Outcomes For African American Women Research Articles

Beyond Birth Work: Addressing Social Determinants of Health With Community Perinatal Support Doulas.

Adverse maternal and infant health outcomes among African Americans are increasingly recognized as indicators of a critical public health crisis in the United States. Research has found that stress is related to structural racism and the social determinants of health (SDOH) that cause avoidable, unfair inequities in resources, education, power, and opportunities across ethnic groups. This paper describes the SDOH needs and experiences of pregnant Black women from the perspective of doulas and Birthing Beautiful Communities (BBC) clients. The design was a qualitative description, using data collected over time (2017-2018, 2020-2021, and 2023). This study took place in Cleveland and Akron, Ohio and the sample included 58 clients, 26 doulas, and 2 resource intake specialist assistants (RISAs). Qualitative data included individual client interviews, three doula focus groups, and one interview with two BBC RISAs. Three coders used content analysis to deductively identify SDOHs and calculate the number of interviews that contained information about specific SDOHs. Although the sample reported issues with all SDOH, particular ones caused a cascade of SDOH effects. Transportation issues, for example, impeded women from being able to make it to work, doctor's appointments, and to purchase essential baby items (e.g., food, infant supplies). An inability to work-whether because of transportation challenges or pregnancy-related health complications-led to unstable housing and an inability to deal with transportation challenges. Many clients mentioned that housing was a major issue, with many clients experiencing housing instability. Implications include ensuring SDOH information is collected from a trusted source who can advocate and ensure access to a wide range of local resources, ensuring policies protect pregnant women from experiencing a cascade of SDOH that may contribute to continuing health disparate infant and maternal health outcomes in African American women.

Life Stressors and Mental Well-Being: Experiences of African American Women Navigating Perinatal Loss and Pregnancy Subsequent to Loss

Historically, African American women have faced racial disparities in perinatal and neonatal mortality rates. There is limited research on the sustained stress and amplified emotional and psychological strain that African American women undergo during perinatal loss. Studies are even scarcer concerning the heightened emotional and psychological difficulties during pregnancies subsequent to loss. Semi-structured interviews were carried out with 22 African American women who had experienced perinatal loss and were either pregnant or had given birth after their loss. Descriptive coding and thematic analysis revealed three main themes: life stressors, mental health complexities, and coping strategies. The results showed a potential pattern of increased risk of adverse perinatal outcomes due to social determinants, including income, access to healthcare, and housing. Furthermore, participants described experiences of systemic racism that appeared to exacerbate psychological distress after perinatal loss, often manifesting as depression and anxiety. The study reveals the urgent need to dismantle systemic racism in maternity and mental healthcare to boost perinatal outcomes for African American women. It provides essential insights for developing effective support programs.

Abstract P3-14-12: Distinct and targetable molecular features of breast cancer in African American women

