Hispanic Breast Cancer Survivors Research Articles

Abstract B129: The association of Covid-19 pandemic restrictions with patient-reported outcomes and lifestyle behaviors among breast cancer survivors: Evidence from a cohort of Black and Hispanic breast cancer survivors in New Jersey

Abstract Purpose: The onset of COVID-19 pandemic restrictions in the US since March 2020 has worsened the disproportionate burden of physical and mental health challenges faced by vulnerable Black and Hispanic breast cancer (BrCa) patients. BrCa survivors experienced delays in their cancer treatments and limited access to supportive care, which may lead to further physical, and psychosocial challenges during an already difficult time. This study aimed to evaluate the association of the COVID-19 pandemic restrictions with patient-reported outcomes (PROs) (i.e. health-related quality of life (HRQoL), sleep, perceived stress, coping and financial toxicity), and lifestyle behaviors (i.e. obesity, smoking, and alcohol) among Black and Hispanic BrCa survivors participating in the Women’s Circle of Health Follow-Up 1 (WCHSFU1) and the New Jersey Breast Cancer Survivors Study (NJBCS), two ongoing population-based studies in New Jersey. Methods: The NJBCS followed similar methods to those in the WCHSFU1. We included a total of 447 Black (npre=364 and npost=83) and 182 Hispanic (npre=102 and npost=80) BrCa survivors who completed a home interview ~24 months post-diagnosis, from 2017 to 2023. The COVID-19 pandemic era was defined as pre- (recruited prior to March 2020) and post-(recruited after March 2020) pandemic. To assess the association of the pandemic with PROs and lifestyle behaviors we employed multivariable adjusted Poisson regression models with robust standard errors to estimate prevalence ratios with 95%CI. Results: Compared to the pre-pandemic group, Black survivors in the post-pandemic group were more likely to be educated, to have higher income, and to be foreign-born, while Hispanic women were significantly more likely to have private insurance and higher HRQoL, physical and emotional well-being mean scores (p<0.05 for all). Adjusted Poisson models indicated that Hispanic women in the post-pandemic group had 1.53 times higher prevalence of low resilience (vs high resilience) (PR:1.53 95% CI: 1.15-2.04), compared to the pre-pandemic group. Whereas Black women in the post-pandemic group reported a higher prevalence of clinically significant sleep disturbance and efficiency (PR: 1.43 95% CI: 1.23-1.68 and PR:1.50 95% CI: 1.30 – 1.73, respectively), compared to the pre-pandemic group. Both Hispanic and Black women in the post-pandemic group showed significantly less perceived stress and a lower prevalence of alcohol consumption. Conclusion: We found heterogeneity in the prevalence of PROs and lifestyle behaviors by pandemic era among Black and Hispanic survivors. Notably, we also noticed differences in demographic characteristics of women participating after the onset of the pandemic, which highlights the importance of considering the impact of the pandemic in all aspects of research, including the interpretation of findings. Continuing research to untangle important factors contributing to racial and ethnic differences in patient characteristics, PROs and lifestyle behaviors post-pandemic in cancer survivorship is warranted. Citation Format: Carola T. Sanchez-Diaz, Nur Zeinomar, Hari S. Iyer, Marley Perlstein, Chi-Chen Hong, Bo Qin, Elisa V. Bandera. The association of Covid-19 pandemic restrictions with patient-reported outcomes and lifestyle behaviors among breast cancer survivors: Evidence from a cohort of Black and Hispanic breast cancer survivors in New Jersey [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 B129.

MHealth Interventions to Improve the Breast Cancer Continuum of Care from Prevention to Survivorship of Hispanic Women: A Scoping Review.

Breast cancer is the leading cause of cancer mortality in Hispanic women in the USA. Current interventions to improve breast cancer care include the use of mHealth, but its application in Hispanic women is limited. This scoping review aimed to describe the extent of research literature on the use of mHealth throughout the breast cancer care continuum (prevention, early detection, and treatment) in Hispanic women. A scoping review guided by the Arksey and O'Malley methodological framework and the Joanna Briggs Institute scoping review reporting protocol. Literature search of peer-reviewed research articles from 2012 to 2022 in PubMed, Scopus, and CINAHL® was conducted in March and June 2022. Of the 10 articles selected, seven included Hispanic breast cancer survivors and three included Hispanic women at risk for developing breast cancer. Seven articles involved mobile applications and three articles used text messaging and/or cell phone voicemail. Overall, the use of mHealth for breast cancer care in Hispanics was favorable but generalizability was limited given the type of design and small samples. All interventions were tailored to Hispanic culture. Scarcity of research on mHealth in Hispanic breast cancer care highlights healthcare disparities in this population. Evidence from this review suggests the use of mHealth to be beneficial to improving breast cancer care in Hispanics, but more research is needed involving randomized clinical trials and larger samples.

Abstract P3-03-06: A pilot study of personal care product use and exposure to environmental chemicals among Black and Hispanic breast cancer survivors

