bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract A22: New instrument to measure functional breast cancer literacy
Authors: Williams Karen Patricia , Templin Thomas N.
Published: December 2010

A critical undertaking in designing research interventions that study effective ways to reduce health disparities among racial/ethnic and underserved women is to have instruments that are linguistically and culturally appropriate. Traditionally, when instruments are developed, even those that are used in health disparities, they have been normed using Caucasians and then used with other populations.

We were funded by the National Institutes of Health, National Institute of Nursing Research to use traditional rigors of psychometric methods in the context of a community-based participatory research intervention to validate cancer literacy assessment tools (CLAT) that measure a woman's functional understanding of breast and cervical cancer in English, Spanish, and Arabic.

With a sample size of 543 women, the reliability, factor structure, validity of the Breast Cancer Literacy Assessment Tool (BCLAT) was determined by exploratory and confirmatory factor analysis. We examined differential item functioning (DIF) with nonparametric IRT Multiple regression was used to identify variables predictive of performance on the BCLAT.

Results: A confirmatory factor analysis (CFA), using a 2-parameter IRT model, had a good fit (CFI = .81, RMSEA = .05) to the proposed three factor structure. Maximum likelihood exploratory factor analysis of tetrachoric correlations and examination of scree plots also indicated a 3-factor solution. No items were eliminated as a result of the DIF analysis. The three scales, Awareness, Screening, and Prevention/Control, were moderately difficult with 63%, 62%, and 68% correct, respectively, with internal consistency reliability of .53, .62, and .63, respectively. The scales were only weakly inter-correlated (r's < .40). The total scale reliability was .70. Income, education and self-rated health were positively associated with Awareness but not related to Screening or Prevention/Control. Age was positively associated with Prevention/Control. Seventy seven participants were in a family with a history of breast cancer. This was associated with higher scores on Screening and Prevention/Control. Having friends with a history of breast cancer was unrelated to any of the BCLAT scales. The BCLAT scales have demonstrated internal consistency reliability and validity in this multiethnic community based sample.

Even when implementing the Kin KeeperSM Cancer Prevention Intervention to deliver cancer education to Black, Latina and Arab women as the context in which we validated our cancer literacy assessment tools, we were still able to adhere to the rigorous of psychometric testing.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A22.
Abstract A25: Reaching diverse populations about cancer clinical trials: Lessons learned from ENACCT's pilot education program
Authors: Michaels Margo , Blakeney Natasha , Britton Abbey , Swords Liz , Bitow Naomi , Gibbs Brian , Yeun Samantha , Rytkonen Bruce , Goodman Robert , Greene Amanda , Jarama Lisbeth
Published: December 2010

Adult participation in cancer clinical trials (CCTs) nationally remains less than 5%, with even fewer participants among communities of color. Barriers to participation are experienced by patients, providers, as well as research staff. Efforts to improve diverse populations’ interest and participation in cancer clinical trials requires a multipronged approach targeting key stakeholders.

The Education Network to Advance Cancer Clinical Trials (ENACCT) is the only national organization solely devoted to evidence-based, community-centered approaches to CCTs education. In 2006, ENACCT launched the Pilot Education Program (PEP), a 3-year initiative which sought to improve CCT awareness, access, and accrual, particularly among medically underserved populations. Three diverse PEP community sites (Boston MA, Tacoma WA, and Decatur, IL) participated in training of community leaders (CLs) and health care providers (HCPs), using an action-oriented train the trainer curriculum that addressed cancer health disparities, past research abuses, and current patient protections, as well as the significance of diverse CCTs participation as a social justice issue. Multiple training modules, as well as educational “palm cards” were translated to Spanish and Korean. Workshops for CCT staff focused on strategies to improve recruitment and retention practices to reach medically underserved populations, highlighting the role of Culturally and Linguistically Appropriate Services (CLAS) standards in the clinical research setting.

PEP reached 461 HCPs (62% nurses), 926 CLs (66% minority) and 61 CCT staff (13% minority) in educational workshops. Four thousand individuals were reached through community presentations and over 49,000 educational palm cards were distributed. Post training, over 60% of CLs trained said they shared messages about CCTs with at least one other person. HCP trainees had more favorable attitudes and beliefs regarding CCTs and HCPs’ role in CCT referral from pre-to post-workshop assessment. Additionally, at first assessment post-training, 81 % of CLs, 95% of HCPs and 94% of CCT staff agreed that equal access to CCTs is a matter of social justice. Nearly 100 unique patient profiles were created via a national CCTs matching service. ENACCT's training overall positively improved recognition of CCTs access and participation as a social justice issue among stakeholders. Successful community based interventions on CCTs must meet the needs of diverse populations by (1) tailoring key education messages to be culturally relevant and (2) building synergistic relationships among stakeholders to reduce barriers to trial access.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A25.
Abstract A28: Reaching vulnerable populations: A process-oriented approach to breast screening
Authors: Baker-Calloway Jena , Albrecht Terrance L. , Berry-Bobovski Lisa , Stengle William , Brittain Kelly , Francis Carie
Published: December 2010

