Breast Cancer Rates Research Articles

Investigating the Relationship between Schizophrenia and Incidence Risk of Breast Cancer: A Systematic Review and Meta-Analysis of Cohort Studies

Objective: Schizophrenia seems to have a complex association with various types of cancer, exerting a protective effect against some cancers while being a risk factor against some others. Therefore, we intended to conduct an updated systematic review and meta-analysis in order to examine the relationship between schizophrenia and the risk of breast cancer incidence. Method: We did a systematic search of databases, namely Web of Science, Scopus, Embase, PubMed, and PsycINFO up to August 15, 2024. Screening and data extraction were performed independently. Data was analyzed using Stata16 software. We used the random effect model to pool the results, while the heterogeneity between studies was calculated using Cochran's Q test and (I2) index. Results: We found 15 studies, among which 12 were included in this meta-analysis. The results indicated that the risk of breast cancer development is significantly increased in women with schizophrenia (SIR: 1.43, 95% CI: 1.08-1.85, P < 0.01; IRR: 1.19, 95% CI: 1.13-1.26, P < 0.01). Subgroup analysis revealed significant differences in the incidence of breast cancer rates among women with schizophrenia based on geographic location and duration of follow-up. Conclusion: The results indicate that schizophrenia increases the risk of developing breast cancer. Therefore, taking preventive measures concerning breast cancer among women with schizophrenia is crucial. Additionally, regular screening programs should be implemented to ensure early diagnosis and treatment in case breast cancer is detected.

Pattern of burden cancer breast and relationshipin to human development index in Iran 2009 to 2019: an observational study based on the Global Burden of Diseases

ObjectiveBreast cancer is one of the most common cancers in women worldwide. This study aims is to investigate the burden of breast cancer in Iran and its relationship with the Human Development Index (HDI) during 2009 to 2019.Study designThe present study is an observational study in Iran during the years 2009 to 2019. Data related to the incidence, mortality, Years of Life with Disability (YLD), Years of Life Lost (YLL) and Disability-Adjusted Life-Years (DALY) of breast cancer in Iran were extracted from the Global Burden of Disease 2019 (GBD-2019) website. Correlation tests are used to check the relationship between these indicators and the human development index.ResultsThe highest incidence rate of breast cancer in 2019 is related to the provinces of Gilan (29 per 100,000) and Tehran (28.55 per 100,000) and the highest rate of death from breast cancer is related to the provinces of Gilan (10.71 per 100,000). and Semnan (9.97 in 100,000). The results showed that there is a positive and significant correlation between DALY (r = 0.626, P < 0.0001), YLL (r = 0.611, P < 0.0001) and, YLD (r = 0.773, P < 0.0001) breast cancer with HDI index. There is a positive and significant correlation between the incidence (r = 0.794, P < 0.0001) and mortality (r = 0.503, P = 0.003) of breast cancer with the HDI index.ConclusionsConsidering that a positive correlation was observed between the incidence and burden of breast cancer and the human development index in the country, it is suggested to implement preventive measures such as public education programs to reduce the incidence and burden of breast cancer and the necessity of screening programs in areas with low human development index. It confirms the diagnosis of disease cases.

Mixed contaminant exposure in tapwater and the potential implications for human-health in disadvantaged communities in California

Water is an increasingly precious resource in California as years of drought, climate change, pollution, as well as an expanding population have all stressed the state's drinking water supplies. Currently, there are increasing concerns about whether regulated and unregulated contaminants in drinking water are linked to a variety of human-health outcomes particularly in socially disadvantaged communities with a history of health risks. To begin to address this data gap by broadly assessing contaminant mixture exposures, the current study was designed to collect tapwater samples from communities in Gold Country, the San Francisco Bay Area, two regions of the Central Valley (Merced/Fresno and Kern counties), and southeast Los Angeles for 251 organic chemicals and 32 inorganic constituents. Sampling prioritized low-income areas with suspected water quality challenges and elevated breast cancer rates. Results indicated that mixtures of regulated and unregulated contaminants were observed frequently in tapwater throughout the areas studied and the types and concentrations of detected contaminants varied by region, drinking-water source, and size of the public water system. Multiple exceedances of enforceable maximum contaminant level(s) (MCL), non-enforceable MCL goal(s) (MCLG), and other health advisories combined with frequent exceedances of benchmark-based hazard indices were also observed in samples collected in all five of the study regions. Given the current focus on improving water quality in socially disadvantaged communities, our study highlights the importance of assessing mixed-contaminant exposures in drinking water at the point of consumption to adequately address human-health concerns (e.g., breast cancer risk). Data from this pilot study provide a foundation for future studies across a greater number of communities in California to assess potential linkages between breast cancer rates and tapwater contaminants.

