of Hawaii Cancer Center). Citation Format: Gian Paras, Su Bin Jin, Rose Grino, Cabrini Aguon, John Shepherd, Grazyna Badowski. Ethnic variations in breast cancer risk factors distribution in Guam, HIPIMR study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A027.

Breast cancer risk and prevention in 2024: An overview from the Breast Cancer UK - Breast Cancer Prevention Conference.

The Breast Cancer UK-Breast Cancer Prevention Conference addressed risk from environmental pollutants and health behaviour-related breast-cancer risk. Epidemiological studies examining individual chemicals and breast cancer risk have produced inconclusive results including endocrine disrupting chemicals (EDCs) Bisphenol A, per- and polyfluorinated alkyl substances as well as aluminium. However, laboratory studies have shown that multiple EDCs, can work together to exhibit effects, even when combined at levels that alone are ineffective. The TEXB-α/β assay measures total estrogenic load, and studies have provided evidence of a link between multiple-chemical exposures and breast cancer. However, prospective studies using TEXB-α/β are needed to establish a causative link. There is also a need to assess real-life exposure to environmental-chemical mixtures during pregnancy, and their potential involvement in programming adverse foetal health outcomes in later life. Higher rates of breast cancer have occurred alongside increases in potentially-modifiable risk factors such as obesity. Increasing body-mass index is associated with increased risk of developing postmenopausal breast cancer, but with decreased risk of premenopausal breast cancer. In contrast, lower rates of breast cancer in Asian compared to Western populations have been linked to soya/isoflavone consumption. Risk is decreased by breastfeeding, which is in addition to the decrease in risk observed for each birth and a young first-birth. Risk is lower in those with higher levels of self-reported physical activity. Current evidence suggests breast-cancer survivors should also avoid weight gain, be physically active, and eat a healthy diet for overall health. A broad scientific perspective on breast cancer risk requires focus on both environmental exposure to chemicals and health behaviour-related risk. Research into chemical exposure needs to focus on chemical mixtures and prospective epidemiological studies in order to test the effects on breast cancer risk. Behaviour-related research needs to focus on implementation as well as deeper understanding of the mechanisms of cancer prevention.

Abstract 4855: Identifying hot spots of breast cancer and industrialized areas in Hermosillo, Sonora, Mexico

Abstract Background: Sonora, a state in Mexico, has the highest rates of breast cancer in the country and has a history of industrial pollution. These factors may contribute to an increased risk of breast cancer. Hermosillo, the state capital, exhibits both of these characteristics. Given these conditions, it is important to further evaluate the prevalence of breast cancer hotspots and the potential links between breast cancer and industrialized areas. Objective: Identify breast cancer hot spots and their association to industrialized areas in Hermosillo, Sonora, Mexico. Methods: This study collected clinical data on breast cancer cases (current, survivors, deceased) from hospital files in Hermosillo that were 10 years old. The primary unit of analysis was neighborhoods. The study estimated breast cancer prevalence by analyzing the number of females per neighborhood, based on data reported by INEGI Census 2020. The data was categorized by age groups (age group no. 1 of 18 to 59 years old, no. 2 of 60 to 64 years old, and no. 3 of 65 years old or older). The estimated prevalence was depicted on a map using ArcGIS software, version 10.8.2. Hot spot analysis was used to identify neighborhoods with high breast cancer prevalence. The study also categorized neighborhoods as industrialized areas if they contained at least six hazard-generator industries. Results: A total of 1394 cases of breast cancer were gathered from hospitals. Location information for 3697 industries was provided by INEGI. Out of the 756 neighborhoods studied, 95 (12.6 %) were found to be industrialized areas, while 661 (87.4 %) were non-industrialized. Four neighborhoods in Hermosillo's southeast were observed to have breast cancer hot spots (unadjusted). After adjusting for age, one hot spot was found in the southeast for age group no. 1 (one neighborhood), while hot spots for group no. 2 (three neighborhoods) and no. 3 (33 neighborhoods) were in Hermosillo's northwest. The hot spots were related to industrialized areas (unadjusted OR = 6.94, 95% CI (0.94, 50.8), p-value = 0.05). After age adjustment, this association was statistically significant for group no. 3 (OR = 2.70, 95% CI (1.27, 5.72), p-value = 0.009), but not for group no. 1 (OR = 1.69, 95% CI (0.06, 41.74), p-value = 0.748) or group no. 2 (OR = 2.56, 95% CI (0.23, 28.46), p-value = 0.44). Conclusions: Our research found a link between industrialized areas and high breast cancer rates. We also found hotspots for women aged 65+ in Hermosillo, with 33 affected neighborhoods in the city's northwest. This is the first comprehensive study examining breast cancer prevalence in Hermosillo over a ten-year period. More extensive studies are needed in other cities in Sonora, Mexico, to confirm our findings. Citation Format: Diana Evelyn Villa-Guillen, Aurelio A. Mata-Valenzuela, Hector Tecuanhuey-Tlahuel, Andres M. Galvez-Arevalo, Kenneth L. Garcia-Castellon, Yoahana E. Guzman-Hernandez, Karla S. Ortega-Landa, Fatima Y. Pelayo-Rodriguez, Jose R. Silva-Rivera, Rogelio A. Ureña-Acosta, David O. Garcia, Jorge A. Villa-Carrillo. Identifying hot spots of breast cancer and industrialized areas in Hermosillo, Sonora, Mexico [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 4855.