Abstract Objectives and rationale: Racial and ethnic minorities are disproportionately exposed to environmental chemicals that have been linked to cardiovascular disease, cognitive decline, metabolic disease, and premature mortality. Recent evidence suggests that personal care products are a source of such exposures and that these products are more frequently used among Black and Hispanic women. Minoritized populations also tend to experience worse breast cancer outcomes compared to White patients. However, few studies have examined personal care product use and environmental exposures among minority cancer survivors. The aim of the present study was to describe personal care product use and chemical exposures, including ambient and dermal sources of exposure, in a pilot study of Black and Hispanic breast cancer survivors. Methods: In November 2020 – December 2021, self-identified Black and Hispanic breast cancer survivors aged ≥21 years were recruited in Washington, DC and Hackensack, NJ. Eligible survivors had been diagnosed with primary Stage I-III breast cancer and had completed breast cancer treatment except endocrine therapy. Surveys collected data on demographics, breast cancer diagnosis, personal care product use, and potential covariates. Participants wore silicone wristbands for 1 week for passive sampling of environmental exposures. Extracts from the wristbands were assessed using a gas chromatograph-mass spectrometer to detect chemical exposures. Values were adjusted for wear time and wristband size to provide sample concentrations of detected chemicals. Results: Among the 25 study participants, 17 were Black and 8 were Hispanic, with a mean age of 58 years. Most survivors (58%) had been diagnosed with Stage I breast cancer. Survivors reported using perfume (52%), make-up (80%), and nail polish (68%) during the week, with common daily use of facial creams, lotions, or moisturizers (60%) and body creams, lotions, or moisturizers (68%). Drinking bottled water every day (64%) or most days (24%); eating prepared food from a fast food restaurant at least once per week (88%); and eating food reheated in a plastic container at least once per week (71%) were also prevalent. However, the majority of survivors reported never using pesticides indoors (76%) or outdoors (79%). The wristbands detected 60 distinct chemicals. On average, 21.8 chemicals were detected per wristband and 19 chemicals were detected in more than half of the samples. Exposure to flame retardants and pesticides was ubiquitous. All participants were exposed to chemicals found in personal care products and in commercial products. Several of the most commonly detected chemicals, including benzyl salicylate (a UV light absorber and fragrance), diisobutyl phthalate (a plasticizer), and lilial (a perfume), are biologically active compounds with potential genotoxic or endocrine effects. Discussion: Exposure to environmental chemicals was ubiquitous among Black and Hispanic breast cancer survivors in DC and New Jersey. Frequent use of personal care products and commercial products suggest an opportunity to reduce potentially harmful exposures. Future studies are needed to investigate the role of environmental chemicals in health outcomes among breast cancer survivors and whether environmental exposures contribute to cancer health disparities. Citation Format: Traci N. Bethea, Jennifer Hicks, Erin Speiser, Adana Llanos, Gail E. Starr, Chiranjeev Dash, Lucile L. Adams-Campbell. A pilot study of personal care product use and exposure to environmental chemicals among Black and Hispanic breast cancer survivors [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 P3-03-06.

Abstract C101: A feasibility study of exposure to environmental chemicals among Black and Hispanic breast cancer survivors using silicone wristbands for passive sampling

Abstract Introduction: Exposure to environmental chemicals may be an important contributor to obesity and cancer due to effects on inflammation, immune function, hormone synthesis, and metabolism, as well as cellular mechanisms including cellular signaling and apoptosis. However, little attention has been paid to environmental exposures among cancer survivors, who are at increased risk of cancer, cardiovascular disease, and metabolic disease compared to the general population. Methods: We recruited 25 Black and Hispanic breast cancer survivors in Washington, DC and Hackensack, NJ. Survivors completed questionnaires about their demographics and breast cancer diagnosis and wore silicone wristbands for 7 days. The wristbands passively sampled participants’ exposome, including ambient air and dermal sources of exposure. After deployment, the wristbands were extracted and extract samples were analyzed to provide quantitative data on >1,500 chemicals by using automated deconvolution software to compare spectra from a gas chromatograph-mass spectrometer with compound libraries. Sample concentrations were adjusted for wear time and wristband size. Results: Seventeen Black and 8 Hispanic breast cancer survivors participated in the study. Study participants had a mean age of 58 years (range: 38-75 years) and most had been diagnosed with Stage I or II breast cancer (84%). Most participants were satisfied or very satisfied with their experience using the silicone wristbands (88%), found the wristbands easy to use (96%), and did not report that the wristband interfered with their daily activities (92%). Sixty distinct chemicals were detected in the wristbands with a mean of 21.8 chemicals (range: 12-29) detected on any single wristband. Nineteen chemicals were detected in >50% of participants. Exposure to chemicals found in personal care products and in commercial products was ubiquitous. All participants were exposed to at least 1 flame retardant (e.g., triphenyl phosphate) and at least 1 pesticide (e.g., diethyl phthalate). Four chemicals detected have been classified as possibly carcinogenic to humans according to the International Agency for Research on Cancer. The most commonly detected chemicals (>96%) were benzyl salicylate (fragrance, UV light absorber), galaxolide (fragrance), diethyl phthalate (plasticizer), diisobutyl phthalate (plasticizer), lilial (perfume), and triphenyl phosphate (flame retardant, plasticizer). Several of the most commonly detected chemicals have the potential for genotoxicity (i.e., lilial) or endocrine disruption (e.g., benzyl salicylate, diisobutyl phthalate), so chronic exposure may have implications for survivors’ long-term health. Conclusions: Passive sampling using silicone wristbands is a feasible and well-tolerated approach to gather data on cancer survivors’ personal exposome. Breast cancer survivors’ exposures to flame retardants and pesticides, particularly biologically active chemicals, warrant additional study. Citation Format: Traci N. Bethea, Jennifer Hicks, Erin Speiser, Gail E. Starr, Lucile L. Adams-Campbell. A feasibility study of exposure to environmental chemicals among Black and Hispanic breast cancer survivors using silicone wristbands for passive sampling [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C101.

