non-Latina White Research Articles

Factors associated with the intention to obtain a COVID-19 vaccine among a racially/ethnically diverse sample of women in the USA.

Widespread uptake of the COVID-19 vaccine is critical to halt the pandemic. At present, little is known about factors that will affect vaccine uptake, especially among diverse racial/ethnic communities that have experienced the highest burden of COVID. We administered an online survey to a Qualtrics respondent panel of women ages 27–45 years (N = 396) to assess vaccine intentions and attitudes, and trusted vaccine information sources. 56.8% intended to be vaccinated and 25.5% were unsure. In bivariate analyses, a greater percentage of non-Latina White (NLW) and Chinese women reported that they would be vaccinated, compared with Latina and non-Latina Black (NLB) women (p < 0.001). Those who were uninsured, unemployed and those with lower incomes were less likely to say that they would be vaccinated. In analyses stratified by race/ethnicity, NLB women remained significantly less likely to report that they would be vaccinated compared with NLW women (adjusted odds ratio: 0.47; 95% confidence interval: 0.23, 0.94), controlling for age, marital status, income, education, employment, and insurance status. When analyses were additionally controlled for beliefs in vaccine safety and efficacy, racial/ethnic differences were no longer significant (adjusted odds ratio: 0.64; 95% confidence interval: 0.31, 1.34). Given that NLB women were less likely to report the intention to be vaccinated, targeted efforts will be needed to promote vaccine uptake. It will be critical to emphasize that the vaccine is safe and effective; this message may be best delivered by trusted community members.

Abstract PS7-75: Why do women experience a delay to chemotherapy? A qualitative analysis

Abstract Background: (Neo) Adjuvant chemotherapy decreases the risk of recurrence and improves overall survival among breast cancer patients, however, delays in chemotherapy initiation are associated with adverse outcomes. While the determinants of such delays are not clearly understood, delays are more likely to occur in those: with additional comorbidities, belonging to a low social economic status, without a partner, enrolled in public health insurance, or who identify as Latino/Hispanic or Black/African Americans. The causes of disparities in the delivery of care among breast cancer patients are complex and include interrelated social, economic, cultural, environmental, and health system factors. The goal of Project Start was to conduct a qualitative investigation to assess and identify the multilevel factors contributing to the barriers and facilitators of initiating chemotherapy in the context of breast cancer treatment. Methods: We enrolled English or Spanish speaking women, ≥18 years, diagnosed with primary invasive breast cancer who experienced a ≥ 60 days delay to chemotherapy initiation, whether adjuvant or neoadjuvant (determined from the date of surgery or the date of histopathologic diagnosis). Participants were identified through electronic medical record review and approached in clinic to participate. Semi-structured interviews were conducted in-person or over the phone to explore participants’ perceptions about individual, community, and system level barriers and facilitators contributing to starting chemotherapy. Interviews were audio-recorded, transcribed verbatim, and coded using the Sort and Sift, Think and Shift qualitative approach to identify concepts and topics within and across transcripts. Participants completed brief questionnaires collecting sociodemographic characteristics, health literacy and numeracy, physician trust, and social support to supplement the qualitative data. Quantitative data were summarized using descriptive statistics. Results: Seventeen participants completed semi-structured interviews and questionnaires (mean age 49.9 years; range 30-70 years). Participants identified as: Latina (n=7); Black (n=2); and non-Latina White (n=8). Most completed interviews in English (n=15) and over half had lower educational attainment (i.e., middle school, high school, associate’s degree; n=10). While the interview included questions addressing chemotherapy delays, explicit insight into chemotherapy delay was rare among participants. When discussing their process to chemotherapy, participants described barriers and facilitators at the patient, family, medical, and community levels contributing to their timeline to start chemotherapy. At the patient level, participants discussed their fear and anxiety, the command over their diagnosis, and the importance of playing an active role in treatment. Within the family realm, participants described their family roles (e.g., caregiving, income), treatment costs, and the need for emotional support (e.g., not shutting family members out). Participants sought out and relied heavily on support from their communities (e.g., churches, other patients, survivors). Finally, patients described their reliance on the medical team for information, the trust needed to navigate their treatment process, and the challenge of managing information associated with their treatment. Conclusions: Women expressed the importance of managing individual stressors, family roles and support, medical information, and community support. Activating women to be engaged in the treatment process at multiple levels appeared to facilitate initiating chemotherapy. Multilevel interventions that engage the patient, family, medical team, and community may provide the supports to enable the initiation of timely chemotherapy. Citation Format: Ashley J. Housten, Edna Paredes, Cassandra L. Harris, Mariana Chavez-MacGregor. Why do women experience a delay to chemotherapy? A qualitative analysis [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-75.

