Cancer-Related Health and Educational Needs and Faith-Based Health Beliefs in an Urban Muslim Population

Cancer screening behaviors in Muslims are under-researched, and there is limited data on how it relates to their unique cultural and religious beliefs. We assessed cancer prevention and screening-related health needs in the Washington DC area. We developed the needs assessment questionnaires and recruitment strategy in collaboration with key faith leaders from four mosques in our catchment area. A total of 203 participants were recruited through community outreach and engagement approaches and were included in the discussion when developing the needs assessment to ensure questions were religiously and culturally sensitive. Of the 203 participants, 56% of women reported receiving screening for a mammogram, while 83% of women reported receiving a screening for cervical cancer. Among men, 45% reported receiving a prostate cancer antigen test to screen for prostate cancer. Among both men and women, 35% reported ever receiving a screening for colorectal cancer. Women reported relying more on their faith when dealing with health concerns than men. Those who did not get screened for breast, colorectal, and cervical cancer relied more on their faith than those who did get screened for these cancers. Participants expressed interest in having health initiatives around cancer education, screening, and survivorship inside mosques. Faith beliefs can influence cancer screening behaviors; however, the relationship between these two variables needs further examination. Continued engagement with key faith leaders can help in leveraging religious beliefs to promote health education and cancer screening.

Multilevel approaches to address disparities in lung cancer screening: a study protocol

BACKGROUND

Low-dose computed tomography (lung cancer screening) can reduce lung cancer-specific mortality by 20-24%. Based on this evidence, the United States Preventive Services Task Force recommends annual lung cancer screening for asymptomatic high-risk individuals. Despite this recommendation, utilization is low (3-20%). Lung cancer screening may be particularly beneficial for African American patients because they are more likely to have advanced disease, lower survival, and lower screening rates compared to White individuals. Evidence points to multilevel approaches that simultaneously address multiple determinants to increase screening rates and decrease lung cancer burden in minoritized populations. This study will test the effects of provider- and patient-level strategies for promoting equitable lung cancer screening utilization.

METHODS

Guided by the Health Disparities Research Framework and the Practical, Robust Implementation and Sustainability Model, we will conduct a quasi-experimental study with four primary care clinics within a large health system (MedStar Health). Individuals eligible for lung cancer screening, defined as 50-80 years old, ≥ 20 pack-years, currently smoking, or quit < 15 years, no history of lung cancer, who have an appointment scheduled with their provider, and who are non-adherent to screening will be identified via the EHR, contacted, and enrolled (N = 184 for implementation clinics, N = 184 for comparison clinics; total N = 368). Provider participants will include those practicing at the partner clinics (N = 26). To increase provider-prompted discussions about lung screening, an electronic health record (EHR) clinician reminder will be sent to providers prior to scheduled visits with the screening-eligible participants. To increase patient-level knowledge and patient activation about screening, an inreach specialist will conduct a pre-visit phone-based educational session with participants. Patient participants will be assessed at baseline and 1-week post-visit to measure provider-patient discussion, screening intentions, and knowledge. Screening referrals and screening completion rates will be assessed via the EHR at 6 months. We will use mixed methods and multilevel assessments of patients and providers to evaluate the implementation outcomes (adoption, feasibility, acceptability, and fidelity).

DISCUSSION

The study will inform future work designed to measure the independent and overlapping contributions of the multilevel implementation strategies to advance equity in lung screening rates.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04675476. Registered December 19, 2020.

Development and Evaluation of Brief Web-Based Education for Primary Care Providers to Address Inequities in Lung Cancer Screening and Smoking Cessation Treatment

Annual lung cancer screening (LCS) is recommended for individuals at high risk for lung cancer. However, primary care provider-initiated discussions about LCS and referrals for screening are low overall, particularly among Black or African Americans and other minoritized racial and ethnic groups. Disparities also exist in receiving provider advice to quit smoking. Effective methods are needed to improve provider knowledge about LCS and tobacco-related disparities, and to provide resources to achieve equity in LCS rates. We report the feasibility and impact of pairing a self-directed Lung Cancer Health Disparities (HD) Web-based course with the National Training Network Lung Cancer Screening (LuCa) course on primary care providers' knowledge about LCS and the health disparities associated with LCS. In a quasi-experimental study, primary care providers (N = 91) recruited from the MedStar Health System were assigned to complete the LuCa course only vs. the LuCa + HD courses. We measured pre-post-LCS-related knowledge and opinions about the courses. The majority (60.4%) of providers were resident physicians. There was no significant difference between groups on post-test knowledge (p > 0.05). However, within groups, there was an improvement in knowledge from pre- to post-test (LuCa only (p = 0.03); LuCa + HD (p < 0.001)). The majority of providers (81%) indicated they planned to improve their screening and preventive practices after having reviewed the educational modules. These findings provide preliminary evidence that this e-learning course can be used to educate providers on LCS, smoking cessation, and related disparities impacting patients.

Association between major discrimination and deficit accumulation in African American cancer survivors: The Detroit Research on Cancer Survivors Study

BACKGROUND

Discrimination can adversely affect health and accelerate aging, but little is known about these relationships in cancer survivors. This study examines associations of discrimination and aging among self-identified African American survivors.

METHODS

A population-based sample of 2232 survivors 20-79 years old at diagnosis were enrolled within 5 years of breast (n = 787), colorectal (n = 227), lung (n = 223), or prostate (n = 995) cancer between 2017 and 2022. Surveys were completed post-active therapy. A deficit accumulation index measured aging-related disease and function (score range, 0-1, where <0.20 is robust, 0.20 to <0.35 is pre-frail, and 0.35+ is frail; 0.06 is a large clinically meaningful difference). The discrimination scale assessed ever experiencing major discrimination and seven types of events (score, 0-7). Linear regression tested the association of discrimination and deficit accumulation, controlling for age, time from diagnosis, cancer type, stage and therapy, and sociodemographic variables.

RESULTS

Survivors were an average of 62 years old (SD, 9.6), 63.2% reported ever experiencing major discrimination, with an average of 2.4 (SD, 1.7) types of discrimination events. Only 24.4% had deficit accumulation scores considered robust (mean score, 0.30 [SD, 0.13]). Among those who reported ever experiencing major discrimination, survivors with four to seven types of discrimination events (vs. 0-1) had a large, clinically meaningful increase in adjusted deficits (0.062, p < .001) and this pattern was consistent across cancer types.

CONCLUSION

African American cancer survivors have high deficit accumulated index scores, and experiences of major discrimination were positively associated with these deficits. Future studies are needed to understand the intersectionality between aging, discrimination, and cancer survivorship among diverse populations.

Lung cancer screening use and implications of varying eligibility criteria by race and ethnicity: 2019 Behavioral Risk Factor Surveillance System data

BACKGROUND

In 2021, the US Preventive Services Task Force (USPSTF) expanded the eligibility criteria for low-dose computed tomographic lung cancer screening (LCS) to reduce racial disparities that resulted from the 2013 USPSTF criteria. The annual LCS rate has risen slowly since the 2013 USPSTF screening recommendations. Using the 2019 Behavioral Risk Factor Surveillance System (BRFSS), this study 1) describes LCS use in 2019, 2) compares the percent eligible for LCS using the 2013 versus 2021 USPSTF criteria, and 3) determines the percent eligible using the more detailed PLCOm2012_Race3L risk-prediction model.

METHODS

The analysis included 41,544 individuals with a smoking history from states participating in the BRFSS LCS module who were ≥50 years old.

RESULTS

Using the 2013 USPSTF criteria, 20.7% (95% confidence interval [CI], 19.0-22.4) of eligible individuals underwent LCS in 2019. The 2013 USPSTF criteria was compared to the 2021 USPSTF criteria, and the overall proportion eligible increased from 21.0% (95% CI, 20.2-21.8) to 34.7% (95 CI, 33.8-35.6). Applying the 2021 criteria, the proportion eligible by race was 35.8% (95% CI, 34.8-36.7) among Whites, 28.5% (95% CI, 25.2-31.9) among Blacks, and 18.0% (95% CI, 12.4-23.7) among Hispanics. Using the 1.0% 6-year threshold that is comparable to the 2021 USPSTF criteria, the PLCOm2012_Race3L model selected more individuals overall and by race.

CONCLUSIONS

Using data from 20 states and using multiple imputation, higher LCS rates have been reported compared to prior BRFSS data. The 2021 expanded criteria will result in a greater number of screen-eligible individuals. However, risk-based screening that uses additional risk factors may be more inclusive overall and across subgroups.

