bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract A31: Patient navigation for culturally diverse populations: The experience of the Moffitt Cancer Center's Patient Navigator Research Program (PNRP)
Authors: Wells Kristen J. , Calcano Ercilia R. , Meade Cathy D. , Roetzheim Richard G. , Roetzheim G. , Estampador Angela , Arevalo-Mez Lillean , Espejo Luis , Abdulla Rania , Sarmiento Yolanda , Ross-Inda Nikki , Sanchez Diana , Gonzalez Lisa , Reyes-Garcia Aileen , Rivera Marlene
Published: December 2010

The purpose of the PNRP patient navigation is to provide individualized assistance to persons with abnormal cancer screening tests or cancer diagnosis by trained, culturally sensitive navigators familiar with the patient's community. The Moffitt Cancer Center is one of nine NCI-funded sites nationally to study the impact that patient navigation has on four main outcomes: 1) time from screening to definitive diagnosis; 2) time from definitive diagnosis to treatment; 3) patient satisfaction; and 4) cost effectiveness. Moffitt's patient navigators navigated over 640 patients referred from seven community clinics in four counties. The majority of the patients were female (93%), Hispanics (54%), with annual household income under $20,000 (80%), mostly unemployed (47.5%), and with an average of 8.8 years of education. Lay patient navigators familiar with the patients’ culture and language were trained to navigate patients with breast or colorectal cancer screening abnormalities. The navigators were asked to record in a log the barriers that they identified, along with the actions they took to assist the patients address such barriers. Navigators addressed 20 different types of barriers in an average of 10 encounters per patient. This presentation will 1) describe the processes of patient navigation utilized by Moffitt PNRP, including training requirements, and caseloads for patient navigators, and 2) discuss the most relevant barriers that navigators found among medically underserved patients to access cancer health services, and actions taken to address such barriers. Moffitt patient navigators engage in a number of actions to help address unique barriers faced by this population when trying to access cancer care services.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A31.
Abstract A33: Culturally relevant cancer risk counseling for underserved Latinas
Authors: Gloria Juarez , Perez Martin , Lagos Veronica , Blazer Katheleen , Ogaz Raquel , Weitzel Jeffrey
Published: December 2010

Background: Latinas are as likely as the majority to have high cancer risk associated with genetic predisposition to breast cancer and ovarian cancer. Disproportionately underserved, Latinas have a compelling need for access to genetic cancer risk assessment (GCRA) and cancer screening and prevention measures.

Objectives: The primary purpose of this project was to evaluate the effects of a culturally relevant GCRA intervention for Latinas.

Methods: Four focus groups were conducted consisting of Latinas that have undergone GCRA. Participants completed a demographic questionnaire that included items assessing perceived cancer risk and satisfaction with GCRA. The focus groups entailed a facilitated discussion of the key study variables and other culturally relevant issues that may impact the GCRA intervention. Descriptive statistics and thematic analysis were used.

Results: Perceived sense of lack of information and uncertainty about what to expect appeared to play a key role in distress. Most women initially had negative expectations (expecting the worse or bad outcome), but ultimately felt hopeful that they could learn more about the GCRA process and what it meant for them. Information was cited as the primary contributor to positive psychosocial outcomes specifically increased locus of control and self-efficacy. The major cultural themes identified were destiny, religious and spiritual coping, how cultural attitudes and belief influence lack of information, community awareness, and public health issues.

Conclusions: Findings indicate that the pre-GCRA window may be most distressing for this population indicating that this may be the most appropriate time for psychological intervention.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A33.
Abstract A34: Short-term evaluation of telephone-based genetic counseling for hereditary breast and ovarian cancer among African American women: A pilot study
Authors: Vadaparampil Susan T. , Pal Tuya
Published: December 2010

Introduction: Genetic counseling (GC) services for inherited breast and ovarian cancer (HBOC) are underutilized by African American (AA) women. One barrier may be availability of in-person GC services. Telephone-based counseling may be one way to increase access to GC services. However, little is known about AA women's reactions to and satisfaction with phone-based GC services. We sought to evaluate experiences associated with phone-based GC for HBOC among AA women diagnosed with early-onset breast cancer.

Methods: Through a cancer registry-based study, phone-based GC for HBOC was provided to AA women diagnosed with breast cancer at or before age 50. A brief baseline survey to evaluate the experience with the GC and testing process was administered when women were being scheduled to receive results of BRCA testing. After phone-based results disclosure with a genetic counselor, a follow-up phone survey was administered to assess results disclosure experiences.

Results: To date, baseline and follow-up surveys have been completed by 33 (72%) of 46 women who completed pre-test GC. Findings from the baseline questionnaire (n=36) showed that the majority of women were glad to have pursued testing (95%), felt that they had taken charge of their healthcare (90%), and were pleased with the telephone GC provided through the study (71 %). Almost 40% of participants indicated that the GC and testing process increased their feelings of control and empowerment. Among the follow-up survey participants (n=33), the majority indicated very positive experiences with various aspects of phone-based results disclosure.

