White Breast Cancer Survivors Research Articles

Abstract A029: Metabolomic profiles among African-American and White breast cancer survivors: An exploratory comparison of correlations with body weight and body composition

Abstract Objective: Obesity, a strong risk and prognostic factor for postmenopausal breast cancer, is associated with numerous disruptions to the metabolome. However, it remains unclear whether obesity-metabolite associations vary when considering direct measures of adiposity versus body weight, particularly among breast cancer survivors. This analysis aims to compare correlations of body mass index (BMI) and dual-energy x-ray absorptiometry (DXA) derived measures of adiposity (percent fat, total fat) with global serum metabolites. Methods: A cross-sectional analysis was conducted among 60 postmenopausal breast cancer survivors, including 25 African-American and 35 White women within five years of their breast cancer diagnosis who were seen for care at the University of Maryland (UM) Greenebaum Comprehensive Cancer Center (Baltimore, Maryland) and the Cancer Institute at the UM St. Joseph Medical Center (Towson, Maryland). Measured height and weight were used to calculate body mass index (kg/m2); percent fat, total fat and lean mass were quantified using DXA. Global metabolomic profiling in EDTA plasma samples was performed by liquid chromatography-tandem mass spectrometry at Metabolon, Inc. Metabolites were log transformed and partial correlations of BMI, percent fat and total fat (adjusted for age, race and fasting status) were estimated. Analyses of total fat also adjusted for lean mass. The Benjamini Hochberg procedure was used to control the false discovery rate for multiple comparisons. Results: A total of 1353 metabolites, including those with known and unknown identities, were detected. After excluding metabolites with a coefficient of variation ³ 25% or with ³ 30% of values below the limit of detection, 978 metabolites remained for analyses. The median BMI among all women (n=60) was 29.7 kg/m2 ranging from 20.7-46.7 kg/m2. Percent fat ranged from 30.5 – 54.3% with a median of 41.1% while the median total fat was 27.9 kg (17.2-62.7 kg). BMI was strongly correlated with %fat (r=0.8, p=6.6e-08) and total fat after adjustment for lean mass (r=0.6, p=5.7e-05). In analyses of all women, after adjustment for age, race and fasting status, 73 metabolites correlated with BMI, 110 with percent fat and 92 with total fat adjusted for lean mass (q-value <.15). Of those, 27 metabolites correlated with all three metrics while 39 metabolites were distinctly correlated with BMI only, 10 with percent fat only and 21 with total fat only. BMI, percent fat and total fat were most commonly correlated with lipids and amino acids. Conclusions: Preliminary analyses suggest characterizing obesity with metrics of body composition may provide further insight into obesity-metabolite associations among breast cancer survivors. Analyses are ongoing to assess differences in correlations by race and to examine metabolite patterns via metabolite set enrichment analyses. Citation Format: Cher M Dallal, Li Feng, Charles Ma, Katherine Tkaczuk, Stephen Thomas, Joanne F. Dorgan. Metabolomic profiles among African-American and White breast cancer survivors: An exploratory comparison of correlations with body weight and body composition [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr A029.

Examining hypertension risk among Black and White breast cancer survivors.

Breast cancer survivors are at increased risk of cardiovascular dysfunction following their diagnosis; however, hypertension remains underexplored within this context. This retrospective cohort study examined the incidence of hypertension in breast cancer survivors and the association of race with hypertension risk among them. Data for this study were abstracted from the electronic health records of women diagnosed with Stages I-III breast cancer. Incident hypertension diagnosis was identified through International Classification of Diseases codes. Bivariate associations were tested using Student's t-test and chi-squared test of independence. Bivariable Cox regression analysis was used to determine demographic and clinical factors that may have been associated with the development of hypertension. A total of 664 women were included. Most women were 50 years of age or younger (52.0%), White (33.0% Black), and received a mastectomy (80.6%). Overall, 45.5% of the cohort developed hypertension. The 1-year hypertension-free survival estimates were 47% (95% confidence interval [CI], 41-54) in Black women and 73% (95% CI, 69-77) in White women (p < 0.0001). Besides race, statistically significant predictors of hypertension included: age greater than 50 (vs. ≤50) (adjusted Hazard Ratio [HR]: 1.40; 95% CI, 1.09-1.80) and residing in a non-metropolitan area (vs. metropolitan) (adjusted HR: 1.60; 95% CI, 1.19-2.16). This study suggests that breast cancer survivors who are older, Black, or residing in non-metropolitan areas may benefit from added surveillance and hypertension prevention strategies during treatment. Future studies are needed to identify contributors to the observed racial and geographic disparities.

Impact of endocrine therapy adherence on racial disparities in breast cancer survival.

