bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of race and age on intrinsic subtype distribution and treatment decisions in metastatic breast cancer: Preliminary analysis of HARMONY (LCCC1829).
Authors: Ivory Joannie M. , Rashid Naim , Zagami Paola , Perou Charles M. , Reeder-Hayes Katherine Elizabeth , Carey Lisa A. 
Published: June 2023

1055 Background: Gene expression profiling (GEP) is used to classify breast cancer (BC) into four intrinsic subtypes: Luminal A (LumA), Luminal B (LumB), HER2-Enriched, and Basal-like. Non-LumA subtypes are associated with poorer outcomes. Studies in early BC show that hormone receptor-positive (HR+)/HER2-negative (HER2-) tumors have a higher frequency of non-LumA subtypes in Black and younger (<50) women. Similarly, triple negative BC, which carries the poorest prognosis and is mostly Basal-like, are overrepresented in Black and younger women. These variations in intrinsic subtype contribute to outcomes disparities. The extent to which these racial and age differences in subtypes and mortality occur in metastatic breast cancer (MBC) is unknown. Methods: HARMONY (NCT03769415) is a prospective clinical trial in patients with newly diagnosed MBC. Bulk tumor GEP (PAM50 intrinsic subtyping) is performed on primary and metastatic tumors. A primary objective is to determine the extent and treatment implications of molecular discordance (defined a priori as treatment differences by intrinsic subtype compared to clinical subtype); other endpoints to be reported later include GEP comparisons between primary and metastatic samples. Here we examine differences in a) intrinsic subtype and b) treatment patterns in MBC by race and age. Results: At the time of analysis, the study had accrued 220 participants. Mean age was 58, 24% were Black women. Sixty-five percent had HR+/HER2- MBC, 14% HER2-positive, and 21% triple negative. Unlike in early BC, LumB exceeded LumA (LumA 27%, LumB 35%, HER2-Enriched 12%, Basal-like 25%). Similar to early BC, subtype varied by race and age with more non-LumA subtypes in young and Black women. Discordance between intrinsic and clinical subtype was seen in 24% of Black, 20% of White women, in 29% of younger and 18% of older women. Treatment patterns also differed by race and age, where a higher percentage of younger Black women received first-line chemotherapy compared to younger White women overall (45% vs. 10%, p=0.0025), and in HR+/HER2- disease (33% vs 8.7%, p=>0.05). No difference was seen in older women (24% vs 17%, p=0.44). Median progression free survival was worst in younger Black women compared to all other participants (5.4 vs 19.5 months, p=0.027), which may be driven by clinical subtype. Conclusions: Intrinsic subtype of tumors in a metastatic population has a different distribution by race and age than early BC, with more poor-prognosis non-LumA subtypes, and approximately 1 in 5 have discordance between clinical and molecular subtype, which may be therapeutically relevant. Clinical trial information: NCT03769415 . [Table: see text]
Disparities in germline genetic testing results from a cohort of 493,515 black and white patients.
Authors: Wyatt Rachel , Nielsen Sarah M. , Chen Elaine , Heald Brandie , Esplin Edward D. , Tomlinson Gail Elizabeth 
Published: June 2023

10550 Background: When undergoing germline genetic testing (GGT), Black patients (pts) are more likely than non-Hispanic White (NHW) pts to receive uncertain results and less likely to receive definitive molecular diagnoses as the Black genome is less well-characterized. As GGT is increasingly pertinent to cancer care, it is important to explore the scope of these disparities. Methods: A retrospective cohort of clinician-reported Black and NHW pts who underwent GGT (43-84 genes) from 2015-2022 was evaluated. Frequencies of pathogenic/likely pathogenic (P/LP) and variant of uncertain significance (VUS) results were compared between Black and NHW pts. Rate and type of VUS reclassifications were also compared. Differences in proportions were determined using Chi-square test and significance was set at 0.05. Results: The cohort consisted of 493,515 pts (48,684 [10%] Black and 444,831 [90%] NHW). VUS results were significantly more frequent and P/LP results significantly less frequent for Black compared to NHW pts (46% vs. 32% and 9 vs.13%, respectively). This was also true for pts who reported a history of cancer, across all common hereditary cancer types (Table). Comparing Black to NHW pts, there were more unique instances of VUS reclassifications over time (13% of 13,629 vs. 9% of 53,195 unique VUS), including 12% vs. 8% downgraded to benign/likely benign and 0.9% vs. 1.3% upgraded to P/LP. Conclusions: Lower rates of actionable results limit risk-reducing interventions for Black pts and their families. However, VUS rates continue to decline, particularly in Black pts, as more individuals (of any race or ethnicity) are sequenced. Clinicians can be reassured that most (but not all) VUS that are reclassified are downgraded to benign. [Table: see text]
African American women who carry the BRCA1/2 mutation: Clinical characteristics and prevention strategies.
Authors: Karki Ujjwal , Ghimire Bipin , Shrotriya Shiva , Rangarajan Tara , Zakalik Dana 
Published: June 2023

