Racial Groups Research Articles

Perceived Vulnerability to Disability-Related Victimization in People With Multiple Sclerosis: Community Survey on Risk and Protective Factors.

The perception that one is at increased risk of interpersonal victimization or violence can deleteriously affect community participation and quality of life. Race, sex, and disability status, often associated with use of an assistive mobility device (AD), are known correlates of perceived risk of victimization; however, almost no research has explored how these variables intersect for individuals with multiple sclerosis (MS), and none have sought to identify potential risk and protective factors. Data for the present study come from a single time point derived from a 10-year longitudinal survey of 446 individuals with MS. Lifetime trauma exposure, personal resilience and self-efficacy, control over participation, and perceived risk of interpersonal victimization due to disability were all assessed via self-report. Statistical analyses included analysis of covariance with participants stratified by race/ethnicity, sex, and AD use. After controlling for lifetime trauma exposure and severity of physical impairment, the use of an AD was significantly associated with greater perceived risk of victimization due to disability. Further, people with MS from racial and ethnic minority groups who used ADs had the highest perceived risk relative to all other groups. Higher levels of perceived risk were associated with a lower sense of control over community participation, lower resilience, and lower disease management self-efficacy. Visible indicators of disability may contribute to perceptions of vulnerability, especially among people with MS who are racially and ethnically marginalized. Clinicians should be aware of how perceived vulnerability may impact a sense of control over community participation, particularly when educating patients on AD use.

Alzheimer Dementia Among Individuals With Down Syndrome

With the advancement in administrative data as a research tool and the reliance on public health insurance for individuals with Down syndrome, population-level trends in Alzheimer dementia in this population are beginning to be understood. To comprehensively describe the epidemiology of Alzheimer dementia in adults with Down syndrome in a full US Medicare and Medicaid sample. This cohort study included 132 720 adults aged 18 years or older with Medicaid and/or Medicare claims data with an International Statistical Classification of Diseases and Related Health Problems code for Down syndrome. Data were collected from January 1, 2011, to December 31, 2019, and analyzed from August 2023 to May 2024. The main outcome was prevalence of Alzheimer dementia in each calendar year and during the 9-year period. Alzheimer dementia incidence rates by calendar year and age and stratified for race or ethnicity as well as time to death after Alzheimer dementia diagnosis were also assessed. There were 132 720 unique adults with Down syndrome from 2011 to 2019: 79 578 (53.2%) were male, 17 090 (11.7%) were non-Hispanic Black, 20 777 (15.7%) were Hispanic, 101 120 (68.8%) were non-Hispanic White, and 47 692 (23.3%) had ever had an Alzheimer dementia diagnosis. Incidence was 22.4 cases per 1000 person-years. The probability of an incident Alzheimer dementia diagnosis over 8 years was 0.63 (95% CI, 0.62-0.64) for those entering the study between ages 55 to 64 years. Mean (SD) age at incident diagnosis was 54.5 (7.4) years and median (IQR) age was 54.6 (9.3) years. Mean (SD) age at death among those with Alzheimer dementia was 59.2 (6.9) years (median [IQR], 59.0 [8.0] years). The mean (SD) age at onset for the Hispanic group was 54.2 (9.2) years, 52.4 (7.8) years for the American Indian or Alaska Native group, and 52.8 (8.2) years for the mixed race groups compared with 55.0 (7.8) years for the White non-Hispanic group. For age at death, there were no differences by sex. The mean (SD) age at death was later for the White non-Hispanic group (59.3 [6.8] years) compared with the Hispanic group (58.5 [7.8] years), Native American group (57.8 [7.1] years), and mixed race group (58.2 [7.0] years). In this cohort study of adults with Down syndrome who were enrolled in Medicaid and Medicare, Alzheimer dementia occurred at high rates. Consistency with clinical studies of dementia in Down syndrome supports the use of administrative data in Down syndrome-Alzheimer dementia research.

Disparities in Syphilis Trends and the Impact of the COVID-19 Pandemic: A Joinpoint Analysis of Florida Surveillance Data (2013-2022).

Syphilis, a sexually transmitted infection caused by the bacterium​​​​​​Treponema pallidum, has reemerged at an increasing rate globally in recent years, posing a significant public health concern. Visualizing and analyzing time series trends of syphilis across various demographics and geographic regions, and how syphilis trends varied during the pandemic coronavirus disease 2019 (COVID-19), would help public health policymakers develop targeted strategies and interventions to effectively address the rising rates of syphilis, ultimately improving overall public health outcomes. A retrospective study was conducted using surveillance data on infectious syphilis cases reported to the Florida Department of Health, between 2013 and 2022. Age-standardized syphilis rates (ASSRs) per 100,000 persons were calculated using the 2000 U.S. standard population data. The average annual percentage change (AAPC) in the ASSRs was analyzed according to age, gender, race, geographic locations, and the COVID-19 pandemic period to quantify the epidemiological syphilis trends using joinpoint regression models. In Florida, the ASSR significantly increased from 8.65/100,000 in 2013 to 23.08/100,000 in 2022 across different demographic groups, with an overall AAPCof 11.47 (95% confidence interval (CI): 9.85-13.43). This increase in the AAPC was more pronounced in females (AAPC= 20.97; 95% CI, 18.61-24.49) than in males (AAPC = 10.34; 95% CI, 8.19-12.98). The increasing trends of infectious syphilis were observed across all age groups, with greater increases among those aged 25-49 years (AAPC = 12.32; 95% CI, 10.09-15.18), aged 50-69 years (AAPC= 13.42; 95% CI, 9.41-18.89), and aged over 70 years (AAPC= 13.63; 95% CI, 9.23-21.95), compared to those aged less than 24 years (AAPC= 7.86; 95% CI, 7.06-8.81). The increasing trends were comparable across racial groups, with an AAPC of 8.08 (95% CI, 5.47-11.15) for Hispanics, 11.84 (95% CI, 10.02-14.09) for non-Hispanic Whites, 10.49 (95% CI, 8.75-12.66) for non-Hispanic Blacks, and 11.29 (95% CI, 5.28-19.57) for non-Hispanic individuals of other races, respectively. The AAPCfor the COVID-19 pandemic period was 12.99 (95% CI, 8.48-16.21), which was comparable to the pre-pandemic period (AAPC= 11.58; 95% CI, 10.17-12.76), indicating that this upward trend in infectious syphilispersisted throughout the COVID-19 pandemic. At the county level, over the 10-year period, the average ASSRs ranged from 0.89/100,000 in 2013 to 25.41/100,000 in 2022, with the estimated AAPCs varied from 2.47 (95% CI, -1.89 to 6.92) in Monroe County to 50.01 (95% CI, 37.71-62.27) in Okaloosa County. The trend of infectious syphilis increases substantially from 2013 to 2022, with notable differences observed among age, gender, and geographic regions in Florida. Females experienced a greater rise in infectious syphilis cases compared to males. This upward trend in infectious syphilispersisted throughout the COVID-19 pandemic. Efforts are needed to implement strategies to address the rising syphilis rates within high-incidence groups and communities across the state.

