bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract B045: Gene expression pathways associated with vigorous physical activity in prostate cancer
Authors: Pernar Claire H. , Parmigiani Giovanni , Giovannucci Edward L. , Rimm Eric B. , Finn Stephen , Fiorentino Michelangelo , Ebot Ericka M. , Mucci Lorelei A.
Published: February 2019

Background: Epidemiologic studies have consistently shown that men engaged in high levels of physical activity have lower risks of advanced and fatal prostate cancer. The mechanisms underlying this association are not well understood but may include changes in hormonal and anti-inflammatory pathways. Our objective was to investigate the link between prediagnostic physical activity and gene expression alterations in prostate tumor and adjacent normal tissue.

Methods: We performed whole-gene expression profiling on tumor (N=248) and adjacent normal tissue (N=117) among a subset of men diagnosed with indolent and lethal prostate cancer between 1986 and 2005 in the prospective Health Professionals Follow-up Study. Men were followed prospectively for prostate cancer outcomes through 2011. Physical activity was ascertained by self-report of the average number of hours per week spent engaged in various forms of recreational physical activity at baseline and every two years thereafter. We examined cumulative average physical activity of vigorous intensity in units of metabolic equivalent of task (MET)-hours/week updated from baseline to the time prostate cancer diagnosis. Gene set enrichment analysis was performed among KEGG and hallmark gene sets to identify pathways with differential expression by vigorous activity.

Results: We identified 33 KEGG and four Hallmark gene sets enriched in the adjacent normal tissue comparing men in the highest compared to the lowest quintile of vigorous activity (false-discovery rate < 0.25). Among the significant gene sets identified were cancer-related pathways as well as vascular smooth muscle contraction, angiogenesis, and insulin-signaling pathways. No gene sets were significantly enriched in the tumor tissue.

Conclusions: These findings suggest that physical activity may influence prostate cancer development through epigenetic alterations in the prostate tissue. Future studies are needed to confirm these findings and further investigate potential mechanisms linking physical activity to risk of lethal prostate cancer.

Citation Format: Claire H. Pernar, Giovanni Parmigiani, Edward L. Giovannucci, Eric B. Rimm, Stephen Finn, Michelangelo Fiorentino, Ericka M. Ebot, Lorelei A. Mucci. Gene expression pathways associated with vigorous physical activity in prostate cancer [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr B045.
Abstract B065: Genomic analysis of localized prostate cancer identifies AZIN1 as driver of metastatic progression
Authors: Broeck Thomas Van den , Moris Lisa , Gevaert Thomas , Smeets Elien , Prekovic Stefan , Helsen Christine , Poppel Hendrik van , Everaerts Wouter , Buerki Christine , Davicioni Elai , Joniau Steven , Claessens Frank
Published: February 2019

High-risk PCa (HRPCa) remains very heterogeneous with an unacceptable variation in patient outcome after radical prostatectomy, with cancer-specific mortality rates ranging from 4.6% to 20.3% at 10 years’ follow-up. Clearly, we need a better understanding of the tumor biology to enhance the subclassification, enable the identification of lethal PCa, and eventually allow a more precise decision-making regarding treatment.

We created a matched case-control study of two clinically identical HRPCa patient groups, both treated with radical prostatectomy but where one developed metastatic recurrence (n=19) and the other did not (n=25), despite very-long-term follow-up. The integrated analysis of copy number aberrations and transcriptome analysis highlighted a focal amplification of 8q22.3 in the metastatic group, associated with a higher expression of antizyme inhibitor 1 (AZIN1) in our cohort. This association of high AZIN1 levels with the metastatic HRPCa phenotype suggests a role for AZIN1 as possible predictor and/or target for metastatic HRPCa. AZIN1 is one of the regulators of the polyamine synthesis, which play a central role in many cellular processes. Our in vitro analyses confirmed that modulation of AZIN1 expression determines both growth and migratory potential of prostate cancer cells. Future experiments are planned to confirm these data in the in vivo setting. RNA sequencing after knockdown of AZIN1 in PCa cells revealed several transcriptional programs that are activated/deactivated upon AZIN1 knockdown. This showed among others a significant upregulation of genes involved in extracellular matrix composition, including genes encoding for subunits of the collagen IV, which is an integral part of the basement membrane. Ongoing experiments focus on identifying the mechanism by which AZIN1 regulates collagen IV expression.

