Underrepresentation Of African Americans Research Articles

Understanding Barriers to STEM: Teachers' Insights on African American Underrepresentation

This study focuses on the development of a measurement instrument to identify Middle and High School mathematics and science teachers’ beliefs about the main factors of underrepresentation of African American students in STEM (Science, Technology, Engineering, and Mathematics) fields. The research method using the stages of instrument development were (1) test design which involved construction of initial item pool by conducting extensive review of literature and coding of participating teachers personal statements (2) determination of validity which involved expert review process to confirm construct and face validity of items, (3) pilot testing which involved collecting data from a second set of participants, (4) determination of reliability which involves conducting a reliability analysis based on data collected from pilot testing and (5) determination of factorial structure which involved Exploratory Factor Analysis (EFA) to identify underlying factors in participating teachers’ belief structures. First, to obtain trustworthy information, voluntary middle and high school mathematics and science teachers were asked to write personal statements where they explain their main reasons for choosing teaching as a career. Secondly, qualitative data obtained from participating teachers’ personal statements were coded. Coding was applied to identify and to group the phrases or sentences that convey the same or similar reasons. Then results from an extensive literature review on this topic were blended in teachers’ common expressions which were determined because of coding procedure. Then 8 content experts assessed content validity and face validity. Finally, the survey was piloted to African American middle and high school mathematics and science teachers. Fifty-three (53) surveys were completed and received back from teachers. Then, exploratory factor analysis was conducted to identify any underlying factors in the scale. Reliability analyses were also conducted for both the entire survey and for each of the factors. Results of the study suggested four underlying components: (1) Access and Resources, (2) Role Models and Representation, (3) Bias and Discrimination, (4) Curriculum and Pedagogy.

"BORN INTO THE WRONG FAMILY": NAVIGATING BEING A BLACK MALE IN STEM

The underrepresentation of African Americans in science, technology, engineering, and mathematics (STEM) degree programs and professional spaces has been a national concern for years. This phenomenon has prompted the development and implementation of various programs and initiatives to increase access to and sustain their participation in STEM. Of considerable importance, African American men only represent three percent of the scientists and engineers working in the field. However, there are few studies that have explored the academic and professional experiences of African American men through critical, holistic perspectives. This project utilizes critical race theory (CRT) and phenomenological variant ecological systems theory (PVEST) to magnify the experiences of Black men in STEM across academic and professional ranks. Through this combined CRT and PVEST lens, analyzing the challenges and navigational strategies of Black men in STEM, we reveal that Black men in STEM minimize their vulnerability to stereotypes and biases through resistance and resilience. Moreover, the utilization of a virtual counterspace as the research context for conversation between the participants provided a unique interventional approach that fostered rich intergenerational dialogue that enhanced both navigational and resistance capital for the participants. Implications for research and praxis are provided.

Are Pivotal CART Trials Representative of Population at Risk?

