Black Women Research Articles

Abstract B101: Knowledge, attitudes, and self-efficacy toward cancer genetic testing among Black women with and without breast cancer

Abstract Germline genetic testing for cancer risk offers opportunities for decision-making about screening and clinical risk management for individuals and their family members. Despite increasing availability of cancer genetic testing, Black individuals are still much less likely to receive or engage with testing compared to non-Hispanic white individuals. We sought to identify individual level factors influencing knowledge about and attitudes toward cancer genetic testing among Black women with and without breast cancer. Participants included 925 women from the Black Women’s Health Study who had previously provided a biospecimen for research and were invited to have their cancer genetic research findings confirmed via a CLIA-certified laboratory and learn their results as part of a randomized controlled trial. Prior to confirmation testing, all women completed a baseline questionnaire about personal and family history of cancer; prior genetic testing for hereditary cancer; and knowledge, attitudes, and confidence in one’s ability to use genetic information (genetics self-efficacy). We used linear regression to evaluate individual-level factors influencing cancer genetics knowledge, attitudes, and self-efficacy. Overall, mean knowledge score was 12.3 out of 16 (SD, 2.5); there were no differences in knowledge score between women who had a personal history of breast cancer and those who did not. While the majority of women answered most questions correctly, 20-30% of women were unable to correctly answer questions about validity of test results, clinical implications of a variant of uncertain significance, and legal protections against health insurance discrimination. Younger age, higher educational attainment, being married, and having had prior genetic testing were statistically significant predictors of higher total knowledge score. There were no differences in mean knowledge scores by first degree family history of breast cancer or personal history of breast or other cancer. Predictors of favorable attitudes and genetics self-efficacy included younger age, higher educational attainment, and being married. Women with a personal history of breast cancer had somewhat more favorable attitudes toward genetic testing compared to those with no prior history of breast cancer. In multivariable adjusted models, higher total knowledge was associated with more favorable attitudes and higher self-efficacy. In this cohort of highly educated Black women, overall cancer genetics knowledge was relatively high; however, evaluation of individual knowledge questions revealed opportunities for improvement in specific areas. Older women, those with lower educational attainment, and women who are not married or living as married may benefit from more targeted education about genetic cancer testing. Further, despite the role genetic testing currently plays in guiding cancer treatment, Black women who had breast cancer did not have higher knowledge scores than those without breast cancer and therefore may also benefit from targeted education. Citation Format: Kimberly A. Bertrand, Michelle Trevino-Talbot, Maggie Rudderman, Maureen Flynn, Howard J. Cabral, Julie R. Palmer, Catharine Wang. Knowledge, attitudes, and self-efficacy toward cancer genetic testing among Black women with and without breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B101.

Abstract B079: Impact of exercise interventions on mental and physical health outcomes among Black breast cancer survivors: A systematic review

Abstract This review aims to identify and characterize physical activity interventions developed to address mental and physical health outcomes among Black breast cancer (BC) survivors. Over 3.8 million BC survivors in the U.S. may experience physical, psychological, and functional symptoms that alter their ability to engage in physical activity. Physical activity for BC survivors is well recognized for managing these cancer-related symptoms and improving quality of life. However, physical inactivity is a public health problem among Black women with BC. Black women experience a 41% higher mortality rate and worse outcomes across all stages of BC than any other racial/ethnic group due to many factors, including psychosocial stressors and disproportionate socioeconomic disadvantages. More research is needed to understand barriers and facilitators among Black BC survivors to engage in physical activity, specifically posttreatment, and to decrease BC disparities. A systematic review was deemed appropriate, and the keywords “breast cancer AND black women AND exercise” were searched using the following databases: PubMed, Web of Science, CINAHL, and PsycINFO as of May 2024. Studies were selected based on inclusion/exclusion criteria using two reviewers. This review included 19 studies (n=8 descriptive and n=11 experimental) involving 9,691 breast cancer patients, focusing on the mental and physical health outcomes associated with physical activity among Black women. Findings indicate that Black women generally do not meet physical activity guidelines, exhibit lower physical functioning, higher body mass index (BMI), and often live with multimorbidity. Studies were categorized into physical health (BMI, lymphedema, fatigue, muscle strength, physical function, diet, and comorbidities) and mental health (quality of life, emotional well-being, social support, and negative mood). Exercise interventions demonstrated potential for improving physical activity, cardiorespiratory fitness, and muscle strength, with mixed results on quality of life (QOL) and fatigue. Significant associations were found between higher physical activity levels and QOL (n=7). Physical health-related findings included significant associations between physical activity and improved BMI (n=2), decreased lymphedema (n=2), and weight loss (n=1). However, four out of six studies focusing on BMI reported no significant associations with physical activity. An 8-week moderate-intensity exercise intervention led to marginal reductions in fatigue and slight improvements in QOL (P = 0.06) compared to baseline. A high prevalence of obesity, physical inactivity, and suboptimal adherence to physical activity among Black BC survivors from this systematic review highlight the need to develop culturally tailored physical activity interventions to address this public health issue. Specifically, more studies are needed to incorporate more goal setting, motivational techniques, and access to physical/psychosocial resources that address barriers and enhance facilitators to long-term exercise adherence. Citation Format: Sabrina M. Guillen, Lakeshia Cousin. Impact of exercise interventions on mental and physical health outcomes among Black breast cancer survivors: A systematic review [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B079.

Abstract C017: Race-Specific Patterns of Vaginal Microbiome and HPV Infections Predict Risk of Precancerous Cervical Lesions

