NH White Research Articles

Return of Research-Related Genetic Test Results and Genetic Discrimination Concerns: Facilitators and Barriers of Genetic Research Participation in Diverse Groups

Background: Most genetics studies lack the diversity necessary to ensure that all groups benefit from genetic research. Objectives: To explore facilitators and barriers to genetic research participation. Methods: We conducted a survey on genetics in research and healthcare from November 15, 2017 to February 28, 2018 among adult Kaiser Permanente (KP) members who had been invited to participate in the KP biobank (KP Research Bank). We used logistic regression to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) comparing the willingness to participate in genetic research under different return of results scenarios and genetic discrimination concerns between groups, according to their demographic characteristics. Results: A total of 57,331 KP members were invited to participate, and 10,369 completed the survey (18% response rate). Respondents were 65% female, 44% non-Hispanic White (NH White), 22% Asian/Native Hawaiian or other Pacific Islander (Asian/PI), 19% non-Hispanic Black (NH Black), and 16% Hispanic. Respondents willing to participate in genetic research ranged from 22% with no results returned to 87% if health-related genetic results were returned. We also found variation by race/ethnicity; when no results were to be returned, Asian/PIs, Hispanics, and NH Blacks were less likely to want to participate than NH Whites (p < 0.05). However, when results were returned, disparities in the willingness to participate disappeared for NH Blacks and Hispanics. Genetic discrimination concerns were more prevalent in Asian/PIs, Hispanics, and NH Blacks than in NH Whites (p < 0.05). Conclusions: Policies that prohibit the return of results and do not address genetic discrimination concerns may contribute to a greater underrepresentation of diverse groups in genetic research.

Race and Gender Differences in Awareness of Colorectal Cancer Screening Tests and Guidelines Among Recently Diagnosed Colon Cancer Patients in an Urban Setting.

The purpose of this study was to first characterize the prevalence of recall, recognition, and knowledge of colon cancer screening tests and guidelines (collectively, "awareness") among non-Hispanic black (NHB) and NH white (NHW) urban colon cancer patients. Second, we sought to examine whether awareness was associated with mode of cancer detection. Low awareness regarding colon cancer screening tests and guidelines may explain low screening rates and high prevalence of symptomatic detection. We examined recall, recognition, and knowledge of colorectal cancer (CRC) screening tests and guidelines and their associations with mode of cancer detection (symptomatic versus screen-detected) in 374 newly diagnosed NHB and NHW patients aged 45-79. Patients were asked to name or describe any test to screen for colon cancer (recall); next, they were given descriptions of stool testing and colonoscopy and asked if they recognized each test (recognition). Lastly, patients were asked if they knew the screening guidelines (knowledge). Overall, awareness of CRC screening guidelines was low; just 20% and 13% of patients knew colonoscopy and fecal test guidelines, respectively. Awareness of CRC screening tests and guidelines was especially low among NHB males, socioeconomically disadvantaged individuals, and those diagnosed at public healthcare facilities. Inability to name or recall a single test was associated with reduced screen-detected cancer compared with recall of at least one test (36% vs. 22%, p = 0.01). Low awareness of CRC screening tests is a risk factor for symptomatic detection of colon cancer.

Trends in Cigar Use in the United States, 2002-2016: Diverging Trends by Race/Ethnicity.