541 Background: Black women have worse breast cancer outcomes compared to their White counterparts, even for hormone receptor positive (HR+) HER2 negative (HER2-) breast cancer (BC). This tumor type is usually treated with 5-10 years of adjuvant endocrine therapy (ET) to reduce risk of BC recurrence and improve survival. We investigated the impact of adherence to ET on racial differences in survival for HR+ HER2- BC survivors. Methods: We conducted a population-based, retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, which links demographic and clinical data with cause of death for persons with cancer and Medicare claims for covered health services. We examined 9,039 women with HR+ HER2- stage I-III BC diagnosed between 2007 and 2016, who received primary breast surgery and initiated ET. Adherence to ET was measured using the medication possession ratio (MPR), which assesses the proportion of time a patient has medication available via filled prescriptions. As in established literature, we defined ET adherence as MPR &gt; = 80%. Causal mediation analysis was performed to measure to impact of adherence on survival disparities between Black and White BC survivors. Results: Mean age at diagnosis was 72 years, 6.5% were Black, and 20.9% were dual eligible for Medicaid (a surrogate for socioeconomic hardship). Most had stage I or II breast cancer (69.3%) and mastectomy as primary surgery (69.7%). Nineteen percent received chemotherapy and 62.5% received radiation. In univariate analyses, factors associated with ET adherence were Black race (OR 0.62, 95% CI 0.54-0.75), insured by Medicaid (OR 0.72, 95% CI 0.65-0.81), being married (OR 1.14, 95% CI 1.03-1.25), and increased comorbidities (Charlson score &gt; = 2) (OR 0.88, 95% CI 0.78-0.99). Age, BC stage, type of surgery, and receipt of chemotherapy or radiation were not associated with ET adherence. In multivariable models adjusting for age, race, marital status, Medicaid eligibility, and Charlson score, Black race and Medicaid eligibility remained inversely associated with ET adherence (OR 0.70, 95% CI 0.59-0.83 and OR 0.77, 95% CI 0.69-0.87 respectively). Among those who were adherent to ET, Black women had 43% higher risk of mortality compared to White women (HR 1.43, 95% CI 1.17-1.76). In mediation analysis, 4.25% of the observed survival disparity between Black and White women can be explained by differences in ET adherence. Conclusions: We identified racial disparities in ET adherence and overall survival among women with BC. Adherence to ET accounted for a small percentage of racial disparities in survival. Further research is needed to delineate other factors contributing to ET non-adherence among Black women and to investigate additional factors contributing to known disparities in BC survival.

Abstract C108: Evaluating the relationship between physical activity and quality of life in a diverse sample of breast cancer survivors with lymphedema

Abstract Background: Compared with White breast cancer survivors, Black breast cancer survivors are more likely to experience adverse cancer treatment effects (e.g., pain and swelling from lymphedema) and suboptimal quality of life. Aerobic exercise has been shown to reduce the risk of breast cancer-related lymphedema. Physical activity has been documented to improve quality of life in predominantly White cancer survivors. However, little is known about the benefits of physical activity on quality of life among Black breast cancer survivors. In addition, there is limited evidence on the link between physical activity and quality of life over time by race in breast cancer survivors. Purpose: The primary objective of this study was to investigate the effect of physical activity on quality of life (social wellbeing, emotional/mental wellbeing, and relationship and body image) in White and Black breast cancer survivors with lymphedema. Methods: Linear mixed effects models were tested on an existing data source in a subset of participants in the control and exercise group of a 12-month completed randomized clinical trial. Results: There were 173 participants included in this analysis, averaging 59 years of age; about 33% of the participants were Black women. There were no significant differences in the quality of life outcomes between the control and exercise groups at 12 months. Exercise improved emotional/mental wellbeing and body image as it relates to social barriers at 12 months in Black and White breast cancer survivors, but the changes in these outcomes over time were only statistically significant in White breast cancer survivors (p&amp;lt;0.05). Conclusions: Results show that physical activity can improve certain domains of quality of life (e.g., emotional/mental wellbeing) over time in Black breast cancer survivors. However, the significance of the effect on quality of life (e.g., emotional/mental wellbeing) was isolated to White breast cancer survivors. After further analysis, the effects on quality of life are likely to be significant in a larger sample of Black women. Implications for Cancer Survivors: Physical activity can be used as a non-pharmaceutical intervention to enhance quality of life among subgroups of breast cancer survivors, possibly including Black women. Citation Format: Natasha R. Burse, Erik Lehman, Vernon M. Chinchilli, Yendelela L. Cuffee, Linda A. Wray, Eugene J. Lengerich, Kathryn H. Schmitz. Evaluating the relationship between physical activity and quality of life in a diverse sample of breast cancer survivors with lymphedema [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C108.

Abstract B082: Collaboration strategies to involve Black women’s perspectives in community engaged breast cancer research

Abstract Purpose: While advancements in treatment and genomic research in breast cancer are on the rise, breast cancer (BC) disparities continue to widen. Black women disproportionately have the worst prognosis and survival rates from BC compared to all racial/ethnic groups of women. Community engagement and dissemination of disparities focused research may help mitigate poor outcomes among Black women. The goal of this study was to build sustainable research-partnerships with community-based organizations to promote guideline concordant breast cancer surveillance behaviors among Black breast cancer survivors. Methods: Several partnerships were formed to conduct breast cancer research among Black women. Community building and communication tools were developed and evaluated to help shape and sustain meaningful research working relationships with breast cancer focused community organizations. Results: Partnerships were commonly established from shared goals and missions. Frequent communication and strength-based activities were key tenants in developing impactful partnerships and research initiatives. From these partnerships a breast cancer campaign, web-based communication platform and rich secondary and qualitative data were collected from a community cohort of Black and White breast cancer survivors (N=266). Conclusion: Communication tools, iterative goal settings and community engaged approaches were essential in launching several research initiatives and outreach to Black women. To date our collaboration practices have resulted in novel and increased recruitment efforts that provide implications for research participation from Black women. Citation Format: Megan C. Edmonds. Collaboration strategies to involve Black women’s perspectives in community engaged breast cancer research [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B082.