Abstract Introduction: Despite having a lower incidence of breast cancer, African American (AA) women suffer disproportionately worse outcomes; with more aggressive cancer and higher mortality rates, as well as higher incidence of triple negative breast cancer (TNBC). The cause of these disparities is unclear, but may be driven by different biologic and molecular features. Information about targetable molecular profiles for breast cancer in AAs is limited, and may not be representative of racial minorities. A better understanding of actionable targets is needed to improve treatment and outcomes of breast cancer for AA women. Materials and methods: This study utilized molecular data from three TCGA Breast Invasive Carcinoma studies (Cell 2015, Firehose Legacy, and PanCancer Atlas) on CBioPortal. Data was stratified by C/White and AA/Black to identify the most commonly affected genes, the most significantly differentially affected genes between the two populations, and 35 actionable genes. Genes were compared between racial subgroups (455 AA cases, 2103 C cases) for analysis of mutation types (point mutations, splice site, deletions, and amplifications) mutation load, overall survival, and mRNA expression vs. copy number variation (CNV). Data was assessed for differences, with p-value set at <0.05, and OncoPrints generated using tools in CBioPortal. Results: 2282 genes were differentially altered between white and black subgroups (P<0.05). Of the most commonly altered genes, only three were significantly different between AA and C: TP53, PIK3CA, and CSMD1 (p<0.001). PIK3CA missense mutations were more common in C (36.28% (C) vs 22.47% in AA). TP53 missense mutations were more prevalent in AA (40.09% vs. 28.58% in C). CSMD1 deletions, a tumor suppressor gene, were more prevalent in AA (19.78%) vs. 10.79% in C. We identified a cluster of genes at 8q24.21 (MYC, CASC8, POU51B, CCAT2) showing frequent co amplification in AA and C. For TNBC cases (18 AA cases, 52 C cases), the alteration rate of following genes was significantly between AA and C groups USF3 (27.8% in AA, 0% in C); PIK3C2B (27.8% AA, 1.9% C); SLC41A1 (27.8% AA, 3.85% C); PDHX, PRICKLE4, TOMM6 (all 27.8% AA, 5.8% C); and EHF and PRPF4B (both 27.8% AA, 7.7% C). Some of the genes with highest frequency in both groups include: TP53 (83.3% in AA, 78.9% C); PVT1 (38.9% AA, 46.2% C); CASC8, MYC, and POU51B (33.3% AA, 46.2% C). For actionable targets, PIK3CA, RAD51B, MSH6, KRAS, and NTRK3 were significantly different between AA and C (p<0.05). Of note, FGFR1 and NTRK1 amplifications were common in both AA and C subgroups, 17% AA/13% C and 15% AA/11% C respectively, and are potential targets for emerging therapeutics. Of note, TTN missense mutations were common in both subgroups (15.93% in AA and 18.11% in C), and may be an important marker of tumor mutational burden and predictive for immunotherapy responsiveness. ERBB2 was also commonly amplified in both groups (14% in AA and 12% in C). Survival analysis showed significantly worse outcomes for AA women with PIK3CA alterations (50% disease free for PIK3CA vs. 75% for unaltered at 75 months), while C women with PIK3CA alterations had improved outcomes (85% disease free for PIK3CA vs. 80% for unaltered at 75 months). Conclusion: Significant and diverse molecular differences exist in breast cancer between AA vs. C subgroups. Many of these molecular alterations are linked to specific treatment opportunities. The results indicate that comprehensive molecular profiling may have a major role in assessing treatments for patients with breast cancer, and that AA women may develop breast tumors with unique molecular features requiring novel treatment strategies. Citation Format: Genevra Magliocco, Roy Khalife, Anthony Magliocco. Distinct and targetable molecular features of breast cancer in African American women [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 P3-14-12.

Abstract PO-099: African American women with breast cancer have unique molecular features and reduced clinical trial enrollment

Abstract Introduction: African American (AA) women have a lower incidence of breast cancer (BC), however experience higher rates of more aggressive subtypes, mortality, and worse outcomes compared to Caucasian (C) women. Data also points to disparities among treatment access and response in AA women. Most existing genetic research and clinical trials have been conducted with majority C women, thus our existing knowledge about molecular profiles and effective treatments may not be accurate for AA women. The aim of this study is to uncover the biological and social factors related to treatment that may be causing this disparity in BC outcomes between AA and C women. Materials and Methods: Data from Surveillance, Epidemiology, and End Results (SEER) and The Cancer Genome Atlas Program (TCGA) was analyzed for differences in etiology, incidence, and prevalence of BC between AA and C. Prevalence of molecular aberrations and subtypes of BC were assessed to gain insight into potential causes of this disparity. FDA's Drug Trials Snapshots data was assessed for clinical trial enrollment by race. Results: SEER data from 2000-2018 reveals AA patients have higher incidences of TNBC and HER2 enriched BC compared to C, with luminal A incidence being higher in C patients. Within all subtypes of BC, 5-year survival rates were significantly lower for AA compared to C. TCGA data found 2282 genes that were significantly differentially altered in C vs. AA subgroups. Among the most commonly altered and significantly different genes, CSMD1 and TP53 were more prevalent among AA (19.78% AA vs. 10.79% in C for CSMD1, and 40.09% AA vs. 28.58% C for TP53), and PIK3CA among C (36.28% (C) vs. 22.47% (AA)). Survival analysis revealed AA women with PIK3CA alterations had lower rates of disease-free survival compared to C women. Clinical trials for oncology drugs approved in 2020 enrolled 5% AAs, with AAs also being underrepresented for BC specific drugs. The recent NCT02492711 trial of MARGENZA, for metastatic HER2 positive BC, had 5% AA compared to 80% C, the NCT01631552 trial of TRODELVY, for metastatic triple negative BC (TNBC), had 7% AA vs. 76% C, and the NCT02614794 trial of TUKYSA, for advanced HER2+ BC, had 9% AA vs. 73% C. Conclusion: Most existing treatments are for luminal A BC; with fewer approved drugs for subtypes more common among AA women, including the more aggressive TNBC. Recent data indicates that AA women continue to be underrepresented in clinical trials, despite having higher incidence of both HER2 and TNBC, resulting in a poor understanding of effective treatment for this subgroup. These factors may perpetuate disparities in outcomes for AA women with BC. Additionally, TCGA data uncovered underlying molecular differences in BC between AA and C women, some that are actionable. Disparities are multifactorial and can include both biological and socioeconomic factors. Thus, as we move towards more personalized medicine, it is increasingly important to improve representation of AA women in precision oncology trials. Citation Format: Genevra Magliocco, Roy Khalife, Anthony Magliocco. African American women with breast cancer have unique molecular features and reduced clinical trial enrollment [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-099.