10554 Background: Carriers of pathogenic variants (PV) in BRCA1/2 have an increased risk of breast, ovarian, and other cancers . The clinical characteristics and uptake of risk-reducing interventions in African American(AA) women with BRCA1/2 PVs are less well studied. Methods: After IRB approval, we performed a retrospective chart review on African American women seen at Nancy and James Grosfeld Cancer Genetics Center at Beaumont Health from January 1, 2006, to December 31, 2021, who tested positive for a BRCA 1/2 mutation. We analyzed demographics, cancer characteristics, outcomes, and prevention strategies. Results: Of 238 African American(AA) women who underwent genetic testing, 69 patients (29%) were identified to be a carrier of BRCA1/2 PVs or likely pathogenic variants (LPVs). The median age at testing was 49 years (range: 24-87). Forty-six women (67%) had a cancer diagnosis, with a median age at diagnosis of 52 years. Four women had two, and one had three cancers, for a total of 52 cancers. Breast cancer was the most common type of cancer (40; 77%), with a median age at diagnosis of 48 years (range 24-73) and a majority (26; 65%) being BRCA2 carriers. Most were invasive ductal carcinoma (87.8%), high-grade (80%), ER-positive (52%), PR-negative (68%), HER2-negative (94%) and stage I or II disease (63%). Fifteen (38%) were triple-negative. Most patients (87%) received adjuvant systemic chemotherapy or endocrine therapy, 31% received neoadjuvant chemotherapy, and 39% received adjuvant radiation. The 3- and 5-year survival was 94% and 91%, respectively, with a median follow-up of 103 months. Three patients (all BRCA2 carriers ) developed contralateral breast cancer (median time to recurrence: 201 months); 3 (all BRCA2) developed local recurrence (median time to recurrence: 60 months), and 4(2 BRCA1, 2 BRCA2) developed metastatic recurrence (median time to recurrence: 34 months). Other cancers observed were ovarian (n = 6; 4 BRCA2, 2 BRCA1), uterine (2), lung (2), kidney (1), and glioblastoma (1). Compared to AA carriers without cancer, those with cancer were more likely to undergo risk-reducing mastectomy (RRM; 68% vs. 23%) and risk-reducing salpingo-oophorectomy (RRSO; 72% vs. 55%). In the non-cancer group, significantly fewer patients elected RRM (23%) compared to RRSO (55%). Conclusions: Our study outlines the characteristics of AA women who carry BRCA1/2 PVs, revealing that most had high-grade invasive ductal breast cancer with excellent survival. Patients without a cancer diagnosis were less likely to undergo risk-reducing surgery, highlighting the importance of effective counseling focusing on primary prevention in these high-risk patients. Further research is needed to better characterize cancer risk and address potential barriers to uptake of risk-reducing interventions in this population.
Racial disparities in aging-related comorbidity among breast cancer survivors.
Authors: Nguyen Kirsten , Wang Cong , De Vis Jill , Alford Mason , Rafat Marjan , Chakravarthy Anuradha Bapsi , Shu Xiao-Ou 
Published: June 2023

