Cooperation between PRMT1 and PRMT6 drives lung cancer health disparities among Black/African American men

Lung cancer is the third most common cancer with Black/AA men showing higher risk and poorer outcomes than NHW men. Lung cancer disparities are multifactorial, driven by tobacco exposure, inequities in care access, upstream health determinants, and molecular determinants including biological and genetic factors. Elevated expressions of protein arginine methyltransferases (PRMTs) correlating with poorer prognosis have been observed in many cancers. Most importantly, our study shows that PRMT6 displays higher expression in lung cancer tissues of Black/AA men compared to NHW men. In this study, we investigated the underlying mechanism of PRMT6 and its cooperation with PRMT1 to form a heteromer as a driver of lung cancer. Disrupting PRMT1/PRMT6 heteromer by a competitive peptide reduced proliferation in non-small cell lung cancer cell lines and patient-derived organoids, therefore, giving rise to a more strategic approach in the treatment of Black/AA men with lung cancer and to eliminate cancer health disparities.

Commentary: Some water in the data desert: the Cancer Intervention and Surveillance Modeling Network's capacity to guide mitigation of cancer health disparities

Despite significant progress in cancer research and treatment, a persistent knowledge gap exists in understanding and addressing cancer care disparities, particularly among populations that are marginalized. This knowledge deficit has led to a "data divide," where certain groups lack adequate representation in cancer-related data, hindering their access to personalized and data-driven cancer care. This divide disproportionately affects marginalized and minoritized communities such as the U.S. Black population. We explore the concept of "data deserts," wherein entire populations, often based on race, ethnicity, gender, disability, or geography, lack comprehensive and high-quality health data. Several factors contribute to data deserts, including underrepresentation in clinical trials, poor data quality, and limited access to digital technologies, particularly in rural and lower-socioeconomic communities.The consequences of data divides and data deserts are far-reaching, impeding equitable access to precision medicine and perpetuating health disparities. To bridge this divide, we highlight the role of the Cancer Intervention and Surveillance Modeling Network (CISNET), which employs population simulation modeling to quantify cancer care disparities, particularly among the U.S. Black population. We emphasize the importance of collecting quality data from various sources to improve model accuracy. CISNET's collaborative approach, utilizing multiple independent models, offers consistent results and identifies gaps in knowledge. It demonstrates the impact of systemic racism on cancer incidence and mortality, paving the way for evidence-based policies and interventions to eliminate health disparities. We suggest the potential use of voting districts/precincts as a unit of aggregation for future CISNET modeling, enabling targeted interventions and informed policy decisions.

Wnt7a deficit is associated with dysfunctional angiogenesis in pulmonary arterial hypertension

INTRODUCTION

Pulmonary arterial hypertension (PAH) is characterised by loss of microvessels. The Wnt pathways control pulmonary angiogenesis but their role in PAH is incompletely understood. We hypothesised that Wnt activation in pulmonary microvascular endothelial cells (PMVECs) is required for pulmonary angiogenesis, and its loss contributes to PAH.

METHODS

Lung tissue and PMVECs from healthy and PAH patients were screened for Wnt production. Global and endothelial-specific Wnt7a -/- mice were generated and exposed to chronic hypoxia and Sugen-hypoxia (SuHx).

RESULTS

Healthy PMVECs demonstrated >6-fold Wnt7a expression during angiogenesis that was absent in PAH PMVECs and lungs. Wnt7a expression correlated with the formation of tip cells, a migratory endothelial phenotype critical for angiogenesis. PAH PMVECs demonstrated reduced vascular endothelial growth factor (VEGF)-induced tip cell formation as evidenced by reduced filopodia formation and motility, which was partially rescued by recombinant Wnt7a. We discovered that Wnt7a promotes VEGF signalling by facilitating Y1175 tyrosine phosphorylation in vascular endothelial growth factor receptor 2 (VEGFR2) through receptor tyrosine kinase-like orphan receptor 2 (ROR2), a Wnt-specific receptor. We found that ROR2 knockdown mimics Wnt7a insufficiency and prevents recovery of tip cell formation with Wnt7a stimulation. While there was no difference between wild-type and endothelial-specific Wnt7a -/- mice under either chronic hypoxia or SuHx, global Wnt7a +/- mice in hypoxia demonstrated higher pulmonary pressures and severe right ventricular and lung vascular remodelling. Similar to PAH, Wnt7a +/- PMVECs exhibited an insufficient angiogenic response to VEGF-A that improved with Wnt7a.

CONCLUSIONS

Wnt7a promotes VEGF signalling in lung PMVECs and its loss is associated with an insufficient VEGF-A angiogenic response. We propose that Wnt7a deficiency contributes to progressive small vessel loss in PAH.

Does the Vaginal Microbiome Operate Differently by Race to Influence Risk of Precervical Cancer?

Background: The vaginal microbiome (VMB) plays an important role in the persistence of human papillomavirus (HPV) infection and differs by race and among women with cervical intraepithelial neoplasia (CIN). Materials and Methods: We explored these relationships using 16S rRNA VMB taxonomic profiles of 3050 predominantly Black women. VMB profiles were assigned to three subgroups based on taxonomic markers indicative of vaginal wellness: optimal (Lactobacillus crispatus, L. gasseri, and L. jensenii), moderate (L. iners), and suboptimal (Gardnerella vaginalis, Atopobium vaginae, Ca. Lachnocurva vaginae, and others). Multivariable Firth logistic regression models were adjusted for age, smoking, VMB, HPV, and pregnancy status. Results: VMB prevalence by subgroup was 18%, 30%, and 51% for the optimal, moderate, and suboptimal groups, respectively. In fully adjusted models, the risk of CIN grade 3 (CIN3) among non-Latina (nL) Blacks was twice that of nL Whites (odds ratio [OR] = 2.0, 95% confidence interval [CI]: 1.1, 3.9, p = 0.02). The VMB modified this association (p = 0.04) such that the risk of CIN3 was significantly higher for nL Blacks than for nL Whites only among women with optimal VMBs (OR = 7.8, 95% CI: 1.7, 74.5, p = 0.007). Within racial groups, the risk of CIN3 was only elevated among nL White women with suboptimal VMBs (OR = 6.0, 95% CI: 1.3, 56.9, p = 0.02) compared with their racial counterparts with optimal VMBs. Conclusions: Our findings suggest that race is a modifier of the VMB in HPV carcinogenesis. An optimal VMB does not appear to be protective for nL Black women compared with nL White women.

Abstract 343: Cooperation between PRMT1 and PRMT6 drives lung cancer health disparities among Black/African American men

Non-Hispanic Black/African American (Black/AA) men in the United States have disproportionally higher incidence and mortality rates of lung cancer compared to non-Hispanic White (NHW) men. Molecular determinants including biological and genetic factors are believed to play critical roles in driving disparities. Yet, several recent large-scale genomic studies fail to identify significant somatic differences in lung cancer driver genes contributing to observed disparities between Black/AA and NHW groups. These findings suggest that epigenetic mechanisms may contribute to lung cancer disparities in Black/AA men. Arginine methylation is a post-translational modification catalyzed by protein arginine methyltransferases (PRMTs) that has gained considerable interest as many cancer types display elevated expression of PRMTs correlating with poor prognosis. Here, we observed a significant difference in the expression levels of PRMT6 between Black/AA men vs. NHW men with non-small cell lung cancer (NSCLC) that may contribute to cancer health disparities. To uncover the molecular mechanism by which PRMT6 drives lung cancer, we performed co-immunoprecipitation, protein arginine methylation, and cell proliferation assays using several NSCLC cell lines. We demonstrated that PRMT6 formed a heteromer complex with PRMT1 and disruption of the complex with a competitive peptide inhibitor significantly reduced cancer cell proliferation. We further showed that PRMT1/PRMT6 heteromer complex recruited and catalyzed arginine methylation of interleukin enhancer-binding factor 2 (ILF2). Disrupting heteromer complex formation leaded to a significant reduction of ILF2 methylation and expression. Finally, downregulation of ILF2 expression reduced the positive effects of PRMT1/PRMT6 complex on cell proliferation. Our findings demonstrate the significant functionality of PRMT1/PRMT6 heteromer complex to positively regulate ILF2 expression that is essential for cancer cell proliferation. Furthermore, we uncover a category of substrates for this complex providing the new insights for more potential therapeutic targets that may set the stage for developing new alternative approach to PRMT inhibition. This approach would potentially allow the ability to overcome the current limitations of PRMT1 or PRMT6 inhibitors, thereby opening up new horizons for efficacious PRMT1/PRMT6-targeted agents that are expected to eliminate lung cancer health disparities in Black/AA men.

Citation Format: Ching-Yi Chen, Pei-Ying Wu, Michelle Van Scoyk, Stephanie A. Simko, Chu-Fang Chou, Robert A. Winn. Cooperation between PRMT1 and PRMT6 drives lung cancer health disparities among Black/African American men [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 343.