Abstract Background: Our previous research indicated that high-grade squamous intraepithelial lesions (HSIL), precursors to cervical cancer (CCa), are influenced by the vaginal microbiome (VMB) differentially by self-reported race. VMB enriched for certain anti-inflammatory Lactobacillus species confer protection against the risk of HSIL for white, but not Black women. Black women exhibit greater VMB diversity (associated with HPV tumorigenesis) and a lower prevalence of anti-inflammatory Lactobacillus species. But not all Black women with diverse VMB develop HSIL. Objective: Given HPV's essential role in cervical cancer, we aimed to assess the influence of sociodemographic, clinical, and microecological HPV attributes on HSIL risk within the context of the vaginal microbiome's variation by race. Methods: The VMB and HPV profiles of 1,168 women were analyzed alongside over 100 sociodemographic and clinical variables. Spearman’s correlation, Point-Biserial Correlation, chi-squared tests, and machine learning models, were employed to evaluate associations between sociodemographic, clinical, and microecological variables with HSIL, with a particular focus on the impact of race on these relationships. Results: The cohort was predominantly Black (72%), showing no significant race-based differences in HPV positivity (45%). However, HSIL incidence was nearly twice as high in Black (7%) compared to White women (4%). Women with HSIL had a higher prevalence of non-Lactobacillus-dominant VMB (68% vs. 51%) and were more likely to be HPV+ (73% vs. 44%) than those without HSIL. Co-infection with multiple HPV strains was associated with a higher risk of CIN3. Specifically, HPV16, HPV56, HPV58, HPV33, and HPV42 infections were significantly associated with higher CIN3 risks. The random forest model identified the relative abundance of Lactobacillus crispatus as the most essential factor in predicting CIN3 risk, followed by the number of HPV strains per sample. However, differential abundance analysis specifically indicated lower L. crispatus levels were associated with HSIL in white but not Black women. Conversely, HPV abundance was only associated with HSIL in Black women. Additionally, Black patients with 2 or more HPV co-infections had a higher likelihood of being diagnosed with CIN3+ compared to white counterparts. ML models highlighted different HPV-specific HSIL predictors by race: HPV number, and HPV 56, 16, and 33 in Blacks; sexual partners, HPV 90, 56, and 16 in whites. Conclusions: Our findings reveal race-specific interplays among individual risk factors, HPV infection, and VMB composition in HSIL development. The identification of key microbial and viral predictors highlights the importance of personalized approaches in preventing and managing HSIL, particularly among racially diverse populations. Citation Format: Katherine Y. Tossas, Bin Zhu, Katarzyna Tyc, Myrna Serrano, Jerome Strauss, Gregory Buck. Race-Specific Patterns of Vaginal Microbiome and HPV Infections Predict Risk of Precancerous Cervical Lesions [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C017.

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

Abstract Background The positive impact of clinical trials is clear in breast cancer, with a five-year survival rate of 90%. While black women represent 12% of breast cancer cases in the US, they comprise 3% of participants in clinical trials. At the Vanderbilt Ingram Cancer Center (VICC), black patients represent 9% of all breast cancer patients, but only 4% of those enrolled in clinical trials. Objective This pilot study will evaluate the role of Patient Navigators (PNs) to increase knowledge of and enrollment on clinical trials among black women with breast cancer at the Breast Cancer Clinic at VICC. Methods All black women in the Breast Clinic at VICC are offered Patient Navigation (PN) services. Those who consent complete a needs assessment and are provided PN as needed up to the duration of their treatment. As part of the PN, patients are provided with educational material about clinical trials as well as assistance with identified needs. Patients are surveyed one-month following the start of the navigation experience. We will compare clinical trial enrollment rates among eligible black women with breast cancer during the study period with historical controls. Covariates of analysis will include age, stage, histology and insurance status. Results From February through May 2024, we have approached 33 patients for PN assignment. Of the 29 patients who accepted a PN, only one was eligible for a clinical trial and was enrolled in the trial. Of 14 patients who completed the first post-navigation survey, 12 stated that PNs improved their cancer care experience, and all 14 found meetings with PNs to be valuable. Additionally, 11 patients reported that they knew very little to nothing about clinical trials prior to PN intervention and 8 reported having increased knowledge following PN. Of 12 respondents, 6 reported that they would be more likely to enroll on a clinical trial as a result of PN, and 9 of 14 indicated that they would share information about clinical trials with others. Conclusions With exceptional survival rates in breast cancer, it is imperative that there is equity in opportunity for enrollment in clinical trials for all patients. Patient navigation may target barriers to access to and increase knowledge of clinical trials and diminish cancer health disparities. As accrual continues in our pilot study, we will examine the impact of PN on enrollment in clinical trials, while also identifying other potential benefits for overall patient care. Citation Format: Tina S. Chai, Sonya Reid, Tuya Pal, Karen Winkfield, Clorissa Campbell, Courtney Thomas, Meredith Smalls, Emma Schremp, Debra Friedman. Increasing clinical trial enrollment rates of black women with breast cancer with the use of Patient Navigation [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B039.

Mindfulness-based therapy for insomnia in Black women: a pilot randomized controlled trial.

The purpose of the study was to evaluate the feasibility, acceptability, and preliminary efficacy of mindfulness-based therapy for insomnia (MBT-I) among Black women. The MBT-I group received weekly sessions that included mindfulness meditation and behavioral sleep strategies. The time and attention control group received lifestyle health education (HE) that included healthy eating, physical activity, and sleep hygiene. The primary outcome was post-intervention changes in insomnia severity score by the Insomnia Severity Index (ISI) at week 10. Other measures included: Pittsburgh Sleep Quality Index, Sleep Hygiene Practice, Spielberger State-Trait Anxiety Inventory (STAI), and Patient Health Questionnaire-9 (PHQ-9). Objective sleep was measured by Actiwatch™ at baseline and week 10. Thirty Black women completed the interventions with no attrition. About 97% of all participants attended 6-8 out of 8 sessions. The ISI scores were reduced at week 10 (MBT-I vs. HE: -7.67 vs. -7.22, p < .05). Anxiety and depression symptoms were significantly improved only in the MBT-I group. This is the first MBT-I for Black women with insomnia. Online MBT-I may be feasible and acceptable for Black women. The MBT-I and HE showed a clinically significant improvement in insomnia symptoms (ISI reduction > 7). MBT-I may be more effective in improving anxiety and depression symptoms than HE. Our findings encourage further study efforts with a longer follow-up and larger sample size to address sleep health disparities among Black women.