Mediterranean-Style Diet and Birth Outcomes in an Urban, Multiethnic, and Low-Income US Population.

Findings on the role of Mediterranean-style diet (MSD) on duration of pregnancy and birth weight have been inconsistent and based largely on Non-Hispanic white populations, making it unclear as to whether they could extend to African Americans who are at a higher risk of unfavorable birth outcomes. Our study addresses this gap using a large urban, multiethnic, predominantly low-income cohort of mother-infant dyads from Boston, MA, USA. Dietary information was obtained via food frequency questionnaires; health information including birth outcomes were extracted from medical records. A Mediterranean-style diet score (MSDS) was formulated based on intake history, and linear and log-binomial regressions were performed to assess its association with birth outcomes. After adjustment, the lowest MSDS quintile from the overall sample was found to be associated with an increased relative risk (RR) of overall preterm birth (RR 1.18; 95% CI: 1.06–1.31), spontaneous preterm birth (1.28; 1.11–1.49), late preterm birth (1.21; 1.05–1.39), and low birth weight (1.11; 1.01–1.22), compared to the highest quintile. The findings were similar for the African American sample. Our study adds to the current understanding of the diet’s influence on birth outcomes by demonstrating that adherence to MSD may improve birth outcomes for African American women.

AFRICAN AMERICAN WOMEN HAVE LOWER ODDS OF LIVE BIRTH FROM DONOR EGG IVF

African American women have poorer ART outcomes compared to Caucasian women and the etiology is unknown. Studies have found African American women to have fewer mature oocytes, fertilized oocytes, and lower blastocyst development rates compared to Caucasian women, suggesting that competence of the oocyte may play a role. Our objective is to assess ART clinical outcomes in African American women, while controlling for oocyte quality by using the oocyte donor–recipient model.

High expression of MKK3 is associated with worse clinical outcomes in African American breast cancer patients

BackgroundAfrican American women experience a twofold higher incidence of triple-negative breast cancer (TNBC) and are 40% more likely to die from breast cancer than women of other ethnicities. However, the molecular bases for the survival disparity in breast cancer remain unclear, and no race-specific therapeutic targets have been proposed. To address this knowledge gap, we performed a systematic analysis of the relationship between gene mRNA expression and clinical outcomes determined for The Cancer Genome Atlas (TCGA) breast cancer patient cohort.MethodsThe systematic differential analysis of mRNA expression integrated with the analysis of clinical outcomes was performed for 1055 samples from the breast invasive carcinoma TCGA PanCancer cohorts. A deep learning fully-convolutional model was used to determine the association between gene expression and tumor features based on breast cancer patient histopathological images.ResultsWe found that more than 30% of all protein-coding genes are differentially expressed in White and African American breast cancer patients. We have determined a set of 32 genes whose overexpression in African American patients strongly correlates with decreased survival of African American but not White breast cancer patients. Among those genes, the overexpression of mitogen-activated protein kinase kinase 3 (MKK3) has one of the most dramatic and race-specific negative impacts on the survival of African American patients, specifically with triple-negative breast cancer. We found that MKK3 can promote the TNBC tumorigenesis in African American patients in part by activating of the epithelial-to-mesenchymal transition induced by master regulator MYC.ConclusionsThe poor clinical outcomes in African American women with breast cancer can be associated with the abnormal elevation of individual gene expression. Such genes, including those identified and prioritized in this study, could represent new targets for therapeutic intervention. A strong correlation between MKK3 overexpression, activation of its binding partner and major oncogene MYC, and worsened clinical outcomes suggests the MKK3-MYC protein–protein interaction as a new promising target to reduce racial disparity in breast cancer survival.