Introduction Since 2017, 6 chimeric antigen receptor T-cell (CAR-T) therapies have been approved for Acute Lymphoblastic Leukemia (ALL), Mantle Cell Lymphoma (MCL), Diffuse Large B-cell Lymphoma (DLBL), Follicular Lymphoma (FL), and Multiple Myeloma (MM) and have changed the treatment landscape immensely. There is significant demographic and geographic under-representation in pivotal clinical trials leading to drug approvals for leukemias, lymphomas and MM compared with the population affected. We investigated whether similar disparities exist in pivotal CAR-T trials. Method Clinical Trials leading to CAR-T approval were identified from the US Food and Drug Administration databases. Demographic data was collected from clinicaltrials.gov and primary manuscripts. Standard descriptive statistics were used to analyze the data with stratification by race, ethnicity, sex, and malignancy subtypes. Total incidence of respective malignancies and the demographic representation was obtained from SEER data. Results A total of 10 out of 11 (90.91%) clinical trials leading to CAR-T approval reported data on race and 8 (72.72%) on ethnicity. These trials led to approvals for MM, non-Hodgkin lymphoma (DLBCL, FL and MCL), and ALL. These trials included 1441 patients of which 1155 (80.15%) were reported as White. NCT02445248, for Tisagenlecleucel (tisa-cel) lacked racial data and was excluded from analysis. Data are summarized in Table 1. For MM, 2 CARTs have been approved, Idecabtagene vicleucel and Ciltacabtagene autoleucel (cilta-cel). African American (AA) representation in these pivotal trials, NCT03361748 and NCT03548207 (CARTITUDE-1), respectively was 4.7 % and 17.5 %. In contrast, SEER data shows that AA population represent 21% of the incident MM cases over the last 5 years (2016-2021). In ALL, 2 CARTs, tisa-cel and Brexucabtagene Autoleucel (brexu-cel) have been approved. AAs had 0.55% of representation in the CAR-T ALL clinical trials, whereas they represent 7.5% of all ALL cases in the past 5 years. For follicular lymphoma, Tisa-cel and Axicabtagene ciloleucel (Axi-cel) have been approved as third line treatment. For DLBCL, lisocabtagene maraleucel (liso-cel), tisa-cel and axi-cel have been approved as third line with liso-cel and axi-cel also having second line DLBCL indication. Brexu-cel has been approved for third line MCL. Under-representation of AAs with respect to disease distribution was noted in all these trials. Female patients were also disproportionately under-represented in lymphoma trials overall. Ethnicity was reported less frequently in aforementioned studies but available data suggests Hispanic groups being underrepresented in these trials. Conclusion There are significant demographic under-representations and imbalances in pivotal clinical trials leading to CART approval compared with the population affected. Efforts need to be directed at ensuring racial and ethnic inclusivity and equity in trials for better applicability to the “real world”. Trials should also consistently report demographic data, especially ethnic and racial, for better transparency and accurate analysis of presented data.

Underrepresentation of African Americans in Plastic Surgery: Examining Demographics, Specialty Factors, and Medical School Experiences

Racial representation among medical trainees translates into physicians that are able to communicate with diverse patient populations and are perceptive to health disparities. This is important within plastic surgery where an optimal physicianpatient relationship is essential to health outcomes. The purpose of this study is to address underrepresentation of African Americans (AA) in plastic surgery through improving understanding of factors that may contribute to AA medical student interest in plastic surgery. This was a voluntary, cross-sectional survey. An online survey was designed to collect information on demographics, specialty factor importance, medical school experiences, and plastic surgery interest among medical students. The survey was distributed to medical students within three national medical organizations between August 2018 and February 2019. The following groups of respondents were statistically COMPARED: AAs interested vs. AAs not interested in plastic surgery and AA vs. Caucasian medical students both interested in plastic surgery. Online survey for medical students in the United States. All 428 participants were medical students that belonged to at least 1 of the 3 national medical organizations between August 2018 and February 2019. The survey was completed by 428 participants of which 142 were excluded for incomplete surveys, leaving 286 (66.8%) participants to be included in the study. Among AA medical students, 128 (75.3%) were not interested in Plastic Surgery and 42 (24.7%) were interested. The 2 groups were similar demographically but differed significantly across multiple specialty factors and medical school experiences (p < 0.05). When compared to interested Caucasian medical students (n = 30), interested AA medical students differed significantly in demographics, specialty factors, and medical school experiences (p < 0.05). This study supports the implementation of medical school interventions emphasizing specialty factors and medical school experiences unique to AA medical students interested in plastic surgery to promote their application into the specialty.

Experiences of African American Spanish Learners in the US: mitigating racialization and fostering belonging through an inclusive curriculum

ABSTRACT This study investigates experiences and investments in Spanish language learning among African American graduates of a university in the southeastern US. In response to evidence of African American underrepresentation in this field, findings will forward those factors which may encourage advanced Spanish study and create a sense of belonging as learners and speakers. Data emerges from eight language learning autobiographies, each written by a self-identifying African American who completed a Spanish major or minor at university. Inductive coding and narrative analysis methods yield the following themes: (1) Limited family/community connections to TL speakers, but wide family interest/support for language learning; (2) Inspiring teachers, formal learning environments, and content, but with significant content omissions; (3) Navigation of racialization in classrooms and TL communities and (4) Learning Spanish shapes career paths, provides empowerment and self-understanding. Findings ultimately suggest that family support and positive experiences during formal learning can encourage continued study, and some learners navigate acute obstacles relating to racialization. The data further evidences the necessity for culturally relevant and social justice pedagogies which facilitate inclusive learning communities and curricular revision. Such revisions would include content representative of African-descended people, histories, and cultures; and an understanding of racialization in the Spanish-speaking world.