Abstract 3458: DNA methylation-predicted blood protein levels and breast cancer risk

Abstract Background: Blood DNA methylation (DNAm) profiles can be used to predict a variety of human physiologic traits that are associated with breast cancer incidence and plasma concentrations of over 100 proteins, including those involved in inflammation, coagulation, metabolism, and growth. DNAm predictions of circulating proteins, here referred to as “DNAm proteins,” may be useful in providing molecular insights into breast cancer etiology and could be a valuable resource for personalizing breast cancer risk prediction. Methods: The Sister Study is a nationwide, prospective cohort of 50,884 women with a family history of breast cancer designed to identify novel environmental and biological risk factors for breast cancer. Epigenome-wide DNAm data were previously generated using the HumanMethylation450 or MethylationEPIC arrays on baseline blood samples collected from two case-cohort samples, for a combined sample of 4,479 women. This sample included 2,151 (48%) women who were selected because they were diagnosed with breast cancer (1,673 invasive cancer and 478 ductal carcinomas in situ) in the 15 years (mean: 7.9 years) following blood draw. Blood levels of 109 DNAm proteins were estimated from DNAm profiles using the method developed by Gadd et al. (eLife, 2022). Weighted Cox regression models were used to estimate associations between these DNAm proteins and incident breast cancer; associations were considered statistically significant at a False Discovery Rate (q) ≤ 0.10. Results: In age and platform adjusted models, higher breast cancer rates were associated with higher DNAm-predicted blood concentrations of RARRES2, IGFBP4, and CCL21 and lower predicted concentrations of F7, SELL, CXCL9, CD48, and IL19. The strongest associations were observed for RARRES2 (per 1-SD increase, HR: 1.24, 95% CI: 1.10, 1.40, P= 6 × 10−4, q= 0.03) and F7 (per 1-SD increase, HR: 0.82, 95% CI: 0.74, 0.91, P= 3 × 10−4, q= 0.03). Estimates were similar after adjustment for known breast cancer risk factors and excluding those diagnosed within two years of their blood draw. Associations appeared stronger for invasive breast cancer. Conclusions: Using novel DNAm-based estimates of blood proteins, we identified associations between circulating proteins and breast cancer incidence. IGFBP4 and RARRES2 have previously been reported to be higher in newly-diagnosed breast cancer patients. We also identify new potential protein biomarkers related to immune response (CCL21, SELL, CXCL9, CD48, and IL19). Citation Format: Jacob K. Kresovich, Brett Reid, Doratha A. Byrd, Katie M. O'Brien, Zongli Xu, Clarice R. Weinberg, Dale P. Sandler, Jack A. Taylor. DNA methylation-predicted blood protein levels and breast cancer risk [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 3458.

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.

Addressing Breast Cancer Equity Through Virtual Community Oncology Navigation and Engagement (vCONET).