Citation Format: Thomas Van den Broeck, Lisa Moris, Thomas Gevaert, Elien Smeets, Stefan Prekovic, Christine Helsen, Hendrik van Poppel, Wouter Everaerts, Christine Buerki, Elai Davicioni, Steven Joniau, Frank Claessens. Genomic analysis of localized prostate cancer identifies AZIN1 as driver of metastatic progression [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr B065.
Abstract IA17: PARP inhibitor resistance in prostate cancer
Authors: D’Andrea Alan D.
Published: February 2019

Large-scale genomic studies have demonstrated that approximately 15% of metastatic castration-resistant prostate cancer (mCRPC) harbors genetic and epigenetic alterations in homologous recombination repair (HRR) pathway genes. The most commonly altered HRR genes are BRCA2, BRCA1, and ATM, followed by other Fanconi anemia genes including FANCN/PALB2 and FANCA. Loss of HRR causes genomic instability, hyperdependence on alternative DNA repair mechanisms, and enhanced sensitivity to platinum analogues and PARP inhibitors (PARPi). The synthetic lethal interaction with PARPi is being exploited therapeutically in diverse clinical contexts and most notably in BRCA2-deficient mCRPC where the PARPi olaparib has demonstrated improvements in progression-free survival. PARPi resistance has already emerged as a vexing clinical problem for the treatment of BRCA1/2-deficient tumors. The most prevalent mechanism of PARPi resistance is secondary events that cancel the original HRR alteration and restore HRR proficiency. These somatic reversions of mutant BRCA2 alleles can be monitored by sequencing of ctDNA. However, PARPi resistance may also develop without restoration of HRR proficiency via disruption of multiple proteins, such as PTIP or CHD4, that leads to replication fork (RF) stabilization. Importantly, this latter mechanism—namely, the restoration of RF stability—appears to be a highly prevalent mechanism of PARP inhibitor resistance in vitro and in vivo, particularly in tumor cells with an underlying BRCA2 deficiency. Due to their underlying deficiency in BRCA2 and inability to generate RAD51 nucleofilaments, these tumor cells are unable to restore HRR mechanisms. Instead, these cells acquire may PARPi resistance by limiting the nucleolytic degradation of their stalled replication forks. We have recently made the surprising observation that BRCA2-deficient ovarian and breast cancer cells can become resistant to PARPi by downregulating the expression of the polycomb repressive complex PRC2, a methyltransferase complex containing EZH2, SUZ12, EED, and RbAp48. Importantly, downregulation of PRC2 results in the reduced recruitment of the nuclease MUS81 to the RF, thereby providing a novel mechanism of RF protection and PARPi resistance. Whether or not the downregulation of the PRC2/MUS81 pathway is also a mechanism of PARPi resistance in mCRPC remains to be determined. A molecular understanding of PARPi resistance mechanisms may allow the generation of a new class of drugs, or a repurposing of existing drugs, which may reverse this resistance and extend the use of PARPi to more tumor types.

Citation Format: Alan D. D’Andrea. PARP inhibitor resistance in prostate cancer [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr IA17.
Abstract IA22: Targeting tumor-infiltrating myeloid cells for prostate cancer therapy
Authors: Alimonti Andrea
Published: February 2019

Prostate cancer cells are surrounded by a complex tumor microenvironment that controls prostate cancer progression and treatment resistance. We are interested in understanding the liaison between tumor-infiltrating myeloid cells and prostate cancer cells to identify new molecular mechanisms that regulate cancer progression and the emergence of castration-resistant prostate cancer (CRPC). We have previously demonstrated that myeloid-derived suppressor cells (MDSCs) trigger senescence evasion and immunosuppression in primary prostate cancers, eventually promoting tumor progression. These studies have provided the rationale to develop in the clinic novel immune therapies targeting MDSCs for the therapy of metastatic prostate cancer patients. I will present recent results on additional tumor-promoting functions played by MDSCs and tumor-associated macrophages (TAMs) in prostate cancer, and I will discuss new therapeutic strategies that combine the use of immunotherapy with androgen deprivation therapy for the treatment of CRPC

Citation Format: Andrea Alimonti. Targeting tumor-infiltrating myeloid cells for prostate cancer therapy [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr IA22.
Abstract A18: An enhanced shared decision-making model to address willingness and ability to undergo lung cancer screening and follow-Up treatment
Authors: Erkmen Cherie P. , Mitchell Mark , Randhawa Simran , Sferra Shelby , Kim Rachel , DiSesa Verdi , Kaiser Larry R. , Ma Grace X.
Published: February 2019

Background: Failure to address willingness and ability to undergo lung cancer treatment before lung cancer screening could cause patients unnecessary anxiety, cost, and care. We employed an enhanced shared decision-making (SDM) model to address willingness and ability to undergo lung cancer screening of low-dose CT (LDCT) scanning. We hypothesized that enhanced SDM was feasible and did not discourage patients from undergoing lung cancer screening.