Abstract A155: Perceived interpersonal racism in healthcare settings and cancer screening

Abstract Introduction: Black and Hispanic people frequently report that perceptions of their race or ethnicity underlie racist and discriminatory experiences in many settings. In the healthcare field, these interpersonal racist experiences can severely impact the decision to receive care and the general health of the patient. Previous studies assessing the role of perceived racial discrimination in the healthcare setting and cancer screenings struggled with low sample sizes that precluded meaningful conclusions. Also, a methodological issue not considered in prior studies is the large degree of uncertainty reported by racialized groups in their assessment of perceived racism and its relevance to the measurement of this construct. In response to these data limitations and newly available nationally representative Behavioral Risk Factor Surveillance System data, we assessed the relationship of perceived racial discrimination in the healthcare setting associated with timely cancer screening across racial/ethnic groups. Methods: Data was collected from the 2022 Behavioral Risk Factor Surveillance System, which is a nationally representative state level population-based household survey with 28 states and the District of Columbia administering the optional modules assessing perceived racial discrimination. Perceived racism in healthcare was measured with the question: “Within the past 12 months when seeking health care, do you feel your experiences were worse than, the same as, or better than for people of other races?”. The outcomes were USPSTF recommendation concordant up-to-date colorectal, cervical, and breast cancer screening. Survey weighted logistic regression models adjusted for age, sex, education, and state estimated prevalence differences stratified by race/ethnicity. Results: Colorectal, cervical, and breast cancer screening were lower in White persons who reported worse (aPD vs. "better": -11.6%, -15.8%, -19.3%) and uncertain (don’t know) experiences of racial discrimination (aPD vs. "better": -7.4%, -4.1%, -5.0%). Among Black people, colorectal and cervical screening were only lower in those reporting uncertain experiences (aPD vs. "better": -10.8% and -12.0%). Among Hispanic persons, breast cancer screening prevalence was lowest in those who reported uncertain and worse racial discrimination (aPD vs. “better”: -12.4% and -15.9%). Conclusions: In this large generalizable sample, perceived racial discrimination in the healthcare setting was associated with cancer screening for both White and Black persons, but in different ways. Worse interpersonal racism in the healthcare setting was associated with lower cancer screening in White persons; but being uncertain relative to other race groups was largely associated with worse cancer screening among Black persons. Uncertainty in self-reported, racist experiences must be considered in institutional efforts to measure and address racism in healthcare settings. Citation Format: Jessica Star, Priti Bandi, Kilan Ashad-Bishop. Perceived interpersonal racism in healthcare settings and cancer screening [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A155.

Abstract C126: Disparities in time-to-treat insured patients with newly diagnosed cancer in a vertically integrated healthcare system

Abstract Purpose. After a cancer diagnosis, delays in initiating treatment may impact treatment response, disease progression, adverse health events, and overall survival. Race and socioeconomic status (SES) may be factors in initiating cancer treatment. Complicating this issue is the lack of insurance or underinsurance. Thus, the purpose of this study was to assess the influence of race/ethnicity and SES on time to treatments for insured patients diagnosed with cancer in a vertically integrated healthcare system. Methods. We conducted a cross-sectional nested study within a cohort of patients diagnosed with cancer between 2010 and 2018 from Kaiser Permanente Southern California (KPSC), a vertically integrated healthcare system. Patients of all ages and all cancer anatomical sites were included. Patients with in-situ cancers were excluded, with no other exclusion criteria. The main independent variables are race/ethnicity and SES, and the dependent variable is time to initial treatment. All information was pulled from the KPSC Cancer Registry, including race/ethnicity, and treatments (surgical; radiation; chemotherapy; immunotherapy; hormonal). SES was categorized into quintiles based on geocoded expected income using home addresses from census tract data. For each patient, we calculated days from diagnosis to first treatment. Results. We identified 153,270 patients of all ages with cancers of all anatomical sites diagnosed between 2010 and 2018, of which 125,943 received treatment. When examining racial groups, the mean time to treatment for White, Black, Hispanic, Asian/PI, and other patients was 42.5, 52.6, 44.3, 44.1, and 41.2 days, respectively. For White patients, mean time to treatment was 42.4 days in the lower 20% income quintile and 42.7 days in the top 20% income quintile. For Black patients, mean time to treat was 53.9 days in the lower 20% income quintile and 52.8 days in the top 20% income quintile. For Hispanic patients, mean time to treat was 45.8 days in the lower 20% income quintile and 42.1 days in the top 20% income quintile. For Asian/PI patients, mean time to treat was 44.1 days in the lower 20% income quintile and 43.5 days in the top 20% income quintile. For other patients, mean time to treat was 51.4 days in the lower 20% income quintile and 39.2 days in the top 20% income quintile. Within each SES quintile, Black patients consistently started cancer treatment later than other racial/ethnic groups. Conclusion. We found minimal disparities in time to initial treatment based on SES in this vertically integrated system of care. Within each of the White, Black, and Asian racial groups, the difference in time to treatment between the highest and lowest SES groups was less than 2%. This difference was closer to 7% in Hispanic patients. Additional work is necessary to elucidate reasons why Black patients initiate cancer treatments later than other racial groups and if this affects recurrence or survival. Citation Format: Robert Cooper, Reina Haque, Andrea Young, Zimin Zhuang. Disparities in time-to-treat insured patients with newly diagnosed cancer in a vertically integrated healthcare system [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C126.

