bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract A42: Association between neighborhood deprivation and lung cancer risk in the Southern Community Cohort Study
Authors: Sanderson Maureen , Aldrich Melinda C. , Levine Robert S. , Kilbourne Barbara , Cai Qiuyin , Blot William J.
Published: February 2019

Purpose: Counties with the highest rates of lung cancer mortality in the United States from the 1980s have been located in the South. This finding is related to high regional smoking prevalence, but we hypothesized that area-level socioeconomic deprivation may also contribute. We used data from the Southern Community Cohort Study to examine this exposure in a multilevel nested case-control study of incident lung cancer.

Methods: Men and women with incident lung cancer were identified through linkage with state cancer registries and the National Death Index (1,334 cases). Approximately four controls were matched to each case on sex, race, age at diagnosis, and year of recruitment (5,315 controls). Individual-level smoking and socioeconomic status were obtained through baseline surveys, while block group-level neighborhood deprivation was obtained from U.S. Census data.

Results: After adjustment for smoking and other confounders, but prior to adjustment for individual-level measures of socioeconomic status, there was an increased risk of lung cancer for persons living in neighborhoods with the greatest quartile of deprivation relative to those in neighborhoods with the least (odds ratio (OR) 1.28, 95% confidence interval (CI) 1.00-1.63). Additional adjustment for individual-level measures of socioeconomic status weakened this effect (OR 1.21, 95% CI 0.94-1.55). There was no evidence of effect modification by race or sex.

Conclusions: Area-level measures of socioeconomic status were associated with lung cancer risk in this population after control for smoking.

Citation Format: Maureen Sanderson, Melinda C. Aldrich, Robert S. Levine, Barbara Kilbourne, Qiuyin Cai, William J. Blot. Association between neighborhood deprivation and lung cancer risk in the Southern Community Cohort Study [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 A42.
Abstract A59: Racial comparisons of the gut microbiota of generally healthy black and white women for insights into colorectal cancer disparities
Authors: Carson Tiffany L. , Wang Fuchenchu , Cui Xiangqin , Jackson Bradford E. , Pol Liam Van Der , Lefkowitz Elliot J. , Morrow Casey , Baskin Monica
Published: February 2019

Racial health disparities persist among black and white women for colorectal cancer (CRC). Since the gut microbiota has been linked to CRC, understanding racial differences in the gut microbiota may yield new insight into unexplained disparities in CRC incidence. Generally healthy non-Hispanic black or white females who were at least 19 years old provided survey data, anthropometrics, and stool samples. Fecal DNA was collected and isolated from a wipe. PCR was used to amplify the V4 region of the 16SrRNA gene and 250 bases were sequenced using the MiSeq platform. Microbiome data were analyzed using the QIIME package. OTU data were log transformed and normalized. Linear models in R Package “limma” were used to test statistical significance differences. Fecal samples were analyzed for 80 females (47 black, 33 white). Mean age and BMI were 39.9 years and 30.1 kg/m2, respectively. Blacks had a higher average BMI than whites (33.3 vs. 27.5 kg/m2; p<0.01) and larger waist circumference (98.3 vs. 86.6 cm; p<0.01). Unadjusted comparisons revealed no racial differences in alpha diversity. Racial differences were observed in beta diversity and abundance of top-10 OTUs. Blacks had higher abundances than whites of Faecalibacterium (p=0.03) and Bacteroides (p=0.04). The association between race and Bacteroides (logFC=1.72; 0=0.02) persisted in fully adjusted models. Black race was associated with a higher abundance of Bacteroides, which has been linked to CRC. Other racial differences in the gut microbiota were also observed. Efforts to cultivate an “ideal” gut microbiota may help reduce CRC risk and health disparities.

Citation Format: Tiffany L. Carson, Fuchenchu Wang, Xiangqin Cui, Bradford E. Jackson, Liam Van Der Pol, Elliot J. Lefkowitz, Casey Morrow, Monica Baskin. Racial comparisons of the gut microbiota of generally healthy black and white women for insights into colorectal cancer disparities [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 A59.
Abstract A69: Racial disparity in breast cancer hospital treatment costs: Examining the effect of depression
Authors: Husaini Baqar , Miller Oscar , Jones Jessica , Levine Robert
Published: February 2019

Objective: The effect of depression on hospital costs for breast cancer (BC) patients by race remains unknown. This presentation examines two issues by race: (i) hospitalized prevalence of BC and depression among discharged patients, and (ii) racial variation regarding the effect of depression on hospital costs of BC patients.