Abstract IA11: Cancer disparities and survivorship challenges facing young Latina women (&amp;lt;50 years) on the U.S.-Mexico border

Abstract Disparities in the incidence of specific cancers are prevalent among young Latinas (i.e., &amp;lt; 50 years). Although research focusing exclusively on Latina cancer survivors is limited, mixed-sample research suggests that Latina cancer survivors experience greater distress relative to non-Latina white (NLW) survivors, predisposing them toward poorer cancer outcomes. Young Latina survivors who are parenting school-age children may be at even higher risk of poor cancer survivorship, given research demonstrating that young NLW women experience worse physical and psychological well-being and greater illness intrusiveness compared to older NLW women (i.e., &amp;gt;50 years). This presentation describes the cancer disparities and survivorship challenges encountered by young Latina women living along the Paso del Norte U.S.-Mexico border region. Methodology: Cancer registries were used to identify cancer disparities in the U.S.-Mexico border counties. Elicitation and focus group interviews conducted with diagnosed child-rearing Latina mothers explored their challenges in coping with cancer while parenting school-age children. Findings from the qualitative research informed the cultural adaptation of an evidence-based program, Enhancing Connections, to help Latina cancer survivors and their children cope with cancer. A subsequent study examined the feasibility and short-term efficacy of the culturally adapted Conexiones program. Results: Based on research conducted exclusively with Latina women along the U.S.-Mexico border, this presentation will demonstrate (1) how cancer disparities worsen as the focus shifts from the national level to the U.S.-Mexico border region, (2) the challenges in cancer survivorship along the Paso del Norte U.S.-Mexico border region, and (3) research efforts designed to improve the quality of survivorship among young Hispanic mothers diagnosed with cancer. Citation Format: Rebecca Palacios. Cancer disparities and survivorship challenges facing young Latina women (&amp;lt;50 years) on the U.S.-Mexico border [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA11.

Abstract PR03: Disparities in work status after treatment for breast cancer: A controlled, longitudinal study

Abstract Low-income and minority groups appear to be at increased risk of post-treatment job loss and its sequelae, including financial strain and bankruptcy. However, the drivers of disparities in job loss are not understood. We surveyed employed women aged 18-64 with stage I-III breast cancer who spoke Chinese, English, Korean, or Spanish. Baseline surveys (telephone or online) were administered during adjuvant treatment; follow-up surveys were conducted 4 months after completion of active treatment except endocrine and targeted therapy (i.e., trastuzumab with or without pertuzumab). The primary outcome was post-treatment work status (working full- or part-time vs. any other work status). We used healthy peers to control for disparities in non-cancer unemployment and multivariable analyses to identify predictors of work status in patients. Our sample (n=479) was 28% Latina, 23% black, 21% non-Latina white, 19% Chinese, and 7% Korean; 56% were foreign-born. Overall, 31% had a household income &amp;lt;200% of the federal poverty level; 26% were under-/uninsured; 33% worked in service/manufacturing jobs at baseline, 19% in sales/administrative jobs, and 47% in management/profession jobs. Most underwent chemotherapy (85%). Four months after treatment completion, 71% of the survivors reported that they were working. The proportion of working patients versus controls was 0.69 for Chinese, 0.73 for Korean, 0.75 for Latinas, 0.78 for blacks, and 0.98 for non-Latina whites. Independent predictors of not working among patients were receipt of chemotherapy (OR 2.20; 95% CI 1.04-4.64); older age (OR 1.06; 95% CI 1.03-1.09); black (OR 2.37; 95% CI 1.01-5.56), Chinese (OR 2.91; 95% CI 1.20-7.05), or Korean (OR 3.68; 95% CI 1.24-10.98) race (vs. non-Latina white); household income &amp;lt;200% of poverty (OR 3.00; 95% CI 1.68-5.35); and service/manufacturing job-type at baseline (OR 2.41; 95% 1.30-4.44, vs. manager/professional). Having an employer who was not accommodating also predicted not working post-treatment (OR 3.05; 95% CI 1,88-4.95). Breast cancer exerts a disparate negative impact on work status in minority and low-income women, which persists after controlling for disparities in background unemployment. Women who work in service or manufacturing jobs are at greater risk. Furthermore, receipt of chemotherapy is a predictor of job loss, even after controlling for race and income. However, employer accommodations appear to abrogate the negative impact of chemotherapy on work status. Interventions are needed to promote job retention in minority and low-income women, particularly those who lack work accommodations or are in high-risk jobs. This abstract is also being presented as Poster A100. Citation Format: Victoria S. Blinder, Sujata Patil, Carolyn Eberle, Gabriel Jung, Lewis J. Kampel, Caroline Hwang, Ting Bao, Mark E. Robson, Manmeet Malik, Francesca Gany. Disparities in work status after treatment for breast cancer: A controlled, longitudinal study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR03.