Although there are racial/ethnic differences in cigarette use, little is known about how non-cigarette tobacco use differs among racial/ethnic groups. This study investigated trends in cigar use from 2002 to 2016, by racial/ethnic group, in nationally representative US data. Data were drawn from the 2002-2016 National Survey on Drug Use and Health public use data files (total analytic sample n = 630 547 including 54 060 past-month cigar users). Linear time trends of past-month cigar use were examined by racial/ethnic group (Non-Hispanic [NH] White, NH Black, Hispanic, NH Other/Mixed Race/Ethnicity) using logistic regression models. In 2016, the prevalence of past-month cigar use was significantly higher among NH Black respondents than among other racial/ethnic groups (ps < .001). Cigar use was also higher among NH White respondents than among Hispanic and NH Other/Mixed Race/Ethnicity respondents. The year by racial/ethnic group interaction was significant (p < .001). Past-month cigar use decreased significantly from 2002 to 2016 among NH White and Hispanic respondents (ps = .001), whereas no change in prevalence was observed among NH Black (p = .779) and NH Other/Mixed Race/Ethnicity respondents (p = .152). Cigar use decreased for NH White men (p < .001) and did not change for NH White women (p = .884). Conversely, cigar use increased for NH Black women (p < .001) and did not change for NH Black men (p = .546). Cigar use remains significantly more common among NH Black individuals in the United States and is not declining among NH Black and NH Other/Mixed Race/Ethnicity individuals over time, in contrast to declines among NH White and Hispanic individuals. This study identified racial/ethnic differences in trends in past-month cigar use over 15 years among annual cross-sectional samples of US individuals. The highest prevalence of cigar use in 2016 was found among NH Black individuals. In addition, cigar use prevalence did not decline from 2002 to 2016 among NH Black and NH Other/Mixed Race/Ethnicity groups over time, in contrast to NH White and Hispanic groups. Further, cigar use increased over time for NH Black women. Targeted public health and clinical efforts may be needed to decrease the prevalence of cigar use, especially for NH Black individuals.

Trends in Multivitamin Use Among Women of Reproductive Age: United States, 2006-2016.

Women of reproductive age can consume 0.4 milligrams of folic acid daily to reduce the risk of a neural tube defect (NTD)-affected pregnancy. Multivitamins (MVs) are one source of folic acid. Using HealthStyles survey data (n = 9268), we assessed change in prevalence of MV use during 2006-2016 among women by age (18-24, 25-34, and 35-44 years), race/ethnicity (non-Hispanic [NH] white, NH black, Hispanic), and pregnancy status (trying to get pregnant, not pregnant nor trying to get pregnant, and pregnant) using log-binomial regression. Daily MV consumption decreased overall from 32.7% to 23.6% during 2006-2016 for women aged 18-44 years (p for trend <0.001). Age-specific decreases were seen in women aged 25-34 years (2006: 34.1%; 2016: 23.7%; p < 0.001) and 35-44 years (2006: 37.3%; 2016: 27.1%; p < 0.001). Decreases in daily MV intake were found among NH whites (2006: 35.4%; 2016: 24.9%; p < 0.001) and Hispanics (2006: 30.6%; 2016: 22.1%; p < 0.001), but remained unchanged among NH blacks (2006: 23.7%; 2016: 21.8%; p = 0.87). Daily MV intake remained unchanged for women trying to get pregnant (2006: 40.2%; 2012: 38.3%; p = 0.19), decreased for women not pregnant nor trying to get pregnant (2006: 31.3%; 2012: 21.3%; p < 0.001), and fluctuated for pregnant women (2006: 53.8%; 2012: 71.0%; p = 0.21). Prevalence of no MV consumption increased significantly across all age and race/ethnicity groups. Overall MV intake decreased for the past decade and varied by age, race/ethnicity, and pregnancy status. Innovative messaging and targeted interventions for increasing folic acid intake are needed to reduce NTDs.

Performance of Hispanics and Non-Hispanic Whites on the NIH Toolbox Cognition Battery: the roles of ethnicity and language backgrounds

Objective: This study examined the influence of Hispanic ethnicity and language/cultural background on performance on the NIH Toolbox Cognition Battery (NIHTB-CB). Method: Participants included healthy, primarily English-speaking Hispanic (n = 93; Hispanic-English), primarily Spanish-speaking Hispanic (n = 93; Hispanic-Spanish), and English speaking Non-Hispanic white (n = 93; NH white) adults matched on age, sex, and education levels. All participants were in the NIH Toolbox national norming project and completed the Fluid and Crystallized components of the NIHTB-CB. T-scores (demographically-unadjusted) were developed based on the current sample and were used in analyses. Results: Spanish-speaking Hispanics performed worse than English-speaking Hispanics and NH whites on demographically unadjusted NIHTB-CB Fluid Composite scores (ps < .01). Results on individual measures comprising the Fluid Composite showed significant group differences on tests of executive inhibitory control (p = .001), processing speed (p = .003), and working memory (p < .001), but not on tests of cognitive flexibility or episodic memory. Test performances were associated with language/cultural backgrounds in the Hispanic-Spanish group: better vocabularies and reading were predicted by being born outside the U.S., having Spanish as a first language, attending school outside the U.S., and speaking more Spanish at home. However, many of these same background factors were associated with worse Fluid Composites within the Hispanic-Spanish group. Conclusions: On tests of Fluid cognition, the Hispanic-Spanish group performed the poorest of all groups. Socio-demographic and linguistic factors were associated with those differences. These findings highlight the importance of considering language/cultural backgrounds when interpreting neuropsychological test performances. Importantly, after applying previously published NIHTB-CB norms with demographic corrections, these language/ethnic group differences are eliminated.