Conclusion: Our results suggest that telephone-based GC and testing for HBOC in a registry-based sample of AA women was perceived favorably by participants. Thus, telephone-based GC may be one approach to reduce barriers in access to GC and testing services in the AA community.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A34.
Abstract A48: Class, culture, and patterns of cancer care navigation
Authors: Gage Elizabeth A.
Published: December 2010

Background: While previous research has established a link between socioeconomic status (SES) and cancer outcomes, there is still little understanding of the processes that contribute to these outcome disparities. The mechanisms though which individuals actually translate SES-related resources into health advantage remain imperfectly understood. The systematically different patterns of health care navigation that patients enact are one pathway in which SES has been hypothesized to impact health outcomes. Building upon research documenting the ways that social class and culture impacts family life, this research examines the adaptive strategies families use after a child has been diagnosed with cancer. It extends Fundamental Cause Theory (Link and Phelan 1995) and Cultural Health Capital (Shim 2010) which have become prominent theories for understanding the role of class in health disparities.

Methods: This research combines in-depth interviews with 55 parents of pediatric cancer patients with ethnographic case studies of five families to document how SES influences patterns of navigating the health care community after a serious medical diagnosis.

Results: Findings indicate that the high SES warrior advocate parents view themselves as collaborative members of the health care team, and peers with physicians. These parents conduct sophisticated medical research, seek second opinions, and actively network within the health care community. Low SES parents enact a survivor style where they maintain boundaries between patient and provider roles. They view physicians as authority figures, trust clinicians to guide their health care and express frustrations communicating with health care professionals.

Conclusions: A more complete understanding of SES-based patterns of communication in heath settings enhances our understanding of the mechanisms underlying socioeconomic health disparities, and will help guide intervention initiatives aimed at reducing disparate outcomes for cancer patients.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A48.
Abstract A54: miRNA profiling: prognostic markers in chemoprevention
Authors: Williams Jennie L. , Ji Ping
Published: December 2010

Epidemiological data has demonstrated that colon cancer is disproportional in incidence and mortality between Caucasians and African Americans (AA). Whereas socioeconomic and dietary differences contribute to this disparity other underlying factors must be involved. For instance, the response to chemopreventive agents is different between these two populations. Since chemopreventive agents exert their effect through a molecular target, this disparity would suggest differences at the genetic level. Therefore, the generation and evaluation of chemopreventive agents that address the issue of chemoresistance is essential. As such, we have demonstrated that promising colon cancer chemopreventive agents, derivatives of nonsteroidal anti-inflammatory drugs (NSAIDs), inhibits colon cancer cell growth by inhibiting cell proliferation and enhancing cell killing. However, very little is known about the molecular targets in the cancer cell that are responsible for this effect. microRNAs (miRNAs), small (17-22 nt) regulatory RNAs, are known to control gene expression and translational repression or degradation, via specific sites at the 3’-UTR of its target mRNAs. The deletion or mutation of one particular miRNA could potentially lead to the progression of disease; specifically, cancer. Therefore, using total RNA isolated from tumors of xenographic mouse and colorectal cancer cells treated with NSAID derivatives, miRNA distribution patterns were determined. Protein lysates of the tumors and tissue culture cells were also examined for levels of transcriptional activating factors (i.e., NF-kB and p53). We demonstrate that derivatives of NSAIDs altered the synthesis or activity of multiple miRNA and transcriptional DNA-binding factors In vivo and In vitro. Of interest, our chemopreventive agents induced expression Levels of, among others, the tumor suppressor Let-7 miRNA family. In addition, this increase was directly related to the presence of a functional p53 gene product. Thus, a correlation of altered level of miRNA and the expression and/or activation of its target genes may assist us with ascertaining the association of miRNAs with poor clinical outcome.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A54.
Abstract A61: Prevalence of memory problems that limit daily functioning in a national representative sample of adult cancer patients in the United States population
Authors: i Michael Anton , Jean-Pierre Pascal , Armstrong Daniel , Lipschultz Steven , Miller Tracie L.
Published: December 2010

Background: Cancer and its treatments can impair many aspects of cognitive functioning, especially memory. Few epidemiological studies, however, have examined the prevalence of memory impairment in cancer patients and survivors. We determined the prevalence of memory problems in cancer and non-cancer populations.

Methods: We analyzed data from a stratified, multistage probability sample of the civilian, noninstitutionalized United States population drawn from the National Health and Nutrition Examination Survey. Participants answered yes or no to the question, “Are you limited in any way because of difficulty remembering or because you experience periods of confusion?” We adjusted our logit model for age, sex, race-ethnicity, education, poverty, and general health.