Methods: For BC, available 2008 Tennessee Hospital Discharge Data System (HDDS) was examined. The BC sample (n=2,522) was mostly white (86%) with an average age of 63 years. We computed age-adjusted BC rates per CDC methodology, and determined racial disparity. We compared the hospital costs for BC patients with depression (BC+D) vs. without depression (BCND).

Results: Age-adjusted BC rates (per 100K) were higher among white than black patients (43.3 vs. 9.2, p<.001). Further, 25% of BC patients were depressed (depression was higher among white than black patients [26% vs. 14%, p<.01]). Hospital costs for BC were 30% higher compared to non-BC patients. Further, the cost for depressed patients (BC+D) was 56% higher compared to nondepressed (BCND) patients ($64,439 vs. $41,344). Importantly, the higher costs for depressed patients (BC+D) were similarly higher among both black and white female patients compared to their nondepressed (BCND) peers.

Conclusion: BC prevalence rate is higher among white females compared to black females. Depression increases hospital costs for both white and black patients. Since depression increased cost for both racial groups of patients, considerable cost savings might be attained by screening and treating depression among BC patients before their hospitalization.

Citation Format: Baqar Husaini, Oscar Miller, Jessica Jones, Robert Levine. Racial disparity in breast cancer hospital treatment costs: Examining the effect of depression [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 A69.
Abstract A70: [Advocate Abstract:] We have breast too! A male breast cancer awareness program
Authors: Dornan Wayne
Published: February 2019

This poster will highlight a proposed male breast cancer educational program that will be carried out throughout Tennessee.

Citation Format: Wayne Dornan. [Advocate Abstract:] We have breast too! A male breast cancer awareness program [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 A70.
Abstract A74: [Advocate Abstract:] The brown faces of colorectal cancer
Authors: Henley Candace
Published: February 2019

The poster will explore the various stories of misdiagnosis, patients fighting to get a colonoscopy under the age of 50, patients and stories of survival through as it relates to minorities and the various challenges it took to find out they had colorectal cancer.

Citation Format: Candace Henley. [Advocate Abstract:] The brown faces of colorectal cancer [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 A74.
Abstract B19: Screen to Save (S2S) implementation across National Outreach Network (NON) region 2
Authors: Fleming Khaliah F. , Lopez Jomar D.
Published: February 2019

Background: S2S aims to increase colorectal cancer (CRC) screening rates among community members aged 50-75 years from racially and ethnically diverse communities. The National Cancer Institute's (NCI) National Outreach Network (NON) and Partnerships to Advance Cancer Health Equity (PACHE) community health educators (CHEs) are implementing a culturally sensitive, evidence-based nationwide CRC outreach and screening initiative. This poster reports on S2S activities within NON Region 2 among multilingual and multicultural populations.

Methods: NCI tasked sites with conducting phase 1 or phase 1 and 2 of S2S. Phase 1 consists of CRC prevention, early detection, and screening education via NCI CRC resources and materials. Phase 2 consists of providing the education and fecal immunochemical test (FIT) kits to those who qualify. Both phases consist of pre- and post-knowledge assessments coupled with demographic information of attendees. A 3-month follow-up survey is administered post the S2S session to determine participants' CRC-screening- related actions. Effective strategies for initiative recruitment include electronic and in-person flyer dissemination, social media postings, and community partner engagement. Colorectal cancer models, a miniature portable toilet, and an NCI-developed S2S PowerPoint presentation have been utilized across the region as educational tools.

Results: Four NON and PACHE CHEs in the region are implementing the S2S initiative with the aid of community partnerships. To date, more than 81 individuals have received CRC education through a total of 5 S2S sessions. A total of 66 FIT kits have been disseminated and 16 returned.

Conclusion: Lessons learned from this ongoing initiative include the importance of having a multilevel educational approach and collaborations at local, state, and national levels for CRC education and screening. Leveraging partnerships for CRC education and screening is an effective strategy to improve CRC awareness and promote FIT uptake.

Citation Format: Khaliah F. Fleming, Jomar D. Lopez. Screen to Save (S2S) implementation across National Outreach Network (NON) region 2 [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 B19.
Abstract B26: [Advocate Abstract:] We all win
Authors: Fields Frank D.
Published: February 2019

To gain long-term survivorship joint interest among the survivor-patient, family-spouse, children, siblings, friends, with an engaging medical community that creates trust for both patient and family are keys to long-term success. After treatment has completed, do both patient and family members understand that long-term success depends on continued follow-up? I have observed that patients after initial treatment make a conscious decision to curtail medical treatment. Cost and quality of life along with no longer wanting to be a burden to patients' family are key issues. The prostate survivor when still with the family is a gift that strengthens the family and is priceless. Continually turning to the medical community after treatment enhances life. Another issue is patients who are 5 years and beyond with their treatment who have health concerns that in part can be related to cancer therapies. These patients choose watchful waiting. We as Health Advocates have to promote continued health care to post-treated patients. We have to nurture and foster families that what is good for Dad is good for them.