Correlates of Reported Use and Perceived Helpfulness of Calorie Information in Restaurants Among U.S. Adults.

This study reports correlates in reported use and helpfulness of calorie information, when available, in restaurants on a national scale in the United States for demographic behavioral and health-related conditions. This study is a secondary data analysis of the 2013 National Cancer Institute's Health Information National Trends Survey data. United States. Adults (n = 3407). Menu labeling use and helpfulness; behavior change attempts; reported fruit, vegetable, and soda consumption; weight status; and chronic health conditions. Trends were identified in weighted logistic and linear regression models. U.S. adults who intended to lose weight (odds ratio [OR] = 5.01 [95% confidence interval 2.96, 8.46]), increase fruit (OR = 1.10 [.66, 1.84]) or vegetable consumption (OR = 2.25 [1.32, 3.83]), or reduce soda consumption (OR = 1.67 [1.11, 2.51]) were more likely to report using menu-labeling information when available. More women reported calorie information was helpful when ordering (p < .05). Racial/ethnic and socioeconomic status disparities were identified in use (non-Hispanic [NH] blacks vs. NH whites OR = .43 [.25, .74]) and helpfulness (NH blacks vs. NH whites β = -.06 [-.44, .32]). Findings highlight potential subgroups to target for communication and education efforts regarding use of calorie information in restaurants. Following publication of final rules for federal menu-labeling legislation and implementation, further surveillance of public response to this information may inform message framing and educational interventions to promote use of calorie information on menu boards.

Abstract C81: Variations in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) across states in the United States

Abstract Background: Previous studies reported substantial racial and socioeconomic disparities in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) in the US. We examined variation in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) across states in the US. We also examined whether black/white disparity in receipt of curative-intent surgery varies by state. Methods: Patients with stage I or II NSCLC diagnosed in 2007–2011 were identified from 38 population-based cancer registries compiled by the North American Association of Central Cancer Registries (NAACCR). We calculated percentage for receipt of curative-intent surgery in each state. Adjusted risk ratios (RRs) were generated using modified Poisson regression to control for sociodemographic (e.g., age, sex, race, insurance) and clinical (e.g., grade, stage, tumor size) factors. NH whites and patients in Massachusetts used as reference for comparisons. Results: Receipt of curative-intent surgery for early-stage NSCLC varied substantially by state, ranging from 52.2% in Wyoming to about 75% in Massachusetts, New Jersey, and Utah. In a multivariable analysis, the likelihood of receiving curative-intent surgery for early-stage NSCLC patients was significantly lower in all states but seven states/registries and ranged from 7% lower in California (RR, 0.93; 95% CI, 0.89–0.97) to 25% lower in Wyoming (RR, 0.75; 95% CI, 0.59–0.95) compared with patients in Massachusetts. Receipt of curative-intent surgery was lower for NH black than NH white patients in all states though statistically significant in only two states (Florida, Texas) after accounting for differences in sociodemographic and clinical characteristics. Conclusions: Receipt of curative-intent surgery for early-stage NSCLC substantially varies across states in the United States, with the rate of receipt for both NH white and NH black patients generally lower and racial disparity higher in southern states. Citation Format: Helmneh M. Sineshaw, Xiao-Cheng Wu, W Dana Flanders, Raymond Uyiosa Osarogiagbon, Ahmedin Jemal. Variations in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) across states in the United States. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C81.