Abstract 5771: The vaginal microbiome as a mediator in the relationship between Black/White race and high grade cervical intraepithelial neoplasia

The vaginal microbiome (VMB) is implicated in the development of high-grade squamous intraepithelial lesions (HSIL). The VMB is taxonomically diverse, immunomodulatory, and racially differentiated. The VMB of Black women exhibits increased microbial diversity (associated with HPV tumorigenesis) and lower prevalence of taxa such as Lactobacillus (inversely associated with severity of cervical abnormalities) compared to white counterparts. Black women also have more persistent HPV infections and higher incidence of HSILs than whites. Our prior publication suggests the relationship between the VMB and HSIL might be differential by self-reported race. Herein we explore the underlying mechanisms by which race may lead to risk of HSIL through the VMB. We used 16S-rRNA VMB taxonomic profiles of 1,168 consented women receiving their annual routine exam between 2009-2013. Of these, 74 (6%) developed HSIL after the VMB sample collection (followed through 10/2020). The VMB profiles were categorized into three subgroups, based on a priori knowledge, by taxonomic abundance as “Lactobacillus crispatus” (including L. crispatus, L. gasseri and L. jensenii, all generally associated with gynecologic health), “L. iners” (considered a transitional state), and “Other” (including taxa, such as Gardenerella vaginalis, Atopibium vaginae, Lachnocurva vaginae and others often associated with adverse gynecologic outcomes). HPV status was obtained by sequencing a fragment of the L1 gene. We used self-reported health histories, confirmed by electronic health records where available, and other socio-demographic information. HIV-positive women were excluded. We used structural equations modeling, following a normal theory maximum likelihood approach with robust errors to estimate the proportion of the association between race and HSIL mediated by the VMB, using STATA version 13.1. The cohort was predominantly Black (72%), with VMB prevalence by subgroup of 18%, 29% and 52% for L. crispatus, L. iners, and Other, respectively. Blacks had a higher prevalence of the “Other” VMB subtype, compared to nL-whites (59% vs. 49%). Forty-five percent of the sample tested positive for HPV, with no significant difference by race (p=0.9). The incidence of HSIL was nearly double for Blacks compared to whites (7% to 4%). Women with HSIL exhibited a higher prevalence of the “Other” VMB (68% vs. 51%) and were more likely to be HPV positive (73%vs. 44%) than their healthy counterparts. In SEM, only the following path was statistically significant at p<0.05: raceàVMBàHSIL, with an estimated proportion mediated by this path of 36%. Findings suggest the VMB is a mediator that might explain some of the underlying mechanisms of the relationship between race and risk of HSIL. If confirmed, this might have potential prophylactic and therapeutic implications as the VMB is amenable to pre and probiotics.

Citation Format: Katherine Y. Tossas, Stephanie Sullivan, Myrna Serrano, Jerome Strauss, Robert A. Winn, Gregory Buck. The vaginal microbiome as a mediator in the relationship between Black/White race and high grade cervical intraepithelial neoplasia. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5771.

KCNF1 promotes lung cancer by modulating ITGB4 expression

Lung cancer continues to be the leading cause of cancer death in the United States. Despite recent advances, the five-year survival rate for lung cancer compared to other cancers still remains fairly low. The discovery of molecular targets for lung cancer is key to the development of new approaches and therapies. Electrically silent voltage-gated potassium channel (KvS) subfamilies, which are unable to form functional homotetramers, are implicated in cell-cycle progression, cell proliferation and tumorigenesis. Here, we analyzed the expression of KvS subfamilies in human lung tumors and identified that potassium voltage-gated channel subfamily F member 1 (KCNF1) was up-regulated in non-small cell lung cancer (NSCLC). Silencing of KCNF1 in NSCLC cell lines reduced cell proliferation and tumor progression in mouse xenografts, re-established the integrity of the basement membrane, and enhanced cisplatin sensitivity. KCNF1 was predominately localized in the nucleoplasm and likely mediated its functions in an ion-independent manner. We identified integrin β4 subunit (ITGB4) as a downstream target for KCNF1. Our findings suggest that KCNF1 promotes lung cancer by enhancing ITGB4 signaling and implicate KCNF1 as a novel therapeutic target for lung cancer.

Miz1 promotes KRAS-driven lung tumorigenesis by repressing the protocadherin Pcdh10

Targeting KRAS-mutated non-small-cell lung cancer (NSCLC) remains clinically challenging. Here we show that loss of function of Miz1 inhibits lung tumorigenesis in a mouse model of oncogenic KRAS-driven lung cancer. In vitro, knockout or silencing of Miz1 decreases cell proliferation, clonogenicity, migration, invasion, or anchorage-independent growth in mutant (MT) KRAS murine or human NSCLC cells but has unremarkable impact on non-tumorigenic cells or wild-type (WT) KRAS human NSCLC cells. RNA-sequencing reveals Protocadherin-10 (Pcdh10) as the top upregulated gene by Miz1 knockout in MT KRAS murine lung tumor cells. Chromatin immunoprecipitation shows Miz1 binding on the Pcdh10 promoter in MT KRAS lung tumor cells but not non-tumorigenic cells. Importantly, silencing of Pcdh10 rescues cell proliferation and clonogenicity in Miz1 knockout/knockdown MT KRAS murine or human tumor cells, and rescues allograft tumor growth of Miz1 knockout tumor cells in vivo. Miz1 is upregulated in MT KRAS lung tumor tissues compared with adjacent non-involved tissues in mice. Consistent with this, Miz1 is upregulated while Pcdh10 is downregulated in human lung adenocarcinomas (LUAD) compared with normal tissues, and high Miz1 levels or low Pcdh10 levels are associated with poor survival in lung cancer patients. Furthermore, the Miz1 signature is associated with worse survival in MT but not WT KRAS LUAD, and Pcdh10 is downregulated in MT compared to WT KRAS LUAD. Taken together, our studies implicate the Miz1/Pcdh10 axis in oncogenic KRAS-driven lung tumorigenesis.

Advancing More Equitable Care Through the Development of a Health Equity Report Card

The root causes of racial disparities in access to optimal cancer care and related cancer outcomes are complex, multifactorial, and not rooted in biology. Contributing factors to racial disparities in care delivery include implicit and explicit bias, lack of representation of people of color in the oncology care and research workforce, and homogenous research participants that are not representative of the larger community. Systemic and structural barriers include policies leading to lack of insurance and underinsurance, costs of cancer treatment and associated ancillary costs of care, disparate access to clinical trials, and social determinants of health, including exposure to environmental hazards, access to housing, childcare, and economic injustices. To address these issues, ACS CAN, NCCN, and NMQF convened the Elevating Cancer Equity (ECE) initiative. The ECE Working Group developed the Health Equity Report Card (HERC). In this manuscript, we describe the process taken by the ECE Working Group to develop the HERC recommendations, the strategies employed by NCCN to develop an implementation plan and scoring methodology for the HERC, and next steps to pilot the HERC tool in practice settings.

Associations in Cigarette Smoking and Health Conditions by Race/Ethnicity Among a Diverse Sample of Patients Receiving Treatment in a Federally Qualified Health Care Setting in Chicago

Purpose

To examine the association of cigarette use and smoking-related health conditions by race/ethnicity among diverse and low-income patients at a federally qualified health center (FQHC).

Methods

Demographics, smoking status, health conditions, death, and health service use were extracted from electronic medical data for patients seen between September 1, 2018, and August 31, 2020 (n=51,670). Smoking categories included everyday/heavy smoker, someday/light smoker, former smoker, or never smoker.

Results

Current and former smoking rates were 20.1% and 15.2%, respectively. Males, Black, White, non-partnered, older, and Medicaid/Medicare patients were more likely to smoke. Compared with never smokers, former and heavy smokers had higher odds for all health conditions except respiratory failure, and light smokers had higher odds of asthma, chronic obstructive pulmonary disease, emphysema, and peripheral vascular disease. All smoking categories had more emergency department visits and hospitalizations than never smokers. The associations between smoking status and health conditions differed by race/ethnicity. White patients who smoked had a greater increase in odds of stroke and other cardiovascular diseases compared with Hispanic and Black patients. Black patients who smoked had a greater increase in odds of emphysema and respiratory failure compared with Hispanic patients. Black and Hispanic patients who smoked had a greater increase in emergency care use compared with White patients.

Conclusion

Smoking was associated with disease burden and emergency care and differed by race/ethnicity.

Health Equity Implications

Resources to document smoking status and offer cessation services should be increased in FQHCs to promote health equity for lower income populations.

Cell Competition in Carcinogenesis

The majority of human cancers evolve over time through the stepwise accumulation of somatic mutations followed by clonal selection akin to Darwinian evolution. However, the in-depth mechanisms that govern clonal dynamics and selection remain elusive, particularly during the earliest stages of tissue transformation. Cell competition (CC), often referred to as 'survival of the fittest' at the cellular level, results in the elimination of less fit cells by their more fit neighbors supporting optimal organism health and function. Alternatively, CC may allow an uncontrolled expansion of super-fit cancer cells to outcompete their less fit neighbors thereby fueling tumorigenesis. Recent research discussed herein highlights the various non-cell-autonomous principles, including interclonal competition and cancer microenvironment competition supporting the ability of a tumor to progress from the initial stages to tissue colonization. In addition, we extend current insights from CC-mediated clonal interactions and selection in normal tissues to better comprehend those factors that contribute to cancer development.

Enrollment Matters: The Reality of Disparity and Pursuit of Equity in Clinical Trials

SUMMARY

Disparities in clinical trial enrollment persist, fortified by the foundation and historical ideologies undergirding clinical cancer research. The scientific community has an ethical responsibility to seize the current moment to deconstruct and reconstruct these paradigms for more equitable research.