Plasma glucocorticogenic activity, race/ethnicity and alcohol intake among San Francisco Bay Area women.

Racial and ethnic minorities are at higher risk for a variety of diseases. While sociodemographic and lifestyle factors contribute to racial/ethnic health disparities, the biological processes underlying these associations remain poorly understood. Stress and its biological consequences through the glucocorticoid receptor (GR) have been hypothesized to mediate adverse disease outcomes. In fasting morning samples of 503 control women from the San Francisco Bay Area Breast Cancer Study, we used a sensitive Chemical-Activated LUciferase gene eXpression (CALUX) assay to examine the association of sociodemographic and lifestyle factors with plasma glucocorticogenic (G) activity in three racial/ethnic groups. The G activity is a sensitive measure that reflects biological activity of total plasma glucocorticoids including cortisol and glucocorticoid-like compounds. Associations between G activity and sociodemographic and lifestyle factors were examined using multivariable linear regression models. Latina and non-Latina Black (NLB) women had 9% (P = 0.053) and 14% (P = 0.008) lower morning G activity than non-Latina White (NLW) women, respectively. Additionally, we replicated a previously reported association between G activity and alcohol intake (women who drank >10gms had 19% higher G activity than non-drinkers, P = 0.004) in Latina and NLB women. Further research should assess the association between G activity and health outcomes in a prospective cohort so as to characterize the relationship between total plasma G activity in pre-disease state and disease outcomes across different racial/ethnic populations.

Abstract C098: Racial disparity in the prevalence of BCL-2 expression and associations with breast cancer survival in the Breast Cancer Care in Chicago study

Abstract Background: BCL-2 is an antiapoptotic protein that regulates apoptosis and has been associated with poor prognosis for many cancer sites. Despite a function that encourages tumorigenesis, increased BCL-2 expression has been associated with improved clinical outcomes in ER+ breast cancers, with mixed results observed for ER/PR- cancers. BCL-2 has been hypothesized to be an indicator of intact and fully functioning hormone receptor pathways and has also been hypothesized to facilitate cell death after treatment through mitochondrial priming. BCL-2 expression correlates strongly with hormone receptor expression; therefore, its association with better prognosis may be due to the strong effect ER/PR status has on survival, or due to its own biologic mechanism. To date, no studies have been conducted on racial differences in BCL-2 expression. We characterized racial/ethnic differences in BCL-2 expression and the association of BCL-2 expression with breast cancer specific survival among participants in the Breast Cancer Care in Chicago Study (BCCC). Methods: The BCCC was a cross-sectional study of 989 recently diagnosed non-Latina (nL) White, nL Black and Latina breast cancer patients diagnosed with a first primary breast cancer aged 30-79 in Chicago from 2005-2008. Tumor tissue was available for BCL-2 immunohistochemical staining for 264 patients. BCL-2 staining scores of 0 were classified as negative and all positive scores (1D, 1H, 2D, 2H, and 3) were classified as positive. Cox proportional hazards models were conducted to estimate the association of BCL-2 expression with breast cancer-specific death. Results: Roughly three-fourths of tumors (77%) stained positive for BCL. The prevalence of positive BCL staining varied by race/ethnicity (p=0.007), being highest for nL Whites (87%) and lowest for nL Blacks (68%); variability in BCL staining appeared to be limited to ER/PR-negative tumors (N=53), for which prevalence of positive BCL staining appeared to be much higher for nL whites than for minority patients (44% vs. 16%, p=0.054). BCL-2 expression was associated with a strong protective effect on BC survival in age and race-adjusted models (HR=0.40, 95% CI: 0.19, 0.84) and BCL-2 expression remained strongly positively associated with protection from breast cancer death with additional adjustment for ER/PR status (HR=0.33, 95% CI: 0.12, 0.89). Within subgroups defined by ER/PR status, BCL2 expression was qualitatively associated with better survival for both ER/PR positive and ER/PR negative subtypes, although sample size was insufficient to conduct a formal stratified analysis. Conclusions: BCL-2 appears to be an independent predictor of improved prognosis for breast cancer even after controlling for ER/PR status. The apparently higher prevalence of BCL2 expression for nL White vs. nL Black patients may provide etiologic clues regarding disparities in BC survival. Citation Format: Jibril M. Alim, Kent Hoskins, Abeer M. Mahmoud, Virgilia Macias, Andre Kadjascy-Balla, Garth H. Rauscher. Racial disparity in the prevalence of BCL-2 expression and associations with breast cancer survival in the Breast Cancer Care in Chicago study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C098.

