Abstract B084: Association between race and ethnicity, area deprivation, and exposure to environmental toxins in the WISDOM clinical trial population
Authors: Leggat-Barr Katherine E , Badal Kimberly , Stover-Fiscalini Allison , Meltzer Dan , Hebert-DeRouen Mindy , Van 'T Veer Laura , Esserman Laura 
Published: February 2024

Background: Women Informed to Screen Depending on Measures of risk (WISDOM) is a preference-tolerant, pragmatic clinical trial comparing the safety and morbidity of personalized risk-based and annual breast cancer screening. Environmental risk factors are not considered in WISDOM’s risk assessment. Geocoded residential addresses were used to understand whether a relationship between area deprivation, exposure to environmental toxins, and race and ethnicity exists within the cohort. Methods: The residential addresses at time of study entry of consented WISDOM participants were geocoded to latitude/longitude coordinates and assigned census tract and/or Zip Code Tabulation Area IDs from the US Census Bureau. Each census tract was assigned an Area Deprivation Index (ADI). The ADI comprises 17 indicators of poverty, housing, education, and employment which classifies a census tract on a scale from 1 (least deprived) to 10 (most deprived). ADI was grouped into highest deprivation (ADIs 8-10), middle deprivation (ADIs 4-7), and least deprivation (ADIs 1-3). Census tracts were also mapped to data from the Environmental Protection Agency Environmental Justice Screen (EJS) on the national percentile rank of 12 toxic exposures such as proximity to hazardous waste sites, air particulate matter and ozone concentrations. Each EJS exposure variable was categorized into quartiles. The cohort was limited to self-reported White, Asian, Black African American, and Mixed participants. The Kruskal-Wallis rank sum test and the Dunn’s test of multiple comparison using Bonferroni adjustment were used to test the association between race and ethnicity, ADI, and EJS variables. Results: The analysis cohort had 42,388 women. Most WISDOM participants were White (85%), followed by Asian (5%), Black or African American (5%), and Mixed (5%) race and ethnicity. Most lived in the least deprivation areas (57%) while a minority lived in the highest deprivation areas (12%). Black or African American women were significantly more likely to live in the highest deprivation areas compared to all other races and ethnicities (p&lt;0.001). The highest deprivation areas where more likely to rank in the highest quartile of exposure to ozone (p&lt;0.001), proximity to hazadous waste sites (p&lt;0.001), and concentration of cancer risk air toxins (p=0.017) compared to the middle and least deprivation areas. White and Asian women were more likely to live in the least deprived areas that were more likely to rank in the highest quartile of exposure to particulate matter 2.5 compared to the most deprived areas (p&lt;0.001). Conclusions: Black and African American women in the WISDOM study were more likely to live in the most deprived areas which have higher exposure to several environmental toxins. Given that exposure to some environmental toxins are known to increase breast cancer risk, investigation on how environmental factors can be encorporated in risk estimation is warranted. WISDOM should also direct targeted recruitment efforts to women who live in the most deprived areas.

Citation Format: Katherine E Leggat-Barr, Kimberly Badal, Allison Stover-Fiscalini, Dan Meltzer, Mindy Hebert-DeRouen, Laura Van 'T Veer, Laura Esserman. Association between race and ethnicity, area deprivation, and exposure to environmental toxins in the WISDOM clinical trial population [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr B084.