Abstract A103: Feasibility of using data from the All of Us Research Program to better understand Asian American breast cancer risk

Abstract Asian Americans (AAs) are the only racial/ethnic group in the United States for whom cancer is the leading cause of death. In AA women, the rate of breast cancer (BC) has significantly increased in the past two decades. However, the reasons behind the observed increase in risk are not well understood. The All of Us (AoU) Research Program aims to enroll one million participants nationwide, focusing on including individuals from diverse backgrounds, to advance precision health research. The goal of this pilot study was to evaluate the feasibility of using AoU data to analyze factors potentially associated with breast cancer risk in AAs and to develop enhanced breast cancer prediction models. There were 3,433 self-reported AA women with available genomic data. In addition to the genomic data, data was available from surveys, participants’ electronic health records (EHRs), and physical measurements taken at the time of their study visit. BC cases were identified by self-report on surveys (n=38), EHR diagnosis data (n=104), or both survey and EHR (n=59), totaling 201 cases identified. Of these, only 17 were incident cases. Of the 163 cases detected in the EHR, 96.3% were invasive BCs, and the median age at diagnosis was 54.2 (±12.6) years. Among the 38 survey-only-identified cases, age at diagnosis was unclear due to the large age ranges (e.g.18-64 years) in the categories presented in the survey. For purposes of the case-control analysis, five AA women with no BC diagnosis were matched to each BC case by age group and geographic region. Body mass index, annual household income, marital status, history of alcohol consumption, and history of cigarette smoking and vaping were not statistically significantly different between cases and controls (a=0.05). One third (34.3%) of cases were born in the U.S. and 65.2% were born in another country vs. 25.0% and 74.0% of controls, respectively (p= 0.01). Employment status was also different, with 50.8% of cases being unemployed vs. 42.0% of controls (p=0.02). There appeared to be a difference in first-degree family history of BC (reported in 8% of cases vs. 5% of controls) although the results were not statistically significant (p=0.08). However, family history of BC data was not available for 43.3% and 51.0% of the cases and controls, respectively. Gynecologic factors, such as ages at menarche and menopause, and hormone use, were not asked in the surveys and were not widely captured in the EHR data. In our analysis of nine BC- associated genes (BRCA1, BRCA2, ATM, TP53, PTEN, CHEK2, CDH1, PALB2, STK11), pathogenic variants were identified in 1.0% of cases and 0.7% of controls. In summary, the AoU data set enables the study of a diverse national cohort with rich genomic data. However, the low representation of AAs, small numbers of incident cases, limited data on personal gynecologic history, cancer family history and social determinants of health, and broad categorization of age at diagnosis present challenges to using this data to build accurate and effective risk prediction models for BC risk in AAs. Citation Format: Catalina Haas Garcia, Wen-Pin Chen, Danni Liu, Alice W Lee, Min Zhang, Argyrios Ziogas, Sora Tanjasiri, Hannah Lui Park. Feasibility of using data from the All of Us Research Program to better understand Asian American breast cancer risk [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 A103.

Abstract B039: Increasing clinical trial enrollment rates of black women with breast cancer with the use of Patient Navigation

Abstract Background The positive impact of clinical trials is clear in breast cancer, with a five-year survival rate of 90%. While black women represent 12% of breast cancer cases in the US, they comprise 3% of participants in clinical trials. At the Vanderbilt Ingram Cancer Center (VICC), black patients represent 9% of all breast cancer patients, but only 4% of those enrolled in clinical trials. Objective This pilot study will evaluate the role of Patient Navigators (PNs) to increase knowledge of and enrollment on clinical trials among black women with breast cancer at the Breast Cancer Clinic at VICC. Methods All black women in the Breast Clinic at VICC are offered Patient Navigation (PN) services. Those who consent complete a needs assessment and are provided PN as needed up to the duration of their treatment. As part of the PN, patients are provided with educational material about clinical trials as well as assistance with identified needs. Patients are surveyed one-month following the start of the navigation experience. We will compare clinical trial enrollment rates among eligible black women with breast cancer during the study period with historical controls. Covariates of analysis will include age, stage, histology and insurance status. Results From February through May 2024, we have approached 33 patients for PN assignment. Of the 29 patients who accepted a PN, only one was eligible for a clinical trial and was enrolled in the trial. Of 14 patients who completed the first post-navigation survey, 12 stated that PNs improved their cancer care experience, and all 14 found meetings with PNs to be valuable. Additionally, 11 patients reported that they knew very little to nothing about clinical trials prior to PN intervention and 8 reported having increased knowledge following PN. Of 12 respondents, 6 reported that they would be more likely to enroll on a clinical trial as a result of PN, and 9 of 14 indicated that they would share information about clinical trials with others. Conclusions With exceptional survival rates in breast cancer, it is imperative that there is equity in opportunity for enrollment in clinical trials for all patients. Patient navigation may target barriers to access to and increase knowledge of clinical trials and diminish cancer health disparities. As accrual continues in our pilot study, we will examine the impact of PN on enrollment in clinical trials, while also identifying other potential benefits for overall patient care. Citation Format: Tina S. Chai, Sonya Reid, Tuya Pal, Karen Winkfield, Clorissa Campbell, Courtney Thomas, Meredith Smalls, Emma Schremp, Debra Friedman. Increasing clinical trial enrollment rates of black women with breast cancer with the use of Patient Navigation [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 B039.