Leveraging African American family connectors for Alzheimer's disease genomic studies.

The underrepresentation of African Americans (AAs) in Alzheimer's disease (AD) research may limit potential benefits from translational applications. This article describes an approach to recruit AA families into an AD genomic study and characteristics of seeds (family connectors) used to overcome recruitment barriers of AA families into AD research. A four-step outreach and snowball sampling approach relying on family connectors was used to recruit AA families. Descriptive statistics of a profile survey were gathered to understand the demographic and health characteristics of family connectors. Twenty-five AA families (117 participants) were enrolled in the study via family connectors. Most family connectors self-identified as female (88%), were 60 years of age or older (76%), and attained post-secondary education (77%). Community-engaged strategies were essential to recruit AA families. Relationships between study coordinators and family connectors build trust early in the research process among AA families. Community events were most effective for recruiting African American families. Family connectors were primarily female, in good health, and highly educated. Systematic efforts by researchers are necessary to "sell" a study to participants.

Racism, structural racism, and the American Association for Anatomy: Initial report from a task force.

In 2021, the American Association for Anatomy (AAA) Board of Directors appointed a Task Force on Structural Racism to understand how the laws, rules, and practices in which the Association formed, developed and continues to exist affect membership and participation. This commentary is the first public report from the Task Force. We focus on African Americans with some comments on Jews and women, noting that all marginalized groups deserve study. Through much of its 130 year history, some members were an essential part of perpetuating racist ideas, the Association largely ignored racism and had some practices that prevented participation. The Task Force concluded that individual and structural racism within the AAA, combined with the broader social context in which the Association developed, contributed to the current underrepresentation of African Americans who constitute 4.1% of the membership even though 13.4% of the U.S. population is Black. Intentional efforts within the AAA to reckon with racism and other forms of bias have only begun in the last 10-20 years. These actions have led to more diverse leadership within the Association, and it is hoped that these changes will positively affect the recruitment and retention of marginalized people to science in general and anatomy in particular. The Task Force recommends that the AAA Board issue a statement of responsibility to acknowledge its history. Furthermore, the Task Force advocates that the Board commit to (a) sustaining ongoing projects to improve diversity, equity, and inclusion and (b) dedicating additional resources to facilitate novel initiatives.

Abstract P2-09-06: Increased rates of genetic variants of unknown significance in Latino and African American populations of south Texas