10555 Background: Black breast cancer (BC) patients have a higher mortality rate than their white counterparts, potentially due to age acceleration caused by cancer and its treatments. However, epidemiological evidence is limited. Methods: Our study includes 1885 BC patients and 1224 cancer free women (controls) recruited at Vanderbilt University Medical Center from 2004 to 2021. Patient demographics and aging-related outcomes were extracted from the tumor registry or electronic health records. Aging-related outcomes included 28 comorbidities and the Charlson Comorbidity Index (CCI) at baseline (biopsy) and follow-up (latest clinical visit). The associations of BC status with CCI and specific comorbidities were evaluated by linear and logistic regression models, respectively. The associations of race with aging-related outcomes were evaluated among cases. All analyses were adjusted for age, and follow-up outcomes were adjusted for baseline information. Results: The median follow-up time is 10 years. BC patients had a higher mean CCI at baseline (1.32 vs 0.59, p<0.01) and follow-up (beta=1.04, 95% CI=0.94-1.14) than controls. Results from individual comorbidities showed that BC survivors had a higher risk of developing cardiovascular disease, liver disease, hypertension, hyperlipidemia, gastroesophageal reflux disease (GERD), and depression. Among BC patients, Black women were diagnosed at a younger age (52.0 vs 55.8, p<0.01), but had a higher baseline and follow-up CCI than Whites. Black BC survivors were more likely to develop peptic ulcer disease, diabetes, second malignancy, hypertension, and GERD than White BC survivors, even after adjustment for baseline comorbidities. [Table: see text]
Sleep health and quality of life in African American cancer survivors: The Detroit ROCS Cohort.
Authors: Beebe-Dimmer Jennifer Lynn , Trendowski Matthew R , Ruterbusch Julie J. , Martin Jennifer , Baird Tara , Schwartz Ann G. , Badr Safwan 
Published: June 2023

10556 Background: Sleep disturbances are particularly prevalent among cancer survivors, likely attributed in part to anxiety over prognosis, treatment, and associated financial concerns. We know little about prevalence, patterns and predictors of poor sleep health in African American (AA) cancer survivors. Sleep problems may contribute in part to the observed disparities in outcomes in this high-risk population and represents a modifiable target to improve quality of life and longer-term health problems. Methods: The Detroit Research on Cancer Survivors (ROCS) study is a large cohort of AA cancer survivors diagnosed with female breast, prostate, colorectal, endometrial, lung or any other early onset cancer on or after 01/01/2013 in Metropolitan Detroit. We have enrolled 5,073 survivors into the study, each completing a baseline survey with annual follow-up to update medical history, health related quality of life (QoL), and other prognostic factors. In 2021, a supplemental sleep survey was administered to all eligible survivors. The current investigation analyzes sleep, QoL (measured using the Functional Assessment of Cancer Therapy - General (FACT-G) survey), and relevant health behavior data from 716 survivors who completed the sleep survey. Sleep health was measured using the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). Block regression was used to estimate the contribution of clustered factors to QoL. Five blocks were evaluated: sleep health, demographics, cancer characteristics, comorbidities, and health behaviors. Results: Nearly 60% of AA cancer survivors in the study reported symptoms indicative of poor sleep quality (PSQI score 6-21) with 17% reporting excessive daytime sleepiness (ESS score 11-24) and 11% reporting moderate to severe insomnia (ISI score ≥ 15). Sleep disturbances and poor quality of sleep were associated with clinically meaningful declines in QoL, where survivors with ISI scores in the clinical range reported adjusted FACT-G scores 19 points lower than those with ISI score below the clinical range (95% CI -14.7, -22.6). Sleep health accounted for the largest proportion of variability in FACT-G scores (R2= 0.28) and accounted for an additional 19% of the variance over and above the other 4 blocks. Finally, AA survivors reporting regular physical activity also reported better sleep quality in all 3 sleep scales (p < 0.001). Conclusions: A substantial proportion of AA cancer survivors reported poor sleep quality which impacted their QoL. Understanding the determinants of sleep health in this population will lead to the development of interventions aimed at improving quality of life and downstream health consequences in AA cancer survivors.
Prevalence of and racial/ethnic distribution of full-body skin examination among sexual and gender minority patients.
Authors: Freeman Jincong Q. , Verghese Michelle , Connor Brian W. , Hazra Aniruddha , Romero Iris , Fisher Andrew R. , Rosenblatt Adena E. 
Published: June 2023