Abstract B050: Health and faith in the Korean community: Increasing breast and colorectal cancer education and screening in Los Angeles

Abstract Background: Koreatown in Los Angeles is home to over 115 churches within 3 miles. Korean churches are sanctuaries that provide support and nurture social connections, especially among Korean immigrants with limited English proficiency, who face challenges in accessing cancer care, including language barriers, lack of health insurance, and fears associated with cancer screening procedures and treatments. Koreans experience higher incidence and prevalence rates of breast and colorectal cancers compared to non-Hispanic White and other Asian subgroups, respectively. To address this, a Health and Faith Initiative was launched in 2018, utilizing evidence-based strategies recommended by Center for Disease Control and Prevention Community Guide and the use of a Cancer 101 curriculum developed by the Fred Hutchinson Cancer Center. METHODS: A three-stage Partnership Development Framework (networking, education, program and research development) was used to grow deep connections and sustainable cancer screening programs with church pastors and leaders, patient navigators, Federally Qualified Health Centers, State Breast and Cervical Early Detection Program providers, Diagnostic facilities, Hospitals and Community Outreach and Engagement staff. Bi- lingual church leaders was selected by pastors and elders at churches were trained as lay community navigators to conduct cancer education workshops using a Cancer 101 curriculum, as well as to support for church member to navigate across the cancer continuum. Church pastors and community health clinics determine outreach, engagement, and research priorities through active participation in Community Advisory Board and research studies. The initiative is sustained through coordination of 2 outreach staff and financial assistance from community benefit and research grants at Cedars Sinai Cancer Center. RESULTS: From June 2023 to May 2024, Community Outreach and Engagement (COE) have led the coordination of 6 breast cancer health education workshops and screening events with 165 people screened (128 screening mammograms, 37 diagnostic mammograms &amp; ultra sounds) in partnership with Koryo Health Foundation. Two patients were diagnosed with breast cancer and were referred to Cedars Sinai for treatment. For colorectal cancer, 8 health education workshops were conducted, and 122 Fit Kits were distributed with 72 kits returned, a 59% return rate. Cancer education workshops using American Cancer Society cancer screening guidelines for breast, colorectal, prostate, cervical, lung cancer has reached 810 people during 5 tabling events. Those who were not up to date were referred to our partnered health clinics for screening. CONCLUSION: Engaging Korean church leaders and training community navigators is an effective outreach strategy to build long-lasting partnership for successful implementation of cancer screening interventions but also support patients in needed follow up care that help immigrant populations to navigate across the cancer continuum. Citation Format: Dong Hee Kim, Min Jung Sung, Moon Ju Kim, Jeong Yup Lee, Reener Balingit, Zul Surani. Health and faith in the Korean community: Increasing breast and colorectal cancer education and screening in Los Angeles [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 B050.

Abstract PR012: Social and Structural Influences of Preventive Cancer Screenings for Native Hawaiian and Pacific Islander Adults in Hawaiʻi

Abstract Background: Native Hawaiians and Pacific Islanders (NHPI) are hindered by sociocultural, geographic, and environmental factors that contribute to cancer health disparities, often masked by aggregated data with Asian Americans. An average of 7,393 Hawai‘i residents are diagnosed with invasive cancer yearly, and rates are disproportionate ethnically; . Native Hawaiians and Micronesians suffer higher mortality rates for breast cancer (24.9 and 21.6 per 100,000) than White women (17.0). This study aims to investigate social drivers of health behaviors among NHPI in Hawaiʻi by examining social factors that influence cancer screenings through mixed methods. Methods: This mixed methods study is a follow-up to a cross-sectional survey administered in 2018 to 3 Pacific Islander ethnic subgroups: Native Hawaiians, Chuukese, and Marshallese in Hawaiʻi using Respondent Driven Sampling within public housing (N=1,010 NHPI). Disparate cancer screening practices were uncovered within these groups when compared to Hawaiʻi state data. Logistic regression was used to analyze predictors of colon, breast, and cervical cancer screenings. The Gelberg Behavioral Model for Vulnerable Populations and socio-ecological model served as the theoretical models. To triangulate the findings, 16 semi-structured interviews with adults living within the communities first surveyed were conducted in 2023 to uncover any additional drivers of health behaviors that the regression missed. Results: Quantitative findings include cultural/linguistic misunderstandings between NHPI and healthcare providers. Participants who indicated difficulty understanding a provider’s instructions because of language were 51% less likely to be screened for cervical cancer (p = .04). Individuals who hold neutral acculturation to both their ethnic and American culture are less likely to be screened for cancer. Those whose responses fell in a neutral category were 40% less likely than those with a high ethnic identity to have had a colon cancer screening (p = .02). Qualitative findings demonstrate differing views among Pacific Islander groups including competition for resources between groups within public housing. All of the interviewees highlight the role of God and faith in decision making. Informational exchanges take place mainly within the family and cohabitants. From triangulating the findings, there is a lack of strong social ties/networks that could facilitate health-based resources and knowledge. Families are not discussing self-care or family histories of disease, which are instrumental in the early detection of cancers and missed within the regression. Conclusion: This study provides insight into the social drivers of cancer screenings for NHPI communities in Hawaiʻi. Novel insights for the fields of medical sociology and public health are highlighted by influential social processes to NHPI cancer screening behaviors. Recommendations include further research and programs that focus on and foster social dynamics of these communities in relation to cancer screenings. Citation Format: Mark L. Willingham Jr., Kevin Cassel, Wei Zhang, Tressa P. Diaz, Angela Sy, Ian Pagano, Munirih R. Ta'afaki, Angelina G. Mummert. Social and Structural Influences of Preventive Cancer Screenings for Native Hawaiian and Pacific Islander Adults in Hawaiʻi [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 PR012.