LAY SUMMARY

In 2013, lung cancer screening (lung screening) was recommended for high risk individuals. The annual rate of lung screening has risen slowly, particularly among Black individuals. In part, this racial disparity resulted in expanded 2021 criteria. Survey data was used to: 1) describe the number of people screened in 2019, 2) compare the percent eligible for lung screening using the 2013 versus 2021 guidelines, and 3) determine the percent eligible using more detailed criteria. Lung screening rates increased in 2019, and the 2021 criteria will result in more individuals eligible for screening. Using additional criteria may identify more individuals eligible for lung screening.

Maximum and Time-Dependent Body Mass Index and Breast Cancer Incidence Among Postmenopausal Women in the Black Women's Health Study

While excess weight is an established risk factor for postmenopausal breast cancer, consideration of maximum body mass index (maxBMI; BMI is calculated as weight (kg)/height (m)2) or BMI at a point in time relevant for breast carcinogenesis may offer new insights. We prospectively evaluated maxBMI and time-dependent BMI in relation to breast cancer incidence among 31,028 postmenopausal women in the Black Women's Health Study. During 1995-2015, a total of 1,384 diagnoses occurred, including 787 estrogen-receptor (ER)-positive (ER+) cases and 310 ER-negative (ER-) cases. BMI was assessed at baseline and 2, 4, 6, and 8 years before diagnosis. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Compared with women with BMI <25, those with BMI ≥35 had increased risk of ER+ breast cancer but not ER- breast cancer. For BMI assessed 2 years before diagnosis, the HRs for ER+ breast cancer associated with maxBMI ≥35 and time-dependent BMI ≥35 were 1.42 (95% confidence interval (CI): 1.10, 1.84) and 1.63 (95% CI: 1.25, 2.13), respectively. The corresponding HR for time-dependent BMI assessed 6 years before diagnosis was 1.95 (95% CI: 1.45, 2.62). These findings suggest strong associations of BMI with risk of ER+ breast cancer in postmenopausal women, regardless of timing of BMI assessment.

Abstract PO-067: Developing provider education to address barriers and reduce disparities in lung cancer screening and smoking cessation treatment among underserved patients

Introduction: Lung cancer is a major public health problem in the US and disparities exist in lung cancer burden and lung cancer screening (LCS) utilization. African Americans (AA) have the highest lung cancer incidence and mortality compared to other racial and ethnic groups; however, LCS rates were lower among AAs compared to Whites under the 2013 United States Preventive Services Task Force (USPSTF) guidelines. While the expanded 2021 USPSTF criteria will significantly raise the number of AAs eligible for LCS, methods to increase rates of LCS among AA patients will still be needed. We describe the development of the first provider educational tool that focuses on barriers to reduce disparities in LCS. Methods: We completed qualitative interviews with primary care providers (N=9) and AA patients eligible for LCS (N=8; 4 screened, 4 unscreened) to assess barriers to LCS and tobacco cessation. Interviews were recorded and analyzed for common themes, which led to the development of the provider intervention. Results: Among patients, common barriers to LCS were a lack of information on the LCS procedure and associated costs, fear of the results, and transportation issues. Patient barriers to utilization of evidence-based cessation treatments included tobacco use stigma, cost of cessation aids, and inconsistent provider communication. Providers acknowledged time constraints during patient visits, lack of standardized training on documenting tobacco use, and the required LCS shared-decision making conversation as barriers to providing LCS referrals and cessation treatment. Both providers and patients noted that LCS rates may be increased by providing patient-facing information on the screening process and by facilitating provider referrals, which are essential for LCS. Based on these findings, we developed a self-directed 30-minute e-learning Health Disparities module that addresses: 1) disparities in the burden of lung cancer; 2) disparities in smoking patterns and utilization of evidence-based smoking cessation treatments; 3) patient barriers to LCS; and 4) resources for providers to address common LCS barriers (e.g., patient reminders to support scheduling the scan, offering transportation options). Experts in health disparities (N=6) and LCS (N=9) provided detailed critiques of the module content and presentation. Conclusions: We identified barriers to LCS and tobacco cessation from the perspectives of providers and AA patients. These findings informed the development of a brief web-based provider educational module to raise awareness about lung cancer and tobacco-related disparities and to provide resources to reduce barriers in diverse patient populations. We have begun a RCT to compare the Health Disparities module to an existing provider module on LCS to evaluate the impact on primary care providers' knowledge, attitudes, and LCS referrals of AA and White patients. These findings will provide preliminary evidence on provider education that can be easily disseminated to address health disparities in LCS and smoking cessation treatments.

Citation Format: Laney Smith, Daisy Dunlap, Randi Williams, Andrea Shepherd, Allison Windels, Maria Geronimo, Vicky Parikh, Chavalia J. Breece, Namita Puran, Eric Anderson, Lucile Adams-Campbell, Kathryn Taylor. Developing provider education to address barriers and reduce disparities in lung cancer screening and smoking cessation treatment among underserved patients [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 PO-067.

Applying a Life Course Biological Age Framework to Improving the Care of Individuals With Adult Cancers: Review and Research Recommendations

Importance

The practice of oncology will increasingly involve the care of a growing population of individuals with midlife and late-life cancers. Managing cancer in these individuals is complex, based on differences in biological age at diagnosis. Biological age is a measure of accumulated life course damage to biological systems, loss of reserve, and vulnerability to functional deterioration and death. Biological age is important because it affects the ability to manage the rigors of cancer therapy, survivors' function, and cancer progression. However, biological age is not always clinically apparent. This review presents a conceptual framework of life course biological aging, summarizes candidate measures, and describes a research agenda to facilitate clinical translation to oncology practice.

Observations

Midlife and late-life cancers are chronic diseases that may arise from cumulative patterns of biological aging occurring over the life course. Before diagnosis, each new patient was on a distinct course of biological aging related to past exposures, life experiences, genetics, and noncancer chronic disease. Cancer and its treatments may also be associated with biological aging. Several measures of biological age, including p16INK4a, epigenetic age, telomere length, and inflammatory and body composition markers, have been used in oncology research. One or more of these measures may be useful in cancer care, either alone or in combination with clinical history and geriatric assessments. However, further research will be needed before biological age assessment can be recommended in routine practice, including determination of situations in which knowledge about biological age would change treatment, ascertaining whether treatment effects on biological aging are short-lived or persistent, and testing interventions to modify biological age, decrease treatment toxic effects, and maintain functional abilities.

Conclusions and Relevance

Understanding differences in biological aging could ultimately allow clinicians to better personalize treatment and supportive care, develop tailored survivorship care plans, and prescribe preventive or ameliorative therapies and behaviors informed by aging mechanisms.

Metabolic syndrome risk components and mortality after triple-negative breast cancer diagnosis in postmenopausal women in the Women's Health Initiative

BACKGROUND

Triple-negative breast cancer (TNBC) has a high recurrence risk and poor clinical outcomes. Associations between metabolic syndrome (MetS) risk components and mortality in postmenopausal women with TNBC were examined in the Women's Health Initiative.

METHODS

Five hundred forty-four postmenopausal women were diagnosed with nonmetastatic TNBC. Baseline risk components included a high waist circumference (≥88 cm), high blood pressure, hypercholesterolemia, and diabetes. Groups were categorized by the number of MetS risk components: none, 1 or 2, or 3 or 4. Hazard ratios (HRs) and 95% confidence intervals (CIs) across groups were computed with multivariable adjusted Cox models. Outcomes included breast cancer-specific mortality and breast cancer overall mortality (breast cancer followed by death from any cause). Variables in the multivariable model included age at TNBC diagnosis; race/ethnicity; income; education; clinical/observational trial status; history of oral contraceptive, hormone, and/or statin use; cancer stage; and chemotherapy and/or radiation treatment status.

RESULTS

Of the 544 participants with TNBC, 33% had no MetS risk components (n = 178), 59% had 1 or 2 risk components (n = 323), and 8% had 3 or 4 risk components (n = 43). After a median follow-up from diagnosis of 8.3 years, multivariable results showed that women with 3 or 4 risk components had a nonsignificantly higher risk of breast cancer mortality (HR, 2.05; 95% CI, 0.94-4.47 trend P = .114) and a significantly higher risk of overall mortality (HR, 2.13; 95% CI, 1.22-3.71; trend P = .006) versus women with 0 risk components.