Abstract B111: Black-White differences in physical and cognitive aging among older breast cancer survivors in the Thinking and Living with Cancer Study

Abstract Introduction: While some cancer survivors experience minimal lasting effects of diagnosis and treatment, others report persistent decrements in physical and cognitive function. These changes may represent aging beyond that expected for the chronological age (i.e., “accelerated aging”). Racial minority groups often have an accelerated aging phenotype even before cancer diagnosis, partly due to chronic stress and other multi-level factors that affect aging and the ability to repair physiologic damage, leaving them more vulnerable to poor survivorship outcomes. However, we know little about physical and cognitive aging in this group and few studies have collected objective measures of physical and cognitive aging in minority cancer survivors. Methods: We examined changes in physical and cognitive function across 60 months of follow-up among Black and White survivors in the Thinking and Living with Cancer Study (TLC). TLC is an ongoing prospective multi-site cohort study recruiting non-metastatic breast cancer survivors aged ≥60 years. Participants completed questionnaires and objective assessments prior to systemic therapy with annual follow-up for up to 60 months. Physical function was measured using the timed up and go test (TUG); cognitive function was measured with Z scores on 11 neuropsychological tests for two domains: learning and memory (LM) and attention, processing, and executive function (APE). Mixed linear regression models predicting TUG, APE, or LM adjusted for age, study site, time, and cognitive reserve using the Wide Range Achievement Test (WRAT). Results: Black and White survivors in TLC were similar in age, education, comorbidities, and year of enrollment (p&amp;gt;0.14), but differed by study site (p&amp;lt;0.01) and WRAT score (p&amp;lt;0.01). On average, Black survivors had slower performance than White survivors on the TUG test (34 Black survivors, 366 White survivors; 12.6 seconds (SD=0.41) vs. 11.0 seconds (SD=0.13), respectively; p&amp;lt;0.001) at 12 months, but racial differences declined over time. Black survivors had poorer performance than White survivors for both LM and APE across 60 months of follow-up (94 Black survivors, 995 White survivors; p&amp;lt;0.001): mean Z scores were -0.23 (SD=0.08) among Black survivors and 0.31 (SD=0.03) among White survivors for LM and -0.29 (SD=0.06) among Black survivors and 0.1 (SD=0.02) among White survivors for APE. In multivariable models, race was a significant predictor of TUG score (β=0.94, p&amp;lt;0.01), LM score (β=-0.58, p&amp;lt;0.01), and APE score (β=-0.38, p&amp;lt;0.01). Conclusions: Older Black breast cancer survivors tended to have worse physical and cognitive function compared to older White breast cancer survivors and may experience accelerated decline. Additional studies are needed to address critical evidence gaps about the prevalence of poor physical and cognitive function, as well as aging trajectories, among Black breast cancer survivors. Citation Format: Traci N. Bethea, Wanting Zhai, Xingtao Zhou, Tim A. Ahles, Jaeil Ahn, Harvey J. Cohen, Asma A. Dilawari, Deena Graham, Heather Jim, Brenna C. McDonald, Zev M. Nakamura, Sunita K. Patel, Kelly E. Rentscher, James C. Root, Andrew J. Saykin, Brent J. Small, Kathleen Van Dyk, Jeanne S. Mandelblatt, Judith E. Carroll. Black-White differences in physical and cognitive aging among older breast cancer survivors in the Thinking and Living with Cancer Study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B111.

Abstract 15439: Longitudinal Assessment of Racial Differences in Exercise Capacity After Breast Cancer Treatment: WF-97415

Introduction: Breast cancer (BC) treatment toxicity contributes to elevated rates of cardiovascular morbidities, such as reduced exercise capacity, a risk factor for long-term cardiovascular disease (CVD) and mortality. Past studies have shown that Black women experience greater cardiotoxicity after BC treatment than white women. No studies have investigated racial differences in exercise capacity. The lack of longitudinal data leaves uncertainty as to whether greater declines in exercise capacity are experienced by Black BC survivors. Methods: This cohort was comprised of 236 women with stage I-III BC (80% white; 20% Black) and 130 cancer-free controls in the UPBEAT (NCT02791581) and DETECT (NCT01719562) studies. Submaximal exercise capacity was obtained via 6-Minute Walk Distance (6MWD, meters [m]) at baseline (pre-treatment) and 3 months. Linear regression was used to examine associations of race with baseline 6MWD and changes in 6MWD. Results: Mean age [SD] of BC survivors was 55.7 [10.9] years. Mean [SD] total meters walked pre-treatment was lower in Black women with BC (423 m [81.0]) than white women with BC (475 m [87.7]; p=0.01), and lower than Black women without BC (471 m [76.9]; p=0.07). Black BC survivors experienced a greater mean decline from baseline to 3-months in 6MWD (30 m [68.5]) than white BC survivors (21.7 m [86.6]; Table 1; p=0.02) or Black women without BC (9.2 m [67.3]; p=0.001), translating to a mean difference of 60 m between Black and white BC survivors during BC treatment. Conclusions: This is the first study to suggest racial differences in submaximal exercise capacity during BC treatment. Black BC survivors experienced a greater reduction in exercise capacity than white BC survivors after cancer treatment as early as 3-months post-diagnosis. This clinically-meaningful difference in exercise capacity warrants further investigation, particularly to determine interventions to reverse the loss of exercise capacity.