Abstract B84: Racial/ethnic and socioeconomic disparities in access to screening mammograms in a statewide sample of mammography facilities in Illinois

Abstract Purpose: The purpose of this study was to use data collected from a recent Metropolitan Chicago Breast Cancer Task Force (MCBCTF) survey to explore racial/ethnic and socioeconomic disparities in access to screening and diagnostic services for breast cancer in Illinois and to compare equitable access to services for Chicago versus the rest of the state. Methods: Facilities that performed mammography were recruited to participate in a quality improvement project that included completing a facility survey. Participants who completed surveys received an increased mammogram reimbursement for Medicaid patients to equal the Medicare rate from the Illinois Department of Healthcare and Family Service. The survey included the following data elements: number of digital and analog machines, number of radiologists dedicated (&amp;gt;75% of their time) to breast imaging and number of general radiologists, number of dedicated and general mammography technicians, monthly volumes of screening and diagnostic mammograms, and whether breast ultrasound, MRI, or image-guided biopsy services were available at the site. In addition, sites reported the percentage of patients who were African-American (AA) or Hispanic, and the percentage of patients who were uninsured and on Medicaid, in categories of &amp;gt;10, 10-25, 25-40, 40-60, 60-75, 75-90, and &amp;gt;90%. Within each patient group defined by ethnicity and health insurance status, we estimated the number of screening mammograms performed separately for facilities with none, partial and sole reliance on dedicated radiologists, and separately by facility availability of breast MRI and image-guided biopsy. In all, 156 out of 359 facilities accredited by the Food and Drug Administration completed the survey, representing approximately 8.2 million screening mammograms conducted in calendar year 2012 in Illinois. Results: Overall, about 3/4 of screening mammograms were performed in nH whites and 4/5 in privately insured patients. Within the city of Chicago, 47% and 30% were performed in ethnic minorities and those without private insurance, compared to 21% and 15% in the rest of the state. Within Chicago, mammograms were more than twice as likely to be performed at facilities relying solely on dedicated radiologists when compared to the rest of the state (39% vs. 17%). In Chicago, non-Hipanic Whites were more likely than their AA and Hispanic counterparts to be screened at facilities relying solely on dedicated radiologists (50% vs. 27% and 15%, respectively) and at facilities with MRI (90% vs. 57% and 71%) and biopsy services (92% vs. 63% and 79%). In a similar manner, privately insured patients were more likely than Medicaid and uninsured patients to be screened at facilities that relied solely on dedicated radiologists (44% vs. 13% and 18%, respectively). When examining equitable access to these services for the rest of the state as a whole, very little was noted in the way of disparities by race/ethnicity or insurance status. Conclusions: Disparities in equitable access to breast cancer screening and diagnostic services exist within Chicago that are generally absent outside of the city. The concentration of academic medical centers within Chicago, while increasing access to quality breast healthcare, has also introduced racial/ethnic and socioeconomic disparities due to unequal access to these academic medical centers. Citation Format: Bethliz Irizarry, Katherine Y. Tossas-Milligan, Garth Rauscher, Anne Marie Murphy. Racial/ethnic and socioeconomic disparities in access to screening mammograms in a statewide sample of mammography facilities in Illinois. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B84.

Abstract B51: Exploring the role of reproductive factors and DNA methylation in ethnic disparities in breast cancer tumor aggressiveness

