Systemic DNA Damage and Repair Activity Vary by Race in Breast Cancer Survivors

Non-Hispanic Black breast cancer survivors have poorer outcomes and higher mortality rates than White survivors, but systemic biological mechanisms underlying these disparities are unclear. We used circulating leukocytes as a surrogate for measuring systemic mechanisms, which might be different from processes in the target tissue (e.g., breast). We investigated race-based differences in DNA damage and repair, using a novel CometChip assay, in circulating leukocytes from breast cancer survivors who had completed primary cancer therapy and were cancer free. We observed novel race-based differences in systemic DNA damage and repair activity in cancer survivors, but not in cells from healthy volunteers. Basal DNA damage in leukocytes was higher in White survivors, but Black survivors showed a much higher induction after bleomycin treatment. Double-strand break repair activity was also significantly different between the races, with cells from White survivors showing more sustained repair activity compared to Black leukocytes. These results suggest that cancer and cancer therapy might have long-lasting effects on systemic DNA damage and repair mechanisms that differ in White survivors and Black survivors. Findings from our preliminary study in non-cancer cells (circulating leukocytes) suggest systemic effects beyond the target site, with implications for accelerated aging-related cancer survivorship disparities.

Improved survival for dose-intensive chemotherapy in primary mediastinal B-cell lymphoma: a systematic review and meta-analysis of 4,068 patients

Primary mediastinal B-cell lymphoma (PMBCL) is a distinct clinicopathologic entity. Currently, there is a paucity of randomized prospective data to inform on optimal front-line chemoimmunotherapy (CIT) and use of consolidative mediastinal radiation (RT). To assess if distinct CIT approaches are associated with disparate survival outcomes, we performed a systematic review and meta-analysis comparing dose-intensive (DI-CIT) versus standard CIT for the front-line treatment of PMBCL. Standard approach (S-CIT) was defined as R-CHOP-21/CHOP-21, with or without RT. DI-CIT were defined as regimens with increased frequency, dose, and/or number of systemic agents. We reviewed data on 4,068 patients (2,517 DI-CIT; 1,551 S-CIT) with a new diagnosis of PMBCL. Overall survival for DI-CIT patients was 88% (95% CI: 85-90) compared to 80% for the S-CIT cohort (95% CI: 74-85). Meta-regression revealed an 8% overall survival (OS) benefit for the DI-CIT group (P<0.01). Survival benefit was maintained when analyzing rituximab only regimens; OS was 91% (95% CI: 89-93) for the rituximab-DI-CIT arm compared to 86% (95% CI: 82-89) for the R-CHOP-21 arm (P=0.03). Importantly, 55% (95% CI: 43-65) of the S-CIT group received RT compared to 22% (95% CI: 15-31) of DI-CIT patients (meta-regression P<0.01). To our knowledge, this is the largest meta-analysis reporting efficacy outcomes for the front-line treatment of PMBCL. DI-CIT demonstrates a survival benefit, with significantly less radiation exposure, curtailing long-term toxicities associated with radiotherapy. As we await results of randomized prospective trials, our study supports the use of dose-intensive chemoimmunotherapy for the treatment of PMBCL.

An 8-week exercise study to improve cancer treatment related fatigue and QOL among African American breast cancer patients undergoing radiation treatment: A pilot randomized clinical trial

BACKGROUND

Cancer treatment related fatigue (CTRF) is one of the most debilitating side effects of adjuvant radiation therapy (RT). Several studies have found that physical activity (PA) may be an effective intervention to decrease fatigue and enhance QOL in cancer survivors. The primary objective of the PEDLAR study is to test the feasibility of an easily administered 8-week structured moderate-intensity PA intervention, delivered concurrently with RT, in reducing CTRF and improving health-related QOL among African-American breast cancer patients. This study is also designed to provide pilot data on the acceptability and adherence of PA interventions in African-American women with breast cancer.

METHODS

It is a prospective, 2-arm, 8-week feasibility trial. Participants are randomized to either a structured, moderate-intensity aerobic training exercise regimen concurrent with radiotherapy or a control group.

RESULTS

Participants in intervention group reported high satisfaction with exercise and adherence was >75% for exercise sessions.

CONCLUSIONS

African-American breast cancer patients in a moderate-intensity 75 min/wk aerobic exercise intervention had marginally lower fatigue at 8-wk follow-up compared to baseline. The control group participants had marginally higher fatigue at 8-wk follow-up compared to baseline. Participants in the intervention group reported slightly better quality of life at 8-wk follow-up compared to baseline (P = 0.06).

Environmentally Induced Sperm RNAs Transmit Cancer Susceptibility to Offspring in a Mouse Model

DNA sequence accounts for the majority of disease heritability, including cancer. Yet, not all familial cancer cases can be explained by genetic factors. It is becoming clear that environmentally induced epigenetic inheritance occurs and that the progeny's traits can be shaped by parental environmental experiences. In humans, epidemiological studies have implicated environmental toxicants, such as the pesticide DDT, in intergenerational cancer development, including breast and childhood tumors. Here, we show that the female progeny of males exposed to DDT in the pre-conception period have higher susceptibility to developing aggressive tumors in mouse models of breast cancer. Sperm of DDT-exposed males exhibited distinct patterns of small non-coding RNAs, with an increase in miRNAs and a specific surge in miRNA-10b levels. Remarkably, embryonic injection of the entire sperm RNA load of DDT-exposed males, or synthetic miRNA-10b, recapitulated the tumor phenotypes observed in DDT offspring. Mechanistically, miR-10b injection altered the transcriptional profile in early embryos with enrichment of genes associated with cell differentiation, tissue and immune system development. In adult DDT-derived progeny, transcriptional and protein analysis of mammary tumors revealed alterations in stromal and in immune system compartments. Our findings reveal a causal role for sperm RNAs in environmentally induced inheritance of cancer predisposition and, if confirmed in humans, this could help partially explain some of the "missing heritability" of breast, and other, malignancies.

A Feasibility Study of Smoking Cessation Utilizing an Exercise Intervention among Black Women: 'Quit and Fit'

BACKGROUND

Women who engage in higher levels of exercise while trying to quit smoking have been shown to be less likely to relapse and to sustain their smoking abstinence longer. This study sought to examine the benefits of exercise for improving smoking cessation among Black women.

METHODS

We evaluated the feasibility of a 12-week smoking and exercise intervention, Quit and Fit, tailored for Black women. All participants (intervention and control) received 12 weeks of smoking cessation counseling via telephone and 9 weeks of nicotine lozenges. Participants who were randomly assigned to the intervention condition were also assigned to a 12-week exercise group.

RESULTS

Thirty-eight women were enrolled and 27 completed a 12-week follow-up assessment. Women from the intervention group were more likely to complete the 12-week follow-up assessment compared to participants in the control group (80% vs. 61%). Overall, 7 of the 38 participants (18%) were abstinent at 12 weeks (biochemically verified by expired carbon monoxide). Among the 25 women who completed the 12-week follow-up, abstinence was reported in 33% of the intervention group and 20% of the control group. Using an intent-to-treat approach, 25% of women in the intervention group were abstinent at 12 weeks (n = 5), compared to 11.1% for the control group (n = 2). These differences were not statistically significant.

CONCLUSIONS

The overall retention rate was 71% (27/38) at 12 weeks with higher among the intervention group (16/20; 80%) compared to the control group (11/18; 61%). The study demonstrates that it is feasible to retain African-American women in a short-term study of smoking cessation and exercise.

Short-term metabolic disruptions in urine of mouse models following exposure to low doses of oxygen ion radiation

Molecular alterations as a result of exposure to low doses of high linear energy transfer (LET) radiation can have deleterious short- and long-term consequences on crew members embarking on long distance space missions. Oxygen ions (¹⁶O) are among the high LET charged particles that make up the radiation environment inside a vehicle in deep space. We used mass spectrometry-based metabolomics to characterize urinary metabolic profiles of male C57BL/6J mice exposed to a single dose of 0.1, 0.25 and 1.0 Gy of ¹⁶O (600 MeV/n) at 10 and 30 days post-exposure to delineate radiation-induced metabolic alterations. We recognized a significant down regulation of several classes of metabolites including cresols and tryptophan metabolites, ketoacids and their derivatives upon exposure to 0.1 and 0.25 Gy after 10 days. While some of these changes reverted to near normal by 30 days, some metabolites including p-Cresol sulfate, oxalosuccinic acid, and indoxylsulfate remained dysregulated at 30 days, suggesting long term prognosis on metabolism. Pathway analysis revealed a long-term dysregulation in multiple pathways including tryptophan and porphyrin metabolism. These results suggest that low doses of high-LET charged particle irradiation may have long-term implications on metabolic imbalance.