Breast cancer remains a leading cause of cancer morbidity and mortality worldwide. In the United States, Black women face significant disparities in screening mammograms, experience higher rates of breast cancer at advanced stages, and are more likely to die from the disease. This study aimed to develop and beta-test a virtual health navigation program to enhance breast cancer care within the Black community. We identified barriers to utilizing virtual patient navigators and factors impacting the adoption of virtual navigation for breast cancer information among Black women. The vCONET (Virtual Community Oncology Navigation and Engagement) intervention was delivered through the Second Life virtual platform. The informational content was collaboratively developed with community members. Participants engaged in an informational session on risk factors, mammography information, and preventive behaviors. Surveys (n = 18) and focus groups (n = 9) assessed knowledge and insights into perceptions. Findings revealed a positive impact of the intervention, with participants expressing increased knowledge and willingness to seek further information about breast cancer prevention, and highlighted the engaging nature of the virtual environment, while acknowledging potential technological challenges. Virtual health navigation shows promise in addressing breast cancer disparities by promoting awareness among Black women. Future efforts should optimize virtual navigation approaches through collaborative engagement for lasting impact, enhancing breast cancer care and equity in communities of color.

The prevalence and predictors of clinical breast cancer screening in Sub-Saharan African countries: a multilevel analysis of Demographic Health Survey.

Despite a higher rate of breast cancer in sub-Saharan Africa (SSA), efforts to treat the disease through breast cancer screening are suboptimal, resulting in late diagnosis of breast cancer and poor outcomes. Several studies have been conducted in SSA countries about screening uptake, yet they addressed country or sub-country level data and did not consider both individual and beyond-individual factors related to screening. Hence, pooled prevalence as well as multilevel correlates of screening in the region is sparse, which have been addressed by this study using the most recent data among women with SSA. This study was conducted using the Demographic Health Survey data (2013-2022) from six countries, and a total weighted sample of 95,248 women was examined. STATA version 16 was used for the data analysis. Multilevel mixed-effects logistic regression was performed and significant predictors were reported using adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). The overall weighted prevalence of clinical breast cancer screening was 14.23% (95% CI: 13.97-14.75), with Namibia and Tanzania having the highest (24.5%) and lowest (5.19%) screening rates, respectively. Higher breast cancer screening uptake was observed among women of advanced age (35-49) [aOR = 1.78; 95% CI: 1.60, 1.98], had higher educational levels [aOR = 1.84; 95% CI: 1.66, 2.03], cohabited [aOR = 1.37; 95% CI: 1.21, 1.55], in the richest wealth quintile [aOR = 2.27; 95% CI: 1.95, 2.64], urban residents [aOR = 1.21; 95%CI: 1.10, 1.33], multiparous [aOR = 1.47; 95% CI: 1.30, 1.68], visited health facilities [aOR = 1.64; 95% CI: 1.52, 1.76], and read newspapers [aOR = 1.78; 95%CI: 1.60, 2.15]. The prevalence of clinical breast cancer screening was low (14%). Strengthening awareness campaigns, improving healthcare infrastructure, health education, universal health coverage, and screening program access, with a focus on rural areas, women who lack formal education, and low socioeconomic status, are critical to increasing breast cancer screening rates and equity. Scale-up local and regional collaborations and the involvement of media agencies in the implementation of screening programs, advocacy, dissemination of information, and integration of screening programs with their routine care, such as perinatal care, can boost the screening. The existing health service delivery points also need to focus on integrating breast cancer screening services with routine care such as perinatal care.

Abstract B072: Reproducibility of plasma metabolome over 1 year in a population-based study of Black breast cancer survivors