Methods: We performed a prospective study of patients referred for lung cancer screening. We measured adherence to the LCS protocol, including consent to discuss lung cancer treatment if cancer is found and direct questions to patients about willingness and ability to undergo lung cancer treatment. We measured race, gender, adherence to the consent process, and questions regarding willingness and ability to undergo lung cancer treatment and subsequent uptake of LDCT.

Results: All 190 patients have a documented SDM visit addressing the risks and benefits of lung cancer screening and consented to discuss lung cancer treatment if lung cancer is diagnosed. One hundred and seventy-nine (179) of 190 (94%) answered yes to being willing and able to undergo lung cancer treatment. One hundred and eighty-seven (187) patients underwent LDCT (98.4%).

Conclusions: Discussion about willingness and ability to undergo lung cancer treatment should be an essential component of an SDM discussion prior to LDCT. This study demonstrated that an enhanced SDM experience is feasible in a clinical setting. Furthermore, patients proceeded with LDCT following the enhanced SDM process.

Citation Format: Cherie P. Erkmen, Mark Mitchell, Simran Randhawa, Shelby Sferra, Rachel Kim, Verdi DiSesa, Larry R. Kaiser, Grace X. Ma. An enhanced shared decision-making model to address willingness and ability to undergo lung cancer screening and follow-Up treatment [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A18.
Abstract A43: [Advocate Abstract:] Dot4life multiple myeloma for Caribbean patients
Authors: Brignoni Marisel
Published: February 2019

The population of Puerto Rico decreased from 3,808,610 on April 1, 2000 to 3,725,789 on April 1, 2010. Population estimates for 2011 indicate that the population continues to decrease. The population structure of Puerto Rico got older. The population 65 years of age and older increased from 11.2% in 2000 to 15.2% in 2011. The poverty level in all people in Puerto Rico for 2011.

In 2011, 7.6% of the noninstitutionalized civilian population in Puerto Rico had no health insurance coverage. Puerto Rico has 250 new cases of multiple myeloma every year. The Veterans Hospital has 15 new cases every year for the same cause. Between 2008-2012 we had 1053 new cases of multiple myeloma. Puerto Rico does not have any specialists for multiple myeloma, although it receives a support from one of the hospitals in Florida that came 1 or 2 times a month to see these patients. Giving the patient education, the correct therapy, helping them with financial programs; we will have the engagement for any clinical trials that exist for this cause.

Note: This abstract was not presented at the conference.

Citation Format: Marisel Brignoni. [Advocate Abstract:] Dot4life multiple myeloma for Caribbean patients [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A43.
Abstract A47: Correlation between non-skin cancer survival, race/ethnicity, and socioeconomic status in the United States
Authors: Song Jingwei , Tian Ligeng , Aliyu Muktar
Published: February 2019

Background: The elimination of disparities in the burden of cancer is one of the overarching themes of the American Cancer Society 2015 challenge goals. However, not much progress has occurred in this area in the U.S, especially among certain populations. This is an area in which progress has yet to be made, even in 2017.

Methods: In 2014, the CDC BFRSS (Behavioral Risk Factor Surveillance System) conducted cancer survivorship telephone surveys in seven states (Alaska, Iowa, Mississippi, Missouri, Nebraska, Ohio, and Wisconsin). We performed logistic regression to determine the cancer survivorship disparities and socioeconomic status of non-skin cancer patients based on race and ethnicity.

Results: A total of 64,202 people participated in the survey. A total of 3,539 persons (age 18 to 79 years) self-reported being diagnosed with at least one non-skin cancer. The prevalence of non-skin cancer was 3.7%, 7.2%, 7.5%, and 10.5% among Hispanics, other non-Hispanics, black non-Hispanics, and white non-Hispanics, respectively. Compared to the other races, White non-Hispanic race was independently associated with being diagnosed with depression (OR=1.72), unable to work (OR=1.85), daily smoking habits (OR=2.07), and having more than one different type of cancer (OR=2.43 for two types of cancers and OR=2.56 for three or more different cancers).

Conclusions: Non-skin cancer is correlated with socioeconomic status and varies by race/ethnicity. These factors include less education, low income, less family support, and lack of a stable job. However, compared to white non-Hispanics, other races reported essentially the same quality of life.