Abstract C119: Exploring the functional role of LRIG1 and WWOX tumor suppressors in breast cancer disparities

Abstract Breast cancer is the most commonly diagnosed cancer among women in the US. Despite a lower rate of breast cancer incidence, Black women in the US suffer higher rates of mortality compared to White women. This disparity poses a major clinical issue for Black women in the US, and we are particularly interested in understanding how molecular and environmental mechanisms may be contributing to these disproportionate outcomes. Our previous study found that in a cohort of women from Baltimore, Maryland (110 Black, 75 White), higher neighborhood deprivation was associated with decreased gene body methylation and gene expression of two tumor suppressor genes, LRIG1 and WWOX. These findings were unique to the tumor, which potentially points to ancestry-specific somatic mutations that may impact gene and protein expression for LRIG1 and WWOX. The goal of this project is to determine gene and protein differences in LRIG1 and WWOX by population group in women with and without breast cancer as it relates to neighborhood-level socioeconomic deprivation. We hypothesize that LRIG1 and WWOX exhibit decreased gene and protein expression in Black women compared to White women. Using the same diverse cohort from Baltimore, Maryland, we identified and conducted DNA genotyping on clinically relevant mutations of LRIG1 and WWOX using amplification by PCR and detection by fluorescent reporters. We found that the genotype frequencies in two single nucleotide polymorphisms (SNPs) for LRIG1, rs1403626 (P=6.3e-1) and rs2306272 (P=0.005967), differ significantly between population groups in these breast tissue samples, an interesting finding that matches our previous predictions. We also identified a dose-dependent relationship between LRIG1 gene expression and rs1403626 SNP genotypes. Additional patient genotyping will be conducted to determine relationships between LRIG1 and WWOX SNPs, differences in DNA methylation, and correlations with neighborhood deprivation measures. To interrogate the impact on protein expression, we will construct LRIG1 and WWOX knockdown mutants in estrogen receptor (ER)-positive and ER-negative commercially available breast cancer cell lines derived from Black and White patients, and determine the functional consequences of LRIG1 and WWOX loss by immunofluorescence and western blot, including how this may differ by population group. These studies will give us a better understanding of how the expression of tumor suppressor genes may contribute to the higher susceptibility of Black women developing more aggressive breast tumors. Citation Format: Angel H. Pajimola, Brittany Jenkins-Lord. Exploring the functional role of LRIG1 and WWOX tumor suppressors in breast cancer disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C119.

Abstract B089: A community-based participatory approach to developing a salon-based HPV self-collection intervention

Abstract Background: Black women in the US experience higher rates of cervical cancer mortality due to delayed diagnosis from lower screening rates. Contributing to this disparity, especially for those who are 40-64 years old, are provider bias, costs, and limited access. Recent FDA approval of HPV self-collection and current innovative research efforts for clinical and simulated home- based HPV self-collection bring promise of increasing access. However, like other innovations, equitable dissemination of HPV self-collection will be challenging. Our project seeks to distribute HPV self-collection kits in unconventional settings like hair salons. We conducted a community-based participatory study using concept mapping to gather diverse insights to design a salon-based HPV self-collection intervention. Methods: We employed GroupWisdom and REDCap online platforms to engage with our participants. Participants were members of the Black Community Advisory Council of Tucson (Black CACTus). Concept mapping steps involved: 1) Brainstorming statements from a prompt, 2) Sorting statements into piles according to meaning by each participant, 3) Rating the importance and feasibility of statements, 4) Reviewing the cluster map, and 5) Reviewing a draft/proposed intervention. Results: Black CACTus members (n=10) included hairstylists (n=3), salon clients (n=4), and healthcare providers (n=3). All participants identified as Black women, with two also identifying as Latina and White. Participants were 23-53 years old. Brainstorming yielded 39 statements. A six-cluster map was generated using the sorting data. Cost-related factors like "free" or "covered by insurance," as well as convenience, were rated as highly important by all participants. Development of clear communication and education about screening benefits, test results, and timely delivery of results were regarded as the most feasible. Conclusions: To equitably increase cervical cancer screening we must look beyond traditional clinical settings to trusted community locales like hair salons. Including the voice of the community and cultural and contextual factors is vital when tailoring cancer screening initiatives, particularly for Black women. Our study used concept mapping, in a collaborative, iterative process with vested community members to identify intervention elements and implementation strategies that have the potential to increase access to and uptake of cervical cancer screening among Black women. Citation Format: Kelly N.B. Palmer, Namoonga M. Mantina, Adebola Adegboyega, Itunu O. Sokale, Kathleen Pryor, Azaria Suero-Davis, Trevon Brooks, Jennifer Hatcher. A community-based participatory approach to developing a salon-based HPV self-collection intervention [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B089.

Abstract A014: Racial and socioeconomic disparities in breast feeding and the impact of pregnancy-related medical conditions among a population-based sample of non-Hispanic Black and White women

Abstract Background: Breastfeeding has been associated with a reduced risk of breast cancer (BC), particularly with Triple Negative BC (TNBC). The risk of TNBC is higher among premenopausal women, Black/African American (AA) women, and poorer women. Notably there are significant disparities in breastfeeding, where non-Hispanic Black (NHB) women and poorer women are less likely to breastfeed in the United States. Studies have identified historical racial trauma, unsupportive work and hospital policies, breast milk formula advertising, and knowledge and beliefs about breast feeding as factors that contribute to breast feeding practices. However, there is a paucity of research on pregnancy related medical conditions (PMCs) that potentially impact initiation and duration of breastfeeding. The purpose of this study is to evaluate racial and socioeconomic differences in breastfeeding, and if PMCs impact breastfeeding practices in a population-based sample of non-Hispanic Black and White women. Method: Data are from the Young Women’s History and Health Study (YWHHS), a population- based case-control study of invasive BC among non-Hispanic Black (NHB) and non-Hispanic White (NHW) women aged 20-49 years residing in Metropolitan Detroit and Los Angeles County, 2010-2015. The analytic sample here includes the first pregnancy of control participants with singleton live births (n=675). Area-based control participants were sampled from the 2010 Census. Interviews assessed complete reproductive histories, including breastfeeding history (never, &amp;lt;6 months, and ≥6 months), PMCs experienced during pregnancy, self-reported race, and household financial struggles before age 13 years (to approximate childhood socioeconomic position (chSEP)). PMCs examined included: 1) premature birth, 2) diabetes or pre-diabetes related PMCs, 3) blood pressure-related PMCs, and 4) BMI ≥ 25 kg/m2 at age 18 years. Weighted percentages were evaluated with a chi-square test and considered significant at p &amp;lt; 0.05. Analyses were further stratified by race/ethnicity and chSEP. Result: NHB women were 2.4 times significantly more likely to never breastfeed than NHW women (W% =52.0 (NHB) and 21.3 (NHW), p=&amp;lt;0.0001). Similarly, women with lower compared to higher chSEP were 1.5 times significantly more likely to never breastfeed (W% = 42.7 (lower chSEP) and 28.5 (higher chSEP), p=0.003). Those with BMI ≥ 25 kg/m2 at age 18 years (p&amp;lt;0.001) alone, and with one or more PMCs (p=0.01) were also less likely to breastfeed. When stratified by race/ethnicity the pattern of breastfeeding did not differ significantly by any PMC within NHB and NHW women. When stratified by chSEP, however, BMI ≥ 25 kg/m2 at age 18 years (p = 0.004) and having one or more PMCs (p=0.03) were significantly associated with never breastfeeding among those with higher chSEP. Conclusion: NHB women and women with lower chSEP were substantially less likely to breastfeed. Additionally, BMI ≥ 25 kg/m2 at age 18 and PMCs were associated with lower frequency of breastfeeding overall and among those with higher chSEP. Citation Format: Meheret B. Gebreegziabher, Lydia R. Post, Chris C. Cho, Zhenzhen Zhang, Kelly A. Hirko, Dorothy R. Pathak, Ann S. Hamilton, Ann G. Schwartz, Ellen M. Velie. Racial and socioeconomic disparities in breast feeding and the impact of pregnancy-related medical conditions among a population-based sample of non-Hispanic Black and White women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A014.