Abstract IA27: Exploring the impact of African ancestry in tumor immune response, a possible role in disparate clinical outcomes

Abstract Disparities in breast cancer survival among ethnic groups have been a persistent finding over the past five decades, exacerbated in part by the lack of improvement to non-white patient outcomes, despite treatment advancements that have improved clinical outcomes in white women. A significant part of this disparity is health equity; however, recent evidence from several groups indicates that histologic and pathologic diversity in tumor phenotypes among ethnic groups is also a key factor affecting the differences in clinical outcome. Specifically, correlated findings among women with significant West African ancestry reveal that there is a genetic link between women across the African Diaspora that is associated with aggressive tumor phenotypes, including triple-negative breast cancer. Aside from the global incidence of TNBC being higher in regions with relatively higher numbers of women with African ancestry, we also find that pathologic progression of tumors in African Americans tends to mimic that of African women. Tumor progression is directly related to the immune response elicited by the onset of tumor growth as well as the underlying tissue microenvironment, particularly the inflammatory status. We have identified several lines of evidence that suggest there is a distinct immune response to breast cancer, which is also tumor phenotype/subtype specific, when comparing patients of significant African ancestry with those of primarily European ancestry. These findings suggest that there could be a unique mechanism of tumor immunology at work, driven by population private genetic alleles derived in Africa and transmitted throughout the African Diaspora, causing a unique tumor phenotype in these breast cancer patients. This unique phenotype is likely the key factor in distinct treatment responses that result in poorer clinical outcomes for African American women. Citation Format: Melissa B. Davis, Brittany D. Jenkins, Rachel A. Martini, Haythem Ali, Clayton C. Yates, Elizabeth A. Howerth, Petros Nikolinakos, Michele Monteil, Lisa A. Newman. Exploring the impact of African ancestry in tumor immune response, a possible role in disparate clinical outcomes [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 IA27.

Abstract A093: Employment and work experiences after breast cancer treatment

Abstract Background: Employment is a social determinant of health. However, few longitudinal studies have examined employment outcomes in African-American women with breast cancer. We examined factors associated with return to work over 2-year follow-up in a sample of African-American breast cancer patients participating in a randomized controlled trial of a cancer-information intervention's impact (vs. standard of care) on quality-of-life and treatment adherence outcomes. Methods: Interview and medical-record data from 227 newly diagnosed African-American breast cancer patients (stage 0-III), who enrolled a mean 6 days from surgical post-op visit or start of neoadjuvant therapy, were analyzed in association with return to work; four more interviews were conducted over two years. Potential predictors included sociodemographic variables (age, marital status, income, education, insurance status), treatment(s) received (surgery type, chemotherapy, radiation), comorbidity, and elevated depressed mood (Center for Epidemiologic Studies Depression Scale [CES-D] score > 15). Multivariable logistic regression models were used to identify factors independently associated with return to work. Results: At enrollment, 100 patients (44%) were employed part- or full-time; 71 of employed patients returned to work during 2-year follow-up. Study arm and other treatment and sociodemographic variables were not significantly associated with return to work and was not included in the final model. Patients with elevated depressed mood at baseline were less likely to return to work than nondepressed patients (adjusted odds ratio = 5.8, 95% CI = 1.7-9.3). Conclusions: Patients with elevated depressed mood were less likely to return to work over 2-year follow-up. Screening for depressed mood at diagnosis and providing treatment might be an effective strategy to improve continued workforce participation in African-American breast cancer patients. Citation Format: Christine C. Ekenga, Cora McElwain, Maria Perez, Donna B. Jeffe. Employment and work experiences after breast cancer treatment [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 A093.

