Proportion Of African American Women Research Articles

Abstract P3-04-01: Information availability about screening for high-risk breast cancer on cancer center websites

Abstract Background: Radiology and oncology clinical guidelines recommend that people with high-risk of breast cancer should be offered screening with magnetic resonance imaging (MRI). Rates of appropriate screening remain low, which could also be related to patient awareness and knowledge about optimal screening modalities/schedules. Appropriate screening is even more critical for African-American women, in whom there are higher rates of genetic mutations (e.g., BRCA) conferring a greater risk of high-risk breast cancer. Southern United States (US) states have a higher proportion of African-American women. We sought to explore the availability of information on high-risk breast cancer screening using breast MRI across the websites of the top 20 cancer centers in the US (as per US News data) as well as the top US News cancer center in each of 5 representative southern US states where the average annual breast cancer-related death rate is greater than 20 per 100,000 people, age adjusted to the 2000 US standard population. Methods:We utilized publicly available data from the 2020-2021 US News website to identify top 20 cancer centers. We performed a google search using two separate keyword phrases (“high-risk breast cancer screening” and “breast MRI”), and the name of the cancer center. US News 2020-21 online ranking data was also used to identify the top cancer center in each of the five representative US states (Alabama, Georgia, Louisiana, Mississippi and South Carolina) and a similar search methodology was adopted for these five cancer centers. We then reviewed each cancer center’s website(s) and webpages to ascertain the availability of information regarding the availability of specific high-risk breast cancer clinic/programs and specific information on screening with breast MRI. Results: Of the top 20 US cancer centers, 15 (75%) have an established high-risk breast cancer clinic/program per their website. Two (2/15) of these cancer centers only had a general high-risk cancer assessment/genetics clinic and two (2/15) had no additional information available about the high-risk clinics. Information on high-risk factors was available on 12/20 (60%) websites. Seventeen centers (85%) included information on breast MRI, but only 8 (40%) had patient-centered detailed information on breast MRI for high-risk patients and 4 (20%) centers included an online, personalized, risk assessment tool. Among the top cancer center in each of the 5 representative Southern states, only 1 (20%) had information regarding a high-risk breast cancer evaluation program. While 4 (80%) had information on breast MRI information, there was no specific information available for high risk screening. Conclusions: These findings underscore the unmet need of easy access to online information from the websites of the top cancer centers nationally as well as the top state level cancer centers in the five representative southern US states for women with high risk of developing breast cancer. These limitations are particularly relevant for African-American women living in the South. Limitations of this study include the cross-sectional assessment of online data and that discrepancies may exist between websites and actual availability of clinical services. Citation Format: Jaspreet Singh Batra, Elizabeth Park, Arjun Gupta. Information availability about screening for high-risk breast cancer on cancer center websites [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 P3-04-01.

California Cardiovascular Screening Tool: Findings from Initial Implementation.

Objective American College of Obstetricians and Gynecologists (ACOG) recently published the California (CA) cardiovascular disease (CVD) screening algorithm for pregnant and postpartum women. We aim to prospectively determine screen-positive and true-positive rates of CVD among women across two populations. Study Design This is a prospective cohort study of obstetrical patients from April 2018 to July 2019 at academic medical centers in CA and New York (NY). We attempted to screen all patients at least once during their pregnancy care (prenatal or postpartum). Women who screened positive (“Red Flags,” >3–4 moderate risk factors, abnormal physical examination, and persistent symptoms) underwent further testing. The primary outcome was the screen-positive rate. Secondary outcomes included the true-positive rate and the strength of each moderate factor in predicting a positive CVD screen. Results We screened 846 women. The overall screen-positive rate was 8% (5% in CA vs. 19% in NY). The sites differed in ethnicity, that is, African American women (2.7% in CA vs. 35% in NY, p < 0.01) and substance use (2.7 vs. 5.6%, p < 0.04). The true-positive rate was 1.5% at both sites. The percentage of screen-positive patients who did not complete follow-up studies was higher in NY (70%) than in CA (27%). CVD was confirmed in 30% with positive screens with complete follow-up. Combinations of moderate factors were the main driver of screen-positive rates in both populations. Conclusion This is the first data describing the performance of the CVD screening algorithm in a general obstetric population. Factors, such as proportion of African American women affect the likelihood of a positive screen. The screening algorithm highlights patients at higher lifetime risk of CVD and may identify a group that could be targeted for more direct care transitions postpartum. Data may be used to design a larger validation study.