Abstract A021: Multilevel approaches to breast cancer disparities in the United States: An integrative review

Abstract Background: Breast cancer is the most common cancer diagnosed among women and the leading cause of cancer death among women worldwide. Since 1990, breast cancer incidence has remained stable and mortality has decreased 2% per year in the U.S. However, ethnic minority and socioeconomically disadvantaged women have not experienced these gains in breast cancer outcomes. Understanding shared factors at different levels across disparities may be helpful for improving the well-being of multiple marginalized populations in the U.S. as well as potentially in other countries. Methods: We conducted an integrative, qualitative review of the literature from 2008-2018 to describe the burden of breast cancer and multilevel interventions to address disparities among three unique, underserved groups in the U.S. We searched Google Scholar and PubMed as well as county, state, and national public health databases and summarized the relevant literature. Results: African Americans in Chicago, non-Latina White women in Appalachia, and Latinas in the Yakima Valley of Washington State represent three subgroups in the U.S. who suffer disproportionately from breast cancer, including late-stage diagnoses, aggressive subtypes, and poor survival. These characteristics are influenced by biologic, individual, social, and societal factors including gene expression, fear and fatalism, poverty and neighborhood, and access to care. Multilevel interventions across the three geographic areas have included patient navigation and community health workers to bolster education and enhance health care access, support groups, and political advocacy. Conclusion: African Americans in Chicago, non-Latina White women in Appalachia, and Latinas in the Yakima Valley of Washington State share disproportionate exposure to a myriad of social determinants of health that contribute to lower rates of breast cancer detection and treatment as well as poorer survival. Concerted efforts that address these factors are needed to ensure that all women have access to equitable screening, detection, treatment, and survivorship resources. Citation Format: Sarah D. Hohl, Beti Thompson, Yamile Molina, Electra D. Paskett. Multilevel approaches to breast cancer disparities in the United States: An integrative review [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A021.

Abstract PR17: The mediating role of unmet social support needs on the racial/ethnic disparity in psychosocial stress among breast cancer patients

Abstract Background: A breast cancer diagnosis is a stressful life event that can reduce quality of life and put a patient at increased risk for additional health problems and may also affect survivorship more generally. Greater levels of psychosocial stress (PSS) have been reported among non-Latina (nL) Black and Latina women when compared to nL White patients, and the absence of adequate social support among cancer patients has been associated with greater psychosocial stress. The goal of these analyses was to examine whether there existed a racial/ethnic disparity in three validated measures of psychosocial stress and how racial disparities are explained by distal mechanisms (i.e., SES) and proximal mechanisms (i.e., unmet social support needs) among recently diagnosed urban breast cancer patients in the Breast Cancer Care in Chicago (BCCC) study (2005-2008). Methods: The BCCC was a cross-sectional study of 989 recently diagnosed breast cancer patients, including 397 non-Latina White (white), 411 non-Latina Black (black), and 181 Latina patients diagnosed with a first primary breast cancer (in situ or invasive) aged 30-79. Income, education and tract level disadvantage and affluence were summed to create a standardized socioeconomic status (SES) score. Low SES was defined as less than one standard deviation below the sample mean. Three measures of PSS were defined based on the Cohen perceived stress subscale (inter-item reliability or alpha = 0.74), UCLA felt loneliness scale (alpha=0.79), and the Cockburn psychological consequences scale (alpha=0.93). High PSS was defined as &amp;gt;1 standard deviation above the mean for each. Unmet emotional, spiritual, informational, financial, and practical support were based on questions regarding support needed and received. We conducted structural equations models in M-Plus in order to disentangle the separate mediating roles of SES and unmet social support needs on disparities in PSS. Results: Black and Latina patients reported greater levels of loneliness (32% vs. 23% vs. 16%, p&amp;lt;0.001), stress (23% and 21% vs. 12%, p=0.001) and psychological consequences (24% and 23% vs. 12%, p&amp;lt;0.001) compared to white patients. Black and Latina patients also reported greater levels of unmet emotional, informational, financial and practical need (p=0.001 for all). In mediation models, all of the disparity in the three PSS outcomes could be explained by SES, with a substantial portion of the mediating influence of SES being further transmitted by unmet financial and practical support needs. Neither tumor nor treatment characteristics appeared to mediate the disparity in PSS. Conclusions: A substantial disparity in distress among breast cancer patients exists and underlying inequities in SES appear to be a “root” cause of the PSS disparity, as opposed to being driven by tumor and treatment differences. Results suggest that providing equitable financial (e.g., health insurance coverage) and practical (e.g., navigation) resources could narrow the racial/ethnic gap in PSS. This abstract is also being presented as Poster C094. Citation Format: Carola T. Sánchez Díaz, Garth H. Rauscher, Yamile Molina. The mediating role of unmet social support needs on the racial/ethnic disparity in psychosocial stress among breast cancer patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR17.

Estrogenic activity, race/ethnicity, and Indigenous American ancestry among San Francisco Bay Area women.