Citation Format: Jingwei Song, Ligeng Tian, Muktar Aliyu. Correlation between non-skin cancer survival, race/ethnicity, and socioeconomic status in the United States [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A47.
Abstract B07: Asian American women's perspectives toward donating healthy breast tissue: Implications for recruitment methods and messaging
Authors: Ridley-Merriweather Katherine E.
Published: February 2019

As long as they remain in their homelands, Asian women have a lower risk than Caucasians, African Americans, and Latinas of developing breast cancer (BC). Yet once Asians move to the U.S. their risk rates measurably increase. The Susan G. Komen® Tissue Bank at the IU Simon Cancer Center (KTB) is the only biobank of its kind in the world that collects healthy breast tissue from women of all racial groups to use as controls in BC research. The KTB represents a critical tool in efforts to treat and prevent BC; however, Asian American (AA) women display marked reticence towards donating breast tissue to the KTB. Therefore, the purpose of this study is to use the basic components of Grounded Practical Theory to explore potential messaging that may result in AAs' more positive outlook on breast tissue donation.

This study recruited seventeen (N=17) AA women to share their perspectives on donating breast tissue for research purposes. Participants took part in an interactive focus group exploring potential messaging for successfully recruiting AA women to the KTB study. Findings revealed that: a) participants retained a culturally embedded discomfort with donating, and a general distrust that their donation would be handled ethically and appropriately; b) the women possessed an extraordinary need for knowledge about all facets of the donation process; c) participants perceived that they lack a personal connection to BC, making it difficult for them to generate any truly altruistic tendencies to perform the desired behavior, or to understand a need to do so; and d) they possess a strong desire to learn why it seems important to the KTB to collect their tissue, and especially about the increased BC rates and risk for Asians who move to or are born in the U.S. The findings from this study have important implications for others who work in applied clinical settings and are interested in addressing racial disparities in medical research through more effective and targeted recruitment messaging.

Citation Format: Katherine E. Ridley-Merriweather. Asian American women's perspectives toward donating healthy breast tissue: Implications for recruitment methods and messaging [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B07.
Abstract B49: Factors affecting the treatment of young women with breast cancer at tertiary referral public and private hospitals
Authors: Patel Ami , Dhage Shubhada
Published: February 2019

Background: Disparities persist in receipt of treatment and outcomes of breast cancer patients with varying race, English proficiency, and socioeconomic backgrounds. This is confounded in young women (≤ 45 years old), as age becomes an additional factor. We sought to assess our surgical experience with young breast cancer patients, at a public safety-net hospital (BH) and a private cancer center (PCC) that are staffed by specialty trained providers from the same university.

Methods: We reviewed demographic and clinical-pathologic data from 275 breast cancer patients with invasive breast cancer (Stage I-III) 45 years old and younger from the public and private hospital IRB-approved databases. There were 69 patients in the BH group and 206 patients in the PCC group. Demographic variables (race, education, and primary language), surgery type, method of presentation, and stage were analyzed using Pearson's chi-square tests and binary logistics.

Results: At PC the patients were Caucasian (68%), Asian (11%), Hispanic (10%), and African American (8.7%). At BH patients were Spanish/Hispanic/Latino (47.8%), Asian (27.5%), and African American (10.1%). The majority of patients (82%) at PC had a college or graduate degree compared to 18.6% of the patients at BH (P<0.001). All the patients at PC reported English as their primary language compared to 30% of patients at BHC (P<0.001). There was a significant difference between the stages at which patients presented to either hospital (P = 0.042). At PC, most patients presented at Stage I (54.4%), while most presented at stage II at BH (42.0%). Additionally, a significantly higher number of patients at BHC (81.2%) than at PC (68.4%) presented with a palpable mass (P = 0.043). Hospital site was not a predictor of receipt of mastectomy (P = 0.502). Stage significantly affected the type of treatment received (P<0.01); patients with higher stage were more likely to receive a mastectomy. A patient's race, primary language, and education level at both hospitals did not increase the likelihood of receiving a mastectomy. A majority of the mastectomy patients at both institutions received immediate cosmetic reconstruction 87% (BH) vs. 76%(PCC).

Conclusion: Young women with breast cancer treated at public hospital affiliated with an academic center had equivalent surgical treatment regardless of race, primary language, method or stage or presentation, and education level as young breast cancer patients treated at an academic private hospital.

Citation Format: Ami Patel, Shubhada Dhage. Factors affecting the treatment of young women with breast cancer at tertiary referral public and private hospitals [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B49.
Abstract B77: Panel testing to evaluate genetic predisposition to breast cancer in African American women
Authors: Blackburn Heather L. , Shriver Craig D. , Ellsworth Rachel E.
Published: February 2019

Background: Although the role of BRCA1 and BRCA2 has been well studied in women of European ancestry, the contribution of these and other genes associated with hereditary cancers remains unknown in other populations. Here, we utilized panel testing to analyze 94 cancer predisposition genes in African American women (AAW) diagnosed with invasive breast cancer.