Integrated copy number and miRNA expression analysis in triple negative breast cancer of Latin American patients

Triple negative breast cancer (TNBC), a clinically aggressive breast cancer subtype, affects 15–35% of women from Latin America. Using an approach of direct integration of copy number and global miRNA profiling data, performed simultaneously in the same tumor specimens, we identified a panel of 17 miRNAs specifically associated with TNBC of ancestrally characterized patients from Latin America, Brazil. This panel was differentially expressed between the TNBC and non-TNBC subtypes studied (p ≤ 0.05, FDR ≤ 0.25), with their expression levels concordant with the patterns of copy number alterations (CNAs), present mostly frequent at 8q21.3-q24.3, 3q24-29, 6p25.3-p12.2, 1q21.1-q44, 5q11.1-q22.1, 11p13-p11.2, 13q12.11-q14.3, 17q24.2-q25.3 and Xp22.33-p11.21. The combined 17 miRNAs presented a high power (AUC = 0.953 (0.78–0.99);95% CI) in discriminating between the TNBC and non-TNBC subtypes of the patients studied. In addition, the expression of 14 and 15 of the 17miRNAs was significantly associated with tumor subtype when adjusted for tumor stage and grade, respectively. In conclusion, the panel of miRNAs identified demonstrated the impact of CNAs in miRNA expression levels and identified miRNA target genes potentially affected by both CNAs and miRNA deregulation. These targets, involved in critical signaling pathways and biological functions associated specifically with the TNBC transcriptome of Latina patients, can provide biological insights into the observed differences in the TNBC clinical outcome among racial/ethnic groups, taking into consideration their genetic ancestry.

Effect of exercise on metabolic syndrome in black women by family history and predicted risk of breast cancer: The FIERCE Study

BACKGROUND

This study examined the effects of supervised and home-based exercise interventions on changes in metabolic syndrome (MetS) according to breast cancer risk (high vs low) in black women enrolled in the Focused Intervention on Exercise to Reduce Cancer (FIERCE) trial.

METHODS

Postmenopausal, obese, metabolically unhealthy black women, 45 to 65 years old, were randomized to supervised aerobic exercise (73 women), home-based walking-based exercise (69 women), or a control arm (71 women). Participants in the exercise arms underwent a 6-month intervention with study assessments conducted at the baseline and 6 months. The primary outcome measure was MetS (fasting glucose, waist circumference, blood pressure, serum triglycerides, and high-density lipoprotein [HDL]). The intervention effects on MetS, stratified by breast cancer risk as measured by the family history of breast cancer and model-based projected breast cancer risk, were examined with intent-to-treat analyses using generalized estimating equation models.

RESULTS

Among women with a family history of breast cancer, the exercise arms had lower mean MetS z scores, which suggested an improvement in the metabolic profile, than controls at 6 months (controls, + 0.55; home-based arm, -0.97, P < .01; supervised arm, -0.89, P < .01). Stratified analyses by projected breast cancer risk suggested similar but statistically nonsignificant findings, with those at high risk having more favorable changes in the MetS z score in the exercise arms versus the control arm. These changes were primarily attributable to changes in blood pressure, triglycerides, and HDL.

CONCLUSIONS

Short-term aerobic activity regimens may improve the metabolic profile and thereby reduce breast cancer risk in obese, metabolically unhealthy black women at high risk for cancer. © 2018 American Cancer Society.

Abstract B22: Trends in mammography utilization at a safety net breast cancer screening center

Background: Breast cancer screening uptake patterns vary based on race and ethnicity, insurance status, socioeconomic status, and age. Among uninsured and resource-poor populations, community-based safety net clinics have emerged as important providers of these breast cancer screening services. The Capital Breast Care Center (CBCC) was established in 2004 to deliver breast and cervical cancer screening to all women in the District of Columbia (DC) metropolitan region. CBCC serves a large Black and Hispanic population with representation of many diverse ethnic groups within these racial categories. Here, we examine the population of women presenting to CBCC for screening mammograms from 2010 to 2016, evaluating patterns of changes in utilization of the services along sociodemographic and economic lines among the women.

Methods: Prospectively collected demographic data were abstracted from the electronic medical records including age, race, menopausal status, insurance status, highest education attainment, and screening outcome. Percentages of women who sought mammography screening were computed for each year by categories of selected characteristics. Time trends in screening were tested with the Cochran-Armitage trend test.

Results: From 2010 to 2016, 8448 women were screened at CBCC with 106 diagnoses of breast cancer. African-American and Hispanic women accounted for about 90%. Trends in the racial/ethnic composition of the women screened shifted, with African American women decreasing while the proportion of Latina patients increased (p-value &lt;0.0001). The uninsured population increased covered under the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) as decreases were seen in women with private commercial insurance, Medicaid, and Medicare (p-value &lt;0.0001). The number of DC residents decreased as more patients traveled from Maryland and Virginia (p-value &lt;0.0001). There was no significant trend in proportion of women who had screening and were diagnosed with breast cancer.

Conclusion: In this analysis of asymptomatic women presenting for breast cancer screening, over a 7-year period there were significant trends in an increase in Hispanic women, those residing in Virginia, and those screened using the NBCCEDP. These analyses of the population of women selecting CBCC for mammography screening may reflect both local and national demographic shifts. Assessment of patient trends can improve preventative/public health efforts and intervention services offered at community clinics.

Citation Format: Bridget A. Oppong, Holly Greenwald, Chiranjeev Dash, Kepher Makambi, Tesha Coleman, Lucile Adams-Campbell. Trends in mammography utilization at a safety net breast cancer screening center [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 B22.

Differentially expressed miRNAs in triple negative breast cancer between African-American and non-Hispanic white women

Triple Negative Breast Cancer (TNBC), a clinically aggressive subtype of breast cancer, disproportionately affects African American (AA) women when compared to non-Hispanic Whites (NHW). MiRNAs(miRNAs) play a critical role in these tumors, through the regulation of cancer driver genes. In this study, our goal was to characterize and compare the patterns of miRNA expression in TNBC of AA (n = 27) and NHW women (n = 30). A total of 256 miRNAs were differentially expressed between these groups, and distinct from the ones observed in their respective non-TNBC subtypes. Fifty-five of these miRNAs were mapped in cytobands carrying copy number alterations (CNAs); 26 of them presented expression levels concordant with the observed CNAs. Receiving operating characteristic (ROC) analysis showed a good power (AUC ≥ 0.80; 95% CI) for over 65% of the individual miRNAs and a high combined power with superior sensitivity and specificity (AUC = 0.88 (0.78−0.99); 95% CI) of the 26 miRNA panel in discriminating TNBC between these populations. Subsequent miRNA target analysis revealed their involvement in the interconnected PI3K/AKT, MAPK and insulin signaling pathways. Additionally, three miRNAs of this panel were associated with early age at diagnosis. Altogether, these findings indicated that there are different patterns of miRNA expression between TNBC of AA and NHW women and that their mapping in genomic regions with high levels of CNAs is not merely physical, but biologically relevant to the TNBC phenotype. Once validated in distinct cohorts of AA women, this panel can potentially represent their intrinsic TNBC genome signature.

The effect of a randomized controlled physical activity trial on health related quality of life in metabolically unhealthy African-American women: FIERCE STUDY

PURPOSE

African-American women (AAW) are more likely to be metabolically unhealthy than White women (WW). Metabolic syndrome (MetS) is associated with increased breast cancer risk and mortality from breast cancer is greater in AAW compared to WW. Data show MetS affects health-related quality of life (HRQoL). Exercise studies report improvements in MetS, however, no study to date has examined HRQoL in metabolically unhealthy AAW enrolled in an exercise trial.

METHODS

This report examined the effect of a 6-month, 3-arm (supervised exercise, home-based exercise, control) randomized exercise controlled trial on HRQoL among 213 obese, metabolically unhealthy, postmenopausal AAW at high risk for breast cancer.

RESULTS

Certain baseline participant characteristics were related to baseline HRQoL dimensions. The "exercise group" (supervised group combined with the home-based group) showed significantly greater improvement in health change scores (M = 13.6, SD = 3.1) compared to the control group (M = 0.7, SD = 4.4) (p = 0.02) over the 6-month study period. There were no significant differences in HRQoL change scores between the 3 study groups, however, although non-significant, data indicated most HRQoL change scores were more favorable in the supervised group.

CONCLUSION

While significant improvement occurred in health change scores in the combined supervised and home-based group compared to the control group, we did not observe any significant differences on HRQoL change scores between all three study groups. However, while non-significant, there was a trend for more favorable HRQoL change scores in the supervised group versus the home-based and control groups. Additional research is needed to further explore this topic.

A Restorative Yoga Intervention for African-American Breast Cancer Survivors: a Pilot Study

BACKGROUND

Data show that yoga is effective for improving health-related outcomes in breast cancer survivors. While breast cancer is the most commonly diagnosed cancer among African-American women (AAW), AAW are less likely to engage in yoga compared to other ethnic groups. The goals of the current study were to assess the feasibility of an 8-week restorative yoga program among African-American breast cancer survivors (AA BCS). Specifically, study aims were to (1) measure changes in study outcomes in a restorative yoga (RY) group compared to a wait list control group, (2) assess adherence to the RY program, and (3) assess program satisfaction among study participants.