Abstract C086: A summary of findings from the Breast Cancer, Race and Place (BCRP) study on structural racism and breast cancer survival disparities in the United States, based in Milwaukee, WI

Abstract Racial disparities in breast cancer survival are significant, with only 68% of US Black women diagnosed with breast cancer remaining alive 10 years post-diagnosis, compared to 84% of White women. However, the size of racial disparities in breast cancer mortality varies geographically across the US. Such geographical variation suggests that disparities are not inevitable, and this variation has not been explained. Structural racism and racial residential segregation are widely considered to contribute to health disparities and may partially explain geographical variation in the size of the disparities. While some studies have shown that segregation is related to poor survival, others have found that this is not always the case, and some studies highlight the case of ethnic enclaves, which may be protective. The NCI funded Breast Cancer, Race and Place (BCRP) study is a national study of structural racism and breast cancer survival with three aims: (1) Construct new metrics of structural racism at the local level for the largest US metropolitan areas, (2) Determine whether these measures are related to breast cancer survival disparities among Black, Hispanic and Non-Hispanic White women, and whether relationships are mediated by local stressors, social resources, or opportunities, and (3) Explore the ways in which Black and Hispanic breast cancer survivors in a highly segregated metropolitan area (Milwaukee, WI) navigate cancer survivorship in the context of segregation. The project is supported by an interdisciplinary research team and a community advisory board. We have published several studies based on this work with others in review or in preparation and share an overview of this body of work here. This summary of findings includes: (1) a description of new measures of contemporary racial bias and property location based bias (redlining) in mortgage lending, (2) a direct association between redlining and breast cancer survival in older women diagnosed with breast cancer in the US, (3) collaborative work using these metrics in other cohorts and locations, (4) a clear gradient association between historic redlining and contemporary redlining, (5) new evidence of potential mediating factors, (6) qualitative evidence of lived experience of Black and Hispanic survivors in Milwaukee, WI, and (7) a new web-based tool to explore and download mortgage lending bias metrics. We hope that this work will support the development of multi-sectoral interventions to reduce cancer disparities by targeting local systems and policies, including in the housing sector. Citation Format: Kirsten M. M. Beyer, BCRP Team. A summary of findings from the Breast Cancer, Race and Place (BCRP) study on structural racism and breast cancer survival disparities in the United States, based in Milwaukee, WI [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C086.

Illuminating Black, Hispanic, and Asian Women’s Breast Cancer-related Cognitive Impairment Symptom Experience: An Integrative Review

Background: Cancer-related cognitive impairment (CRCI) affects up to 75% of breast cancer survivors (BCSs). Biopsychosocial stressors contribute to CRCI. Thus, given the socioeconomic disparities and discrimination experienced by racial/ethnically minoritized women in the Unites States, it is important to understand how these women experience CRCI when diagnosed with breast cancer. Objective: To synthesize and evaluate published literature from 2000 to 2021 addressing the CRCI symptom experience throughout breast cancer survivorship for racial/ethnically minoritized women in the United States. Methods: Systematic search of PubMed, PsycINFO, CINAHL, Google Scholar, Embase, and Scopus and review following Whittemore and Knafl’s methodology. Results: Of 970 identified articles, 13 were included. Literature primarily focused on Black BCSs. Black and Hispanic BCSs were more likely than White BCSs to experience cognitive impairment pre- and postchemotherapy. Black BCSs consistently perceived greater CRCI than White BCSs contributing to overall symptom burden and challenging quality of life. Conclusions: Studies describing the CRCI experience of Black, Hispanic, and Asian American BCSs are limited with few focused on CRCI as the primary variable of interest, delineating minoritized women’s data from others’, or assessing via neurological batteries or brain imaging, pointing to gaps in this field. Implications for Practice: Health practitioners should assess Black, Hispanic, and Asian BCSs for CRCI throughout their cancer trajectory and intervene to reduce the contribution of co-occurring symptoms and institutional racism to CRCI. What is Foundational: This review identifies knowledge gaps and limitations in the existing body of evidence to support future research on CRCI among Black, Hispanic, and Asian BCSs.

Spirituality and financial toxicity among Hispanic breast cancer survivors in New Jersey.

Cancer survivors often incur significant out-of-pocket costs; this can result in financial toxicity, defined as the adverse financial impact of cancer due to direct or indirect costs related to the disease. There has been little research on whether spirituality is associated with the experience of financial toxicity. In this study, we tested the hypothesis that spirituality would be inversely associated with financial toxicity. We evaluated these associations in a cross-sectional study of Hispanic breast cancer survivors (n = 102) identified through the New Jersey State Cancer Registry. Participants completed the FACIT-Sp-12, which has two spirituality subscales (meaning/peace; faith). Financial toxicity was assessed using the 11-item COST measure; lower scores suggest worse toxicity. In multivariable linear regression analyses, we examined the associations between spirituality scores and financial toxicity, adjusting for age, race, education, household income, and insurance status. The spirituality total score (β = 0.49, 95% confidence interval (CI): 0.17, 0.8), meaning/peace subscale score (β = 0.71, 95% CI: 0.12, 1.31), and faith (β = 0.71, 95% CI: 0.2, 1.21) subscale score were all inversely associated with financial toxicity. Spirituality may be an important factor in ameliorating the detrimental effects of financial toxicity among Hispanic breast cancer survivors and should be considered in interventions for financial toxicity in this population.

Reducing Metabolic Dysregulation in Obese Latina and/or Hispanic Breast Cancer Survivors Using Physical Activity (ROSA) Trial: A Study Protocol.

BackgroundLatina and Hispanic breast cancer survivors (LHBCS) are at increased risk for long-term complications and poorer metabolic health, including metabolic dysregulation (MetD) before and following breast cancer diagnosis. MetD can increase risk of cancer recurrence, death, and comorbid conditions by increasing inflammation and cancer cell proliferation. While exercise improves physical fitness and metabolic outcomes in breast cancer survivors, there is a lack of studies including underrepresented and disadvantaged minority groups such as LHBCS.MethodsOur 12-month randomized (exercise or attention control) controlled trial (the ROSA trial) aims to utilize a progressive combined aerobic and resistance exercise program to improve MetD, insulin resistance, and visceral adiposity among obese LHBCS. We aim to recruit 160 women with Stage I-III breast cancer who are sedentary, centrally obese, and have completed treatment (e.g., surgery, radiation, chemotherapy) prior to enrollment. Participants randomized to the exercise group receive 16-weeks of virtually supervised aerobic and resistance training, followed by 16-weeks of unsupervised home-based aerobic and resistance exercise, and 16-weeks of follow-up. The attention control group receive a 12-month home-based stretching program. Primary and secondary outcomes are measured every 4-weeks during study visits.DiscussionThe ROSA trial is the first exercise oncology trial targeting high-risk sedentary, obese LHBCS to improve MetD-related outcomes. Results of this trial will help illuminate how exercise impacts health-related outcomes, survivorship, and recurrence, and inform future exercise oncology guidelines to reduce health disparities among minority cancer survivors.