This community-based project evolved out of relationships established through the Detroit CNP for Older, Underserved African-Americans (NIH# U01-CA114583-04) to address the unmet needs of the clientele of three partnering community agencies. The need for breast cancer screening among older women from lower socioeconomic groups, the mentally ill, and the disabled has been well-documented. However, mammography among these special populations is low. This project brought together five organizations (three community service agencies, the NCI's Cancer Information Service Partnership Program, and the Karmanos Cancer Institute's Community Network Program) to provide breast health awareness, mammography screening, and navigation to underserved African American women. The five agencies collaborated to address the needs of the homebound, developmentally disabled, homeless, nursing home residents, grandparents raising grandchildren, and others. All groups were identified through a community assessment to identify significant barriers to accessing preventive health care services.

Through community-based participatory research (CBPR), the members of the partner organizations worked with community health education professionals to define: 1) community-level needs; 2) assess how best to integrate screening messages and health service navigation into existing service provision; and 3) identify ways to obtain external funding for program implementation. The CBPR process yielded an intervention that consisted of staff training, improved screening needs assessment and procedures for case management referral and follow-up that increased agency capacity to address breast health disparities.

A total of 490 women participated in this “high-touch” breast health education and screening intervention. Of those, 170 women received screening mammography and six women were diagnosed and received subsequent treatment and follow-up. The project was recently recognized by the Michigan Cancer Consortium, receiving their highest recognition, the Spirit of Collaboration Award.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A28.
Abstract A4: Do social class gradients predict breast cancer burden differently for black and white women?
Authors: Klassen Ann C. , Curriero Frank , Ward Abigail
Published: December 2010

This research utilizes 50,000 cases of breast cancer diagnosed during 1992-2003 reported to the Maryland Cancer Registry, and linked by residential address to U.S. Census block group data. The goal of the research is to model social class patterns in breast cancer burden for white and black women, and examine the ways in which social class influences differ across racial groups.

After geocoding cases to their Census blockgroup, we used factor analysis to create two indices capturing distinct aspects of area-level social resources. A composite index for social class captured area-level educational attainment, overall employment rates, portion of white collar employment, and income. The material resources index combined the portion of households with cars, telephones, living above poverty, and owning their own home. These indices were used to predict four aspects of case disease characteristics related to adverse outcome: tumor size, histologic grade, histologic type, and stage of disease at diagnosis. Multilevel random and fixed effects models estimated social resource effects across the State of Maryland's 3600 blockgroups. Race-specific models were used to examine whether social gradients in disease burden differed between black and white women.

Results indicate that the two indices effectively capture social gradients in breast cancer burden for both ethnic groups, but that there are important differences. For white women, social class is a stronger predictor for tumor grade, size and type but both social class and material resources are predictive of stage at diagnosis. For black women, material resources are a stronger predictor for grade and tumor size, and social class is a stronger predictor for stage at diagnosis and tumor type. We found significant or borderline significant effects of race on the effect of both indices on all tumor characteristic outcomes. In almost all models, the direction of the interaction suggests that the protective effect of social resources on the outcome of interest is stronger for white women, than for black women. Additional analyses further examine the impact of neighborhood racial composition on social class influences.

We conclude that investigating race-specific patterns of social class influences is one important strategy for understanding how social class patterns influence breast cancer disparities, as well as identifying possible avenues for intervention.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A4.
Abstract A42: Optimizing health care systems recruitment and retention practices for medically underserved populations: Impact of ENACCT cancer clinical trial staff training
Authors: Blakeney Natasha C. , Michaels Margo , Britton Abbey , Swords Liz , Bitow Naomi , Gibbs Brian , Yeun Samantha , Rytkonen Bruce , Goodman Robert , Greene Amanda , Jarama Lisbeth
Published: December 2010

Cancer clinical trials (CCTs) are essential to making progress in cancer care, yet many cancer care sites within health care systems struggle with improving adult trial participation, which nationally is less than 5%, even lower among communities of color. Challenges to improving participation include patient barriers such as fear, lack of awareness and costs as well as institutional barriers (limited staff and resources, study design, provider attitudes and behaviors) that can limit patient access to trials, particularly among minority and medically underserved populations.

The Education Network to Advance Cancer Clinical Trials (ENACCT) seeks to improve access to CCTs through education and collaboration with communities, health care providers, and researchers. ENACCT's Pilot Education Program (PEP), was a 3-year community-based intervention designed to enhance access, awareness and accrual to trials. Implemented in three communities nationwide, training was targeted to key stakeholders in trial participation, including CCTs staff.