The National Heart Lung and Blood Institute Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Alliance

OBJECTIVE

To describe the National Heart Lung and Blood Institute (NHLBI) sponsored Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease (DECIPHeR) Alliance to support late-stage implementation research aimed at reducing disparities in communities with high burdens of cardiovascular and/or pulmonary disease.

STUDY SETTING

NHBLI funded seven DECIPHeR studies and a Coordinating Center. Projects target high-risk diverse populations including racial and ethnic minorities, urban, rural, and low-income communities, disadvantaged children, and persons with serious mental illness. Two projects address multiple cardiovascular risk factors, three focus on hypertension, one on tobacco use, and one on pediatric asthma.

STUDY DESIGN

The initial phase supports planning activities for sustainable uptake of evidence-based interventions in targeted communities. The second phase tests late-stage evidence-based implementation strategies.

DATA COLLECTION/EXTRACTION METHODS

Not applicable.

PRINCIPAL FINDINGS

We provide an overview of the DECIPHeR Alliance and individual study designs, populations, and settings, implementation strategies, interventions, and outcomes. We describe the Alliance's organizational structure, designed to promote cross-center partnership and collaboration.

CONCLUSIONS

The DECIPHeR Alliance represents an ambitious national effort to develop sustainable implementation of interventions to achieve cardiovascular and pulmonary health equity.

Cancer statistics for African American/Black People 2022

African American/Black individuals have a disproportionate cancer burden, including the highest mortality and the lowest survival of any racial/ethnic group for most cancers. Every 3 years, the American Cancer Society estimates the number of new cancer cases and deaths for Black people in the United States and compiles the most recent data on cancer incidence (herein through 2018), mortality (through 2019), survival, screening, and risk factors using population-based data from the National Cancer Institute and the Centers for Disease Control and Prevention. In 2022, there will be approximately 224,080 new cancer cases and 73,680 cancer deaths among Black people in the United States. During the most recent 5-year period, Black men had a 6% higher incidence rate but 19% higher mortality than White men overall, including an approximately 2-fold higher risk of death from myeloma, stomach cancer, and prostate cancer. The overall cancer mortality disparity is narrowing between Black and White men because of a steeper drop in Black men for lung and prostate cancers. However, the decline in prostate cancer mortality in Black men slowed from 5% annually during 2010 through 2014 to 1.3% during 2015 through 2019, likely reflecting the 5% annual increase in advanced-stage diagnoses since 2012. Black women have an 8% lower incidence rate than White women but a 12% higher mortality; further, mortality rates are 2-fold higher for endometrial cancer and 41% higher for breast cancer despite similar or lower incidence rates. The wide breast cancer disparity reflects both later stage diagnosis (57% localized stage vs 67% in White women) and lower 5-year survival overall (82% vs 92%, respectively) and for every stage of disease (eg, 20% vs 30%, respectively, for distant stage). Breast cancer surpassed lung cancer as the leading cause of cancer death among Black women in 2019. Targeted interventions are needed to reduce stark cancer inequalities in the Black community.

Impact of Federal, State, and Local Housing Policies on Disparities in Cardiovascular Disease in Black/African American Men and Women: From Policy to Pathways to Biology

Racist and discriminatory federal, state, and local housing policies significantly contribute to disparities in cardiovascular disease incidence and mortality for individuals that self-identify as Black or African American. Here we highlight three key housing policies - "redlining," zoning, and the construction of highways - which have wrought a powerful, sustained, and destructive impact on cardiovascular health in Black/African American communities. Redlining and highway construction policies have restricted access to quality health care, increased exposure to carcinogens such as PM_2.5, and increased exposure to extreme heat. At the root of these policy decisions are longstanding, toxic societal factors including racism, segregation, and discrimination, which also serve to perpetuate racial inequities in cardiovascular health. Here, we review these societal and structural factors and then link them with biological processes such as telomere shortening, allostatic load, oxidative stress, and tissue inflammation. Lastly, we focus on the impact of inflammation on the immune system and the molecular mechanisms by which the inflamed immune microenvironment promotes the formation of atherosclerotic plaques. We propose that racial residential segregation and discrimination increases tissue inflammation and cytokine production, resulting in dysregulated immune signaling, which promotes plaque formation and cardiovascular disease. This framework has the power to link structural racism not only to cardiovascular disease, but also to cancer.

American Cancer Society's report on the status of cancer disparities in the United States, 2021

In this report, the authors provide comprehensive and up-to-date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5-year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence-based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.

Project COALESCE-An Example of Academic Institutions as Conveners of Community-Clinic Partnerships to Improve Cancer Screening Access

In Virginia, 56% of colorectal cancers (CRC) are diagnosed late, making it one of three enduring CRC mortality hotspots in the US. Cervical cancer (CCa) exhibits a similar pattern, with 48% late-stage diagnosis. Mortality for these cancers is worse for non-Latinx/e(nL)-Black people relative to nL-White people in Virginia, but preventable with equitable screening access and timely diagnostic follow-up. However, structural barriers, such as fractured referral systems and extended time between medical visits, remain. Because Federally Qualified Health Centers (FQHCs) care for a large proportion of racial and ethnic minorities, and underserved communities, regardless of ability to pay, they are ideal partners to tackle structural barriers to cancer screenings. We piloted a quality improvement initiative at five FQHCs in southcentral Virginia to identify and address structural, race-related barriers to CRC, as well as CCa screening and diagnostic follow-up using evidence-based approaches. Uniquely, FQHCs were paired with local community organizations in a didactic partnership, to elevate the community’s voice while together, increase support, acceptance, uptake, and intervention sustainability. We report on project development, and share preliminary data within the context of project goals, namely, to increase cancer screenings by 5–10%, improve knowledge and diagnostic follow-up processes, and build longitudinal partnerships.

Abstract IA-01: Health disparity research: The new frontier of research

In 2020, the AACR's U.S. Cancer Disparities Progress Report showed that the there is still a significant gap in cancer incidence and mortality between white Americans and other racial and ethnic groups. That's not because the science hasn't progressed or because people of color are biologically predisposed to cancer. It's because the systems and structures put in place decades ago continue to harm the health of racial and ethnic minorities. Red-lining in the 1930s created segregated housing, and then the creation of the national highway system decimated majority-Black neighborhoods, leaving them treeless, polluted, and lacking healthy food and medical facilities. As a result, people living in these neighborhoods are more likely to get cancer and also more likely to die from it. So, when COVID-19 hit, many of us were not surprised that communities of color were disproportionately affected. And the current situation with COVID-19 vaccines is a great demonstration that while science is necessary for improving health, it's not sufficient. Those amazingly effective vaccines can't keep hospitals from being overwhelmed if a large chunk of the population won't get the shot, just as advances in cancer screening and treatment can't end disparities if they're predominantly going to wealthy white people. This realization has been one of our blind spots as scientists and physicians. Not only must work toward equitable access to care, but we must also work on building trust in medicine, which we do by demonstrating that we're trustworthy. There's a science to it, though we're going to have to allow for greater flexibility and messiness than we're accustomed to.

Citation Format: Robert A. Winn. Health disparity research: The new frontier of research [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-01.

Abstract PR-14: A synergy between the vaginal microbiome and HPV may have explanatory value for racial disparities in risk of pre-cervical cancer

The vaginal microbiome (VMB) is suggested to be a key player in high-risk Human Papilloma Virus (HPV) infection persistence, leading to the development of cervical intraepithelial neoplasia (CIN). While it is generally accepted that the VMB of women with CIN differs from that of healthy women, the VMB composition before a woman develops CIN has not been well studied. Moreover, no studies have evaluated the role of self-reported race on the VMB-CIN relationship, despite reports that the VMB of non-Latina Black (Black) women generally exhibits increased microbial diversity (often associated with HPV tumorigenesis) and lower prevalence of taxa such as Lactobacillus (reported to have an inverse association with severity of cervical abnormalities) compared to their non-Latina White (White) counterparts. Black women have higher HPV prevalence than Whites (39% vs. 24%), and more persistent HPV infections (601 days vs. 316 days, respectively), despite having a similar number of HPV infections to Whites. This suggests that factors beyond multiple HPV exposures sustain the infection. We hypothesize that HPV and the VMB may interact differently by race, to promote development of CIN. Methods: We used 16S-RNA profiles from the VMB of 3,050 consented women visiting the Virginia Commonwealth University clinics for their annual routine exam between August 2009 and November 2013. Of these, 259 had evidence of subsequent CIN after the VMB sample collection, through October 2020. The VMB profiles were characterized into three groups as “Lactobacillus (L) crispatus” group (including L. crispatus, L. gasseri and L. jensenii), “L. iners” group and “Other” based on a priori knowledge of profiled taxa. The “Other” subgroup included taxa, such as G. vaginalis, A vaginae, and others usually associated with bacterial vaginosis-like states. We used self-reported health histories, confirmed by electronic health records to determine HPV status and obtain other socio-demographic information. Multivariable logistic regression models were adjusted for age, smoking, VMB, HPV, marital and pregnancy status. Results: The cohort was mainly Black (70%), and the VMB prevalence by group was 19%, 30% and 51% for L. crispatus, L. iners, and Other, respectively. Twelve percent reported having an HPV diagnosis in the past, and 302 (10%) women developed CIN during an average of 3.6 years of follow-up (259 with CIN 1/2 and 43 with CIN3+). In crude analyses, risk of CIN was 80% higher for Black women (RR=1.8, p<0.0001) compared to Whites. However, a significant interaction between HPV status and the VMB revealed that the risk of a CIN diagnosis for HPV+ Black women with the “Other” VMB subtype, is five-fold (RR=5.3, p<0.40) the risk for Whites. Conclusions: These preliminary results suggest that interactions between the VMB and HPV may account for the differential risk of CIN by race. If replicated in further analyses, VMB profiling could help elucidate the basis of CIN racial disparities.