Results: The sample included 9,819 individuals (4,862 men; 4,957 women) age 40 years and older from diverse educational and racial-ethnic backgrounds (blacks [1,938], whites [5,552], Hispanics [1,998] and other race/multi-racial [331]). Of the total sample, 1,305 had cancer and 8,514 had not. Memory problems were reported more often by participants who had cancer (14%) than by those who did not (8%). Having had cancer was independently associated with memory impairment (odds ratio = 1.5[95% CI = 1.1 to 1.9]). Other predictors of memory impairment included older age, sex, race-ethnicity, lower education, higher poverty, and poor general health (P < 0.01). Overall, participants with cancer had a 40% greater likelihood of having memory problems that interfered with daily functioning. Conclusions: Cancer history is an independent predictor of memory impairment. Strategies to assess and control this memory impairment for cancer patients and survivors are needed.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A61.
Abstract A79: Vitamin D status and breast cancer aggressiveness among African American and European American women in South Carolina
Authors: Steck Susan E. , Rosling Rebecca , Murphy E. Angela , Davis J. Mark , Hebert James R.
Published: December 2010

Background and Significance: Racial disparities exist in breast cancer, with African-American (AA) women being diagnosed with more aggressive disease and exhibiting higher mortality than their European-American (EA) counterparts. Vitamin D is of interest in breast cancer prevention and prognosis because of its ability to inhibit cell proliferation and induce apoptosis and differentiation in both normal and malignant breast cells. Circulating 25hydroxyD [25(OH)D] concentrations in humans are a measure of vitamin D status, and vary based on sun exposure, dietary intake, supplement use, skin tone, age, and body mass index [BMI = weight(kg)/height(m)2], among other factors. This study examines racial differences in vitamin D status and the association between serum 25(OH)D and clinical parameters among women diagnosed with breast cancer in South Carolina.

Methods: A total of 107 women between 33 and 84 years of age and diagnosed with breast cancer in the previous five years were enrolled in the study (n=60 AA, n=47 EA). Each participant donated a blood sample, and serum 25(OH)D was measured by enzyme immunoassay. Age, BMI, clinical characteristics, and treatment were abstracted from medical records.

Results: The mean (±SD) concentration of serum 25(OH)D in EA women was 29.8 ± 12.1 ng/ml while the mean concentration in AA women was 19.3 ± 10.0 ng/ml. Vitamin D deficiency (defined as serum 25(OH)D <20ng/ml) was much more common among AAs (60%) compared with EAs (15%). Serum 25(OH)D concentrations decreased with increasing stage of disease and were lowest among women who were triple (ER/PR/HER2) negative compared with other groups. Women who were vitamin D deficient were 8 times more likely to be diagnosed with aggressive disease (defined as regional or distant stage) as compared to women who were sufficient in vitamin D, though the confidence interval was wide, indicating imprecision of the result (OR=8.6,95%CI=1.8,41.2, after adjustment for age, race, BMI, season and months since diagnosis).

Conclusions: This study corroborates other research showing racial differences in vitamin D status and provides further support for a protective role of vitamin D in breast cancer, particularly for highly aggressive disease. The prevalence of vitamin D deficiency and insufficiency was high, suggesting the need for monitoring of vitamin D levels among breast cancer patients.

This work was supported by grants from the National Cancer Institute, Center to Reduce Cancer Health Disparities (Community Networks Program) to the South Carolina Cancer Disparities Community Network (SCCDCN) [1 U01 CA114601] and the Cancer Center of the University of South Carolina.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A79.
Abstract A80: Physical activity reduces breast cancer risk in African American women
Authors: Sheppard Vanessa , Makambi Kepher , Wallington Sherrie , Sween Jennifer , Adams-Campbell Lucile , Taylor Teletia
Published: December 2010

Background: The reported inverse relationship between physical activity and breast cancer risk is under constant scrutiny, and the evidence is inconsistent. Furthermore, few studies have been conducted with African Americans.

Methods: A population-based case-control study identified 97 cases and 102 controls from the Washington, DC, area. A self-report physical activity questionnaire elicited responses on walking for exercise and vigorous physical activity (e.g., running, aerobics, etc.) in the past year. Responses were used to calculate a metabolic equivalent (MET) score [MET-hours/week= hours/week vigorous activityx7+ hours/week walking x3]. The MET score was categorized into low, medium and high tertiles. Multivariate logistic regression examined the association between physical activity and breast cancer.

Results: African American women who engaged in vigorous physical activity (> 2 hours/week in the past year) had a 64% reduced risk of breast cancer compared to those who did not participate in any vigorous activity (odds ratio, OR = 0.36; 95% confidence interval, CI = 0.17-0.75). We also found a 64% reduced breast cancer risk in women with a high versus low tertile of total activity (OR = 0.36; 95% CI = 0.16-0.79). For postmenopausal women, vigorous physical activity and total activity (high versus low tertile) also had an inverse relationship with breast cancer (p<.05).

Conclusion: Modest levels of physical activity can reduce breast cancer risk in African American women.