Abstract Purpose: Non-Hispanic (nH) Black and Hispanic (or minority) breast cancer patients tend to be diagnosed with more aggressive forms of breast cancer compared to their nH White counterparts. Prior research as well as analyses from the current study has identified hormonal and reproductive factors associated with breast cancer aggressiveness subtypes. We explored the potential role of hormonal and reproductive factors, and the potential contribution of DNA methylation, in explaining the racial/ethnic disparity in tumor aggressiveness in a population based study of breast cancer disparities. Methods: The breast Cancer Care in Chicago (BCCC) study included 989 recently diagnosed nH White, nH Black and Hispanic patients with first primary breast cancer. Analyses include a subset of 286 patients with available tumor immunohistochemistry (IHC) data on estrogen and progesterone receptor (ER/PR), HER2, p53 and Ki67 status. A tumor aggressiveness score (TAS) with a high internal reliability coefficient (Chronbach's alpha=0.76) was created from tumor grade and IHC data on ER, PR, HER2, p53 and Ki67. Values were standardized to have a mean of 0 and standard deviation of 1, then summed together and re-standardized to create the score. Pyrosequencing assays for DNA methylation were conducted on a set of DNA sequences identified based on prior literature, ENCODE data for DNA methylation, and transcription for normal vs. cancer cell lines from the UCSC genome browser. Of the 286 patients with tumor aggressiveness data, 214 had available methylation data for BRCA1, GSTM2, EGFR, RASSF1, Sat2 and TFF1 genes. Multivariable linear regression models were estimated with standardized aggressiveness score as the dependent variable and using nested models to conduct likelihood ratio tests for both forward (type 1) and backwards (type 3) analyses. A method of rescaled-coefficients was then used to estimate an average controlled direct effect representing the ethnic disparity in breast cancer tumor aggressiveness and the extent to which the disparity might be explained by patient reproductive factors and tumor DNA methylation. Because stage at diagnosis is downstream of, and strongly influenced by, tumor aggressiveness, it was excluded from our analyses. Results: Factors significantly associated with having a higher TAS (p&amp;lt; 0.05) included: nH black or Hispanic race/ethnicity; younger age at first birth; nulliparity; positive family history (FH) of breast cancer, longer use of oral contraceptives; higher pathologic stage; and higher mean BRCA1, GSTM2 and TFF2 methylation levels. In multivariable modeling, variables retained for further analysis included: FH, nulliparity, and methylation of BRCA1, GSTM2, TFF1 and Sat2. In forwards (type 1) analysis of nested models, both nulliparity (p= 0.034) and DNA methylation variables (p&amp;lt; 0.001) were retained. In backwards (type 3) analyses, DNA methylation variables (p&amp;lt; 0.001) but not nulliparity (p= 0.261) were retained. As independent domains, DNA methylation variables explained 46% of the ethnic disparity in TAS (p= 0.054), whereas nulliparity explained 38% (p= 0.058), and family history did not explain any of the disparity. Further, the combination of DNA methylation variables and nulliparity together explained 63% of the disparity (p= 0.033). Conclusions: Our findings suggest that DNA methylation of specific genes may influence breast cancer tumor aggressiveness and may help to explain the preponderance of aggressive subtypes diagnosed in ethnic minority women. DNA methylation may represent a promising avenue for biomarker development for early detection for biologically aggressive tumor types in vulnerable populations. These findings require replication and validation in other studies. Citation Format: Keith A. Dookeran, Abeer M. Mahmoud, Matthew Poulin, Liying Yan, Melanie Ehrlich, Jacob K. Kresovich, Virgilia Macias, Andre Kajdacsy-Balla, Elizabeth Wiley, Garth H. Rauscher. Exploring the role of reproductive factors and DNA methylation in ethnic disparities in breast cancer tumor aggressiveness. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B51.

Factors associated with receipt of radiation therapy for rectal cancer.

747 Background: Appropriate treatment for rectal cancer is vital to increasing the likelihood of survival. Disparities in receipt of appropriate radiation treatment have been observed with respect to race/ethnicity and socioeconomic status. We used enriched cancer registry data to identify alternative factors associated with receipt of appropriate radiation therapy for rectal cancer. Methods: Data were obtained from the Florida Cancer Data System and were enriched with detailed treatment information collected from a Centers for Disease Control and Prevention Comparative Effectiveness Research study. Using multivariable regression, we evaluated factors associated with receipt of radiation therapy among rectal cancer cases summary stage II/III. Our sample (n=403) included cases diagnosed in Florida in 2011 who were 18 years and older. Cases clinically staged as 0/1/4 were excluded. Though patients over age 80 years (n=67) and those with stage IIA disease (n=185) may not routinely be prescribed radiation, these cases were included in order to maximize the sample size. Results: Our sample was an average of 64 years-old, more often male (59%), NH White (56%), diagnosed with stage III disease (54%), insured (92%), had received surgical intervention (87%), chemotherapy (68%), or radiation (57%), were in the highest SES quartile (56%), and had one or more comorbid condition (57%). Older age (OR=0.96; 95%CI=0.94-0.97), the presence of more than one comorbidity (0.61; 0.39-0.96), and receipt of surgical intervention (0.44; 0.22-0.90) were predictors of not receiving radiation. Conclusions: Contrary to our hypothesis, socio-demographic factors such as race/ethnicity, insurance status, and socioeconomic status, did not influence the receipt of radiation. Further research is needed, however, to understand why age, comorbidity, and surgery present a barrier to radiation, particularly given that radiotherapy is a well-tolerated modality.