Abstract A135: Social disparities in breast cancer screening: Up-to-date screening versus overscreening

Abstract Objective: The United States Preventative Services Task Force breast cancer (BC) screening guidelines in 2022 recommended biennial mammography for women aged 50-74 and cited insufficient evidence to assess mammography’s benefits vs. harms in women aged ≥75. Other guidelines recommend screening cessation for women with &amp;lt;10 years of life expectancy. We examined how racial/ethnic, socioeconomic and geographic patterns observed in up-to-date screening (UTDS) for age-eligible women differ from women aged out of these guidelines or those with limited life expectancy (i.e. overscreening). Methods: We used nationally representative data from the 2022 Behavioral Risk Factor Surveillance System for women aged 50+. Women screened in the past 1-2 years were considered UTDS in age group 50-74 and ‘overscreened’ if 75+ or with a high mortality risk of any age (≥8 score using modified Lee mortality index). We used multivariable logistic regressions to examine UTDS and overscreening in relation to self-identified race/ethnicity, metropolitan status, having a personal health care provider, highest education level, and marital status, stratified by age group and mortality risk. Results: 19.2% of 99601 women aged 50-74 did not have UTDS, while 73.7% of 34545 women 75+ and 60.2% of 22225 women with limited life expectancy continued to receive screening (overscreened). Among those aged 50-74, compared to non-Hispanic (NH) White, NH American Indian/Alaskan Native women (OR=0.60, 95% CI=0.45–0.82) and NH women of unknown race (OR=0.61, 95% CI=0.45–0.82) were less likely to have UTDS while NH Black (OR=1.81, 95% CI=1.60–2.03) and Hispanic (OR=1.24, 95% CI=1.05–1.46) women were more likely to have UTDS. Lower socioeconomic resources were consistently associated with lower likelihood of UTDS (e.g. not having vs. having a personal health care provider (OR=0.22, 95% CI=0.19–0.26) or high school or less education vs. higher than high school (OR=0.73, 95% CI=0.67–0.79)). In ages 75+, compared to NH White, NH Black women were more likely to be overscreened (OR=1.32, 95% CI=1.06–1.65), and NH women of unknown race were less likely to be overscreened (OR=0.49, 95% CI=0.29–0.83). Low socioeconomic indicators were also associated with lower likelihood of overscreening (e.g. not having vs. having a personal health care provider (OR=0.48, 95% CI=0.36–0.63) or high school or less education vs. higher than high school (OR=0.76, 95% CI=0.67–0.86)). Among women with a higher mortality risk, NH Black women (OR=2.05, 95% CI=1.64–2.56) and Hispanic women (OR=1.61, 95% CI=1.09– 2.38) were more likely to be overscreened than NH White women. Conclusion: The findings reveal racial/ethnic, socioeconomic and geographic disparities in UTDS. NH Black and Hispanic women, who are more likely to have UTDS, may be at risk of overscreening as they age or if they have limited life expectancy. These patterns in UTDS and overscreening are critical considerations for implementing equitable BC screening guidelines and optimizing the benefits while minimizing the harms of screening in diverse populations. Citation Format: Michelle L. Lui, Erica Lee Argov, Anita G. Karr, Rebecca D. Kehm, Parisa Tehranifar. Social disparities in breast cancer screening: Up-to-date screening versus overscreening [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A135.

Abstract IA053: Grateful strides toward spiritual well-being and exercise self-efficacy for Black breast cancer survivors

Abstract Background: Breast cancer (BC) survivorship care poses significant psychosocial and physical challenges, with survivors experiencing stress, inflammation, and poor lifestyle behaviors that impact their well-being and health-related quality of life. Black women with BC, who often experience higher rates of metabolic syndrome and related health complications, are particularly vulnerable. Black women with BC face unique health disparities, including a higher prevalence of metabolic syndrome, contributing to poorer prognoses. Spiritual well-being, particularly through practices such as gratitude journaling, has shown potential in improving psychological and physiological outcomes, but its effectiveness in Black BC survivors remains underexplored. Purpose: This pilot study aimed to assess the feasibility, acceptability, and preliminary efficacy of a gratitude journaling intervention tailored for Black BC survivors to enhance spiritual well-being, exercise self-efficacy, and mitigate inflammatory biomarkers. Methods: A two-group parallel random-assignment experimental design was used to compare a gratitude journaling intervention group with a general memory journaling control group over eight weeks. Twenty-six Black women with a history of BC in the community were enrolled and randomized. Surveys and biospecimen collections were conducted at baseline and post-intervention. Psychosocial measures included dispositional gratitude, spiritual well-being, perceived stress, Superwoman Schema dimensions, and exercise self-efficacy. Inflammatory biomarkers (TNF-α, IL-6, GDF15, CRP) were also measured. Results: Feasibility analysis indicated high recruitment (95%) and baseline assessment completion (100%), with 73% completing baseline and post-intervention assessments. Participants reported high satisfaction with the intervention. Significant improvement in spiritual well-being (p=0.014, ES=0.57) was observed in the intervention group, alongside large effect sizes in exercise self-efficacy (p=0.10, ES=0.391). Changes in dispositional gratitude, perceived stress, and Superwoman Schema dimensions were not statistically significant, although trends suggested positive impacts. Inflammatory biomarkers showed mixed results, with some indicating potential improvements but no significant differences overall. Discussion: The study highlighted the importance of culturally tailored interventions for Black BC survivors, demonstrating significant benefits in spiritual well-being and potential improvements in exercise self-efficacy. While changes in dispositional gratitude and perceived stress were not significant, the intervention group showed positive trends, suggesting potential benefits. Although the impact on inflammatory biomarkers was inconclusive, the study underscores the holistic approach of gratitude interventions in promoting overall well-being among Black BC survivors. Future research should focus on larger, randomized controlled trials to further elucidate the efficacy of gratitude-based interventions in this population. Citation Format: Lakeshia Cousin, Dejana Braithwaite, Stephen Anton, Zhongyue Zhang, Ji-Hyun Lee, Christiaan Leeuwenburgh, Debra Lyon. Grateful strides toward spiritual well-being and exercise self-efficacy for Black breast cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr IA053.