Impact: Targeted efforts to encourage more African American women to engage in modest levels of physical activity may positively impact disparate breast outcomes in this group.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A80.
Abstract A85: Breast cancer pathology, receptor status, and patterns of metastasis in a rural Appalachian population
Authors: Vona-Davis Linda C. , Gadiyaram Vijaya , Ducatman Barbara , Kurian Sobha , Abraham Jame , Hazard Hannah , Hobbs Gerald
Published: December 2010

Background: Breast cancer patients in rural Appalachia have a high prevalence of obesity and poverty, together with excessive expression of the triple-negative phenotype.

Methods: Clinical records for 687 patients provided data which included tumor receptor status and time to distant metastasis. Breast cancers with the triple-negative phenotype were compared with other receptor combinations. Body mass index, tumor size, grade, nodal status, and receptor status, were related to metastatic patterns.

Results: Ninety-five of 687 patients, (13.8%) developed metastases to bone (n=42) or visceral sites (n=53). Metastases to viscera occurred within five years, a latent period which was shorter than that for bone (P = 0.042). Significantly more women with visceral metastasis presented with grade 3 tumors compared with the bone and non-metastatic groups (P = 0.0002). There were 135/574 women (23.5%) with triple-negative breast cancer, who presented with lymph node involvement and visceral metastases (68.2% versus 24.3%; P = 0.033). Triple-negative tumors that metastasized to visceral sites were significantly larger (P = 0.007). Although the probability of developing a visceral metastasis within 10 years was higher among women with triple-negative tumors, this relationship was not influenced by increasing body mass index.

Conclusions: For all breast cancer receptor subtypes, the probability of remaining distant metastasis-free was greater for brain and liver than for lung. The excess risk of metastatic spread to visceral organs in triple-negative breast cancers, even in the absence of positive nodes, was combined with the burden of larger and more advanced tumors.

Impact: The reduced survival of breast cancer patients in rural areas may be explained by a high prevalence of triple-negative tumors with a propensity for visceral metastasis.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A85.
Abstract A87: The epidemiology of breast and cervical cancer: Pre-and post-National Health Insurance Scheme in Ashanti region of Ghana
Authors: Dokurugu Yussif , Brown Perry , Dark Tyra , Awuah Baffour
Published: December 2010

Background: The relationship between breast and cervical cancer, inequality in income distribution and access to health care has attracted much attention during the last two decades. To reduce this problem of financial access to health care, Ghana's government is committed, and has introduced a convenient, affordable and sustainable health financing arrangement to protect the people, especially the poor, through the National Health Insurance Scheme (NHIS). Breast cancer and cervical cancer, once rare, is now becoming a major public health concern in Kumasi, Ghana. The introduction of the “cash and carry” system in 1992 compounded the problem of financial access to quality health care, and thus led to low utilization of health services especially, by the poor. This led to deteriorating health status for the people of Ghana. Though laudable, little is known about the efficacy of the health insurance in improving breast and cervical cancer care in Ghana. The purpose of this study was to examine the epidemiology of breast and cervical cancer both prior to and following the enactment of the NHIS. Time-Series data obtained from the Ghana Okonfo Anokye Teaching Hospital was utilized.

Methods: This project consisted of two phases. Medical records of inpatient and outpatient records for the period of 2001 through 2009 in the hospital were reviewed. Phase 1 consisted of pre-NHIS and post-NHIS data compilation and aggregation, variable construction and univariate and bivariate descriptive statistics provided an overview of the state of the health care system in Ghana. Phase 2 consisted of a time series analysis on 2001-2009 data. The SAS Proc ARIMA was utilized to determine if significant changes in the demographic characteristics of inpatients and outpatients occurred after the institution of the NHIS.

Results: Ghana recorded 0.54 outpatient visits per capita in 2005 (before national health insurance). The hospital admission rate was 36.5, per 1000 in 2005. Skilled obstetrical deliveries increased to 40.3% in 2005. It is against this background that trends in inpatient and outpatient medical visits were analyzed. Trends by gender, age, and diagnostic group were examined over an eight year period.

Conclusions: Prior to 2006 the country instituted a national health insurance plan. This plan provided free health coverage to all citizens. Prior to the NHIS the predominant mode of payment for healthcare services was cash and carry. Rates of outpatient services provided and inpatient admissions have changed by age group, gender and by diagnosis after national health insurance in Ghana.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A87.
Abstract A90: Nonmelanoma skin cancer epidemiology and DNA repair in Puerto Ricans
Authors: Bayona Manuel , Vidal Jose F. , Morales Luisa , Alvarez-Garriga Carolina , Sanchez Jorge , Villa Jaime , Ruiz Abigail , Matta Jaime L
Published: December 2010

Introduction: Nonmelanoma skin cancers (NMSC) including basal cell and squamous cell carcinomas are the most common human cancers. DNA damage can be caused by exposure to solar UV light and other types of radiation, dietary factors, and ageing. The relationship between DNA damage and oncogenesis suggests that diminished DNA repair capacity (DRC) is involved in tumorigenesis.

Purpose: The purpose of this study was to identify and assess selected exposures and DRC as predictors for NMSC in Puerto Rico.