Citation Format: Katherine Y. Tossas, Jinlei Zhao, Myrna Serrano, Jerome Strauss, Victoria Seewaldt, Gregory Buck, Robert A. Winn. A synergy between the vaginal microbiome and HPV may have explanatory value for racial disparities in risk of pre-cervical cancer [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PR-14.

Identification of the SARS-CoV-2 Entry Receptor ACE2 as a Direct Target for Transcriptional Repression by Miz1

Multiple lines of evidence have demonstrated that cigarette smoke or Chronic Obstructive Pulmonary Disease upregulates angiotensin-converting enzyme 2, the cellular receptor for the entry of the severe acute respiratory syndrome coronavirus 2, which predisposes individuals to develop severe Coronavirus disease 2019. The reason for this observation is unknown. We recently reported that the loss of function of Miz1 in the lung epithelium in mice leads to a spontaneous COPD-like phenotype, associated with upregulation of angiotensin-converting enzyme 2. We also reported that cigarette smoke exposure downregulates Miz1 in lung epithelial cells and in mice, and Miz1 is also downregulated in the lungs of COPD patients. Here, we provide further evidence that Miz1 directly binds to and represses the promoter of angiotensin-converting enzyme 2 in mouse and human lung epithelial cells. Our data provide a potential molecular mechanism for the upregulation of angiotensin-converting enzyme 2 observed in smokers and COPD patients, with implication in severe Coronavirus disease 2019.

Clinical Application of Computational Methods in Precision Oncology: A Review

Importance

There is an enormous and growing amount of data available from individual cancer cases, which makes the work of clinical oncologists more demanding. This data challenge has attracted engineers to create software that aims to improve cancer diagnosis or treatment. However, the move to use computers in the oncology clinic for diagnosis or treatment has led to instances of premature or inappropriate use of computational predictive systems.

Objective

To evaluate best practices for developing and assessing the clinical utility of predictive computational methods in oncology.

Evidence Review

The National Cancer Policy Forum and the Board on Mathematical Sciences and Analytics at the National Academies of Sciences, Engineering, and Medicine hosted a workshop to examine the use of multidimensional data derived from patients with cancer and the computational methods used to analyze these data. The workshop convened diverse stakeholders and experts, including computer scientists, oncology clinicians, statisticians, patient advocates, industry leaders, ethicists, leaders of health systems (academic and community based), private and public health insurance carriers, federal agencies, and regulatory authorities. Key characteristics for successful computational oncology were considered in 3 thematic areas: (1) data quality, completeness, sharing, and privacy; (2) computational methods for analysis, interpretation, and use of oncology data; and (3) clinical infrastructure and expertise for best use of computational precision oncology.

Findings

Quality control was found to be essential across all stages, from data collection to data processing, management, and use. Collecting a standardized parsimonious data set at every cancer diagnosis and restaging could enhance reliability and completeness of clinical data for precision oncology. Data completeness refers to key data elements such as information about cancer diagnosis, treatment, and outcomes, while data quality depends on whether appropriate variables have been measured in valid and reliable ways. Collecting data from diverse populations can reduce the risk of creating invalid and biased algorithms. Computational systems that aid clinicians should be classified as software as a medical device and thus regulated according to the potential risk posed. To facilitate appropriate use of computational methods that interpret high-dimensional data in oncology, treating physicians need access to multidisciplinary teams with broad expertise and deep training among a subset of clinical oncology fellows in clinical informatics.

Conclusions and Relevance

Workshop discussions suggested best practices in demonstrating the clinical utility of predictive computational methods for diagnosing or treating cancer.

Similarities in Risk for COVID-19 and Cancer Disparities

Coronavirus disease 2019 (COVID-19) is a novel infectious disease that has spread worldwide. In the United States, COVID-19 disproportionately affects racial and ethnic minorities, particularly African Americans, with an observed 2-fold higher rate for hospitalization and greater than 2-fold higher rate for death as compared with White Americans. The disparity seen with COVID-19 is consistent with patterns of disparities observed for cancer; it is well documented that 5-year survival rates for multiple cancers are lower in African Americans compared with White Americans. Root cause contributions for the disparity overlap between COVID-19 and cancer. While cancer is a genetic disease that is influenced by tissue microenvironment, COVID-19 is an infectious disease that is enabled by cellular expression of angiotensin-converting enzyme 2 receptors. However, socioeconomic disadvantages, level of education, lifestyle factors, health comorbidities, and limited access to medical care appear to fuel underlying risk for both cancer and COVID-19 disparities. In addition to African Americans demonstrating higher risk of acquiring and dying from either disease, they are underrepresented in clinical trials involving cancer or COVID-19. Long-term disparities are present with survivorship from cancer and may be likely with survivorship from COVID-19; both have revealed untoward effects on postdiagnosis economic viability for African Americans. Collaborative strategies that include community engagement, diverse participation in cancer and COVID-19 clinical trials, providing insurance for affected persons who lost employment due to either disease, and supporting safety-net and public hospitals for health care access will be critical to stem these disparities.

Association of Insurance Status and Racial Disparities With the Detection of Early-Stage Breast Cancer

Importance

Compared with non-Hispanic white women, racial/ethnic minority women receive a diagnosis of breast cancer at a more advanced stage and have higher morbidity and mortality with breast cancer diagnosis. Access to care with adequate insurance may be associated with earlier diagnosis, expedited treatment, and improved prognosis.

Objective

To examine the extent to which insurance is associated with access to timely breast cancer diagnosis and breast cancer stage differences among a large, diverse population of US patients with breast cancer.

Design, Setting, and Participants

This retrospective, cross-sectional population-based study used data from the Surveillance, Epidemiology, and End Results Program on 177 075 women aged 40 to 64 years who received a diagnosis of stage I to III breast cancer between January 1, 2010, and December 31, 2016. Statistical analysis was performed from August 1, 2017, to October 1, 2019.

Main Outcomes and Measures

The primary outcome was the risk of having a more advanced stage of breast cancer at diagnosis (ie, stage III vs stages I and II). Mediation analyses were conducted to determine associations of race/ethnicity and proportion of observed differences mediated by health insurance status with earlier stage of diagnosis.

Results

A total of 177 075 women (mean [SD] age, 53.5 [6.8] years; 148 124 insured and 28 951 uninsured or receiving Medicaid) were included in the study. A higher proportion of women either receiving Medicaid or who were uninsured received a diagnosis of locally advanced breast cancer (stage III) compared with women with health insurance (20% vs 11%). In multivariable models, non-Hispanic black (odds ratio [OR], 1.46 [95% CI, 1.40-1.53]), American Indian or Alaskan Native (OR, 1.31 [95% CI, 1.07-1.61]) and Hispanic (OR, 1.35 [95% CI, 1.30-1.42]) women had higher odds of receiving a diagnosis of locally advanced disease (stage III) compared with non-Hispanic white women. When adjusting for health insurance and other socioeconomic factors, associations between race/ethnicity and risk of locally advanced breast cancer were attenuated (non-Hispanic black: OR, 1.29 [95% CI, 1.23-1.35]; American Indian or Alaskan Native: OR, 1.11 [95% CI, 0.91-1.35]; Hispanic: OR, 1.17 [95% CI, 1.12-1.22]). Nearly half (45%-47%) of racial differences in the risk of locally advanced disease were mediated by health insurance.

Conclusions and Relevance

This study's findings suggest that nearly half of the observed racial/ethnic disparities in higher stage at breast cancer diagnosis are mediated by health insurance coverage.

Abstract IA08: Re-examining the Interplay between Structure, Cancer, and Cancer Health Policy

The current COVID crisis has reminded many of us of the importance of structure on health. Whether the structure is a built environment, housing, education, or of the social construct type, it has significant impact at both the community and on an individual level. Many of the current structures contribute to the large disparities we have witnessed especially during this period of COVID. While there is much talk about the upstream determinants of health, it is important to recognize that these upstream determinants are also affected by the politics, policies, and economic realities of the day. For example, while informal discrimination and segregation has always existed in the US, the start of "Red-Lining" was started with the creation of the National Housing Act of 1934, which established the Federal Housing Administration (FHA). The effects of Red-lining exacerbated and formalized segregation in the US, and the long lasting negative consequences of this policy are still felt today. There are a number of structural issues that have enhanced health disparities and specifically cancer health disparities. We will examine how the history of e.g. of “structural racism” has contributed to cancer health disparities and the current efforts underway to reduce these disparities. We will further discuss the interplay between current existing structures and their contribution to cancer, and the policies that contribute to cancer health disparities. Lastly, we will address the call to action to create beneficial policies that will help eradicate cancer health disparities.

Citation Format: Robert A. Winn. Re-examining the Interplay between Structure, Cancer, and Cancer Health Policy [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA08.