Using an interactive learning format, PEP training for CCT staff focused on the impact of culture and changing demographics within the clinical research setting; the relationship of cultural competency and Culturally and Linguistically Appropriate Services (CLAS) Standards to CCTs participation; and assisted CCT staff to design an action plan to adopt CLAS Standards in the conduct of research at one's own institution. Additionally, local sites addressed policy barriers to enhance access. PEP impact was evaluated using pre and post tests, follow-up assessments, as well as interview and focus group data. PEP trained 61 CCTs staff (70% nurses). Post-training, at first assessment, 94% of CCT staff indicated increased commitment to advocate for adoption of CLAS standards within their institutions and 84% indicated intention to discuss with their peers the importance of cultural competency on patient recruitment and retention. Site initiatives to address access barriers included implementation of consent short forms for limited English proficiency patients, use of Six Sigma quality improvement measures to improve hospital recruitment processes and launching city-wide symposia on CCTs reaching community leaders and health care providers. A total of 3027 website sessions and 88 unique patient profiles were created with a national CCTs matching service associated with PEP.

Results from PEP suggest that training CCT staff in strategies to enhance cultural competency in the research setting may positively impact awareness and access to CCTs among medically underserved populations.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A42.
Abstract A44: Minority enrollment to clinical trials: Experience at the Dan L. Duncan Cancer Center
Authors: Mims Martha P. , Blaney Susan , Grilley Bambi , Heslop Helen , Osborne C. Kent , Maria L. , Jibaja Weiss , Dan L.
Published: December 2010

Background: The Dan L Duncan Cancer Center (DLDCC) is located in Houston, Texas, and provides care to uninsured and minority patients in several large hospitals including Ben Taub General Hospital, The Michael E. DeBakey VA Medical Center, and Texas Children's Hospital. The catchment area for the DLDCC is Harris County, an urban area with a population of nearly 4 million; approximately 18% of county residents are African American and 39% are Hispanic. While the percentage of African Americans in Harris County is nearly equal in all age groups, Hispanics make up nearly 45% of residents less than 30 years old, but only 10% of residents over 60, those most likely to develop cancer. One-third of the county population has no health insurance.

Objective: In 2006 the DLDCC set out to increase overall enrollment to therapeutic clinical trials while maintaining enrollment of patients belonging to racial and ethnic minorities.

Methods: A four-pronged strategy was used to maintain and improve accrual of racial and ethnic minority patients to cancer-related clinical trials while increasing overall accrual. First, the DLDCC invested significant resources in establishing research infrastructure in the hospitals including hiring bilingual coordinators and nurses, translating consents into Spanish, and underwriting the cost for conduct of NCI-sponsored trials. Second, the DLDCC partnered with hospitals to make office space available for research personnel, to provide discounted investigational pharmacy services and to obtain access to laboratory and imaging data and pathology samples. Third, the DLDCC introduced programs to make minority residents aware of clinical trials and build relationships and trust in the community including the establishment of a community advisory board, sponsorship of plays by minority playwrights that carry a cancer message, sponsorship of community health events, and creation of clinical trials newsletters and websites. Finally, the DLDCC pioneered and gained IRB approval for a form designed to collect accurate racial and ethnic data from trial participants.

Results: Overall enrollment to DLDCC therapeutic clinical trials increased by more than 50% between 2005/2006 and 2009 to an average of 13.4% of new cancer patients enrolled on trial. In 2009, 16.8% of subjects enrolled to therapeutic trials were African American, and 35.4% were Hispanic. Accrual of minority subjects was equivalent in pediatric and adult programs and on therapeutic and nontherapeutic trials.

Conclusion: Recruitment of pediatric and adult members of underserved minorities to clinical trials is possible with targeted strategies, dedicated research staff, hospital partnership and community involvement.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A44.
Abstract A45: Patterns of care regarding surgical choice and application of adjuvant radiation therapy for preinvasive and early-stage breast cancer in rural Appalachia
Authors: Freeman Andrew , Huang Bin , Dragun Anthony
Published: December 2010

Objective: To conduct a cross-sectional registry analysis of women in Appalachian Kentucky with the diagnosis of early-stage breast cancer to identify factors affecting surgical choice [breast conserving surgery (BCS) versus mastectomy] and appropriate use of adjuvant radiation therapy (RT).

Methods: Database collection was performed through the Kentucky Cancer Registry. Inclusion criteria included female breast cancer patients diagnosed between 1998 and 2007. All patients were ≥ 20 years of age diagnosed with DCIS or AJCC stage I or II disease as a first primary diagnosis. Database search was limited to Appalachian residents and were stratified by Beale codes 1-3 for urban locales and 4-9 for rural. Statistics including univariate, multivariate, and Cox survival analyses were performed to identify factors affecting surgical choice, receipt of RT and variables relating to survival.