Abstract Background: African American/Black women have higher rates of breast cancer (BrCa) mortality and morbidity than White women. The metabolomics approach using blood samples from epidemiological studies has the potential to elucidate pathways or uncover biomarkers for adverse BrCa outcomes. Therefore, understanding the within-person reproducibility of the blood metabolome of BrCa survivors and factors that influence metabolite levels over time is crucial. However, the stability of blood metabolome among Black BrCa survivors is unknown. Objective: This study aimed to estimate the within-person reproducibility of metabolites over 1 year via global untargeted metabolomic profiling of plasma samples collected in the Women’s Circle of Health Follow-Up Study (WCHFS), a population-based longitudinal study of Black BrCa survivors in New Jersey. The study also aims to identify factors associated with reproducibility. Methods: We estimated the metabolite reproducibility among 61 Black women with BrCa diagnosed between 2012 and 2017 in WCHFS. Plasma samples were collected once for each participant at ~2 and 3 years post-diagnosis, respectively, and analyzed at Metabolon via ultrahigh performance liquid chromatography-tandem mass spectrometry. Using a mixed-effects model, we calculated the intraclass correlation coefficients (ICC) for each metabolite by dividing the between-person variance by the total variance (i.e., within- and between-person variances). ICCs were compared by age, obesity status, estrogen receptor (ER) status, and seasons, fasting status and time interval between two visits when blood samples were collected. Statistical significance was determined using the Wilcoxon test. Results: Of the 857 named metabolites identified after excluding those undetectable in ≥80% of samples or with a coefficient of variance≥0.25, the median ICC was 0.58 (interquartile range [IQR]: 0.44-0.70). 16.6% had high within-person reproducibility (ICC≥0.75), spanning across all metabolite classes, while 65.6% had an ICC within 0.4-0.75, and the remaining 17.9% had an ICC<0.4. Significant differences in ICCs were noted by participants’ age (median ICC [IQR; same below]: 0.56 [0.40 - 0.68] for younger women, i.e. ≤ 55.6 years vs. 0.61 [0.44 - 0.73] for older women), obesity status (0.55 [0.40 - 0.68] for non-obese vs. 0.62 [0.46 - 0.75] for obese), and ER status (0.56 [0.41 - 0.68] for ER+ vs. 0.62 [0.45 - 0.79] for ER-). The reproducibility also differed by fasting status (0.63 [0.45 - 0.77] for fasting vs. 0.53 [0.39 - 0.67] for non-fasting), but not the seasons or time interval between blood collections. Conclusion: The within-person reproducibility of plasma metabolites over 1 year among Black breast cancer survivors was generally reasonable, suggesting a single-time-point measurement could be useful in evaluating associations between metabolites and BrCa outcomes. However, the reproducibility varied across metabolites and was influenced by participant characteristics and certain sample collection conditions, which need consideration in future analysis or design. Citation Format: Bo Qin, Madhir Vyas, Steven C. Moore, Xiaoyang Su, Eileen White, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Reproducibility of plasma metabolome over 1 year in a population-based study of Black breast cancer survivors [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 B072.

The Role of Crohn Disease on Breast Cancer Incidence: A Clinical Analysis.

Crohn disease is a chronic inflammatory disease that can affect the entire gastrointestinal tract. The pathophysiology of this disease characteristically involves transmural inflammation, which predisposes patients to various gastrointestinal cancers such as colon cancer. Although the increased risk of gastrointestinal cancers in Crohn disease has been well established, the risk of extra-gastrointestinal cancers remains unknown. We sought to study the risk of breast cancer in patients with Crohn disease. The data for this retrospective study were compiled using the International Classification of Disease Ninth Revision (ICD-9) and ICD 10th Revision (ICD-10) codes from the national Health Insurance Portability and Accountability Act (HIPAA)-compliant PearlDiver database from 2010 to 2019. Patients were matched for age, sex, and Charlson Comorbidity Index (CCI). Statistical analyses were implemented to assess Chi-squared, logistic regression, and odds ratio. The database query resulted in 70,027 patients in both the control and Crohn disease groups. The incidence of breast cancer was 4,087 in the control group compared to 654 in the Crohn disease group. The P value was < 2.2 × 10-16 and the odds ratio was 0.15 (95% confidence interval (CI)). Patients without Crohn disease had an increased prevalence of breast cancer throughout all age ranges compared to patients with Crohn disease. Additionally, patients without Crohn disease had higher rates of breast cancer throughout the four major regions of the United States. In terms of healthcare costs, patients with breast cancer and a history of Crohn disease paid $23.87 more per hospital visit compared to patients with breast cancer and no history of Crohn disease. The results of this study indicate a statistically significant correlation between Crohn disease and a reduced incidence of breast cancer. This finding is true across all age groups and across the United States. Further study is required to investigate a possible mechanism between the pathophysiology of Crohn disease ultimately leading to reduced tumorigenesis in the breast.

VetConnect Cancer Navigator: Enhancing care for veterans with breast and gynecologic cancers.