Abstract B131: Disparities in late-stage breast cancer: The impact of socioeconomic status across racial groups by healthcare utilization and community healthcare access

Abstract BACKGROUND: Late-stage breast cancer (LSBC, defined as stage 3 or 4) significantly contributes to breast cancer (BC) mortality, underscoring the importance of early detection and intervention. Understanding the individual and community factors contributing to LSBC is crucial for improving LSBC diagnoses and outcomes. OBJECTIVE: To evaluate the association between LSBC and individual demographic/socioeconomic status (SES) characteristics by race, and describe differences in individual healthcare utilization (IHU) and community healthcare access (CHA). Methods: This population-based retrospective study used demographic and SES data (age at diagnosis, marital status, years of education, income, poverty status, health insurance, and body mass index) from the Carolina BC Study Phase 3, a population-based cohort of women diagnosed with invasive BC from 2008-13. We analyzed all cases of LSBC (n=545) and stage 1 (n=1,225). Age-adjusted relative frequency differences (RFDs) and 95% confidence intervals (CIs) assessed the relationship between LSBC and SES for Black (n=835, 47.2%) and non-Black (n=935, 52.8%) women. Analyses were stratified by IHU status (High vs Low: High: Had regular pre-diagnostic care and were adherent to BC screening guidelines, >0.5 mammograms per year; Low: Lacked one or both forms of care); and stratified by CHA status (High vs Low), a census tract-level measure of cancer-specific healthcare infrastructure (e.g., oncologist density) and utilization (e.g., insurance rates). High CHA had either high or low infrastructure and high use; Low CHA had low infrastructure and low use. Results: Compared to non-Black women, Black women had more LSBC diagnoses (38.7% vs 23.7%), were more likely to be unmarried (59.1% vs 28.7%), have an income of <$50k (71.8% vs 38.2%), and be impoverished (27.0% vs 6.1%). Age at diagnosis, years of education, and income were significantly, positively associated with LSBC for all women, but the age-adjusted RFDs were greater among Blacks. After stratifying by IHU, income remained significantly associated with LSBC for Blacks with low IHU. For those with high IHU, the effects of SES on LSBC were not statistically significant. After stratifying by CHA, income and poverty status were significantly positively associated with LSBC for all women with high CHA; Marital status was significantly associated with LSBC for Blacks. Among the low CHA group, income and poverty were significantly associated for Blacks; RFDs were not estimable for non-Blacks due to small sample size (n=66). Notably, 36.5% of Blacks lived in low CHA areas compared to 7.1% of non-Blacks. Conclusion: Healthcare access exacerbates the effects of IHU but does not mitigate the impact of demographic/SES characteristics on LSBC diagnoses. Enhancing CHA alone is insufficient. Targeted interventions addressing individual and community factors are crucial to reduce LSBC diagnoses and improve outcomes, especially for Black women. Citation Format: Joel A. Begay, Brittney A. Gedeon, Matthew R. Dunn, Melissa A. Troester, Marc A. Emerson. Disparities in late-stage breast cancer: The impact of socioeconomic status across racial groups by healthcare utilization and community healthcare access [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B131.

Abstract B149: Investigating Disparities in Cost-Associated Barriers to Medication Adherence in Breast Cancer Survivors in the National Institutes of Health All of Us Research Program

Abstract Purpose: Medication adherence (e.g., endocrine therapy, antihypertensives) during survivorship remains suboptimal. Racial disparities in medication adherence continue to persist, yet reasons for this disparity are not fully understood. This study aimed to assess racial differences in cost-associated barriers to medication adherence. Methods: This cross-sectional analysis utilized data from the National Institutes of Health All of Us Research Program. Cohort eligibility included identifying as Black/African American or White, being at least 18 years old, and having a diagnosis of breast cancer. Survivors must have completed the Healthcare Access and Utilization survey, a validated assessment of factors impacting healthcare behaviors. Comparisons between patient characteristics (e.g., age, annual income, marital status, employment, education, etc.) and survey responses were analyzed by race using Pearson’s chi-square tests. Univariable and multivariable logistic regression models were fitted to investigate the unadjusted and adjusted associations of cost-related barriers to medication adherence and race. Results: Among the 1,840 breast cancer survivors included in this cohort, the mean age was 63.8 (standard deviation (sd) = 10.4). The majority of survivors were White (94.3%) (5.7% Black), married (58.9%) and unemployed (57.4%). The mean score for racial discrimination in healthcare was 10.3 (sd = 3.8) (range = 7 - 35). Most survivors did not report any cost-related barriers to adherence (74.9%); however, 19.5% of survivors asked their doctor for lower cost medication to save money. When compared with White survivors, a higher proportion of Black survivors reported that they could not afford prescription medicines (6.5% vs. 12.4%). In the multivariable model, no significant association by race was observed (p=0.387). Survivors who reported annual household income levels above $50k were less likely to report cost-reported barriers when compared to survivors who reported a household income of <$25k (p<0.001). Each one-point increase in perceived discrimination in healthcare increased the odds of reporting a cost-related barrier to adherence by a factor of 1.10 (95% confidence interval: 1.07, 1.13). Conclusions: Although racial differences were not noted for overall cost-related barriers, results highlight a need to understand nuanced differences in perceived cost-related barriers to adherence and how survivors navigate those differences. Further research is needed to understand providers’ roles in encouraging medication adherence and how discrimination in healthcare may serve as a barrier to adherence. Citation Format: Arnethea L. Sutton, Jian He, Lakeshia Cousin, Keesha Powell-Roach, Mandy J. Hill, Wendy Bottinor. Investigating Disparities in Cost-Associated Barriers to Medication Adherence in Breast Cancer Survivors in the National Institutes of Health All of Us Research Program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B149.

Abstract A025: Trends in liver cancer mortality by sex, race, and ethnicity in California from 2000-2019

Abstract Background: Liver cancer disproportionately affects foreign-born individuals and racial and ethnic minoritized groups, with higher incidence among Asian American/Pacific Islander (AAPI) and Hispanic populations than non-Hispanic (NH) White populations. California has one of the highest overall mortality rates from liver cancer and a large proportion of AAPI and Hispanic residents compared to other U.S states. While prior studies have examined racial and ethnic disparities in liver cancer incidence and treatment, few studies have examined trends in liver cancer mortality in California by sex, race, and ethnicity. Methods: Adults aged 20+ years diagnosed with first primary malignant liver and intrahepatic bile duct cancer from January 2000 through December 2019 were identified through the California Cancer Registry, a statewide population-based cancer registry. We used SEER*Stat software to compute age-adjusted mortality rates (per 100,000 population; standardized to the 2000 U.S. standard million population) by sex, race, and ethnicity. To analyze temporal trends of mortality rates, we calculated annual percent change (APC) using Joinpoint regression. Results: Overall, the mortality rate of liver cancer increased from 8.05 to 10.75 per 100,000 (average APC=1.53, 95% CI 1.23, 1.82) from 2000-2019. For males, rates increased from 11.39 in 2000 to 15.77 until 2013 (APC=2.53, 95% CI 2.07, 3.21), and stabilizing thereafter (APC=-0.74, 95% CI -2.37, 0.30). In contrast, for females, mortality rates increased continuously from 2000-2019 from 5.27 to 7.17 (APC=1.63, 95% CI 1.27, 2.04). Across racial and ethnic groups, the mortality rate for liver cancer was highest for the AAPI adults at 16.77 in 2000, and this decreased over time to 12.29 in 2019 (APC=-3.17, 95% CI -5.36, -2.24). Similarly, the liver cancer mortality rate among Hispanic adults increased initially and then decreased. Mortality among non-Hispanic Black adults increased from 10.98 in 2000 to 12.99 in 2019 (APC=0.89, 95% CI -0.07, 2.02), though this did not reach statistical significance. The liver cancer mortality rate was lowest among non-Hispanic White adults from 5.65 in 2000 but increased over time to 7.87 in 2019 (APC=1.76, 95% CI 1.39, 2.08), which is still the lowest compared to other racial and ethnic groups. Discussion: In contrast to studies that show a decline in liver cancer mortality in recent years, liver cancer mortality rates have continued to increase in California, particularly for females. Liver cancer mortality rates initially increased for AAPI and Hispanic populations but have started to stabilize. Next steps are to understand multilevel drivers contributing to these trends in liver cancer mortality in California, including individual sociodemographic and clinical factors, healthcare system factors, and neighborhood factors, including neighborhood socioeconomic status and ethnic enclaves. Citation Format: Janet N. Chu, Meera Sangaramoorthy, Meg Mckinley, Stephen Li, Mindy C. DeRouen, Alice Guan, Michele M. Tana, Ma Somsouk, Caroline A. Thompson, Chanda Ho, Hashem B. El-Serag, Iona Cheng, Scarlett L. Gomez, Salma Shariff-Marco. Trends in liver cancer mortality by sex, race, and ethnicity in California from 2000-2019 [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A025.