CONCLUSIONS

Postmenopausal women with TNBC and 3 or 4 MetS risk components have a nonsignificantly higher breast cancer mortality risk and a significantly higher overall mortality risk, likely because of negative influences of metabolic risk factors on several causes of death.

Call to action: breast cancer screening recommendations for Black women

African-American/Black women have more aggressive breast cancer subtypes, are diagnosed at younger ages, and have an increasing incidence rate. These disparities have resulted in Black women continuing to experience the highest mortality rate from breast cancer of any US racial or ethnic group. However, national screening mammography guidelines do not reflect the high-risk status of Black women. Here we review breast cancer screening guidelines and address the lack of inclusion of the specific needs of Black women. In order to equitably care for the health needs of Black women, high-risk designation would improve access to earlier screening and supplemental imaging including breast MRI.

Viral Suppression Is Associated with HIV Treatment Self-Efficacy in a Cohort of Women in Washington, DC

The goal of HIV treatment is viral suppression as it is linked with improved health outcomes and decreased risk of viral transmission. We assessed the sociodemographic, behavioral, and patient-provider interaction associations with viral suppression with an administered survey to HIV-seropositive women in the metropolitan Washington, DC, site of the Women's Interagency HIV Study (WIHS) between 2017 and 2018. Logistic and mixed models were used to explore related factors between HIV viral suppression groups and HIV treatment self-efficacy, respectively. Higher HIV treatment self-efficacy and disclosure concerns were positively associated with viral suppression, while illicit drug use had a negative association. In mixed models, more health care provider trust was associated with higher HIV treatment self-efficacy, while depressive symptoms were associated with lower HIV treatment self-efficacy. Depression, illicit substance use, and HIV treatment self-efficacy are potentially modifiable factors that can influence viral suppression. Implementation studies are needed to determine whether interventions to manage depression or self-efficacy and improve trust in health care providers will influence treatment outcomes.

Does Scalp Cooling Have the Same Efficacy in Black Patients Receiving Chemotherapy for Breast Cancer?

LESSONS LEARNED

Despite U.S. Food and Drug Administration approval to reduce alopecia, data on efficacy of scalp cooling in Black patients with cancer are limited by lack of minority representation in prior clinical trials. Scalp cooling devices may have less efficacy in Black patients; additional studies are required to explore the possible causes for this, including hair texture and cap design.

BACKGROUND

The Paxman scalp cooling (SC) device is U.S. Food and Drug Administration (FDA)-approved for prevention of chemotherapy-induced alopecia. Studies report 50%-80% success rates and high patient satisfaction, yet there have been no studies of SC in Black patients. We conducted a phase II feasibility study of Paxman SC with a planned enrollment of 30 Black patients receiving chemotherapy for stage I-III breast cancer.

METHODS

Black patients who planned to receive at least four cycles of chemotherapy with non-anthracycline (NAC) or anthracycline (AC) regimens were eligible. Alopecia was assessed by trained oncology providers using the modified Dean scale (MDS) prior to each chemotherapy session. Distress related to alopecia was measured by the Chemotherapy Alopecia Distress Scale (CADS).

RESULTS

Fifteen patients enrolled in the intervention before the study was closed early because of lack of efficacy. Median MDS and CADS increased after SC, suggesting increased hair loss (p < .001) and alopecia distress (p = .04). Only one participant was successful in preventing significant hair loss; the majority stopped SC before chemotherapy completion because of grade 3 alopecia (>50% hair loss).

CONCLUSION

SC may not be efficacious in preventing alopecia in Black women. Differences in hair thickness, hair volume, and limitations of cooling cap design are possible contributing factors.

Disparities in colorectal cancer screening among breast and prostate cancer survivors

Background

Colorectal cancer (CRC) screening is recommended as an integral part of cancer survivorship care. We compared the rates of CRC screening among breast and prostate cancer survivors by primary cancer type, patient, and geographic characteristics in a community‐based health‐care system with a mix of large and small metro urban areas.

Materials and Methods

Data for this retrospective study were abstracted from medical records of a multi‐specialty practice serving about 250,000 individuals in southern Maryland. Breast (N = 1056) and prostate (N = 891) cancer patients diagnosed prior to 2015 were followed up till June 2018. Screening colonoscopy within the last 10 years was considered to be guideline concordant. Multivariate logistic regression was used to determine the prevalence odds ratios of being concordant on CRC screening by age, gender, race, metro area type, obesity, diabetes, and hypertension.

Results

Overall 51% of survivors had undergone a screening colonoscopy. However, there was a difference in CRC screening rate between prostate (54%) and breast (44%) cancer survivors. Older age (≥65 years), being a breast cancer survivor compared to prostate cancer, and living in a large compared to small metropolitan area were associated with a lower probability of receiving CRC screening. Having hypertension was associated with higher likelihood of being current on colonoscopy screening guidelines among survivors; but diabetes and obesity were not associated with CRC screening.

Conclusions

Low levels of CRC screening utilization were found among breast and prostate cancer survivors in a single center in Southern Maryland. Gender, comorbidities, and residential factors were associated with receipt of CRC screening.

Cancer Incidence and Cancer Screening Practices Among a Cohort of Persons Receiving HIV Care in Washington, DC

In this era of effective combination antiretroviral therapy the incidence of AIDS defining cancers (ADCs) is projected to decline while the incidence of certain non-AIDS defining cancers (NADCs) increases. Some of these NADCs are potentially preventable with appropriate cancer screening. We examined cancer incidence, screening eligibility, and receipt of screening among persons actively enrolled in the DC Cohort, a longitudinal observational cohort of PLWH, between 2011 and 2017. Cancer screening eligibility was determined based on age, sex, smoking history and co-morbidity data available and published national guidelines. The incidence rate of NADCs was 12.1 (95% CI 10.7, 13.8) and ADCs 1.6 (95% CI 0.6, 4.6) per 1000 person-years. The most common incident NADCs were breast 2.6 (95% CI 0.5,1 2.1), prostate 2.3 (95% CI 1.2, 4.3), and non-melanoma skin 1.2 (95% CI 0.6, 2.3) incident diagnoses/cases per 1000 person-years. Among cohort sites where receipt of cancer screening was assessed, less than 60% of eligible participants had any ascertained anal HPV, breast, cervical, colorectal, hepatocellular carcinoma, or lung cancer screening. In this cohort of PLWH, there were more incident NADCs versus ADCs in contrast to earlier cohort studies where ADCs predominated. Despite a large eligible population there were low rates of screening. Implementation of cancer screening is an important component of care among PLWH.

Physical activity, health-related quality of life, and adjuvant endocrine therapy-related symptoms in women with hormone receptor-positive breast cancer

BACKGROUND

Physical activity (PA) is recommended for women with breast cancer (BC); however, data are sparse on the association of PA with quality of life (QOL) and patient-reported symptoms for women on adjuvant endocrine therapy (AET).

METHODS

Women with hormone receptor-positive BC who were taking AET completed standardized surveys about their health-related QOL, AET-related symptoms, and levels of PA using validated measures. A Wald chi-square test and an analysis of variance were used to assess associations with PA and independent variables. Generalized linear regression analyses assessed associations between PA, QOL, and AET-related symptoms.

RESULTS

The analytic cohort included 485 Black and White women. Black race, a high body mass index (BMI), and being on aromatase inhibitors (vs tamoxifen) were associated with lower PA in a bivariate analysis. In a multivariate analysis, lower self-reported PA was associated with a high BMI (P = .02) and chemotherapy uptake (P = .006). Better health-related QOL (P = .01), less severe overall AET-related symptoms (P = .02), and less severe gynecological symptoms (P = .03) were associated with increasing levels of moderate PA.

CONCLUSIONS

Among women taking AET, moderate levels of PA may be associated with fewer medication-related symptoms and overall better ratings of health-related QOL. Because of the low levels of PA observed in the sample overall and particularly for Black women, identifying successful strategies to promote PA are needed.

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.

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.

Abstract A40: Capital Breast Care Center: A Patient Navigation Exemplar

Introduction. Breast cancer is the second leading cause of cancer deaths for American women. Washington, DC, has one of the highest incidence and mortality rates for breast cancer in the U.S. Patient navigation coupled with informational and community resources are important strategies that assist patients' access and help them understand the complex world of cancer care.

Aims.The Georgetown Lombardi Comprehensive Cancer Center's Capital Breast Care Center (CBCC) serves as an exemplary community-embedded facility that develops multiple intra community partnerships to improve patient access to health care. The aim of this study is to detail the role of patient navigation at the Capital Breast Care Center, with an emphasis on community engagement and community-based partnerships.