METHODS

Thirty-three AA BCS were randomly assigned to either the RY intervention (n = 18) or wait list control group (n = 15). RY classes met once per week for 8 weeks. Pre- and post-testing assessments were measured at 0 and 8 weeks (immediately post-intervention).

RESULTS

Depression scores at follow-up were significantly lower in the yoga group (M = 4.78, SD = 3.56) compared to the control group (M = 6.91, SD = 5.86). No significant group differences were observed for sleep quality, fatigue, or perceived stress. Yoga program participants completing baseline assessments demonstrated 61% adherence to the yoga classes. Average rating of the yoga program was "very useful." Recommendations for future yoga programs were provided.

CONCLUSIONS

This study suggests that yoga has a beneficial effect on depression in AA BCS. There is, however, a need to further explore the benefits of yoga among minority breast cancer survivors using a study with larger sample sizes.

Abstract A02: Comparative analysis of breast density among Black, White, and Hispanic women presenting for screening mammography

Background: Data on ethnic variations in breast density are limited and often not inclusive of underrepresented minorities, including Black and Hispanic women. As breast density is associated with elevated breast cancer risk, investigating racial and ethnic difference may elucidate the observed differences in breast cancer risk among different populations.

Methods: We reviewed breast density recorded at the initial mammographic screening study in women presenting to the Capital Breast Care Center (CBCC) and Georgetown University Hospital (GUH) from 2010 to 2014. Patient demographics including race, age at screening, education and menopausal status were abstracted in addition to body mass index (BMI). From imaging reports, we recorded the BI-RADS density categories: 1-fatty, 2-scattered fibroglandular densities, 3-heterogeneously dense and 4-extremely dense. Multivariable unconditional logistic regression was used to identify predictors of breast density.

Results: Density categorization was recorded for 2,146 women over the five-year period, with 940 (43.8%) Black, 893 (41.6%), Hispanic and 314 (14.6%) White. Analysis of subject characteristics by low density (categories 1 and 2) and high density (categories 3 and 4) show that high category is observed in younger, Hispanic, nulliparous, premenopausal and non-obese women (P-values &lt;.0001). Obese women are 70% less likely to have high breast density compared to non-obese women. Being Hispanic, premenopausal, and non-obese were predictive of high mammographic density on logistic regression.

Conclusion: In this analysis of density distribution in a diverse sample of women presenting for mammography, Hispanic women have the highest breast density, followed by Black women with Whites having the lowest. Unique in our findings is women who identify as Hispanic having the highest breast density and lower rates of obesity. Further investigation of the impact of obesity on breast density in minority women, especially in the understudied Hispanic group is needed.

Citation Format: Bridget A. Oppong, Chiranjeev Dash, Suzanne Oneill, Kepher Makambi, Tesha Coleman, Lucile L. Adams-Campbell. Comparative analysis of breast density among Black, White, and Hispanic women presenting for screening mammography [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr A02.

Breast density in multiethnic women presenting for screening mammography

Data on ethnic variations in breast density are limited and often not inclusive of underrepresented minorities. As breast density is associated with elevated breast cancer risk, investigating racial and ethnic difference may elucidate the observed differences in breast cancer risk among different populations. We reviewed breast density from initial screening of women from the Capital Breast Care Center and Georgetown University Hospital from 2010 to 2014. Patient demographics including race, age at screening, education, menopausal status, and body mass index were abstracted. We recorded the BI-RADS density categories: (1) "fatty," (2) "scattered fibroglandular densities," (3) "heterogeneously dense," and (4) "extremely dense." Multivariable unconditional logistic regression was used to identify predictors of breast density. Density categorization was recorded for 2146 women over the 5-year period, comprising Blacks (n = 940), Hispanics (n = 893), and Whites (n = 314). Analysis of subject characteristics by breast density showed that high category is observed in younger, Hispanic, nulliparous, premenopausal, and nonobese women (t-test or chi-square test, P-values <.0001). Obese women are 70% less likely to have high density. Being Hispanic, premenopausal, and nonobese were predictive of high density on logistic regression. In this analysis of density distribution in a diverse sample, Hispanic women have the highest breast density, followed by Blacks and Whites. Unique in our findings is women who identify as Hispanic have the highest breast density and lower rates of obesity. Further investigation of the impact of obesity on breast density, especially in the understudied Hispanic group is needed.

Abstract 737: Signficant DLX4 expression in inflammatory breast cancer tumors from African American patients

Purpose: To examine protein expression characteristics of Distal-less homeobox4 (DLX4) in inflammatory breast cancer (IBC) cases from an African-American population to determine if a) DLX4 over-expression occurs in IBC vs. normal mammary tissue and b) over-expression is associated with clinico-pathologic features such as ER, PR, HER2.

Experimental Design: Twenty nine blocks of formalin-fixed paraffin-embedded (FFPE) tissues from well-characterized human IBC cases were used for immuno-histochemical staining (IHC). Tumor tissues were from African American subjects seen at Howard University Hospital. Normal breast tissues from 30 mammoplasties were controls. IHC results were assigned intensity and percentage scores based upon intensity of positive staining and % of stained cells. Percentage scores were assigned as 0, 1 (0%-25%), 2 (26%-50%), 3 (51%-75%) or 4 (76%-100%) and intensity scores were assigned 0, 1+, 2+ or 3+. For the analysis of the IHC, a percentage score of 3 or 4 was considered high and an intensity score of 2+ or 3+ was categorized as high. Chi-square and Fisher’s exact tests were used for analysis.

Results: The staining pattern for the categorized cohort in which 82.8% (24 out of 29) of IBC cases showed high percentages of positive cells staining for DLX4 protein, while 40.0% (12 out of 30) normal breast tissues demonstrated DLX4 expression (P=0.001). In terms of staining intensity, 75.9% (22 out of 29) of IBC cases showed a high level of intensity, compared to 20.0% (6 out of 30) of normal breast tissues (P&lt;0.001). In terms of the association between breast cancer characteristics and IHC staining, intensity of DLX4 was higher in HER2- (87.0%, 20 out of 23) than HER2+ (33.3%, 2 out of 6; P=0.018). Other associations were not statistically significant in this pilot study.

Conclusions: DLX4 expression is significantly higher in this pilot study of IBC cases from AA patients than in normal breast tissue cases. In addition, HER2- is associated with high intensity of DLX4 expression in IBC.

Associations DLX4 protein expression (IHC) In IBC and normal breast tissuesLowHighP-valuePercent positivityn (%)n (%)Controls (n=30)18 (60.0)12 (40.0)0.001IBCs (n=29)5 (17.2)24 (82.8)Staining intensityn (%)n (%)Controls (n=30)24 (80.0)6 (20.0)&lt;0.001IBCs (n=29)7 (24.1)22 (75.9)

Citation Format: Jaehong Jeong, Tammey Naab, Martin Ongkeko, Kepher Makambi, Farhan A. Khan, Jan Blancato. Signficant DLX4 expression in inflammatory breast cancer tumors from African American patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 737. doi:10.1158/1538-7445.AM2017-737

Abstract P5-10-10: Predictors of breast density among Black and Hispanic women presenting for mammographic screening

Background: Increased breast density has been associated with elevated breast cancer risk and complicating mammographic interpretation. Although previous studies have investigated population variations in breast density, Black and Hispanic women are often underrepresented in these analyses. Moreover, it is unclear how breast density differs between these ethnicities. We report on the mammographic density distribution of Black and Hispanic women having breast cancer screening at the Capital Breast Care Center (CBCC) and analyze factors associated with high breast density.

Methods: Retrospective data from electronic medical records at a population-based mammography screening center were abstracted. From 2010 to 2014, data from women undergoing their first breast cancer screening were reviewed. Patient demographics including race, age at screening, education and menopausal status were abstracted in addition to body mass index (BMI) and Breast Imaging-Reporting and Data System (BI-RADS) density category:1- “fatty”, 2- “scattered fibroglandular densities”, 3- “heterogeneously dense” and 4- “extremely dense”. Logistic regression was used to investigate factors associated with breast density.

Results: Density categorization was recorded for 1747 women over the five-year period, with 855 (49%) Black and 892 (51%) Hispanic. Patient characteristics associated with high density (categories 3 and 4) were younger age, Hispanic ethnicity, nulliparity, premenopausal status, and BMI &lt; 30 kg/m2. On multivariate logistic regression, Hispanic ethnicity, premenopausal status, and BMI &lt; 30 kg/m2 were predictive of high mammographic density.

Conclusion: In a sample of women presenting for mammographic screening at CBCC, Hispanic women were more likely to have higher breast density compared to Black women. After controlling for ethnicity, postmenopausal and obese women were less likely to have dense breasts. Additional investigation is needed to further study the impact of obesity on breast density in underserved minority women.

Citation Format: Oppong BA, Dash C, Li Y, Makambi K, Coleman T, Adams-Campbell L. Predictors of breast density among Black and Hispanic women presenting for mammographic screening [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-10-10.