Estrogens play a significant role in breast cancer development and are not only produced endogenously, but are also mimicked by estrogen-like compounds from environmental exposures. We evaluated associations between estrogenic (E) activity, demographic factors and breast cancer risk factors in Non-Latina Black (NLB), Non-Latina White (NLW), and Latina women. We examined the association between E activity and Indigenous American (IA) ancestry in Latina women. Total E activity was measured with a bioassay in plasma samples of 503 women who served as controls in the San Francisco Bay Area Breast Cancer Study. In the univariate model that included all women with race/ethnicity as the independent predictor, Latinas had 13% lower E activity (p = 0.239) and NLBs had 35% higher activity (p = 0.04) compared to NLWs. In the multivariable model that adjusted for demographic factors, Latinas continued to show lower E activity levels (26%, p = 0.026), but the difference between NLBs and NLWs was no longer statistically significant (p = 0.431). An inverse association was observed between E activity and IA ancestry among Latina women (50% lower in 0% vs. 100% European ancestry, p = 0.027) consistent with our previously reported association between IA ancestry and breast cancer risk. These findings suggest that endogenous estrogens and exogenous estrogen-like compounds that act on the estrogen receptor and modulate E activity may partially explain racial/ethnic differences in breast cancer risk.

County of Residence and Screening Practices among Latinas and Non-Latina Whites in Two Rural Communities

Latinas are less likely than non-Latina Whites (NLW) to utilize mammographic screening and are more likely to be diagnosed with late-stage breast cancer. Here, we examine the effects of county-level factors on guideline-concordant breast-cancer screening behaviors in Latinas and NLWs. Latinas (N=108) and NLW women (N=132) aged >40 years, residing in two adjacent rural, medically underserved counties in eastern Washington State, completed a baseline questionnaire on mammography utilization and demographics. Differences in socioeconomic variables and knowledge of screening practices were examined by ethnicity and county of residence. Predictors of having had a mammogram within the past two years were analyzed using multivariate logistic regression. Ethnicity was not associated with having a guideline-concordant mammogram; however, age (odds ratio [OR]=1.04, 95%CI:1.01-1.08); having >12 years of education (OR=2.09, 95%CI:1.16-3.79); having a regular clinic for health care (OR=2.22, 95%CI:1.05-4.70); having had a prior clinical breast exam (OR=5.07, 95%CI:1.71-15.02), and county of residence (OR=2.27, 95%CI:1.18-4.37) were all associated with having had a guideline-concordant mammogram. County of residence and having had a prior CBE were strong predictors of screening utilization. Community-level factors in medically underserved areas may influence screening patterns.

Father's Lifetime Socioeconomic Status, Small for Gestational Age Infants, and Infant Mortality: A Population-Based Study.

To ascertain the association between father's lifetime socioeconomic status (SES) and rates of small for gestational age (SGA, defined as weight for gestational age <10th percentile) and infant mortality (defined as <365 days). The study sample was limited to the singleton births of African American (n=8,331), non-Latina White (n=18,200), and Latina (n=2,637) women. Stratified and multilevel, multivariable logistic regression analyses were conducted on the Illinois transgenerational dataset of infants (1989-1991) and their Chicago-born parents (1956-1976) with appended US census income data (n=29,168). The median family income of father's census tract residence during childhood and parenthood were used to assess lifetime SES. Births (n=8,113) to fathers with a lifetime low SES had a SGA rate of 13.3% compared with 6.6% for those (n=10,329) born to fathers with a lifetime high SES, RR = 1.97 (1.79, 2.17). The infant mortality rate of births to fathers with a lifetime low SES exceeded that of infant mortality rate of births to fathers with a lifetime high SES: 13/1,000 vs 5/1,000, respectively; RR = 2.71 (1.94, 3.77). The adjusted (controlling for mother's age, education, marital status, and race/ethnicity) OR of SGA for fathers with childhood, parenthood, and lifetime low (vs high) SES were 1.15 (1.01, 1.31), 1.13 (1.02, 1.26), and 1.19 (1.05, 1.34), respectively. The adjusted OR of infant mortality for births to fathers with childhood, parenthood, and lifetime low (vs high) SES were 1.14 (.78, 1.67), 1.40 (.90, 2.18), and 1.31 (.90, 1.92), respectively. Low paternal socioeconomic status is a previously unrecognized determinant of SGA birth regardless of mother's demographic status.