A Mixed Method Approach to Examine Surveillance Mammography Experiences in Black and White Breast Cancer Survivors

PurposeThe use of surveillance mammography following a breast cancer (BC) diagnosis is associated with early detection of disease relapse and increased overall survival; yet Black women compared to White women have the lowest surveillance mammography rates, with limited explanation. To further understand this racial disparity the present study examines the association of mammography beliefs, knowledge, and healthcare delivery factors on receipt of surveillance mammography among Black and White breast cancer survivors. MethodsThis is a convergent parallel mixed method study design of an online survey and online focus groups among Black and White BC survivors (N = 266) recruited from community engagement. The online focus groups consisted of a series of theory-informed questions via social media platforms (eg Breastcancer.org, Quora, Reddit). An in-depth thematic analysis approach was used to extract themes from online focus group data. Bivariate (χ2) and multivariable logistic regression analyses were conducted using the survey data to examine associated factors with receipt of a surveillance mammography within 12 months (yes vs. no). Results76% (n = 177) of women were Black, 62% were <5 years since diagnosis, 98% had health insurance, with an age range from 23 to 79 (mean = 55) years. 72% of the sample received a surveillance mammogram relative to 27%. Women more frequently received a surveillance mammogram if they reported perceived mammography benefits (<.001), underwent lumpectomy (P< .001) and had health insurance (P = .04). Black women without communication about surveillance care with providers had a lower likelihood of receiving a surveillance mammogram (OR:0.09,95% CI: 0.01-0.45, P = .003). Thematic findings from online focus groups included motivators for receipt of surveillance mammograms: physician recommendation, regular physical exams, and knowledge of recommended guidelines. Barriers of non-receipt of surveillance mammograms included: transportation, medical cost/financial barriers, feeling ignored from providers, and medical mistrust. ConclusionWomen may require more individualized information regarding their surveillance care to support routine guideline concordant follow-up. Patient-provider-communication is an integral part of Black survivors’ surveillance care needs. Improving patient-provider communication for Black women's is necessary to address this group cancer care needs.

A randomized controlled trial of the effect of supervised exercise on functional outcomes in older African American and non-Hispanic White breast cancer survivors: Are there racial differences in the effects of exercise on functional outcomes?

The objective of this study was to test the hypothesis that exercise would be more effective than a support group plus Fitbit (SG+Fitbit) program in improving functional outcomes in older breast cancer survivors (BCSs) and that race would moderate the exercise effect on outcomes. Older African American (AA) and non-Hispanic White (NHW) BCSs were purposively recruited and enrolled into the 52-week randomized controlled trial. The interventions included 20 weeks of supervised moderate-intensity aerobic and resistance training followed by 32 weeks of unsupervised exercise called IMPROVE (n = 108) and a 20-week SG+Fitbit program followed by 32 weeks of unsupervised activity (n = 105). Study outcomes were assessed at 20 and 52 weeks. The primary outcome was the change in Short Physical Performance Battery (SPPB) scores 20 weeks from the baseline between arms. Secondary outcomes included change in the 6-Minute Walk Test (6MWT) in meters 20 weeks from the baseline between arms. General linear regression and multivariable logistic regression analyses were used. The mean age was 71.9 years (SD, 5.9 years), and 44% were AA. SPPB scores did not differ between arms (adjusted difference in mean change, 0.13; 95% CI, -0.28 to 0.55; P = .53). However, the exercise arm (vs the SG+Fitbit arm) improved on the 6MWT (21.6 m; 95% CI, 2.5-40.6 m; P = .03). Race moderated the exercise effect on the 6MWT (adjusted interaction effect, 43.3 m; 95% CI, 6.3-80.2 m; P = .02); this implied that the change in the adjusted mean for the 6MWT at 20 weeks from the baseline was 43.3 m higher in AA exercise participants versus NHW exercise participants. Combined aerobic and resistance exercise appears to improve physical performance in older BCSs, and the exercise effect might be moderated by race, with AAs appearing to derive larger benefits in comparison with NHWs. Larger studies are warranted to confirm the study findings.