Methods: 145 self-described AAW who enrolled in the Clinical Breast Care Project from 2001-2012 and had genomic DNA available were identified. Targeted sequencing was performed using the TruSight Cancer panel (Illumina). Pathogenic mutations were identified using VariantStudio and classified as pathogenic, uncertain significance (VUS), or benign using ClinVar.

Results: Mean age at diagnosis was 52.1 years (range 25-81 years), and 32% of AAW had a family history. The majority of tumors were ER+HER2- (53%) followed by triple-negative breast cancer (TNBC, 34%). Seven percent of AAW had pathogenic mutations in high-risk genes including BRCA1 (n=7), BRCA2 (n=3), and TP53 (n=1); VUS were detected in BRCA1 (n=1) and BRCA2 (n=2); and an additional woman had a private variant (D2965E) in BRCA2. A further 1% of AAW harbored mutations in the moderate-penetrance gene CHEK2. VUS were also detected in ATM (n=9), CDH1 (n=1), CHEK2 (n=2), MSH2 (n=1), MSH6 (n=5), NBN (n=1), PALB2 (n=4), PMS2 (n=3), RAD51C (n=1), SMAD4 (n=1), TP53 (n=1), and TSC2 (n=1).

Conclusions: Although 94 cancer predisposition genes were evaluated, pathogenic mutations in AAW were detected only in four well-established breast cancer predisposition genes (BRCA1, BRCA2, CHEK2, and TP53). Overall mutation frequency was 9%; however, an additional 25% of AAW harbored private variants and VUS, underscoring the critical need to establish the pathogenicity of these variants.

The opinions or assertions contained herein are the private ones of the author/speaker and are not to be construed as official or reflecting the views of the Department of Defense, the Uniformed Services University of the Health Sciences, or any other agency of the U.S. Government.

Citation Format: Heather L. Blackburn, Craig D. Shriver, Rachel E. Ellsworth. Panel testing to evaluate genetic predisposition to breast cancer in African American women [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B77.
Abstract B87: [Advocate Abstract:] Prostate cancer survivorship among African American males
Authors: Bowen Earl
Published: February 2019

African American survivors of prostate cancer and their families share common experiences yet express their reactions in widely divergent ways. Understanding what factors account for those differences helps explain why some survivors have coped extremely well after treatment and why others have struggled. This research is focused on what enabled victims to become successful survivors and its potential impact on subsequent generations. This study sheds new light on the coping and adaptation of survivors and their families from their own perspective. The study was conducted to describe the lived experiences of African American survivors of prostate cancer, to understand the phenomena in their own terms, to provide a description of their experiences with prostate cancer, and to identify interventions that are ethnically and culturally sensitive. The researcher administered a 49-question sociodemographic survey and conducted 25 in-depth interviews, which entailed descriptions of significant events that influenced the recovery process, perceptions of the health care delivery process and health care providers, and specific recommendations for program development and community outreach in African American communities.

Citation Format: Earl Bowen. [Advocate Abstract:] Prostate cancer survivorship among African American males [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B87.
Abstract C06: Adapting a breast cancer education program to reach Arab Muslim women
Authors: Gonzalez Evelyn T. , Salam Alia
Published: February 2019

Breast cancer (BC) is the most common cancer in women in the United States as well as in Arab countries. Yet, Arab women have lower mammography rates than women of other ethnicities. This is due to an array of barriers, including but not limited to lack of knowledge, cultural and linguistic barriers, and fear of discrimination. Moreover, Arab immigrants have been underserved by research and outreach efforts primarily because many Arabs are considered of the White (Caucasian) race. Given that there is a large Arab population in our catchment area (Philadelphia, PA) we customized a breast cancer education program specifically for Arab Muslim women. In the first phase of the project, 10 Arab Muslim women (ages 35 and older) living in Philadelphia were recruited to provide formative feedback regarding the appropriateness and clarity of the presentation. Participants were encouraged to communicate their thoughts, preferences, concerns, and questions surrounding breast health. Even though most participants indicated that they are insured, can find health information easily, and can understand what health professionals say, their discussion conveyed a strong need for breast health education in this community. After analyzing their input, we refined the presentation and evaluated its effectiveness in a second group of Arab Muslim women (n = 21). Knowledge, attitudes, and beliefs surrounding BC were captured at the beginning of the workshop and at the end using a pre/post-test. A paired t-test showed a significant increase in BC knowledge scores after the presentation (93.5%, SD = 8.46) than before the presentation (79.22%, SD = 17.37); t (20) = -4.088, p = 0.001. In addition, there was an improvement in attitudes and intent regarding self-awareness of breast health and mammography screening. To further augment the educational program, an Arab plain-language brochure was developed and reviewed with the participants. Results from Phase I and II will be reviewed during the session, including additional questions asked by participants during the formative evaluation process. The findings from this effort further indicate the need to expand education (and screening) services to this community.