Abstract B34: Race/ethnicity and disparities in mastectomy use in the Breast Cancer Care in Chicago Study

Abstract Purpose: To examine population-based racial/ethnic disparities in mastectomy use among women with breast cancer, and explore potential predictors of this disparity. Methods: Participants were 989 women aged 30-79 years, in a cross-sectional, population-based (NCI-funded, Breast Cancer Care in Chicago) study of newly diagnosed female breast cancer (primary in-situ/invasive) in Chicago, Illinois, from 2005-2008. Participants submitted to an in-person interview of social, health care and attitudinal factors. Medical records were abstracted for tumor characteristics and diagnostic/treatment variables. Multivariable logistic regression models with model-based-standardization were used to estimate risk differences (RDs) with bias-corrected bootstrapped 95% confidence Intervals (CIs). Models incorporated variables pertaining to various domains (socioeconomic disadvantage, cultural beliefs, health care access, and tumor aggression/progression) in order to estimate disparities in mastectomy use, and the extent to which various domains might account for the disparity. Results: There were 397 non-Hispanic (nH) White, 411 nH Black and 181 Hispanic participants. Prevalence proportions for mastectomy use were 40% overall, 34% among nH Whites, 44% among nH Blacks, and 45% among Hispanics. Factors significantly associated with increased mastectomy use overall (p&amp;lt; 0.05) included: younger age at diagnosis; minority ethnicity; lower socioeconomic status (SES); lack of recency of, and adherence to, screening mammography; higher tumor pathologic stage at diagnosis and higher grade; and specific self-reported beliefs/misconceptions regarding breast cancer management (notably: only need to have a lump checked if it gets bigger, mammograms can cause breast cancer, and if a breast tumor is cut open in surgery it will grow faster). In age-adjusted models, compared to nH Whites, mastectomy use was significantly increased by 10 percentage points in both nH Blacks (RD= 0.10, 95% CI: 0.02, 0.17, p= 0.006) and Hispanics (RD= 0.10, 95% CI: 0.01, 0.19, p= 0.029). In models accounting for differences in tumor stage at diagnosis and grade, the apparent disparity was reduced by about half in both nH Blacks (RD= 0.05, 95% CI: -0.03, 0.13) and Hispanics (RD= 0.04, 95% CI: -0.07, 0.13). Additional control for differences in SES, access and utilization, and beliefs/misconceptions eliminated the mastectomy disparity completely for nH Black patients (RD= -0.04, 95% CI: -0.16, 0.09) and further diminished the disparity for Hispanic patients (RD= 0.03, 95% CI: -0.10, 0.16). Conclusions: In this population-based study, compared to nH Whites, significant disparities in mastectomy use for treatment of primary breast cancer were observed in nH Black and Hispanic women. These findings could substantially be explained by differences in tumor aggression/progression. Differences in beliefs, sociodemographics, and access variables may be contributing to disparities in mastectomy either directly or through their influence on stage at diagnosis. Our findings suggest that the best approach to reducing disparities in mastectomy would be to intervene on factors that could reduce disparities in stage at diagnosis. Citation Format: Keith Anthony Dookeran, Abigail Silva, Garth Rauscher. Race/ethnicity and disparities in mastectomy use in the Breast Cancer Care in Chicago Study. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B34. doi:10.1158/1538-7755.DISP13-B34

Abstract P181: Processed food intake is adversely associated with multiple indicators of cardiometabolic health in US adults: Findings from the National Health and Nutrition Examination Surveys (2005-2008)