Abstract B111: A needs assessment of genetic and hereditary breast cancer awareness in Southern California women diagnosed with a genetic mutation

Abstract Background: Breast cancer is a global public health dilemma, considering the public awareness the issue has garnered over the years it continues to be diagnosed in advanced stages. Genetic mutations can increase the risk of developing breast cancer. Literature findings have identified the lack of knowledge surrounding genetic breast cancer susceptibility. Methods: In partnership with Southern California Chapter of The Breasties (SoCal Breasties), an all inclusive nonprofit organization that creates a community for survivors, previvors, thrivers, and caregivers impacted by breast and gynecological cancers, 20 women with a breast cancer related genetic mutation diagnosis were surveyed in a cross-sectional study to determine the need for health education on breast cancer genetic susceptibility. Of the 20 women surveyed, the racial/ethnic identities of the respondents is as follows: 10% identified as Asian American/Pacific Islander; 5% identified as Black; 35% identified as Hispanic/Latinx; 5% identified as “Mixed Race: Black, White”; 40% identified as White; and 5% identified as Ashkenazi Jewish, White. Results: 70% of survey respondents identified not having adequate knowledge of genetic breast cancer susceptibility prior to diagnosis. When looking at racial and ethnic groups, Black, Hispanic/Latinx, and Asian American/Pacific Islander women made up 71% of the population that lacked proper knowledge of the topic when compared to their white counterparts. 75% identified health education as the most needed resource for genetic breast cancer susceptibility. When asked to share one piece of insight, the most common sentiment expressed was “Knowledge is Power.”Conclusions: There is a need for greater health education on genetic breast cancer susceptibility, especially in racial and ethnic minority populations. Health educators and public health professionals should consider generating awareness campaigns and partnering with community based organizations to disseminate proper knowledge. In addition, resources and awareness campaigns should be culturally tailored and linguistically appropriate to meet the needs of all racial and ethnic groups. Citation Format: Dayanara Ruiz. A needs assessment of genetic and hereditary breast cancer awareness in Southern California women diagnosed with a genetic mutation [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B111.

Abstract C155: Differential colorectal cancer mortality across racial and ethnic groups: Impact of socioeconomic status, clinicopathology, and treatment-related factors

Abstract Introduction: Non-Hispanic Black colorectal cancer (CRC) patients have a higher risk of mortality compared to most other racial/ethnic groups. Limited studies examine the contribution of socioeconomic (SES), clinicopathologic, or treatment variations toward mortality disparities. This retrospective cohort investigation examined the extent to which SES, clinicopathologic, and treatment factors explain racial/ethnic differences in CRC mortality. Methods: We studied 146,515 individuals ,18+ years old, with a confirmed diagnosis of CRC within 2010-2017 identified from the Surveillance, Epidemiology, and End Results (SEER) database. We performed Cox regression analyses to examine the association of race/ethnicity, surgery type, and tumor site with all-cause mortality and CRC-specific mortality. We then performed mediation analysis to quantify the extent to which mortality differences were mediated by SES, clinicopathologic, and treatment factors. Results: Non-Hispanic Black patients had a significantly higher hazard of all-cause mortality than non-Hispanic White patients. The non- Hispanic White versus non-Hispanic Black patients’ comparison demonstrated that variations in SES and clinicopathologic factors significantly explained 46.63% (indirect effect HR: 0.92, 95% CI 0.91-0.93) and 10.87% (indirect effect HR: 0.98, 95% CI 0.97-99) of the excess all-cause mortality among non-Hispanic Black patients, respectively. The Hispanic vs. non-Hispanic Black comparisons identified SES as the most influential mediator, explaining 19.68% of the excess all-cause mortality. The proportions mediating for CRC-specific mortality showed comparable outcomes to all-cause mortality. Conclusions Non-Hispanic Black patients had greater risk for all-cause mortality and CRC-specific mortality attributed to SES and clinicopathologic variations compared to other racial/ethnic groups. Future studies should investigate equity in healthcare through interventions addressing SES-related disparities. Citation Format: Pierre Fwelo, Toluwani E. Adekunle, Tiwaladeoluwa B. Adekunle, Ella R. Garza, Emily S. Huang, Wayne R. Lawrence, Aldenise P. Ewing. Differential colorectal cancer mortality across racial and ethnic groups: Impact of socioeconomic status, clinicopathology, and treatment-related factors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C155.