Methods: An incident-cases case-control study was conducted. A total of 477 NMSC cases and 365 controls were compared regarding DRC levels and other selected factors. Participants with low and high DRC levels were also compared regarding the same factors as in NMSC. DRC was measured using a host-cell reactivation assay with a luciferase reporter gene irradiated with UV light and transfected into human peripheral lymphocytes from participant's blood samples. A standardized epidemiological questionnaire was used to collect data from the participants. The crude and multiple logistic regression adjusted odds ratio was used to assess the associations between NMSC or DRC levels with selected factors after adjusting for age, gender, skin, hair, and eye color, and other potential confounders simultaneously.

Results: Exposures increasing the odds for NMSC were being male, aging, light skin, presence of freckles, light hair, light eye color, increased sun exposure, severe insolations, family history of NMSC, and low DRC (p < 0.05). Protective factors found in the study included using sun block, taking aspirin regularly, and multivitamin supplements intake (p < 0.05). Factors associated with low DRC level were aging, light skin, sun exposure, severe insolations and not using sun block regularly.

Discussion: The present study identified major epidemiologic factors for NMSC in Puerto Rico that are consistent with similar investigations elsewhere. Low DRC was strongly associated with NMSC (Matta et al, 2003). New unpublished data include the finding of the protective effect of multivitamin supplementation. Light skin, increased sun exposure, severe insolations and not using sun block regularly were associated with low DRC.

Conclusions: The protective effect of multivitamins deserves further consideration to confirm our findings. Persons with light skin, increased sun exposure and not using sun block regularly had low DRC levels and increased odds for NMSC. DRC measurements might be used to monitor the potential preventive impact of multivitamins and sun block when used as preventive therapy.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A90.
Abstract A91: Epigenetic deregulation of IGF2 and cervical cancer precursors in HIV+ and HIV-patients
Authors: Hoyo Cathrine
Published: December 2010

Introduction: Early detection and aggressive treatment programs to prevent cervical carcinoma in situ (CIS) and invasive uterine cervical cancer (ICC) have been available for more than 30 years with more than 80% population coverage. Despite this, 11,000 cases of ICC and 40,000 cases of CIS continue to be diagnosed in the United States annually. Women of African descent are at >2-fold higher risk of invasive cervical cancer death compared to other ethnic groups.

Objective: The overarching goal is to develop epigenetic biomarkers that can be used for early identification of aggressive cases likely to result in invasive cervical cancer and death.

Methods: We conducted a hospital-based, case-control study comprising 26 women with ICC, 18 with CIN2/3/HSIL, and 41 with normal cytology, at Kilimanjaro Christian Medical Center in Moshi, Tanzania. We analyzed methylation of three regions in the IGF2/H19 imprinted domain known to regulate the expression of imprinted IGF2. Aberrant methylation is associated with IGF2 deregulation, including changes in expression, loss of imprinting, and neoplasia.

Results: At the IGF2/H19 imprint center upstream of H19, methylation profiles for all women with no evidence of cervical abnormality or those with CIN2-CIN3 were within normal ranges (40%-60%), while 23% with invasive cancer had hypermethylation. In contrast, 25% of the CIN2/3 cases were abnormally hypomethylated at the IGF2 DMR in IGF2 intron 2, and the methylation profile worsened in the invasive cervical cancer cases with 64% having an abnormal methylation profile. A similar trend was found for the regulatory region in IGF2 intron 6. Stratifying these analyses by HIV status in ICC revealed that aberrant intragenic IGF2 hypomethylation was observed only among women without HIV. These associations persisted after adjusting for HPV genotype.

Conclusion: Our findings suggest that regulation of IGF2 is substantially altered in CIN2 or worse via epigenetic alterations. DNA methylation profiles of these regions may be markers of risk of progression especially in HIV-women. The findings support our hypothesis that epigenetic deregulation of this imprinted gene could be useful in discriminating women with dysplasia likely to progress.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A91.
Abstract A92: Preliminary report on the methylation status of CDKN2A and MLH1 genes in Puerto Rican patients with acute myeloid leukemia
Authors: Tirado-Gomez Maribel , Bernabe-Dones Raul D. , Lacourt Mercedes Y. , Castro-Munoz Cristina I. , Cotto-Santiago Maribel
Published: December 2010

In acute myeloid leukemias, aberrant DNA methylation of promoter-associated CpG islands represents an important mechanism in leukemogenesis. Hypermethylation of promoters blocks transcriptional activity of genes associated with tumor suppression and cell cycle control. In this study, we evaluate the promoter methylation status of genes CDKN2A and MLH1 in a small sample of Puertorrican patients with acute myeloid leukemia.

Methods: Peripheral blood was obtained from 6 patients with acute myeloid leukemia at the time of their diagnosis. Mononuclear cells were isolated by density gradient technique. DNA was isolated and further modified with sodium bisulfite. Methylation-specific polymerase (MSP) chain reaction was performed to detect the aberrant promoter methylation of CDKN2A and MLH1 genes in 6 patients with acute myeloid leukemia.