PM2.5 as a marker of exposure to tobacco smoke and other sources of particulate matter in Cairo, Egypt

SETTING

Cairo and Giza governorates of Egypt.

BACKGROUND

Particulate matter under 2.5 μm in diameter (PM2.5) arises from diverse sources, including tobacco smoke from cigarettes and waterpipes, and is recognized as a cause of acute and chronic morbidity and mortality.

OBJECTIVE

To measure PM2.5 in workplaces with different intensities of smoking and varying levels of smoking restrictions.

DESIGN

We conducted an air sampling study to measure PM2.5 levels in a convenience sample of indoor and outdoor venues in 2005-2006.

RESULTS

Using a calibrated SidePak instrument, 3295 individual measurements were collected at 96 venues. Compared to indoor venues where tobacco smoking was banned (PM2.5 levels 72-81 μg/m(3)), places offering waterpipes to patrons of cafes (478 μg/m(3)) and Ramadan tents (612 μg/m(3)) had much higher concentrations, as did venues such as public buildings with poor enforcement of smoking restrictions (range 171-704 μg/m(3)). Both the number of waterpipe smokers and the number of cigarette smokers observed at each venue contributed significantly to the overall burden of PM2.5.

CONCLUSION

Such data will support smoke-free policies and programs aimed specifically at reducing environmental tobacco exposure and improving air quality in general, and will provide a baseline for monitoring the impact of tobacco control policies.

Increased sialylation of site specific O-glycoforms of hemopexin in liver disease

Background

Non-invasive monitoring of liver disease remains an important health issue. Liver secreted glycoproteins reflect pathophysiological states of the organ and represent a rational target for serologic monitoring. In this study, we describe sialylated O-glycoforms of liver-secreted hemopexin (HPX) and quantify them as a ratio of disialylated to monosialylated form (S-HPX).

Methods

We measured S-HPX in serum of participants of the HALT-C trial using a LC–MS/MS-MRM assay.

Results

Repeated measurements of S-HPX in the samples of 23 disease-free controls, collected at four different time points, show that the ratio remains stable in the healthy controls but increases with the progression of liver disease. The results of measurement of S-HPX in serum of participants of the HALT-C trial show that it increased significantly (Kruskal–Wallis test, p < 0.01) in liver disease as the stage of fibrosis progressed in liver biopsies. We observed a 1.7-fold increase in fibrosis defined as Ishak score 3–4 (24.9 + 14.2, n = 22) and 4.7-fold increase in cirrhosis defined as Ishak score 5–6 (68.6 + 38.5; n = 24) compared to disease-free controls (14.7 + 6.7, n = 23). S-HPX is correlated with AFP, bilirubin, INR, ALT, and AST while inversely correlated with platelet count and albumin. In an independent verification set of samples, S-HPX separated the Ishak 5–6 (n = 15) from the Ishak 3–4 (n = 15) participants with AuROC 0.84; at the same time, the Ishak 3–4 group was separated from disease-free controls (n = 15) with AuROC 0.82.

Conclusion

S-HPX, a measure of sialylated O-glycoforms of hemopexin, progressively increases in fibrotic and cirrhotic patient of HCV etiology and can be quantified by an LC–MS/MS-MRM assay in unfractionated serum of patients. Quantification of sialylated O-glycoforms of this liver secreted glycoprotein represents a novel measure of the stage of liver disease that could have a role in monitoring the progression of liver pathology.

Electronic supplementary material

The online version of this article (doi:10.1186/s12014-016-9125-x) contains supplementary material, which is available to authorized users.

Abstract 3467: Moderate-intensity exercise to reduce radiation therapy-related fatigue in black breast cancer patients: A feasibility trial

Background: Fatigue is an important side-effect of radiation therapy (RT) for treatment of early stage breast cancer. Evidence on the efficacy of physical activity (PA) interventions in reducing fatigue among Black cancer patients undergoing RT is lacking. In a randomized controlled trial we tested the efficacy of a structured PA intervention, coinciding with the start of RT, in reducing cancer-related fatigue among Black patients undergoing RT for breast cancer.

Methods: We randomly assigned 30 Black, sedentary, RT-naïve, non-pregnant patients diagnosed with stage 0-IIIA breast cancer who had completed adjuvant or neo-adjuvant chemotherapy and were scheduled for RT to the PA intervention (n = 15) and control groups (n = 15). PA intervention was an 8-week structured, moderate-intensity aerobic exercise regimen (75 minutes/week) using PEDLARS (portable stationary cycle ergometers) concurrent with RT. Fatigue was measured by using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) survey, a 13-item scale whose score ranges from 0 to 52 with a higher score denoting lower fatigue. We used ANCOVA to compare fatigue levels between the groups at T8 weeks after adjusting for baseline (T0) fatigue levels. We also compared change in fatigue scores (T8 weeks - T0) using 2-sample t-tests. All tests were double-sided with alpha = 0.05.

Results: 27 women completed baseline and follow-up assessments. After adjusting for baseline fatigue scores, intervention group participants reported lower fatigue at T8 weeks than the control group (42.53 vs. 37.12; P = 0.17). Intervention group participants improved their fatigue scores at T8 weeks compared to T0 (mean change +1.3) but the control group did not (mean change -1.91; P = 0.42).

Conclusion: Although statistically not significant, moderate-intensity exercise regimen among Black breast cancer patients undergoing RT was associated with lower RT-associated fatigue. This trial demonstrated the feasibility and acceptability of conducting a randomized clinical trial of a moderate-intensity exercise program among women initiating RT for breast cancer.

Citation Format: Chiranjeev Dash, Mary Mills, Vivian Watkins, Pamela Randolph-Jackson, Claudine Isaacs, Kepher Makambi, Lucile L. Adams-Campbell. Moderate-intensity exercise to reduce radiation therapy-related fatigue in black breast cancer patients: A feasibility trial. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3467.

Cardiorespiratory Fitness and Metabolic Syndrome in Postmenopausal African-American Women

We examined the association of cardiorespiratory fitness with metabolic syndrome in overweight/obese postmenopausal African-American women. Pooled baseline data on 170 African-American women from 2 exercise trials were examined. Metabolic syndrome was defined as at least 3 of the following: abdominal obesity, glucose intolerance, hypertension, low high-density lipoprotein cholesterol (HDL-C), and high triglycerides. Cardiorespiratory fitness (VO2peak) was determined using the Bruce treadmill protocol and categorized as: Very Low (VLCRF<18 mL·kg(-1) min(-1)), Low (LCRF=18.0-220-22-22.0 mL·kg(-1) min(-1)), and Moderate (MCRF>22.0 mL·kg(-1) min(-1)). Associations of metabolic syndrome with cardiorespiratory fitness were analyzed using one-way ANOVA and linear regression. VO2peak was significantly lower in the VLCRF compared to the MCRF group. Lower cardiorespiratory fitness was associated with higher prevalence of metabolic syndrome, abdominal obesity, hypertriglyceridemia, and low HDL among overweight/obese postmenopausal African-American women. In fully adjusted models, higher waist circumference and triglycerides were associated with lower VO2peak levels (P<0.01) and higher HDL-C was associated with higher VO2peak levels (P=0.03). Overweight/obese postmenopausal African-American women with very low cardiorespiratory fitness are more likely to have metabolic syndrome, higher body mass index, and unhealthier levels of certain metabolic syndrome components than women with moderate cardiorespiratory fitness.

An exercise trial to reduce cancer related fatigue in African American breast cancer patients undergoing radiation therapy: Design, rationale, and methods

BACKGROUND

Cancer related fatigue (CRF) is a common and debilitating side-effect of radiotherapy in breast cancer patients. Physical activity interventions can attenuate CRF but evidence in African-American women with breast cancer is lacking.

METHODS/DESIGN

The "Pedlar" Study is a prospective, 8-week structured moderate-intensity exercise intervention, delivered concurrently with radiotherapy, to reduce CRF and improve health-related quality of life among African American breast cancer patients. Forty African American women with breast cancer scheduled to receive radiation therapy at MedStar Washington Hospital Center will be randomized to one of the two trial arms: 1) a facility-based aerobic exercise utilizing a portable stationary pedal exerciser; and 2) a control group. Intervention arm participants will exercise at the hospital either before or after their radiation treatment. Assessments will be conducted at baseline, 4, and 8 weeks. The outcome variables are CRF, biomarkers of inflammation, and health-related quality of life.

DISCUSSION

The Pedlar Study will provide preliminary evidence on whether a short-term moderate-intensity exercise intervention might be effective in reducing CRF in African American women undergoing radiotherapy for breast cancer, and whether this effect is mediated by inflammation.

The feasibility and acceptability of a diet and exercise trial in overweight and obese black breast cancer survivors: The Stepping STONE study

PURPOSE

Black breast cancer survivors have high rates of obesity and low physical activity levels. Little is known about the acceptability and feasibility of interventions in this population.

OBJECTIVE

A two-arm RCT was launched to assess the efficacy of a culturally targeted 12-week multimodal lifestyle intervention in overweight and obese black survivors.