Results: Analysis was based on 5541 evaluable Appalachian patients, of whom 86.2% lived in a rural location and 13.8% were urban. The overall distribution of primary surgery slightly favored BCS (54.1 %) over mastectomy (45.9%). On multivariate analysis, the most significant factors for mastectomy as the initial surgical procedure were advanced stage (OR 2.571, P<0.0001), rural location (OR 2.075, p<0.0001), and insurance status (OR 1.546, p<0.0001). Of patients choosing BCS, 56.2% received adjuvant RT. On multivariate analysis age >70 (OR 2.506, p<0.0001), rural location (OR 2.416, p<0.0001), and lack of insurance (OR 1.651, p=0.0168) were the strongest predictors for not receiving adjuvant RT. Cox survival analysis correlated with receipt of RT after BCS, ER/PR status, age, smoking history, insurance status, stage, and tumor size.

Conclusions: The rate of mastectomy remains higher and the rate of RT after BCS is significantly lower in Appalachian women compared to other contemporary studies of women with preinvasive and early stage breast cancer. Within the Appalachian population, these disparities are most apparent among rural and uninsured women. Further studies are needed to advance awareness of and access to health care initiatives to improve quality of breast cancer care for the underserved.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A45.
Abstract A46: Neighborhood socioeconomic deprivation and all-cause, cancer-, and CVD-specific mortality: NIH-AARP Study
Authors: Major Jacqueline M. , Doubeni Chyke A. , Freedman Neal D. , Park Yikyung , Lian Min , Hollenbeck Albert R. , Schatzkin Arthur , Graubard Barry I. , Sinha Rashmi
Published: December 2010

Background: The impact of person-level socioeconomic status (SES) on mortality is well documented. However, residing in deprived areas may increase the risk of mortality beyond that explained by a person's own SES-related factors and lifestyle. As few studies possess both person-level and area-level data, the interaction between these measures, though potentially of significant importance, is poorly understood. The large longitudinal NIH-AARP Study provides a rich resource to personal characteristics and health risk factors and is linked to census tract data which details the composition and socioeconomic context of each participant's local environment. The purpose of the present study was to examine the relation between neighborhood socioeconomic deprivation and all-cause, cancer-and cardiovascular disease (CVD)-specific mortality for men and women after accounting for education and other important person-level risk factors.

Design, Setting, and Participants: In the longitudinal National Institutes of Health (NIH)-AARP (formerly known as the American Association of Retired Persons) Diet and Health Study, we analyzed data from healthy participants, ages 50-71 years at baseline. Deaths (n=33831) were identified through linkage to Social Security Administration Death Master File and National Death Index from recruitment (1995-1996) to December 31,2005. Information on census tracts was obtained from the 2000 US Census. A multilevel analysis approach was employed; marginal and random effects (frailty) models for Cox proportional hazards regression, which account for correlation of individuals residing within the same census track, estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for quintiles of neighborhood deprivation. Multivariable models were adjusted for person-level risk factors, including age, education, smoking, physical activity, body mass index, and diet.

Results: During a median follow-up of 9.5 years, 21843 men and 11988 women died. Participants residing in the highest vs. lowest quintile of the deprivation index had elevated risks for overall mortality (HRmen=1.17,95% CI=1.10-1.24; HRwomen=1.13,95% CI=1.05-1.22) and marginally increased risk for cancer mortality (HRmen=1.09,95% CI=1.00-1.20; HRwomen=1.09,95% CI=0.99-1.22). Regarding CVD mortality, associations appeared stronger in men (HR=1.33,95% CI=1.19-1.49) than women (HR=1.18,95% CI=1.01-1.38). There was no evidence of an effect modification by education.

Conclusion: Higher neighborhood socioeconomic deprivation was associated with modest increases in all-cause mortality, cancer mortality, and cardiovascular disease mortality in both men and women even after accounting for a large number of established risk factors.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A46.
Abstract A55: Regional differences in breast cancer biomarkers in American Indian and Alaska Native women
Authors: Kaur Judith S. , Vierkant Robert , Myers Shannon
Published: December 2010

Introduction: Breast cancer is a major cause of cancer mortality in American Indian and Alaska Native (AIAN) women. However regional differences are striking with lowers rates in Arizona and highest in Alaska with almost a three-fold difference in incidence and mortality between the two states. These differences may be due in part to varying levels of biologic tumor aggressiveness. To evaluate this, we compared a panel of biomarkers on consecutively diagnosed AIAN breast cancer cases from AZ (N=53) and AK (N=42).