Abstract PO-109: “At some point or another, it has affected all of my five senses.”: A qualitative assessment of treatment-related side effects in Black and White breast cancer survivors

Abstract Background: Racial disparities in breast cancer outcomes persist and are attributed to multiple factors; however, treatment-related side effects, one of the most frequently implicated reasons for poor quality of life and treatment disruptions have been underexplored as a contributor to the disparity. The purpose of this study was to explore similarities and differences in Black and White women's experiences with breast cancer treatments, with a particular focus on their experiences with side effects. Methods: This was a secondary analysis of qualitative data that were originally collected to understand breast cancer survivor's experiences taking adjuvant endocrine therapy (AET). This analysis focused on discussions about side effects related to multiple treatment modalities, including chemotherapy, radiation, and AET. Women were recruited from healthcare centers and via community organizations in an urban U.S. city. Women were eligible for the study if they identified as Black/African American or White and were taking AET. Participants attended one focus group with women who identified as the same race. Focus groups were conducted between August 2014-August 2015, lasted 90-120 minutes, and were transcribed verbatim. Using an iterative approach, initial open codes were identified by two individuals, compared within and between interviews, and refined to generate themes. Disagreements were resolved via a third reviewer. Results: A total of 21 women attended one of three focus groups (n=16 Black women; n=5 White women). Three overarching themes were identified: Side Effect Recognition, Communication about Side Effects, and Coping with Side Effects. Women's descriptions of their side effects closely mirrored domains of the Functional Assessment of Cancer Therapy Endocrine Therapy scale (e.g., vasomotor symptoms). Black and White women also reported weight changes as a result of adjuvant endocrine therapy (weight gain) and chemotherapy (weight loss). The majority of women in our sample reported at least one side effect; however, reporting ‘no side effects' only occurred among White women. Ratings of provider communication about symptoms were mixed; some women found communication helpful while others reported feeling dismissed. While one woman expressed provider negligence concerning mitigating side effects, another remarked on the accessibility of her provider to answer all her questions. Women discussed various methods to cope with side effects, including exercise and medications to relieve joint and bone pain. Spirituality as a method to cope only emerged in the focus groups with Black women. Conclusion: Black and White women reported relatively similar experiences with treatment-related side effects. Future work is needed to understand why Black women may experience more side effects to treatment. Further, culturally-tailored approaches to address treatment side effects that incorporate spirituality are needed to mitigate side effects, which may ultimately improve treatment adherence, quality of life, and outcomes in Black women. Citation Format: Arnethea L. Sutton, Maria D. Thomson, Alejandra Huratdo-de-Mendoza, Vanessa B. Sheppard. “At some point or another, it has affected all of my five senses.”: A qualitative assessment of treatment-related side effects in Black and White breast cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-109.

Association between aspects of social support and health-related quality of life domains among African American and White breast cancer survivors.

Social support is associated with breast cancer survivors' health-related quality of life (HRQoL). More nuanced information is needed regarding aspects of social support associated with different HRQoL domains among diverse populations. We assessed the association between emotional/informational and tangible support and five HRQoL domains and evaluated race as an effect modifier. African American and White women (n = 545) diagnosed with hormone-receptor-positive breast cancer completed a survey that assessed sociodemographic, clinical, and psychosocial factors. We assessed bivariate relationships between emotional/informational and tangible support along with overall HRQoL and each HRQoL domain.We tested interactions between race and emotional/informational and tangible social support using linear regression. The sample included African American (29%) and White (71%) breast cancer survivors. Emotional/informational social support had a statistically significant positive association with emotional well-being (β = .08, p = 0.005), social well-being (β = 0.36, p < 0.001), functional well-being (β = .22, p < .001), breast cancer concerns (β = .16, p = 0.002), and overall HRQoL (β = .83, p < .001). Similarly, tangible social support had a statistically significant positive association with emotional well-being (β = .14, p = 0.004), social well-being (β = .51, p < .001), functional well-being (β = .39, p < .001), and overall HRQoL (β = 1.27, p < .001). The interactions between race and social support were not statistically significant (p > 0.05). Results underscore the importance of the different social support types among breast cancer survivors, regardless of survivors' race. Population-based interventions can be standardized and disseminated to provide guidance on how to increase emotional/information and tangible support for all breast cancer survivors by caregivers, health providers, and communities.

Influential factors in Black and White breast cancer survivors' beliefs about breast cancer.

Breast cancer beliefs are widely studied to improve preventative screening behaviors in women without cancer; however, limited research has examined breast cancer beliefs among breast cancer survivors. To fill this gap in research we investigated racial differences and the predicting role of influential factors (e.g., stage) in survivors' beliefs about their breast cancer. This study is a secondary analysis of data from the Narrowing Gap in Adjuvant Therapy Study (2006-2011), where Black (N=210) and White women (N=149) were interviewed within 20 weeks following their breast cancer diagnosis and primary surgery in Washington DC and Detroit, MI. Outcomes of this analysis were perceived susceptibility to a breast cancer recurrence and perceived severity of breast cancer. Bivariate analyses were conducted to assess racial differences in sample characteristics, and on the study outcomes. Adjusted multiple regression models examined correlates between independent variables (e.g., sociodemographic/clinical) and women's breast cancer beliefs about susceptibility of a recurrence and disease severity. Most of the sample were Black women (58%), had breast-conserving surgery (64%), and were privately insured (67%). Black women reported higher perceived disease severity beliefs than White women (p=0.004). Other associated factors with greater perceived severity beliefs included lower education (p=0.008), public health insurance (p=0.021) and greater levels of medical mistrust (p=0.016). In our adjusted multiple regression models' women with lower satisfaction regarding financial aspects of their healthcare were more likely to have higher perceived severity beliefs (p=0.007); women with stage II cancer compared to stage I had greater susceptibility beliefs to a cancer recurrence (p=0.001). We found racial differences in women's perceived severity beliefs, and identified theory-based clinical and psychosocial correlates in survivor's breast cancer beliefs by race. Specifically, women diagnosed at stage (II) compared to stage (I) reported greater perceived susceptibility to a recurrence. Survivors diagnosed at stage (I) and (III) cancers may serve as important target groups to monitor their surveillance and follow-up behaviors. This study contributes salient predictors in survivors' beliefs about their BC and informs navigation strategies to improve cancer survivorship recommendations in the context of psycho-oncology and follow-up cancer care.