METHODS

Intervention components included nutrition education, exercise groups, and survivor-led motivational interviewing phone sessions. The analytic sample included women who completed the trial (intervention n=10; control n=12). Anthropometric measures, physical activity, and VO2max were assessed at baseline and follow-up. Change scores (intervention vs. control) were assessed with Wilcoxon rank-sum tests. A process evaluation assessed intervention acceptability.

RESULTS

Overall adherence was 70% and overall satisfaction was high (86%). Despite the 5% weight loss target, the intervention group lost 0.8% but BMI improved. Total physical activity levels increased in the intervention vs. control arm (+3501METmin/week vs. +965METmin/week, respectively). VO2max improved in the intervention group (+0.10±1.03kg/L/min). Intervention participants reduced energy intake (-207.3±31.5kcals) and showed improvements in fat intake (-15.5±3.8g), fiber (+3.2±1.2g) and % energy from fat (-4.8±3.1%). Survivors suggested providing diet/exercise information within a cancer context.

CONCLUSIONS

Group and individualized intervention strategies are acceptable to black survivors. Observed differences between self-report and objective outcomes may suggest reporting bias or changes in body composition. Increasing supervised intervention components and assessment of body composition will be important for future trials.

Abstract A92: Patients' experiences with breast cancer care: Do sociocultural factors attenuate racial disparities in ratings of quality?

Background: Several studies have reported disparities in access to quality cancer care in women from racial/ethnic groups compared to non-Hispanic whites. Few reports examine the factors associated with breast cancer patients' ratings of quality care. The goal of this study is to (1) assess racial disparities in patients' ratings of quality care and (2) identify factors that may attenuate these disparities.

Methods: We surveyed and abstracted medical records for 359 breast cancer patients (59% black; 41% white) in Washington, DC and Detroit, MI. Ratings of quality of cancer care were assessed for four domains (general satisfaction, technical quality, interpersonal manner, and financial aspects).

Results: Black women were more likely to report lower ratings on three dimensions including technical (black m=3.99; white m=4.27; p&lt;.001), interpersonal (black m=4.17; white m=4.36; p&lt;.01), and financial (black m=3.82; white m=4.01; p&lt; .05).

General satisfaction ratings: In bivariate analysis, women with higher ratings were those who made surgery decisions with the physician, reported fewer barriers to use health care services (appointment, physical, and emotional barriers) perceived lower discrimination, lower medical mistrust, had high health self-efficacy (maintaining a positive attitude, seeking information, and participating in care), and had high trust in their providers and oncologist (all p&lt;.05). In multivariate analysis, only trust in the oncologist (B=.085, SE=.04, p=.033), trust in providers (B=.069,SE=.02, p=.00), and appointment barrier (B=-.32, SE=.15, p=.04) remained significant.

Technical care ratings: In bivariate analysis, women with higher ratings were those who made decisions about treatment with the physician, were in racially concordant patient-provider relationship, had lower perceived discrimination, lower medical mistrust, higher trust in the providers and in the oncologist, and did not endorse limited office hours or emotional barriers. Additionally, self-efficacy (the three subscales) was associated with higher ratings (all p&lt;.05). In multivariate analysis, medical mistrust (B=-0.20, SE=.007, p=.003) and trust in provider remained significant (B=.083, SE=.011, p=.000).

Interpersonal care ratings: Factors associated with higher ratings in bivariate analysis included: oncologist race concordance, high trust in oncologist and in the provider, high self-efficacy (participating in care). Participants who reported more barriers (limited office hours and health insurance in particular), those with lower perceived discrimination, lower medical mistrust, and lower ratings of communalism had higher ratings of interpersonal care (all p&lt;.05). Only trust in provider (B=.05, SE= .012, p=.000) and total number of barriers (B= -.057, SE=.019, p=.003) remained significant in multivariate analysis.

Financial aspects of care ratings: In bivariate analysis, number of barriers (appointment, health insurance, money, physical, and emotion in particular), religiosity, perceived discrimination, self-efficacy (positive attitude and participating in care), medical mistrust, trust in providers and in oncologist were significantly related to ratings of financial aspects of care (all p&lt;.05). In multivariate analysis, perceived discrimination (B=-.067, SE=.028, p=.019), trust in provider (B=.053, SE=.013, p=.000), insurance (B=-.491, SE=.162, p=.003) and money barrier (B=-.672, SE=.129, p=.000), and religiosity (B=.017, SE=.007, p=.024) remained significant.

Conclusion: Black women reported lower ratings of quality for most domains. Both sociocultural (e.g. communalism) and healthcare process factors (e.g. trust) appear to diminish the impact of race. This study adds to the limited knowledge about black and white women's cancer care experiences and suggests potential intervention targets that may help reduce disparities.

Citation Format: Vanessa B. Sheppard, Alejandra Hurtado de Mendoza, Minna Song, Kepher Makambi. Patients' experiences with breast cancer care: Do sociocultural factors attenuate racial disparities in ratings of quality? [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A92.

Hepatitis C virus Genotype 1a core gene nucleotide patterns associated with hepatocellular carcinoma risk

Specific sequence changes in codons 70 and 91 of the hepatitis C virus genotype 1b (HCV GT1b) core gene have been associated with increased risk of hepatocellular carcinoma (HCC). Essentially all previous studies were conducted in Asian populations with a wide range of liver disease, and none were conducted specifically in GT1a-infected individuals. We conducted a pilot study in a multiethnic population in the USA with HCV-related cirrhosis to determine if this association extended to GT1a-infected individuals and to determine if other sequence changes in the HCV core gene were associated with HCC risk. HCV core gene sequences from sera of 90 GT1 HCV carriers with cirrhosis (42 with HCC) were analysed using standard RT-PCR-based procedures. Nucleotide sequence data were compared with reference sequences available from GenBank. The frequency of sequence changes in codon 91 was not statistically different between HCC (7/19) and non-HCC (11/22) GT1b carriers. In GT1a carriers, sequence changes in codon 91 were observed less often than in GT1b carriers but were not observed in non-HCC subjects (4/23 vs 0/26, P = 0.03, Fisher's exact test). Sequence changes in codon 70 were not distributed differently between HCC and non-HCC GT1a and 1b carriers. Most importantly, for GT1a carriers, a panel of specific nucleotide changes in other codons was collectively present in all subjects with HCC, but not in any of the non-HCC patients. The utility of this test panel for early detection of HCC in GT1a-infected individuals needs to be assessed in larger populations, including longitudinal studies.

An exercise trial targeting African-American women with metabolic syndrome and at high risk for breast cancer: Rationale, design, and methods

BACKGROUND

Metabolic syndrome and obesity are known risk factors for breast cancers. Exercise interventions can potentially modify circulating biomarkers of breast cancer risk but evidence in African-Americans and women with metabolic syndrome is lacking.

METHODS/DESIGN

The Focused Intervention on Exercise to Reduce CancEr (FIERCE) trial is a prospective, 6-month, 3-arm, randomized controlled trial to examine the effect of exercise on obesity, metabolic syndrome components, and breast cancer biomarkers among African-American women at high risk of breast cancer. Two hundred-forty inactive women with metabolic syndrome and absolute risk of breast cancer ≥ 1.40 will be randomized to one of the three trial arms: 1) a supervised, facility-based exercise arm; 2) a home-based exercise arm; and 3) a control group that maintains physical activity levels through the course of the trial. Assessments will be conducted at baseline, 3 months, and 6 months. The primary outcome variables are anthropometric indicators of obesity, metabolic syndrome components, and inflammatory, insulin-pathway, and hormonal biomarkers of breast cancer risk.

DISCUSSION

The FIERCE trial will provide evidence on whether a short-term exercise intervention might be effective in reducing breast cancer risk among African-American women with comorbidities and high breast cancer risk--a group traditionally under-represented in non-therapeutic breast cancer trials.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02103140.

Telomere length variation: A potential new telomere biomarker for lung cancer risk

OBJECTIVES

In this report the associations between telomere length variation (TLV), mean telomere length in blood lymphocytes and lung cancer risk were examined.

MATERIALS AND METHODS

The study design is case-control. Cases (N=191) were patients newly diagnosed with histologically confirmed non-small cell lung cancer. Controls (N=207) were healthy individuals recruited from the same counties as cases and matched to cases on age and gender. Telomere fluorescent in situ hybridization was used to measure telomere features using short-term cultured blood lymphocytes. Logistic regression was used to estimate the strength of association between telomere features and lung cancer risk.

RESULTS

Telomere length variation across all chromosomal ends was significantly associated with lung cancer risk; adjusted odds ratios 4.67 [95% confidence interval (CI): 1.46-14.9] and 0.46 (95% CI: 0.25-0.84) for younger (age≤60) and older (age>60) individuals, respectively. TLV and mean telomere length jointly affected lung cancer risk: when comparing individuals with short telomere length and high TLV to those with long telomere length and low TLV, adjusted odd ratios were 8.21 (95% CI: 1.71-39.5) and 0.33 (95% CI: 0.15-0.72) for younger and older individuals, respectively.