Citation Format: Frank D. Fields. [Advocate Abstract:] We all win [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 B26.
Abstract B30: [Advocate Abstract:] Health disparities among Latinos with pancreatic cancer
Authors: Zelada-Arenas Fatima
Published: February 2019

The purpose of this project is to examine health disparities and quality of care received by Latino patients with pancreatic cancer. We connect with many Spanish speakers through our Patient Services program and will be conducting interviews to determine the level of care Latino patients are receiving. We are hoping to identify if they have any issues with accessing cancer care, whether they are being seen in a community oncology center, and how often they experience insurance access issues. The goal is to determine the needs of this very specific community to help us understand how to best guide them and provide them with resources.

Citation Format: Fatima Zelada-Arenas. [Advocate Abstract:] Health disparities among Latinos with pancreatic cancer [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 B30.
Abstract B46: Vorinostat modulates the expression of the progesterone receptor in subtypes of triple-negative breast cancer cell lines
Authors: Lyn-Cook Beverly , NouriEmamzadeh Fatemeh , Word Beverly , Moore Rhonda , Miranda-Carboni Gustav
Published: February 2019

Triple-negative breast cancer (TNBC) is a subtype of breast cancer that is characterized by a lack of clinically significant levels of hormone receptors for estrogen (ER) and progesterone (PR) and the human epidermal growth factor receptor-2 (HER2). TNBC has a high cell proliferation rate and has been described as an “interval cancer,” developing between yearly mammograms. TNBC accounts for 10-15% of all breast cancers diagnosed, and risk factors include age (> 40) and mutational status of tumor-suppressor genes (p53, BRCA1). Additionally, Hispanic American, African American, and women of African descent have been shown to be 3x more likely to develop this more aggressive subtype. The lack of cell surface receptors for ER, PR, and Her2 makes these tumors unresponsive to conventional hormone or targeted therapy, and currently there are no FDA-approved targeted therapies for this disease. This, combined with a higher rate of relapse and shorter overall survival period, leads to an overall poor prognosis for this breast cancer subtype. Vorinostat is a histone deacetylase inhibitor and has been shown to exert effects through epigenetic mechanisms. Previous studies have shown its ability to re-express ERα in triple-negative breast cancer cells. In this study we examined whether Vorinostat can re-express the PR in subtypes of TNBC cell lines HCC70, HCC1143, HCC1806, and BT549 and render these resistant cells sensitive to cancer agents. Using real-time PCR and immunostaining, the re-expression of the PR receptor was shown in BT549 (4-fold), HCC70 (13-fold), HCC 1143 (5-fold), and HCC1806 (20-fold). PR is known to modulate ERα in breast cancer. Indole-3-carbinol (I3C) alone or in combination with tamoxifen decreased PR expression in HCC1806 and HCC70 cells. Tamoxifen and I3C also inhibited cell growth of triple-negative breast cancer cells with vorinostat. These results show promise for the use of vorinostat in sensitizing subtypes of triple-negative breast cancer cells to tamoxifen and a dietary agent, I3C. Furthermore, this study revealed that vorinostat can re-express critical receptors in triple-negative breast cancer, suggesting its possible use in combinational therapy for this aggressive form of breast cancer.

Citation Format: Beverly Lyn-Cook, Fatemeh NouriEmamzadeh, Beverly Word, Rhonda Moore, Gustav Miranda-Carboni. Vorinostat modulates the expression of the progesterone receptor in subtypes of triple-negative breast cancer cell lines [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 B46.
Abstract B53: Psychosocial stress exposure results in inhibition of mammary gland development and increased mammary stem cells in a rat model of breast cancer
Authors: Johnson Marianna B. , Hoffmann Joscelyn N. , You Hannah M. , Allaw Ahmad B. , Strober Jordan W. , Brady Matthew J. , McClintock Martha K. , Conzen Suzanne D.
Published: February 2019

Exposure to unremitting psychosocial stressors common to underserved populations (i.e., social marginalization and isolation, economic uncertainty, and racism) manifest in physiologic changes that are associated with highly aggressive mammary cancer. Many environmental exposures that influence breast cancer risk in adulthood occur earlier in life during the time of mammary gland development. However, the effect of stress physiology on mammary gland development and its link to breast cancer remains unknown. In a model of psychosocial stress (social isolation), we studied whether a social isolation-induced stress response would affect mammary gland development. To this end, we used the Sprague Dawley rat, where there is an established effect of psychosocial stress on increasing later-life mammary cancer risk. Here, we found that post-weaning social isolation was associated with decreased ductal differentiation and increased mammary stem cells (MaSC). Using an in vitro model, we next determined if glucocorticoid receptor activation increased MaSC survival through direct and paracrine mechanisms. Our findings provide evidence that social stressors induce glucocorticoid exposure and decrease mammary gland differentiation leading to an increased MaSC population, potentially contributing to a greater mammary cancer risk.