Methods: Retrospective analysis of tissue blocks measured expression levels for the following panel of biomarkers: ER and PR (ordinally coded as positive vs. negative); her2, BCL-2, and EGFR (coded 0.1.2. and 3+) and P53, MIB-1 and cyclin D (continuous percent of cells stained). Distributions of biomarker values were compared across state of residence using t-tests for continuous and ordinally scaled markers and chi-square tests of significance for binary markers. Age adjusted analyses were also carried out using linear and logistic regression models as appropriate to account for possible differences in age at diagnosis across states. Chart reviews recorded demographics and treatment characteristics.

Results: The following demographics were observed with 95 cases of AIAN women with breast cancer analyzed. Average age at diagnosis was similar in the two states (mean, 58.4 for AZ vs. 56.1 for AK, t-test p value=0.45). 74% presented with a palpable mass. 32% had lumpectomy and axillary node dissection. 28% were premenopausal. 8% had a first-degree relative with breast cancer. 46% received adjuvant chemotherapy. 54% received adjuvant hormonal therapy. Cases from AK had higher levels of p53 staining (40.3 vs. 18.5, p=0.004) and lower levels of both EGFR (mean ordinal scaling 0.15 vs. 0.53, p=0.02) and Her2 (mean ordinal scaling 0.81 vs. 1.32, p=0.02) tan those from AZ. No differences in distribution were observed for MIB-1, Cyclin D, BCL-2, ER or PR. When examined together, the triple negative combination of ER/PR/Her2 also did not differ across states (12% for AK vs.13%forAZ, p=0.85).

Conclusions: Our findings indicate that regional differences in biomarker expression levels of P53, EGFR and Her2 may exist in AIAN women. Further research is needed to confirm our results and determine to what extent these differences may explain the observed differences in mortality. Genetic testing for BRCA1,2 or other genetic associations with breast cancer have not been done in these populations and may also be useful to examine the reasons for differences in incidence and mortality. In addition, AIAN women are more likely to present with palpable masses representing higher risk stages of breast cancer. Outreach activities in this population continue to be highly important to change mortality. Supported in part by NCI U01 114609 Spirit of Eagles Community Network Program

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A55.
Abstract A57: Progress on a universal classifier for tumor samples
Authors: Jackson Nia , Enkemann Steven
Published: December 2010

Gene expression arrays are widely used to analyze tumor samples with the intention of identifying tumor identity or aspects of the tumors that may influence disease prognosis. Although arrays have illustrated the large diversity of individual tumors, most research efforts have focused on classifying tumors according to currently established classification systems. In this study we directly tested whether the pathological classification of tumor samples was necessary or sufficient to group tumors into subgroups based on biological similarity. Microarray data obtained from tumor samples was obtained from public databases. Individual data files were rigorously screened to remove poor quality samples. The samples were initially grouped according to large pathological divisions and training sets and test sets were created. Working back and forth between clustering samples and selecting genes an optimal grouping of samples was achieved in the training data along with the list of genes that defined each group. The final classification was then tested on the independent data sets to validate the classification of the tumor groups. We found the glioblastoma tumors clearly subclassified into distinct groups based on tumor grade whereas most other tumor classes did not. Interestingly, ovarian tumors, endometrial tumors and a few breast tumors classified as one single tumor group that might be further subgrouped, but not by site of origin. For cases of sarcoma the observed subclasses only partially recapitulate pathologically defined tumor types. Only with adenocarcinoma tumors did the major subclassification depend on the tumor site of origin. A preliminary classification scheme is presented where tumors are classified on a primary, secondary, and sometimes a tertiary level. One implication of this analysis is that many tumor classes that have been traditionally separated for clinical trials may be similar enough to consider combined trials and other groups of tumors may be inappropriately combined in current trials.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A57.
Abstract A59: Developing novel peptide inhibitors to chromosomal cohesion using mRNA display for nanodrug delivery in breast cancer therapy
Authors: McCullum Elizabeth O. , Pati Debananda
Published: December 2010