Intervening during and after pregnancy to prevent weight retention among African American women

Efforts to prevent postpartum weight retention in extant clinical trials of African American women have proven exceedingly challenging. The primary purpose of this pilot study was to determine whether a behavioral intervention implemented in early pregnancy through 6 months postpartum could increase the proportion of African American women who were at or below their early pregnancy weights by 6 months postpartum. We additionally evaluated whether mothers' postpartum weight loss could be maintained at 12 months postpartum. Participants were 66 socioeconomically disadvantaged African American women (36% overweight, 64% obese) randomly assigned to a behavioral intervention or usual care group. The intervention, implemented from early pregnancy to 6 months postpartum, promoted weight control through: (1) empirically supported behavior change goals; (2) interactive self-monitoring text messages; (3) weekly to monthly health coach calls; and (4) skills training and support through Facebook. In modified intent-to-treat analyses, participants assigned to the intervention were significantly more likely to be at or below their early pregnancy weights by 6 months postpartum compared to usual care (56% vs. 29%, p = 0.04). At 12 months postpartum, the maternal weight difference between intervention and usual care groups was not maintained (41% vs. 38% respectively at or below early pregnancy weights, p = 0.83). Findings suggest that a combined pregnancy and postpartum weight control intervention improves 6 month weight outcomes in socioeconomically disadvantaged African American women with obesity. Longer interventions may be needed to overcome late postpartum weight gain among this high risk group.Clinical trial registration number: ClinicalTrials.gov identifier NCT01530776

Racial Disparities in Perinatal Depression in an Underserved Los Angeles County Population [3OP

INTRODUCTION: Perinatal depression affects one in seven women, and is associated with significant morbidity. Limited data suggest depression rates to be twice as high among low-income, minority women. This study aimed to identify associations between race/ethnicity and perinatal depression in a medically and psychosocially at-risk population. METHODS: Study data were collected from interviews conducted from December 2013 through August 2016 by Community Health Workers as part of the initial obstetric assessment. Depression was scored on the Center for Epidemiologic Studies Depression (CES-D) Scale, with depression defined as a score of greater than 16 for clinical symptoms. Race and ethnicity were self-reported. Chi-square analyses were performed. RESULTS: A total of 3,214 women were included in the study. Analyses revealed that a larger proportion of African American women (26.2%) met criteria for depression than their White (20.1%), Asian (5.2%) and Mixed Race counterparts (2.6%; chi-square less than .01, P greater than .001). Analyses involving ethnicity revealed that women who identified as Hispanic/Latina (27.1%) were less likely than non-Hispanic women (38.5%) to meet CES-D depression criteria (chi-square=44, P less than .001). CONCLUSION: Race and ethnicity were significantly associated with perinatal depression. A higher proportion was seen among African American women, while a lower proportion seen among Hispanic/Latinas. Implications for practice include increasing mental health support and a referral network to access during pregnancy and postpartum. Future research might include examination of protective factors for depressive symptoms in pregnant women of different ethnic/racial backgrounds. Screening tools for other mental health conditions may account for other ethnic/racial differences.

Abstract A52: Racial Differences in Prevention Decision Making among Women at High Risk of Breast Cancer