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.

Detection of Promoter DNA Methylation in Urine and Plasma Aids the Detection of Non-Small Cell Lung Cancer

PURPOSE

Low-dose CT screening can reduce lung cancer-related mortality. However, CT screening has an FDR of nearly 96%. We sought to assess whether urine samples can be a source for DNA methylation-based detection of non-small cell lung cancer (NSCLC).

EXPERIMENTAL DESIGN

This nested case-control study of subjects with suspicious nodules on CT imaging obtained plasma and urine samples preoperatively. Cases (n = 74) had pathologic confirmation of NSCLC. Controls (n = 27) had a noncancer diagnosis. We detected promoter methylation in plasma and urine samples using methylation on beads and quantitative methylation-specific real-time PCR for cancer-specific genes (CDO1, TAC1, HOXA7, HOXA9, SOX17, and ZFP42).

RESULTS

DNA methylation at cancer-specific loci was detected in both plasma and urine, and was more frequent in patients with cancer compared with controls for all six genes in plasma and in CDO1, TAC1, HOXA9, and SOX17 in urine. Univariate and multivariate logistic regression analysis showed that methylation detection in each one of six genes in plasma and CDO1, TAC1, HOXA9, and SOX17 in urine were significantly associated with the diagnosis of NSCLC, independent of age, race, and smoking pack-years. When methylation was detected for three or more genes in both plasma and urine, the sensitivity and specificity for lung cancer diagnosis were 73% and 92%, respectively.

CONCLUSIONS

DNA methylation-based biomarkers in plasma and urine could be useful as an adjunct to CT screening to guide decision-making regarding further invasive procedures in patients with pulmonary nodules.

Lysocardiolipin acyltransferase regulates NSCLC cell proliferation and migration by modulating mitochondrial dynamics

Lysocardiolipin acyltransferase (LYCAT), a cardiolipin (CL)-remodeling enzyme, is crucial for maintaining normal mitochondrial function and vascular development. Despite the well-characterized role for LYCAT in the regulation of mitochondrial dynamics, its involvement in lung cancer, if any, remains incompletely understood. In this study, in silico analysis of TCGA lung cancer data sets revealed a significant increase in LYCAT expression, which was later corroborated in human lung cancer tissues and immortalized lung cancer cell lines via indirect immunofluorescence and immunoblotting, respectively. Stable knockdown of LYCAT in NSCLC cell lines not only reduced CL and increased monolyso-CL levels but also reduced in vivo tumor growth, as determined by xenograft studies in athymic nude mice. Furthermore, blocking LYCAT activity using a LYCAT mimetic peptide attenuated cell migration, suggesting a novel role for LYCAT activity in promoting NSCLC. Mechanistically, the pro-proliferative effects of LYCAT were mediated by an increase in mitochondrial fusion and a G₁/S cell cycle transition, both of which are linked to increased cell proliferation. Taken together, these results demonstrate a novel role for LYCAT in promoting NSCLC and suggest that targeting LYCAT expression or activity in NSCLC may provide new avenues for the therapeutic treatment of lung cancer.

Abstract B029: Community-based colorectal cancer screening initiative to address colorectal cancer disparities among African Americans and sexual and gender minorities on the Southside of Chicago

Background Colorectal cancer (CRC) persists as the second leading cause of cancer death and African Americans (AA) carry a disproportionate burden of CRC, having the highest incidence and mortality. Although CRC is one of the few cancers where screening can be prevention, AAs have lower uptake of CRC screening. Additionally, sexual and gender minorities (LGBTQ) are another population with growing CRC disparities. To date, few initiatives address CRC among LGBTQ populations. Factors impacting screening uptake among AA and LGBTQ populations are multi-factorial including access, awareness, and stigma. To attenuate low rates of CRC screening, the University of Illinois Cancer Center through funding from the Bristol-Myer Squibb Foundation has developed the UI CAAN (Cancer Screening; Access; Awareness; Navigation) Project. UI CAAN is a community focused cancer education, prevention, screening and navigation program aimed at addressing the elevated burden of CRC within the UI Cancer Center catchment population targeting 200 AA per year for three years. Methods Building upon the Center for Disease Control and Prevention socio-ecological model, UI CAAN will address multi-level barriers impacting CRC screening. The American Cancer Society recommends screening starting at age 45 using Fecal immunochemical tests (FITs). Community Lay navigators will work with barber shops, beauty/nail salons and venues frequented by members of the LGBTQ community to provide education and free FIT kits to AA on the Southside of Chicago. Participants who return their FIT kit will be compensated with a $25 Certificate for the barber or beauty salon or $25 gift card for those engaged through community venues. The project will partner with a Federally Qualified Health Center (FQHC) on the Southside of Chicago to support navigation for follow up. Results Year I is devoted to planning, priority setting and community engagement. The key community stakeholder for UI CAAN is Project Brotherhood, a non-profit community based organization with over two decades of successful engagement of AA communities. To date the project has identified a) A community health worker/lay patient navigator from the targeted community; b) identified and trained one barber and one beautician; c) identified and trained a community health psychologist to assist with program design and implementation and d) has identified two Community Health workers from the LGBTQ community in the target area. IRB approval has been obtained. Conclusion Completion of planning and priority setting of the UI CAAN Project to improve CRC screening among AA and LGBTQ populations on the Southside of Chicago demonstrate the feasibility of community engagement to plan and implement a community based CRC screening initiative. Phase II of Year I will begin August 2019 with screening and recruitment from a barber shop, beauty salon and key community events on the Southside of Chicago with navigation to a local FQHC.

Citation Format: Karriem S Watson, Vida Henderson, Jessica Madrigal, Jeanette Gonzalez, Erica Martinez, Nasima Mannan, Tonya Roberson, Marcus Murray, Katherine Tossas-Milligna, Robert A Winn. Community-based colorectal cancer screening initiative to address colorectal cancer disparities among African Americans and sexual and gender minorities on the Southside of Chicago [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 B029.

Abstract A036: Engaging African American men as citizen scientist to validate a prostate cancer biomarker

Background/Introduction: The purpose of this study is to examine the feasibility of engaging African American (AA) men as Citizen Scientists (CSs) to support the engagement, recruitment, and retention of AA men in a prostate cancer (PCa) study to validate a new biomarker, Prostate Health Index (PHI) in AA men. AA men are traditionally under-represented in PCa research. Additionally, PCa screening studies that have sought to validate innovative ways of improving the screening of PCa often exclude or do not intentionally focus on the engagement of AA men. Using a Community Engaged Participatory Research (CBPR) model, this study purposes to engage the social networks of AA men trained as CSs to engage and recruit a cohort of healthy controls as a low-cost first step in validating PHI as a PCa screening test in AA men.

Methods: Building upon the social networks of the multi-PI team from 3 academic medical institutions and 2 community-based organizations, we sought to identify, recruit, and train 8-12 AA men as CSs. A CS training curriculum was developed and adapted from other CS training models to meet the specific needs of AA men engaged in PCa research. A training series of 5 two-hour modules was developed for the CSs; module 5 is a booster. Validated surveys and post-training evaluations were administered to CSs to assess medical mistrust, cancer knowledge, and adverse childhood experiences. Post-training questionnaires were used to assess quality of training and areas for improvement. Sessions were conducted using CBPR principles to allow CSs to inform the recruitment and retention approaches for AA men in the CSs social network. CSs and PIs collaboratively developed a series of recruitment events within their social networks. IRB approval was obtained across the three academic partners involved.

Results: Nine AA men from the social networks of the multi-PI team have been identified. The 9 CSs include 3 PCa survivors, 2 faith-based leaders, 1 fraternity order member, 1 civic leader, 1 barber, and 1 community social worker. The CSs have completed 3 of 5 modules. All the 9 CSs have completed CITI IRB training and are key personnel in the research protocol. Attendance at meetings ranged from 75-100%. Medical mistrust was high among AA CSs. All CSs strongly agreed that their contribution to AA health equity was a reason for their participation. To date, one pilot community event has been developed from the social network of the faith-based and civic CSs. Six events have been planned for summer/fall 2018 to reach Year 1 recruitment goals.

Conclusion: Early outcomes indicate that it is feasible to engage/train AA men as CSs to conduct PCa disparities research. Attendance and survey data suggest that AA male CSs are willing to support AA-focused PCa disparities research. Pending the assessment of the recruitment feasibility of AA men, this represents a potentially scalable model for engaging AA men in cancer disparities research and for leveraging social networks to support recruitment and retention of AA men in cancer disparities research.

Citation Format: Karriem S. Watson, Josef Ben Levi, Tiffany McDowell, Alfreda Beth-Holloway, LeAndre Moore, Ivanhoe Hall, Alexander Kimbrough, Pooja Gogana, Robert A. Winn, Marcus Murray, Adam Murphy. Engaging African American men as citizen scientist to validate a prostate cancer biomarker [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A036.

Abstract A048: Creating a mobile device-based educational intervention for African American women with hereditary breast cancer risk

Background: Our foundational work found very low rates of attendance at a genetic counseling (GC) consultation among AA women with hereditary breast cancer (BC) risk who were referred for GC, and a strong desire among women and their primary care physicians (PCPs) for culturally sensitive educational material to help women understand the purpose of GC. We are creating a story-based educational intervention delivered on a mobile device platform that is designed to motivate AA women with familial BC risk to attend GC. Content for the intervention is informed by constructs from the Integrative Model of Behavioral Prediction and by themes identified through qualitative research with high-risk AA women. Kreuter's model for culturally tailoring health interventions guided the creation of the intervention.