Abstract Hereditary susceptibility studies for breast cancer are key to enhancing early detection and exercising prevention strategies in order to reduce breast cancer mortality. Germline pathogenic variants that have shown susceptibility to breast and ovarian cancer are detected in gene panels including ATM, BRCA1, BRCA2, BRIP1, CDH1, CDKN2A, CHEK2, DICER1, EPCAM, MLH1, MSH2, MSH6, NBN, NF1, PALB2, PMS2, PTEN, POLE, RAD50, RAD51C, RAD51D, RECQL, STK11, and TP53. Historically, minority populations have been overlooked both in reach and access to genetic testing, resulting in a lack of knowledge of the genomic landscape and creating a barrier to the application of genetics in clinical medicine. This is the case with the populations of South Texas including the Texas-Mexico border region. According to the US Census Bureau, the South Texas region population is comprised of 69% Hispanics while the Texas-Mexico border region population is comprised of over 90% Hispanics. Previous studies have shown multiple pathogenic variants and also variants of unknown significance (VUS) specific to ethnic populations and regions, but there is little information regarding the Mexican American population of South Texas.Our GRACIAS Texas Program has provided services to individuals and professionals across 26 counties in the South Texas area by specifically providing cancer genetic counseling and testing to individuals and families at highest risk. Recruitment was accomplished through comprehensive outreach to communities through health fairs, small group education sessions, mammography centers, hospitals, FQHCs, and direct interactions with medical providers. Although our program focused on recognizing both breast and colon cancer, and also reached those with rare cancer predisposition syndromes, the concern for breast cancer risk was most commonly addressed, accounting for the majority of cases. A total of 1595 individuals were identified as appropriate for cancer genetic counseling, and of these, 1377 individuals completed genetic testing. Of all individuals who received cancer genetic counseling, 1269 (79.5%) were Hispanic, 16% non-Hispanic White, 3% African American, and 1% other race/ethnicity. The group of individuals receiving testing consisted of 86% females and 14% males. Of those tested, 259 (18.8%) individuals were found to have pathogenic genetic variant and 187 (13.7%) individuals were found to have a VUS. Notedly, the VUS were nearly twice as common in the Hispanic population (14%) as compared to non-Hispanic White population (7.2%). This underscores the disparities of knowledge in genomic variation in Hispanic and non-Hispanic population. We also note that although the percentage of African American patients seen was small, 12 of 45 (26.6%) were found to have a VUS which further reflects the underrepresentation of African Americans in genomic landscape studies.These variants are important because they present a dilemma when advising patients as to need for cancer screening. However, recognition and further exploration of these VUS provide a future pathway to functional assessment and thus eventual knowledge to guide patient care. We continue to monitor for any changes to the status of these VUS. Although many variants are ultimately classified as benign variations, we have seen cases in which a VUS is reclassified into a likely pathogenic or definitely pathogenic variation having significant implications for screening, prevention, and management for these individuals and their families emphasizing further the need to continue to follow individuals tested. Our observations will help define the gene-specific risks of individuals and families in our underserved communities and will support the goal of closing gaps in genomic disparities.Supported by CPRIT grants PP120089 and PP160011 and NIH P30 CA54174. Citation Format: Stephanie Soewito, Rachel Wyatt, Emily Berenson, Natalie Poullard, Shawn Gessay, Lindsey Mette, Kristin Shelby, Elise Alvarez, Clarissa Aviles, Anna Maria Pulido Saldivar, Pamela Otto, Ismail Jatoi, Virginia Kaklamani, Gail E Tomlinson. Increased rates of genetic variants of unknown significance in Latino and African American populations of south Texas [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-09-06.

Corrigendum to: Review of “The Color of Culture: African American Underrepresentation in the Fine Arts and Outdoor Recreation”

Corrigendum to: Review of “The Color of Culture: African American Underrepresentation in the Fine Arts and Outdoor Recreation”

Review of “The Color of Culture: African American Underrepresentation in the Fine Arts and Outdoor Recreation”

Review of “The Color of Culture: African American Underrepresentation in the Fine Arts and Outdoor Recreation”

FDA Analysis of Screen Failures By Race in Clinical Trials of Acute Myeloid Leukemia

Background: Ethnic and racial minorities are underrepresented in oncologic clinical trials. One potential barrier to participation may be narrow eligibility criteria which contribute to an increased rate of screen failure among minorities. Prior work in multiple myeloma demonstrated a higher rate of screen failure among black or African-American (AA) patients and lower rate of screen failure among Asian patients compared with white patients (1). Here, we examine screen failure rates by race in patients screened for participation in clinical trials of acute myeloid leukemia (AML). Methods: Trials submitted to the U.S. Food and Drug Administration (FDA) to support approval of new treatments for AML between 2016-2019 were examined. Trials which included information on screen failures and race were included. Trial, screen failure status, basic demographic information (age, gender, race, and ethnicity), country of participant, and reason for screen failure (if relevant) were abstracted from the trials. Screen failure rates were calculated based on this information. Results: Twenty-one trials of AML therapies were identified, of which screen failure and race information were available in fourteen. Of these, information on reason for screen failure was available in nine. A total of 6,471 patients were identified across fourteen trials (Table 1). Race was recorded as unknown for 2,934 (46%) of patients. A total of 3,372 (52%) screen failures occurred. Minorities were more likely to be screen failures at 201/603 (33%) compared to whites at 27%. Of minorities, screen failures occurred in 29% of black/AA patients, 36% of Asians, and 36% of patients of any other race. A total of 579 patients were included in the nine trials that included data on reasons for screen failures (Table 2). Lack of appropriate mutation (i.e. IDH1/2, FLT3) was the most common reason for screen failure overall and was more common in black/AA (41%) and Asian patients (66%) compared to white patients (29%). Other issues related to the disease course (e.g. not at the appropriate point in treatment, not treated within the time limit set in the protocol) led to screen failure in 28% black/AA patients versus 9-22% for other races (19% overall). White patients were more likely than patients of other races to be screen failures due to cardiac issues (4%) and laboratory abnormalities (6%). Conclusions: Minority patients were numerically more likely to be screen failures compared to whites in trials of AML therapeutics, which exemplifies the known issue of lower minority recruitment in clinical trials. Minority patients were more likely to be screen failures due to lack of appropriate mutation and less likely due to lab abnormalities or cardiac issues. The significance of this finding is uncertain given the limited information on reasons for screen failure and the small number of minority patients in the database. Further investigation into screen failures in minority patients with AML is indicated. These results underscore the importance of including racial and ethnic minorities in all phases of translational and clinical research to further precision oncology for all patients since oncogenic driver mutation frequencies may vary among different populations. (1) Kanapuru B, Fernandes L FDA analysis of multiple myeloma trials supporting approval; Presented at FDA-AACR workshop to examine under-representation of African Americans in multiple myeloma clinical trials 2/13/20 Disclosures No relevant conflicts of interest to declare.