Abstract Background &amp; Objectives: Prior research has documented significant racial disparities in adherence to breast cancer screening recommendations, use of breast-conserving surgery by early stage breast cancer patients, and breast cancer mortality. Decision making about breast cancer prevention options among high risk women has been less thoroughly studied, and racial differences remain mostly unexplored in this arena. The current study employs semi-structured interviews and inductive analytic methods to explore prevention decision making among African American and White women. Its core objective is to investigate the degree to which decision-making processes and outcomes differ across racial groups, and the specific content of these differences, in order to support interventions and programs to facilitate empowered, preventive decision making. Methods: In-depth, semi-structured interviews were conducted with 20 African American and 30 non-Hispanic White women at elevated risk of breast cancer. Allowing women to speak in their own words, these interviews explore women's perception of their risk status; the sources and content of risk information they have obtained; their understanding and consideration of prevention options; decision-making processes; decision-making networks, psychosocial well-being; and women's use of financial, time, and energy resources in coping with risk and prevention. Interviews ranged in length from 30 to 140 minutes and were professionally transcribed. Transcribed data are analyzed through grounded theory methods, using the NVivo 10 software package for qualitative data. Results: High risk African American women's experiences are distinct from those of their White counterparts in a range of ways, including the following. (1) African American women are much less frequently aware of the existence of prophylactic surgeries and chemoprevention options are clinically recommended for women at their own level of risk. (2) Among women who do know about these prevention options, African American women are less likely to consider or undertake prophylactic surgeries or chemoprevention to lower their breast cancer risk. (3) A much higher proportion of African American women have experienced several different types of cancer among their loved ones. These women tend to perceive of themselves as at risk for cancer in general, and not to perceive a specific high risk for breast or ovarian cancer. (4) African American women experience considerably more financial limitations on their ability to access health care and engage in specific prevention activities. Most have been uninsured for some period, and have had at least one health care decision affected by financial constraints. (5) African American women are considerably more likely to reference faith, spirituality, and religion in discussing their perceived risk of cancer and their attitudes toward prevention behavior. Conclusions &amp; Implications: High risk women's narratives reveal substantial racial differences in perceptions, feelings, and choices related to breast cancer prevention. African American women who are clinically determined to be at high risk for breast and ovarian cancer are less likely than similar White women to understand this specific risk, to know about prevention options that could lower the risk, or to consider using these options even when they do know about them. The processes through which African American women navigate risk and prevention are also more heavily influenced by religious faith and financial constraint than those of White women. These distinctions merit further investigation, and confirmation with larger samples. Ultimately, knowledge of such inter-group differences may contribute to tailored interventions to support empowered and health-protective decision making among women at elevated risk. Citation Format: Tasleem J. Padamsee, Anna Muraveva, Electra D. Paskett. Racial Differences in Prevention Decision Making among Women at High Risk of Breast Cancer. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A52.

Infant Feeding Decision-Making and the Influences of Social Support Persons Among First-Time African American Mothers.

Background While breast milk is considered the gold standard of infant feeding, a majority of African American mothers are not exclusively breastfeeding their newborn infants. Objective The overall goal of this critical ethnographic research study was to describe infant feeding perceptions and experiences of African American mothers and their support persons. Methods Twenty-two participants (14 pregnant women and eight support persons) were recruited from public health programs and community based organizations in northern California. Data were collected through field observations, demographic questionnaires, and multiple in-person interviews. Thematic analysis was used to identify key themes. Results Half of the mothers noted an intention to exclusively breastfeed during the antepartum period. However, few mothers exclusively breastfed during the postpartum period. Many participants expressed guilt and shame for not being able to accomplish their antepartum goals. Life experiences and stressors, lack of breastfeeding role models, limited experiences with breastfeeding and lactation, and changes to the family dynamic played a major role in the infant feeding decision making process and breastfeeding duration. Conclusions for Practice Our observations suggest that while exclusivity goals were not being met, a considerable proportion of African American women were breastfeeding. Future interventions geared towards this population should include social media interventions, messaging around combination feeding, and increased education for identified social support persons. Public health measures aimed at reducing the current infant feeding inequities would benefit by also incorporating more culturally inclusive messaging around breastfeeding and lactation.

Preventing excessive gestational weight gain among African American women: A randomized clinical trial.

ObjectiveEvidence is lacking regarding effective weight control treatments in pregnancy for ethnic minority women with obesity. This study evaluated whether a technology-based, behavioral intervention could decrease the proportion of overweight or obese African American women who exceeded Institute of Medicine (IOM) guidelines for gestational weight gain.MethodsWe conducted a 2-arm pilot randomized clinical trial. Participants were 66 socioeconomically disadvantaged African American pregnant women (12.5 ± 3.7 weeks’ gestation; 36% overweight, 64% obese) recruited from 2 outpatient obstetric practices at Temple University between 2013 and 2014. We randomized participants to usual care (n = 33) or a behavioral intervention (n = 33) that promoted weight control in pregnancy. The intervention included: 1) empirically-supported behavior change goals; 2) interactive self-monitoring text messages; 3) biweekly health coach calls; and 4) skills training and support through Facebook.ResultsThe intervention reduced the proportion of women who exceeded IOM guidelines compared to usual care (37% vs. 66%, p = 0.033). Intervention participants gained less weight during pregnancy (8.7 vs. 12.3 kg, adjusted mean difference −3.1 kg, 95% CI −6.2, −0.1). No group differences in neonatal or obstetric outcomes were found.ConclusionsThe intervention resulted in lower prevalence of excessive gestational weight gain.