Program process description. We describe the development and application of the CBCC patient navigation process and navigation components: (a) creating partnerships; (b) educating members of the community about mammograms; (c) providing patient navigation into screening assistance; and (d) helping women with coordination of diagnostic follow-up. Data were collected from 2004-2015 and analyzed in 2015.

Program process evaluation results. CBCC established 41 community partnerships categorized by different organizational types that include transitional housing facilities, health service providers, neighborhood associations, churches, senior centers, and local neighborhood recreation centers. Application of the CBCC navigation model yielded important lessons; in general, partnerships and patient navigation.

Discussion. Partnerships, community engagement, and informational resources are all crucial to the patient navigation process in providing access to quality care for all patients.

Citation Format: Sherrie Flynt Wallington, Bridget Oppong, Chiranjeev Dash, Tesha Coleman, Holly Greenwald, Tanya Torres, Marquita Iddirisu, Lucile Adams-Campbell. Capital Breast Care Center: A Patient Navigation Exemplar. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A40.

The 2015 Dietary Guidelines Advisory Committee Scientific Report: Development and Major Conclusions

The Dietary Guidelines for Americans (DGA) is published every 5 y jointly by the Department of Health and Human Services (HHS) and the USDA and provides a framework for US-based food and nutrition programs, health promotion and disease prevention initiatives, and research priorities. Summarized in this report are the methods, major conclusions, and recommendations of the Scientific Report of the 2015 US Dietary Guidelines Advisory Committee (DGAC). Early in the process, the DGAC developed a conceptual model and formulated questions to examine nutritional risk and determinants and impact of dietary patterns in relation to numerous health outcomes among individuals aged ≥2 y. As detailed in the report, an expansive, transparent, and comprehensive process was used to address each question, with multiple opportunities for public input included. Consensus was reached on all DGAC's findings, including each conclusion and recommendation, and the entire report. When research questions were answered by original systematic literature reviews and/or with existing, high-quality expert reports, the quality and strength of the evidence was formally graded. The report was organized around the following 5 themes: 1) food and nutrient intakes and health: current status and trends; 2) dietary patterns, foods and nutrients, and health outcomes; 3) diet and physical activity behavior change; 4) food and physical activity environments; and 5) food sustainability and food safety. The following 3 cross-cutting topics were addressed: 1) sodium, 2) saturated fat, and 3) added sugars. Physical activity recommendations from recent expert reports were endorsed. The overall quality of the American diet was assessed to identify overconsumed and underconsumed nutrients of public health concern. Common food characteristics of healthy dietary patterns were determined. Features of effective interventions to change individual and population diet and physical activity behaviors in clinical, public health, and community settings were identified. The report was used by the HHS and the USDA to develop the 2015 DGA.

Abstract PD4-03: Adherence to diet, physical activity and body composition guidelines and breast cancer in the black women's health study

Background: While breast cancer incidence rates have declined in non-Hispanic Caucasian populations, rates have remained stable in African American women, who are often affected by more aggressive subtypes. Previous studies have found that adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations, and the similar American Cancer Society (ACS) guidelines, is associated with lower incidence of breast cancer. However, few African American women were included in these studies, and guidelines are based primarily on research among Caucasian women.

Objective: To evaluate the association between adherence to the WCRF/AICR cancer prevention recommendations and breast cancer incidence among African American women.

Design: The Black Women's Health Study is an ongoing prospective study of African American women from across the United States who were 21-69 years of age at baseline in 1995. They are followed biennially through health questionnaires. Among 49,103 women who were free of cancer at baseline and who provided relevant dietary and data on the baseline questionnaire, 1,827 incident cases of breast cancer were ascertained during follow-up through 2011. Questionnaire data on physical activity, body composition and diet were used to compute adherence scores for seven WCRF/AICR recommendations involving those factors. For each individual recommendation, participants were categorized as adherent (1 point), partially adherent (0.5 points) or non-adherent (0 points). Scores were summed to a total adherence score (maximum score: 7 points) and a diet only adherence score (maximum score: 5 points). Adherence scores (categorical and continuous) based on baseline data only and on time-varying data were assessed in relation to breast cancer incidence using Cox proportional hazards regression models, with control for potential confounding factors.

Results: In the analytic cohort, 8.5% of participants had an adherence score of 4.5-7.0, while 46% had a score less than 3.0. For individual recommendations, 15.2% were adherent to body weight recommendations, 24.7% were adherent to physical activity, and 5.4% were adherent to more than 4 diet recommendations. Participants were most likely to adhere to the alcohol recommendation (94.3%). In the time varying model, higher overall adherence (per 0.5 unit increase) was associated with lower breast cancer incidence (HR: 0.90, 95% CI: 0.84-0.96), with greater adherence to diet overall, physical activity, sugar beverage intake, and red and processed meat recommendations all significantly associated with reduced risk. The adherence score based on baseline variables was not associated with significantly reduced risk (HR: 0.96, 95% CI: 0.90-1.02), although meeting physical activity recommendations was associated.

Conclusions: Our findings suggest that adherence to the WCRF/AICR guidelines may lower risk of developing breast cancer in African American women. However, body weight and alcohol, factors that are widely considered important for breast cancer prevention appear to be less relevant in this population.

Citation Format: Nomura SJO, Yu J, Dash C, Rosenberg L, Palmer J, Adams-Campbell L. Adherence to diet, physical activity and body composition guidelines and breast cancer in the black women's health study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD4-03.

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 C13: Use of air monitoring and urine biomarker assays to measure geographic disparities in exposure to VOCs in Washington, DC

The District of Columbia has one of the highest cancer incidence and mortality rates in the nation in conjunction with significant cancer-related geographic and racial disparities. Increased exposure to environmental carcinogens, such as benzene, in high risk areas of DC is of public health importance and may play a role in these disparities in cancer incidences and mortality rates. Volatile Organic Compounds (VOC), such as toluene and benzene, are absorbed by the body and undergo metabolism to produce bio-activated (can lead to cancer and other serious health effects) metabolites that are excreted from the body via the urine and/or feces. Air monitoring and urinary biomarker assays are accepted methods for exposure assessment of VOCs but little is known regarding the correlation between the two. In this study we compared the urinary concentrations of hippuric acid and t,t-muconic acid (two known benzene and toluene metabolites, respectively) with indoor and outdoor exposure levels of toluene and benzene in high risk (&lt;1 mile from highway/freeway) and low risk urban areas (&gt;3 miles from the highway/freeway) in Washington, DC. First morning void urine samples were collected from 16 adult residents in high risk areas and 14 adult residents in low risk areas after 72 hours of air monitoring. Urine samples were sent to NMS laboratory and metabolite levels were measured using liquid chromatography/ mass spectrometry. Indoor and outdoor benzene and toluene levels were measured in the same homes over 72 hours using a 3M Organic Vapor Monitor and analyzed using gas chromatograph mass spectrometer (GC/MS). t,t-muconic acid urinary concentration levels in normal non-exposed individuals has been previously reported at .0001g/l and hippuric acid levels have been reported at &lt;1.4 g/l. In our study participants, mean levels of urinary t,t-muconic and hippuric acid were .0003g/l and .35 g/l, respectively. Toluene levels, as measured by air monitoring, indoors (-0.34, p=0.08) and outdoors (-0.004, p=0.98) were both negatively correlated with urinary hippuric acid levels. A negative correlation was also observed between outdoor benzene levels and t,t-muconic acid (-0.23, p =0.11), however indoor levels showed a positive correlation with the urinary biomarker (0.13, p =0.52). We also observed higher levels of t,t-muconic acid in the high risk residents (87.17g/gCR) compared to low risk residents (59.54 g/gCR; p =0 .56). The positive correlation between indoor benzene levels and urinary t,t-muconic acid levels suggest the presence of additional sources of benzene inside the homes. Though air levels of VOCs are a good indicator of exposure, urinary metabolites may give a more measure of VOC exposure. Although not statistically significant, we observed a disparity in exposure to VOCs in “high risk” versus “low risk” areas in Washington, DC.