Effect of blood pressure control in early pregnancy and clinical outcomes in African American women with chronic hypertension

Chronic hypertension (cHTN) affects 3-5% of all pregnancies and is twice as prevalent in African American (AA) women. AA women develop more severe HTN at an earlier onset and have higher rates of adverse pregnancy outcomes. Blood pressure control during pregnancy is controversial. This retrospective cohort included AA women with cHTN and singleton pregnancies delivering between January 2013 and December 2016. Patients were classified as not receiving antihypertensives in the first 20weeks (Group A), on antihypertensives in the first 20weeks but with an average BP <140/90 during pregnancy (Group B) and on antihypertensives in the first 20weeks but with average BP during pregnancy ≥140/90 (Group C). Adverse outcomes including severe HTN and preterm delivery <35weeks was compared between groups. Of the 198 patients included, 68 received at least one AHT before 20weeks including 45 patients with average BP <140/90 and 23 with average BP ≥140/90 during pregnancy. The incidence of superimposed PE and preterm birth was significantly higher among women with elevated BPs on AHT (39.1% vs 8.9% vs 17.7%, p=0.01; preterm birth 52.2%, 8.9% and 9.2%, p<0.001 for Groups C, B and A, respectively). A significantly higher proportion of adverse neonatal outcomes were observed in Group C (78.3%) as opposed to those in Group B (53.3%) or Group A (50.0%; p=0.04). Among AA women with cHTN, use of antihypertensives prior to 20weeks and lower antenatal BP was associated with a decreased risk of adverse maternal and neonatal outcomes.

Preeclampsia Among African American Pregnant Women: An Update on Prevalence, Complications, Etiology, and Biomarkers.

Preeclampsia is a devastating disease of pregnancy associated with increased risk of fetal and maternal complications. African American pregnant women have a high prevalence of preeclampsia, but there is a need of systemic analyses of this high-risk group regarding complications, etiology, and biomarkers. The aim of this study was to provide a synopsis of current research of preeclampsia specifically related to African American women. A comprehensive search was performed in the bibliographic database PubMed with keywords "preeclampsia" and "African American." African American women with preeclampsia were at an increased risk of preterm birth, which resulted in low-birth-weight infants. Intrauterine fetal death among African American preeclamptic patients occurs at twice the rate as in other races. On the maternal side, African American mothers with preeclampsia have more severe hypertension, antepartum hemorrhage, and increased mortality. Those who survive preeclampsia have a high risk of postpartum cardiometabolic disease. Preexisting conditions (eg, systemic lupus erythematosus) and genetic mutations (eg, sickle cell disease in the mother, FVL or APOL1 mutations in the fetus) may contribute to the higher prevalence and worse outcomes in African American women. Many blood factors, for example, the ratio of proteins sFlt/PlGF, hormones, and inflammatory factors, have been studied as potential biomarkers for preeclampsia, but their specificity needs further investigation. Further studies of preeclampsia among African American women addressing underlying risk factors and etiologies, coupled with identification of preeclampsia-specific biomarkers allowing early detection and intervention, will significantly improve the clinical management of this devastating disease.

OUTCOMES OF AFRICAN AMERICAN VS. NON-AFRICAN AMERICAN WOMEN WITH PERIPARTUM CARDIOMYOPATHY: A COMPARISON ANALYSIS BETWEEN CANADIAN AND UNITED STATES COHORTS

The prevalence of peripartum cardiomyopathy (PPCM) is higher in women of African ancestry. Although previous studies have reported poorer outcomes in African American women, it remains uncertain whether this is confounded by socioeconomic factors. In this study, we sought to evaluate whether the association between African ancestry and prognosis differs among countries with different healthcare systems.

Peer approaches to self-management (PALS): comparing a peer mentoring approach for disease self-management in African American women with lupus with a social support control: study protocol for a randomized controlled trial