Abstract A128: Adherence to mammography screening guidelines by family history of breast cancer in Guam: Preliminary results of HIPIMR study

Abstract Background: In Guam, breast cancer is the most common cancer affecting women, accounting for approximately 34% of all cancer cases. The risk of developing breast cancer is higher for women with a first-degree relative diagnosed with the disease (FHBC). The American Cancer Society recommends annual mammograms for women aged 45-54, with the option to start screening at 40-44. For women aged 55 and older, biennial or annual screenings are advised. Our study aims to investigate the relationship between having a first-degree relative with breast cancer (FHBC) and adherence to these screening guidelines. Methods: This research utilizes preliminary data from the Hawai‘i and Pacific Island Mammography Registry (HIPIMR), a collaborative effort between the University of Hawai‘i Cancer Center and the University of Guam Cancer Research Center, which collects health and breast imaging data in Hawai‘i and Guam. Logistic regression was used to assess the association between having a first-degree relative with breast cancer (FHBC) and adherence to breast cancer screening guidelines. The analysis was conducted across different ethnic groups and adjusted for education and age. Results: The study included 1,017 women who filled out a risk factor questionnaire, including questions about FHBC, before undergoing screening mammography at a clinic in Guam from November 2023 to May 2024. Among the participants, almost 40% were CHamoru, 41% Filipino, 5% Micronesian, 7.4% Asian, and 4.4% White. Of the 1,017 participants, 18.3% reported having a FHBC, and 37.1% did not meet the screening guidelines. Women with FHBC were more likely to meet screening recommendations than those without FHBC (OR=1.63, 95% CI: 1.12, 2.38, adjusted for age and education). Micronesian women (OR=0.54, 95% CI: 0.30, 0.97) and Asian women (OR=0.50, 95% CI: 0.31, 0.82) were less likely to follow screening guidelines compared to Filipino women, after adjusting for age and education. Conclusion: Women with a FHBC were more likely to follow screening guidelines. However, a significant percentage of women in Guam do not adhere to these recommendations, particularly Micronesian women, who also have the highest rates of breast cancer in Guam. Therefore, more outreach and education efforts are needed to improve breast cancer screening adherence in this population. Acknowledgement: This research was funded by the National Cancer Institute: The University of Guam/University of Hawaii Cancer Center Partnership to Advance Cancer Health Equity, Grant U54CA143728 (University of Guam)/Grant U54CA143727 (University of Hawaii Cancer Center). Citation Format: Reina Evangelista, Su Bin Jin, John Shepherd, Grazyna Badowski. Adherence to mammography screening guidelines by family history of breast cancer in Guam: Preliminary results of HIPIMR 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 A128.

Abstract A046: Disparities in cancer burden and survival rates in persistent poverty communities in Los Angeles County