Results: A total of 6 samples were analyzed. The mean age was 44 years (24-66) and most of the patients were female (5/6,83%). Four of the patients had diploid cytogenetics, one patient had t(8;21) and one had-7q cytogenetics. WBC counts at presentation were 5.35/uL (0.8-13.8). Hypermethylation of CDKN2A and MLH1 was not detected in any of the samples.

Conclusions: Hypermethylation of CDKN2Aand MLH1 was not seen in the first six samples analyzed in this cohort of Puertorrican patients. Collection of more patient's samples and correlation with clinical data is ongoing.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A92.
Abstract B108: “GET SCREENED”: A randomized trial of reminders, recall, and outreach (RRO) to improve cancer screening in safety-net primary care practices
Authors: Fiscella Kevin , Hendren Samantha , Humiston Sharon , Ford Patricia , Winters Paul , Specht Ray , Loader Starlene , Yosha Amy , Marcus Steve , Pope Shirley , Idris Amna
Published: December 2010

Background: Members of racial and ethnic groups and persons with low socioeconomic status (SES) tend to be diagnosed at later stages of cancer and experience higher cancer related mortality. Overall rates of cancer screening have improved, but there has been only modest improvement in disparities in screening. A practice-based intervention using a combination of repeated reminders, recall and outreach (RRO) has been shown to significantly improve child and adult immunizations within safety net practices and reduce community wide disparities. We hypothesized that a similar approach could improve cancer screening in primary care practices that service predominantly minority and low SES patients.

Objective: To measure the efficacy of RRO on cancer screening rates within a large practice serving low income minority patients.

Methods: A patient-level randomized controlled trial was conducted within a family practice serving large numbers of minority and low SES patients. Eligibility criteria included (1) being a registered patient at the practice; (2) having at least 1 visit in the last 2 years; (3) age 40-75 for Breast Cancer (BC) screening and 50-75 for Colorectal Cancer (CRC) screening; (4) being past due for BC screening, CRC screening or both. Patients were assigned based on their medical record number to either intervention or usual care. The intervention included reminders (repeated point of care prompts to patients and their providers), recall (personalized letters to patients) and outreach (follow-up phone calls and mailed fecal occult blood testing kits). Relevant patient information was abstracted from the electronic medical record and imported into a customized patient tracking registry created in MicrsoftAccess™.

Results: Of 3,528 appropriately-aged patients in the practice, 2,389 were overdue for screening and met the eligibility criteria (1730 female; 686 male). At the end of the study period, the BC screening rate was 17% among controls vs 41% in the intervention group (p<0.0001); the CRC screening rates were 10% vs 30% (control vs intervention, p<0.0001).

Conclusion: Practice-based RRO significantly improves cancer screening among largely low income and minority patient population.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B108.
Abstract B111: Disparities in colorectal cancer: Who receives screening?
Authors: Oliver JoAnn S. , Allen Rebecca S. , DeCoster Jamie , Worley Courtney , Palardy Leslie , Kim Giyeon
Published: December 2010

Background: Colorectal cancer is a leading cause of cancer morbidity and mortality in the United States. It is estimated that approximately 142,570 new cases of colorectal cancer will be diagnosed and over 51,000 will die in 2010. Further, African Americans are diagnosed at later stages and suffer disproportionately higher mortality rates from colon cancer. Despite the increased attention to the importance of colorectal cancer screening, the American Cancer Society reports half of the US population has not been tested. The purpose of this study was to examine the characteristics of individuals who receive three common screening methods for colorectal cancer: Fecal occult blood test (FOBT), sigmoidoscopy and colonoscopy

Methods: Data were drawn from the 2007 Health Information National Trends Survey (HINTS). Following the American College of Gastroenterology Guidelines, a total of 4,464 participants aged from 45 to 75 years were selected for secondary data analysis. The selected sample included both men and women participants whose mean age was 58.89 (±8.41) with approximately 59.7% female, 74.1% Caucasian and 9.3% African American. Logistic regressions were performed to determine significant predictors of having fecal occult testing, colonoscopy, and sigmoidoscopy.

Results: Odds of having FOBT, colonoscopy or sigmoidoscopy was increased among older individuals with higher education. FOBT was higher among females and those with insurance compared to those without (both p<.05). Colonoscopy was higher among those with insurance and higher income (p<.001). Having a sigmoidoscopy was more likely among those with higher income, but differed among subgroups. There were significant interaction effects of gender by age and race by gender in having a sigmoidoscopy. Both males and females had higher log odds of having a sigmoidoscopy among older individuals, compared to younger individuals, but the age difference was more pronounced among females. The odds of having a sigmoidoscopy were much lower among African American men than other groups.