Citation Format: Evelyn T. Gonzalez, Alia Salam. Adapting a breast cancer education program to reach Arab Muslim women [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C06.
Abstract C18: [Advocate Abstract:] The job or work of being a cancer patient: How to advocate for yourself and a loved one
Authors: Gelb Richard H.
Published: February 2019

The Job or Work of Being a Cancer Patient is the most important job a cancer patient will ever have; their life depends on it! The Job or Work entails learning how to acquire complicated scientific cancer information, becoming skilled at communicating, negotiating and problem-solving with a family, health care providers, insurance and pharmaceutical companies, government agencies and other cancer patients.

Personal Advocacy: is about taking charge of your disease/illness and your life; includes learning how to do research on your cancer diagnosis in order to gather information about the disease/illness.

Personal observations: importance of Developing a Relationship with your physicians where you are comfortable and able to have conversations about the following:

a. Medical narrative: domain of diagnosis, treatment and cures, i.e., of symptoms, tests, diet, and medications; but equally important.

b. Be able to identify Illness Beliefs and the role they play in a cancer patient's management of their illness; understand the difference between

c. Constraining Illness Beliefs, beliefs that negatively impact and limit the cancer patient's management of his/her disease and illness.

Citation Format: Richard H. Gelb. [Advocate Abstract:] The job or work of being a cancer patient: How to advocate for yourself and a loved one [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C18.
Abstract C38: Increasing colorectal cancer screening in rural populations: A systematic literature review
Authors: Atere-Roberts Joelle , Hall Ingrid J. , Smith Judith Lee
Published: February 2019

Background: Research demonstrates that early detection through recommended screening for colorectal cancer (CRC) yields favorable treatment outcomes; however, screening rates remain low, particularly in rural communities. Residents of rural communities have unique barriers to health care that often result in poorer health outcomes. Targeted interventions to increase CRC screening are needed to tackle barriers to preventive health behaviors among individuals in rural communities.

Methods: A systematic literature search of PubMed/Medline was performed to identify CRC screening interventions conducted in rural communities. English language articles from peer-reviewed journals published from January 2006 to December 2016 were included if they reported results for CRC screening interventions in rural communities in the United States.

Results: Of the 358 articles abstracted, 29 met the inclusion criteria. The studies detailed interventions in rural settings, particularly among populations with low CRC screening rates including American Indians/Alaska Natives, African Americans, and uninsured individuals. Studies varied in design and mode of intervention delivery; however, interventions emphasizing community-based participatory research principles yielded improved CRC screening adherence. Interventions to increase CRC screening included communication campaigns, home-based screening, and patient navigation. Few interventions included a theoretical foundation or information on cost-effectiveness.

Conclusions: More research is needed to examine the theoretical framework, design, delivery, and cost-effectiveness of CRC screening interventions for rural populations. Additional assessment is needed to determine how effectively these interventions can be translated to different types of rural settings. Synthesis of this literature may inform efforts to develop targeted interventions to increase CRC screening in rural populations.

Citation Format: Joelle Atere-Roberts, Ingrid J. Hall, Judith Lee Smith. Increasing colorectal cancer screening in rural populations: A systematic literature review [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C38.
Abstract C67: Addressing racial disparity in colorectal cancer screening with CT colonography: Experience in an African-American cohort
Authors: Fibus Todd , Moreno Courtney C. , Krupinski Elizabeth A. , Kim David H. , Pickhardt Perry J.
Published: February 2019

Purpose: Incidence and mortality from colorectal cancer (CRC) are higher among minorities, including African Americans, compared with non-Hispanic whites, and CRC screening rates for African Americans lag behind non-Hispanic whites. The purpose of this investigation was to evaluate computed tomographic (CT) colonography performance and outcome measures in an African-American cohort.

Materials and Methods: Institutional review board-approved and HIPAA-compliant study. Informed consent was waived. Retrospective evaluation of the African-American cohort from the Atlanta Veterans Affairs Medical Center CT colonography screening program. Colonoscopy referral rates and histologic diagnoses were evaluated.