Abstract Objective: Persistent poverty census tracts (PPT) are those with socioeconomic challenges where prolonged economic disadvantages may significantly influence health outcomes. This study examined the cancer burden and survival patterns in PPTs compared to non-PPTs in Los Angeles County (LAC) considering disparities by race/ethnicity and stage at diagnosis. Methods: A comprehensive analysis of 2012-2021 Cancer Registry data examined age-adjusted incidence rates (AAIRs) and survival rates for lung, colorectal, liver, stomach, breast, and prostate cancers, which are the Norris Comprehensive Cancer Center priority cancers. Cancer-specific data were further stratified by racial/ethnic group and stage at diagnosis, and compared across residents in PPTs, non-PPTs, and LAC overall. Survival rates were calculated using the Kaplan-Meier method and differences between groups were assessed by log-rank tests. Results: PPTs in LAC were characterized by a higher proportion of racial/ethnic minorities, lower education levels, and higher unemployment compared to non-PPTs. In all racial/ethnic groups combined, AAIRs for lung, breast, and prostate cancers were lower in PPTs than non-PPTs, whereas AAIRS for liver and stomach cancers were higher in PPTs, with no differences for colorectal cancer. Disparities emerged when considering race and ethnicity, with higher lung cancer AAIRs among Non-Hispanic White (NHW) and Black/African American (B/AA) PPT residents compared to non-PPT, while AAIRs for lung and colorectal cancers were lower among Hispanic/Latino (H/L) PPT residents compared to non-PPTs. Breast and prostate cancer AAIRs remained lower in PPTs than in non-PPTS regardless of racial/ethnic group. Patients in PPTs exhibit significantly lower five-year survival rates across all studied cancers, except stomach, compared to non-PPTs. B/AA patients showed the lowest five-year survival rates for lung and colorectal cancer, with patients in PPTs experiencing significantly lower rates than patients in non-PPTs regardless of disease stage (p &amp;lt; 0.01 for early- or late-stage). Liver cancer survival rates were notably low, especially for H/L and Asian/Pacific Islander patients in PPTs, with five-year survival for late-stage cancer at 4.9% (95%CI: 2.8-8.5) and 5.4% (95%CI: 2.1-14.0), respectively. Patients in PPTs with late-stage breast or prostate cancer exhibited significantly lower 5-year survival (compared to non-PPTs) across all race/ethnicities, with B/AA patients experiencing the lowest survival rates for breast cancer and NHW patients experiencing the lowest survival rates for prostate cancer. Conclusions: Cancer outcomes for patients in PPTs were significantly poorer compared to those in non-PPT communities. The notably lower AAIRs in PPTs versus non-PPTs for more screen-able cancers, such as breast, prostate, and early-stage colorectal cancer, suggest a need for greater efforts to provide access to routine screening in areas affected by persistent poverty, though other causes cannot be ruled out. Citation Format: Miriam L Gorbatov, Joel S. Mendez, Myles Cockburn, Laura K. Thompson, Lihua Liu, Jennifer Tsui, Kali Zhou, V. Wendy Setiawan, Chanita Hughes-Halbert, Mariana C. Stern. Disparities in cancer burden and survival rates in persistent poverty communities in Los Angeles County [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 A046.

Abstract A027: Ethnic variations in breast cancer risk factors distribution in Guam, HIPIMR study

Abstract Background: Guam has significant ethnic disparities in breast cancer incidence, with rates varying from 46.7 per 100,000 among Asian women to 137.5 per 100,000 among Micronesian women. Incidence rates for Filipino, CHamoru (indigenous people), and White women are 59.8, 94.0, and 121.9 per 100,000, respectively (2013-2017). The Hawai‘i and Pacific Island Mammography Registry (HIPIMR), a collaborative effort between the University of Hawai‘i Cancer Center and the University of Guam Cancer Research Center, collects health and breast imaging data to enhance early cancer detection tailored to the unique ethnic profiles of women in Hawai‘i and Guam. This study aims to identify the distribution of breast cancer risk factors among different ethnic groups in women undergoing screening in Guam. Differences in the prevalence of risk factors may explain variations in incidence patterns. Methods: This study included 1,413 women undergoing mammography screening at FHP Health Center in Guam, from November 2023 to May 2024. The risk factors were classified as follows: BMI (≥25), age of menarche (≤13), age of first pregnancy (≥30), number of live births (≤1), age of menopause (≥55), and family history of first-degree relatives. The robust Poisson method was used to estimate prevalence ratios (PR) of risk factors among ethnic groups, adjusted for age and education. Asians were used as the reference group due to their lowest incidence rates. Furthermore, the total risk score was calculated by summing all the risk factors. ANOVA was used to test the differences in average risk scores among different ethnic groups. Results: All ethnic groups had significantly higher prevalence of being overweight or obese compared to Asian women. The prevalence ratios were highest for Micronesians (PR=1.73, 95% CI: 1.40, 2.13) and CHamoru (PR=1.55, 95% CI: 1.27, 1.90). CHamoru women had the highest rates of breast cancer family history (PR=1.74, 95% CI: 1.19, 2.54). However, CHamoru women had a lower prevalence of having a small number of live births (PR=0.39, 95% CI: 0.24, 0.65) and an older age at first birth (PR=0.83, 95% CI: 0.71, 0.96) when compared to Asian women. There was a significant difference in average score among ethnic groups (P&amp;lt;.001). CHamoru women had significantly higher score (2.35) than Filipino (2.08) and Asian (2.00) women. Conclusion: Our study reveals disparities in risk factors across ethnic groups, consistent with the Guam Cancer Registry's reports of high breast cancer rates among Micronesian and CHamoru women. This project is ongoing, with the aim of linking our data with the Guam Cancer Registry. This linkage will enable us to identify breast cancer cases among participants and compare risk factors across different ethnic groups for women with and without breast cancer. Acknowledgement: This research was funded by the National Cancer Institute: The University of Guam/University of Hawaii Cancer Center Partnership to Advance Cancer Health Equity, Grant U54CA143728 (University of Guam, YCP)/Grant U54CA143727 (University of Hawaii Cancer Center). Citation Format: Gian Paras, Su Bin Jin, Rose Grino, Cabrini Aguon, John Shepherd, Grazyna Badowski. Ethnic variations in breast cancer risk factors distribution in Guam, HIPIMR 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 A027.