Conclusion: Those who were older and more educated are more likely to participate in colorectal screening. Higher income was associated with both colonoscopy and sigmoidoscopy screening procedures with insurance also being significant for colonoscopy. African American men, who are at greater risk for colorectal morbidity and mortality, are significantly less likely to have participated in screening using a sigmoidoscopy. Socioeconomic dividers which often parallel health disparities e.g. income, education and insurance are similarly associated with colorectal cancer screening participation. Understanding the characteristics of individuals who choose to participate in colorectal cancer preventive screenings could contribute to the development of interventions and or policies geared toward those who do not.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B111.
Abstract B22: Demographic and psychosocial predictors of low-income mothers’ decision to vaccinate their daughters against HPV
Authors: Floyd Tiffany
Published: December 2010

Human papillomavirus (HPV) is the leading cause of cervical cancer, which disproportionately affects women of low-income. The availability of a safe and efficacious vaccine against HPV offers a novel approach to cancer prevention and control, as well as an important opportunity to eliminate income-based disparities in cervical cancer. Realization of this potential, however, will depend in part on low-income mothers’ decisions to either vaccinate or not vaccinate their daughters against HPV. In the present study, N=68 low-income mothers participated in a pediatric waiting-room assessment of theory-driven factors associated with medical decision-making. Daughters’ vaccination status was assessed 8-months post-baseline via medical chart review. At eight months, 63% of mothers had not initiated the vaccine series for their daughter. Older age of daughter was the strongest predictor of initiating the vaccine series (p < .01). Results of chi-square analyses indicated that, compared to mothers who pursued vaccination, those who did not had less knowledge of HPV as a condition affecting both males and females, were more likely to agree that giving their daughter a new vaccine is like performing an experiment on her, and were more likely to believe that their daughter should have no role in the decision-making process. Findings provide insight into factors influencing uptake of childhood HPV vaccination within low-income populations, among whom there is an excess burden of cervical cancer.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B22.
Abstract B34: Discrimination, stress and risk factors for cancer among Latinos
Authors: Ornelas India , Mariscal Norma , Martinez Javiera , Ceballos Rachel , Thompson Beti
Published: December 2010

Racial/ethnic discrimination is associated disparate health outcomes among racial/ethnic minorities. Theory and empirical evidence suggest that stress associated with experiencing discrimination can lead to the adoption of unhealthy behaviors such as poor diet, tobacco and alcohol use. Our study sought to explore the relationship between discrimination, stress and health behaviors among Latinos in both rural and urban settings in Washington state. Latinos were recruited for the study through community based organizations serving Latinos in both Seattle (urban) and the lower Yakima valley (rural). The sample of 40 participants included both men and women, United States and foreign-born, and a broad age range (20 – 70). Qualitative in-depth interviews were conducted in participants’ preferred language (Spanish or English). Interviews were transcribed, entered into Atlas. ti and coded for analysis. Analysis allowed for deductive codes based on theory and previous literature, as well as deductive codes that emerged from the data. Transcripts were also analyzed to identify differences by urban/rural setting, language use and immigrant status. The analysis revealed several key themes related to types of discrimination, health effects of discrimination and stress, and coping strategies. The majority of the participants had experienced discrimination in their lifetime, most often related to their race/ethnicity or language use. Settings in which discrimination occurred included work, school, and when seeking services. Common reactions to discrimination were to avoid it, ignore it, talk with someone about it, or pray about it. Respondents also reported that discrimination and other stressors influenced their sleeping habits, diet, physical activity, smoking and alcohol use. The findings reveal important relationships between discrimination, stress and behavioral risk factors for cancer. The results can inform future research on the health impact of discrimination among Latinos, including the measurement of discrimination and stress.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B34.
Abstract B37: Negative affect and fruit/vegetable consumption: The nature of the relation differs by race/ethnicity
Authors: Kiviniemi MarcT. , Orom Heather , Giovino Gary A.
Published: December 2010

Dietary practices, including low fruit and vegetable consumption, are associated with risk for multiple cancers. Some work has shown that negative affectivity is associated with lower fruit and vegetable consumption. Previous work from our lab has shown that smoking behavior is differently associated with negative affectivity as a function of race/ethnicity. Given this evidence, it is plausible that the relationship between negative affectivity and fruit/vegetable consumption might also differ by race. To examine this question, data from the National Cancer Institute's Health Information National Trends Survey (HINTS) were used. Respondents reported current negative affect, daily fruit and vegetable consumption, and race. Linear regression analyses examined race, negative affect, and their interaction as predictors of fruit/vegetable consumption. Race analyses compared White (n=5445) to Black (n=687) respondents. Analyses controlled for demographics and were run in STATA10 using complex survey design techniques to account for the HINTS sampling design. For the overall sample, there was a significant relation between negative affect and fruit/vegetable consumption; r=-.15, p < .05. However, this effect was qualified by a marginally significant race x negative affect interaction; f=1.74, p=0.08. When examined separately by race, the relation of negative affectivity to behavior was significant for White (f=2.73, p < .05) but not Black respondents (f < 1, ns). These findings indicate that the relation of negative affect to fruit/vegetable consumption may differ by race/ethnicity and may be more applicable to White individuals. This has implications for understanding factors that influence dietary behavior and for developing intervention strategies to address diet for members of racial/ethnic minority groups.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B37.
Abstract B46: Fear as a barrier to mammography for African American women
Authors: Hatcher Jennifer
Published: December 2010