Abstract P3-14-05: Racial/ethnic disparities in cancer mortality after a second breast cancer

Abstract Background: Eighteen percent of breast cancer survivors will develop a second cancer within 25 years of diagnosis, of which breast cancer is the most common type. We have previously reported a higher cancer mortality among survivors who had a second cancer compared to a first cancer. In this study, we examined whether the increased cancer mortality from a second breast cancer differs by race/ethnicity. Method: A prospective cohort study was conducted among breast cancer survivors who developed a second breast cancer using data collected from the Surveillance, Epidemiology, and End Results (SEER) 18 database between 2000 and 2016. Hazard ratio (HR) and 95% confidence interval (CI) for cancer mortality after second breast cancer were estimated from Cox proportional hazard regression, comparing Non-Hispanic Black (NHB), Non-Hispanic American Indian/Alaska Native (NHAIAN), Non-Hispanic Asian/Pacific Islander (NHAPI), and Hispanic women to Non-Hispanic White (NHW) women. Models were adjusted for age at diagnosis, year of diagnosis, tumor stage, tumor grade, estrogen receptor (ER) status, and treatments (surgery, radiotherapy, and chemotherapy) of the second breast cancer. Analyses were also stratified by second cancer ER status, tumor stage, age at diagnosis (<50, 50-75, and ≥75 years), and time since first breast cancer diagnosis (≤5 and >5 years). In a subgroup of women diagnosed of second cancer after 2010 (N=8,224), we also conducted the analysis stratified by breast cancer molecular subtype [luminal A, triple-negative, and human epidermal growth factor receptor 2 (HER2)-positive]. Results: There were 14,392 breast cancer survivors diagnosed with a second breast cancer, including 9,928 NHW, 1,975 NHB, 70 NHAIAN, 988 NHAPI, and 1,431 Hispanic during the study period. The median age at diagnosis of the second cancer ranged from 57 to 66 years and the median follow-up time from diagnosis to cancer death ranged from 52 to 62 months across racial and ethnic groups. Cancer mortality was increased among NHB (HR: 1.28, 95%CI: 1.15-1.43) and Hispanic survivors (HR: 1.17, 95%CI: 1.03-1.33) compared to NHW. There was no increased cancer mortality among NHAIAN (HR: 1.07, 95%CI: 0.61-1.90) and NHAPI survivors (HR: 0.94, 95%CI: 0.80-1.12). The increased cancer mortality in NHB was observed irrespective of second cancer ER status, tumor stage, age at diagnosis, and time since first breast cancer diagnosis. Increased cancer mortality in NHB was also observed for luminal A (HR: 1.26, 95%CI: 1.11-1.44) and triple-negative subtypes (HR: 1.42, 95%CI: 1.10-1.83), but not for HER2-positive (HR: 1.19, 95%CI: 0.88-1.60) disease. For Hispanic patients, increased cancer mortality was observed in women with ER-positive disease, regional stage disease, cancer diagnosed <50 years of age, and cancer developed after 5 years. Conclusion: Racial/ethnic disparities in cancer mortality are present even among NHB and Hispanic breast cancer survivors who developed a second breast cancer. Studies are needed to understand the drivers of these disparities and to test preventive strategies to mitigate them. Citation Format: Zhengyi Deng, Miranda R Jones, Mei-Cheng Wang, Kala Visvanathan. Racial/ethnic disparities in cancer mortality after a second breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-05.

Exploring the relationship between loneliness, spirituality, and health-related quality of life in Hispanic cancer caregivers

Caregivers of cancer patients find it challenging to perform their roles and to meet the demands of caregiving. Spirituality has been investigated as a potential coping strategy employed by caregivers, yet spirituality and related practices vary among cultural groups. In this study, we investigated the relationship between spirituality and health-related quality of life (HRQOL) and evaluated mediation effects of loneliness on this relationship. The sample was 234 lower socioeconomic status (SES) Hispanic caregivers of breast cancer survivors using existing data from the Support for Latinas with Breast Cancer and Their Intimate and Family Partners study, funded by the American Cancer Society (Badger, PI). A cross-sectional analysis was conducted at baseline, using self-reported spirituality, loneliness, and HRQOL data collected from 2012 to 2017. The exposures and outcomes were assessed using the Spiritual Well-Being Scale, the Social Isolation—Short Form 8a PROMIS Item Bank v2.0 scale, and the Global Health Scale PROMIS v.1.0/1.1 scale. Descriptive and mediation analyses using the Preacher and Hayes’ approach were conducted to estimate the direct effect of spirituality on HRQOL and the indirect effect of spirituality through mediation of loneliness in relation to HRQOL. A positive association between spirituality and HRQOL was found, whereas loneliness was inversely associated with HRQOL (b = − .18, SE = .03, p < .0001). Age did not function as a moderator of the spirituality-HRQOL association in any of the models tested, but in the model testing mediation, loneliness was shown to mediate the association between spirituality and HRQOL (b = − .17, p < .0001). These results suggest that spirituality may be beneficial to HRQOL in caregivers of Hispanic breast cancer survivors, due in part to reduced loneliness among more spiritual caregivers.