Citation Format: Ashley Corrin Huderson, Chiranjeev Dash, Lucile Adams-Campbell. Use of air monitoring and urine biomarker assays to measure geographic disparities in exposure to VOCs in Washington, DC. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C13. doi:10.1158/1538-7755.DISP13-C13

Abstract LB-285: Obesity and breast cancer subtypes in African American women participating in the AMBER Consortium

Introduction. Obesity has been shown to be associated with reduced risk in premenopausal women and increased risk in postmenopausal women, with evidence coming largely from studies in white women. African American (AA) women are more likely than white women to be obese and to have central obesity (measured as a high waist to hip ratio (WHR) or waist circumference). They are also more likely to be diagnosed with ER- and triple negative (TN) breast cancers, which tend to have poorer prognosis than ER+ tumors. There is growing evidence that risk profiles for these subtypes may differ. However, few studies have evaluated the impact of general and central obesity on breast cancer subtypes in AA women.

Methods. We pooled data from three studies in AA women, the Black Women Health Study, the Carolina Breast Cancer Study, and the Women's Circle of Health Study, to evaluate the association of recent body mass index (BMI), young adult BMI (at age 18-21 y), and waist to hip ratio (WHR) with breast cancer subtypes. Cases were categorized according to hormone receptor subtype as ER+, ER-, and triple negative (TN: ER-, PR-, and HER2-) based on pathology reports or cancer registry data. A total of 1,809 ER+ cases, 1,024 ER- cases (which included 478 TN cases), and 9,593 controls were included in the analyses. Odds ratios (OR) and 95% confidence intervals (CI) were computed using unconditional polytomous or regular logistic regression, as appropriate, taking into account all major risk factors for breast cancer.

Results. Recent BMI was inversely associated with postmenopausal ER- breast cancer (OR: 0.74; 95% CI: 0.53-1.02), and more strongly with tumors that were also PR- and HER2- (TN), (OR: 0.61; 95% CI: 0.39-0.97 for BMI≥35 vs. &lt;25). For ER+, ORs were below one for pre-menopausal and above one for post-menopausal breast cancer, but confidence intervals included 1.0. However, among women who were thin as young adults (BMI&lt;19.4, lowest tertile), recent high BMI (≥35) was associated with more than a twofold increase in risk of postmenopausal ER+ breast cancer (OR: 2.24; 95% CI 1.46-3.43, p for interaction: 0.02). Associations between recent BMI and ER- breast cancer did not differ by young-adult BMI. There was a suggestion of increased risk for high WHR (highest vs. lowest quartile) independent of BMI, which only approached statistical significance for premenopausal ER+ tumors (OR: 1.31; 95% CI: 0.98-1.75; p for trend: 0.05). In analyses of the joint effects of recent BMI and WHR, the association of WHR with ER+ tumors in postmenopausal women was strongest for women with normal BMI (OR: 1.61; 95% CI: 1.02-2.56), p for interaction: 0.05.

Conclusion. Our results indicate the need to consider subtypes when evaluating the impact of general and central obesity on breast cancer and warrant the study of mechanisms underlying these complex associations.

Citation Format: Elisa V. Bandera, Urmila Chandran, Chi-Chen Hong, Christine B. Ambrosone, Melissa Troester, Kathryn L. Lunetta, Lucile Adams-Campbell, Andrew Olshan, Julie R. Palmer, Lynn Rosenberg. Obesity and breast cancer subtypes in African American women participating in the AMBER Consortium. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr LB-285. doi:10.1158/1538-7445.AM2014-LB-285

Abstract A37: Disparities in exposures to volatile organic compounds among the marginalized communities of inner city Washington DC

The District of Columbia has one of the highest cancer incidence and mortality rates in the nation in conjunction with significant cancer-related geographic and racial disparities. Besides exposures to behavioral and occupational risk factors, characterizing potential exposures to environmental carcinogens in such high risk areas as well as understanding exposure disparities is of public health importance. It has been reported that individuals residing in over-populated and /or underserved areas of major cities are at increased risk of being exposed to various air pollutants, but no studies to date have explored this issue among such communities of inner city Washington DC. Environmental carcinogens, such as chloroform, and benzene, are major components of air pollution from vehicular exhaust, factory and refinery emissions, some building materials and industrial/household solvents. In this study we examined the levels of chloroform, benzene, toluene, and 1,2-dichlorobenzene in high risk areas (&lt;1 mile from highway/freeway) and compared it to those of low risk areas (&gt;3 miles from the highway/freeway). Levels of selected volatile organic compounds (VOCs) including benzene, chloroform, toluene and 1,2-dichlorobenzene were measured inside and outside of 16 homes in high risk areas and 14 homes in low risk areas over a 72 hour time period using an 3M Organic Vapor Monitor and analyzed using gas chromatograph mass spectrometer (GC/MS). The levels of all the four VOCs in the high risk areas were higher both inside and outside the homes compared to the low risk areas. Mean chloroform levels outside the residences in high risk areas were significantly higher (1.24 μg/m3) in comparison to low risk areas (0.43μg/m3), (P &lt; .05). Levels of all four compounds were higher inside the homes in both high and low risk areas than outside the homes, however, the inside-outside differences were significant for chloroform and toluene only. The mean exposure level of 1,2-dichlorobenzene was the highest (33.66μg/m3) inside the homes located in high risk areas as opposed to 1.48μg/m3 inside the homes in the low risk areas. This indicated a presence of additional indoor sources of this compounds including air fresheners, cleaning solvents, moth balls etc. in the high risk/low income communities. The results suggest that individuals living in high risk areas are more likely to be exposed to higher levels of indoor environmental carcinogens compared to low risk areas. Preventive efforts targeting indoor environmental carcinogens are warranted in efforts to reduce the cancer burden that disproportionately impacts African-Americans.

Citation Format: Ashley C. Huderson, Chiranjeev Dash, Everett Dodson, Amir Sapkota, Lucile Adams-Campbell. Disparities in exposures to volatile organic compounds among the marginalized communities of inner city Washington DC. [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 A37.

Compliance with national nutrition recommendations among breast cancer survivors in "stepping stone"

INTRODUCTION

Compared with White breast cancer survivors, African American survivors are more likely to be overweight and obese. Differences in weight status may be attributed to differences in dietary intake; however, there is limited research pertaining to the dietary habits of African American breast cancer survivors.

METHODS

We compared baseline dietary intakes of 31 overweight and obese African American breast cancer survivors enrolled in a healthy lifestyle intervention to national dietary guidelines and also examined beverage intake habits. Dietary intake was assessed using the National Cancer Institute's Diet History Questionnaire and beverage intake was assessed using 3-day food intake records.

RESULTS

Overall, the majority of survivors consumed the recommended daily servings of fruits and vegetables (71.0%) and red meat (83.9%); however, survivors exceeded national recommendations for energy intake from fat (64.5%), saturated fat (87.1%), and added sugars (77.4%). Few women met the guidelines for whole grain and fiber intake (6.5% and 35.5%, respectively). Additionally, survivors consumed ~10% of total energy intake from beverages alone and drank only ~3.5 cups of water daily.

CONCLUSIONS

Current dietary guidelines for cancer survivors recommend consuming >5 servings per day of fruits and vegetables and broad guidelines regarding limiting discretionary fat and added sugars but do not specify beverage intake recommendations. Future dietary interventions in African American breast cancer survivors should focus on reducing intake from dietary fat and added sugar, as well as increasing whole grain consumption as a means for increasing daily fiber intake. Furthermore, substituting caloric beverages with water or noncaloric beverages may be a strategy to decrease caloric intake in African American breast cancer survivors. Nutrition information targeting these nutrients could be administered during treatments or doctor's visits as a means to prevent weight gain that often occurs following diagnosis.

Excess weight and physical health-related quality of life in postmenopausal women of diverse racial/ethnic backgrounds

BACKGROUND

Studies of weight and health-related quality of life (HRQOL) generally focus on white populations. This analysis examines the association between clinical weight categories and physical HRQOL in five racial/ethnic groups of older women and determines the extent to which emotional/psychological (social support, caregiver burden) and physical health (diabetes, osteoarthritis) factors modify this relationship.

METHODS

The cross-sectional analysis, completed in 2007, used baseline data from postmenopausal women enrolled in the Women's Health Initiative (WHI) during the 5-year recruitment period (1993-1998).