CONCLUSIONS

TLV in blood lymphocytes is significantly associated with lung cancer risk and the associations were modulated by age. TLV in combination with mean telomere length might be useful in identifying high risk population for lung cancer computerized tomography screening.

Disparities in breast cancer surgery delay: the lingering effect of race

BACKGROUND

Delays to surgical breast cancer treatment of 90 days or more may be associated with greater stage migration. We investigated racial disparities in time to receiving first surgical treatment in breast cancer patients.

METHODS

Insured black (56 %) and white (44 %) women with primary breast cancer completed telephone interviews regarding psychosocial (e.g., self-efficacy) and health care factors (e.g., communication). Clinical data were extracted from medical charts. Time to surgery was measured as the days between diagnosis and definitive surgical treatment. We also examined delays of more than 90 days. Unadjusted hazard ratios (HRs) examined univariate relationships between delay outcomes and covariates. Cox proportional hazard models were used for multivariate analyses.

RESULTS

Mean time to surgery was higher in blacks (mean 47 days) than whites (mean 33 days; p = .001). Black women were less likely to receive therapy before 90 days compared to white women after adjustment for covariates (HR .58; 95 % confidence interval .44, .78). Health care process factors were nonsignificant in multivariate models. Women with shorter delay reported Internet use (vs. not) and underwent breast-conserving surgery (vs. mastectomy) (p < .01).

CONCLUSIONS

Prolonged delays to definitive breast cancer surgery persist among black women. Because the 90-day interval has been associated with poorer outcomes, interventions to address delay are needed.

Abstract C22: Telomere length variation and frequency of short telomeres in blood lymphocytes: Novel biomarkers for lung cancer risk

Background: Although it is widely recognized that telomere dysfunction plays an important role in cancer, the relationship between telomere function in somatic cells and lung cancer risk is not well defined. In a case-control study of non-small cell lung cancer, we examined relationship between several key telomere features and lung cancer risk. Method: Telomere fluorescent in situ hybridization was used to measure telomere features using short-term cultured blood lymphocytes. Logistic regression was used to estimate the strength of association between telomere features and lung cancer risk. Results: Telomere length variation across all chromosomal ends was significantly associated with lung cancer risk, with adjusted odds ratios of 4.67 [95% confidence interval (CI) = 1.46 – 14.9] and 0.46 (95% CI = 0.25 – 0.84) for young (age &lt; 60) and old (age &gt; 60) individuals, respectively. Similar strength and direction of associations between percentage of short telomeres and lung cancer risk were also observed. Telomere length variation and average telomere length jointly affect lung cancer risk. When comparing individuals with short telomere and high telomere length variation to those with long telomere and low telomere length variation, adjusted odd ratios were 8.21 (95% CI = 1.71 – 39.5) and 0.33 (95% CI = 0.15 – 0.72) for young and old individuals, respectively. Conclusion: Telomere length variation and percentage of short telomeres in blood lymphocytes are significantly associated with lung cancer risk and the associations are modulated by age. Telomere length variation in combination with average telomere length may be a promising tool for lung cancer risk assessment.

Citation Format: Bing Sun, Ying Wang, Krishna Kota, Yaru Shi, Salaam Motlek, Kepher Makambi, Christopher A. Loffredo, Peter G. Shields, Qin Yang, Curtis C. Harris, Yun-Ling Zheng. Telomere length variation and frequency of short telomeres in blood lymphocytes: Novel biomarkers for lung cancer risk. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C22.

The importance of contextual factors and age in association with anxiety and depression in Black breast cancer patients

OBJECTIVES

Limited research exists on correlates of psychosocial distress in Black breast cancer patients. The goals of the study were to describe the prevalence of distress (anxiety and depression) in Black women with breast cancer and to examine the influence of demographic, clinical, contextual (e.g., self-efficacy, medical mistrust), and process of care factors (e.g., patient satisfaction) on women's level of anxiety and depression.

METHODS

Eighty-two Black women diagnosed with invasive non-metastatic breast cancer were interviewed by phone. Collected data included demographic, clinical, contextual, and process of care factors. Bivariate correlations were used to examine relationships between those variables. Multiple linear regressions were used to examine predictors of anxiety and depression.

RESULTS

About one-third of the women (32%) met cut-off thresholds for distress. Medical mistrust and positive attitude had significant influences on anxiety levels, whereas age and positive attitude were determinants of levels of depression. Participants with higher medical mistrust reported more anxiety (r = .379; p < .001) and depression (r = .337; p = .002), whereas women with higher self-efficacy reported less anxiety (r = -.401; p < .001) and depression (r = -.427; p < .001). Age was inversely related to both anxiety and depression (r = -.224; r = -.296, respectively; p < .05).

CONCLUSIONS

Findings support national recommendations for routine distress screening in the delivery of cancer care particularly in younger Black patients. Interventions targeted to boost self-efficacy or reduce medical mistrust through enhanced patient-provider interactions may decrease psychological distress. Psychosocial needs of younger patients warrant particular attention.

Quantitative liquid chromatography-mass spectrometry-multiple reaction monitoring (LC-MS-MRM) analysis of site-specific glycoforms of haptoglobin in liver disease

Development of liver disease is associated with the appearance of multiply fucosylated glycoforms of haptoglobin. To analyze the disease-related haptoglobin glycoforms in liver cirrhosis and hepatocellular carcinoma, we have optimized an LC-MS-multiple reaction monitoring (MRM) workflow for glycopeptide quantification. The final quantitative analysis included 24 site-specific glycoforms generated by treatment of a tryptic digest of haptoglobin with α(2-3,6,8)-neuraminidase and β(1-4)-galactosidase. The combination of LC-MS-MRM with exoglycosidase digests allowed resolution of isobaric glycoforms of the haptoglobin-T3 glycopeptide for quantification of the multiply fucosylated Lewis Y-containing glycoforms we have identified in the context of liver disease. Fourteen multiply fucosylated glycoforms of the 20 examined increased significantly in the liver disease group compared with healthy controls with an average 5-fold increase in intensity (p < 0.05). At the same time, two tri-antennary glycoforms without fucoses did not increase in the liver disease group, and two tetra-antennary glycoforms without fucoses showed a marginal increase (at most 40%) in intensity. Our analysis of 30 individual patient samples (10 healthy controls, 10 cirrhosis patients, and 10 hepatocellular carcinoma patients) showed that these glycoforms were substantially increased in a small subgroup of liver disease patients but did not significantly differ between the groups of hepatocellular carcinoma and cirrhosis patients. The tri- and tetra-antennary singly fucosylated glycoforms are associated with a MELD score and low platelet counts (p < 0.05). The exoglycosidase-assisted LC-MS-MRM workflow, optimized for the quantification of fucosylated glycoforms of haptoglobin, can be used for quantification of these glycoforms on other glycopeptides with appropriate analytical behavior.

A randomized, controlled community-wide intervention to reduce environmental tobacco smoke exposure

INTRODUCTION

Tobacco use in low- to middle-income countries is a major public health concern for both smokers and those exposed to environmental tobacco smoke (ETS). Egypt has made important strides in controlling tobacco use, but smoking and ETS remain highly prevalent. This randomized intervention sought to improve the target population's knowledge regarding the hazards of smoking and ETS and to change attitudes and smoking behaviors within the community and the household.

METHODS

In this 2005-2006 study in Egypt's Qalyubia governorate, trained professionals visited schools, households, mosques, and health care centers in rural villages randomly selected for the intervention to discuss the adverse effects of smoking and ETS exposure and ways to reduce one's ETS exposure. Data collected in interviewer-facilitated surveys before and after the intervention period were analyzed in pairwise comparisons with data from control villages to assess the effectiveness of the intervention in achieving its aims.

RESULTS

The intervention group showed a greater increase in understanding the dangers associated with smoking cigarettes and waterpipes and became more proactive in limiting ETS exposure by asking smokers to stop, avoiding areas with ETS, and enacting smoking bans in the home. However, the intervention had little to no impact on the number of smokers and the amount of tobacco smoked.

CONCLUSIONS

Results are consistent with previous studies showing that changing smokers' behavior can be difficult, but community-wide efforts to reduce ETS exposure through smoking bans, education, and empowering people to ask smokers to stop are effective. The method can be generalized to other settings.

A six-month crossover chemoprevention clinical trial of tea in smokers and non-smokers: methodological issues in a feasibility study

BACKGROUND

Chemoprevention crossover trials of tea can be more efficient than parallel designs but the attrition and compliance rates with such trials are unknown.

METHODS

Attrition (dropouts) and compliance with treatment were assessed in a 25-week randomized, placebo controlled, crossover, feasibility clinical trial of four tea treatments to investigate the effect of tea on oral cancer biomarkers. Each treatment lasted 4 weeks with 2 weeks of washout in between. Participants were 32 smokers and 33 non-smokers without any evidence of premalignant oral lesions. The interventions consisted of packets of green tea, black tea, caffeinated water, or placebo. Participants were assigned to each treatment for four weeks, and were instructed to drink five packets per day while on the treatment. Dropout from the trial and compliance (consumption of ≥85% of the prescribed treatment packets) are the main outcome measures reported.