Breast cancer subtype and survival among Indigenous American women in Peru

Latina women in the U.S. have relatively low breast cancer incidence compared to Non-Latina White (NLW) or African American women but are more likely to be diagnosed with the more aggressive “triple negative” breast cancer (TNBC). Latinos in the U.S. are a heterogeneous group originating from different countries with different cultural and ancestral backgrounds. Little is known about the distribution of tumor subtypes in Latin American regions. Clinical records of 303 female Peruvian patients, from the Peruvian National Cancer Institute, were analyzed. Participants were diagnosed with invasive breast cancer between 2010 and 2015 and were identified as residing in either the Selva or Sierra region. We used Fisher’s exact test for proportions and multivariable Cox Proportional Hazards Models to compare overall survival between regions. Women from the Selva region were more likely to be diagnosed with TNBC than women from the Sierra region (31% vs. 14%, p = 0.01). In the unadjusted Cox model, the hazard of mortality was 1.7 times higher in women from the Selva than the Sierra (p = 0.025); this survival difference appeared to be largely explained by differences in the prevalence of TNBC. Our results suggest that the distribution of breast cancer subtypes differs between highly Indigenous American women from two regions of Peru. Disentangling the factors that contribute to this difference will add valuable information to better target prevention and treatment efforts in Peru and improve our understanding of TNBC among all women. This study demonstrates the need for larger datasets of Latin American patients to address differences between Latino subpopulations and optimize targeted prevention and treatment.

Breast Cancer Disparities Among Women in Underserved Communities in the USA.

Breast cancer disparities that exist between high-income countries (HIC) and low- and middle-income countries (LMICs) are also reflected within population subgroups throughout the United States (US). Here we examine three case studies of US populations "left behind" in breast cancer outcomes/equity. African Americans in Chicago, non-Latina White women in Appalachia, and Latinas in the Yakima Valley of Washington State all experience a myriad of factors that contribute to lower rates of breast cancer detection and appropriate treatment as well as poorer survival. These factors, related to the social determinants of health, including geographic isolation, lack of availability of care, and personal constraints, can be addressed with interventions at multiple levels. Although HICs have reduced mortality of breast cancer compared to LMICs, there remain inequities in the US healthcare system. Concerted efforts are needed to ensure that all women have access to equitable screening, detection, treatment, and survivorship resources.

Abstract A15: Challenges and successes in delivering a cancer survivorship support program among rural Latinas

Abstract Introduction: Rates of cancer survivorship are increasing for most cancers. However, Latina cancer survivors tend to experience lower quality of life and higher levels of distress following cancer compared to non-Latina Whites (NLW). While social support resources can alleviate the negative psychosocial impact of cancer sequelae, there are often limited resource availability and uptake among Latina cancer survivors. Objective: This presentation will include descriptions of the qualitative and quantitative study design, recruitment strategies, cultural adaptations of the intervention, challenges, and successes in data collection and intervention delivery. Methods: This study included a qualitative needs assessment of Latina survivors of breast and gynecologic cancers living in a rural region of Washington State, development of a 10-week Spanish-language survivor-support program, and a randomized control trial (RCT) whose effectiveness was evaluated with psychosocial and biologic outcomes. Intervention delivery and qualitative and quantitative data collection were conducted by promotores (lay health workers). Conclusion: Challenges and successes of conducting the qualitative assessment, delivering the intervention, and data collection will be discussed. Future studies can build on the methodologic insight gained from this project. Citation Format: Rachel M. Ceballos. Challenges and successes in delivering a cancer survivorship support program among rural Latinas [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A15.

Abstract B25: Empowering Latinas to obtain breast cancer screenings: Comparing intervention effects, part 1