RESULTS

Of 161,393 women, 83% were non-Hispanic white, 9% were African American, 4% were Hispanic/Latina, 3% were Asian/Pacific Islander, and <1% were American Indian/Alaska Native. Obesity (body mass index [BMI] > or =30 kg/m(2)) was most common in non-Asian minority groups. Regression modeling showed higher odds of poor physical HRQOL with increasing weight category in all groups. In the total sample, these odds were at least 6 times as high in women with class 3 obesity as in women of normal weight and were only mildly attenuated after the analysis adjusted for emotional/psychological factors. Further adjustment for physical health factors made odds ratio (OR) estimates drop from 2.36 to 1.59 for class 1 obesity and from 6.96 to 3.71 for class 3 obesity. This pattern generally persisted within each racial/ethnic group.

CONCLUSIONS

Heavier weight negatively affects physical HRQOL in postmenopausal women across diverse racial/ethnic backgrounds. Weight-relevant physical health factors have a greater impact on this weight-HRQOL association than do emotional/psychological factors.

Collaborative modeling of the impact of obesity on race-specific breast cancer incidence and mortality

Obesity affects multiple points along the breast cancer control continuum from prevention to screening and treatment, often in opposing directions. Obesity is also more prevalent in Blacks than Whites at most ages so it might contribute to observed racial disparities in mortality. We use two established simulation models from the Cancer Intervention and Surveillance Modeling Network (CISNET) to evaluate the impact of obesity on race-specific breast cancer outcomes. The models use common national data to inform parameters for the multiple US birth cohorts of Black and White women, including age- and race-specific incidence, competing mortality, mammography characteristics, and treatment effectiveness. Parameters are modified by obesity (BMI of ≥ 30 kg/m(2)) in conjunction with its age-, race-, cohort- and time-period-specific prevalence. We measure age-standardized breast cancer incidence and mortality and cases and deaths attributable to obesity. Obesity is more prevalent among Blacks than Whites until age 74; after age 74 it is more prevalent in Whites. The models estimate that the fraction of the US breast cancer cases attributable to obesity is 3.9-4.5 % (range across models) for Whites and 2.5-3.6 % for Blacks. Given the protective effects of obesity on risk among women <50 years, elimination of obesity in this age group could increase cases for both the races, but decrease cases for women ≥ 50 years. Overall, obesity accounts for 4.4-9.2 % and 3.1-8.4 % of the total number of breast cancer deaths in Whites and Blacks, respectively, across models. However, variations in obesity prevalence have no net effect on race disparities in breast cancer mortality because of the opposing effects of age on risk and patterns of age- and race-specific prevalence. Despite its modest impact on breast cancer control and race disparities, obesity remains one of the few known modifiable risks for cancer and other diseases, underlining its relevance as a public health target.

The influence of health and lifestyle characteristics on the relation of serum 25-hydroxyvitamin D with risk of colorectal and breast cancer in postmenopausal women

The authors' objective was to discern whether lifestyle or health-related factors were confounders, effect modifiers, or irrelevant with regard to understanding observational associations of serum 25-hydroxyvitamin D (25(OH)D) with colorectal and breast cancer. The authors conducted nested case-control studies of colorectal cancer (310 cases, 310 controls) and breast cancer (1,080 cases, 1,080 controls) in the Women's Health Initiative Calcium and Vitamin D Clinical Trial (1994-2005). Case-control matching factors included age, latitude, race/ethnicity, and blood collection date. Serum 25(OH)D was assayed in baseline fasting blood. Conditional logistic regression was used to estimate odds ratios for each cancer by serum 25(OH)D concentration, comparing the relative effects of successively adding body mass index, physical activity, and other health and lifestyle characteristics particular to each cancer. In models with matching factors only, low (vs. high) serum 25(OH)D was associated with a colorectal cancer odds ratio of 2.72 (95% confidence interval (CI): 1.55, 4.77) and a breast cancer odds ratio of 1.33 (95% CI: 1.02, 1.72). In multivariate-adjusted models for colorectal cancer, the association strengthened (OR = 4.45, 95% CI: 1.96, 10.10). However, in multivariate-adjusted breast cancer models, associations were no longer significant (OR = 1.06, 95% CI: 0.78, 1.43). Adjusting for health and lifestyle characteristics has differential effects depending on the cancer site; when modeling such relations, investigators should take these factors into account.

Low incidence of new biochemical and clinical hypogonadism following hypofractionated stereotactic body radiation therapy (SBRT) monotherapy for low- to intermediate-risk prostate cancer

Background

The CyberKnife is an appealing delivery system for hypofractionated stereotactic body radiation therapy (SBRT) because of its ability to deliver highly conformal radiation therapy to moving targets. This conformity is achieved via 100s of non-coplanar radiation beams, which could potentially increase transitory testicular irradiation and result in post-therapy hypogonadism. We report on our early experience with CyberKnife SBRT for low- to intermediate-risk prostate cancer patients and assess the rate of inducing biochemical and clinical hypogonadism.

Methods

Twenty-six patients were treated with hypofractionated SBRT to a dose of 36.25 Gy in 5 fractions. All patients had histologically confirmed low- to intermediate-risk prostate adenocarcinoma (clinical stage ≤ T2b, Gleason score ≤ 7, PSA ≤ 20 ng/ml). PSA and total testosterone levels were obtained pre-treatment, 1 month post-treatment and every 3 months thereafter, for 1 year. Biochemical hypogonadism was defined as a total serum testosterone level below 8 nmol/L. Urinary and gastrointestinal toxicity was assessed using Common Toxicity Criteria v3; quality of life was assessed using the American Urological Association Symptom Score, Sexual Health Inventory for Men and Expanded Prostate Cancer Index Composite questionnaires.

Results

All 26 patients completed the treatment with a median 15 months (range, 13-19 months) follow-up. Median pre-treatment PSA was 5.75 ng/ml (range, 2.3-10.3 ng/ml), and a decrease to a median of 0.7 ng/ml (range, 0.2-1.8 ng/ml) was observed by one year post-treatment. The median pre-treatment total serum testosterone level was 13.81 nmol/L (range, 5.55 - 39.87 nmol/L). Post-treatment testosterone levels slowly decreased with the median value at one year follow-up of 10.53 nmol/L, significantly lower than the pre-treatment value (p < 0.013). The median absolute fall was 3.28 nmol/L and the median percent fall was 23.75%. There was no increase in biochemical hypogonadism at one year post-treatment. Average EPIC sexual and hormonal scores were not significantly changed by one year post-treatment.

Conclusions

Hypofractionated SBRT offers the radiobiological benefit of a large fraction size and is well-tolerated by men with low- to intermediate-risk prostate cancer. Early results are encouraging with an excellent biochemical response. The rate of new biochemical and clinical hypogonadism was low one year after treatment.

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 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.

Abstract CN06-01: Obesity, physical activity, and colon polyps: Black Women's Health Study

CN06-01

Incidence and mortality rates of colorectal cancer are higher in African-American women than any other ethnic group in the United States and the disparity may be widening. The obesity epidemic in the United States has disproportionately affected African-American women, with obesity being nearly twice as prevalent in African-Americans as Whites. The causes of these increasing rates of obesity are not well understood, although it is hypothesized to be caused by dietary changes and decreased physical activity in the general population over time. An appreciable body of evidence suggests that leisure-time physical activity reduces the incidence of colon cancer. There is much less evidence on whether physical activity protects against colorectal adenomas, which are thought to be precursors to most colon cancers, although the evidence has been inconsistent. No findings have been reported on the relation of physical activity to the incidence of colorectal polyps in African-American women. We report here on the effect of obesity and physical activity on the incidence of colorectal polyps in the Black Women’s Health Study (BWHS), a large follow-up study of black women in the U.S.

Citation Information: Cancer Prev Res 2008;1(7 Suppl):CN06-01.

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.

Abstract B31: Collaborative breast health education addressing an alarming public health concern in the District of Columbia

B31

Background

Washington D.C. has the highest breast cancer mortality rate in the country(30.3 per 100,000 )*. Project Early Awareness is a breast health education program of Howard University Cancer Center supported by the Prevent Cancer Foundation that serves to address this disparity. The program is designed for 10th-12th grade students in Washington, D.C..

Methods

PEA sessions follow a standardized format. The class begins with a young breast cancer survivor’s story, followed by information on breast health topics including risk factors, breast growth and development, clinical breast exams, and mammography. The students are shown an age and culturally appropriate video on how to perform a breast self-exam. Students are then given breast models to practice breast self-exam techniques. The session ends with a question and answer period and a discussion on myths about breast cancer. At the completion of the program, they are handed an information packet to take home and share with their female relatives.