Citation Format: Marianna B. Johnson, Joscelyn N. Hoffmann, Hannah M. You, Ahmad B. Allaw, Jordan W. Strober, Matthew J. Brady, Martha K. McClintock, Suzanne D. Conzen. Psychosocial stress exposure results in inhibition of mammary gland development and increased mammary stem cells in a rat model of breast cancer [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 B53.
Abstract B58: The role of epigenetic reader and alternative mRNA splicing variant MBD2_v2 in IL6 signaling in prostate cancer
Authors: Girsch Emily , Bao Bin , Mitrea Cristina , Sakr Wael A. , Dyson Gregory , Powell Isaac , Bollig-Fischer Aliccia
Published: February 2019

Background: African American men (AAM) have a 60% higher risk of being diagnosed with prostate cancer and a 2 to 3 times greater risk of dying from the disease compared to European American men (EAM). We previously reported evidence of molecular underpinnings for these disparities from high-throughput gene expression analysis of prostate cancer (PCa) specimens. The data showed that proinflammatory cytokine signaling factors, including IL6 and TGFB1, are significantly over-represented in PCa specimens from AAM. The limitation of that study, however, is that it did not investigate the potential molecular diversity for high-grade PCa, and it did not consider adjacent noncancer tissue.

Methods: We conducted a pilot RNA-sequencing study of high-grade PCa, GS greater or equal to 7(4+3), and matched non-cancer adjacent prostate tissue specimens from AAM and EAM. We also studied the molecular biology of PCa cell lines derived from AAM and EAM tumors.

Results: According to our genomic analysis, IL6 was once again relevant to our research, this time upregulated in PCa specimens from EAM, but also higher in the stromal compartment in AAM. Also, we noted that whether or not a PCa cell line expresses IL6 appears to be linked to TP53 mutation status. Moreover, cell lines derived from AAM (MDA-PCa-2b and RC77T), which are TP53 wild-type, did not express IL6 and showed an increased stem cell-like phenotype in response to IL6 treatment that was dose dependent. PCa cell lines that are TP53 mutant and expressed IL6 did not respond to exogenous IL6 treatment. We uncovered that in responsive PCa cell lines, IL6 treatment induced mRNA and protein expression of the epigenetic reader methyl CpG binding domain protein 2 (MBD2), more specifically the alternative mRNA splicing variant MBD2_v2. Further investigation validated that this short isoform promotes self-renewal and expansion of PCa stem cell-like cells.

Conclusion: The outcomes suggest that there may be a dual nature for IL6 signaling in PCa that remains to be understood, yet contributes to the molecular diversity of high-grade prostate cancer and race disparities.

Citation Format: Emily Girsch, Bin Bao, Cristina Mitrea, Wael A. Sakr, Gregory Dyson, Isaac Powell, Aliccia Bollig-Fischer. The role of epigenetic reader and alternative mRNA splicing variant MBD2_v2 in IL6 signaling in prostate cancer [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 B58.
Abstract B75: Nutritional profiling reveals glutamine-utilizing transaminases as a metabolic vulnerability of TAZ/YAP-driven breast cancer cells
Authors: Stampouloglou Eleni , Kingston Nathan , Yang Chih-Sheng , Zhang Liye , Monti Stefano , Varelas Xaralabos
Published: February 2019

The aberrant activity of the transcriptional regulators TAZ and YAP (TAZ/YAP) drives many oncogenic traits, including the resistance to cell death, sustaining cell growth, and control of cell fate. Aggressive breast cancers in particular exhibit high TAZ/YAP levels and activity, and thus understanding the roles of these factors may offer therapeutic opportunity for these poorly treatable diseases. Here, we report that TAZ/YAP play an important role in driving breast cancer dependency to exogenous glutamine, an abundant amino acid that has emerged as central for tumor growth. We observed that breast cancer cells with high levels of TAZ/YAP are more sensitive to glutamine deprivation, and that knockout of TAZ/YAP in these cells alleviated defects resulting from glutamine. Rescue experiments with glutamine-derived metabolites suggested an essential role for glutamate and α-ketoglutarate (AKG) in TAZ/YAP-driven cell growth. Analysis of enzymes mediating the conversion of glutamate to α-ketoglutarate (AKG) showed that TAZ/YAP induce the expression of distinct transaminases, and that TAZ/YAP activity positively correlates with transaminase expression in breast cancer patients. Notably, the transaminase inhibitor aminooxyacetate (AOA) repressed cell growth in a TAZ/YAP-dependent manner, identifying transamination as a potential vulnerable metabolic requirement for TAZ/YAP-driven breast cancer. Considering the link between breast cancer risk and obesity, and the connection between obesity-driven metabolic changes to glutamine metabolism, our study offers a potential direction for future therapeutic targeting of aggressive breast cancers in underserved populations, where obesity is becoming a prevalent factor.