Methods: Using an iterative process encompassing semistructured, one-on-one interviews and group story circles with AA women referred for GC (primarily nonattenders), we identified themes that represent barriers and motivators to attendance for AA women. The storyline and educational content for the script were based on the themes identified. The script and artwork were tested with focus groups that included members of the target audience AA women with a family history of BC) and key community stakeholders. We are also conducting key informant interviews with PCPs providing care for AA women. The intervention, which will include live-action video sequences and segments of animation to illustrate key educational content, is based on the script that emerged through this iterative process.

Results: Findings from semistructured interviews (N=20) were augmented with data collected from group story circle sessions with a subgroup of women who participated in the one-on-one interviews (N=11). Nine thematic domains emerged from the combined data that are relevant to attendance at a GC appointment: (1) health education/health literacy, (2) trust, relationships, communication with providers, (3) empowerment, (4) health beliefs, (5) motivation/facilitators of breast care, (6) family support and secrecy, (7) religion/spirituality, (8) barriers, and (9) fear resulting from equating genetic counseling with receiving a cancer diagnosis. The findings were used to create a story-based script. Focus groups conducted with community stakeholders and the target audience led to revision in the overall design and style of the intervention (e.g., increased use of live actors and decreased animation) and additional content revisions (e.g., addressing familial secrecy and self-efficacy for women who do not have a referral for GC from a physician). Additional findings from focus groups will be presented and the completed educational video will be previewed.

Conclusion: A technology-enabled, culturally sensitive educational intervention that motivates AA women with increased BC risk to attend a GC consultation will facilitate implementation of a population health approach to eliminating BC disparities.

Citation Format: DeLawnia Comer-HaGans, Vickii Coffey, Giesela Grumbach, Shirley Spencer, Carolyn Rodgers, Ravneet Kaur, Karen Aguirre, Ifeanyi Beverly Chukwudozie, Vida Henderson, Karriem S. Watson, Catherine Balthazar, Angela Odoms-Young, Robert A. Winn, Kent F. Hoskins. Creating a mobile device-based educational intervention for African American women with hereditary breast cancer risk [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A048.

Society of Behavior Medicine (SBM) Urges Congress to Ensure Affordable Care Act Coverage of Prostate Cancer Screening Support Services for High-Risk Men

Prostate cancer (PCa) disproportionately affects African American men. Early detection reduces risk of mortality. The United States Preventive Services Task Force (USPSTF) issued an updated recommendation statement on serum Prostate Specific Antigen (PSA)-based screening for PCa. Specifically, in 2012, the USPSTF recommended against PSA-based screening due to risk for overdiagnosis and overtreatment. However, the updated 2018 guidelines recommend consideration of screening for certain at risk men and revised the recommendation rating from "D" to "C." This new guideline recommends providers to educate high-risk men on the benefits and harms of PSA-based PCa screening so that they can make an informed decision. The Affordable Care Act (ACA) includes provisions of service coverage for patient navigators who can help patients decide whether screening is appropriate, given potential risks and benefits, and training of health care providers in shared-decision regarding screening/treatment. These services can be utilized to support health care providers to better adhere to the new guideline. However, recommendations that are given a C rating or lower are not consistently reimbursed through many plans, including those offered through the ACA marketplace. The Society of Behavioral Medicine (SBM) supports the USPSTF guideline for the consideration of prostate cancer screening for high-risk men between the ages of 55 and 69. SBM encourages policymakers to include provisions for coverage of patient navigation services in the ACA to facilitate shared decision-making between providers and patients regarding screening.

Fostering health equity research: Development and implementation of the Center for Health Equity Research (CHER) Chicago

INTRODUCTION

The purpose of this article is to describe the process of developing and implementing a transdisciplinary community-based research center, the Center for Health Equity Research (CHER) Chicago, to offer a model for designing and implementing research centers that aim to address structural causes of health inequality.

METHODS

Scholars from diverse backgrounds and disciplines formed a multidisciplinary team for the Center and adopted the structural violence framework as the organizing conceptual model. All Center activities were based on community partnership. The Center activities were organized within three cores: administrative, investigator development, and community engagement and dissemination cores. The key activities during the first year were to develop a pilot grant program for early-stage investigators (ESIs) and to establish community partnership mechanisms.

RESULTS

CHER provided more than 60 consultations for ESIs, which resulted in 31 pilot applications over the three application cycles. Over 200 academic and community partners attended the community symposium and discussed community priority. Some challenges encountered were to improve communication among investigators, to clarify roles and responsibilities of the three cores, and to build consensus on the definition and operationalization of the concept of structural violence.

CONCLUSION

There is an increasing need for local hubs to facilitate transdisciplinary collaboration and community engagement to effectively address health inequity. Building consensus around a shared vision among partners is a difficult and yet important step toward achieving equity.

PRMT6 Promotes Lung Tumor Progression via the Alternate Activation of Tumor-Associated Macrophages

Increased expression of protein arginine methyl transferase 6 (PRMT6) correlates with worse prognosis in lung cancer cases. To interrogate the in vivo functions of PRMT6 in lung cancer, we developed a tamoxifen-inducible lung-targeted PRMT6 gain-of-function mouse model, which mimics PRMT6 amplification events in human lung tumors. Lung-targeted overexpression of PRMT6 accelerated cell proliferation de novo and potentiated chemical carcinogen (urethane)-induced lung tumor growth. To explore the molecular mechanism/s by which PRMT6 promotes lung tumor growth, we used proteomics-based approaches and identified interleukin-enhancer binding protein 2 (ILF2) as a novel PRMT6-associated protein. Furthermore, by using a series of in vitro gain-of-function and loss-of-function experiments, we defined a new role for the PRMT6-ILF2 signaling axis in alternate activation of tumor-associated macrophages (TAM). Interestingly, we have also identified macrophage migration inhibitory factor, which has recently been shown to regulate alternate activation of TAMs, as an important downstream target of PRMT6-ILF2 signaling. Collectively, our findings reveal a previously unidentified noncatalytic role for PRMT6 in potentiating lung tumor progression via the alternate activation of TAMs. IMPLICATIONS: This is the first study to demonstrate an in vivo role for PRMT6 in lung tumor progression via the alternate activation of TAMs.

Breaking the Cycle of Health Inequities: The Bioethics of Data

Social epigenomics measures the mechanisms through which place and context change our biology. Big data science connects, analyzes, and allows inferences from previously disconnected data. Precision medicine promises individually-tailored treatments. Together, these emerging fields are changing the way we discover, decipher, and deliver new science to populations. However, differential participation in and uptake (by adopter type-from innovators to laggards) of the discovering, deciphering, and delivering of these new mechanisms may exacerbate health disparities. Innovators and early adopters are generally from higher-resourced environments. This leads to data and findings biased towards those environments. Such biased data in turn continue to be used to generate new discoveries, further obscuring potentially underrepresented populations, and creating a nearly inescapable cycle of health inequity. We argue that equitable access to representative data is of special moral (bioethical) importance, necessary to break the cycle of health inequities.

Building Cross-Institutional Collaborative Infrastructure and Processes: Early Lessons From the Chicago Cancer Health Equity Collaborative

BACKGROUND

Addressing cancer health disparities requires a multitiered, comprehensive approach. The Chicago Cancer Health Equity Collaborative (ChicagoCHEC) was established as a tri-institutional partnership to advance cancer health equity through scientific discovery, education, and community engagement.

OBJECTIVES

Large-scale partnerships rarely document the challenges encountered when establishing processes and operations in the formative years of engagement. We outline selected lessons learned from the first three years of ChicagoCHEC in hopes that future collaborations may be better poised to hit the ground running and create the needed infrastructure for a strong, effective, and sustainable partnership.

LESSONS LEARNED

Unifying a diverse group of stakeholders under a shared mission is imperative. A shared governance structure, in which all individuals understand the aims of partnership and can facilitate progress, is crucial for success. Ongoing monitoring of collaborative processes should occur and attention should be given to the optimization of communications.

CONCLUSIONS

Large-scale collaborative research and education projects across institutions can be challenging, particularly when establishing a working infrastructure and aligning priorities. However, the benefit of establishing key processes in the early years of the collaborative process can lead to high-quality research output, impact, and a sustainable partnership.

Community-Academic Partnerships: Approaches to Engagement

Current public health problems such as cancer have an expansive set of lifestyle and social circumstances that affect the cause and course of the disease. In response, over the past 7 years, the National Cancer Institute (NCI) has recognized the important role that cancer centers play in their community and has gradually increased the requirements and stringency of these sections in the Cancer Center Support Grant guidelines to include a plan for community outreach and engagement. Developing sustainable community-academic partnerships is an essential factor for the successful dissemination and implementation of promising interventions and programs aimed at decreasing barriers and improving cancer outcomes. Understanding how best to facilitate linkages and collaboration can expedite translation of research knowledge into practice and allow more evidence-based improvements to be implemented into practice as well as influence research agendas. This article will examine several examples of successful community-academic partnerships focused on cancer prevention and control and explore lessons learned.