Results

Since 2001, 2,880 public high school students and their relatives have received breast health information through PEA. Pre and post-test evaluations have been enormously positive, showing a measurable impact in knowledge for the girls attending. Overall, the program generated improvements in specific knowledge elements. A 69% improvement was shown when asked if the age of menarche was a risk factor. The overall increase in self-efficacy for BSE was 39%.

Conclusion

The high breast cancer mortality rates of African American women living in the District of Columbia mandates the implementation of programs such as this, which focus on long term solutions towards reducing health disparities. PEA is able to reach these young women in a culturally sensitive manner and increase awareness, as well as the understanding of the key screening tools available to women as they age.

*American Cancer Society, Surveillance Research , 2007

Citation Information: Cancer Prev Res 2008;1(7 Suppl):B31.

Molecular Breast Cancer Subtypes in Premenopausal African-American Women, Tumor Biologic Factors and Clinical Outcome

INTRODUCTION

Breast cancer is currently viewed as a heterogeneous disease made up of various subtypes, with distinct differences in prognosis. Our goal was to study the distribution and to characterize the clinical and biological factors that influence the behavior and clinical management of the different molecular breast cancer subtypes in premenopausal African-American women.

METHODS

A retrospective analysis of Howard University Hospital tumor registry, for all premenopausal African-American women aged less than 50 years, diagnosed with breast cancer from 1998-2005, was performed.

RESULTS

The luminal A subtype was the most prevalent (50.0%), vs basal-cell-like (23.2%), luminal B (14.1%), and HER-2/neu (12.7%). However when stratified by age groups, results showed that in the age group <35 years the basal-cell-like subtype was the most prevalent (55.6%), vs 25.9%, 14.8%, and 5.6% for luminal A, luminal B, and HER-2/neu subtypes, respectively (P < .000). P53 mutation was more prevalent in the basal-cell-like subtype compared to luminal A (48.0% vs 18.6%, P < .01). The expression of the Bcl-2 gene differed by subtype, with the luminal A and luminal B subtypes more likely to overexpress the Bcl-2 gene (89.1% luminal A, 80.0% luminal B vs 47.6% basal-cell-like and 40.0% HER-2/neu, P < .000). Though not statistically significant, HER-2/neu and basal-cell-like subtypes had the shortest survival time (P < .31).

CONCLUSION

The high prevalence of the basal-cell-like subtype in young premenopausal African-American women aged <35 years may contribute to the poorer prognosis observed in this cohort of African-American women.

Low-fat dietary pattern and risk of invasive breast cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial

CONTEXT

The hypothesis that a low-fat dietary pattern can reduce breast cancer risk has existed for decades but has never been tested in a controlled intervention trial.

OBJECTIVE

To assess the effects of undertaking a low-fat dietary pattern on breast cancer incidence.

DESIGN AND SETTING

A randomized, controlled, primary prevention trial conducted at 40 US clinical centers from 1993 to 2005.

PARTICIPANTS

A total of 48,835 postmenopausal women, aged 50 to 79 years, without prior breast cancer, including 18.6% of minority race/ethnicity, were enrolled.

INTERVENTIONS

Women were randomly assigned to the dietary modification intervention group (40% [n = 19,541]) or the comparison group (60% [n = 29,294]). The intervention was designed to promote dietary change with the goals of reducing intake of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily. Comparison group participants were not asked to make dietary changes.

MAIN OUTCOME MEASURE

Invasive breast cancer incidence.

RESULTS

Dietary fat intake was significantly lower in the dietary modification intervention group compared with the comparison group. The difference between groups in change from baseline for percentage of energy from fat varied from 10.7% at year 1 to 8.1% at year 6. Vegetable and fruit consumption was higher in the intervention group by at least 1 serving per day and a smaller, more transient difference was found for grain consumption. The number of women who developed invasive breast cancer (annualized incidence rate) over the 8.1-year average follow-up period was 655 (0.42%) in the intervention group and 1072 (0.45%) in the comparison group (hazard ratio, 0.91; 95% confidence interval, 0.83-1.01 for the comparison between the 2 groups). Secondary analyses suggest a lower hazard ratio among adherent women, provide greater evidence of risk reduction among women having a high-fat diet at baseline, and suggest a dietary effect that varies by hormone receptor characteristics of the tumor.

CONCLUSIONS

Among postmenopausal women, a low-fat dietary pattern did not result in a statistically significant reduction in invasive breast cancer risk over an 8.1-year average follow-up period. However, the nonsignificant trends observed suggesting reduced risk associated with a low-fat dietary pattern indicate that longer, planned, nonintervention follow-up may yield a more definitive comparison.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov Identifier: NCT00000611.

Insulin resistance and weight gain in postmenopausal women of diverse ethnic groups

OBJECTIVE

This study was conducted to examine the influence of insulin resistance on weight change in postmenopausal women of various ethnic groups.

SUBJECTS

Data were obtained from 3389 women (60% White, 20% Black, 12% Hispanic, and 8% Asian/Pacific Islander), ages 50-79, enrolled in either the Women's Health Initiative Clinical trial or Observational Study, whose blood samples were selected randomly from the full cohort of 161 809 women for analyses.

MEASUREMENTS

Glucose, insulin, and lipids were measured on fasting serum samples drawn at baseline and after 3 y of follow-up. Weight, height, waist circumference, and blood pressure were measured. Physical activity and energy intake were assessed via questionnaire. Insulin resistance was estimated using the HOMA (homeostasis model) calculation.

RESULTS

Average age was 62 y, average BMI (body mass index) was 27.4 kg/m2, and average weight change was a gain of 0.4 kg in 3 y. In a multivariate analysis, insulin resistance and insulin concentrations were independent predictors of increases in weight in White women (P=0.002 and 0.004, respectively) and in the combined group (P=0.027 and 0.039). For the whole group, after adjustment for other covariates, those in the highest quartile of insulin resistance gained 0.4 kg in 3 y, whereas those in the lowest quartile lost 0.06 kg. Similar trends were found for insulin resistance and weight gain in Hispanic and Asian/Pacific Islander women, but they did not reach statistical significance. In Black women, no relation was seen between either insulin or insulin resistance and weight change. A significant interaction between obesity and insulin resistance was observed (P=0.002 for White women and 0.032 for the whole group), so that there is weight gain with increasing insulin resistance in the leaner women, but weight loss with increasing insulin resistance in the most obese.

CONCLUSION

Insulin resistance appears to be a predictor of weight gain in postmenopausal women, except for the most obese women. The effect is more pronounced in women who have a lower BMI, and the effect was not seen in the Black women who as a group had a higher BMI.

Inherited BRCA2 mutations in African Americans with breast and/or ovarian cancer: a study of familial and early onset cases

In order to identify the spectrum of BRCA2 mutations in African Americans, breast or ovarian cancer patients from 74 independent families at elevated risk of germline mutations were investigated. The entire coding regions and flanking introns of BRCA2 were screened for germline mutations by single-stranded conformation polymorphism, protein truncation test, or denaturing high performance liquid chromatography followed by DNA sequencing. Eight distinct protein-truncating mutations were detected in six female patients (average age of onset of breast cancer: 37.6 years) and two male patients, but not in 163 unrelated disease-free controls. Two (1993delAA, 8643delAT) of the eight pathogenic mutations observed in African Americans have not been previously described. The other six pathogenic mutations (1882delT, 1991delATAA, 2001delTTAT, 2816insA, 4075delGT, 4088delA) have been detected in Caucasians; only the 2816insA mutation has been reported previously in African Americans. There were no significant differences in the frequency of deleterious BRCA2 mutations in African Americans compared with Caucasians. Six rare variations, not previously reported, were identified in five breast cancer patients but not in 163 disease-free control subjects. Of 11 different polymorphisms identified in high-risk African-American breast cancer patients, four may be unique to African Americans. An intron 10 polymorphism observed in patients was not detected in 163 disease-free African-American control subjects; this difference is statistically significant. Since many different pathogenic mutations and variants of unknown significance are observed in African Americans, BRCA2 genetic testing in high-risk African-American families must include the entire coding and flanking non-coding regions of the gene.

Prevalence of elevated serum prostate-specific antigen in rural Nigeria

BACKGROUND

Recent hospital and cancer registry data show increasing prostate cancer incidence in Nigeria, which was previously regarded as a low incidence region. This study investigates the prevalence of prostate cancer risk in a previously unscreened cohort of rural Nigerians.

METHODS

Rural Nigerian men, 40 years and older, were screened by serum prostate-specific antigen (PSA) and digital rectal examination (DRE) and those with PSA >/= 4 ng/mL and/or abnormal DRE were referred for prostate biopsy.