Citation Format: Eleni Stampouloglou, Nathan Kingston, Chih-Sheng Yang, Liye Zhang, Stefano Monti, Xaralabos Varelas. Nutritional profiling reveals glutamine-utilizing transaminases as a metabolic vulnerability of TAZ/YAP-driven breast cancer cells [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 B75.
Abstract B91: [Advocate Abstract:] Metastatic patients and clinical trials
Authors: Knowles April
Published: February 2019

Clinical trials have the potential to extend and possibly save lives. But they are not readily accessible to patients with metastatic cancer. They place undue burdens on patients, employ restrictive eligibility requirements, and do not reflect the perspective of the metastatic population, making it difficult to impossible for patients to participate in appropriate, convenient trials in a timely manner. Clinical trials are often the last resort for metastatic patients, who have exhausted all “standard of care” options. Yet, for that very reason, metastatic patients are typically excluded from most clinical trials.

Citation Format: April Knowles. [Advocate Abstract:] Metastatic patients and clinical trials [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 B91.
Abstract C33: [Advocate Abstract:] The power of music
Authors: Foster William
Published: February 2019

As a musician I feel that music has healing powers. There are Music Therapy Departments in many major hospitals and there has been a lot a research done on the subject. I think there need to be more. The poster explains some of the research that has been done and the results of the research.

Citation Format: William Foster. [Advocate Abstract:] The power of music [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 C33.
Abstract C70: A community guide systematic review of multicomponent interventions to increase breast, cervical, and colorectal cancer screening: Findings in underserved populations
Authors: Okasako-Schmucker Devon , Peng Yinan , Sabatino Susan , Ramon Ismaila , Roberts Kristin Tansil , Mercer Shawna L. , Elder Randy
Published: February 2019

Background: Underserved adults are disproportionately not up-to-date with cancer screening. This systematic review examined effectiveness of multicomponent interventions (MCIs) to increase breast, cervical, and colorectal cancer (CRC) screening. Special attention was paid to underserved populations and interventions that engage community health workers (CHWs) and patient navigators (PNs).

Methods: This systematic review consists of studies in high-income countries with eligible screening outcomes (recent or repeat mammography, Pap test, or CRC screening). Summary effects were calculated and stratified by income, insurance, involvement of Federally Qualified Health Centers (FQHCs) or community health centers (CHCs), and involvement of CHWs and PNs.

Results: Eighty-eight studies were included. Among majority low-income populations, MCIs increased breast (median increase 10.5 percentage points (pp), interquartile interval (IQI) 6.5-25.7; 10 arms), cervical (median 7.0 pp, IQI 5.3-58.9; 7 arms), and CRC screening (median 15.5 pp, IQI 6.9-23.6; 13 arms). Screening use increased among majority uninsured populations across all three cancers (median 31.8 pp, range 23.2-40; 3 arms). MCIs involving FQHCs or CHCs increased breast and cervical (median 7.0 pp, IQI 2.3-11.0; 5 arms) and CRC screening (median 16.3 pp, IQI 13.9-23.8; 8 arms). Interventions engaging CHWs and PNs among low-income, majority-uninsured populations, or those utilizing FQHCs or CHCs also increased screening use across all three cancer types combined (CHWs: median 15.5 pp, IQI 5.8-60.1; 10 arms; PNs: median 11.9 pp, IQI 7.0-15.5; 11 arms).

Conclusions: MCIs targeting underserved populations are effective in increasing breast, cervical, and CRC screening. MCIs engaging CHWs and PNs are effective among these populations.

Citation Format: Devon Okasako-Schmucker, Yinan Peng, Susan Sabatino, Ismaila Ramon, Kristin Tansil Roberts, Shawna L. Mercer, Randy Elder. A community guide systematic review of multicomponent interventions to increase breast, cervical, and colorectal cancer screening: Findings in underserved populations [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 C70.
Abstract C84: African Americans' perceived benefits and barriers to colorectal cancer screening: Differences by screening modality
Authors: Williams Randi M. , Holt Cheryl L.
Published: February 2019

Background: Perceived benefits and barriers are key individual-level factors that play a role in colorectal cancer (CRC) screening behavior. Utilizing data harmonized from three CRC screening trials, we examine how measures of benefits and barriers by screening type (colonoscopy and fecal occult blood test (FOBT)) predict preintervention screening behaviors among African American (AA) trial participants.