Several specific molecular networks mediate the cellular proliferation of tumorogenic cells. One signaling pathway of interest is the transition from metaphase to anaphase which is dependent on cleavage of the cohesin protein complex by separase, an endopeptidase. A normal transition allows the protein complex to form, sister chromatid cleavage and the onset of anaphase. However, failure to properly assemble or maintain the integrity of this complex results in the premature separation of chromatids (PCS), mitotic arrest and apoptosis in cultured cells. This research effort will focus on the identification of cohesin Rad21, a proapoptotic protein that is over-expressed in breast cancer cells, mimcs for the induction of apoptosis in the cohesin-disrupted tumors. Using mRNA display, Rad21 mimetopes will be selected to bind a SMC-1 target in the formation of standard cohesin complex assembly. The pool of isolated peptides will be further characterized for their specificity, induction of PCS, mitotic arrest and apopotosis both in vitro and in vivo. Finally, peptides will be conjugated to a RAFT-peptide scaffold drug delivery system to exclusively target rapidly proliferating breast tumor cells. The potential advantages provide an area of promising therapeutics for antitumor effects when coupled with chemotherapy at the point of early detection.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A59.
Abstract A7: Ethnic variations in trusted sources of prostate cancer information among American, Jamaican, and Bahamian black men
Authors: Williams Shanita D. , Ross Louie , Hinton Lisa , Woods V. Diane , Roberts Robin
Published: December 2010

Introduction: Prostate cancer is the leading cancer and the second leading cause of cancer deaths among men in the United States. African American (AA) and West Indian men are at greater risk than white and other racial/ethnic social groups in both incidence and mortality related to prostate cancer. AA men also have a greater likelihood of presenting at higher stage and grade with poorer treatment and health outcomes. Little is known about how black men obtain information about prostate cancer and if there is variation in trusted sources of information. The purpose of this study was to explore how black men obtain information about prostate cancer and screening and to identify sociodemographic and other ethnocultural characteristics that are associated with trusted sources of health information regarding prostate cancer.

Methods: U.S.-born/American, Jamaican, and the Bahamian black men age 40 or older were asked questions about their trusted sources of health information related to prostate cancer and screening using DRE and PSA. The study used a convenience sample of 448 AA men and 48 Jamaican men residing in the Southeastern U.S. and 55 Bahamian men in the Bahamas. Data were self-reported survey responses and analyzed using SAS.

Results: Study participants were likely married (54%), had some college or technical training (78%), and employed (60%). Over 90% of the men reported hearing of the DRE and 77% had heard of the PSA test. The major sources of health information were television news (65%), news/talk radio (54%), print materials (47%), and the Internet (45%). There were no significant ethnic differences in trusted source of health information. Further analysis revealed two information source subfactors: (1) oral (word of mouth)-oriented and (2) print-oriented preferences. Reporting good or excellent health, higher income, and having health insurance were associated with oral (word of mouth) information preferences. Reporting good or excellent health, higher levels of education and income, being employed, married, AA ethnicity, nonveteran status, and having had a recent health checkup and having heard of the PSA test and DRE were associated with print-oriented information preferences. In addition, printed sources of information were associated with awareness of DRE and PSA, but not recent screening.

Conclusions: Blacks in the U.S. and Caribbean bear a greater burden of prostate cancer among men. Therefore it is important to understand what information sources are trusted and preferred within diverse cultures along with ethnocultural factors that may influence health information preferences. Future studies are needed to further explore the relationship between black men's information preferences and their prostate cancer-related outcomes.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A7.
Abstract A71: Perceived stress management skills and quality of life in ethnic minority men newly diagnosed with prostate cancer
Authors: Bustillo Natalie E. , Rasheed Mikal , Benedict Catherine , Zhou Eric , Kava Bruce , Soloway Mark , Antoni Michael , Szapocznik Jose , Penedo Frank J.
Published: December 2010

Ethnic group differences exist in the diagnosis and treatment outcomes of prostate cancer (PC). African American men have the highest PC incidence, are more likely to be diagnosed at an advanced stage, and are twice as likely to die of PC than are Non-Hispanic White men. Previous research has shown ethnic minority men report poorer general and health-related quality of life (QOL) prior to initiating PC-related treatment. However, little is known about psychosocial factors associated with pre-treatment levels of QOL. This study examined the relationship between perceived stress management skills (PSMS) and QOL in men recently diagnosed with PC who had not initiated treatment. Sixty-two men completed a baseline assessment prior to initiating PC-related treatment. Participants’ mean age was 61.77 (SD= 6.39) and had been diagnosed within the past 3 months. All were ethnic minorities (53% Hispanic and 47% African American/Black). Measures included the Measure of Current Status, the Functional Assessment of Cancer Therapy, and the Expanded Prostate Cancer Index Composite to assess PSMS, general QOL, and disease-specific QOL, respectively. Several hierarchical regression models were tested to examine whether PSMS were positively related to QOL at baseline, controlling for relevant covariates (e.g., age and ethnicity). Results indicated that PSMS associated with better general and disease specific QOL and accounted for a significant amount of the variance (i.e., 14 to 20%) in several functioning and QOL domains (i.e., urinary functioning [R1,58)= 4.55, p<.04, β=.261], urinary incontinence [F(1,58)= 8.95, p<.01, β=.367], social/family well-being [R1,58)= 10.20, p<.01, β=.394], functional well-being [R1,58)= 8.08, p<.01, β=.355], and total well-being [F(1,58)= 13.75, p<.01, β=.447]. Results suggest that among ethnic minorities, greater perceived ability to manage stress at diagnosis is associated with several indices of QOL. Future studies should investigate the extent to which PSMS may impact adjustment and recovery following treatment and whether psychosocial interventions targeting such skills are effective in improving QOL in this population.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A71.
Abstract A77: Gastric cancer risk in relation to capsaicin intake, H. pylori CagA status, and IL1B-31 C>T genotypes
Authors: Lopez-Carrillo Lizbeth , Camargo Constanza , Cebrian Mariano E. , Schneider Barbara G. , Sicinschi Liviu A. , Hernandez-Ramirez Raul U. , Correa Pelayo
Published: December 2010

