Abstract IA-03: Making progress, together: An inclusive, broad-based approach to reducing excess burden of breast cancer among African American women in St Louis - with lessons for national implementation
Authors: Colditz Graham A. 
Published: January 2022

Breast cancer deaths in Missouri are among the highest in the Nation. In St Louis City and North County late-stage diagnosis and mortality have remained high. Cancer disparities can be driven by behavioral risk factors, by health systems, and by biology. Research on all these aspects must be rewarded in academic promotion and tenure review. Siteman created the Program for the Elimination of Cancer Disparities (PECaD) to build community partnerships and develop outreach and education; conduct quality improvement and research in breast health services; and train community members in public health research principles. We developed a breast cancer community partnership in 2007 and identified priorities for the community and the partnership. These included improve awareness of prevention and breast health services, build trust, develop strategies to help patients keep appointments, support adherence to routine screening. We partnered with the African American newspaper (The St Louis American), public library, and federally qualified health centers. In collaboration with FQHCs, we evaluated referral patterns and identified strategies to improve communication between providers. Using the collective impact model to sustain change, for over a decade PECaD supports the St Louis Regional Breast Navigator workgroup. Diagnoses of breast cancer among Black women were 32% stage III/IV in 2000. By 2019, Siteman had expanded services and partnerships to reduce late-stage diagnosis to 16.4% of incident cancers among Black women, still higher than 9.8% observed among white women. To ensure access to clinical trials we implemented system changes for monitoring trial protocols, defining eligibility targets by race, and monitored accruals by race, integrating the process into PRMC and Siteman leadership review. We reported breast cacner outcomes from SEER and Missouri cancer registries by race and engaged bench researchers to study pathways that may drive disparities. They now study pathways that may drive triple negative breast cancer in African American women and DNA repair pathways that may modify response to treatment. This includes research by Dr. Weber (breast program) on adenosine deaminase acting on RNA (ADAR1, encoded by ADAR) and by Dr. Shao on repair of double strand DNA breaks that may counteract therapy for TNBC. We have expanded community service aspects of promotion review traditionally framed as service to medical center, university, and community. We now specifically call out service to Siteman through our Research Programs or Community Outreach and Engagement activities. Thus, faculty can make explicit their contributions to diversity, equity, and inclusion, and their disparities focused research. By working at multiple levels, we have improved access to screening and breast health services, improving stage at diagnosis among African American women. We have engaged bench scientists to address excess risk of TNBC in African American women, and have used the promotion criteria to reward disparities and community engaged research.

Citation Format: Graham A. Colditz. Making progress, together: An inclusive, broad-based approach to reducing excess burden of breast cancer among African American women in St Louis - with lessons for national implementation [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 IA-03.