Methods: The data were collected in AA churches (Study 1: N=103; Study 2: N=285; Study 3: N=374) where trained lay community health advisors conducted CRC education to increase screening.

Results: In Study 1, colonoscopy benefits were associated with greater odds of being adherent to CRC screening at baseline (p=.03), while colonoscopy barriers were not significant. FOBT benefits/barriers were not significantly related to screening at baseline. For Study 2, individuals who perceived more colonoscopy benefits were more likely to be adherent (p=.01), whereas those with more perceived barriers were less likely to be adherent at baseline (p=.04). FOBT benefits/barriers were not significant. In Study 3, FOBT benefits positively predicted FOBT screening behavior and barriers were negatively associated with screening (p's=.01 and .02, respectively). Colonoscopy benefits were marginally significant (p=.06) such that individuals with higher benefits were more likely to report screening, whereas perceived barriers were not related to screening.

Conclusions: In the present data, perceived benefits and barriers more consistently predicted preintervention screening behavior for colonoscopy relative to FOBT. Additional study is needed to evaluate the role of benefits/barriers in CRC screening behavior in response to interventions.

Citation Format: Randi M. Williams, Cheryl L. Holt. African Americans' perceived benefits and barriers to colorectal cancer screening: Differences by screening modality [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 C84.
Abstract IA05: Research addressing cervical cancer disparities: Progress, challenges, and opportunities
Authors: Paskett Electra D.
Published: February 2019

In 2007, disparities in cervical cancer incidence and mortality were evident among black vs white women, Hispanic vs non-Hispanic women, and rural vs non-rural women. Reasons for these disparities include lack of Pap testing, inappropriate follow-up after an abnormal test, and high rates of infection with high-risk human papillomavirus (HPV). In 2017, these disparities still exist. While early detection tests for cervical cancer have been available since the late 1950s, prevention of cervical cancer began with the identification of HPV as a necessary cause for cervical cancer and the subsequent development, testing, and approval of the HPV vaccine in 2006 for girls and 2011 for boys. Uptake of the vaccine in age-eligible girls and boys has been slow in the US, with better uptake--and a complementary reduction in HPV infection and preinvasive cervical abnormalities--in other countries such as Australia, the United Kingdom, and Rwanda. Screening guidelines have been updated to focus on more appropriate age and cotesting with HPV cytology.

Challenges are apparent in assuring that rates of uptake of the vaccine series approach the 80% threshold set by the CDC for all populations. Moreover, rates of appropriate screening--including the new guidelines for cotesting--are challenging to maintain, as there is confusion regarding these guidelines among both patients and providers. Appropriate follow-up after an abnormal Pap test remains a problem, with lower follow-up among minority, low-income, and rural populations.

There are many opportunities for increasing the uptake of the HPV vaccine series, appropriate screening, and prompt and proper follow-up of abnormalities in populations experiencing disparities. Several areas of investigation show promise and deserve further exploration. These include: one vs two/three doses of the HPV vaccine; HPV self-testing strategies to increase adherence to screening; and use of “see and treat” strategies to assure follow-up and treatment of cervical abnormalities in low-resource settings. In addition, creative and culturally appropriate multilevel intervention approaches should be tested to increase adherence in populations suffering from disparities.

Strategies to increase adherence to HPV vaccine series, screening, and follow-up recommendations can make a significant reduction in cervical cancer incidence and mortality disparities.

Citation Format: Electra D. Paskett. Research addressing cervical cancer disparities: Progress, challenges, and opportunities [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 IA05.
Abstract IA22: Financial well-being and health: Definitions and measurement issues
Authors: Tucker-Seeley Reginald
Published: February 2019

The cost of cancer care is rising faster than other diseases, and the financial hardship that cancer imposes on families may exacerbate racial/ethnic and socioeconomic disparities in outcomes throughout survivorship. Discussions about the financial burden of cancer care have increased in recent years in the academic literature and popular press, and several terms have been used to describe this burden. Yet, the discussion oftentimes conflates the lack of material resources to cover medical expenses, the potential psychosocial distress accompanying the lack/reduction in financial resources, and the behavioral coping responses to address the lack /reduction in financial resources. Many health care professionals report feeling unprepared to address family financial well-being in the context of health care delivery, and research suggests that most individuals report low levels of financial self-efficacy even outside the context of managing a chronic disease. We currently lack reliable and valid measures to adequately assess the material, psychosocial, and behavioral aspects of household financial well-being prior to, during, and following cancer care. The dearth in assessment tools of financial well-being in the cancer context impedes efforts to identify modifiable intervention targets of the financial burden of cancer care to ensure that families do not succumb to financial ruin as they manage a chronic disease and navigate the health care system.