Systemic inflammation and risk of all-cause mortality after invasive breast cancer diagnosis among Hispanic and non-Hispanic white women from New Mexico

IntroductionSoluble tumor necrosis factor receptor-II (sTNF-R2), a pro-inflammatory biomarker, is associated with obesity and breast cancer (BC). The association between sTNF-R2 and risk of mortality after BC has not been studied, specifically among Hispanic women, an at-risk population due to their high prevalence of obesity and poor prognosis. We examined the association between sTNF-R2 and mortality among Hispanic and non-Hispanic white (NHW) BC survivors. MethodsA total of 397 invasive BC survivors (96 Hispanic, 301 NHW) contributed baseline interview data and blood samples. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazards regression models adjusting for clinical factors including body mass index. ResultsAfter a median follow-up time of 13 years, 133 deaths occurred. The association between high vs low levels of plasma sTNF-R2 and mortality was not statistically significant overall (HR, 1.32; 95% CI 0.89–1.98). However, when stratified the mortality risk among Hispanic women was nearly 3-fold (HR, 2.83; 95% CI 1.21–6.63), while risk among NHW women was attenuated (HR, 0.99; 95% CI 0.61–1.61) (p-interaction=0.10). ConclusionOur results suggest Hispanic BC survivors with high sTNF-R2 levels may have increased risk of mortality and could inform targeted interventions to reduce inflammation and improve outcomes.

Effect of aerobic and resistance exercise on the mitochondrial peptide MOTS-c in Hispanic and Non-Hispanic White breast cancer survivors

MOTS-c is a mitochondrial derived peptide with exercise mimetic activity that elicits beneficial effects on metabolism and exercise capacity. Furthermore, MOTS-c effects in humans are affected by race, potentially via ethnic-specific mtDNA variations. Women treated for breast cancer are at an increased risk for cardiovascular disease, diabetes and obesity, due to side effects of cancer-treatments. We conducted a secondary analysis of the effects of a 16-week aerobic and resistance exercise intervention on MOTS-c in Hispanic and Non-Hispanic White breast cancer survivors (BCS). BCS (Stage I–III) were randomized to exercise or standard care. The intervention promoted aerobic and resistance exercise for 16 weeks. MOTS-c was analyzed in fasting plasma using an in-house ELISA. Within and between group differences were assessed by paired t-test and repeated measures ANOVA. Pearson’s correlation was computed to assess the association between MOTS-c and metabolic biomarkers at baseline and post-exercise. Twenty-five Hispanic-BCS and 24 non-Hispanic White BCS were included. Hispanic BCS were younger, of greater adiposity, had higher stage cancers, and had worse metabolic profiles at baseline compared to non-Hispanic White BCS (p < 0.001). Post-exercise, MOTS-c levels significantly increased when compared to baseline and the usual care group among non-Hispanic White BCS (p < 0.01) but not among Hispanic breast cancer survivors (p > 0.01). Post-exercise levels of MOTS-c among non-Hispanic White BCS were significantly associated with reductions in fat mass, body weight, HOMA-IR, CRP, and an increase in lean mass (p < 0.01). A 16-week aerobic and resistance intervention increased MOTS-c levels among non-Hispanic White BCS.Trial registration: This trial is registered on ClinicalTrials.gov: NCT01140282 as of June 9, 2010. https://clinicaltrials.gov/ct2/show/NCT01140282.

Abstract 415: Effect of aerobic and resistance exercise on the mitochondrial peptide MOTSc in Hispanic and non-Hispanic breast cancer survivors

Abstract Background MOTS-c is a mitochondrial derived peptide with exercise mimetic activity that elicits beneficial effects on metabolism and exercise capacity. MOTS-c stimulates glucose utilization, fat-oxidization, reduces inflammation, and protects against experimental models of metabolic disease. Furthermore, MOTS-c effects in humans are affected by race, potentially via ethnic-specific mtDNA variations. Women treated for breast cancer are at an increased risk for risk for cardiovascular disease, diabetes and obesity, due to side effects of cancer-treatments. Exercise mitigates many of these side effects, but the role of MOTS-c regulation by exercise among breast cancer survivors (BCS) of varying ethnicities is unknown. We examined the effects of a 16-week aerobic and resistance exercise intervention on MOTS-c in Hispanic and Non-Hispanic BCS. Methods BCS (Stage I-III) were randomized to exercise (n=50) or standard care (n=50). The intervention promoted supervised, progressive moderate-vigorous aerobic and resistance exercise thrice weekly for 16 weeks. Aerobic exercise was performed at 65-85% maximum heart rate. Resistance exercise was performed in circuit-fashion with 3 sets of 10-15 repetitions including upper and lower body exercises at 65-70% 1-repetition maximum. Fasting blood draws were obtained at baseline and post-intervention (4 months). Body composition was assessed by dual energy x-ray absorptiometry. MOTS-c was analyzed in plasma using an in-house ELISA. Within and between group differences were assessed by paired t-test and repeated measures ANOVA. Pearson's correlation was computed to assess the association between MOTS-c and metabolic biomarkers. ResultsTwenty-five Hispanic BCS and 24 non-Hispanic BCS (age 53.5±10.4 years) and BMI of 33.5±5.5 kg/m2 were included. Hispanic BCS were younger, of greater adiposity, had higher stage cancers, and had worse metabolic profiles at baseline compared to non-Hispanic BCS (p&amp;lt;0.001). Post-exercise, MOTS-c levels significantly increased when compared to baseline and the usual care group among NHBCS (p&amp;lt;0.01). Post-exercise levels of MOTS-c among non-Hispanic BCS were significantly associated with reductions in fat mass, body weight, HOMA-IR, CRP, and an increase in lean mass (p&amp;lt;0.01). MOTS-c did not significantly change following exercise among Hispanic BCS (p&amp;gt;0.05). Conclusions A 16-week aerobic and resistance intervention increased MOTS-c levels among non-Hispanic BCS but not Hispanic BCS. Non-Hispanic BCS who experience exercise-induced improvements in MOTS-c may also experience improved insulin sensitivity thereby reducing the risk for comorbid conditions. Despite poorer metabolic profiles, Hispanic BCS may not experience exercise-induced benefits on MOTS-c. Future trials should aim for reducing potential ethnic differences in cardiometabolic health. Citation Format: Christina M. Dieli-Conwright, Nathalie Sami, Mary K. Norris, Junxiang Wan, Hiroshi Kumagai, Pinchas Cohen. Effect of aerobic and resistance exercise on the mitochondrial peptide MOTSc in Hispanic and non-Hispanic breast cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 415.