Results: CT colonography studies (n = 2,490; mean age 59.5 years [range 50-80]; 85.5% male), were performed between 2007 and 2016. The per-patient positive rate of CT colonography was 9.8% for polyps 6-9 mm, 5.4% for polyps 10-29 mm, and 1.3% for masses > 30 mm. Based on CT colonography findings and patient preference, 13.9% of patients were referred to optical colonoscopy and 2.9% were referred to CT colonography follow-up. Of patients recommended to undergo colonoscopy, 80.6% completed the procedure and colonic pathology was confirmed in 83.2% thereof. Histologic diagnoses were 221 tubular adenomas (161 6-9 mm; 60 > 10 mm), 60 tubulovillous adenomas/villous adenomas (14 6-9 mm; 46 > 10 mm), 31 hyperplastic polyps (26 6-9 mm; 5 > 10 mm), 17 adenocarcinomas (all > 10 mm), 10 adenomas with high-grade dysplasia (all > 10 mm), and 3 serrated polyps (1 6-9 mm; 2 > 10 mm). The per-patient positivity rate for patients who had optical colonoscopy (n = 279) was 71.3% for adenoma, 9.7% for hyperplastic polyp, and 6.1% for adenocarcinoma.

Conclusions: CT colonography is an effective screening modality for African-American adults and could potentially improve rates of colorectal screening in African-Americans.

Citation Format: Todd Fibus, Courtney C. Moreno, Elizabeth A. Krupinski, David H. Kim, Perry J. Pickhardt. Addressing racial disparity in colorectal cancer screening with CT colonography: Experience in an African-American cohort [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C67.
Abstract C92: A diagnostic review of barriers to and opportunities for improving HPV vaccination in Alabama
Authors: Dilley Sarah E. , Peral Sylvia , Straughn J. Michael , Scarinci Isabel
Published: February 2019

Background: The human papillomavirus (HPV) vaccine is an important tool for cancer prevention. Vaccination rates in Alabama, a state with high rates of HPV-related cancers, remain below the national average. Our objective was to develop a comprehensive assessment of HPV vaccination in our state, with the goal to make recommendations for tailored multilevel interventions.

Methods: With the PRECEDE-PROCEED model as a theoretical framework, a multimodal approach with quantitative and qualitative data was used to determine barriers and facilitators to HPV vaccination in Alabama. This included a survey of pediatricians and family medicine providers as well as structured qualitative interviews with pediatricians, parents, nurses, and community stakeholders. Two separate investigators evaluated the interview transcripts for major themes that occurred in 65% or more interviews.

Results: Major barriers that overlapped between all groups in both qualitative and quantitative data included lack of parental knowledge, concerns about vaccine safety, and the link between the HPV vaccine and sexuality. Opportunities for increasing HPV vaccination identified include parental education, establishment of a reminder system, increasing access to HPV vaccine providers, and education for providers. Qualitative interviews further expanded on these themes and revealed barriers such as misinformation received from the Internet and parental vaccine hesitancy. Additional opportunities and facilitators revealed through interviews included the trust patients have in physicians, using the Internet or social media to propagate positive messaging about the HPV vaccine, provider education for both physicians and clinical staff, utilizing existing technology more effectively, highlighting nurses' roles as partners in HPV prevention, and the potential of schools as a venue for patient education and promotion of the vaccine.

Conclusion: Our data are consistent with prior research showing major barriers to HPV vaccination. There is an especially high resistance to vaccination due to the link between the vaccine and sexual activity, often attributed to religious beliefs. Several recommendations for optimizing HPV vaccination uptake in Alabama on the patient, provider, and system level are given.

Citation Format: Sarah E. Dilley, Sylvia Peral, J. Michael Straughn, Jr., Isabel Scarinci. A diagnostic review of barriers to and opportunities for improving HPV vaccination in Alabama [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C92.
Abstract IA10: Childhood cancer disparities: Past, present, and future
Authors: Scheurer Michael E.
Published: February 2019

With decades of progress in the successful treatment of many childhood cancers, overall survival now approaches 80%. However, there are persistent disparities in outcomes for several groups of children and adolescents, as well as a lack of research on the factors that contribute to these differences. This paucity of research greatly limits our efforts to address these important differences. We recently held a dedicated one-day symposium to increase awareness of the disparities that exist for childhood cancers, to stimulate the development of new research, and to begin to establish a research strategy for addressing key disparities. We discussed the genetic, environmental, social, and medical system factors associated with disparities in risk and outcomes, specifically for patients with leukemias and sarcomas. We also discussed factors specific to Hispanic and African-American children, to non-English-speaking families, and to children who live in rural or impoverished areas. Moving into the future, a plan was discussed for increasing research on disparities among children and adolescents across the cancer continuum.