Abstract A050: The impact of air pollution on aggressive breast cancer prognoses in women of African descent

Abstract Significance. Breast cancer (BC) is the most diagnosed cancer among women in the US. Though highly heterogeneous, different subtypes can be characterized by the expression of membrane receptors on the cell surface: ER+, HER2+, PR+, or basal-like which does not express any of the three receptors. Basal-like triple-negative breast cancer (TNBC) is a highly aggressive subtype of BC that represents about 15% of overall BC cases. Black women disproportionately experience higher rates of early-onset TNBC phenotypes and worse prognoses when compared to White women. Though genetics is a key factor in oncogenesis and cancer progression, it is now widely recognized that differences in cancer outcomes are influenced, also, by various environmental, social, and lifestyle factors known collectively as the social determinants of health (SDOH). For example, air pollution has consistently been shown to be associated with an increased risk of breast cancer, however, little is known about how air pollution alters biological and molecular mechanisms impacting breast cancer progression. Elucidating these influential factors is critical to understanding and addressing disparate outcomes. We are interested in understanding how air pollution impacts immune-oncology related proteins in breast cancer, specifically for Black and White women living in Baltimore City, Maryland. Methods. In a cohort of 217 women (142 Black, 75 White), we performed statistical analyses to determine the correlation between particulate matter 2.5 (PM2.5) with breast cancer subtype and oncogenic molecular drivers within the tumor and its microenvironment. PM2.5 concentration for Census year 2000 was measured using the EPA Downscale Model. Concentrations at the census-tract level were then linked to each participant's geocoded residential address at study baseline. Results. [BJ1] Our data reveal that a higher exposure to PM2.5 is correlated with breast cancer subtypes incidences[BJ2] (p- value[BJ3] =0.051), specifically for hormone receptor positive (ER+ and/or PR+) and TNBC subtypes (p-value=0.035). Elevated air pollution is also associated with estrogen-receptor status overall (p-value=0.002) and in Black (p-value=0.043) and White (p-value=0.008) women in the stratified analysis. Serum protein measurements in this cohort also revealed significant relationships between elevated air pollution and immune-oncology related proteins, including PD-L1, CAIX, CXCL9, and MCP-2.Discussion. Our preliminary evidence reveals an association between air pollution, breast cancer subtypes, and immune-oncology related proteins, with some of these relationships affecting Black and White populations differently. We will continue to interrogate these differences and begin to reveal the underlying mechanisms exacerbating breast cancer disparities. Citation Format: Kayla S. Ingram, Brittany Jenkins-Lord. The impact of air pollution on aggressive breast cancer prognoses in women of African descent [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A050.

Abstract C019: Peripheral Absolute Lymphocyte Count and Breast Cancer Mortality among Racially Diverse Women

Abstract Background: Among patients with triple-negative breast cancer (TNBC), higher tumor infiltrating lymphocytes (TILs) are associated with increased overall mortality (OM) and breast cancer-specific mortality (BCSM). We previously found that low peripheral absolute lymphocyte count (ALC) is associated with increased OM and BCSM in a sample of mostly non-Hispanic White (NHW) patients with TNBC. Here, we investigated the association between low ALC and mortality (OM and BCSM) across different breast cancer subtypes and whether the association is potentially modified by race and ethnicity. Methods: We used the Oncoshare database, which links electronic medical records (EMRs) data to the California Cancer Registry (CCR), and assessed women diagnosed with stage I-III breast cancer between 2000-2017, who had at least one ALC measurement and treated at two healthcare systems in California. Patient and tumor characteristics were obtained from the CCR and laboratory testing from EMRs. Patients with metastatic disease and chemotherapy receipt after one year of diagnosis were excluded. Multivariable logistic models assessed factors associated with “low ALC” (&amp;lt;1 K/µL, ever vs. never). We applied Cox models to evaluate the association between “min ALC” (lowest ALC value after diagnosis) and OM and BCSM within each breast cancer subtype (Luminal A, HER2-enriched, and TNBC), and further explored the interaction between min ALC and race and ethnicity. All models adjusted for low absolute neutrophil count, demographics, and tumor features. Results: Among 10,750 women analyzed, the risk of “low ALC” was associated with TNBC vs Luminal A (odds ratio (OR) 1.22, p=0.0098), older age (OR 1.01 per year, p&amp;lt;0.001), higher grade (grade 3 vs. 1, OR 1.15, p=0.042), higher stage (stage III vs. I, OR 1.81, p&amp;lt;0.001), and public vs. private health insurance (OR 1.29, p&amp;lt;0.001). Cox models showed that higher min ALC was associated with lower OM across breast cancer subtypes (Luminal A: HR 0.37, HER2-enriched: HR 0.32, TNBC: HR 0.22; all p&amp;lt;0.001) and BCSM (Luminal A: HR 0.29, HER2-enriched: HR 0.23, TNBC: HR 0.19; all p&amp;lt;0.001). Interaction analysis showed that race and ethnicity modified the association between min ALC and OM (interaction-p &amp;lt;0.001) and BCSM (interaction-p &amp;lt; 0.001) in the overall cohort; compared to NHW women (HR 0.38, 95% confidence interval [0.34-0.43]), the association between min ALC and OM was stronger among Hispanic (HR 0.24, [0.18-0.33]), Asian (HR 0.19, [0.14-0.25]), and Black (HR 0.21, [0.13-0.35]) women. Similar results were observed for BCSM. Conclusions: Low peripheral ALC, a routinely measured clinical lab result, strongly predicts higher BCSM and OM across breast cancer subtypes, beyond TNBC. The association between min ALC and BCSM/OM was stronger among Black and Asian women vs. NHW women, suggesting that maintaining normal ALC during breast cancer treatment may reduce BCSM and OM, especially for women from racial and ethnic minoritized groups. Future research should investigate differences in ALC, immune response, and BCSM in diverse populations. Citation Format: Candice N. Thompson, Ingrid Luo, Mina Satoyoshi, Lidia Schapira, Esther M. John, Summer S. Han, Allison W. Kurian. Peripheral Absolute Lymphocyte Count and Breast Cancer Mortality among Racially Diverse Women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C019.