554 Background: With women becoming the fastest-growing group in the Veteran population, the prevalence of breast and gynecologic cancers among Veterans is a growing concern. Studies have demonstrated higher rates of breast cancer among Veterans compared to nonveterans. As the number of women Veterans continues to rise, an increased incidence of breast and gynecologic cancers is expected. Unfortunately, efficient identification of newly diagnosed cases among Veterans is often lacking, leading to delays in diagnosis and treatment. The Breast/Gynecological System of Excellence (BGSOE) aims to ensure that Veterans with breast and gynecologic cancers receive state-of-the-art, guideline-adherent care, whether within the VA system or at outside institutions. Methods: To address this issue, BGSOE stakeholders collaborated to develop a comprehensive care coordination infrastructure called the VetConnect Cancer Navigator. This tool not only identifies newly diagnosed cases of breast and/or gynecologic cancers, but also provides additional navigation support to Veterans who may be receiving their cancer care within the VA or other healthcare systems. The development process involved designing a user-friendly interface, extracting relevant data, and integrating advanced analytics to optimize user experience. Continuous evaluations, both formal and informal, were conducted to ensure optimal usability and workflow fitness. In January 2023, the VetConnect Cancer Navigator was launched as a pilot program at the Durham VA Medical Center. Results: From January 2021 to June 2023, a total of 5,519 Veterans were identified with newly diagnosed breast and/or gynecologic cancers throughout the entire nationwide VA system. Since the launch of the navigator at the Durham VA Medical Center pilot site, it has successfully identified 37 Veterans with newly diagnosed breast and/or gynecologic cancers. Of these cases, 27 patients have been contacted by the dedicated nurse navigator, 22 have completed an intake form, and 18 have agreed to enroll in the BGSOE navigation program. Conclusions: The VetConnect Cancer Navigator represents a pioneering approach to the design and implementation of health information technology tools. As demonstrated through the pilot site, the navigator facilitates innovative coordination and delivery of healthcare, specifically tailored to the need of the BGSOE program, this tool significantly enhances the quality of care provided to Veterans with breast and/or gynecologic cancers. Through improved care coordination and navigation support, the VetConnect Cancer Navigator plays a crucial role in ensuring Veterans receive optimal, guideline-based care regardless of their treatment location within or outside the VA system.

Intraoperative Radiation Exposure in Adolescent Idiopathic and Neuromuscular Scoliosis.

Intraoperative imaging is often used to aid pedicle screw placement during scoliosis operations. Higher rates of cancer and death have been observed in orthopaedic surgeons and radiation technologists, including a fourfold higher rate of breast cancer in female orthopaedic surgeons. The purpose of this study was to evaluate variability in intraoperative radiation during spinal fusions for both adolescent idiopathic scoliosis (AIS) and neuromuscular scoliosis (NMS). A retrospective review of posterior spinal fusion and segmental spinal instrumentation for scoliosis performed by pediatric orthopaedic surgeons from 2017 to 2019 at a single institution was performed. Inclusion criteria included: a diagnosis of AIS or NMS and patients between 8 and 18 years of age. Exclusion criteria included: revision surgery, use of intraoperative navigation, and patients younger than 10 at the time of scoliosis onset within the AIS cohort. Data collected included: preoperative curve, body mass index (BMI), number of levels fused, number of Ponte osteotomies, and fluoroscopy time. One-way analysis of variance tests, Bonferroni post hoc tests, independent t tests, and Pearson correlations were utilized with significance determined at the 95% confidence level (a = 0.05). A total of 148 patients were included in the study. The average fluoroscopy time was 143 ± 67 seconds. Patients with NMS had higher average fluoroscopy times (193 ± 75 s) compared with patients with AIS (129 ± 58 s, P < 0.001). In patients with AIS, fluoroscopy time correlated to the patient's preoperative curve (r = 0.182, P = 0.050). Patients with AIS with fewer than 12 levels fused had significantly less radiation exposure than those with 12 or more levels fused (P = 0.01). When controlling for the number of levels fused, patients with AIS with higher BMIs had significantly greater fluoroscopy times (P = 0.001). In patients with NMS, fluoroscopy time negatively correlated with BMI (r = -0.459, P = 0.009) and positively correlated with a preoperative curve (r = 0.475, P = 0.007). Fluoroscopy times vary greatly during adolescent spinal fusions for scoliosis. Longer fluoroscopy times are correlated with: NMS diagnosis, larger preoperative curve, BMI, and number of levels fused. Surgeons' knowledge of factors affecting fluoroscopy time will increase awareness and may be the first step in decreasing intraoperative radiation risks. Level III; Therapeutic-a retrospective study.

Turning the Page on Breast Cancer in Ohio: Lessons learned from implementing a multilevel intervention to reduce breast cancer mortality among Black women.