Genomics of esophageal squamous cell carcinoma in African Americans.

e16552 Background: Esophageal cancer (EC) is one of the most lethal cancers with 90% mortality rate. Uneven Worldwide geographical distribution and varying etiologic factors contribute to the heterogenic nature of EC worldwide. In the US, 75% esophageal squamous cell carcinoma (ESCC) is diagnosed in African Americans (AA). However, despite comprehensive and multi-geographical efforts to understand the genomic basis of ESCC, the knowledge of molecular and genetic mechanisms leading to genomic subtyping of AA has been limited due to the underrepresentation of AAs in these studies. We hypothesized that the differences in mutational events in AA ESCC might, in part, cause the disparity in outcome and the mutational events may determine treatment options. Methods: Whole exome sequencing (WES) of matched- tumor and normal-cell DNA from late-stage ESCC of ten AA patients were performed by using Agilent SureSelect XT Human All Exon V6+UTR. Somatic variants per tumor samples called by two or more methods (Mutect2, VarScan2, and Strelka2) were combined and used for downstream population filtering. Somatic copy number changes were determined by using CNVKit in SevenBridges Genomics. Results: Somatic variants called by two or more algorithms filtered and sorted for rare mutations (equal to or less than 1% African originated population frequency) demonstrated an average of 23 nonsynonymous mutations per MB in high mutation rate AA ESCC. The remaining four samples had two or fewer nonsynonymous mutations per MB. TP53 was one of the most frequently mutated gene with 50% of mutation frequency. ARID2 mutated in 30%, EP300 in 20%, and RB1 in 10% of our cohort. Multiple amplified and deleted regions ranging from 94 to 46 were observed in seven samples in contrast to three samples that were silent in terms of copy number variations ranging from 29 to 9. Significant CNV were mostly seen in proliferation, cell cycle and checkpoint genes, squamous cell homeostasis, epithelial to mesenchymal transition, invasion and metastasis, receptor tyrosine kinase and signaling pathways, chromatin remodeling, detoxification, RNA/DNA editing and angiogenesis. Conclusions: WES of ten AA ESCC samples demonstrated a higher mutation rate in a group of patients with many passenger mutations and complex and recurrent copy number changes that affect oncogenic driver genes, which might suggest enhanced subtyping of ESCC in AA.

Confidence in Law Enforcement When African-Americans are Underrepresented on the Force: An Exploratory Study