Citation Format: Michael E. Scheurer. Childhood cancer disparities: Past, present, and future [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA10.
Abstract IA12: Poverty and pediatric leukemia outcomes
Authors: Bona Kira
Published: February 2019

Novel efforts to identify and address residual drivers of morbidity and mortality in pediatric cancer are essential. Poverty, in addition to biology, is emerging as a target for improvement in childhood cancer outcomes. While population-based evidence has suggested that poverty negatively impacts overall survival (OS) in childhood leukemia, limited data have explored the relationship between poverty and disease outcomes in the standardized care setting of clinical trials. Furthermore, measures of poverty amenable to targeted intervention have not been previously described in the pediatric oncology setting. We examined overall survival (OS), event-free survival (EFS), and cumulative incidence and timing of relapse by community-level poverty for 575 children with newly diagnosed acute lymphoblastic leukemia (ALL) treated on consecutive phase III multicenter consortium protocols between 2000-2010. Children were categorized as living in a high- or low-poverty area using aggregate U.S. Census data linked to zip code. Children from high-poverty areas experienced inferior OS as compared to those in low-poverty areas (85% vs. 92%, p=0.02), which remained marginally significant after adjustment for NCI risk criteria. Among children who relapsed, children from high-poverty areas were significantly more likely to experience early relapse (<36 months in complete remission; 92% vs 48%, p=0.008), which is more challenging to salvage. These data identified poverty-related disparities in childhood leukemia outcomes, suggesting a need for further investigation of poverty measures amenable to intervention. We subsequently sought to describe the prevalence of a concrete measure of poverty termed household material hardship (HMH)--defined as food, energy, and housing insecurity--in a cohort of newly diagnosed pediatric oncology families. HMH in primary care is associated with inferior health outcomes, remediable with targeted intervention, and associated with improved health outcomes when remediated. We conducted a single-site prospective cohort study of 99 families of newly diagnosed pediatric cancer families receiving chemotherapy. We found that 20% of families reported pre-existing HMH at the time of diagnosis, and 29% of families reported HMH following 6 months of chemotherapy despite existing psychosocial supports. These data suggest that a quantifiable and remediable measure of poverty is present in a significant proportion of children undergoing cancer therapy in the U.S. and represents a potential target for future intervention.

Citation Format: Kira Bona. Poverty and pediatric leukemia outcomes [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA12.
Abstract IA19: Cancer chemotherapy and the tools needed to advance treatment in a medical diverse population
Authors: Williams Jennie L.
Published: February 2019

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and is the third leading cause of cancer-related deaths in the Western world. The mortality from colorectal cancer in Caucasian American (CAs) has been declining, but the death rate continues to be higher in African Americans (AAs), maintaining the racial disparity. In addition, AAs more often present with CRC at advanced stages contributing to the lower five-year survival rate. Hispanic-Americans (HAs) have significantly lower CRC incidence and mortality rates when compared with non-Hispanic AA (NH-AA) and non-Hispanic CA (NH-CA) populations. However, rates among HAs are significantly higher than those among residents of Puerto Rico and other Spanish-speaking countries in South and Central America. Furthermore, preliminary data and documented results show that for HA the age at presentation is lower and the stage of the disease is higher than that of AA and CAs. We hypothesize that various factors (i.e., familial, socioeconomic, environmental, and dietary) may contribute to the underlying problem of colon cancer racial/ethnic health disparity. Also, it has been noted that the response to chemopreventive agents differ as to the biologic/genetic heterogeneity of the tumors of NH-AAs, Has, and NH-CAs. Since chemopreventive agents exert their effect through a molecular target, this disparity would suggest differences at the genetic level. Therefore, the formulation and evaluation of chemopreventive/chemotherapeutic agents that address the issue of differential chemoresponse and chemoresistance is essential to survival. To study, in vitro and in vivo, the development of and chemoresponsiveness of therapeutic agents to colonic diseases in diverse populations, the availability of the appropriate cells (cell lines/organoids) and animal (PDX) models is critical. Our overarching goal is to assess racial and ethnic genetic/epigenetic dysregulations and associate these changes to chemoresponse and colon cancer racial disparity. The availability of these biologic tools will facilitate overcoming differential incidence and outcome seen among racial and ethnic groups for CRC. To achieve this goal, we are generating and characterizing novel cell lines, PDXs, and organoids derived from NH-CAs, Has, and AAs patients with colorectal cancer. Downstream use of these biologic tools will assist our group and the scientific community at large in improving targeted personal cancer treatment. This research effort is inclusive of all and will benefit a diverse population.

Citation Format: Jennie L. Williams. Cancer chemotherapy and the tools needed to advance treatment in a medical diverse population [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA19.