Abstract A006: Disparities, social determinants of health, and ovarian cancer: predicting ovarian cancer using sociodemographic information and comorbidities as risk factors

Abstract Introduction In this study, we aimed to identify associations between ovarian cancer (OC) and patient information, including demographics and comorbidities in order to increase awareness of OC risk factors and the ways in which disparities affect individual risk. Methods Administrative data analysis was performed using Florida state inpatient data collected by the Healthcare Cost and Utilization Project in 2012. Demographic variables included age, race, insurance type, and income level. Comorbidities included hypothyroidism, diabetes, hysterectomy, obesity, alcohol abuse, and drug abuse. For each variable, descriptive and logistic regression analyses were performed using SAS software and confirmed with SPSS software to determine frequencies within binary OC outcomes and calculate associations. Results Descriptive analysis revealed that OC was most frequent in white women (73.47%) over 65 (50.17%), who were Medicare beneficiaries (57.00%) within the second quartile of annual income ($38,000-$48,000) (30.71%). Most OC patients did not have any comorbidities. Logistic regression analysis revealed higher risk of OC in women over 65 compared to younger women (OR= 4.277; 95% CI= 3.585-5.103). Black women had reduced odds of OC compared to White women (OR=0.790; 95% CI= 0.693-0.900). Privately insured women had higher odds of OC compared to women with Medicare (OR= 1.426; 95% CI= 1.245-1.634). The risk of OC was reduced in patients in the first, second, and third quartiles of annual income when compared to the highest quartile of annual income (OR= 0.606; 95% CI= 0.527-0.698, OR= 0.618; 95% CI= 0.537-0.710, OR= 0.644; 95% CI= 0.557-0.743, respectively). The risk of OC was increased in women with hypothyroidism (OR= 1.083; 95% CI= 1.021-1.148), diabetes (OR= 1.134; 95% CI= 0.973-1.331), and women who had a hysterectomy (OR= 18.543; 95% CI= 15.262-22.530), compared to those without. Odds of OC were significantly reduced in women with obesity (OR= 0.574; 95% CI= 0.503-0.654) compared to those without. Women who abused alcohol or drugs had lower odds of OC than those who did not (OR= 0.296; 95% CI= 0.205-0.426, OR= 0.280; 95% CI= 0.205-0.382, respectively). Conclusions This study identifies OC risk factors and highlights differences in the prevalence and risk of OC between women of different sociodemographic groups and between women with and without various comorbidities. Groups with socioeconomic privilege were at higher risk of OC. Financial stability and access to healthcare increase the likelihood of receiving a diagnosis, suggesting potential detection bias. Decreased risk of OC was observed in patients with stigmatized comorbidities such as obesity and substance abuse disorders. Under-investigation of symptoms is common in patients with these conditions, leading to underdiagnosis. Health and socioeconomics are inextricable, so it is necessary to understand the relationship between these aspects of patient health and OC to more accurately assess individual risk. Citation Format: Anna E. Langston, Zahra Bahrani-Mostafavi. Disparities, social determinants of health, and ovarian cancer: predicting ovarian cancer using sociodemographic information and comorbidities as risk factors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A006.

Evaluation of dermal exposure to phthalates and parabens resulting from the use of hair relaxers

ABSTRACT Hair relaxers have been suggested as a source of exposure to parabens and phthalates. However, dermally absorbed doses of these chemicals resulting from consumer use of hair relaxers have yet to be quantified, and results from epidemiological studies have consistently demonstrated that there is no increased risk for hormone-sensitive, reproductive cancers associated with use of hair relaxers among Black women. Therefore, dermal absorption of parabens and phthalates associated with hair relaxer use for several commercially available hair relaxer kits was modeled using IH SkinPerm™. The chemicals detected in the hair relaxer kits included methylparaben (MP), ethylparaben (EP), butylparaben (BP), diethyl phthalate (DEP), bis(2-ethylhexyl) phthalate (DEHP), and the phthalate substitute bis(2-ethylhexyl) adipate (DEHA). The daily absorbed dose ranges (mg/kg/day), standardized over a year of product use, were as follows: 8.64 × 10−5-0.00116 MP, 2.30 × 10−8-3.07 × 10−6 EP, 3.24 × 10−8-4.33 × 10−6 BP, 8.65 × 10−9-1.15 × 10−6 DEP, and 8.94 × 10−7-0.000119 DEHP for Kit #1; 8.44 × 10−5-0.00113 MP and 7.91 × 10−5-0.00106 DEP for Kit #2; and 2.49 × 10−6-3.33 × 10−5 MP, 1.52 × 10−8-2.03 × 10−6 EP, 3.29 × 10−9-4.39 × 10−7 DEP, and 3.11 × 10−6-4.14 × 10−5 DEHA for Kit #3. These absorbed doses were well below applicable health-based guidance values, indicating consumer exposure from product use is not expected to pose a health risk. These results provide valuable information for health risk evaluations for hair relaxer use.

Abstract C148: Triple negative breast cancer in Black women: The genomic rearrangement landscape and its relationship to obesity and neoadjuvant treatment outcomes