BackgroundSystemic lupus erythematosus (SLE or lupus) is a chronic autoimmune disease that is associated with increased morbidity, mortality, healthcare costs and decreased quality of life. African Americans in the USA have three to four times greater prevalence of SLE, risk of developing SLE at an earlier age, and SLE-related disease activity, damage, and mortality compared with Caucasians, with the highest rates experienced by African American women. There is strong evidence that patient-level factors are associated with outcomes, which justifies targeting them with intervention. While evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function, and delayed disability among patients with SLE, African Americans and women are still disproportionately impacted by SLE. Peer mentoring interventions are effective in other chronic conditions that disproportionately affect minorities, such as diabetes mellitus, HIV, and kidney disease, but there is currently no empirically tested peer mentoring intervention developed for patients with SLE. Preliminary data from our group suggest that peer mentoring improves self-management, reduces disease activity, and improves health-related quality of life (HRQOL) in African American women with SLE.MethodsThis study will test an innovative, manualized peer mentorship program designed to provide modeling and reinforcement by peers (mentors) to other African American women with SLE (mentees) to encourage them to engage in activities that promote disease self-management. Through a randomized, “mentored” or “support group” controlled design, we will assess the efficacy and mechanism(s) of this intervention in self-management, disease activity, and HRQOL.DiscussionThis is the first study to test peer mentorship as an alternative strategy to improve outcomes in African American women with SLE. This could result in a model for other programs that aim to improve disease self-management, disease activity, and HRQOL in African American women suffering from chronic illness. The peer mentoring approach is uniquely fitted to African Americans, and this intervention has the potential to lead to health improvements for African American women with SLE that have not been attainable with other interventions. This would significantly reduce disparities and have considerable public health impact.Trial registrationClinicalTrials.gov, NCT03734055. Registered on 27 November 2018.

O15 Health Habits of African American Women and the Impact of Racial Identity

Background Social position, discrimination based on group identity, and stress are major contributors to an individual's social determinant of health. Managing health outcomes for African American women becomes far more than simply providing education and access; it hinges on understanding the construct of race and the implications of race-based stress (Hill-Collins, 2005; Sanders-Phillips, Settles-Reaves, Walker & Brownlow, 2009; Shavers, 2006). Objective To investigate the impact of racial identity and resilience on the health habits of African American women. Study Design, Settings, Participants A cross-sectional design using a non-probability sample was used to study the relationship between fruit and vegetable consumption, racial identity, and resilience. Participants were recruited using social media focusing on platforms for Black/African American women. Cis-gendered African American who were 18 years of age or older were studied. Measurable Outcome/Analysis In this study, the Multidimensional Model of Black Identity, the Resilience Scale for Adults, and a modified NHANES survey was use to collect data to examine the relationships between resilience, Black identity, and health habits. Results Survey results were analyzed using SPSS v.11 for Windows. Simple linear regression used to examine the relationship between resilience, Black identity, and health habits. Public regard was positively association with fruit intake and vigorous physical activity. Additionally, centrality was associated with vigorous physical activity and minority identity was associated with fruit intake (P Conclusion Positive racial regard and social competence had beneficial impacts on fruit consumption, while a high association with the minority identity had an inverse relationship with fruit consumption. Public regard and racial centrality was positively associated with vigorous physical activity. Significant changes in morbidity and in health behavior are associated with acculturation for all ethnic minority groups in Anglo-majority host cultures such as the United States. Consequently, acculturation is an important variable in health psychology and behavioral medicine, which requires examination. Funding None.

Abstract 4208: Integrated molecular approach to identify biological factors contributing to breast cancer disparities in Chicago

Abstract BACKGROUND: African American (AA) women have a 4-5 fold greater risk of death from estrogen and/or progesterone receptor positive (ER/PR positive) breast cancer compared to non-Latina white (white) women, even after controlling for stage at diagnosis, treatment, and other prognostic factors. The purpose of this study is to examine whether there are racial differences in biologic mechanisms typically activated in ER/PR positive breast cancer and whether they might lead to a higher rate of distant metastases and/or resistance to endocrine therapies. METHODS: Eligible cases -AA and white women, aged 20-79, with a new diagnosis of stage I-III ER+ breast cancer- are being recruited from 3 cancer institutions in Chicago. Control subjects -AA and white women presenting for a screening mammogram without breast symptoms and no history of cancer- have been recruited from the corresponding mammography centers. We are collecting serum from AA and white cases and controls in order to conduct a metabolomic analysis to identify oncometabolites that might promote aggressive phenotypes in ER/PR breast cancer cells. Serum collection is taking place prior to breast surgery or initiation of any neoadjuvant or adjuvant therapies to ensure that our findings are not due to treatment effects on metabolites. RESULTS: To date, we have enrolled 175 out of 300 planned study participants. Recruitment will be completed by January 2019, and preliminary metabolomic data will be presented. We will explore associations between candidate oncometabolites and neighborhood socioeconomic deprivation as well as individual patient and tumor characteristics typically related to poor outcomes in AA women with BC. Analyses will adjust for tumor intrinsic subtype (Luminal A vs. Luminal B) to account for known differences in molecular pathways by tumor subtype. We hope to identify biochemical differences in serum that could help to explain the unanswered question regarding why AA patients with ER/PR positive breast cancer or more likely to die from the disease compared to their white counterparts. Note: This abstract was not presented at the meeting. Citation Format: Ashlie M. Santaliz Casiano, Zeynep Madak-Erdogan, Oana Danciu, Hariyali Patel, Landan Banks, Jermya Buckley, Garth Rauscher, Anita Fareeduddin, Elonia Martin, Archana Bargaje, Carlos Garcia, Lauren Schulte, Deanna Taiym, Julie Kim, William Gradishar, Scott Hegerty, Jonna Frasor, Kent Hoskins. Integrated molecular approach to identify biological factors contributing to breast cancer disparities in Chicago [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4208.