Lung Cancer Screening and Epigenetics in African Americans: The Role of the Socioecological Framework

Lung cancer is the leading cause of cancer morbidity and mortality in the U.S. and racial/ethnic minorities carry the greatest burden of lung cancer disparities with African Americans (AAs) impacted disproportionately. Inequities in lung cancer health disparities are often associated with multiple bio-behavioral and socio-cultural factors among racial/ethnic minorities. Epigenetic research has advanced the understanding of the intersectionality between biological and socio-cultural factors in lung cancer disparities among AAs. However, gaps exist in the engagement of diverse populations in epigenetic lung cancer research, which poses a challenge in ensuring the generalizability and implementation of epigenetic research in populations that carry an unequal cancer burden. Grounding epigenetic lung cancer research within a socio-ecological framework may prove promising in implementing a multi-level approach to community engagement, screening, navigation, and research participation among AAs. The University of Illinois Cancer Center (UI Cancer Center) is employing an evidence–based (EB) model of community/patient engagement utilizing the socio-ecological model (SEM) to develop a culturally sensitive epigenetic lung cancer research program that addresses multiple factors that impact lung cancer outcomes in AAs. By implementing epigenetic research within a group of Federally Qualified Health Centers (FQHCs) guided by the SEM, the UI Cancer Center is proposing a new pathway in mitigating lung cancer disparities in underserved communities. At the individual level, the framework examines tobacco use among patients at FQHCs (the organizational level) and also tailors epigenetic research to explore innovative biomarkers in high risk populations. Interpersonal interventions use Patient Navigators to support navigation to EB tobacco cessation resources and lung cancer screening. Community level support within the SEM is developed by ongoing partnerships with local and national partners such as the American Lung Association (ALA) and the American Cancer Society (ACS). Lastly, at the policy level, the UI Cancer Center acknowledges the role of policy implications in lung cancer screening and advocates for policies and screening recommendations that examine the current guidelines from the United States Preventive Services Task Force (USPTF).

Engaging African American Men as Citizen Scientists to Validate a Prostate Cancer Biomarker: Work-in-Progress

BACKGROUND

African American men (AAM) are under-represented in prostate cancer (PCa) research despite known disparities. Screening with prostate-specific antigen (PSA) has low specificity for high-grade PCa leading to PCa over diagnosis. The Prostate Health Index (PHI) has higher specificity for lethal PCa but needs validation in AAM. Engaging AAM as citizen scientists (CSs) may improve participation of AAM in PCa research.Results and Lessons Learned: Eight CSs completed all training modules and 139 AAM were recruited. Challenges included equity in research leadership among multiple principal investigators (PIs) and coordinating CSs trainings.

CONCLUSIONS

Engaging AAM CSs can support engaging/recruiting AAM in PCa biomarker validation research. Equity among multiple stakeholders can be challenging, but proves beneficial in engaging AAM in research.

OBJECTIVES

Assess feasibility of mobilizing CSs to recruit AAM as controls for PHI PCa validation biomarker study.

METHODS

We highlight social networks/assets of stakeholders, CSs curriculum development/implementation, and recruitment of healthy controls for PHI validation.

Abstract B31: Creating a mobile device-based educational animation for African American women with hereditary breast cancer risk

Background: Women residing in predominantly African America (AA) communities on the south side of Chicago have a breast cancer (BC) mortality rate twice as high as women living in predominantly white communities on the north side of the city. The emerging precision health paradigm for BC control that bases screening and prevention on individual level of risk has the potential to narrow the mortality gap by providing effective enhanced screening and preventive measures to AA women at high risk. Implementing a precision medicine strategy will require cancer genetic risk assessment (CGRA) in the primary care setting and referral of women with familial BC risk for genetic counseling (GC). Our prior work with CGRA in primary care clinics in AA communities revealed that women with a family history of BC who meet criteria for genetic counseling are unlikely to attend a GC consultation even when they are referred by their primary care physician (PCP). We found a strong desire among AA women and their PCPs for culturally sensitive educational materials tailored to AA women at risk for hereditary BC to help them understand the purpose of genetic counseling. We are developing a scientific educational animation delivered on a mobile device platform that is designed to motivate AA women with familial BC risk to attend a genetic-counseling consultation.

Methods: Scientific animations are an effective tool for educating individuals with low health literacy on the benefits of cancer screening. Scientific animations delivered on smart phones have been used successfully in low-resource countries to provide basic health information. The intervention will be a scientific animation that can be viewed on smart phones, which will be created through an iterative process and will incorporate key elements of culturally sensitive health behavior interventions. The initial step involves semistructured interviews to identify factors that motivated attendance or nonattendance at a GC consultation among AA women who meet national guidelines for genetic counseling based on family history of breast cancer and were referred for counseling by their PCP in an earlier study. The sample (n=20) includes both women who did and who did not attend a GC session. Themes identified in the qualitative interviews will be used to create the script for the animation. The script will be story-driven. We will conduct two “story circles” with a subgroup of women participating in the semistructured interviews. The story circle fosters a safe environment for learning across modes of intelligence, expertise, and praxis. Participants will be asked to relate their family's experience with breast cancer in a story format, and to describe how that story affected them. Findings from the story circles will augment themes identified in semistructured interviews to create a storyline, script, and artwork for the animation that is based on the participants' family experiences. We will then conduct focus groups with key stakeholders from local AA communities and AA women with family history of BC to elicit responses to the script, storyboards, and artwork, and revisions will be made as needed based on input from the focus groups. The animation is created in collaboration with the Scientific Animations without Borders, and we will test the final animation with the same participants who viewed the draft storyboards and artwork.

Results: Semistructured interviews and the story circles will be completed by the end of July, 2017, and a draft of the script and initial artwork will be completed by September of 2017. Key themes and stories for the script and preliminary artwork for the animation will be presented.

Conclusion: A technology-enabled, culturally sensitive scientific animation that motivates AA women with increased breast cancer risk to attend a genetic counseling consultation will facilitate implementation of a population-based, precision health approach to eliminating BC disparities.

Citation Format: Zo Ramamonjiarivelo, DeLawnia Comer-Hagans, Ifeanyi Beverly Chukwudozie, Shirley Spencer, Vida Henderson, Barry Pittendrigh, Julia Bello-Bravo, Karriem S. Watson, Catherine Balthazar, Rupert Evans, Robert A. Winn, Angela Odoms-Young, Kent Hoskins. Creating a mobile device-based educational animation for African American women with hereditary breast cancer risk [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 B31.

Abstract C85: Inside to outside: Addressing cancer disparities among formerly incarcerated populations

Cancer is the leading cause of death in the United States. Disparities in cancer rates and outcomes exist among diverse underserved populations. In 2016, the Epidemiology and Genomics Research Program of the National Cancer Institute (Division of Cancer Control and Population Sciences) identified inmates as an understudied population, about which there are limited data regarding cancer risks and outcomes. In June, 2015, the Illinois state prison population was 47,165. In that same year, over 50% (28,478) of Illinois state prisoners were released and a majority disproportionately returned to impoverished and vastly under-resourced communities on Chicago's south side.

Through the collaborative effort of the University of Illinois Cancer Center (UICC) and Governors State University (GSU) NCI funded P20 grant (the GUIDE), we are exploring cancer health disparities on Chicago's far south side and south suburban communities. The NCI P20, CRCHD GUIDE serves a growing population of citizens who are part of or recently released from the criminal justice system. However, much of the research in these areas is happening in academic centers that are not geographically located within high-risk communities. Advancing this dialogue with faculty and early-stage investigators at Governors State University meets the mission and aims of the P20 GUIDE by developing research and resources in underserved community areas.

A range of risk factors including poor health care, health risk behaviors, and lack of participation in cancer screening position incarcerated and formerly incarcerated populations at greater risk for cancer diagnosis. This pattern is likely to persist given the aging of the prison population. Further, cancer diagnosis is not only evident among older inmate populations; there is also growing evidence of a younger population (30-45) presenting with cancer at intake or receiving a cancer diagnosis within months of admission to our jails and prisons. These findings underscore the importance of advocating for the inclusion of currently and formerly incarcerated persons in cancer prevention and control efforts.

Given the consistent increase in patients with a diagnosis of cancer, there is need to explore strategies to provide care meeting best practice standards, and the development of policies that decrease the risk of cancer disparities among incarcerated and formerly incarcerated populations. The purpose of this presentation is to: (1) describe the rates and risk factors for cancer disparities among incarcerated and formerly incarcerated populations, (2) examine models of reentry program linkages in health care and strategies for engagement in cancer screening and early detection, and (3) advocate for the inclusion of best practices in cancer care in prison in the National Commission on Prison Health Care Guidelines for prison health care delivery.

Citation Format: Vickii P. Coffey, Mary V. Muse, Karriem S. Watson, Rupert Evans, Catherine Hanson Balthazar, Robert A. Winn, Phoenix Alicia Matthews. Inside to outside: Addressing cancer disparities among formerly incarcerated 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 C85.