10557 Background: Skin cancer disproportionately affects sexual and gender minorities in the United States. A full-body skin examination (FBSE) can help detect early signs of skin cancer and is an important prevention method. However, there are no national guidelines of routine FBSE for skin cancer. Further, data on FBSE participation among lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+) patients are lacking, and little is known about the racial/ethnic distribution of FBSE in this patient population. Methods: Cross-sectional survey data on FBSE participation and key characteristics were collected from patients who were recruited at clinics and community centers or via social media from August 2022 to January 2023. Eligibility criteria included being at least 18 years old and self-identifying as LGBTQ+. Receipt of an FBSE, assessed by asking patients whether they had ever received an FBSE in the past, was dichotomized as yes and no. Descriptive statistics, i.e., mean (SD) and count (%), were calculated, with distribution comparisons using Student’s t, Pearson’s Chi-square, or Fisher’s exact tests as appropriate. Results: A total of 124 LGBTQ+ patients responded to the survey. The mean age was 32.4 (SD = 12.1) years. Overall, 41.5% of the patients reported ever having received an FBSE in the past. By race/ethnicity, 62.5% of Non-Hispanic Black patients reported ever having received an FBSE, followed by 52.1% of Non-Hispanic White, 28.6% of Hispanic or Latino, 28.6% of multiple races, and 10.5% of Asian ( p= 0.005). By gender identity, 61.5% of transgender male patients reported receipt of an FBSE in the past, followed by 57.1% of transgender female, 39.3% of cisgender female, 35.4% of cisgender male, and 35.0% of genderqueer, non-binary, or gender non-conforming. Comparing patients who reported ever having received an FBSE, those who did not were more likely to not be employed (47.9% vs. 26.0%, p= 0.046), to be on Medicaid (18.5% vs. 6.1%, p= 0.074), to not have visited a dermatologist in the past (41.7% vs. 7.8%, p< 0.001), and to not have been told at an increased risk for skin cancer (87.3% vs. 43.2%, p< 0.001). No significant differences in educational attainment or sexual orientation were observed between patients who reported ever having received an FBSE and those who did not. Conclusions: The prevalence of FBSE was higher among Non-Hispanic Black or Non-Hispanic White LGBTQ+ patients than among those who are Hispanic or Latino, multiracial, or Asian. In addition, our findings suggest that low socioeconomic status and health care utilization may influence FBSE access or participation in LGBTQ+ patients. Strategies for improving equitable access to FBSE among LGBTQ+ patients, particularly among those with ethnic minority background or low socioeconomic status and health care utilization, may be needed.
Vitamin D deficiency as a risk factor for breast cancer development.
Authors: Mackey James David , Young Peter , Zimmerer Rene , Miles Brittany 
Published: June 2023

10559 Background: Previous studies and meta-analyses have suggested that women with low levels of vitamin D may be at increased risk of breast cancer development and recurrence. The relationship is suspected to be inverse, nonlinear, and predominantly present in postmenopausal women. The purpose of this study was to use the TriNetX platform to determine the magnitude of breast cancer risk increase for women with significant vitamin D deficiency and evaluate the significance of menopause on vitamin D-associated breast cancer risk. Methods: The TriNetX platform was used to generate patient cohorts via International Classification of Disease-10 (ICD-10) codes. All patients were females over 40, had no prior history of breast cancer (C50), and had been diagnosed with menopause (Z78.0). One cohort had less than 20 ng/mL of vitamin D while the other had greater than 30 ng/mL. The cohorts were balanced for age, race, and ethnicity, resulting in 73,659 patients in each arm. They were then evaluated for the future development of breast cancer (C50). Two additional cohorts were created of premenopausal patients aged 40-55 using the same vitamin D parameters and cohort balancing. Results: Postmenopausal women with vitamin D levels below 20 ng/mL had a 45% greater risk of developing breast cancer (risk ratio 1.45, 95% CI (1.38,1.52), p-value <0.0001). (Table) Deficient premenopausal women were also found to be at significantly increased risk although the absolute risk difference was small (relative risk 1.18, 95% CI (1.10,1.27), p-value <0.0001). Conclusions: These results confirm and also quantify the previously-suspected increased breast cancer risk for women who are deficient in vitamin D. The impact of low vitamin D levels on breast cancer risk in premenopausal patients was statistically significant but small in magnitude, while postmenopausal women were found to have approximately 45% higher risk as compared to women who were not deficient. Vitamin D supplementation for all deficient postmenopausal women should be considered. [Table: see text]
A nationwide population based primary CNS lymphoma (PCNSL) analysis: Do Hispanics have better outcomes?
Authors: Orellana Ysaith , Lucero Kana , Liu Qianqian , Michalek Joel , Diaz Duque Adolfo Enrique 
Published: June 2023

