Abstract IA21: Social factors and prostate cancer disparities in African American men
Authors: Gomez Scarlett Lin , Cheng Iona , Shariff-Marco Salma , DeRouen Mindy C. , Hamilton Ann S. , Lichtensztajn Daphne Y. , Inamdar Pushkar , Oh Debby , Allen Laura , Beyer Kirsten , Zhou Yuhong , Gibbons Joseph , Pinder Richard , Press David J. , Conti David , Haiman Christopher 
Published: September 2020

Abstract
African-American (AA) men experience the highest prostate cancer (PCa) incidence and mortality rates of all U.S. racial/ethnic groups. They are also known to present with more aggressive high-risk disease, especially of higher Gleason score and PSA levels. Factors contributing to the high burden of PCa among AA men are not known. AAs are exposed to considerably higher levels of social stressors such as institutional and interpersonal discrimination, early life adversity, crime, low socioeconomic status, social isolation, and resource-poor environments. These social stressors exist at multiple levels, from individual to neighborhood to institutional, and across the lifecourse, leading to chronic stress. These social stressors experienced among AA men may thus be a contributor to the development of aggressive PCa and high mortality. This presentation will explore the conceptual multilevel frameworks that emphasize the consideration and evaluation of exposures from “cells to society” to understand how “stress gets under the skin” to cause biologic vulnerability, specifically the high burden of PCa among AA men. Within the infrastructure of the new RESPOND (Research on Prostate Cancer in Men of African Ancestry: Defining the Roles of Genetics, Immunity and Social Stress) Study, a nationwide cohort of 10,000 AA men with incident PCa, our project aims to: 1) Examine the associations between exposures to neighborhood social stressors and risk of aggressive PCa and mortality among AA and non-Hispanic White (NHW) men. Among population-based samples of all AA (N=149,000) and NHW (N=668,000) men diagnosed with PCa in the RESPOND catchment areas, we will link geospatial neighborhood data on segregation, racial composition, socioeconomic deprivation, and other social and built environment attributes to cancer registry data and examine the associations between these neighborhood factors and aggressive PCa and risk of mortality. 2) Examine the associations between exposures to multilevel social stressors across the lifecourse and risk of aggressive PCa among 10,000 AA men in RESPOND. 3) Examine the associations between exposures to multilevel social stressors across the lifecourse and genetic factors, as well as their combined effects in association with aggressive PCa. Covering 6 states and 1 metropolitan region and representing 38% of all AA men with PCa in the US, RESPOND will represent the single largest coordinated research effort to study aggressive PCa in AA men, with an innovative focus on social stressor exposures that are most relevant to this population. This project has the potential of identifying modifiable risk factors for aggressive prostate cancer to inform targeted prevention on a broad public health scale, such as targeting community support resources to neighborhoods with high stressors; the lifecourse approach will also provide the opportunity to identify critical time windows of disease susceptibility. The short-term impact of this research will be our expanded understanding of contextual- and individual-level stressors that are associated with aggressive disease among African American men, and the long-term impact, with future follow-up, is the determination of the effect of these social factors on disease progression and mortality.
Citation Format: Scarlett Lin Gomez, Iona Cheng, Salma Shariff-Marco, Mindy C. DeRouen, Ann S. Hamilton, Daphne Y. Lichtensztajn, Pushkar Inamdar, Debby Oh, Laura Allen, Kirsten Beyer, Yuhong Zhou, Joseph Gibbons, Richard Pinder, David J. Press, David Conti, Christopher Haiman. Social factors and prostate cancer disparities in African American men [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA21.