Abstract Purpose: Obesity affects Black women disproportionately, for multifactorial reasons, 57.2% (Black) vs. 38.2% (White). A higher central body fat as measured by waist-to-hip ratio was associated with a higher risk of all-cause and breast cancer-specific death among Black women who had triple negative breast cancer (TNBC), an aggressive disease which affects Black women at a higher rate and contributes to the 41% worse survival outcomes compared to White women. Obesity is a chronic, inflammatory state which creates a mitogenic microenvironment, promotes tumorigenesis and may drive signaling pathways and genomic alterations associated with TNBC. The relevance of certain genomic alterations in breast cancer and the relationship with treatment has been less well described for TNBC and even less so in Black women. Majority of women with early stage TNBC are treated with neoadjuvant chemotherapy (NAC) given prior to surgery and have excellent survival outcomes if there is no residual breast cancer at the time of surgery, i.e. a pathologic complete response (pCR). The purpose of this pilot study was to investigate the genomic rearrangement and gene expression landscape changes in tumors from Black women with TNBC treated with NAC in a major large health system. Methods: A pilot cohort of 38 Black women with early stage I-III TNBC treated with NAC were identified from the tumor registry of Rutgers Cancer Institute and its affiliates within the RWJBarnabas-Health System, the largest in the state of New Jersey. pCR at time of surgery, pretreatment obesity (BMI ≥30 kg/m2) vs. non-obese (&amp;lt;30 kg/m2) was abstracted from pathology reports and the EMR. Whole genome sequencing and RNA sequencing on archived tissue of pre- and post-treatment tumor specimens and normal tumor-free tissue was performed. Results: Mean age at breast cancer diagnosis was 55, and 65% of women were obese. All patients received standard chemotherapy regimens. 20% achieved a pCR, while 80% had residual disease. Out of those with residual disease, 57% were obese. Preliminary data show differences in tumor genomic alterations between obese and non- obese Black patients treated with NAC and in selected obesity-related genes whose differential expression is known to contribute to aggressive breast cancer. Genes important in tumor promotion, tumor suppression, immunomodulation, drug delivery, and have an impact on survival depending on their expression levels, were differentially expressed. Conclusion: Our findings suggest that among Black women with TNBC, a higher BMI is inversely associated with achieving a pCR. Differences in tumor genomic alterations between obese and non-obese Black patients treated with NAC and in selected obesity-related genes were observed. Differentially expressed genes were also identified. Ongoing work will focus on Black patients with residual disease after NAC, and are thus chemoresistant, and determine whether there are associations with genomic alteration patterns and obesity. Extensive gene expression analysis and signaling pathway analysis will be performed. Citation Format: Coral Omene, Gregory Riedlinger, Anya Litvak, Anupama Nehra, Anita Kinney, Elisa Bandera, Adana AM Llanos, Hao Liu, Mridula George, Deborah Toppmeyer, Shridar Ganesan. Triple negative breast cancer in Black women: The genomic rearrangement landscape and its relationship to obesity and neoadjuvant treatment outcomes [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C148.

Abstract C057: Pilot study of vaginal microbiome profiles among Black and White endometrial cancer survivors

Abstract Background: Lower vaginal microbiome diversity, and specifically a Lactobacillus crispatis-dominant vagitype, is associated with more favorable health outcomes. Racial variation in the vaginal microbiome has been reported in some studies, including gynecologic cancers. Racial disparities in endometrial cancer 5-year survival are stark—62% for Black women vs. 83% for White women. Cancer treatments can acutely impact the microbiome of surrounding tissues with potential impacts on quality of life in survivorship, including sexual function. The objectives of this pilot research were to assess the feasibility of self-sampling and variation in vaginal microbiome communities by race, cancer treatment, and sexual function among endometrial cancer survivors. Methods: Endometrial cancer survivors (N=50, mean=11 months from diagnosis) enrolled in the Carolina Endometrial Cancer Study were mailed Genotek vaginal microbiome self-collection kits and the validated Sexual Function-Vaginal Changes Questionnaire (SVQ) before a nurse home visit. Microbiota profiles were characterized by bacteria 16S rRNA amplicon sequencing. Vagitypes were classified as Lactobacillus-dominant and other based on relative abundance (&amp;gt;50% vs. ≤50%) and Ward hierarchical clustering. Results: Overall, 48 vaginal samples were obtained. We excluded samples from women who reported antibiotic use within the last month (N=8) or were missing treatment data (N=6), leaving 34 samples. Of these, 47% were from Black survivors and 53% from White. Cancer treatments were categorized as surgery only (47%) vs. any chemotherapy or radiation (53%); and did not vary by race (p &amp;gt;.9). Black women did not have statistically significant different alpha (Shannon p=0.9) or beta (p=0.4) diversity, or a differential proportion of Lactobacillus dominant vagitype (59% vs. 41%, p=0.3) compared to White women. Alpha (Shannon p=0.04) and beta (p=0.004) diversity varied by cancer treatment with higher microbial diversity after chemotherapy or radiation compared to surgery alone. In the surgery only group, 63% of samples were Lactobacillus dominant, compared to 17% among the chemotherapy or radiation group (p=0.006). We examined cancer treatment associations in analyses restricted to the more favorable endometroid histology (N=25), as surgery alone is associated with endometrioid histology and better prognosis. In this subgroup, 57% (8/14) of women treated with surgery only had Lactobacillus-dominant vagitypes compared to 27% (3/11) in the chemotherapy/ radiation group (p=0.1). Lactobacillus-dominant vagitype was not associated with SVQ scales (global satisfaction; changes in intimacy or interest; dryness; pain). Conclusion: Self-collection of vaginal microbiome samples is feasible in cancer survivors. In our study, Lactobacillus-dominant vagitypes were less abundant among women who were treated with more intensive cancer therapies and did not vary by race or sexual function. Radiation and chemotherapy for endometrial cancer may affect vaginal microbiome composition after treatment ends. Citation Format: Mu Jin, Tope Keku, Nikki McCoy, Jordyn Brown, Jamie Hunter, Victoria Bae-Jump, M. Andrea Azcarate-Peril, Stephanie Engle, Andy Olshan, Hazel B Nichols. Pilot study of vaginal microbiome profiles among Black and White endometrial cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C057.

Unveiling the Strategy Behind Blackfishing: Kim Kardashian's Instagram and the New Beauty Discourse

As a fashion and beauty icon in America, Kim Kardashian is one of the public figures who supports the new beauty discourse. The emerging concept of new beauty in America challenges conventional limits for the delineation of beauty. This idea emphasizes that beauty is not limited by skin color, body shape, age, and hairstyle; instead, it emphasizes the need of embracing of natural body. This study examines how Kim Kardashian's personal Instagram posts from 2014-2023 showcases new notions of beauty via the lens of semiotic theory by Barthes (1964) and the concept of blackfishing. New forms of beauty discourse displayed by Kim Kardashian are accused of being blackfishing by excessively darkened skin, curvy body shapes, full lips, and hair. According to the findings of this study, there is a sense of ambivalence towards black women's bodies. Consequently, white people have internalized certain characteristics of black bodies without appreciating the unique qualities of black women. Kim Kardashian promotes a new beauty discourse that is considered blackfishing through her collaboration with the fashion and beauty industry and building her own cosmetics business. This demonstrates the participation of other influential individuals in the fashion business who endorse Kim's blackfishing appearance so that this appearance continues to appear in public and is normalized.