Turning the Page on Breast Cancer (TPBC) uses a multilevel approach to reduce breast cancer (BC) mortality among Black women. TPBC intervenes by (1) improving health care facilities' ability to conduct effective BC screening, follow-up, and treatment; (2) involving community-based organizations; and (3) providing education and personal risk information through a culturally relevant website. Ohio has among the worst BC mortality rates in the United States for Black women. TPBC is in its third year of providing targeted interventions in 12 Ohio counties with particularly high BC rates among Black women. TPBC enrolls health care facilities, collects organizational and patient data, and conducts key informant interviews to inform the provision of appropriate evidence-based interventions. TPBC engages Black communities through community-based organizations and social media advertising. The TPBC website offers BC information, connects Black women to community BC resources, and provides access to a risk-assessment tool. TPBC has provided tailored information packets, evidence-based interventions, and systematic support for improving the tracking and follow-up of breast health care among patients in 10 clinical partnerships. The project has provided education at community events monthly since mid-2021. The TPBC website (http://endbreastcancerohio.org) is promoted through social media (primarily Facebook) and community events to reach Black women aged 25-70 years. To date, 4108 unique users have visited the website, of whom 15.9% completed the risk assessment. Novel strategies are needed to address persistent disparities in BC outcomes among Black women. TPBC demonstrates the potential effectiveness of multiple methods of community-based, clinic-based, and web-based engagement. Turning the Page on Breast Cancer (TPBC) aims to reduce breast cancer mortality among Black women in Ohio by conducting multilevel, community-engaged interventions in 12 counties. Women are provided risk information and education at virtual and in-person community events and through a community-friendly website that was launched in November 2020. Almost 4000 women have visited the website, which offers community-targeted information, urges screening for individuals at elevated risk, and offers access to patient navigation services; 655 users have used a breast cancer risk-assessment tool on the site. Community-based organizations conduct educational efforts. TPBC partners with health care facilities, which are taught to improve their ability to conduct effective breast cancer screening, follow-up, and treatment. So far, TPBC has provided educational information, evidence-based intervention lists, tailored information packets, and ongoing quarterly support to partners in 10 counties. Evaluation will focus on aggregated data for screening and genetic testing referral at the clinic level.

Geospatial Associations between Female Breast Cancer Mortality Rates and Environmental Socioeconomic Indicators for North Carolina.

In North Carolina, over 6000 women will be diagnosed with breast cancer yearly, and over 1000 will die. It is well known that environmental conditions contribute greatly to health outcomes, and many of these factors include a geographic component. Using death data records from 2003-2019 extracted from North Carolina Vital Statistics Dataverse, a spatial database was developed to map and analyze female breast cancer mortality rates at the ZIP code scale in North Carolina. Thirty-nine hot spots and thirty cold spots of age-adjusted death rates were identified using the Getis-Ord analysis. Two-tailed t-tests were run between each cohort for environmental socioeconomic-related factors associated with breast cancer progression and mortality. The median age and household income of individuals who resided in ZIP codes with the highest breast cancer mortality were significantly lower than those who lived in ZIP codes with lower breast cancer mortality. The poverty rate, percentage of SNAP benefits, and the percentage of minorities were all significantly higher (p < 0.05, p < 0.001, and p < 0.001) in ZIP codes with high breast cancer rates. High-quality (ZIP code) granular cancer data were developed for which detailed analysis can be performed for future studies.

Dispelling Myths Regarding Cisgender Sexual Minority Women and Breast Cancer

Lesbian and bisexual cisgender women have higher rates of breast cancer and breast cancer mortality than their heterosexual counterparts (Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities, 2014). There is not much known about why this is the case, although most researchers revert to the common hypotheses that the increased prevalence of obesity, substance abuse, and nulliparity (not having given birth) among lesbian and bisexual women contributes to incidences of breast cancer (Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities, 2014). These hypotheses place individual responsibility on sexual minority women with breast cancer as opposed to identifying complicated, underlying structural problems. This literature review argues that homophobia and bisexual invisibility, in conjunction with fatphobia and inaccurate research methodology, have prevented clinicians and scientists from thoroughly examining the ways in which increased rates alcohol abuse, the physiological effects of stress due to discrimination, and a lower rate of receiving mammograms caused by perceived negative judgment from healthcare providers contribute to the higher prevalence of breast cancer among lesbian and bisexual women.