Abstract Purpose: Latinas suffer disproportionately from breast cancer relative to non-Latina Whites (NLWs), partially due to lower guideline-concordant screening. In response, a significant body of work first sought to characterize disparities and associated determinants. Second, multiple approaches were developed to address this disparity, including community health worker (CHW)-driven education to the target population and empowerment interventions, wherein CHWs train a subset of the population to disseminate education to other members of the target population and mobilize in the context of health. The next logical step is to compare the relative effectiveness of interventions for future large-scaled implementation. Objective: We report emerging evidence from an ongoing, quasi-experimental trial that compares the effects of education and empowerment approaches on Latinas who are nonadherent to US Preventive Services Task Force breast cancer screening guidelines. Methods: The setting for this trial is in two Latino, lower-income communities in Chicago (Pilsen/Little Village, East Side/Chicago). Women are recruited via two community-based organizations (The Resurrection Project, Centro Comunitario Juan Diego) and snowball sampling. Eligibility criteria include: 1) age of 50-74; 2) lack of screening within past 2 years; 3) no previous breast cancer diagnosis; and 4) no prior health volunteerism experience. After screening and providing informed consent, women are assigned to a cohort (6-10 sessions) and participate in a three-week intervention (three 2-hour sessions). The education intervention is administered in East Side/Chicago and the empowerment intervention is administered in Pilsen/South Chicago to avoid contamination effects. The education intervention consists of a session focused on breast cancer and methods of early detection, a session focused on diet as a method of prevention, and a session focused on physical activity as a method of prevention. The empowerment intervention consists of a session focused on breast cancer and methods of early detection, a session focused on one-on-one conversations with family and friends about breast cancer, and a session focused on health-related volunteerism. For women who wish to obtain mammography (from either arm), study team provides navigation to free/low-cost services and tracks participants throughout the continuum of care. Three questionnaires are given: baseline (before Session #1), postintervention (after Session #3), and a follow-up (6 months after Session #3). Receipt of screening is confirmed by study and medical records for women who have completed HIPAA forms. Participants are compensated $80 for their participation. As well, during and after the intervention, participants may refer other nonadherent Latinas to the study for a small incentive ($15). Results: Our current sample is 37 women (20 education; 17 empowerment). The average age was 61.62 years old (SD = 6.02). Approximately 89% of participants were born in Mexico and approximately 81% had less than a high school education. The median annual household income was &amp;lt;$15,000. A greater proportion of empowerment participants have scheduled a mammogram relative to education participants (20% vs. 76%; p=.001). Relative to education participants, a greater proportion of empowerment participants have discussed breast cancer with other nonadherent Latinas and referred them to the study (5% vs 33%; p = .05). Discussion: Preliminary findings suggest the empowerment approach may be more effective in promoting breast cancer screening among nonadherent Latinas and disseminating information to their peers. Limitations concern generalizability due to a non-probability based sample and limited ability for causal inferences due to a lack of randomization. Next steps include comparing receipt of screening and characterizing diffusion of information throughout participants' social networks. Citation Format: Yamile Molina, Liliana G. San Miguel, Lizeth Tamayo, Sylvia Gonzalez, Rosa de la Torre, Kryztal Peña, Araceli Lucio, Oliva Hernandez, Juanita Arroyo, Maria C. Medina, Nora Coronado. Empowering Latinas to obtain breast cancer screenings: Comparing intervention effects, part 1 [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B25.

Perceptions of Family Problems and Pessimism Among Latina and Non-Latina White Mothers Raising Children with Autism Spectrum Disorder.

To address the limited research on diverse families of children with ASD, we examined the impact of ASD on 46 Latina and 56 non-Latina White mothers from a resiliency perspective. We explored perceptions of family problems, optimism and pessimism among mothers of child with ASD between 1 and 22years old. Mothers were recruited through support groups and listservs. Univariate and multivariate analyses were conducted. Results indicated fewer perceived family problems and less pessimism about the child's future among Latina mothers. We found maternal optimism and family cohesion were associated with perceived family problems and mother's pessimism about the child's future. Understanding the impact of ASD among diverse families will aid in developing appropriate services that enhances family strengths.

Women With Breast Cancer Who Work For Accommodating Employers More Likely To Retain Jobs After Treatment.

Breast cancer affects one in eight women across the United States, and low-income minority survivors of breast cancer are at increased risk of job loss, compared to higher-income white survivors. Employer accommodations, such as schedule flexibility, have been associated with job retention in higher-income whites, but the role of such accommodations in job retention among low-income minorities is not well understood. We conducted a longitudinal study of 267 employed women ages18-64 who were undergoing treatment for early-stage breast cancer and spoke English, Chinese, Korean, or Spanish. We categorized patients by income level and by race/ethnicity. The category with the lowest job retention after treatment was low-income women (57percent). Job retention varied widely by race/ethnicity, ranging from 68percent among Chinese women to 98percent among non-Latina whites. Women who had accommodating employers were more than twice as likely to retain their jobs as those without accommodating employers. Low-income women were less likely than higher-income women to have accommodating employers, however. More uniform implementation of accommodations across low- and high-paying jobs could reduce disparities in employment outcomes among workers with a cancer diagnosis. Additional research is needed to better understand the barriers that employers, particularly those with low-income workers, may face in providing accommodations.

Ethnic differences in social support after initial receipt of an abnormal mammogram.

We examine access to and type of social support after initial receipt of an abnormal mammogram across non-Latina White (NLW), African American, and Latina women. This cross-sectional study used a mixed method design, with quantitative and qualitative measures. Women were recruited through 2 community advocates and 3 breast-health-related care organizations. With regard to access, African American women were less likely to access social support relative to NLW counterparts. Similar nonsignificant differences were found for Latinas. Women did not discuss results with family and friends to avoid burdening social networks and negative reactions. Networks' geographic constraints and medical mistrust influenced Latina and African American women's decisions to discuss results. With regard to type of social support, women reported emotional support across ethnicity. Latina and African American women reported more instrumental support, whereas NLW women reported more informational support in the context of their well-being. There are shared and culturally unique aspects of women's experiences with social support after initially receiving an abnormal mammogram. Latina and African American women may particularly benefit from informational support from health care professionals. Communitywide efforts to mitigate mistrust and encourage active communication about cancer may improve ethnic disparities in emotional well-being and diagnostic resolution during initial receipt of an abnormal mammogram. (PsycINFO Database Record