Effect of aerobic and resistance exercise on the mitochondrial peptide MOTS-c in Hispanic and Non-Hispanic White breast cancer survivors

MOTS-c is a mitochondrial derived peptide with exercise mimetic activity that elicits beneficial effects on metabolism and exercise capacity. Furthermore, MOTS-c effects in humans are affected by race, potentially via ethnic-specific mtDNA variations. Women treated for breast cancer are at an increased risk for cardiovascular disease, diabetes and obesity, due to side effects of cancer-treatments. We conducted a secondary analysis of the effects of a 16-week aerobic and resistance exercise intervention on MOTS-c in Hispanic and Non-Hispanic White breast cancer survivors (BCS). BCS (Stage I–III) were randomized to exercise or standard care. The intervention promoted aerobic and resistance exercise for 16 weeks. MOTS-c was analyzed in fasting plasma using an in-house ELISA. Within and between group differences were assessed by paired t-test and repeated measures ANOVA. Pearson’s correlation was computed to assess the association between MOTS-c and metabolic biomarkers at baseline and post-exercise. Twenty-five Hispanic-BCS and 24 non-Hispanic White BCS were included. Hispanic BCS were younger, of greater adiposity, had higher stage cancers, and had worse metabolic profiles at baseline compared to non-Hispanic White BCS (p < 0.001). Post-exercise, MOTS-c levels significantly increased when compared to baseline and the usual care group among non-Hispanic White BCS (p < 0.01) but not among Hispanic breast cancer survivors (p > 0.01). Post-exercise levels of MOTS-c among non-Hispanic White BCS were significantly associated with reductions in fat mass, body weight, HOMA-IR, CRP, and an increase in lean mass (p < 0.01). A 16-week aerobic and resistance intervention increased MOTS-c levels among non-Hispanic White BCS.Trial registration: This trial is registered on ClinicalTrials.gov: NCT01140282 as of June 9, 2010. https://clinicaltrials.gov/ct2/show/NCT01140282.

Abstract LB081: Systemic inflammation is associated with increased risk of mortality after invasive breast cancer among Hispanic women from New Mexico

Abstract Introduction: Soluble tumor necrosis factor receptor-II (sTNF-R2), a circulating pro-inflammatory biomarker, has been found to associated with obesity and increased risk of breast cancer. No studies to date have examined the association between sTNF-R2 and risk of mortality among Hispanic breast cancer survivors, an at-risk population due to their high prevalence of obesity and poor prognosis. The current study examined the long-term effects of sTNF-R2 on risk of mortality among Hispanic and non-Hispanic white (NHW) breast cancer survivors from the New Mexico Health Eating Activity and Lifestyle Study. Methods: A total of 397 invasive breast cancer survivors (96 Hispanic, 301 NHW) contributed data for the present study. Women with breast cancer diagnosed between July 1996 and March 1999 were ascertained through the National Cancer Institute's Surveillance Epidemiology and End Results registry in New Mexico. Baseline demographic characteristics, anthropometric measures, and blood samples were collected approximately 5 months post diagnosis by trained interviewers. Plasma levels of sTNF-R2 were assayed and measures were log-transformed to conform to normality. The main predictor of low (referent) vs high sTNF-R2 levels was based on the median value. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the associations between sTNF-R2 and all-cause mortality were calculated using Cox proportional hazards regression models overall and by ethnicity. Models were adjusted for age at diagnosis, education, breast cancer stage, treatment, and body mass index (BMI). Results: A total of 133 deaths (53 breast cancer-specific deaths) were observed after a median follow-up time of 13 years. While Hispanic women had higher baseline BMI (mean= 27.21, standard deviation (SD)= 5.83) compared to NHW women (mean= 25.68, SD= 5.36) (p&amp;lt; 0.001), significant differences by ethnicity for sTNF-R2 levels were not observed. In models adjusted for ethnicity and other covariates, the association between high vs low levels of plasma sTNF-R2 and risk of mortality was not statistically significant among all women (HR, 1.36; 95% CI 0.90-2.03). However, in models stratified by ethnicity, Hispanic women had increased risk of mortality of almost 3-fold (HR, 2.83; 95% CI 1.21-6.63), while the association among NHW women was attenuated and was not statistically significant (HR, 0.99; 95% CI 0.61-1.61). The statistical interaction between sTNF-R2 and ethnicity with risk of mortality was not statistically significant (p= 0.10). Conclusion: Our study results suggest Hispanic breast cancer survivors with high levels of systemic inflammation measured by sTNF-R2 are at increased risk of mortality. These results could inform targeted intervention studies to decrease inflammation and reduce risk of mortality among this at-risk population. Citation Format: Avonne E. Connor, Stephanie D. Boone, Kathy B. Baumgartner, Richard N. Baumgartner. Systemic inflammation is associated with increased risk of mortality after invasive breast cancer among Hispanic women from New Mexico [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB081.