Abstract C150: Evaluating breast cancer risk by race and ethnicity using the Tyrer Cuzick and Gail models in the Komen Tissue Bank cohort

Abstract Introduction: Breast cancer is the second leading cause of cancer death in women after lung cancer in the United States. While early detection is critical to reducing morbidity and mortality, predication of individualized risk is important in prevention and could also reduce unnecessary costs related to screening. The Susan G. Komen Tissue Bank (KTB) at Indiana University is the only tissue bank in the world that provides breast tissue specimens donated by healthy individuals to further to breast cancer research; however, as donors are volunteers, it is not clear how representative they are with respect to breast cancer risk compared to the general population. Methods: In this study, we calculated Breast Cancer Risk Assessment scores using Tyrer Cuzick (TCZ) and the Breast Cancer Risk Assessment Tool (The Gail Model, GM) in the KTB cohort by race and ethnicity. Recruited between 2007 and 2023, the participants completed a questionnaire encompassing their demographics, personal health and reproductive history, family history, and modifiable risk factors like smoking and alcohol use. In both models, participants with a lifetime risk of breast cancer of more than 15% were classified as having higher than average risk, while those with a risk of less than 15% were classified as having an average risk. Data analysis was performed using SAS v.9.4 software. Statistical significance was determined by p-values <0.05. Results: Out of 5118 participants, 206 with prior breast cancer and 37 male donors were excluded, resulting in a final sample of 4875 participants (aged 18–90) for analysis. The cohort was predominantly non-Hispanic white (NHW, 69.73%), followed by non-Hispanic black (NHB, 16.7%), Hispanic (8. 6%), and Asian individuals (3.3%), with 1.8% reporting multiracial or other race. The GM consistently categorized fewer women as having higher than average risk compared to the TZM. Across both TCZ and GM, the percentages of individuals classified as higher than average risk was greatest for NHW women, with 29.2% being categorized as higher than average risk in the TCZ, compared to 21.0% in the GM. The greatest discordance between the models was seen in NHB women, with the TCZ estimating 25.2% were at greater than average risk, and the GM only reporting 3.7% to be at greater than average risk. Overall, risk assessment scores varied across racial and ethnic groups (p- value<0.001). Factors driving these differences will be presented in additional analyses. Conclusion: There are known limitations in breast cancer risk assessment models by race and ethnicity that were confirmed in the women who comprise the KTB cohort. Donors to the KTB are generally representative of the US population with respect to breast cancer risk. As the KTB cohort continues to grow and mature, it can be utilized to assess breast cancer risk models for various racial and ethnic groups to assist in the identification of high-risk individuals that may benefit from prevention strategies and targeted screening. Citation Format: Vidya Patil, Michele L. Cote, Jenny Cui. Evaluating breast cancer risk by race and ethnicity using the Tyrer Cuzick and Gail models in the Komen Tissue Bank cohort [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C150.

Abstract C157: Unraveling Early Onset Disparities and Determinants: A Two-decade Analysis of Colorectal Cancer Trends in Texas

Abstract Background: Colorectal cancer (CRC) remains a significant public health concern in the United States, with substantial disparities observed in survival rates and age at diagnosis among different racial and ethnic groups. In Texas counties bordering Mexico, which have predominantly Hispanic populations, show higher CRC diagnoses. Hispanic patients generally exhibit lower screening rates, higher mortality, and late-stage diagnosis compared to non- Hispanic counterparts. Understanding the factors behind these disparities is crucial for developing targeted interventions to improve outcomes and reduce the burden of CRC. Methods: Using data from the Texas Cancer Registry, a retrospective study examined CRC survival rates and age at diagnosis among 235,076 patients of various racial and ethnic groups in Texas from 1995 to 2016. The association between Race and ethnicity and survival time over two periods (1995-2005 and 2006-2016) was analyzed using Kaplan-Meier survival analysis and pairwise comparisons. Additionally, the effects of Race and ethnicity on age at diagnosis were examined for the same periods using Welch ANOVA and posthoc comparisons. Results: Persistent survival disparities were observed, with Black patients facing the lowest median survival times across both periods (1995-2005 and 2006-2016). Hispanic patients showed significantly lower median survival rates compared to their non-Hispanic counterparts. Comparisons between races showed significant differences in median survival time between the two periods (1995-2005 and 2006-2016). Black: Hispanic patients showed no significant improvement in survival time between the periods. Significant improvements in survival time were observed in Black: non-Hispanic, White: Hispanic, and White: non-Hispanic patients. Lastly, the mean age at diagnosis depended on the ethnicity of the patient, with Hispanic patients displaying an earlier onset of CRC compared to non-Hispanic equivalents. Hispanic ethnicity was associated with an earlier onset of CRC compared to non-Hispanic counterparts. Conclusion: Geographic and ethnic disparities significantly influence CRC outcomes in Texas. Hispanic populations in border counties face increased risks due to lower screening and socioeconomic challenges. The rising incidence of early-onset CRC, particularly among younger, socioeconomically disadvantaged, and minority populations, necessitates targeted public health interventions to improve screening, early detection, and treatment access. Addressing these disparities is crucial to enhancing CRC survival rates and reducing mortality across diverse demographic groups. Citation Format: Tyler J Torres, Elias Arellano Villanueva, Yossef Alsabawi, Manish Tripathi. Unraveling Early Onset Disparities and Determinants: A Two-decade Analysis of Colorectal Cancer Trends in Texas [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C157.

Abstract C026: Analyzing the effect of annonacin on diverse breast cancer cell lines as a potential therapeutic agent for triple negative breast cancer

Abstract Triple negative breast cancer (TNBC) grows and spreads faster than most invasive breast cancer. Additionally, available treatment options and prognosis are poor. Due to limited available treatment options, finding the appropriate and effective chemotherapeutic agents for TNBC patients is a key research effort. Importantly, differential therapeutic response reported between ethnic and racial groups has prompted a need for better treatment modalities. In previous studies, Annonacin (Annona Muricata-a plant with anti-inflammatory properties) has been tested and shown to have cytotoxic effects on various cancer cell lines. The objective of this study is to analyze the effects of Annonacin across racial backgrounds. For this study, we used two TNBC cell lines; MDA-MB-468 (derived from a 51-year old African American female) and MDA-MB-231 (derived from a 40-year old Caucasian American female). Our hypothesis is that Annonacin will inhibit cell proliferation in both TNBC cell lines, potentially giving rise to a beneficial therapeutic agent that will address health disparity. To assess the efficacy of Annonacin, cell viability was measured using a MTT assay providing IC50 values for each cell line. The 50% inhibitory concentrations were 8.5 uM and 15 uM for MDA-MB-468 and MDA-MB-231, respectively. Cell cycle analysis was performed using flow cytometry to assess the effect of Annonacin on the induction of cell cycle arrest. MDA-MB-231 was arrested at the G2 phase in a dose-dependent manner. MDA-MB-468 was arrested at the G2 phase at 7.5 uM. Induction of apoptosis was at 15 uM (MDA-MB-468) and 30uM (MDA-MB-231). In addition, protein expression for both cell lines, as determined by western blotting analysis, showed an increase of the cell cycle regulatory proteins cyclin B1 and CDK1 and the apoptotic protein caspase-3. Results for this small sample size demonstrate efficacy of treatment for both racial populations. Further studies analyzing the effect of Annonacin on additional diverse TNBC cell lines, organoids, and patient derived xenografts will advance the progression of alternative treatments for all patients with TNBC. Citation Format: Jennifer Hernandez-Torres, Kelly Argueta Guzman. Analyzing the effect of annonacin on diverse breast cancer cell lines as a potential therapeutic agent for triple negative breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C026.