Abstract C31: Exploring disparities in sentinel lymph node biopsy within the Breast Cancer Care in Chicago study

Abstract Background: Lymph node biopsy is a critical component of a diagnostic work-up for patients with invasive breast cancer and is necessary for evaluating the extent and stage of disease so that appropriate treatment can be recommended. The standard procedure prior to the advent of sentinel lymph node biopsy (SLNB) procedures was axillary lymph node dissection (ALND), which is associated with debilitating side effects such as lymphedema. SLNB diffused into practice during the early 2000s and is associated with fewer side effects; for this reason, SLNB has become the standard of care for women diagnosed with invasive breast cancer without clinically palpable lymph node involvement. Using data from the Breast Cancer Care in Chicago study (BCCC), we investigated racial/ethnic disparities in the receipt of SLNB vs. ALND and whether certain tumor, patient, or facility characteristics might help to explain the likelihood of receiving a SLNB. Methods: A total of 989 female patients newly diagnosed with breast cancer were recruited and interviewed for the study. Eligible patients were female, resided in Chicago, had a first primary in situ or invasive breast cancer; were diagnosed between 2005 and 2008 between the ages of 30 and 79 at diagnosis; and self-identified as either non-Latina (nL) White, nL Black or Latina. Of these, 74% (N=731) consented to medical record abstraction and had complete information on receipt of either ALND or SLNB. The racial/ethnic disparity in receipt of SLNB was estimated as a prevalence difference (PD) using logistic regression with marginal based standardization. Mediation analyses were conducted using the method of rescaled coefficients (Karlson, Holm, and Breen). All models were adjusted for age at diagnosis. Results: Roughly half of patients (57%) received a SLNB; nL White women were more likely to receive a SLNB as compared to nL Black and Hispanic women (67% vs 50% and 50%; p=&amp;lt;.001). The prevalence of SNLB was 33%, 75%, 70%, 38% and 20% for stage 0, 1, 2, 3 and 4 breast cancer (p&amp;lt;0.0001) and was higher for ER/PR positive versus negative tumors (p&amp;lt;0.0001) and decreased with increasing tumor grade (p=0.007). SLNB did not vary appreciably for patients who were uninsured, publicly insured or privately insured and SLNB was more common for patients diagnosed at facilities with accreditations from the National Accreditation Program for Breast Centers (NAPBC) and the Commission on Cancer (COC) and less common for patients diagnosed at disproportionate share facilities (p&amp;lt;0.05 for all). After adjusting for age, stage at diagnosis, and tumor characteristics, the disparity in receipt of SLNB was 24 percentage points. In mediation analysis, facility accreditation and disproportionate share status explained 43% of the disparity (p=0.030). Conclusion: During the mid to late 2000s when the practice of SLNB as an alternative to ALND was reaching about half of eligible patients in Chicago, ethnic minority patients were less likely than their nL White counterparts to receive SLNB. Facility accreditation explained a substantial portion of this disparity. Better access and opportunities to go to highly accredited facilities may decrease this disparity. Citation Format: Bethliz Irizarry, Keith Dookeran, Garth Rauscher. Exploring disparities in sentinel lymph node biopsy within the Breast Cancer Care in Chicago study. [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 C31.

Psychological Outcomes After a False Positive Mammogram: Preliminary Evidence for Ethnic Differences Across Time.

Adverse psychological consequences of screening mammography are well-documented for women who receive a false positive result. However, little is known about ethnic differences. To address this gap, we examine distress associated with an abnormal mammogram (results-related distress) and perceived lifetime risk of breast cancer (perceived risk) among Latinas and non-Latina White (NLW) women 3months after receipt of a false positive result. A sample of 28 Latina and 27 NLW women who received an initial abnormal mammogram result and later, a definitive non-cancer diagnosis were recruited for this descriptive, longitudinal study. Women were interviewed twice: within 30days and 3months after a false positive result. Questionnaires included standard sociodemographic questions, the Impact of Events Scale-Revised, and two perceived breast cancer risk items. All participants experienced decreased distress 3months after the initial results. Latinas experienced higher levels of distress, F(1,45)=4.58, p=0.04, and had a significant increase in perceived breast cancer risk over time, F(1,45)=3.99, p=0.05. Larger population-based studies are necessary to confirm ethnic differences in mental health consequences of false positive results. Given cultural emphases concerning respect for authority figures, healthcare professionals may be particularly helpful in working with Latinas to mitigate distress and clarify accurate perceptions of breast cancer risk through evidence-based practice.