Confidence in Law Enforcement When African-Americans are Underrepresented on the Force: An Exploratory Study, Charles E. MacLean, 2019: Dissertation, Nova Southeastern University, Abraham S. Fischler College of Education and School of Criminal Justice. This dissertation explores the prediction that when African-Americans are underrepresented among sworn officers in a community’s local law enforcement agencies compared to the African-American proportions in that community’s overall population, African-American civilians’ confidence in their local law enforcement agencies may suffer, leading to impaired respect for law, reduced civilian cooperation with law enforcement, and civilian impressions of weakened procedural justice and fairness. With low civilian confidence, the argument goes, one could expect an enhanced sense of disenfranchisement among the underrepresented sub-populations. The purpose of this study is to consider the impact of underrepresentation of African-Americans among sworn officers serving a local community, explore the key correlates of civilian confidence viewed through the lens of African-American perceptions and attitudes, and confront the superordinate roles that procedural justice and police effectiveness play in forming African-American civilian attitudes of confidence, trust, and satisfaction in local law enforcement. To quantify representativeness, this study expresses relative racial compositions of the police and the policed as a Racial Mirror Index (“RMI”). If the percent of a community’s police, who are African-American, exactly matches the percent of the policed in that community, who are African-American, the RMI-AA (“Racial Mirror Index-African-American”) would equal 100. RMI-AAs over 100 indicate African-Americans are overrepresented on the local law enforcement agency compared to the African-American share of the general population; RMI-AAs under 100 indicate African-Americans are underrepresented among sworn officers on the force. Despite expectations, as this study makes clear, RMI-AA is not a significant predictor of African-American civilian confidence, trust, and satisfaction in local law enforcement. Instead, African-American attitudes about local law enforcement are overwhelmingly driven by African-American perceptions of procedural justice and police effectiveness. African-American confidence, trust, and satisfaction in law enforcement remains far lower than for Whites regardless of RMI-AA and the degree of underrepresentation on the force. Thus, law enforcement agencies cannot hire their way out of this confidence gap through minority recruitment. Instead, improving African-American confidence in local law enforcement will require the agencies to engage with the far more substantive work of ensuring their officers deliver both procedural justice and effective policing.

Mission Drift: Are Medical School Admissions Committees Missing the Mark on Diversity?

Diversity initiatives in U.S. medical education, following the passage of the Civil Rights Act of 1964, were geared toward increasing the representation of African Americans-blacks born in the United States whose ancestors suffered under slavery and Jim Crow laws. Over time, blacks and, subsequently, underrepresented minorities in medicine (URMs), became a proxy for African Americans, Puerto Ricans, Mexican Americans, and Native Americans, thus obscuring efforts to identify and recruit specifically African Americans. Moreover, demographic shifts resulting from the recent immigration of black people from Africa and the Caribbean have both expanded the definition of "African American medical students" and shifted the emphasis from those with a history of suffering under U.S. oppression and poverty to anyone who meets a black phenotype.Increasingly, research indicates that African American patients fare better when their physicians share similar historical and social experiences. While all people of color risk discrimination based on their skin color, not all have the lived experience of U.S.-based, systematic, multigenerational discrimination shared by African Americans. In the high-stakes effort to increase URM representation in medical school classes, admissions committees may fail to look beyond the surface of phenotype, thus missing the original intent of diversity initiatives while simultaneously conflating all people of color, disregarding their divergent historical and social experiences. In this Perspective, the authors contend that medical school admissions committees must show greater discernment in their holistic reviews of black applicants if historical wrongs and continued underrepresentation of African Americans in medicine are to be redressed.

Abstract P2-10-10: Lower pathologic complete response rate with dual-HER2 blockage and chemotherapy in African Americans and ethnic minorities