Abstract A01: Standardizing tracking and evaluation in cancer disparities research: Utilizing REDCap to track training, education, and community engagement activities

The Center to Reduce Cancer Health Disparities (CRCHD) of the National Cancer Institute (NCI) is dedicated to enhancing the diversity of the scientific workforce through training and education and supporting community engagement. The utilization of standardized tools to track and assist in the evaluation of outcomes from training, education, and community engagement programs is important to grants supported by the CRCHD. This case study describes the utilization of a readily available and secure web-based electronic tool, REDCap (Research Electronic Data Capture), to broadly track and evaluate community engagement activities and training and education milestones in an Academic Cancer Center. Aim 1 describes the online survey tool created in REDCap to track all community engagement activities for the Cancer Center. Aim 2 describes methods and assessment tools created to track and evaluate mentoring relationships, training, educational activities, and career outcomes of trainees in an emerging cancer center seeking NCI designation. Training programs in the University of Illinois (UI) Cancer Center occur across the pipeline and target high school and undergraduate students, graduate and pre- and post-doctoral students, and early-stage investigators with a focus on populations under-represented in health disparities research. The utilization of REDCap will allow outcomes from NCI CRCHD funded programs and other training, education, and community engagement programs to uniformly track outcomes and assess efficacy to ensure alignment with NCI priorities for cancer centers in community engagement and training and education. Our case study supports the NIH's efforts to ensure longitudinal tracking of training and education programs for a minimum of 10 years and to ensure community engagement targeting the cancer center's catchment area. This case study can provide generalizable information to other cancer centers and NCI CRCHD awardees.

Citation Format: Ifeanyi Beverly Chukwudozie, Karriem S. Watson, Stacey Rhodes, Ahlam Al-Kodmany, Erica Martinez, Christopher Gay, Marian L. Fitzgibbon, Paul Grippo, Robert A. Winn, Robert A. Winn. Standardizing tracking and evaluation in cancer disparities research: Utilizing REDCap to track training, education, and community engagement activities [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 A01.

Abstract C09: Building capacity to conduct cancer disparities research: Progress and evaluation of NCI CRCHD P20 GUIDE Project

The NCI CRCHD P20 partnerships aim to support collaborations between investigators at institutions serving underserved health disparity populations and under-represented students (ISUPS) and cancer centers with integrated cancer research programs. The P20 GUIDE (GSU-UICC-Disparities-Education) Training and Research Program is entering its third year of collaboration between the UI Cancer Center (UICC) and GSU. Early outcomes provide key insight into best practices to advance partnerships and training to support cancer disparities research. Aims: 1) Describe early outcomes of the NCI P20 collaboration between a cancer center and teaching institution. 2) Discuss midway program evaluation of training and education core of P20 collaboration to guide current/future collaborations to support workforce development, training, and education. 3) Examine data from undergraduate students and ESIs from ISUPS to evaluate progress and early lessons learned from a P20 collaboration aimed to increase the capacity of the ISUPS to conduct cancer disparities research. The P20 GUIDE Program enhances the capacity of GSU to conduct cancer disparities research through mentoring, education, training, and a pilot research project. The training, education, and mentoring program pairs 6 GSU ESIs with mentors from the UICC and University of Illinois at Chicago (UIC) NCI R25 Program. The training and education core exposes undergraduates from GSU to cancer disparities research through mentoring and a summer research immersion. The capacity of the ESIs from GSU to conduct cancer disparities research is enhanced through one-on-one mentoring; writing boot-camps to support peer-review manuscript development; health disparities coursework, which in turn supports grant development, research proposal development, and collaboration on a cancer disparities pilot research project. During the summer of Yr II, undergraduates from GSU participated in a 10-week summer research immersion that will be supported through ongoing mentoring and collaboration. Progress and outcomes from Yr I and II specific to the Training and Education Core of the partnership collaboration were assessed to determine the feasibility of the collaboration in achieving the aims of the P20 collaboration and to identify lessons learned midway through the collaboration to allow iterative program assessment and adjustment to support goals of the NCI CRCHD P20 partnerships. Lessons learned from the Training and Education Core demonstrate that the partnership-building collaboration is enhancing the capacity of ESIs from GSU to conduct cancer disparities research and support the development and advancement of other P20 or partnership development proposals. To date, 2 of the 6 ESIs from GSU have received tenure and were promoted to Associate Professors. Two of the GSU ESIs have collaborated on a peer-reviewed manuscript and national conference presentations with mentors from the UIC R25 Program and UICC. GSU also received a diversity supplement to support enhanced research collaboration between a GSU ESI and the pilot research team. Four of the 6 GSU ESIs are actively taking coursework at UIC in the health disparities certificate program. Three of the GSU ESIs are actively working on grant proposals that will be submitted by the end of Yr III, and two of the ESIs have submitted grant proposals pending review. The summer of Year II will also yield pre/post program data demonstrating effectiveness of the GUIDE Summer fellows program in increasing the interest/knowledge of careers in cancer disparity research among undergraduate students at GSU. Year II data will demonstrate mixed-method data on interest, progress, and needs among the GSU ESIs in developing a cancer disparities research portfolio. Key early lessons learned are the need for additional funding, course buy-out, and collaborative teaching opportunities to allow the ESIs from the ISUPS to further engage in cancer disparities research.

Citation Format: Karriem S. Watson, Alicia K. Matthews, Kent Hoskins, Rupert Evans, Ifeanyi Beverly Chukwudozie, Stacey Rhodes, Erica Martinez, Marian L. Fitzgibbon, Catherine Balthazar, Robert A. Winn. Building capacity to conduct cancer disparities research: Progress and evaluation of NCI CRCHD P20 GUIDE Project [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 C09.

Abstract 138: PRMT6 promotes lung tumor growth via the modulation of macrophage M2 polarization

Lung cancer kills more people in the United States than any other malignancy. High mortalities are in part due to the diagnosis at an advanced inoperable stage where the 5-year survival is only 4%. Therefore, improving survival will require increased knowledge of genes that drive the complex mechanisms of lung cancer initiation and progression. Emerging data implicate novel roles for protein arginine methylation in lung cancers. In protein arginine methylation, nitrogen/s of arginine can be post-translationally modified via the addition of a methyl group, catalyzed by a class of enzymes, protein arginine methyl transferases (PRMTs). Based on the computational analysis, tissue staining, and immunoblotting we have identified an increased expression of PRMT6 in lung tumors. To test the biologic relevance of PRMT6 in lung tumor development, we employed an inducible lung-targeted PRMT6 gain-of-function (GOF) mouse model. For the first time, we show that lung-targeted overexpression of PRMT6 results in spontaneous lung tumor development. We also observed a robust increase in lung tumors in the PRMT6 GOF mice in response to urethane, a KRas mutagen, and a prototypical model to study lung tumorigenesis. Excitingly, we detected an increase in the number of tumor-associated macrophages (TAMs) in the PRMT6 GOF mice. Further characterization of the TAMs from the PRMT6 GOF mice revealed that they were M2 polarized with immunosuppressive, angiogenesis-enhancing, and tumor-promoting activities. Taken together, these results demonstrate a novel role for PRMT6 in lung tumor development by way of macrophage M2 polarization. Therefore, defining the complete mechanism of PRMT6-mediated macrophage M2 polarization could lead to the development of novel therapeutic strategies to treat lung cancer.

Citation Format: Sreedevi Avasarala, Pei-Ying Wu, Samia Q. Khan, Michelle Van Scoyk, Yanlin Su, Odile David, Vineet Gupta, Mark T. Bedford, Robert A. Winn, Rama Kamesh Bikkavilli. PRMT6 promotes lung tumor growth via the modulation of macrophage M2 polarization [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 138.

Abstract 5515: Ras-like estrogen-regulated growth-inhibitory gene (RERG): A novel biomarker and potential therapeutic target for women with lung cancer

Background: Lung cancer is the second most common cancer diagnosed in women. In fact, twice as many women will die from lung cancer compared to breast cancer, the key risk factor being tobacco use. Hence, there is a need to identify new molecular biomarkers to aid in early detection and develop new therapeutic strategies in tobacco-related lung cancer. Ras-like Estrogen-Regulated Growth-Inhibitory Gene (RERG) is a member of the Ras superfamily of GTPases that play an important role in cellular processes such as proliferation, differentiation, and apoptosis. Unlike other members of the Ras superfamily members of proto-oncogenes, RERG functions as a tumor suppressor.

Objective: To investigate the utility of RERG expression as a novel biomarker and a potential therapeutic target in lung cancer.

Results: In silico analysis of The Cancer Genome Atlas (TCGA) lung cancer datasets revealed a significant downregulation of RERG expression in lung tumors. Furthermore, reduced expression of RERG in lung tumors was also observed to be correlated with poor prognosis as determined by Kaplan-Meier survival analysis. Evaluation of formalin-fixed, paraffin-embedded (FFPE) human lung cancer tissues and fresh frozen lung tumor tissues corroborated our in silico observations. Most notably, tobacco smoke was identified to be associated with decreased RERG expression in lung tumors. The most intriguing observation from this study is the significant decrease of RERG expression in female smokers as a result of promoter hypermethylation.

Conclusion: Taken together, these findings suggest that RERG may represent a potential biomarker in lung cancer, particularly among smokers. Further investigation would focus on the mechanism of RERG loss and its influence on lung tumor development, particularly in female smokers.

Citation Format: Michelle Van Scoyk, Sreedevi Avasarala, Pei-Ying Wu, Yanlin Su, Lane Lerner, Alicia Hulbert, Kamesh Bikkavilli, Robert A. Winn. Ras-like estrogen-regulated growth-inhibitory gene (RERG): A novel biomarker and potential therapeutic target for women with lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5515.