Association of environmental factors with breast cancer incidence among African American women in Memphis, Tennessee

ABSTRACT African American (AA) women confront distinct disparities in breast cancer rates, and the impact of their living environment is unclear. This study aimed to examine the association between breast cancer incidence and environmental factors among a high-risk female population. The study recruited 355 AA women ages 20–88 in Memphis from 2016–2018. Their addresses were geocoded and linked to environmental and socioeconomic data. The final dataset contained 50 cases and 157 controls. Associations between breast cancer incidence and social and environmental factors were examined using logistic regression. Spatial analysis in ArcGIS showed that cases clustered in Southwest Memphis. Proximity to traffic and Superfund sites had odds ratios of 1.636 (95% CI: 25 1.046, 2.560) and 12.262 (95% CI: 1.814, 82.864), respectively. Mediating analyses further revealed that environmental inequities contributed significantly to breast cancer inequalities. In conclusion, the built environment plays a role in breast cancer onset among AA females.

Dual-Prodrug-Based Hyaluronic Acid Nanoplatform Provides Cascade-Boosted Drug Delivery for Oxidative Stress-Enhanced Chemotherapy.

Insufficient drug accumulation in tumors severely limits the antitumor efficiency of hyaluronic acid (HA) nanomedicine in solid tumors due to superficial penetration depth, low cell uptake, and nonspecific drug release. Hence, we constructed a dual NO prodrug (alkynyl-JSK) and doxorubicin prodrug (cis-DOX)-conjugated HA nanoparticle (HA-DOX-JSK NPs), which achieved cascade-boosted drug delivery efficiency based on a relay strategy of NO-mediated deep tumor penetration─HA target CD44 tumor cell uptake─tumor microenvironment (TME)-responsive drug release. The nanoparticle demonstrated sustained and locoregionally GSH/GST-triggered NO release and GSH/pH-responsive DOX release in the tumor. The released NO first mediated collagen degradation, causing deep tumor penetration of nanoparticles in the dense extracellular matrix. Immediately, HA was relayed to enhance CD44-targeted tumor cell uptake, and then, the nanoparticles were finally triggered by specific TME to release DOX and NO in the deep tumor. Relying on the relayed delivery strategy, a significant improvement of DOX accumulation in tumors was realized. Moreover, NO depleted GSH-induced intracellular reactive oxygen species, enhancing DOX chemotherapy. Based on this strategy, the tumor inhibition rate in breast cancer was up to 87.8% in vivo. The relay drug-delivery HA system would greatly cascade-boost drug accumulation in deep tumors for efficient solid tumor therapy.

PAM50 breast cancer subtypes and survival of patients in rural Ethiopia without adjuvant treatment: a prospective observational study

PurposeSurvival rates of breast cancer (BC) patients are particularly low in rural regions in sub-Saharan Africa (SSA) which is due to limited access to therapy. In recent years, gene expression profiling (GEP) of BC showed a strong prognostic value in patients with local tumour surgery and (neo)adjuvant treatment. The aim of this study was to evaluate the impact of intrinsic subtypes on survival of patients in rural Ethiopia without any (neo)adjuvant therapy.MethodsIn total, 113 female patients from Aira Hospital with histologically proven BC and treated only with surgery were included in this study. All samples were analysed by immunohistochemistry (IHC) for estrogen receptor, progesterone receptor, HER2 and Ki67, as well as RNA-expression analysis for PAM50 subtyping.ResultsA positive hormone receptor status was found in 69.0% of the tumours and intrinsic subtyping demonstrated Luminal B to be the most common subtype (34.5%). Follow-up data was available for 79 of 113 patients. Two-year overall survival (OS) was 57.3% and a considerably worse OS was observed in patients with Basal-like BC compared to Luminal A BC. Moreover, advanced tumours showed an increased risk of mortality.ConclusionThe OS was very low in the patient cohort that received no (neo)adjuvant treatment. Immunohistochemistry and GEP confirmed endocrine-sensitive tumours in more than half of the patients, with a large proportion of Luminal B, HER2-enriched and Basal-like tumours so that adjuvant chemotherapy should be recommended.