RESULTS

There was a high rate of dropout (51%) from the study, and the rates were significantly higher among smokers (64%) than non-smokers (36%). Among participants who completed the study the rate of compliance was 72%. The highest rates of dropouts occurred between the first and second treatment visits in both smokers (38% dropout) and non-smokers (18% dropout). Throughout the study smokers were more likely to dropout than non-smokers. Black tea treatment was associated with the highest rates of dropout among smokers (37%), but was associated with the lowest rate of dropout among non-smokers (4%).

CONCLUSIONS

In a study conducted to test the feasibility of a four-treatment crossover tea trial, a high rate of dropout among smokers and non-smokers was observed. Multi-arm crossover tea trials might pose a higher burden on participants and research is needed to improve adherence and treatment compliance in such trials.

TRIAL REGISTRATION NUMBER

ISRCTN70410203.

The effect of a supervised exercise trial on exercise adherence among African American Men: a pilot study

OBJECTIVE

The objective of this pilot study was to determine the effect of a supervised short-term exercise trial on exercise adherence in a sample of African American males.

METHODS

We observed exercise adherence rates among a group of African American men in response to an exercise intervention. Exercise adherence was determined by dividing the total number of actual sessions attended by the total number of possible sessions (12 sessions). A participant was classified as an adherer if they completed 9 out of 12 exercise sessions (75%).

RESULTS

Seventy-one percent of the study participants (12/17) completed at least 75% of the study sessions and therefore adhered to the study protocol. Among the adherers, 7 out of 12 (58%) had adherence rates of 100%. Five participants withdrew from the exercise group due to lack of time and lack of interest.

CONCLUSION

Exercise adherence rates among African-American men in this study were favorable during this supervised exercise intervention and were comparable to adherence rates observed in other supervised exercise interventions. Recommendations based on this pilot study are provided to reduce participant withdrawal and to inform future large-scale studies.

Meta-analysis of Endoscopic vs Sublabial Pituitary Surgery

Objective: Determine whether the endoscopic or sublabial transseptal transsphenoidal approach for pituitary surgery has superior outcomes or decreased complication rates.

Method: A Medline search was conducted identifying all relevant literature in the English language from 1998 through 2010. Studies explicitly identifying pure sublabial or completely endoscopic approaches were included. Meta-analysis comparing the two techniques was performed for multiple outcome measures utilizing a random effects approach.

Results: A total of 21 endoscopic studies (n = 2335) and 17 sublabial studies (n = 2565) met inclusion criteria. Analysis revealed significantly superior rates of gross tumor resection (79% vs 65%, P < .0001), as well as lower rates of cerebral spinal fluid leak (5% vs 7%, P < .01), septal perforation (0% vs 4%), and postoperative epistaxis (1% vs 4%, P < .0001) for the endoscopic approach compared to the sublabial approach. There was no difference between the 2 techniques in the incidence of meningitis, diabetes insipidus, or resolution of hormonal abnormality. Hospital stay ( P = .01) and length of operation were shorter for endoscopic surgery compared to sublabial surgery.

Conclusion: The sublabial transsphenoidal approach has been the gold standard for pituitary surgery for many years. However, meta-analysis of the recent literature demonstrates superior outcomes and decreased postoperative complications with the endoscopic approach, potentially justifying a shift toward endoscopic pituitary surgery.

Understanding sleep disturbances in African-American breast cancer survivors: a pilot study

OBJECTIVES

The goals of this study were (i) to report the prevalence and nature of sleep disturbances, as determined by clinically significant insomnia symptoms, in a sample of African-American breast cancer survivors; (ii) to assess the extent to which intrusive thoughts about breast cancer and fear of recurrence contributes to insomnia symptoms; and (iii) to assess the extent to which insomnia symptoms contribute to fatigue.

METHODS

African-American breast cancer survivors completed surveys pertaining to demographics, medical history, insomnia symptoms, and intrusive thoughts about breast cancer, fear of cancer recurrence, and fatigue. Hierarchical regression models were performed to investigate the degree to which intrusive thoughts and concerns of cancer recurrence accounted for the severity of insomnia symptoms and insomnia symptom severity's association with fatigue.

RESULTS

Forty-three percent of the sample was classified as having clinically significant sleep disturbances. The most commonly identified sleep complaints among participants were sleep maintenance, dissatisfaction with sleep, difficulty falling asleep, and early morning awakenings. Intrusive thoughts about breast cancer were a significant predictor of insomnia symptoms accounting for 12% of the variance in insomnia symptom severity. After adjusting for covariates, it was found that insomnia symptom severity was independently associated with fatigue accounting for 8% of variance.

CONCLUSIONS

A moderate proportion of African-American breast cancer survivors reported significant problems with sleep. Sleep disturbance was influenced by intrusive thoughts about breast cancer, and fatigue was associated with the severity of participants' insomnia symptoms. This study provides new information about sleep-related issues in African-American breast cancer survivors.

Physical activity reduces breast cancer risk in African American women

OBJECTIVE

To examine the relationship between physical activity and breast cancer in African American women.

DESIGN

A population-based case-control study was conducted with 199 women (97 cases and 102 controls) from the Washington, DC metro area. A physical activity questionnaire elicited responses on frequency of walking for exercise and vigorous physical activity (eg, running, aerobics) in the past year. Responses were used to calculate a metabolic equivalent (MET) score (MET-hours/week = hours/week vigorous activity x 7 + hours/week walking x 3). The MET score was categorized into low, medium, and high tertiles. Multivariate logistic regression examined the association between physical activity and breast cancer.

RESULTS

African American women who engaged in vigorous physical activity (> or = 2 hours/week in the past year) had a 64% reduced risk of breast cancer compared to those who did not participate in any vigorous activity (odds ratio, OR = .36; 95% confidence interval, CI = .17-.75). We also found a 64% reduced breast cancer risk in women with a high vs low tertile of total activity (OR = .36; 95% CI = .16-.79). For postmenopausal women, vigorous physical activity and total activity (high vs low tertile) also had an inverse relationship with breast cancer (P<.05).

CONCLUSION

Data regarding the association of physical activity and breast cancer have been equivocal and lacking for African American women. This study found that modest levels of physical activity reduced breast cancer risk in this group. Targeted efforts are needed to encourage more African American women to engage in physical activity.

Abstract A88: Differences in plasma and breast tissue adipokine levels by race and obesity status

Background: Adipokines, specifically leptin and adiponectin, are directly linked to obesity and it has been suggested that they may contribute to breast carcinogenesis as well. High plasma leptin and low adiponectin concentrations are associated with high levels of body fat, and similar associations have been reported for breast cancer risk. However, little is known about the concentrations of these hormones in breast tissue and if they influence the tissue microenvironment to modify breast cancer risk. Moreover, few studies have investigated racial/ethnic differences in adipokine concentrations and how these differences determine adipokine predictors in different groups.

Methods: Plasma and breast tissues collected from one hundred twelve women (67 European American (EA) women and 45 African American (AA) women), without breast cancer, undergoing reduction mammoplasty surgery were analyzed for leptin and adiponectin concentrations. Tissue and plasma leptin and adiponectin were quantified by commercially available enzyme-linked immunosorbent assays (R&D Systems, Minneapolis, MN). Tissue adipokine concentrations were adjusted by total protein concentration (reported as nanograms of hormone per milligram of protein (ng/mg of protein)). Assays were highly reproducible and all CVs were ≤9.3%. Spearman rank correlation coefficients were used to describe associations between plasma and tissue adipokine concentrations as well as associations among adipokine concentrations and selected breast cancer risk variables. Two-way ANOVAs were used to determine associations between adipokine concentrations and race and obesity status.

Results: Overall, AAs had significantly higher plasma and tissue leptin and lower plasma adiponectin concentrations than EAs. They also had significantly lower adiponectin to leptin ratios in both plasma and tissue. There was no significant difference in tissue adiponectin concentrations between EAs and AAs. Obese women had significantly higher plasma and tissue leptin than non-obese women, but no significant difference in plasma and tissue adiponectin concentrations were observed. Generally, there were several significant associations observed among plasma and tissue adipokines and selected breast cancer risk variables; however several of these associations were attenuated in AAs and non-obese women. Plasma and tissue leptin correlated well in EAs, but not in AAs. There was no correlation between plasma and tissue adiponectin concentrations in any individual group, but when combined there was a marginal association.

Conclusions: We found differences by race/ethnicity and by obesity status in adipokines in tissue and blood. Additionally, we found a lack of association between circulating adiponectin and breast tissue levels for AA women. If adipokines play a role in carcinogenesis in the breast, there may be effect modification by race/ethnicity and by body weight.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A88.

Abstract A80: Physical activity reduces breast cancer risk in African American women

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

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

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

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

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

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A80.