Citation Format: Reginald Tucker-Seeley. Financial well-being and health: Definitions and measurement issues [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 IA22.
Abstract IA29: Overcoming barriers to screening in rural areas: No bus, no taxi, no services
Authors: Thompson Beti , Carosso Elizabeth , Briant Kathy , Ibarra Genoveva
Published: February 2019

Background: Cancer screening in rural areas is hampered by numerous barriers; among these are systemic factors such as access to care in the rural area, lack of culturally appropriate physicians, and lack of screening systems. These barriers are often accompanied by structural impediments such as lack of transportation to distant clinics and screening settings, lack of child care, and inconvenient times for appointments. New and innovative approaches to dealing with rural populations are needed to overcome some of these barriers. In Eastern Washington State, the many rural areas are served by a Federally Qualified Health Center (FQHC) system. A number of their clinics are spread throughout the region, and we collaborated with them to work on two innovative cancer prevention strategies in the rural area.

Methods: Using a giant inflatable colon, we brought fecal occult blood test (FOBT) kits to 300 individuals who were over the age of 50 at regularly scheduled health fairs in the area. Individuals went through a brief educational tour of the colon, then received the kits, which were returned to us via mail or drop-off. A local hospital analyzed the kits and results were returned to participants. In a second study, women who were nonadherent with Pap testing were identified by the FQHC; after HIPAA consent, they were randomized to receive one of three intervention arms: a usual care arm, a video arm, or a promotora outreach arm. Adherence after seven months was assessed via medical records.

Results: For the colon study, we received a return rate of 75.6%. Of these, seven were abnormal and those participants received free or low-cost colonoscopies. For the cervical cancer study, the rates of adherence after seven months were 34% (usual care), 38.7% (video arm), and 53.4% (promotora outreach). In both studies, knowledge and intention to be screened were significantly increased.

Discussion: Rural areas suffer unique barriers to obtaining cancer prevention screening. Our approach of “meet the people where they are” has been positive in increasing screening rates. Whether it is participation at local community health fairs or collaboration with an FQHC, it is clear that “going to the people” is a method that works. More emphasis should be put on such methods in rural areas.

Citation Format: Beti Thompson, Elizabeth Carosso, Kathy Briant, Genoveva Ibarra. Overcoming barriers to screening in rural areas: No bus, no taxi, no services [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 IA29.
Abstract IA37: Intersectional approaches to studying the interaction of multiple and multilevel social determinants on cancer health disparities
Authors: Gomez Scarlett Lin
Published: February 2019

Social determinants of health are the characteristics and conditions that determine where and how people live, work, and play. Social determinants of health exist at multiple levels and can range from individual characteristics such as gender, education, and income, to local environmental conditions such as social and built environments, to societal influences such as health care policies and racial residential segregation. These characteristics can impact cancer outcomes across the continuum, from risk to death. Moreover, these characteristics are often highly correlated and can interact to influence disparate cancer outcomes above and beyond their individual health effects. The intersectional approach considers the impact on health and health equity of intersecting social positions and processes. To date, the intersectional approach has primarily been applied to qualitative research. This educational presentation will describe the concept of intersectionality, and explore approaches to apply the intersectional approach to cancer health disparities research questions at a population level.

Citation Format: Scarlett Lin Gomez. Intersectional approaches to studying the interaction of multiple and multilevel social determinants on cancer health disparities [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 IA37.
Abstract PR03: Somatic mutations and ancestry markers in Hispanic lung cancer patients
Authors: Cress William D. , Gimbrone Nicholas T. , Sarcar Bhaswati , Gordian Edna , Rivera Jason I. , Lopez Christian , Teer Jamie K. , Welsh Eric A. , Chiappori Alberto A. , Schabath Matthew B. , Reuther Gary W. , Santiago-Cardona Pedro G.
Published: February 2019

Introduction: Hispanics are projected to constitute 23% of the U.S. population by 2050. However, large-scale sequencing projects, such as The Cancer Genome Atlas (TCGA), provide little information on this ethnic population. In fact, only seven out of over 500 lung adenocarcinoma tumors sequenced in the TCGA database are reported to be Hispanic. To address the lack of genomic data from Hispanic/Latino patients with lung cancer, the Latino Lung Cancer Registry was established to collect patient data and biospecimens from these patients.