A SYSTEMATIC ANALYSIS FOR THE GLOBAL, REGIONAL AND LOCAL TREND OF BREAST CANCER, 1990-2019

The goal of this work is to perform a thorough investigation of the incidence, death and disability-adjusted life-years (DALYs) rates of breast cancer (BC) in local, regional, and worldwide contexts. It examines how variations in breast cancer incidence, death rates and DALYs are caused by elements including socioeconomic position, cultural norms and beliefs. Data were extracted from the Global Burden of Disease study 2019) and were calculated to quantify temporal trends in the age-standardized rates of BC incidence, deaths, and disability-adjusted life-years (DALYs) by region. From 1990 to 2019, the BC incidence, deaths, and DALYs increased worldwide by 128%, 84%, and 77%, respectively. The global age-standardized incidence rate increased, whereas both the age-standardized death rate and age-standardized DALY rate presented downward trends. In particular, Western Europe had the largest burden of BC, and globally, BC was more frequently reported in high-middle and high SDI regions. Expanding upon this thorough examination, the article suggests a range of focused, empirically supported tactics aimed at enabling healthcare decision-makers, physicians, and community leaders. Future BC preventive strategies should therefore focus on addressing the global health challenge of breast cancer, aiming to improve survival rates globally through the three pillars of health promotion, timely presentation and diagnosis, and comprehensive treatment and supportive care.

Surgical complications after immediate implant-based breast reconstruction for breast cancer in women over 65 years.

While immediate breast reconstruction rates in breast cancer are increasing, they remain low in women over 65 years old. The aim was to investigate surgical outcomes in women older than 65 years receiving implant-based immediate breast reconstruction. The population-based Stockholm Breast Reconstruction Database includes all adult women with breast cancer receiving an implant-based immediate breast reconstruction in Stockholm, Sweden, 2005-2015. Primary outcomes within 30 days from immediate breast reconstruction were: infection requiring antibiotics and reoperation on. Implant removal was a secondary outcome. Women more than 65 years were compared with younger age groups. Chi-square tests and multivariable logistic regression were applied for the primary outcomes, and Kaplan-Meier analysis for the secondary outcome. Among 1749 cases of immediate breast reconstruction, 140 (8.0%) were in women more than 65 years. Median follow-up was 74 months (1-198). Postoperative infection was not more common in women older than 65 years old (22 of 140, 15.7%) than in women under 65 years old (303 of 1609, 18.8%; P = 0.221). Reoperation on was more frequent in women older than 65 years than in other age groups (more than 65: 8.6%; 50-64: 6.5%; 40-49: 3.5%; less than 40: 1.6%; P < 0.001), however, age older than 65 years was not an independent risk factor in the multivariable analysis (OR 1.00, 95% c.i. 0.44 to 2.28). Overall, 6-year probability of implant removal was 11.4%, (8.1% due to complications and 3.3% due to patient preference). There was no statistically significant difference between age groups for either reason (P = 0.085 and P = 0.794 respectively). Older age alone was not associated with worse surgical outcomes after implant-based immediate breast reconstruction in highly selected patients older than 65 years when compared with their younger counterparts.

Breast cancer risk and prevention in 2024: An overview from the Breast Cancer UK - Breast Cancer Prevention Conference.

The Breast Cancer UK-Breast Cancer Prevention Conference addressed risk from environmental pollutants and health behaviour-related breast-cancer risk. Epidemiological studies examining individual chemicals and breast cancer risk have produced inconclusive results including endocrine disrupting chemicals (EDCs) Bisphenol A, per- and polyfluorinated alkyl substances as well as aluminium. However, laboratory studies have shown that multiple EDCs, can work together to exhibit effects, even when combined at levels that alone are ineffective. The TEXB-α/β assay measures total estrogenic load, and studies have provided evidence of a link between multiple-chemical exposures and breast cancer. However, prospective studies using TEXB-α/β are needed to establish a causative link. There is also a need to assess real-life exposure to environmental-chemical mixtures during pregnancy, and their potential involvement in programming adverse foetal health outcomes in later life. Higher rates of breast cancer have occurred alongside increases in potentially-modifiable risk factors such as obesity. Increasing body-mass index is associated with increased risk of developing postmenopausal breast cancer, but with decreased risk of premenopausal breast cancer. In contrast, lower rates of breast cancer in Asian compared to Western populations have been linked to soya/isoflavone consumption. Risk is decreased by breastfeeding, which is in addition to the decrease in risk observed for each birth and a young first-birth. Risk is lower in those with higher levels of self-reported physical activity. Current evidence suggests breast-cancer survivors should also avoid weight gain, be physically active, and eat a healthy diet for overall health. A broad scientific perspective on breast cancer risk requires focus on both environmental exposure to chemicals and health behaviour-related risk. Research into chemical exposure needs to focus on chemical mixtures and prospective epidemiological studies in order to test the effects on breast cancer risk. Behaviour-related research needs to focus on implementation as well as deeper understanding of the mechanisms of cancer prevention.

Predicting Non-Mass Breast Cancer Utilizing Ultrasound and Molybdenum Target X-Ray Characteristics.