Dietary patterns and breast cancer risk in women participating in the Black Women's Health Study

BACKGROUND

No studies have examined dietary patterns and breast cancer risk in a large cohort of African American women.

OBJECTIVE

We investigated the association between dietary patterns and breast cancer risk in the Black Women's Health Study.

DESIGN

This is a prospective cohort study of 50,778 participants followed biennially from 1995 through 2007. During 443,742 person-years of follow-up, 1094 incident cases of breast cancer were identified. Factor analysis was used to derive food patterns based on 69 food variables. We used Cox regression models to obtain incident rate ratios (IRRs) for breast cancer in relation to quintiles of each of the 2 dietary patterns, with adjustment for other breast cancer risk factors.

RESULTS

Through factor analysis, we identified 2 dietary patterns: Western (refined grains, processed meat, and sweets) and prudent (whole grains, vegetables, fruit, and fish). The prudent diet was weakly associated with lower breast cancer risk overall; P for trend = 0.06. In analyses stratified by body mass index (BMI; in kg/m(2)), the prudent dietary pattern was associated with a significantly lower risk of breast cancer in women with a BMI <25 (IRR: 0.64; 95% CI: 0.43, 0.93; P for trend = 0.01). The prudent dietary pattern was also associated with a significantly lower risk of breast cancer in premenopausal women (IRR: 0.70; 95% CI: 0.52, 0.96; P for trend = 0.01), and we found a significant inverse association for the prudent dietary pattern and estrogen receptor-negative breast cancer (IRR: 0.52; 95% CI: 0.28, 0.94; P for trend <0.01).

CONCLUSION

Our findings suggest that the prudent dietary pattern may protect against breast cancer in some black women.

Predicting regular breast cancer screening in African-American women with a family history of breast cancer

OBJECTIVE

To evaluate the impact of socioeconomic, personal and affective factors on regular breast cancer screening in at-risk African-American women.

METHODS

The study was a cross-sectional analysis assessing socioeconomic and affective predictors of breast cancer screening practices. Unaffected African-American women ages 40-64 with a family history of breast cancer were recruited from community settings. The main outcome measures were recent mammography, regular mammography and regular breast self-examinations.

RESULTS

The majority of women reported having a recent mammogram (73%) and yearly mammograms (71%). More than half (56%) reported monthly breast self-examinations (BSEs). Available health insurance and risk perception had significant independent associations with regular mammography screening so that women having a mammogram every 6-12 months were more likely to have health insurance [odds ratio (OR)=4.99, 95% confidence interval (CI): 1.05-23.52], and women not engaged in regular screenings were less likely to perceive future breast cancer risk (OR=0.10, 95% CI: 0.01-0.96). Access to regular healthcare had a significant independent association with recent mammography so that women having a mammogram in the past 12 months were more likely to have access to regular healthcare (OR=6.59, 95% CI: 1.01-42.79).

CONCLUSIONS

A significant majority of this subset of African-American women engage in repeat mammography screenings with cognitive and economic factors predicting noncompliance. Additional research with repeat mammography users is required so that regular screening practices can be encouraged among all at-risk women.

Abstract B32: Colonoscopy utilization in the Black Women's Health Study

B32

Objectives

The primary objective of the present study is to determine colorectal screening patterns via colonoscopy utilization in a national prospective cohort, the Black Women’s Health Study.

Methods

In 1995, 59,000 Black women aged 21 to 69 years were initially enrolled in the Black Women’s Health Study through questionnaires consisting of 54 self-report items that included demographics, medical history, health behaviors, and use of medical care. Follow-up questionnaires were sent every 2 years to update risk factors of interest and ascertain newly diagnosed diseases and screening practices. Logistic regression models were used to estimate odds ratios and the corresponding 95% confidence interval (CI).

Results

The study sample comprised 10,992 black women whose ages ranged from 50 to 72 years in 1997 when detailed questions were first asked about cancer screening. Women who utilized mammography were more likely to have a colonoscopy than women who never screened for breast cancer (odds ratio = 2.64, 95% CI 2.27, 3.08). This was the strongest predictor of colonoscopy screening.

Conclusion

The importance of promoting multiple concurrent cancer screenings may be the best approach to increasing colonoscopy utilization among women.

Citation Information: Cancer Prev Res 2008;1(7 Suppl):B32.

CES-D four-factor structure is confirmed, but not invariant, in a large cohort of African American women

This study examined the factor structure of the Centers for Epidemiologic Studies Depression Scale (CES-D) in a sample of 40,403 African American women participating in the Black Women's Health Study (BWHS). To examine within group differences in the structural characteristics of the CES-D, women were stratified by age (< 60 vs. > or = 60 years). Confirmatory factor analysis indicated that a four-factor solution was a good fit for the data in both groups. The four factors extracted (depressed, somatic, positive, and interpersonal) matched findings from previous studies in other populations. Although item loadings were identical for 19 of 20 items, when equality restrictions were placed on factor loadings, the factors were not shown to be equivalent across groups. The only observed difference in item loadings was that the item "people disliked me" loaded higher on the interpersonal factor for younger women than older women. The variance/covariance matrix differed between groups. The correlations between the depressed and somatic factors were identical for the two age groups. However, correlations among the other factors were weaker among older women. We conclude that four-factor structure of the CES-D is supported for African American women, but the relationships among the factors vary with age.

Legume intake and reduced colorectal adenoma risk in African-Americans

Colorectal adenomas are known precursors for colorectal cancer. Several studies have shown that dietary factors can influence adenoma formation and growth. This study was conducted using African-American men and women who were undergoing colonoscopies in order to examine the relationship between selected dietary factors and the risk for colon polyps. In a case-control design, 186 men and women with a mean of 58 years of age were studied. A multiple logistic regression model was used to adjust for potential confounding variables and to determine which factors influence colorectal adenoma risk. Study results revealed that consumption of legumes such as dried beans, split peas, or lentils was negatively associated with risk (OR = 0.19; 95% CI: 0.04-0.91). Legumes are a good source of dietary fiber and of phytochemical compounds that may play a role in reducing adenoma formation or growth, thereby decreasing the risk of colorectal cancer. Nurses working with African-Americans should encourage consumption of these foods to decrease this risk.

Validation of physical activity instruments: Black Women's Health Study

PURPOSE

Few studies have reported on the validity of physical activity measures in African Americans. The present study was designed to determine the validity of a self-administered physical activity questionnaire (PAQ) that was used in a large prospective study of African American women in the United States against an accelerometer (actigraph), an objective assessment of movement, and a seven-day activity diary.

METHODS

The study was conducted among 101 women enrolled in the Black Women's Health Study (BWHS) cohort who resided in the Washington, DC, metropolitan area, representing 11.2% (101/900) of this sample. Physical activity levels were obtained from the parent BWHS PAQ (eg, 1997 and 1999) and repeated in the present study. This information entailed hours per week of participation in walking for exercise, hours per week of moderate activity (eg, housework, gardening, and bowling), and hours per week of strenuous activity (eg, basketball, swimming, running, and aerobics) during the previous year. The participants were required to wear actigraphs for seven days and then record their physical activities in their diaries (seven-day physical activity diary) during this time. The diaries were used to record the amount and pattern of daily energy expenditure.

RESULTS

Significant positive correlations were seen between the BWHS PAQ and the actigraph for total activity, r=.28; walking, r=.26; and vigorous activity, r=.40, P<.001. For the seven-day physical activity diary, the BWHS PAQ also demonstrated significant correlations for total (r=0.42, P<.01); moderate (r=.26, P<.05); and vigorous activities (r=.41, P<.01).

CONCLUSIONS

The BWHS PAQ is a useful measure of physical activity in the BWHS cohort and thus has utility in prospective epidemiologic research.

Bone mass in physicians: a Howard University Hospital pilot study

PURPOSE

This observational cross-sectional study was done to determine bone mass in physicians and to determine if variables, such as calcium intake and exercise, were related to their bone mass.

METHODS

One-hundred physicians of different ethnicities (African, African American, Asian, Caribbean, and Hispanic) were studied. Using dual-energy x-ray absorptiometry (DEXA), bone mass (BMD) of the lumbar spine and hips was measured. A validated questionnaire was used to determine the daily calcium intake and exercise. Student t-test, logistic regression, and Pearson chi-square were used to analyze the data.

RESULTS

The study population consisted of 52% men and 48% women, with a mean age of 42 years old and a body mass index of 18.5 to 39.9 kg/m2. Low BMD occurred in 68% of the physicians (osteoporosis in 12%, osteopenia in 56%). Low calcium intake was found in 71%-14% of whom had osteoporosis and 49% osteopenia. Two-thirds of the physicians had inadequate exercise; 57% of this group had decreased BMD (osteoporosis in 9%, osteopenia in 38%). There was no statistical significance between BMD and calcium intake or exercise.

CONCLUSION

A high percentage of the physicians in this unique study had a reduced BMD. Most of the physicians with low BMD were less than 45 years of age. This study indicates the need to define BMD in a larger cohort of young, ethnically diverse clinicians, and other health workers.