Introduction: Reducing intake of ingredients characteristic of processed foods is vital to improving ideal cardiovascular dietary behaviors described in the American Heart Association 2020 Strategic Impact Goals. Hypothesis: We sought to develop an indicator of processed food intake and evaluate its hypothesized adverse relationships with biomarkers of cardiometabolic health in a nationally representative sample of US adults. Methods: Data from two 24 hour recalls were examined for US adults (&gt;=18y) in NHANES (2005-2008). An index of processed food intake (PFI) was developed using the mean of the standardized (mean=0, standard deviation=1), energy-adjusted (per 1000 kcal) intakes of refined grains, processed meat, discretionary oils, discretionary solid fat, added sugar and sodium. We evaluated bivariate associations of PFI with demographics (sex, poverty-income ratio, education) and behavioral factors (smoking, nutritional supplement use). Multivariable linear regressions were used to examine associations of PFI with BMI (kg/m2), waist circumference (cm), and biomarkers for cardiometabolic health (total cholesterol, HDL-C, LDL-C, triglycerides, apo-b and c-reactive protein), adjusting for demographic and behavioral covariates. We tested for potential interactions between PFI and weight status, sex, and smoking. Results: PFI was higher in smokers than never smokers (p&lt;.001). PFI was lower for those with at least a college degree than those with less education (p=.004) and for NH White vs. NH Black adults (p=.04). Adjusting for covariates, higher PFI was associated with greater BMI (p&lt;.001) and waist circumference (p&lt;.001), lower HDL-C (p&lt;.001), and higher c-reactive protein (p=.01). Interactions (p&lt;.05) were observed between PFI and sex for predicting BMI, and between PFI and smoking for predicting TC and HDL-C. The magnitude of associations was larger for female vs. male and for current and former smokers vs. non-smokers. No interactions were observed between PFI and weight status. Conclusion: Intake of components characteristic of processed foods is adversely associated with a variety of cardiometabolic biomarkers. Positive associations of PFI with BMI were greater for females vs. males, while associations of PFI with TC and HDL-C were greater for current and former smokers vs. never smokers. The nutritional value of dietary components of PFI is primarily restricted to energy, protein, and sodium, none of which are considered lacking in the diets of US adults. These findings underscore the rationale for encouraging replacing such components with foods that promote cardiovascular health including fruit, vegetables, whole grains, fish, legumes, nuts and seeds. Acknowledgment: This research was supported in part by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.

Assessing racial/ethnic disparities in chemotherapy treatment among breast cancer patients in context of changing treatment guidelines

Conflicting study results with regards to racial/ethnic disparities in chemotherapy use among breast cancer patients may be due to the different sample populations, treatment data sources, and treatment eligibility definitions used. This study examined chemotherapy disparity in the context of changing treatment guidelines and explored factors that may help explain treatment differences observed. The data come from a population-based study that included interview and medical record data (including state cancer registry) from non-Hispanic (nH) White, nH Black, and Hispanic breast cancer patients diagnosed in 2005-2008. Logistic regression using model-based standardization was used to estimate age-adjusted risk differences and multivariate analysis was conducted to identify explanatory factors of the differences. Per the 2005/2006 National Comprehensive Cancer Network (NCCN) guidelines, minority patients appeared more likely than nH White patients to receive a chemotherapy recommendation (0.87 vs 0.75, p = 0.003). When eligibility was determined per the 2007 guidelines, there was no disparity because under these guidelines, nH White patients were more likely than minority patients to have tumors that no longer required chemotherapy. There was evidence that chemotherapy advances for breast cancer patients are implemented in the clinical setting well ahead of NCCN guidelines. Finally, among eligible patients, chemotherapy recommendation was very high and virtually always accepted and received, with no disparities found at these points of clinical care. The findings suggest that an evaluation of guideline-adherent chemotherapy treatment patterns must carefully consider the definition of treatment eligibility, given ongoing changes in treatment guidelines and early uptake of new diagnostic tools and treatments.

Abstract B39: Socioeconomic disadvantage predicts more aggressive estrogen/progesterone receptor negative breast cancer and mediates racial and ethnic disparities in breast cancer aggressiveness.