The aim of this study is to investigate the influence of ultrasound and molybdenum target X-ray characteristics in predicting non-mass breast cancer. A retrospective analysis was conducted on the clinical data of 185 patients presenting with non-mass breast lesions between September 2019 and 2021. The non-mass lesions were categorized into benign and malignant types based on ultrasonographic findings, which included lamellar hypoechoic, ductal alteration, microcalcification, and structural disorder types. Furthermore, an examination was undertaken to discern variances in molybdenum target X-ray parameters, ultrasonographic manifestations, and characteristics among individuals diagnosed with non-mass breast lesions. The ultrasonographic depiction of microcalcified lesions and the identification of suspicious malignancy through molybdenum target X-ray evaluation exhibited independent associations with non-mass breast cancer, yielding statistically significant differences (p < 0.05). Subsequently, the logistic regression model was formulated as follows: Logit (P) =-1.757+2.194* microcalcification type on ultrasound + 1.520* suspicious malignancy on molybdenum target X-ray evaluation. The respective areas under the receiver operating characteristic curves for microcalcification type on ultrasound, suspicious malignancy on molybdenum target X-ray, and the integrated diagnostic model were 0.733, 0.667, and 0.827, respectively, demonstrating discriminative capacities. Using both ultrasound and molybdenum target X-ray diagnostics can increase the accuracy of non-mass breast cancer detection. The findings of this study have the potential to augment the detection rate of non-lumpy breast cancer and provide an imaging basis for enhancing the prognosis of individuals with breast cancer.

Increased detection of relevant breast cancers with DBT in mammography screening?

AbstractScreening with digital breast tomosynthesis plus synthetic mammography (DBT+SM) increases invasive breast cancer detection compared to digital mammography (DM). Since a reduction in breast cancer mortality is largely based on the detection of histological grade 2 or 3 breast cancers, a comparison of the detection rates of invasive breast cancers (iCDR), independent of the stage, of grades 2 or 3, was carried out, taking into account breast density, after screening with DBT+SM vs. DM.The 1:1 randomized, multicenter TOSYMA study recruited participants from 7/2018 to 12/2020 in the German Mammography Screening Program. This explorative subanalysis included 49479 participants in the DBT+SM arm and 49689 participants in the DM arm, with complete documentation including visual density categorization (A/B: non-dense parenchyma, C/D: dense parenchyma).The iCDR of grade 2 or 3 was 5.1 per 1000 women screened with DBT+SM vs. 3.6 ‰ screened with DM (difference +1.5 ‰). In the case of non-dense parenchyma, the corresponding DBT+SM rate was 4.5 ‰ (difference to DM +1.3 ‰), and in dense parenchyma it was 5.7 ‰ (difference to DM +1.7 ‰).The iCDR of grade 1 was 2.1 ‰ with DBT+SM (difference to DM +0.8 ‰). In non-dense parenchyma, the corresponding DBT+SM rate was 1.7 ‰ (difference to DM +0.7 ‰), in dense parenchyma it was 2.6 ‰ (difference to DM +1.0 ‰).When screening with DBT+SM, invasive breast cancer detection rates of grade 2 or 3 tumors are higher than with DM. Detection rates and their differences are also higher in women with dense than non-dense parenchyma. These detection rates and their differences are consistently higher for DBT+SM and DM than those for grade 1 cancers. The explorative analyses of this large, randomized trial indicate that DBT+SM screening increases the detection of prognostically more relevant breast cancers.

Survival rate and prognosis of single hormone receptor positive breast cancer.

Survival rate and prognosis of single hormone receptor positive breast cancer.

Hypofractionated Radiation Therapy: A Cross-sectional Survey Study of US Radiation Oncologists.

For many malignancies, hypofractionated radiotherapy (HFRT) is an accepted standard associated with decreased treatment time and costs. United States provider beliefs regarding HFRT likely impact its adoption but are poorly studied. We surveyed US-based radiation oncologists (ROs) to gauge HFRT utilization rates for prostate (PC), breast (BC), and rectal cancer (RC) and to characterize the beliefs governing these decisions. From July to October 2021, an anonymized, online survey was electronically distributed to ROs actively practicing in the United States. Demographic and practice characteristic information was collected. Questions assessing rates of offering HFRT for PC, BC, and RC and perceived limitations towards using HFRT were administered. A total of 203 eligible respondents (72% male, 72% White, 53% nonacademic practice, 69% with 11+ years in practice) were identified. Approximately 50% offered stereotactic body radiation therapy (SBRT) for early/favorable intermediate risk PC. Although >90% of ROs offered whole-breast HFRT for early-stage BC, only 33% offered accelerated partial-breast irradiation (APBI). Overall, 41% of ROs offered short-course neoadjuvant RT for RC. The primary reported barriers to HFRT utilization were lack of data, inexperience, and referring provider concerns. HFRT is safe, effective, and beneficial, yet underutilized-particularly prostate SBRT, APBI, and short-course RT for RC. Skills retraining and education of ROs and referring providers may increase utilization rates.