Abstract LB081: Systemic inflammation is associated with increased risk of mortality after invasive breast cancer among Hispanic women from New Mexico

Abstract Introduction: Soluble tumor necrosis factor receptor-II (sTNF-R2), a circulating pro-inflammatory biomarker, has been found to associated with obesity and increased risk of breast cancer. No studies to date have examined the association between sTNF-R2 and risk of mortality among Hispanic breast cancer survivors, an at-risk population due to their high prevalence of obesity and poor prognosis. The current study examined the long-term effects of sTNF-R2 on risk of mortality among Hispanic and non-Hispanic white (NHW) breast cancer survivors from the New Mexico Health Eating Activity and Lifestyle Study. Methods: A total of 397 invasive breast cancer survivors (96 Hispanic, 301 NHW) contributed data for the present study. Women with breast cancer diagnosed between July 1996 and March 1999 were ascertained through the National Cancer Institute's Surveillance Epidemiology and End Results registry in New Mexico. Baseline demographic characteristics, anthropometric measures, and blood samples were collected approximately 5 months post diagnosis by trained interviewers. Plasma levels of sTNF-R2 were assayed and measures were log-transformed to conform to normality. The main predictor of low (referent) vs high sTNF-R2 levels was based on the median value. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the associations between sTNF-R2 and all-cause mortality were calculated using Cox proportional hazards regression models overall and by ethnicity. Models were adjusted for age at diagnosis, education, breast cancer stage, treatment, and body mass index (BMI). Results: A total of 133 deaths (53 breast cancer-specific deaths) were observed after a median follow-up time of 13 years. While Hispanic women had higher baseline BMI (mean= 27.21, standard deviation (SD)= 5.83) compared to NHW women (mean= 25.68, SD= 5.36) (p&amp;lt; 0.001), significant differences by ethnicity for sTNF-R2 levels were not observed. In models adjusted for ethnicity and other covariates, the association between high vs low levels of plasma sTNF-R2 and risk of mortality was not statistically significant among all women (HR, 1.36; 95% CI 0.90-2.03). However, in models stratified by ethnicity, Hispanic women had increased risk of mortality of almost 3-fold (HR, 2.83; 95% CI 1.21-6.63), while the association among NHW women was attenuated and was not statistically significant (HR, 0.99; 95% CI 0.61-1.61). The statistical interaction between sTNF-R2 and ethnicity with risk of mortality was not statistically significant (p= 0.10). Conclusion: Our study results suggest Hispanic breast cancer survivors with high levels of systemic inflammation measured by sTNF-R2 are at increased risk of mortality. These results could inform targeted intervention studies to decrease inflammation and reduce risk of mortality among this at-risk population. Citation Format: Avonne E. Connor, Stephanie D. Boone, Kathy B. Baumgartner, Richard N. Baumgartner. Systemic inflammation is associated with increased risk of mortality after invasive breast cancer among Hispanic women from New Mexico [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB081.

Racial/ethnic differences in health-related quality of life among female breast cancer survivors: cross-sectional findings from the Medical Expenditure Panel Survey

ObjectivesBreast cancer survivors have reported worse health-related quality of life (HRQoL) outcomes on some subscales when compared with members of the general population. However, the increased attention to breast cancer survivorship should have improved the HRQoL of these survivors. Our aim was to examine whether physical and mental component scores (PCS-12 and MCS-12) using the Short Form (SF-12) questionnaire were different for racial/ethnic minorities, specifically for Black and Hispanic women relative to White women. Furthermore, we stratified the data by age group to evaluate these racial/ethnic differences in HRQoL of breast cancer survivors. Study designCross-sectional study. MethodsPooled cross-sectional analyses using data from the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the racial/ethnic differences in PCS-12 and MCS-12 scores of breast cancer survivors. Furthermore, stratified analyses by age group were conducted to evaluate racial/ethnic differences in HRQoL by the age of breast cancer survivors. ResultsAfter adjusting for confounders, there was no association between race/ethnicity and PCS-12 scores. However, Hispanic breast cancer survivors had statistically significantly lower MCS-12 scores (by 1.9 points [95% confidence interval {CI}: −3.53 to −0.37]) when compared with White breast cancer survivors. For PCS-12, after stratifying by age, the adjusted analyses showed no significant differences in PCS-12 scores when White female breast cancer survivors were compared with the other racial/ethnic categories. On the other hand, Black female survivors aged <50 years had 4.3 points (95% CI: 0.46–8.13) higher MCS-12 scores when compared with their White counterparts, while Hispanic breast cancer survivors aged <50 years had 3.1 points (95% CI: −0.40–6.69) higher MCS-12 scores relative to White women. Furthermore, among female breast cancer survivors aged ≥50 years, Hispanic women had 3.2 points (95% CI: −4.98 to −1.40) lower MCS-12 scores than White women. ConclusionOur study generated findings showing the racial/ethnic differences in HRQoL of breast cancer survivors and presented results stratified by age group. These findings provide the much-needed rationale for targeted and racial/ethnic-specific HRQoL improvement strategies among breast cancer survivors.