Abstract Introduction: Racial disparities in breast cancer outcomes are well documented with age-adjusted mortality among African American (AA) women 40% higher than Caucasian women. Some studies have demonstrated poor response to neoadjuvant chemotherapy in AA with triple negative breast cancer but data regarding pathologic complete response rate (pCR) in HER2 positive disease are lacking. TRYPHAENA trial demonstrated a high pCR rate after treatment with dual HER2 blockage along with chemotherapy. Due to underrepresentation of African Americans and minorities in the trials leading to the approval of dual HER2 blockage (Gianni et al; Lancet Oncology;13: 25-32) in early stage breast cancer, data is lacking on the efficacy and tolerability of this treatment in this subgroup of patients. Methods: After IRB approval, pharmacy records were utilized to identify patients treated with dual HER2 blockade in neoadjuvant setting at our institution. Individual patient charts were reviewed to identify AA patients and other ethnic minorities. We also obtained details of the patient age, clinical stage, pathological stage, ER/PR status, treatment received, side effects leading to dose reductions if any. pCR was defined as absence of invasive or noninvasive cancer in the breast and lymph nodes (ypT0N0). Results:50 patients with a median age of 53 years met our inclusion criteria. 86% patients self-reported as AA and 14% were other minorities as recorded in EMR. 90% patients were treated with Taxotere, Carboplatin, Trastuzumab and Pertuzumab (TCHP) and 10% received Adriamycin, Cyclophosphamide, Paclitaxel, Trastuzumab and Pertuzumab (AC-THP) chemotherapy. Clinical staging was: Stage I- 4 %; Stage II- 84 %, and Stage III- 12 %. 46% of patients had hormone receptor (HR) positive tumors and 54% patients were HR negative. 30% (15/50) of patients required dose reduction or omission for diarrhea, neuropathy, or cytopenia. 18%(9/50) patients had doses omitted. The overall observed pCR rate (ypT0N0) was 42%(21/50). As expected, the pCR rate was higher in patients with HR negative/HER2 positive breast cancer compared to HR positive/HER2 positive breast cancer. 44% (12/27) vs. 39% (9/23), respectively.Conclusion: Dual HER2 blockade was associated with a lower pCR rate (42%) in AA and other minorities compared to rate of 52% as reported by TRYPHAENA trial (n=77). The treatment was well tolerated but higher percent of patients required a dose reduction or omission (Tiwari et al; Breast Cancer Res Treat; 158:189-193).The most common side effects were diarrhea, neuropathy and cytopenias. Further prospective studies are needed to elucidate the role of biologic differences in chemosensitivity and balancing the variables of increased number of dose reductions and effect of socioeconomic differences in an underserved minority population. Citation Format: Shruti R Tiwari, Prasun Mishra, Asma Dilawari, Christopher M Gallagher, Ami Chitalia, Patricia Wehner, Marc E Boisvert. Lower pathologic complete response rate with dual-HER2 blockage and chemotherapy in African Americans and ethnic minorities [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-10-10.

Targeting risk factors for reducing the racially disparate burden in breast cancer.

African-American (AA) women are more likely to die from breast cancer (BC), at any age, compared to European-American women. Although breakthroughs in pre-clinical studies have resulted in potentially actionable targets in AA BC, drugs that were rationally designed for these targets have performed poorly in clinical trials. Challenges with interpatient and intratumoral heterogeneity, lack of drug sensitivity and specificity, suboptimal biomarker cut-offs, lack of drug response predictive biomarkers, drug side effects, high costs of drug development, and under-representation of AAs in clinical trials complicate the development of targeted therapies for AA BC patients. Accumulating evidence suggests that racial disparities exist in non-genetic risk factors that can alter genetic and epigenetic programs to promote breast tumorigenesis. Herein, we present a "roadmap" that addresses non-genetic risk factors that are suspected to contribute to the racial disparity in BC mortality. Increased targeting of these non-genetic risk factors may proffer a safer and more economical route to alleviating the racially disparate burden in BC.

Black faces, black spaces: Rethinking African American underrepresentation in wildland spaces and outdoor recreation

The Wilderness Act of 1964 defines wilderness as “an area where the earth and its community of life are untrammeled by man, where man himself is a visitor who does not remain”. It goes on to limit acceptable activities in designated wilderness areas to those associated with leisure, scenic viewing, education, and scientific inquiry. These precepts are the basis for federal wilderness management in national parks, national forests, national wildlife refuges, and lands administered by the Bureau of Land Management. They are derived from the interests and values held by the early environmental movement's predominantly white middle and upper class patrons, and imposed on diverse groups who may not hold the same views. This study examined how the imposition of wilderness management at Congaree National Park greatly restricted local African Americans' traditional fishing practices and how fishers made meaning of their displacement. Participants' experience of alienation is a result of their perceptions of racial discrimination in the park's preferential treatment of white visitors. This study argues that African American presence in the Great Outdoors is erased both materially and symbolically by racial bias in the Wilderness Act, a general lack of attention to black outdoor spaces, and the use of white outdoor values and pursuits as the criterion for which to assess African American outdoor ethos.