Abstract Purpose: Racial and ethnic disparities in breast cancer stage at diagnosis are often attributed to social and behavioral factors (e.g., socioeconomic disadvantage, cultural beliefs, health care access and utilization). However, few studies have directly examined their potential role in generating a disparity in the biological aggressiveness of tumors. It is well established that Hispanic and non-Hispanic (nH) Black breast cancer patients are more likely than their non-Hispanic White counterparts to be diagnosed with more aggressive tumors that are negative for estrogen and progesterone receptors (ER/PR negative). Tumor aggressiveness disparities are important because they contribute not only to disparities in stage at diagnosis, but also to disparities in prognosis more generally. We sought to investigate whether the disparity in ER/PR negative disease might be transmitted through the socioeconomic environment. Methods: Data were obtained from a population-based sample of 989 recently diagnosed breast cancer patients (397 nH White, 411 nH Black, 181 Hispanic) recruited as part of the Breast Cancer Care in Chicago study, aged 30-79 who had been diagnosed with a primary in situ or invasive breast cancer. Of these, 742 patients consented to medical record abstraction and had available medical record data on ER/PR status. Patients were defined as ER/PR negative if their tumor lacked both ER and PR receptors. Four measures of socioeconomic disadvantage were defined: individual income and education were reported at interview, and census tract measures of socioeconomic status (concentrated disadvantage and concentrated affluence) were derived. In order to assess potential mediation, in age-adjusted logistic regression models we used the method of Karlson, Holm and Breen (2010) to compare rescaled coefficients for the disparity in ER/PR negative status before and after adding all four socioeconomic disadvantage variables to the model. Results: Compared to nH-Whites, nH-Black and Hispanic patients were more likely to have hormone receptor negative tumors (29% and 20% vs. 12%, respectively, p≤0.001); more likely to have less income and education, and more likely to live in more disadvantaged and less affluent neighborhoods (p&amp;lt;0.001 for all). All four measures of socioeconomic disadvantage were strongly associated with ER/PR negative status (p=0.002 or less). Comparison of rescaled coefficients suggested that at least half of the racial/ethnic disparity in ER/PR negative status could be explained by differences in socioeconomic disadvantage (proportion mediated=51%, p-value for difference in reduced and full models =0.015). Conclusions: A substantial portion of the racial/ethnic disparity in breast tumor aggressiveness may be transmitted through social influences that impact the biology of the developing tumor, predisposing disadvantaged groups to more aggressive breast cancer. Socioeconomic disadvantage could lead to higher levels of chronic stress, as well as to differences in dietary or hormonal and reproductive histories, any of which might contribute to disparities in tumor biology. Citation Format: Garth H. Rauscher, Elizabeth L. Wiley, Richard T. Campbell. Socioeconomic disadvantage predicts more aggressive estrogen/progesterone receptor negative breast cancer and mediates racial and ethnic disparities in breast cancer aggressiveness. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B39.

Ten-year trends in colorectal cancer (CRC) control in Texas.

e12044 Background: The 2015 colorectal cancer control goals are to reduce age-adjusted incidence to 34.8/100,000 and mortality to 12.0/100,000 and to increase the number of 50 year and older undergoing screening per national guidelines up to 75%. Methods: In order to determine progress and trends toward meeting the 2015 objectives we have reviewed Texas Cancer Registry 2000 – 2009 data for incidence, 1999 – 2008 data for mortality, and BRFSS 2002 0 2010 data for screening rates. Results: 91,260 Texans were diagnosed with CRC and 32,840 died from it. Non-Hispanics represent 50.1% of population they account for 66.4% of cases diagnosed with it. Hispanics account for 34.7% of population and contribute to 18.7% of diagnoses. Blacks, 12.1% of population contribute 12.6% of cases. Male and female contribution to diagnosed CRC was 53.5 % and 46.% of cases. Black male incidence rates were highest 74.7 and Hispanic females lowest 32.7/100,000. While NH White and Blacks reduced incidence rates by about 1% per year, Hispanics rate of decrease was 0.5/yr. Gender and race played role in this decrease. Mortality rates declined most in Blacks and NH Whites, while no appreciable improvement was observed in Hispanics. Race and gender mortality rates varied. Black male mortality rates were highest, 36.0 and Hispanic females lowest, 10.5. Frequency of sigmoidoscopy-colonoscopy increased in all 3 racial/ethnic groups, but was lowest among Hispanics. Lack of insurance is big obstacle to progress. Conclusions: Major coordinated screening push will be needed to reach 2015 goals.