Abstract C173: Influence of Socio-Demographic and Lifestyle Factors on Lung Cancer Incidence Among African American and European American

Abstract The persistent gap in cancer incidence and outcomes between African American (AA) and European American (EA) populations remains a significant public health challenge. Understanding these discrepancies is pivotal for crafting targeted interventions to mitigate health disparities. To comprehensively assess these inequalities, this study delves into the association between smoking and lung cancer incidence within a diverse cohort of 5270 participants, comprising both AA (868 participants) and EA (3137 participants) individuals. Among the 2901 lung cancer patients identified in our analysis, diagnoses ranged from Malignant Tumors of the Lung to various subtypes of Non-Small Cell and Small Cell Lung Cancer. Surprisingly, only a significant subset of these patients were smokers, with statistical analysis indicating a p<0.001, pointing to other influential demographic factors. Employing the Chi-Square Test of Independence, Logistic Regression, and Multivariate Analysis, we evaluated the impact of smoking alongside additional variables on lung cancer incidence. Factors such as Age, Gender, Socioeconomic Status, Occupational Exposures, Geographic Location, Family History of Cancer, Comorbidities, and Lifestyle Factors were considered in the multivariate analyses to ascertain their contribution to lung cancer risks. Our findings from Relative Risk (RR) and Attributable Risk (AR) assessments suggest that while smoking constitutes a notable risk factor, a substantial proportion of lung cancer cases in this cohort were not linked to smoking. Stratified and Sensitivity Analyses further unveiled nuanced risk profiles within subgroups, elucidating the intricate interplay between lifestyle factors and genetic predispositions. Our study highlights that a significant portion of lung cancer cases, particularly among EA and AA populations, occur in non-smokers, with smoking often associated with other comorbidities rather than solely lung- specific diseases. This underscores the multifaceted nature of lung cancer risk factors across different racial groups, advocating for public health strategies that address a broader spectrum of influences beyond smoking to combat cancer disparities within these communities effectively. Citation Format: Murugesh Eswaran, Briana A Briana A Brock, Hina Abdulrehman Mir, Eric L. Flenaugh, Oprea M. Gabriela, Brian Rivers, Rajesh Singh, Shailesh Singh. Influence of Socio-Demographic and Lifestyle Factors on Lung Cancer Incidence Among African American and European American [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C173.

Abstract C139: Cancer related excess death and potential life years lost among Black Americans

Abstract Introduction: Cancer represents the second leading cause of death in the United States and disproportionately affects Black Americans. In recent years, cancer-related mortality rates have declined for both Black and White Americans. However, mortality rates and rate ratios alone are insufficient for characterizing the burden of cancer disparities between racial groups. Among the most prevalent cancers in the US, we evaluated trends in excess mortality and years of potential life lost between Black and White Americans. Methods: This was a serial cross-sectional study using US national level data from CDC Wonder between the years 1999-2020. We included White and non-Hispanic Black Americans with a cause of death from breast, prostate, lung, colon, bladder, or uterine cancer. We measured age-adjusted excess death as well as excess years of potential life lost for each cancer site among Black and White Americans, stratified by sex when applicable. Annual mortality rates for each cancer site were sourced from the CDC Cancer Statistic Data Visualization tool. Results: The age adjusted mortality rate for all cancers declined between 1999-2020 for Black (257.2 to 166.8 per 100,000) and White Americans (200.9 to 149.3 per 100,000). Site specific cancer mortality rates declined in Black and White Americans for breast, prostate, lung, colon, and bladder cancer, but increased for uterine cancer. Among the most prevalent cancer sites, there were a total of 115,43 excess deaths with 2,093,327 excess years potential life lost for Black men and 59,134 excess deaths with 1,508,052 excess years potential life lost for Black women over a 22-year period. The trend of annual excess death and years potential life lost has slowly increased for Black men with colon cancer as well as Black women with breast and uterine cancer. Annual excess death and years potential life lost in Black men with prostate cancer decreased until 2013 after which it has slowly increased. Conclusion: Despite declining mortality rates in most cancers in the United States, Black Americans still experience a staggering number of excess deaths and years potential life lost due to cancer. Furthermore, the discordance between declining mortality rates and increasing excess death or years potential life lost in breast, prostate, colon, and uterine cancer highlight that racial disparities in cancer care and outcomes are likely worsening among Black Americans. Action is needed to support interventions and organizations committed to addressing cancer health inequities among Black Americans. Citation Format: Daniel S. Carson, Navya Gunaje, Sarah K. Holt, Nana Frimpong, Jenney R. Lee, Liz Sage, Erika M Wolff, Yaw A. Nyame. Cancer related excess death and potential life years lost among Black Americans [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C139.

Abstract A061: The impact of race and obesity on the prostate tumor microenvironment

Abstract Black Americans have the highest prostate cancer incidence and are twice as likely to die from their disease compared to Non-Hispanic White men, making this one of the largest cancer disparities between these two racial groups in the United States. While access to health care is one of the strongest contributors to this disparity, studies suggest biological distinctions exist between tumors from Black and Non-Hispanic White men. Furthermore, obesity is associated with worse prostate cancer outcomes, and research showing a stronger association between obesity and prostate cancer risk among Black men compared to Non-Hispanic White men suggests obesity and Black race may work in combination to create aggressive disease. Hence, we sought to thoroughly and precisely characterize tumors from Black men, with and without obesity, to identify tumor behavior and potential therapeutic options for this population, which to date, has not been done mostly because of the lack of racially diverse cohorts of prostate cancer. Also, we sought to determine the impact of obesity on the composition of the prostate tumor microenvironment, which to date remains unknown. Given that in the US obesity rates are over 40% and the pressing need to better address high-risk populations, it is critical to better understand how obesity and race impact disease biology. We hypothesized obesity and Black race, individually and combined, increase tumor immune infiltration, creating a distinct tumor microenvironment. Specifically, we hypothesized this microenvironment will be characterized by higher overall inflammation, but also will enable us to identify therapeutic targets that in time can lead to the creation of personalized treatments for this population. To test this hypothesis, we used a large and racially diverse patient cohort from men who underwent radical prostatectomy at the Veterans Affairs Medical Center in Durham, North Carolina. To analyze the tumor microenvironment at the single cell level and define spatial organization, we used imaging mass cytometry in tissue microarrays of tumor and normal prostate samples from patients similar in tumor stage. We created a customized marker panel to determine cell phenotype and expression of immune checkpoints. We detected 25 cell phenotypes in the prostate microenvironment and determined differential phenotypic abundance and interactions by race and obesity. Next, we will expand our study to include a larger number of samples and associate tumor microenvironment characteristics with patient recurrence, metastasis, and survival. In this study, we generated new insights into disease drivers in an understudied and disproportionately affected population and lay important groundwork for future research identifying novel therapeutic targets for high-risk populations, such as men with African descent and obesity. Citation Format: Gloria Cecilia Galvan, Simeon Mahov, Sungyong You, Simon Knott, Michael Freeman, Akil Merchant, Stephen J Freedland. The impact of race and obesity on the prostate tumor microenvironment [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A061.