Understanding Perceived Benefit of Early Cancer Detection: Community-Partnered Research with African American Women in South Los Angeles.

African American women have lower 5-year cancer survival rates than non-Latino White women. Differences in perceived benefits of early cancer detection among racial/ethnic groups may affect cancer-screening behaviors. This study assessed correlates of perceived benefits of early breast, cervical and colorectal cancer detection among 513 African American women. Using a community-partnered participatory research approach, we conducted a survey on cancer screening, risk behaviors, and related knowledge and attitudes among African American parishioners at 11 churches in South Los Angeles, a neighborhood that experiences one of the highest cancer mortality rates in California. African American women who participated in this study were more likely to believe that chances for survival are very good or good after early detection of breast cancer (74%) than after early detection of colorectal (51%) and cervical cancer (52%). Multivariate analyses show that perceived benefit of early cancer detection is associated with higher cancer knowledge and having discussed one's cancer risk with a doctor. Given that 5-year survival rates for early stage breast, cervical, and colorectal cancer range from 84% to 93%, our data suggest that a substantial proportion of African American women in South Los Angeles are not aware of the benefits of early detection, particularly of colorectal and cervical cancers. Programs that increase cancer knowledge and encourage a discussion of individual's cancer risk with a doctor may be able to increase perceived benefit of early detection, a construct that has been shown to be associated with cancer screening in some studies.

Abstract 29: Loss of Ideal Total Cholesterol Early in Life: The National Health and Nutrition Examination Survey (NHANES)

Introduction: Ideal total blood cholesterol (TC) levels are associated with lower cardiovascular disease (CVD) morbidity and mortality. In the U.S. TC increases up to middle age, but declines at older ages. Few studies have characterized the transition from ideal to intermediate and poor TC levels in different life epochs and in minorities. Methods: Cross-sectional 2007-2012 NHANES data (N = 11,140) were used to estimate the age-, race-, and sex- specific prevalence of ideal (≥20 years: &lt;200 mg/dL untreated, 16-19 years: &lt;170 mg/dL), intermediate (≥20 years: 200-239 mg/dL or treated to goal, 16-19 years: 170-199 mg/dL), and poor (≥20 years: ≥240 mg/dL, 16-19 years: ≥200 mg/dL) TC, defined per American Heart Association criteria. We then used these data and novel Markov-type models to estimate net transition probabilities between ideal, intermediate and poor TC. Results: Between the ages of 16 and 18, the prevalence of ideal TC among European American (EA) and African American (AA) men was approximately 68%, notably higher than the prevalence in EA women (63%) and AA women (61%). Variation in the loss of ideal TC was also observed by race and sex. Between 16-50 years of age, the proportion of AA men, EA men and EA women with ideal levels of TC declined approximately 2.0% (95% CI: 1.8%, 2.2%) per year. In AA women by contrast, the age-specific decline in ideal TC was not uniform between 16-50 years of age. The proportion of AA women with ideal levels of TC declined 0.7% (95% CI: 0.2%, 1.2%) per year from 16-20 years of age but increased to 2.8% (95% CI: 2.4%, 3.3%) per year by age 50. Among populations with intermediate TC levels, estimated 1-year net transitions to poor TC peaked at age 16, the earliest age under investigation, for EA men, EA women, and AA men but remained stable for AA women through 70 years of age, where a net 0.6% (95% CI: 0.1%, 1.3%) of the population with intermediate TC levels transitioned to poor TC levels one year later. In all demographic groups and life epochs, greater proportions of the population transitioned from intermediate to poor TC than from poor to intermediate TC. Conclusions: Loss of ideal TC begins early in life and shows divergent patters by gender and race. Difficulties re-attaining ideal TC once classified as intermediate or poor support interventions that promote ideal TC levels in younger ages, especially among AA women.

Why do pregnant women die? A review of maternal deaths from 1990 to 2010 at the University of Alabama at Birmingham.