Background: In contrast to the situation in most countries, gastric cancer (GC) incidence is not declining in Mexico. Capsaicin (Cap) is the pungent active substance of chili peppers and it is related to an increased risk of GC in studies performed in Mexico, Spain, Serbia, Korea and India. Host genetic characteristics and variations in dietary patterns are considered concomitant risk factors for GC development. Helicobacter pylori (H. pylori) infection is considered a necessary but not sufficient cause of GC, as less than 3 % of infected patients develop this tumor. Increased risk for GC has been observed among Mexican C allele carriers of the pro-inflammatory interleukin 1B position-31 (IL1B-31) infected with more virulent H. pylori CagA = strains, we explored if that risk varies according to the consumption of Cap, since chili pepper consumption is highly prevalent among Mexicans.

Methods: A total of 158 histologically confirmed GC patients and 317 clinical controls from three states with contrasting GC mortality rates in Mexico were included in this report. Cap intake was estimated by a previously validated food frequency questionnaire. H. pylori CagA status was assessed by an ELISA test, and genotypes of the IL1 B-31 were determined byTaqMan assays and Pyrosequencing in DNA samples isolated from serum.

Results: Using unconditional adjusted logistic regression models, a significant 3.5-fold increased GC risk was observed among individuals with moderate to high Cap consumption, who were IL1B-31 C allele carriers and were H. pylori CagA positive, with a significant interaction term between Cap consumption and IL1B-31 genotypes (p=0.039): Odds Ratio (OR) among TC vs.TT carriers: 3.48; 95%CI: 1.01-12.0, and OR among CC vs. TT carriers: 3.37; 95%CI: 1.05-10.85; in contrast, no significant negative associations with GC were estimated when any of these three factors was absent.

Conclusions. This is the first epidemiological report considering a potential interaction amongst dietary, infectious and genetic factors on GC risk and suggests that moderate to high Cap intake synergistically increases the risk of GC in genetically susceptible individuals (IL1 B-31 C allele carriers) infected with more virulent H. pylori (CagA positive) strains. The significant interaction between Cap consumption and genotypes of the IL1 B-31 suggests that a reduction of Cap intake under 30 mg/day among susceptible carriers with high consumption of Cap would reduce GC risk. Underlying mechanisms that explain these results, warrant attention and may include an up-regulation of H. pylori CagA expression in response to high capsaicin consumption.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A77.
Abstract A86: Sociodemographic correlates of cancer survivors in the United States
Authors: Clarke Tainya C. , Lee David J. , Fleming Lora E. , Arheart Kristopher L. , Caban-Martinez Alberto J. , Ocasio Manuel , Antoni Michael H.
Published: December 2010

Introduction: Approximately 40% of the more than 1 million Americans diagnosed with cancer each year are working-age adults, likewise more than 11 million people in the U.S. are cancer survivors. Given almost 50% of cancer survivors are under 65 years of age, a large proportion of them return to work after treatment or even maintain regular work schedules during their cancer treatment. We described the socio-demographic characteristics and risky health behaviors of U.S. adults diagnosed with cancer by the five most commonly diagnosed cancer types.

Methods: Data pooled from the 1997-2009 National Health Interview Survey (NHIS) on adults 18 years of age and older with self-reported physician diagnosed cancer (n=27,906) were analyzed. Estimates on self-reported socio-demographic characteristics (age, gender, race, ethnicity, education, employment status, and job type) general health status, and negative health behaviors (risky alcohol drinking [men who consume ≥ 2 drinks and women who consume ≥1 drink per day] and cigarette use [current, former, never]) were stratified by specific-cancer type (non-melanoma skin cancer, lung cancer, colorectal, prostate, and breast) and employment status.