10560 Background: Over the last decade, overall survival (OS) of PCNSL patients has increased from 12.5 months to 26 months (N. Oncol, PMID 30418592). One study examined the incidence of PCNSL in the Hispanic (HI) population in Texas (Cureus, PMID: 33042676), but a national study is needed to understand ethnic disparities, as many HI face barriers to health care access (Natl Cance Inst Monogr, PMIDL 8562207). This study aims to understand demographics, treatment patterns, and outcomes of HI and Non-Hispanic (NH) patients with PCNSL nationally. Methods: Data analyzed on PCNSL patients in the United States (US) was reported to the Surveillance, Epidemiology, End Results (SEER) 18 database between 2000 and 2018. Racial groups analyzed included NH whites, HI whites, Blacks, and Asian/Pacific Islanders (PI). Patient characteristics, age-adjusted incidence rate, and survival rate were compared across ethnic groups (HI vs. NH). Stratification by age, gender, and stage at diagnosis was considered. Data was stratified using Kaplan-Meier and Cox regression analyses to compare OS between HI and NH. Multivariate analysis and propensity score matching was performed with adjustment for age, stage, and B-symptoms. Results: Of 5819 PCNSL patients, 15% were HI, and 85% NH. 57% were male compared to 51% of NH. As compared to NH at diagnosis, HI patients were younger, 59 years vs. 66 years(y) (p<0.001); the majority of HI (42%) were diagnosed in the age bracket of 60-80y (p<0.001). Approximately 30% of HI were diagnosed in 2015-2018, while most of NH (29%) were diagnosed in 2010-2014 (p=0.054). With 52% of HI being diagnosed at <60y, only 32% in NH. As for race, most of HI and NH were White (97% vs. 79%), followed by Black (1% vs. 8%). On survival analysis, the survival probability at 2, 5, and 10y of HI vs. NH were (0.507 vs. 0.441), (0.395 vs. 0.322), and (0.237 vs. 0.225), respectively. The median survival time was 2.1y for HI vs. 1.2y for NH. There was an OS difference favoring HI (p=0.0009). On multivariate analysis, when adjusted for age, patients with PCNSL between 60-80y and above have 3.4 times more likely to die from disease after diagnosis with HR 3.4 (95% CI:2.9-4) and 1.7 (95% CI: 1.6-1.9). Conclusions: Our study demonstrates statistically longer median survival and OS favoring the HI population. The younger age of diagnosis in HI patients could be a factor in their survival probability for PCNSL, given that both HI and NH received similar treatment and had a similar staging. However, additional studies would be needed to validate this observation and determine other biological or socioeconomic factors that may play a role. [Table: see text]
Elevated cancer risk among individuals with combinations of cancer-related risk factors: A large claims database analysis.
Authors: Cong Ze , Ye Xiangyang , Kurian Allison W. 
Published: June 2023

10561 Background: Besides age, many risk factors have been associated with elevated cancer risk. Understanding cancer incidence rates among patients with single or multiple risk factors can help inform cancer prevention and detection efforts. Methods: A retrospective observational analysis was conducted on individuals aged 50-79 in 2020 using Optum’s de-identified Clinformatics Data Mart Database which includes Medicare Advantage (MA) (vast majority aged 65+) and commercially insured members (mostly below 65 and employed). Patients with no prior cancer diagnosis (continuously enrolled with no cancer claims for one year) and with cancer risk factors were identified using ICD-10-CM and CPT-4 codes, including autoimmune-related chronic inflammation (diabetes, inflammatory bowel disease, asthma, or rheumatoid arthritis) (INFLAM AUTO); non-autoimmune related chronic inflammation (fatty liver disease, obesity, or cirrhosis/chronic hepatitis B/C) (INFLAM NONAUTO); immunodeficiency (primary or secondary immunodeficiency, HIV, or status post organ transplant); and smoking. Cancer incidence rate ratios (IRR) were calculated by comparing one-year cancer incidence rate among the groups with risk factors versus the general population by insurance type (IRR>1 means elevated risk of cancer). Groups with evidence of any risk factor and combinations of risk factors were assessed. Statistical significance of IRRs was evaluated using logistic regression models adjusting for demographic characteristics. Results: Cancer incidence rates of 1.12% and 2.11% were observed among the approximately 1.3 and 2.4 million general population aged 50-79 in commercial and MA plans, respectively. Enrollees with any of the risk factors or combinations analyzed had statistically significantly elevated risk of cancer (IRRs>1.00, p<0.05). Commercially insured groups with highest risk included transplant (IRR=7.68, prevalence=0.02%), immunodeficient and smokers (IRR=3.66, prevalence=0.16%), cirrhosis/chronic hepatitis B/C (IRR=2.61, prevalence=0.41%), INFLAM AUTO and smokers (IRR=2.43, prevalence=3.56%), and smoker (IRR=2.33, prevalence=11.11%). Results in MA were generally consistent with the commercial plan (Table). Conclusions: Patients in both commercial and MA plans with any risk factor experienced significantly elevated cancer risk. Cancer prevention and screening strategies can be informed by risk levels among different patient subgroups to optimize resource allocation. [Table: see text]