Abstract A070: Real world treatment patterns and patient outcomes of neuroendocrine tumors: A single institution study

Abstract Neuroendocrine tumors (NETs) are rare and diverse, with increasing incidence but poorly understood prognostic variables. While African American or Black patients typically have poorer outcomes across various tumor types, this is not well documented for NETs. Our study aimed to investigate racial disparities in NET outcomes. Patients who had a diagnosis of neuroendocrine tumor between 2014 and 2022 were identified and analyzed in this retrospective chart analysis, with race determined as Caucasian (CA) or Black African American (BAA). Histology was stratified as high grade or those without high grade histology. Grade of tumor was identified as well differentiated, moderately or poorly differentiated, and other/unknown. Log-rank test was conducted to compare the survival curves between CA and AA groups. Cox proportional hazards model was built to adjust for potential confounders, including age at diagnosis and gender (if applicable) while comparing racial disparities. The CA vs. AA hazard ratio (HR) and p-values were calculated. Among the 655 patients analyzed, 63.4% were Caucasian (CA) and 36.6% were Black African American (BAA). The average age at diagnosis across the cohort was 61.5 years. The gender distribution was approximately equal, with 50.2% females and 49.8 % males. High-grade histology was identified in 114 patients, of whom 28.1% were BAA and 71.9% were CA. Within this subgroup, males were more prevalent than females (61.4% vs. 38.6%). Overall survival (OS) for CA patients with high-grade histology was 57.4 months, compared to 67.5 months for BAA patients (p=0.7). Additionally, no statistically significant difference in OS was observed between males and females with high-grade histology (60.8 months vs. 68.1 months, respectively; p=0.3). Analysis of tumor grade revealed that well- differentiated tumors were present in 122 patients (18.63%). Among these patients, there was no statistically significant difference in survival between BAA and CA. The primary tumor site was the colon in 89 patients (13.6%), with 77.5% being CA and 22.5% BAA. Pancreatic tumors were present in 119 patients (18.2%), with 72% being CA and 28% BAA. The next most common primary sites were the small intestine (24.9%), rectum (17.6%), and stomach (9.9%). In comparing survival outcomes between racial groups, CA patients had a significantly worse OS (76.9 months) compared to BAA patients (84.6 months) (p=0.05). Regardless of race, females demonstrated better survival (84.2 months) compared to males (75.7 months) (p=0.04). In our retrospective analysis, Caucasian (CA) patients had worse overall survival (OS) than Black African American (BAA) patients, likely due to a higher proportion of CA patients with high- grade histology and primary tumors in the colon. Females showed better OS than males across all subtypes. The reasons for the higher incidence of worse histology in CA patients are unclear. Larger studies are needed to confirm these findings, understand racial disparities, and develop strategies to mitigate them. Citation Format: Radhika Gutta, Wan-Ting su, Ruicond She, Muhammad Shahid, Gazala Khan. Real world treatment patterns and patient outcomes of neuroendocrine tumors: A single institution study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A070.

Abstract A071: County-level racial and ethnic diversity index and cancer mortality in the U.S.

Abstract Background: The United States is experiencing a demographic trend of increasing racial and ethnic diversity. While persistent racial and ethnic disparities in cancer mortality are well documented, little is known about the impact of racial and ethnic diversity on cancer outcomes in the United States. Purpose: We examined associations between the U.S. county-level racial & ethnic diversity index and age-adjusted cancer mortality rates. We also assessed whether associations differed by geographic region, persistent poverty, and rurality. Methods: We used the U.S. Census Bureau’s 2020 Racial and Ethnic Diversity Index, which estimates the chance that two people chosen at random will be from different racial and ethnic groups. The diversity index was calculated at the county-level and categorized as follows: less than 35% (lowest), 35.0 to 44.9%, 45.0 to 54.9%, 55.0 to 64.9% and 65.0% or more (highest). We described county- level sociodemographic characteristics according to the diversity index categories. We calculated mean and standard errors of the county-level age-adjusted cancer mortality rates per 100,000 from 2016-2020 (overall and by site for the top four sites for cancer mortality) across the diversity index categories. We used multivariable linear regression models to examine associations between racial and ethnic diversity and cancer mortality, overall and by cancer site. We also assessed models stratified by geographic region (U.S. Census regions), persistent poverty and rurality. Results: Counties with more racial and ethnic diversity had a younger median age, a higher proportion of college graduates, and were less likely to be rural. Cancer mortality rates per 100,000 were lower in the most vs. least diverse counties, overall (144.7 vs. 164.6), and for lung (32.5 vs. 44.8), and colorectal cancer (13.0 vs. 15.6). In adjusted models, the highest vs. lowest racial and ethnic diversity was associated with a 7.25 decrease in overall cancer mortality rates (95% CI: -10.5 to -4.0), a 6.55 decrease in lung cancer mortality (95% CI: -8.0 to -5.1) and a 1.49 increase in breast cancer mortality (95% CI: 0.7 to 2.3). The diversity index was not associated with colorectal cancer mortality or pancreatic cancer mortality in adjusted models. Inverse associations of diversity index and overall cancer mortality were strongest in the South Census region (b=-13.0, 95% CI: -17.5 to -8.4), in non-persistent poverty counties (b=-9.0, 95% CI: -12.4 to -5.5), and in rural counties (b=-8.6, 95% CI: -13.2 to -4.1). Conclusions: Greater racial and ethnic diversity was associated with lower overall cancer mortality and lung cancer mortality rates, although it was associated with significantly higher breast cancer mortality rates. Findings help elucidate whether and how social factors may differentially impact subgroups of the population to influence cancer mortality. This study addresses an urgent need to explore contextual factors that may shape racial and ethnic disparities at the population level. Citation Format: Kelly A. Hirko, Breanna Greteman, Sabrina Ford, Sarah H. Nash. County-level racial and ethnic diversity index and cancer mortality in the U.S. [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A071.