Racial/ethnic differences in health-related quality of life among female breast cancer survivors: cross-sectional findings from the Medical Expenditure Panel Survey

ObjectivesBreast cancer survivors have reported worse health-related quality of life (HRQoL) outcomes on some subscales when compared with members of the general population. However, the increased attention to breast cancer survivorship should have improved the HRQoL of these survivors. Our aim was to examine whether physical and mental component scores (PCS-12 and MCS-12) using the Short Form (SF-12) questionnaire were different for racial/ethnic minorities, specifically for Black and Hispanic women relative to White women. Furthermore, we stratified the data by age group to evaluate these racial/ethnic differences in HRQoL of breast cancer survivors. Study designCross-sectional study. MethodsPooled cross-sectional analyses using data from the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the racial/ethnic differences in PCS-12 and MCS-12 scores of breast cancer survivors. Furthermore, stratified analyses by age group were conducted to evaluate racial/ethnic differences in HRQoL by the age of breast cancer survivors. ResultsAfter adjusting for confounders, there was no association between race/ethnicity and PCS-12 scores. However, Hispanic breast cancer survivors had statistically significantly lower MCS-12 scores (by 1.9 points [95% confidence interval {CI}: −3.53 to −0.37]) when compared with White breast cancer survivors. For PCS-12, after stratifying by age, the adjusted analyses showed no significant differences in PCS-12 scores when White female breast cancer survivors were compared with the other racial/ethnic categories. On the other hand, Black female survivors aged <50 years had 4.3 points (95% CI: 0.46–8.13) higher MCS-12 scores when compared with their White counterparts, while Hispanic breast cancer survivors aged <50 years had 3.1 points (95% CI: −0.40–6.69) higher MCS-12 scores relative to White women. Furthermore, among female breast cancer survivors aged ≥50 years, Hispanic women had 3.2 points (95% CI: −4.98 to −1.40) lower MCS-12 scores than White women. ConclusionOur study generated findings showing the racial/ethnic differences in HRQoL of breast cancer survivors and presented results stratified by age group. These findings provide the much-needed rationale for targeted and racial/ethnic-specific HRQoL improvement strategies among breast cancer survivors.

Distress Trajectories in Black and White Breast Cancer Survivors: From Diagnosis to Survivorship

BackgroundBlack breast cancer survivors have greater morbidity and mortality than White survivors. However, evidence comparing Black survivors’ psychological symptoms with their White counterparts has been mixed. Prior studies have not compared Black and White survivor’s distress-related symptom trajectories from pre- to post-treatment – the goal of the current study. MethodsAt three annual visits from shortly after diagnosis to 6 and 18 months post-treatment, 195 women (n = 163 White; n = 32 Black) reported their cancer-related distress (intrusive thoughts and avoidance), perceived stress, anxiety and depressive symptoms, fatigue, and pain. ResultsAdjusting for age, educational attainment, income, treatment type, stage at diagnosis, and physical comorbidities, Black and White breast cancer survivors had different trajectories of cancer-related distress (p = .004), intrusive thoughts about cancer diagnosis and treatment (p = .002), perceived stress (p = .04), emotional fatigue (p = .01), and vigor (p = .02). Specifically, among White women, these distress-related symptoms improved from diagnosis to 6 months post-treatment (ps < 0.0001) and then remained stable between 6 and 18 months post-treatment, whereas Black women had persistently elevated distress – even 18 months after finishing treatment. Additionally, Black women reported more avoidance of cancer-related thoughts and emotions across visits (p = .047). Race was unrelated to the trajectories of anxiety and depressive symptoms, other fatigue subscales, or pain levels (ps > 0.08). ConclusionLongitudinal assessment of the same breast cancer survivors from diagnosis to early survivorship revealed that Black and White survivors had divergent trajectories of psychological distress symptoms that were not reliably evident at a single timepoint. Overall, White women reported less psychological distress from pre- to post-treatment, but Black women’s distress remained high from diagnosis to 18 months post-treatment. If left untreated, Black women’s high distress levels may contribute to their poorer health throughout survivorship.

EP082 - Knowledge and use of BRCA genetic testing among Chinese and Non-Hispanic white breast cancer survivors

eP082 - Knowledge and use of BRCA genetic testing among Chinese and Non-Hispanic white breast cancer survivors

Differences in Emotional Distress Among Black and White Breast Cancer Survivors During the Covid-19 Pandemic: a National Survey.

The Covid-19 pandemic is straining US healthcare resources, causing significant disruptions in cancer care. Prior to the pandemic, Black cancer survivors experienced a disproportionate burden of delays in cancer treatment compared to White cancer survivors. As a result of the pandemic, disruptions in care are widespread and affect cancer survivors regardless of race. This shift presented an opportunity to investigate differences in how Black and White cancer survivors experience disruptions in cancer care due to the pandemic. We conducted a national survey of adult breast cancer survivors, distributed online from 4/2/20 to 4/27/20. We used t-tests to compare cancer and non-cancer-related worry during the Covid-19 pandemic between Black and White breast cancer survivors. Analysis of data from 570 respondents (106 Black and 464 White) indicated significantly higher levels of distress among White respondents compared to Black respondents. Our results point to the importance of assessing race differences in emotional response to disruptions in cancer care during the pandemic. We suggest that differences in emotional distress may reflect differences in previous experience of treatment delays and coping strategies between Black and White breast cancer survivors.