The number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to a high of 17.8 deaths per 100,000 live births in 2009. Compared to Caucasian women, African American women were nearly 4 times as likely to die from childbirth. To better understand the reason for this trend, we conducted a case-control study at University of Alabama at Birmingham (UAB) Hospital. Our primary study hypothesis was that women who died at UAB were more likely to be African American than women in a control group who delivered an infant at UAB and did not die. We expected to find a difference in race proportions and other patient characteristics that would further help to elucidate the cause of a racial disparity in maternal deaths. We reviewed all maternal deaths (cases) at UAB Hospital from January 1990 through December 2010 identified based on electronic uniform billing data and ICD-9 codes. Each maternal death was matched 2:1 with women who delivered at a time that most closely coincided with the time of the maternal death in 2-step selection process (electronic identification and manual confirmation). Maternal variables obtained were comorbidities, duration of hospital stay, cause of death, race, distance from home to hospital, income, prenatal care, body mass index, parity, insurance type, mode of delivery, and marital status. The strength of univariate associations of maternal variables and case/control status was calculated. The association of case/control status and race was also examined after controlling for residential distance from the hospital. There was insufficient evidence to suggest racial disparity in maternal death. The proportion of African American women was 57% (42 of 77) in the maternal death group and 61% (94 of 154) in the control group (P = 0.23). The univariate odds ratio for maternal death for African American to Caucasian race was 0.66 (95% confidence interval [CI], 0.37-1.19); the adjusted odds ratio was 1.46 (95% CI, 0.73-3.01). Longer compared with shorter distance of residence to the hospital was a highly significant predictor (P < 0.001) of maternal death. We did not observe a racial disparity in maternal deaths at UAB Hospital. We suggest that the next step toward understanding racial differences in maternal deaths reported in the United States should be directed at the health care delivery outside the tertiary care hospital setting, particularly at eliminating access barriers to health care for all women.

Abstract 3715: Increasing access for disparate women to participate in breast cancer research

Abstract The purpose of our study is to increase recruitment of rural and disparate populations within the Spit for the Cure Breast Cancer Cohort. The Spit for the Cure Breast Cancer Cohort being established at the University of Arkansas for Medical Sciences provides a repository of information and DNA samples to study breast cancer in Southern women. Currently, over 19,000 women from Arkansas and surrounding states have been recruited into the cohort. Demographics of the cohort closely match the demographics of the state of Arkansas, though our cohort is better educated and younger on average than the state's overall female population. One of our goals is to over-sample disparate populations in rural areas, which presents many challenges; these areas tend to have sparse populations which are located in largely agricultural areas of Arkansas. Furthermore, it has been reported in literature that a lower percentage of minority populations and rural populations participate in biorepositories and cancer research. These are the same populations that suffer from limited access to health services. The assumption is that these populations are not willing to participate in cancer research; however, we hypothesize that disparate populations would enroll in research studies if given access to research opportunities. As a novel method for reaching underrepresented populations, Spit for the Cure recruiters collaborated with a mobile mammography unit, the Mammovan, based out of the Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences. We compared the demographics of participants recruited through community events in Southeast Arkansas, whose residents live in the rural Delta region, to recruitment from the Mammovan in that same region. Mammovan participants from Southeast Arkansas had a lower education level compared to women in that same area recruited through community events; 53.7% of Mammovan participants had no education beyond high school, compared to 25% of community participants (p-value &amp;lt;0.0001). Also, a greater proportion of African American women were recruited through the Mammovan (40.3%) compared to community events (31.1%) within the southeast region (p-value 0.01). Overall, the recruitment of Mammovan participants more closely reflects the actual demographics of the population of Southeast Arkansas. Interestingly, a high proportion of the Mammovan participants (81.8%) reported having had a mammogram prior to their Mammovan experience; indicating that these marginalized groups with limited access to health care facilities, are still able to leverage available resources in order to address their health needs. In conclusion, traveling with the mobile mammography unit is a valuable resource for the Spit for the Cure Breast Cancer Cohort to recruit disparate populations, who are in fact willing to participate, in order to more accurately mirror the demographics of Arkansas women. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3715. doi:10.1158/1538-7445.AM2011-3715

The Context Matters: The Effects of Single‐Member versus At‐Large Districts on City Council Diversity

Scholars continue to debate the degree to which electoral institutions matter for representation. The literature predicts that minorities benefit from districts while women benefit from at‐large elections. The mechanisms by which institutions affect the ability of traditionally underrepresented groups to win seats have been understudied. Using an analysis of over 7,000 cities and interviews with city councilors, we find that compared to at‐large systems, district systems can increase diversity only when underrepresented groups are highly concentrated and compose a substantial portion of the population. In addition, we find that the electoral system has a significant effect on representation only for African American male and white female councilors; the proportion of African American women and Latina councilors is not affected by the use of either district or at‐large systems.