Screening mammography is the single most effective method of early detection of breast cancer however mammography rates in America remain suboptimal among certain groups of women. African American women are one of those groups, experiencing high mortality rates and low rates of screening as compared to other ethnic groups. One of the factors related to inadequate screening is fear. Fear has been associated with participation in screening, however it is a concept that has been poorly explored within the context of culture. This report examined how African American women, who had been seen in the emergency department for non urgent complaints, describe their fear and its impact on their breast cancer screening patterns. Semi-structured interviews were used to gather data from 35 African American women, both screened and unscreened, between 2008 and 2010. Interview transcripts were analyzed and recurrent themes and patterns were identified. Most women expressed fear regarding cancer screening in some way, either fear of pain, fear of the unknown, or fear of finding out that something is wrong. This fear could be either a motivator or a barrier to mammography. This report illuminates that fear in the context of the other barriers and benefits to mammography experienced by these women. These findings will be important in the design of culturally relevant interventions that address the ongoing issue of inadequate screening mammography among African American women.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B46.
Abstract B54: Pregnancy and postpartum involution promote tumorigenesis in a preclinical model for triple negative/basal breast cancer
Authors: Russell Tanya D. , Fornetti Jaime , Schedin Pepper
Published: December 2010

Young African American women have an increased risk of developing and dying from “triple negative/basal breast cancer” compared to young Caucasian women, but the reason for this is unknown. Insight into this problem may be elucidated by the fact that breast cancers associated with a recent pregnancy are more likely to be metastatic. For all women, having had a recent pregnancy is an independent risk factor for poor prognosis. Epidemiologic data shows increased risk of triple negative/basal breast cancer with increased childbearing in African American women (Millikan et al 2008). We speculate that the hormones of pregnancy combined with the tissue-remodeling of the post-partum breast back to its pre-pregnant state (a normal process called postpartum involution that occurs after childbirth in the absence of breastfeeding, or at weaning in women who breastfeed) provides a two-hit tumor promotional tissue environment that results in increased metastasis of these tumors. Using an innovative, intraductal preclinical model developed in our laboratory, we tested whether a triple negative/basal breast cancer cell line (MCF10ADCIS.com) is promoted by pregnancy or postpartum involution. When these cells are injected into mammary ducts of nulliparous female mice, there is evidence of tumor progression from hyperplastic alveolar nodules to ductal carcinoma in situ to local invasion that is accompanied by progressive loss of the protective myoepithelial cell layer. Further, tumor burden in pregnancy and postpartum involution is much greater than their respective nulliparous controls. Importantly, with pregnancy and postpartum involution the protective myoepithelial cell layer surrounding tumors is compromised at earlier stages than in nulliparous controls. Physiologic changes to adherens junctions and myoepithelial cells occur during normal pregnancy and post-partum involution, respectively. These data suggest that the physiological environments of pregnant and involuting glands promote tumor progression and begin to unfold the biological mechanisms for the effects of parity on aggressive breast cancers.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B54.
Abstract B61: Phospholipid scramblase is a critical mediator of estrogen-induced apoptosis in antihormone resistant breast cancer cells
Authors: Lewis-Wambi Joan S. , King Tabitha , Smith Annalese
Published: December 2010

Phospholipid scramblase 1 (PLSCR1) is a mutiply palmitoylated protein which is localized in either the cell membrane or nucleus depending on its palmitoylated state and is responsible for the translocation of phospholipids between the two monolayers of a lipid bilayer of a cell membrane in a calcium (Ca2+)-dependent manner. There is evidence that PLSCR1 plays a role in cell signaling and apoptosis. In the present study, we investigated the functions of PLSCR1 in hormone-sensitive MCF-7 and T47D breast cancer cells versus antihormone-resistant MCF-7:5C and MCF-7:2A cells. We found that PLSCR1 protein and mRNA levels were dramatically increased in MCF-7:5C and MCF-7:2A cells compared to parental MCF-7 and T47D cells and suppression of PLSCR1 in these cells using small interfering RNA (siRNA) reduced their growth rate and altered their morphology to become more differentiated and spindle-shaped. Suppression of PLSCR1 also completely blocked estrogen-induced apoptosis in MCF-7:5C cells. Furthermore, we found that stable expression of PLSCR1 in MCF-7 cells enhanced their sensitivity to etoposide-induced apoptosis and that treatment of these cells with interferon-alpha 2 (IFN- 2) resulted in cell cycle arrest. Overall, these data show that PLSCR1 is overexpressed in antihormone-resistant breast cancer cells and they suggest that PLSCR1 plays an important role in sensitizing these cells to estrogen-induced apoptosis. These data also shed new insights into the biological and biochemical functions of PLSCR1 in breast cancer.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B61.