Results: Thirty-three percent of adults diagnosed with cancer work post-diagnosis. Among employed cancer survivors, 69.3% were employed in white collar jobs while 14.7% were in service jobs. This distribution differed among employed persons without a cancer diagnosis, with 58.5% employed in white collar jobs and 23.4% in service jobs. Among employed persons with cancer, 65.9% were 35-54 years old, while 15.6% were greater than 55 years. Breast and non-melanoma skin cancer rates were highest among those who returned to work. The percentage of cancer workers reporting fair-poor health was greater than workers without cancer. Lastly, workers with cancer reported lower risky drinking (7.8%) and cigarette use (4.7%) compared to workers without cancer (14.5% and 11.4%, respectively).

Conclusion: A large occupational health disparity exists among persons returning to work following a cancer diagnosis. Among all worker types, we found service workers were less likely (as compared to white collar workers) to be currently employed suggesting the need for integrating vocational rehabilitation programs and treatments services tailored to their workplace organization. In addition, the changing gender distribution in the U.S. workforce reflects our study findings that twice as many females as males continued to work following cancer diagnosis. The new U.S. healthcare reform bill that supports workplace health promotion programs may assist employers in developing the aforementioned reintegration programs and thwart the burgeoning occupational health disparities among working cancer survivors.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A86.
Abstract A93: Investigating reasons for ethnic disparities in breast cancer survival in New Zealand
Authors: McKenzie Fiona , Ellison-Loschmann Lis , Jeffreys Mona
Published: December 2010

Background: In New Zealand the burden of breast cancer is not shared equally among ethnic groups. Although incidence is similar for indigenous Maori women and Pacific women compared with non-Maori/non-Pacific women, Maori and Pacific women are more likely to die from breast cancer. This suggests much of the breast cancer mortality disparities are due to inequalities in survival rather than incidence. We investigated the role that demographic and tumor factors play in explaining ethnic disparities in breast cancer survival.

Methods: Breast cancer cases notified to the New Zealand Cancer Registry (NZCR) from April 2005 to April 2007 were followed up to April 2009. Maori, Pacific and non-Maori/non-Pacific women were categorized according to ethnicity on the NZCR. Deprivation was analyzed as quintiles of the New Zealand area-based index of socioeconomic position. Relative survival rates were estimated using ethnic-specific life tables. Missing values were imputed and excess mortality modeling was used to estimate the contribution of demographic and tumor factors to ethnic inequalities in survival.

Results: There were 2,968 breast cancer cases (76.5% non-Maori/non-Pacific, 17% Maori, and 6.5% Pacific) included and 433 recorded deaths. Relative survival rates at 4 years were 91.45% (CI 89.68 to 92.93) for non-Maori/non-Pacific, 86.15 (CI 80.33 to 90.36) for Maori, and 79.56% (CI 68.17 to 87.24) for Pacific women. Using non-Maori/non-Pacific as the reference group, the age-adjusted hazard ratio (HR) dropped for Maori from 1.76 (CI 1.22 to 2.48) to 1.43 (CI 0.97 to 2.10) when further adjusted by deprivation. For Pacific the HR dropped from 2.49 (CI 1.57 to 3.94) to 1.94 (CI 1.20 to 3.13). Inequalities persisted after adjustment for subtype variables (ER/PR/HER2), but adjusting for access to care variables (stage/size) eliminated the ethnic inequalities in excess mortality.

Conclusion: Ethnic disparities in breast cancer survival in New Zealand can be attributed to differential access to health care rather than differences in breast cancer subtypes.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A93.
Abstract B114: Comparative effectiveness research on colorectal cancer screening
Authors: Chyke Doubeni A. , Zauber Ann G. , Fletcher Robert H.
Published: December 2010

Screening is an established strategy for reducing death from colorectal cancer. The availability of multiple guidelines-recommended for colorectal cancer increases the complexity of screening decision-making for patients, clinicians and policy makers. This is compounded by differences in the strength of the evidence supporting the use of currently available tests in actual clinical practice. Therefore, colorectal cancer screening represents an important focus for comparative effectiveness research: the available tests also vary in cost, complexity and risk of complications.

Another unique situation with colorectal cancer screening is the increasing use of colonoscopy for screening, the effectiveness of which has been recently called into question, while tests with proven efficacy such as sigmoidoscopy and fecal-based tests are now less frequently used. This presentation will discuss colorectal cancer comparative effectiveness research from the context of an NCI-funded project. The specific aim of that project is to estimate the effectiveness of screening colonoscopy in reducing death from colorectal cancer among average risk adults when compared to no screening. Of particular interest is to determine if colonoscopy is effective in reducing death from right-sided colon cancers and to examine the impact of quality of colonoscopy on its effectiveness.

The presentation will discuss the following concerning colorectal cancer screening comparative effectiveness research: 1) the disconnect between health care policies, clinical practice and scientific evidence; 2) the methodological challenges of studying the comparative effectiveness of colorectal cancer screening tests; and 3) review the design of the funded observational study.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B114.