The Breastfeeding Decision: Racial/Ethnic Differences

The Northside Breastfeeding Campaign is a community-based effort to create a supportive breastfeeding environment in an economically-disadvantaged community in Minneapolis, MN by changing community norms and health professional practices. A survey to assess women's infant feeding decision was conducted as part of baseline data collection. We obtained responses from 433 (83%) English-speaking women who delivered babies at 2 hospitals in April and May 1998. Several differences between racial/ethnic groups were found. While 56% of Caucasian women and 60% of other women (American Indian, Asian/Pacific Islander, Hispanic, other) decide before pregnancy how to feed their babies, only 37% of African-American women decide at this time. African-American mothers are more likely to decide during pregnancy (54%). Caucasian women are more likely to exclusively breastfeed (67%). African Americans have the lowest proportion of women who start out either exclusively breastfeeding (24%) or both bottle and breastfeeding (21%) at the hospital. While many women make the decision themselves (47% African-American, 61% Caucasian, and 55% Other), African-American women also rely on family members (7%), doctors (6%), and WIC staff (4%) to help them make the decision. Family members are also consulted by Caucasian women (11%). Compared to Caucasian breastfeeders, a higher proportion of African American women expect to quit breastfeeding by 6 weeks (18% vs. 10%); however, more African American women plan to continue breastfeeding beyond one year (16% vs. 8%). Survey results are being used to plan effective strategies to increase breastfeeding initiation rates and duration in this community. The survey will be repeated to evaluate campaign effectiveness after one year.

Sociodemographic Analysis of Patients in Radiation Therapy Oncology Group Clinical Trials

Purpose: To assess the degree to which the sociodemographic characteristics of patients enrolled in Radiation Therapy Oncology Group (RTOG) clinical trails are representative of the general population. Methods and Materials: Sociodemographic data were collected on 4016 patients entered in 33 open RTOG studies between July 1991 and June 1994. The data analyzed included educational attainment, age, gender, and race. For comparison, we obtained similar data from the U.S. Department of Census. We also compared our RTOG data with Surveillance Epidemiology and End Results (SEER) data for patients who received radiation therapy, to determine how RTOG patients compared with cancer patients in general, and with patients with cancers at sites typically treated with radiotherapy. Results: Overall, the sociodemographic characteristics of patients entered in RTOG trials were similar to those of the Census data. We found that, in every age group of African-American men and at nearly every level of educational attainment, the proportion of RTOG trial participants mirrored the proportion in the census data. Significant differences were noted only in the youngest category of African-American men, where the RTOG accrues more in the lower educational categories and fewer with college experience. For African-American women, we found a similar pattern in every age group and at each level of educational attainment. As with men, RTOG trials accrued a considerably larger proportion of younger, less educated African-American women than the census reported. Using SEER for comparison, the RTOG enrolled proportionately more African-American men to trials all cancer sites combined, and for prostate and head and neck cancer. In head and neck trials, the RTOG enrolled nearly twice as many African-American men than would be predicted by SEER data. In lung cancer trials, RTOG underrepresented African-American men significantly; however, there was no difference for brain cancer trials. There were no racial differences in RTOG accrual and SEER incidence data for women on trials in brain, lung, and head and neck cancer. However, the RTOG trials accrued nearly twice the proportion of African-American women in cervical cancer trials and in all sites combined, compared to the SEER data. Conclusions: Comparisons with the U.S. Census and SEER show that African-Americans are proportionally well represented in cancer clinical trials conducted by the Radiation Therapy Oncology Group. The comparative analysis indicates that all educational levels in each age group of African-Americans generally mirror the U.S. Census, with one exception. The exception is a significant overrepresentation of less-educated African-Americans in the youngest age category. This exception is counter to the expectation that better-educated patients are more likely to enroll in trials. When compared with SEER data, the RTOG trials either parallel or overrepresent African-American men and women, with the only exception being in lung cancer, where men are underrepresented. These results show that, in comparison to the Census and SEER data, the RTOG has fulfilled its commitment to enroll African-American patients in its clinical trials.