PCN146 Association of Health Related Quality of Life with Breast Cancer Survival Among Hispanic Population Using Medical Expenditure Panel Survey DATA (2006-2015)

Breast cancer is the most commonly diagnosed cancer among women in the United States and it is the leading cause of death among the Hispanic population. Little evidence exists the association of health-related quality of life (HRQoL) by the presence of breast cancer survival among Latina population. This study was to look at the association of the presence of breast cancer survival on HRQoL measure in the US Hispanic population. This was a cross-sectional study analyzing data from the 2006-2015 Medical Expenditure Panel Survey (MEPS). The target population was comprised of Hispanic community-dwelling residents with breast cancer in the US. Two multivariate regression models were used to predict HRQoL measure by the presence of breast cancer survival among Hispanic population. A total 207 breast cancer survivors met the study inclusion criteria, and the estimated population size was 1.200,337 breast cancer survivors. In the multiple regression analysis on the SF-12 PCS scores, age, census region, poverty level, perceived health status, BMI, and employment were associated with SF-12 PCS scores. The multiple regression analysis on the SF-12 MCS scores presented that age, census region, insurance type, perceived mental health status, and CCI were associated with SF-12 MCS scores. This study presents data on the HRQoL of Hispanic breast cancer survivors in the U.S. It builds on previous research that examines the HRQoL as expressed through the SF-12 PCS and SF-12 MCS surveys, rather than other types of measurement. This study may also be used as a guide in the implementation of clinical interventions and plans for survivorship care in improving the HRQoL of Hispanic breast cancer survivors.

Trends in health-related quality of life of female breast cancer survivors using the Medical Expenditure Panel Survey (MEPS), 2008-2016.

In recent years, breast cancer detection and treatment have advanced. As a result, increased attention to breast cancer survivorship should have improved their health-related quality of life (HRQoL). Our aim was to examine the trends in the HRQoL of female breast cancer survivors between 2008 and 2016, to determine whether or not the increased focus on survivorship has translated into improved HRQoL. Furthermore, stratified analyses were conducted by race/ethnicity and age group and these were compared to a similar group of women without a breast cancer history. Repeated cross-sectional analyses using the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the trends in physical component scores (PCS-12) and mental component scores (MCS-12) among breast cancer survivors and a similar population of women without a breast cancer history. Analyses stratified by race/ethnicity and age group were also conducted. Among breast cancer survivors, after adjusting for confounders, there was no change in PCS-12 scores over time, but the MCS-12 scores increased by 0.27 points (95% CI 0.09-0.45). Those without a history of breast cancer had mean PCS-12 scores that were 0.13 points greater each year (95% CI 0.02-0.24) while their mean MCS-12 scores were 0.10 (95% CI 0.00-0.21) points greater each year. After stratifying by race/ethnicity, Hispanic breast cancer survivors had a small increase in PCS-12 (β: 0.65; 95% CI 0.01-1.29), and MCS-12 scores (β: 0.70; 95% CI0.06-1.33) over time. Similar small effects were found when stratified by age group, both among breast cancer survivors and those without a history of breast cancer. The younger age group (< 50years) reported poorer MCS-12 than the older population (age 50years and above). Our study generated findings showing the trends in the HRQoL of breast cancer survivors and compared these to a similar population of women without a history of breast cancer. This paper highlights the importance of focusing on the mental health of young breast cancer survivors to improve their prospects at a good quality of life post-breast cancer diagnosis and treatment.

Prevalence and risk factors for vasomotor symptoms in Hispanic female breast cancer survivors, 0-3 years post-treatment: Results of a single-center retrospective analysis.

e24038 Background: Early detection and a growing complement of treatment options have led to improved survival among women with breast cancer in the U.S. Vasomotor symptoms (VMS) such as hot flashes and night sweats are among the most common side effects reported by breast cancer survivors (BCS) following treatment. These symptoms may affect quality of life and increase the risk of non-adherence to anti-hormonal therapies. Hispanics are one of the fastest growing ethnic populations in the U.S. However, research exploring whether Hispanic BCS report VMS at similar rates as their non-Hispanic counterparts remains an important gap in the science. The purpose of this study was to compare the prevalence and risk factors for VMS between Hispanic and non-Hispanic BCS following cancer treatment. Methods: Data for this single-center, retrospective study came from a database of self-reported symptom data collected at survivorship visits. Results: Over a 2.8-year period, 815 female BCS were evaluated for VMS (Hispanic: 63.0% (n=513) vs. Non-Hispanic: 37.0% (n = 302)). Mean age of the sample was 58.4 + 11.7 (range 24.2 - 91.8).Approximately four in ten (42.9%) BCS reported VMS at their initial survivorship visit, 0-3 years post-treatment. Results found virtually no difference in VMS prevalence between Hispanic and non-Hispanic BCS, (42.5% vs 43.7%, p = 0.735). BCS who reported VMS after treatment were 6.5 years younger, on average, than BCS who did not report VMS (54.7 ±11.0 vs. 61.2 ±11.3, p &lt; 0.001). Multivariate logistic regression models using age, race, stage of cancer, chemotherapy, radiation and hormone therapy as predictors showed that only age was associated with reporting VMS. For every one-year increase in age, the odds of reporting VMS fell by approximately 5.3% (OR: 0.947, 95% CI: 0.933-0.963, p &lt; 0.0001). Conclusions: Results found no difference in VMS prevalence between Hispanic and non-Hispanic BCS. VMS were reported by over 40 % of BCS in the study. In addition, symptoms were more prevalent in younger BCS. Given the potential impact of VMS on quality of life and mediation adherence, studies validating these findings as well as exploring the prevalence and risk factors for VMS in Hispanic BCS from distinct nationalities and cultures are needed.