Abstract C135: The heterogenous impact of healthcare access factors throughout the breast cancer care continuum

Abstract Background: Delays in breast cancer diagnosis and treatment lead to worse survival and quality of life decrements. Racial disparities in care timeliness have been reported, but few studies have examined access at multiple points along the care continuum (diagnosis, treatment initiation, treatment duration, and genomic testing). Methods: The Carolina Breast Cancer Study Phase 3 (CBCS3) is a population-based cohort (n=2998, 50% Black) with invasive breast cancer diagnoses (2008-2013). We used latent class analysis (LCA) to group participants based on patterns of factors within 3 separate domains: “socio-economic status (SES)”, “care barriers”, and “care use.” These classes were evaluated in association with delayed diagnosis (approximated with stage 3 or 4 at diagnosis), delayed treatment initiation (more than 30 days between diagnosis and first treatment), prolonged treatment duration (time between first and last treatment – by treatment modality), and receipt of OncotypeDx genomic testing (evaluated among patients with early stage, ER+, HER2- disease). Associations were evaluated using adjusted linear-risk regression to estimate relative frequency differences (RFDs) with 95% confidence intervals (CIs). Results: Overall, 18% of CBCS participants had late stage/delayed diagnosis, 35% had delayed treatment initiation, 48% had prolonged treatment duration, and 62% did not receive OncotypeDx. Black women had greater frequency of each unfavorable care outcome compared to non-Black women, including diagnostic delay (22% vs 15%, RFD= 6.9, 4.1-9.6), treatment initiation delay (39% vs 31%, RFD=7.9, 4.5-11.3), prolonged treatment (50% vs 46%, RFD= 4.3, 0.5-8.2), and OncotypeDx non-receipt (69% vs 57%, RFD= 12.2, 7.3-16.7). We identified 3 latent classes for SES (“high SES”, “moderate SES,” and “low SES”) 2 classes for care barriers (“few barriers”, “more barriers”), and 5 classes for care use (“short travel/high preventive care”, “short travel/low preventive care,” “medium travel,” “variable travel,” and “high travel”). Low-SES and more barriers to care were associated with greater frequency of delayed diagnosis (RFDadj = 5.5, 2.4-8.5; RFDadj =6.7, 2.8-10.7, respectively) and prolonged treatment (RFDadj = 9.7, 4.8-14.6; RFDadj = 7.3, 2.4-12.2, respectively). Variable travel (short time to diagnosis but long time to surgery) was associated with delayed treatment in the entire study population (RFDadj = 10.7, 2.7-18.8) compared to the short travel, high use referent group. The high travel group (representing long travel to both diagnosis and surgery) was associated with delayed treatment only among Black women relative to the same referent group (RFDadj = 10.0, -3.3-23.2). Conclusions: Black patients face more frequent delays throughout the care continuum, likely stemming from different types of access barriers at key junctures. Improving breast cancer care access will require intervention on multiple aspects of SES and healthcare access. Citation Format: Matthew R. Dunn, Didong Li, Marc A Emerson, Caroline A. Thompson, Hazel B Nichols, Sarah C Van Alsten, Mya L. Roberson, Lisa A. Carey, Terry Hyslop, Jennifer Elston Lafata, Melissa A. Troester. The heterogenous impact of healthcare access factors throughout the breast cancer care continuum [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C135.

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

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

Abstract C135: The heterogenous impact of healthcare access factors throughout the breast cancer care continuum

Abstract Background: Delays in breast cancer diagnosis and treatment lead to worse survival and quality of life decrements. Racial disparities in care timeliness have been reported, but few studies have examined access at multiple points along the care continuum (diagnosis, treatment initiation, treatment duration, and genomic testing). Methods: The Carolina Breast Cancer Study Phase 3 (CBCS3) is a population-based cohort (n=2998, 50% Black) with invasive breast cancer diagnoses (2008-2013). We used latent class analysis (LCA) to group participants based on patterns of factors within 3 separate domains: “socio-economic status (SES)”, “care barriers”, and “care use.” These classes were evaluated in association with delayed diagnosis (approximated with stage 3 or 4 at diagnosis), delayed treatment initiation (more than 30 days between diagnosis and first treatment), prolonged treatment duration (time between first and last treatment – by treatment modality), and receipt of OncotypeDx genomic testing (evaluated among patients with early stage, ER+, HER2- disease). Associations were evaluated using adjusted linear-risk regression to estimate relative frequency differences (RFDs) with 95% confidence intervals (CIs). Results: Overall, 18% of CBCS participants had late stage/delayed diagnosis, 35% had delayed treatment initiation, 48% had prolonged treatment duration, and 62% did not receive OncotypeDx. Black women had greater frequency of each unfavorable care outcome compared to non-Black women, including diagnostic delay (22% vs 15%, RFD= 6.9, 4.1-9.6), treatment initiation delay (39% vs 31%, RFD=7.9, 4.5-11.3), prolonged treatment (50% vs 46%, RFD= 4.3, 0.5-8.2), and OncotypeDx non-receipt (69% vs 57%, RFD= 12.2, 7.3-16.7). We identified 3 latent classes for SES (“high SES”, “moderate SES,” and “low SES”) 2 classes for care barriers (“few barriers”, “more barriers”), and 5 classes for care use (“short travel/high preventive care”, “short travel/low preventive care,” “medium travel,” “variable travel,” and “high travel”). Low-SES and more barriers to care were associated with greater frequency of delayed diagnosis (RFDadj = 5.5, 2.4-8.5; RFDadj =6.7, 2.8-10.7, respectively) and prolonged treatment (RFDadj = 9.7, 4.8-14.6; RFDadj = 7.3, 2.4-12.2, respectively). Variable travel (short time to diagnosis but long time to surgery) was associated with delayed treatment in the entire study population (RFDadj = 10.7, 2.7-18.8) compared to the short travel, high use referent group. The high travel group (representing long travel to both diagnosis and surgery) was associated with delayed treatment only among Black women relative to the same referent group (RFDadj = 10.0, -3.3-23.2). Conclusions: Black patients face more frequent delays throughout the care continuum, likely stemming from different types of access barriers at key junctures. Improving breast cancer care access will require intervention on multiple aspects of SES and healthcare access. Citation Format: Matthew R. Dunn, Didong Li, Marc A Emerson, Caroline A. Thompson, Hazel B Nichols, Sarah C Van Alsten, Mya L. Roberson, Lisa A. Carey, Terry Hyslop, Jennifer Elston Lafata, Melissa A. Troester. The heterogenous impact of healthcare access factors throughout the breast cancer care continuum [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C135.