Abstract P6-03-01: The MERIT Cohort: An MD Anderson Initiative to Integrate Blood and Imaging Biomarkers to Personalize Breast Cancer Risk

Abstract Background: The MERIT cohort (Mammography, Early Detection, Risk Assessment, and Imaging Technologies, 2017-present) has enrolled women receiving annual screening mammograms (MG) at MD Anderson with a primary goal to integrate clinical data and imaging data with blood biomarker profiles to determine risk of developing breast and other cancers. Here we report interim results for breast cancers among post-menopausal women in the cohort categorized based on breast density and BMI and differences between participants who underwent MRI/MG screening vs standard annual MG screening. Methods: The study annually collects comprehensive health measurements, questionnaire information, imaging data, and blood specimens. Plasma is processed and frozen within 4 hours of collection (draw-to-freezer, &amp;gt;500,000 aliquots to date) for biomarker research. Part of the cohort also has MRI screening every 6 months alternating with standard mammography (MRI/MG). BI-RADS breast density was determined by radiologist scoring using the baseline mammogram. Self-reported post-menopausal status (12 months without a menstrual period) was used to classify participants. When not available, those participants older than 50 years were classified as post-menopausal. Results: 4,392 of the 6,222 eligible subjects from MERIT were post-menopausal and included in the analyses. The average follow up was 2.4 mammograms per participant. MRI/MG screening was used for 385 (8.8%) participants who were more likely to be younger (59.6 vs 62.1 years, P&amp;lt; 0.01), have lower BMI (27.9 vs 28.6, P = 0.02) and dense breasts (64% vs 50%, P&amp;lt; 0.01). The rates of breast cancer were overall higher for those screened by MRI/MG vs standard MG (13.9 vs 6.9 cases per 1,000 mammograms). A total of 79 breast cancers (7.6 cases per 1,000 mammograms) were diagnosed with the highest rate of breast cancers in high BMI participants with dense breasts (see table). A blood-based biomarker profile for risk of breast cancer with high BMI was developed using matched pre-diagnostic plasma by mass spectrometry metabolomic analyses. Conclusions: The MERIT cohort has a higher-than-average rate of breast cancers, in part explained by a high-risk MRI/MG screening group. High BMI and dense breasts were generally associated with higher rates of breast cancer. The differences in the rates of breast cancer incidence for the high BMI group between non dense and dense breasts is likely understated for the standard mammogram group because of the lower sensitivity of mammography in dense breasts. Interestingly, the rates of breast cancers in the low BMI/non dense breast group were almost equally high as the low BMI/dense breast group, likely a result of reduced sensitivity of mammography for dense breasts. For future work, we will integrate the blood biomarker profiles with the breast density and BMI information to develop a more personalized risk model. MERIT Cohort Breast Cancers Rates of diagnosed breast cancers per 1,000 mammograms for post-menopausal women (N = 79 breast cancers)*‡P&amp;lt;0.01, †P&amp;lt;0.05, Fisher’s exact test Citation Format: Jessica Leung, Olena Weaver, Samir Hanash, Jennifer Dennison. The MERIT Cohort: An MD Anderson Initiative to Integrate Blood and Imaging Biomarkers to Personalize Breast Cancer Risk [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-03-01.

Benign Breast Disease, NSAIDs, and Postmenopausal Breast Cancer Risk in the CPS-II Cohort.

Nonsteroidal anti-inflammatory agents (NSAID) are associated with modest inconsistent reductions in breast cancer risk in population-based cohorts, whereas two focused studies of patients with benign breast disease (BBD) have found lower risk with NSAID use. Given that BBD includes fibroinflammatory lesions linked to elevated breast cancer risk, we assessed whether NSAID use was associated with lower breast cancer risk among patients with BBD.Participants were postmenopausal women in the Cancer Prevention Study-II (CPS-II), a prospective study of cancer incidence and mortality, who completed follow-up surveys in 1997 with follow-up through June 30, 2015. History of BBD, NSAID use, and covariate data were updated biennially. This analysis included 23,615 patients with BBD and 36,751 patients with non-BBD, including 3,896 incident breast cancers over an average of 12.72 years of follow-up among participants. NSAID use, overall and by formulation, recency, duration, and pills per month was analyzed versus breast cancer risk overall and by BBD status using multivariable-adjusted Cox models; BBD status and NSAID use were modeled as time-dependent exposures.Patients with BBD who reported using NSAIDs experienced lower breast cancer risk (HR, 0.87; 95% CI, 0.78-0.97), with similar effects for estrogen receptor (ER)-positive breast cancers [HR, 0.85; 95% confidence interval (CI), 0.74-0.97] and ER-negative breast cancers (HR, 0.87; 95% CI, 0.59-1.29); among women without BBD, NSAID use was unrelated to risk (HR, 1.02; 95% CI, 0.92-1.13; Pinteraction = 0.04). Associations stratified by age, obesity, menopausal hormone use, and cardiovascular disease were similar.Among patients with BBD, NSAID use appears linked to lower breast cancer risk. Further studies to assess the value of NSAID use among patients with BBD are warranted. We examined whether NSAID use, a modifiable exposure, is associated with breast cancer risk in postmenopausal women from the Cancer Prevention Study-II with self-reported benign breast disease, an often inflammatory condition associated with higher rates of breast cancer.