Cost-effectiveness of a peer mentoring intervention to improve disease self-management practices and self-efficacy among African American women with systemic lupus erythematosus: analysis of the Peer Approaches to Lupus Self-management (PALS) pilot study.

The Peer Approaches to Lupus Self-management (PALS) program was developed as a peer mentoring tool to improve health behaviors, beliefs, and outcomes in African American women with systemic lupus erythematosus (SLE). This study aims to assess the cost of the PALS intervention and determine its effectiveness when compared to existing treatments. Peer mentors and mentees were paired on shared criteria such as life stage, marital status, or whether they were mothers. This 12-week program consisted of a weekly peer mentoring session by telephone. Cost of healthcare utilization was evaluated by assessing the healthcare costs pre- and post-intervention. Validated measures of quality of life, self-management, disease activity, depression, and anxiety were collected. Total direct program costs per participant were totaled and used to determine average per unit improvement in outcome measures. The benefit-cost ratio and pre- versus post-intervention hospital charges were examined. A total of 20 mentees and 7 mentors were enrolled in the PALS program. All PALS pairs completed 12 sessions lasting an average of 54 minutes. Mentees reported statistically significant decreases in patient-reported disease activity, depression, and anxiety, with improved trends in patient activation or patient engagement in their disease and management. The total cost per patient was $1291.50, which was $107.62 per patient per week. There was a savings of $23,417 per individual receiving the intervention with a benefit-cost ratio of 18.13 per patient. These findings suggest that the PALS intervention was effective in improving patient-level factors and was cost-effective. Future research will need to validate these findings in a larger sample.

Treatment Fidelity in Mind-Body Interventions.

To contribute to the treatment fidelity literature by providing real-world examples and suggestion for future research and potential clinical application, this article reports on implementation, assessment, and evaluation of treatment fidelity in mind-body self-care approaches in at-risk women. Aligning with best practices, treatment fidelity was integrated into three randomized clinical trials. The first examined the effects of a tai chi intervention designed to decrease cardiometabolic risk factors in women; the second examined the effects of a tailored guided imagery intervention on pregnancy outcomes in African American women; and the third explored effects of a mindful physical activity intervention (yoga) on psychological outcomes in women with moderate to severe depressive symptoms. Each of the studies successfully designed, implemented, and evaluated strategies to address recommended treatment fidelity components. These strategies provided qualitative and quantitative data that informed intervention refinement, directions for future research, and application in clinical practice. The treatment fidelity framework used here is based on best practices and was a feasible and reliable approach for ensuring and reporting on treatment fidelity, which is contributing to future research to foster translation of potentially effective mind-body self-care approaches into practice.

Abstract B67: Overexpression of claudin-3 tight junction protein in endometrial cancer cell lines and tumor tissues derived from African American women