Abstract A048: Association between ambient particulate matter and colorectal cancer incidence: The Multiethnic Cohort Study

Abstract Background: Growing evidence suggests that air pollution may be a risk factor for colorectal cancer (CRC). We examined the association between ambient particulate matter (PM) exposure and CRC risk within the Multiethnic Cohort Study (MEC), representing the first study to include a large sample of racial and ethnic minoritized populations. Methods: The MEC is a prospective study that recruited, from 1993 through 1996, men and women ages 45-75 years largely from five racial and ethnic groups (African American, Japanese American, Latino, Native Hawaiian, and Non-Hispanic White) living in Hawai‘i and California. This study included 98,675 California MEC participants, residing predominately in Los Angeles County. Satellite-based PM2.5 (PM with an aerodynamic diameter <2.5μm) exposures were estimated from a published spatiotemporal model. Kriging interpolation was used to estimate PM10 (PM <10μm) exposures using routine air monitoring data from the US Environmental Protection Agency. Time-varying PM exposures were assessed from time of recruitment through 12/31/2018. Incident invasive CRC cases were identified via linkage with the California Cancer Registry (n=3,217). Cox proportional hazards models were used to examine the association between PM and CRC risk using age as the time metric, with strata defined by age at cohort entry and race and ethnicity, and adjusting for demographic and lifestyle factors. Heterogeneity of the PM-CRC association was assessed by sex, race and ethnicity, and CRC subsite (right colon, left colon, rectum). Results: Risk of CRC increased with PM2.5 (per 10μg/m3 hazard ratio [HR] 1.13, 95% confidence interval [CI] 0.96-1.33) with a larger HR observed among females (HR 1.29, 95% CI 1.03-1.62) than males (HR 0.96, 95% CI 0.76-1.22) (Pheterogeneity=0.24). CRC risk was positively associated with PM2.5 across race and ethnicity (except for African American participants) with the largest HR observed among Latino participants (HR 1.47, 95% CI 1.03-2.08) (Pheterogeneity=0.20). There was no statistically significant heterogeneity of PM2.5 effect by tumor subsite (Pheterogeneity=0.07); although larger HRs were seen for left colon (HR 1.52, 95% CI 1.08- 2.14) and rectal cancers (HR 1.54, 95% CI 1.05-2.25) than right colon cancers (HR 1.09, 95% CI 0.88-1.35). PM10 was not associated with CRC risk (per 10 μg/m3; HR 1.02, 95% CI 0.93-1.22) with no evidence of heterogeneity in associations by sex or race and ethnicity (respective Pheterogeneity 0.75, 0.44). Although HRs for PM10 appeared to differ by CRC subsite (Pheterogeneity=0.03), the 95% CI of these HRs included the null (right HR 0.95, 95% CI 0.84-1.06; left HR 1.13, 95% CI 0.95-1.35; rectal HR 1.18, 95% CI 0.97-1.43). Conclusions: Preliminary findings suggest that PM2.5 exposure is associated with CRC risk with larger associations in females and, possibly, for left colon and rectal cancer. Additional studies are needed to confirm these findings and evaluate the potential biological pathways underlying these associations. Citation Format: Ugonna Ihenacho, Chiuchen Tseng, Jun Wu, Scott Fruin, Timothy V. Larson, Salma Shariff-Marco, Loïc Le Marchand, Daniel O. Stram, Lynne R. Wilkens, Christopher A. Haiman, Beate Ritz, Iona Cheng, Anna H. Wu. Association between ambient particulate matter and colorectal cancer incidence: The Multiethnic Cohort Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A048.

Abstract B096: Patient, Provider, and Advocate Perspectives on Factors that Impact Participation of Black Women in Breast Cancer Clinical Trials

Abstract Background: Black women are more likely to present with advanced stage disease and to die following a breast cancer (BC) diagnosis compared with women from other racial and ethnic groups. This persistent health inequity is in part driven by underrepresentation in clinical trials (CTs), as well as structural and social drivers of health. Multi-level factors impact patients’ decision to enroll on a cancer CT. Objective: The goal of the FOR ME (Fostering Opportunities in Research through Messaging and Education) study is to develop, optimize, and test a narrative web-based video intervention for Black women diagnosed with BC to promote shared decision making and CT participation. Here, we report findings from the development phase, wherein we engaged Black women with BC, oncologists and CT office staff, and cancer advocates. Our objective was to identify cross-cutting and unique themes concerning barriers and motivating factors to CT participation, intervention priorities, and to understand lived experiences to enhance authenticity and to inform video content. Methods: Guided by community engaged research approaches, we used multiple qualitative methods, including story circles and 1:1 interviews. We used thematic analysis and inductive and deductive coding approaches. Data analysis for each group followed the same approach: we annotated a subset of transcripts, compiled the annotations into a preliminary codebook, and conducted inter-coder reliability to improve quality and refine the codebook. Finally, we used Dedoose to analyze quotations and code co-occurrences, application frequencies, and relationships. We examined cross-cutting and unique themes during data collection and analysis. Results: In total, 38 Black women with BC participated in interviews and story circles, ranging in age from 27-75 years (M=59, SD =12); about 27% were currently receiving BC treatment and 27% had prior CT participation. Oncologists (n=16) and CT office staff (n=4) reported having on average 11.6 and 9.5 years of CT experience, respectively). Finally, 15 cancer advocates completed interviews, of whom 73% identified as Black women; 87% reported that the organization they were involved with connected patients to or provided education about CTs. Several cross-cutting themes were identified, including: 1) Acknowledgement of time, financial, and logistical burdens of CT participation; 2) The impact that current and historical racism, discrimination and mistreatment has had on CT enrollment for Black BC patients; 3) A lack of accessible CT information poses significant challenges for health literacy; and 4) Positive provider relationships and communication are important facilitators to CT participation. Conclusion: To promote health equity and participation in CTs among Black women with BC, interventions should consider multiple perspectives and prioritize addressing culturally sensitive patient-provider communication, shared decision-making, and patient empowerment. The information we learned will inform the development of a culturally tailored decision aid video. Citation Format: Leslie R. Carnahan, Eliza B. Cohn, Tigist Mersha, Neha Hippalgaonkar, Ryan Nguyen, Kauthar Salum, Ana Williams Waite, Christen Sandoval, Lolita Coleman, Beulah Brent, Paris Thomas, Paramjeet Khosla, Kent F. Hoskins, Vida Henderson. Patient, Provider, and Advocate Perspectives on Factors that Impact Participation of Black Women in Breast Cancer Clinical Trials [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B096.