IMPROVE, a community-based exercise intervention versus support group to improve functional and health outcomes among older African American and Non-Hispanic White breast cancer survivors from diverse socioeconomic backgrounds: Recruitment strategies and baseline characteristics.

Behavioral intervention studies in older breast cancer survivors, particularly older African American (AA) and socioeconomic status-disadvantaged breast cancer survivors, are lacking. To inform future studies, the authors examined recruitment strategies in older breast cancer survivors who participated in an exercise intervention study. IMPROVE is a randomized trial designed to evaluate a group-based exercise intervention versus a support group (ClinicalTrials.gov identifier, NCT02763228). Participants were aged ≥65 years who had survived stage I through III breast cancer and were within 5 years of treatment completion. Participants were recruited through multiple approaches, including peripheral, linguistic, and constituent-involving strategies that incorporated the identification of potentially eligible patients from 3 local hospitals and from State of Ohio registries and through direct clinician and community organization referrals. Between October 2016 and November 2019, 7487 patients were screened, 4790 were potentially eligible, and 213 were randomized into the study. The eligible:randomization rates were 4.4% overall and 84%, 8%, and 2% for recruitment using direct referrals, hospital registries, and state registries, respectively. The median age of the randomized cohort was 70 years (range, 65-88 years) and included 44% AA and 44% socioeconomic status-disadvantaged breast cancer survivors. Compared with all registry-eligible patients, directly referred-eligible patients were more likely to be AA versus Non-Hispanic White (41% vs 19%; P = .006), to be contacted successfully (100% vs 33%; P < .0001), and to accept study participation (88% vs 16%; P < .0001). Direct referrals appeared to be the most efficient strategy for recruiting AA survivors. Behavioral intervention studies seeking to target older AA and socioeconomic status-disadvantaged breast cancer survivors should include strategies that foster direct referrals to study participation.

Abstract PO-176: Obesity, breast cancer treatment, and systemic inflammation: A cross- sectional analysis of Hispanic and non-Hispanic white breast cancer survivors from New Mexico

Abstract Background: Circulating markers of systemic inflammation have been found to be important long-term prognostic factors for breast cancer (BC). Studies have shown that obesity measured by percent body fat is the most significant predictor of inflammation in BC survivors. Specific BC treatments may also stimulate both local and systemic increases in inflammation. Little is known about the impact of other body size measures and BC treatment effects on inflammation among Hispanic BC survivors, an at-risk population due to their high prevalence of obesity and poor prognosis. Objective: We examined the associations between body size measures, BC treatment, and odds of systemic inflammation measured by soluble tumor necrosis factor receptor-II (sTNF-R2), a circulating pro-inflammatory biomarker, among Hispanic and non-Hispanic white (NHW) women diagnosed with breast cancer (stages I-IIIa) from the New Mexico Health, Eating, Activity, and Lifestyle cohort. Methods: A total of 397 BC survivors (96 Hispanic, 301 NHW) contributed data for the present study. Women with BC diagnosed between July 1996 and March 1999 were ascertained through the National Cancer Institute’s Surveillance Epidemiology and End Results registry in New Mexico. Baseline demographic characteristics, anthropometric measures, and blood samples were collected approximately 5 months post diagnosis by trained interviewers. Plasma levels of sTNF-R2 were assayed and measures were log-transformed to conform to normality. The study outcome of low vs high sTNF-R2 levels was based on the median value. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression models and were stratified by ethnicity. Results: There were higher proportions of women with high compared to low sTNF-R2 levels and the following obesity measures: high percent body fat (≥35%), high body mass index (BMI) (≥30 kg/m2), and high waist-hip ratio (&amp;gt;0.85). No significant differences were observed by sTNF-R2 levels and ethnicity or treatment. In multivariable models, we observed significant positive associations among women with high body fat percentage (compared to &amp;lt; 35%) (OR= 1.62, 95% CI 1.01-2.60) and morbid obesity (BMI ≥35 kg/m2 compared to BMI&amp;lt; 35 kg/m2) (OR= 4.16, 95% CI 1.43-12.10). High waist-hip ratio was not significantly associated with sTNF-R2. While current tamoxifen use was not associated with sTNF-R2, we did find that women who received radiation and chemotherapy were 2 times more likely to have high sTNF-R2 levels compared to women who did not have chemotherapy and radiation (OR= 2.04, 95% CI 1.03-4.01). Our results were not significantly modified by ethnicity. Conclusion: BC survivors with high body fat percentage and extreme BMI have increased odds of systemic inflammation measured by sTNF-R2. Survivors treated with chemotherapy and radiation are also more likely to experience systemic inflammation. Future studies will examine the long-term effects of these associations on poor prognosis. Citation Format: Avonne E. Connor, Kala Visvanathan, Stephanie D. Boone, Kathy B. Baumgartner, Richard N. Baumgartner. Obesity, breast cancer treatment, and systemic inflammation: A cross- sectional analysis of Hispanic and non-Hispanic white breast cancer survivors from New Mexico [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-176.