Abstract According to the American Cancer Society (2017), endometrial cancer is the most common type of reproductive tumor in the US. Notably, whereas the incidence of endometrial cancer is similar in women of different races, the mortality rate is significantly higher in African American women. Currently, the molecular etiology of this disease is not well understood nor is there an explanation as to the disparity between the clinical outcomes for African American women and women of other races. Thus, the purpose of the current study was to determine (1) the expression of claudin-3 mRNA and protein in a panel of endometrial cancer cell lines and (2) the expression of claudin-3 protein in matched pairs of normal and tumor tissues derived from African American women with endometrial cancer. RT-PCR was used to measure claudin-3 mRNA expression, and immunoblotting was used to evaluate claudin-3 protein levels. We observed overexpression of claudin-3 protein in 4 of the 10 endometrial cancer cell lines and in 4 of the 6 primary endometrial cancer tissues (relative to their matched normal control tissues). Consistent with the immunoblotting data, the levels of claudin-3 mRNA were elevated in the same 4 cell lines that showed overexpression of the protein. These data suggest that increased transcription of the claudin-3 gene is responsible for the elevated levels of the claudin-3 protein. Consistent observations of elevated claudin-3 gene expression may indicate its use as a diagnostic marker. The finding of claudin-3 overexpression in the majority of endometrial tumor tissues suggests a role for tight junction disruption in the development of endometrial cancer in African American women. Citation Format: Maria E. Cuevas, Maria C. Todd. Overexpression of claudin-3 tight junction protein in endometrial cancer cell lines and tumor tissues derived from African American women [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 B67.

Abstract A09: Urban neighborhood and residential factors associated with breast cancer in African American women: A systematic review

Abstract Certain residential characteristics in urban neighborhoods have shown to have negative impacts on health, especially in the African American population. The purpose of this systematic review is to understand the relationship between urban neighborhood and residential factors and breast cancer risk, incidence, stage at diagnosis/late stage diagnosis, survival, and mortality in African Americans. Using PubMed and Web of Science, the existing literature was reviewed. Observational, cross-sectional, cohort, and prospective studies until February 2017 were examined. Studies that included populations of African American women, setting in “urban” areas, and a measure of a neighborhood or residential factor were reviewed. Three parameters related to neighborhood/residential factors were extracted, including neighborhood socioeconomic status (SES), residential segregation, and residential pollution. Eighteen studies were identified for systematic review. 10 studies showed significantly higher odds of late-stage diagnosis, higher mortality, and lower survival in African American women living in lower socioeconomic neighborhoods. One study showed slightly higher odds of upward neighborhood change and probability of distant metastasis at diagnosis of African American woman compared to White women (OR=1.24). Similarly, 5 studies showed significantly high associations between residential segregation and late-stage diagnosis, as well as high associations of residential segregation and higher mortality in African American women. Two studies assessed residential pollution on breast cancer risk. The first study showed a weak rate of breast cancer risk in African American women between differentiating levels of trihalomethane in public water (RR=1.2). The second assessed the association of magnetic field exposure and breast cancer risk and found that the odds of getting breast cancer were not significant in African American women (OR=1.02). This review provides a qualitative synthesis of major neighborhood and residential factors on breast outcomes in African American women. By enacting health policies and utilizing tools such as health informatics, steps can be taken to drive the breast cancer disparity down in this population. Citation Format: Brandi Patrice Smith, Zeynep Madak-Erdogan. Urban neighborhood and residential factors associated with breast cancer in African American women: A systematic review [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 A09.

Abstract 3012: Urban neighborhood and residential factors associated with breast cancer in African American women: A systematic review

Abstract Residential characteristics in urban neighborhoods impacts health and might be an important factor contributing to health disparities, especially in the African American population. The purpose of this systematic review is to understand the relationship between urban neighborhood and residential factors and breast cancer incidence and prognosis in African American women. Using PubMed and Web of Science, the existing literature was reviewed. Observational, cross-sectional, cohort, and prospective studies until February 2017 were examined. Studies including populations of African American women, setting in “urban” areas, and a measure of a neighborhood or residential factor were reviewed. Four parameters related to neighborhood or residential factors were extracted including: neighborhood socioeconomic status (nSES), residential segregation, spatial access to mammography, and residential pollution. Our analysis showed that African American women living in low nSES have greater odds of late stage diagnosis and mortality. Furthermore, African American women living in segregated areas (higher percentage of Blacks) have higher odds of late stage diagnosis and mortality compared to White and Hispanic women living in less segregated areas (lower percentage of Blacks). Late stage diagnosis was also shown to be significantly higher in areas with poor mammography access and areas with higher Black residential segregation. Lastly, residential pollution did not affect breast cancer risk in African American women. Overall, this systematic review provides a qualitative synthesis of major neighborhood and residential factors on breast cancer outcomes in African American women. Citation Format: Brandi P. Smith, Zeynep Madak-Erdogan. Urban neighborhood and residential factors associated with breast cancer in African American women: A systematic review [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3012.