RESULTS

Of 200 consecutive men invited, 151 (75.5%) presented for screening, the mean age was 56.45 + 15.1 and 95 (61.6%) were >/= 50 years of age. Of the 140 who consented to a blood test, PSA correlated with age (r = 0.3, P < 0.01), 14 (10.0%) had abnormal PSA >/= 4 ng/mL, increasing from 3 (3.6%) in men < 60 years to 4 (50%) in men >/= 80 years. The rate was 13 (15.7%) for men >/= 50 years and there was no evidence of increased incidence of prostatitis in the community. Mean (median) PSA in ng/mL increased from 1.17 (0.60) in the youngest to 13.75 (4.45) in the oldest cohort. Of those who accepted DRE, 38 (29.0%) had an enlarged prostate, including two who had nodular prostate, one-third with symptoms, increasing from 4 (5.4%) in those < 50 years to 6 (75.0%) in men >/= 80 years. The proportion of men with PSA >/= 4 ng/mL among those with enlarged vs normal prostate is 27.0 to 3.4%, P < 0.001, and the pattern was similar for men >/= 60 years and those < 60 years of age. The 40 (32.0%) men referred for prostate biopsy defaulted mainly because they did not fully understand the need for further investigation because they were symptom free or afraid of the possible side-effects of the procedure or diagnosis of cancer.

CONCLUSION

The proportion of men with PSA >/= 4 ng/mL is comparable to that of previously unscreened populations with high incidence of prostate cancer such as African-American men. A larger study is required to confirm these findings and intensify efforts to determine the prostate cancer detection rate by biopsy in this population. A prostate cancer awareness and education campaign will be useful in this community.

DRD4 promoter SNPs and gender effects on Extraversion in African Americans

There is strong evidence for genetic influences on personality traits. Interest in one such gene, the dopamine D4 receptor (DRD4) grew after an exon III polymorphism was associated with Novelty Seeking and related measures of Extraversion. However, the findings were not confirmed in later studies. Recently, a -521C/T single nucleotide polymorphism (SNP) within the promoter region of the DRD4 gene was found to be related to Novelty Seeking scores in populations from Japan and Hungary. Since little is known about the role DRD4 plays in personality in other populations we evaluated if two DRD4 promoter SNPs, -521C/T and -616C/G, were related to personality traits in African Americans. Personality traits were measured by the NEO-FFI in 71 unrelated African Americans. Genotyping was performed using PCR-RFLP. Multivariate analyses of variance (MANOVA) were performed to evaluate the effects of gender and -616 and -521 genotypes on personality traits. A significant three-way interaction effect from gender, -616 genotype, and -521 genotype was observed for Extraversion scores (F(1,54) 5.86, P < 0.02). Subsequent analyses revealed that the association was mainly due to -521C/T genotype among females (P = 0.01). This study provides further evidence that genetic variation within the DRD4 promoter and gender differences contribute to variation in Novelty Seeking behaviors such as Extraversion.

CYP3A4-V and prostate cancer in African Americans: causal or confounding association because of population stratification?

CYP3A4-V, an A to G promoter variant associated with prostate cancer in African Americans, exhibits large differences in allele frequency between populations. Given that the African American population is genetically heterogeneous because of its African ancestry and subsequent admixture with European Americans, case-control studies with African Americans are highly susceptible to spurious associations. To test for association with prostate cancer, we genotyped CYP3A4-V in 1376 (2 N) chromosomes from prostate cancer patients and age- and ethnicity-matched controls representing African Americans, Nigerians, and European Americans. To detect population stratification among the African American samples, 10 unlinked genetic markers were genotyped. To correct for the stratification, the uncorrected association statistic was divided by the average of association statistics across the 10 unlinked markers. Sharp differences in CYP3A4-V frequencies were observed between Nigerian and European American controls (0.87 and 0.10, respectively; P<0.0001). African Americans were intermediate (0.66). An association uncorrected for stratification was observed between CYP3A4-V and prostate cancer in African Americans (P=0.007). A nominal association was also observed among European Americans (P=0.02) but not Nigerians. In addition, the unlinked genetic marker test provided strong evidence of population stratification among African Americans. Because of the high level of stratification, the corrected P-value was not significant (P=0.25). Follow-up studies on a larger dataset will be needed to confirm whether the association is indeed spurious; however, these results reveal the potential for confounding of association studies by using African Americans and the need for study designs that take into account substructure caused by differences in ancestral proportions between cases and controls.

Extent of linkage disequilibrium between the androgen receptor gene CAG and GGC repeats in human populations: implications for prostate cancer risk

While studies have implicated alleles at the CAG and GGC trinucleotide repeats of the androgen receptor gene with high-grade, aggressive prostate cancer disease, little is known about the normal range of variation for these two loci, which are separated by about 1.1 kb. More importantly, few data exist on the extent of linkage disequilibrium (LD) between the two loci in different human populations. Here we present data on CAG and GGC allelic variation and LD in six diverse populations. Alleles at the CAG and GGC repeat loci of the androgen receptor were typed in over 1000 chromosomes from Africa, Asia, and North America. Levels of linkage disequilibrium between the two loci were compared between populations. Haplotype variation and diversity were estimated for each population. Our results reveal that populations of African descent possess significantly shorter alleles for the two loci than non-African populations (P<0.0001). Allelic diversity for both markers was higher among African Americans than any other population, including indigenous Africans from Sierra Leone and Nigeria. Analysis of molecular variance revealed that approx. 20% of CAG and GGC repeat variance could be attributed to differences between the populations. All non-African populations possessed the same common haplotype while the three populations of African descent possessed three divergent common haplotypes. Significant LD was observed in our sample of healthy African Americans. The LD observed in the African American population may be due to several reasons; recent migration of African Americans from diverse rural communities following urbanization, recurrent gene flow from diverse West African populations, and admixture with European Americans. This study represents the largest genotyping effort to be performed on the two androgen receptor trinucleotide repeat loci in diverse human populations.

Cyp17 promoter variant associated with prostate cancer aggressiveness in African Americans

Androgens play an important role in the etiology of prostate cancer. The CYP17 gene encodes the cytochrome P450c17alpha enzyme, which is the rate-limiting enzyme in androgen biosynthesis. A T to C polymorphism in the 5' promoter region has recently been associated with prostate cancer. However, contradictory data exists concerning the risk allele. To investigate further the involvement of the CYP17 variant with prostate cancer, we typed the polymorphism in three different populations and evaluated its association with prostate cancer and clinical presentation in African Americans. We genotyped the CYP17 polymorphism in Nigerian (n = 56), European-American (n = 74), and African-American (n = 111) healthy male volunteers, along with African-American men affected with prostate cancer (n = 71), using pyrosequencing. Genotype and allele frequencies did not differ significantly across the different control populations. African-American men with the CC CYP17 genotype had an increased risk of prostate cancer (odds ratio, 2.8; 95% confidence interval, 1.0-7.4) compared with those with the TT genotype. A similar trend was observed between the homozygous variant genotype in African-American prostate cancer patients and clinical presentation. The CC genotype was significantly associated with higher grade and stage of prostate cancer (odds ratio, 7.1; 95% confidence interval, 1.4-36.1). The risk did not differ significantly by family history or age. Our results suggest that the C allele of the CYP17 polymorphism is significantly associated with increased prostate cancer risk and clinically advanced disease in African Americans.

Environmental influences, employment status, and religious activity predict current cigarette smoking in the elderly

The objective of this study was to describe the smoking histories, patterns of cigarette use, and quitting behaviors in a predominantly African American sample of older adults. Study participants were a convenience sample of senior center attendees in the Washington, DC metropolitan area. Self-report questionnaires were used to measure depression, nicotine dependence, smoking motives, and readiness to quit. Results showed that living with another smoker increased the likelihood of current smoking (odds ratio = 2.07, 95% CI = 1.72-36.73). Being employed or seeking work was also associated with a higher likelihood of current smoking (odds ratio = 2.73, 95% CI = 2.00-118.76). Subjects who reported less frequent participation in organized religious activities were also more likely to smoke (odds ratio = 2.04, 95% CI = 1.17-50.38). Both former and current smokers identified personal will power and physician advice as the two most influential factors in successful smoking cessation. However, current smokers believed that nicotine replacement would aid in a successful cessation attempt, while former smokers did not endorse the efficacy of these products. The findings are discussed in terms of implications for intervention.