Methods: This retrospective observational study examined lung cancer tumor samples from 163 Hispanic/Latino patients, and tumor-derived DNA was subjected to targeted-exome sequencing (>1000 genes, including EGFR, KRAS, STK11, and TP53) and ancestry analysis. Mutation frequencies in this Hispanic/Latino cohort were compared with those in a similar cohort of non-Hispanic white (NHW) patients. Novel mutations in EGFR were functionally characterized, and mutation rates were correlated with ancestry, patient sex, smoking status, and tumor histology.

Results: Among adenocarcinomas (n=120) in the Hispanic/Latino cohort, 31% had EGFR mutations versus 17% in the NHW control group (p < 0.001). The EGFR mutations in Hispanic/Latino patients included well-characterized activating mutations, such as L858R, and uncharacterized EGFR variants. A rare exon 19 mutation, W731R, was identified that conferred resistance to both erlotinib and AZD9291. KRAS (20% vs. 38%; p=0.002) and STK11 (8% vs. 16%; p=0.065) mutations occurred at lower frequency, and mutations in TP53 occurred at similar frequency (46% vs. 40%; p=0.355) in Hispanic/Latino and NHW patients, respectively. Within the Hispanic cohort, ancestry influenced the rate of TP53 mutations (p=0.009) and may influence the rate of EGFR, KRAS, and STK11 mutations.

Conclusions: Driver mutations in Hispanic/Latino lung adenocarcinoma patients differ in frequency from those in NHWs associated with their Indigenous American ancestry. The spectrum of driver mutations needs to be further assessed in the Hispanic/Latino population.

Citation Format: William D. Cress, Nicholas T. Gimbrone, Bhaswati Sarcar, Edna Gordian, Jason I. Rivera, Christian Lopez, Jamie K. Teer, Eric A. Welsh, Alberto A. Chiappori, Matthew B. Schabath, Gary W. Reuther, Pedro G. Santiago-Cardona. Somatic mutations and ancestry markers in Hispanic lung cancer 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 PR03.
Abstract A30: Gene regulatory mechanisms governing invasive mucinous adenocarcinoma of the lung (IMA)
Authors: Guo Minzhe , Tomoshige Koichi , Fink-Baldauf Iris , Maeda Yutaka
Published: February 2019

Background: Invasive mucinous adenocarcinoma of the lung (IMA) comprises 5-10% of lung adenocarcinoma. IMA is pathologically characterized as lung tumor cells with goblet cell morphology containing abundant intracytoplasmic mucin. Recent advances using next-generation sequencing technology revealed driver oncogenes (e.g., KRAS mutation and NRG1 fusions) and a gene expression signature (e.g., NKX2-1 negative and SPDEF positive) inducing IMA. However, the genetic mechanism governing the pathogenesis of IMA is not fully understood. Here, we report the mechanism of the gene regulatory network regulating mucins and immune checkpoints in IMA.

Methods: Using lentiviral vectors expressing the anti-mucous transcription factor NKX2-1 (also known as TTF-1) and the pro-mucous transcription factor SPDEF, we assessed their functions in regulating the expression of mucins and immune checkpoints in multiple lung cancer cell lines. Using ChIP-seq datasets, we further identified genome-wide binding sites of NKX2-1 and SPDEF in A549 lung carcinoma cells that carry a KRAS mutation and produce mucins. We further deleted such binding sites in the genome using CRISPR/Cas9 to assess the function of the sites.

Results: NKX2-1 influenced the expression of immune checkpoints, including PD-L1, and mucin-related genes, including MUC5AC and SPDEF. Notably, NKX2-1 bound to the same noncoding region upstream of MUC5AC as SPDEF. The genomic deletion study using CRISPR/Cas9 indicated that both NKX2-1 and SPDEF bound to the enhancer region (but not the silencer region) of MUC5AC, suggesting that NKX2-1 suppresses mucin gene expression by blocking the activity of the enhancer region but not by recruiting a co-repressor complex such as HDAC to the region.

Conclusion: Transcription factors NKX2-1 and SPDEF function as yin and yang to affect the pathogenesis of IMA.

Citation Format: Minzhe Guo, Koichi Tomoshige, Iris Fink-Baldauf, Yutaka Maeda. Gene regulatory mechanisms governing invasive mucinous adenocarcinoma of the lung (IMA) [abstract]. In: Proceedings of the Fifth AACR-IASLC International Joint Conference: Lung Cancer Translational Science from the Bench to the Clinic; Jan 8-11, 2018; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(17_Suppl):Abstract nr A30.