Abstract 17058: Generalizability of Outcomes From Cardiac Resynchronization Therapy Trials to African-Americans

Generalizability of Outcomes from Cardiac Resynchronization Therapy Trials to African-Americans Introduction: Underrepresentation of African-Americans in clinical trials calls to question the generalizability of the observed results to this population. Methods: We studied 294 Caucasians and African-Americans and compared outcomes with those reported in major cardiac resynchronization therapy trials (CRT). Results from MIRACLE, COMPANION, CARE-HF, REVERSE, and MADIT-CRT were analyzed. Kaplan-Meier survival analysis and Cox proportional hazards regression were applied to our dataset. Results: We included 294 patients (45% African-Americans). In African-Americans the mean age was 65±12 compared with 70±13 for Caucasians, (p=0.0003). The median follow-up was 8.1± 6 years. Baseline characteristics were similar to landmark trials in age, ejection fraction, proportion with ischemic cardiomyopathy (ICM), diabetes mellitus and glomerular filtration rate (GFR). African-Americans had similar NYHA functional class as in MIRACLE, COMPANION, and CARE-HF. Survival in our patients was 7.6±0.3 years (95% CI 6.9-8.2). There was no difference in mortality between African-Americans (28%,) and Caucasians (37%, P=0.19) compared with that reported in MADIT-CRT (29 and 22%, respectively). Treatment with an aldosterone antagonist and a GFR greater than 60 were associated with lower mortality (P=0.04 and P=0.005, respectively). In African-Americans lack of treatment with an angiotensin converting-enzyme inhibitor (ACEI), GFR less than 60, and ischemic cardiomyopathy (ICM) were associated with increased mortality when compared with Caucasians (P=0.01, P=0.03, and P=0.04, respectively). In Caucasians, none of these variables were associated with increased mortality. Conclusions: Despite lack of specificity in details from the major trials, African-Americans had similar mortality outcomes as reported in the initial trials. These results support extrapolations of outcomes from landmark trials to African-Americans.

Perceptual and Structural Facilitators and Barriers to Becoming a Surgeon: A Qualitative Study of African American and Latino Surgeons.

As racial and ethnic heterogeneity in the United States increases, it is important that the health care workforce, including surgery, mirror that diversity. Structural and perceptual barriers may contribute to an underrepresentation of African American and Latino surgeons. Understanding these barriers may translate into interventions and, in turn, improved diversification of the U.S. surgery workforce. In 2016, the authors conducted in-depth semistructured interviews, exploring structural and perceptual barriers that African American and Latino surgeons face. The authors used conventional qualitative techniques to analyze data and identify themes. The authors interviewed 23 participants and observed three major themes characterizing the path to becoming a surgeon: creating a path to medicine, surgical culture, and mentorship. Subthemes provided further nuance. For creating a path to medicine, the subthemes were personal attributes, family support, community assets/barriers, and minority experience. For surgical culture, the subthemes comprised quality of life, surgeon-patient relationship, and restoring health. For mentorship, the subthemes were aspirational figures, formal programs/peer support, and professional opportunities. Experiences described by African Americans and Latinos were similar, but the experiences of participants of different self-identified childhood socioeconomic status were dissimilar. The path to a surgical career as experienced by African American and Latino surgeons is heavily influenced by mentors mediating their integration into surgical culture and engendering a feeling of belonging. Future surgeons from groups underrepresented in medicine would benefit from identifying aspirational figures early, a structured introduction into the rigors of the profession, and a deconstruction of negative surgical norms.

Death Qualification in Black and White: Racialized Decision Making and Death‐Qualified Juries

Death qualification has been shown to have a number of biasing effects that appear to undermine a capital defendant's Sixth Amendment right to a fair jury. Attitudes toward the death penalty have shifted modestly but consistently over the last several decades in ways that may have changed the overall impact of death qualification. Specifically, the very large gap between black and white Americans' current support for capital punishment raises the question of whether death qualification procedures disproportionately exclude African Americans from capital jury participation. In order to examine this possibility, we conducted two countywide death penalty attitude surveys in the California county that has the highest percentage of African American residents in the state. Results show that death qualification continues to have a number of serious biasing effects—including disproportionately excluding death penalty opponents—which result in the significant underrepresentation of African Americans. This creates a death‐qualified jury pool with the potential to be significantly more likely to ignore and even misuse mitigating factors and to rely more heavily on aggravating factors in their death penalty decision making. The implications of these findings for the fair administration of capital punishment are discussed.