ASSESSMENT OF SPECIFICITY AND SENSITIVITY OF TRU-CUT BIOPSY AS COMPARED WITH POSTOPERATIVE HISTOPATHOLOGICAL RESULTS IN YOUNG FEMALES WITH BREAST MASS

Breast cancer affects 5-7% of 25-39-year-olds, and early detection increases the chance of recurrence (CBC). African-American women under the age of 40 had the highest rate of breast cancer. After breast cancer radiation and family history, younger persons are more likely to get colon cancer. Some women misdiagnose breast symptoms as cancer due to fear and stress. A clinical examination cannot distinguish between benign and malignant tumours. Stages of treatment the diagnosis decides the treatment. Biopsies and FNAC are used to detect lumps. Plaques. Biopsies of histopathology (CNB) (CNB). OTP biopsy failed. True-cut biopsies minimize the types and grades of malignancy. Bleeds/infects FNAC detects cancer. Cytology is inexpensive. Low sample counts, erroneous negatives, and aggressive tumours According to the study, FNAC assesses breast lumps. False positives and false negatives could be reduced. CNB's results call into question FNAC's mission. CNB. The downsides of CNB include treatment time, patient pain (1.7% to 3.7%), hematoma (0.72%), and pneumothorax. FNAC is less painful and intrusive than CNB for older, weaker patients (more painless). FNAC is not just for radiologists. FNAC examines chemotherapy. Antifreeze. CNB, diagnosis, and anxiety were all improved with FNAC. After neoadjuvant treatment, FNAC reveals tumours, suspicious zones, and a concerning lesion. FNAC replaces mammography.

Sociodemographic, Clinical, and Variation Outcomes for Breast Cancer and Breast Cancer-Related Mutations in a Ten-Year Cohort From Neiva, Huila, Colombia.

Background Some breast cancer cases are related toinherited mutations, and this is the reason why early mutation screening is emerging as an area of focus for cost-effective care. However, breast cancer-related mutations vary according to race, ethnicity, geographic origin, and healthcare access. Surveillance for familial breast cancer is not performed routinely in Colombia. Our main aim in this study was to describe a cohort of breast cancer patients, carrying founder breast cancer gene (BRCA) mutations, which were followed up for up to 10 years (2010-2019) in Neiva, Colombia. Methods We performed a retrospective description from an outpatient care center in Huila, Colombia, a region with high breast cancer rates. This study included patients with both a breast cancer diagnosis and an incident genetic mutation for breast cancer (detected during a breast cancer consultation). We captured information from patient medical records. Descriptive analyses were performed. Results A total of 105 patients met the study's inclusion criteria and were includedpatients with the BRCA1 mutation and three with BRCA2 mutations. They had a median age of 45 years (IQR, 36 to 51 years). Relatives with a breast cancer history were found in 74 carriers (70.5%). Most patients had a report of Breast Imaging-Reporting and Data System (BIRADS) ≥ 4.A TNM (tumor, node, metastasis) changed reclassification was observed in anatomical vs. prognostic classification. Median follow-up was of 74 months (IQR, 44 to 130), overall observed mortality was 22.9%, and specific mortality was 19.1%. Conclusion Women with breast cancer who carry a mutation related to breast cancer are usually younger than age 50 at diagnosis. Developing strategies and specific policies for this population is needed, and a prevalent BRCA1 c.3331_3334delCAAG mutation could be used as a cost-effective first approach. Among these patients, a risk-increased reclassification was observed.