Prevalence and risk factors for self-reported sexual dysfunction in Hispanic female breast cancer survivors 0-3 years post-cancer treatment: Results of a single-center retrospective study.

e24039 Background: Improvements in breast cancer screening and treatment have improved survival for many women in the U.S. However, side-effects associated with cancer treatment remain a serious issue for survivors. It is estimated that up to half or more of female breast cancer survivors (BSC) report unwanted changes in sexual function following cancer treatment. Studies have also suggested that both younger BCS and Hispanic women may be at higher risk for developing sexual dysfunction following treatment. However, women of Hispanic origin remain highly underrepresented in research on sexual dysfunction, despite being one of the fastest growing racial/ethnic populations in the U.S. The purpose of this study was to compare the prevalence and risk factors for sexual dysfunction between Hispanic and non-Hispanic BCS during the first-three years post-cancer treatment. Methods: Data for this single-center, non-randomized, retrospective study came from a database of self-reported symptom data collected as part of routine clinical practice in our institution’s Survivorship Clinic. Results: Over a 2.8-year period between Apr. 2017 and Dec. 2019, a total 815 female BCS were evaluated for sexual dysfunction. Nearly two-thirds (63.0%) of BCS identified as Hispanic, and 37.0% (n = 302) of BCS identified as non-Hispanic. Mean age of the sample was 58.4 ± 11.7 (range: 24.2–91.8). Results found that approximately a quarter (25.8%) of BCS reported “vaginal dryness, discharge, or pain with intercourse” at their initial survivorship visit. Rates of sexual dysfunction were nearly identical between Hispanic and Non-Hispanic BCS (25.7% vs. 25.8%; p = 0.975). Consistent with previous studies, BCS who reported sexual dysfunction tended to be younger, on average (53.7±10.5 years vs. 60.0 ±11.6 years; p = 0.002) and more likely to have been diagnosed with Stage 2 or 3 cancer (p = 0.038) than BCS not reporting sexual dysfunction. Multivariate logistic regression models using age, race, stage of cancer, chemotherapy, radiation type, and hormone therapy as predictors confirmed this association between younger age and likelihood of sexual dysfunction, showing that for every one-year younger BCS were at their initial survivorship visit, the odds of reporting sexual dysfunction at the initial survivorship visit increased by approximately 6.5% (OR: 0.943, 95% CI: 0.927-0.96; p &lt; .0001). Conclusions: Results suggest that signs/symptoms such as vaginal dryness, discharge, or pain with intercourse are common for both Hispanic and non-Hispanic BCS following treatment, affecting as many as one in four BCS. Results also show that symptoms are prevalent among younger BCS. Together, results underscore the need for clinicians to be prepared to assess and manage sexual dysfunction, especially in younger BCS.

Abstract PO-176: Obesity, breast cancer treatment, and systemic inflammation: A cross- sectional analysis of Hispanic and non-Hispanic white breast cancer survivors from New Mexico

Abstract Background: Circulating markers of systemic inflammation have been found to be important long-term prognostic factors for breast cancer (BC). Studies have shown that obesity measured by percent body fat is the most significant predictor of inflammation in BC survivors. Specific BC treatments may also stimulate both local and systemic increases in inflammation. Little is known about the impact of other body size measures and BC treatment effects on inflammation among Hispanic BC survivors, an at-risk population due to their high prevalence of obesity and poor prognosis. Objective: We examined the associations between body size measures, BC treatment, and odds of systemic inflammation measured by soluble tumor necrosis factor receptor-II (sTNF-R2), a circulating pro-inflammatory biomarker, among Hispanic and non-Hispanic white (NHW) women diagnosed with breast cancer (stages I-IIIa) from the New Mexico Health, Eating, Activity, and Lifestyle cohort. Methods: A total of 397 BC survivors (96 Hispanic, 301 NHW) contributed data for the present study. Women with BC diagnosed between July 1996 and March 1999 were ascertained through the National Cancer Institute’s Surveillance Epidemiology and End Results registry in New Mexico. Baseline demographic characteristics, anthropometric measures, and blood samples were collected approximately 5 months post diagnosis by trained interviewers. Plasma levels of sTNF-R2 were assayed and measures were log-transformed to conform to normality. The study outcome of low vs high sTNF-R2 levels was based on the median value. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression models and were stratified by ethnicity. Results: There were higher proportions of women with high compared to low sTNF-R2 levels and the following obesity measures: high percent body fat (≥35%), high body mass index (BMI) (≥30 kg/m2), and high waist-hip ratio (&amp;gt;0.85). No significant differences were observed by sTNF-R2 levels and ethnicity or treatment. In multivariable models, we observed significant positive associations among women with high body fat percentage (compared to &amp;lt; 35%) (OR= 1.62, 95% CI 1.01-2.60) and morbid obesity (BMI ≥35 kg/m2 compared to BMI&amp;lt; 35 kg/m2) (OR= 4.16, 95% CI 1.43-12.10). High waist-hip ratio was not significantly associated with sTNF-R2. While current tamoxifen use was not associated with sTNF-R2, we did find that women who received radiation and chemotherapy were 2 times more likely to have high sTNF-R2 levels compared to women who did not have chemotherapy and radiation (OR= 2.04, 95% CI 1.03-4.01). Our results were not significantly modified by ethnicity. Conclusion: BC survivors with high body fat percentage and extreme BMI have increased odds of systemic inflammation measured by sTNF-R2. Survivors treated with chemotherapy and radiation are also more likely to experience systemic inflammation. Future studies will examine the long-term effects of these associations on poor prognosis. Citation Format: Avonne E. Connor, Kala Visvanathan, Stephanie D. Boone, Kathy B. Baumgartner, Richard N. Baumgartner. Obesity, breast cancer treatment, and systemic inflammation: A cross- sectional analysis of Hispanic and non-Hispanic white breast cancer survivors from New Mexico [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-176.