Sara Horton

Patterns of 21-gene assay testing and chemotherapy use in black and white breast cancer patients.

BACKGROUND In women with early stage, hormone receptor (HR)-positive (HR(+)) breast cancer, the 21-gene recurrence score (RS) assay quantifies recurrence risk and predicts chemotherapy responsiveness. Recent data suggest that not all women with early-stage, HR(+) disease receive this testing. We examined sociodemographic, clinical, and attitudinal factors associated with RS testing receipt and the RS testing effect on chemotherapy use in black and white patients. PATIENTS AND METHODS Women with newly diagnosed invasive, nonmetastatic breast cancer were recruited and interviewed to collect sociocultural and health care process data; clinical data were collected from charts. Of the sample (n = 359), 270 had HR(+) disease. Primary analysis focused on those with HR(+) node-negative disease (n = 143); secondary analyses included node-positive women. Logistic regression models evaluated factors associated with receipt of RS testing and chemotherapy. RESULTS Among women eligible for the 21-gene assay, 62 patients [43%] received RS testing. In multivariable analysis, older age (odds ratio, 1.04 per 1 year increase; 95% confidence interval, 1.01-1.08) was associated with RS testing after adjustment for covariates. Chemotherapy use was 23%. In multivariable analysis, positive attitudes about chemotherapy and greater risk of recurrence were associated with chemotherapy use (P < .05). CONCLUSION Patterns of genomic testing might vary according to age. Efforts to understand factors associated with low testing rates will be important.

Correlates of Triple Negative Breast Cancer and Chemotherapy Patterns in Black and White Women With Breast Cancer.

Background: Triple negative breast cancer (TNBC) tumors are estrogen receptor‐negative, progesterone receptor‐negative, and human epidermal growth factor‐negative. TNBC is responsive to chemotherapy, but chemotherapy might be underused in some patient subgroups. The goal of the present study was to characterize the patterns of chemotherapy use (uptake and completion) in TNBC patients. Patients and Methods: Women with primary invasive, nonmetastatic breast cancer were recruited in Washington, DC, and Detroit. Data were collected using a standardized telephone survey that captured sociocultural and health care process factors. Clinical data were abstracted from the medical records. We used χ2 tests to access the association between the receipt of chemotherapy use (initiation and completion) and categorical variables, and t tests were used for continuous variables. Logistic regression models were used to evaluate the factors associated with chemotherapy uptake. Results: Women with TNBC (16% of sample) were more likely to be black than white (68% vs. 32%; P < .05). Among women with TNBC, 60% underwent chemotherapy. Chemotherapy uptake was greater for black than for white women (48.3% vs. 11.7%; P = .01) and in women without (vs. with) healthcare discrimination (35% vs. 25%; P = .04). In multivariable models, only race was associated with the receipt of chemotherapy. Black women were more likely to receive chemotherapy than were white women. The odds ratio of receiving chemotherapy by race was 4.1 (95% confidence interval, 1.3–13.1). Each 1‐year increase in age was associated with a lower likelihood of chemotherapy completion (odds ratio, 0.9; 95% confidence interval, 0.826–0.981; P = .02). Women with at least some college were less likely to complete chemotherapy than were those with other education levels (P = .02). Conclusion: A substantial number of TNBC patients failed to receive and/or complete chemotherapy. Differences in chemotherapy uptake by race and sociocultural factors diminished in multivariable models but age and stage remained significant. Suboptimal treatment among women with TNBC could contribute to adverse outcomes. Future investigations are necessary to assess whether the noninitiation and/or noncompletion of chemotherapy is clinically warranted. Micro‐Abstract: Triple negative breast cancer is responsive to chemotherapy but chemotherapy might be underused in some patient subgroups. Women with primary invasive, nonmetastatic breast cancer were recruited in Washington, DC, and Detroit. Chemotherapy uptake was greater for black than for white women (48.3% vs. 11.7%; P = .01) and for women without (vs. with) health care discrimination (35% vs. 25%; P = .04). Future investigations are necessary to assess whether the noninitiation and/or noncompletion of chemotherapy is clinically warranted.

Abstract C48: Racial-specific differences in breast cancer treatment

Although the incidence of breast cancer (BCa) among Blacks is lower than Whites, health outcomes are dire, as the cancer is often diagnosed at a higher grade and more advanced stage. Additionally, in Blacks, BCa tends to be more aggressive, as triple negative breast cancer is more prevalent, is more lethal and less treatable than the cognate disease in Whites. In addition to the high prevalence of aggressive disease in Blacks, we hypothesized that recurrence and survival outcomes may also be due to treatment differences between populations. Therefore, the objective of this study was to determine if there were racial-specific treatment differences in BCa cases in Washington, DC (N=5932) between 2000 and 2010. Using chi-square and regression analysis, we demonstrate that after controlling for age, stage, grade, ER, PR, HER2, and BCa molecular subtype, no significant racial-specific differences in surgery or radiation were found. However, overall, Blacks and Hispanics were more likely to receive chemotherapy for BCa when compared to whites (OR for Blacks: 3.57, 95% CI: 1.66-8.33 and OR for Hispanics: 4.76, 95% CI: 1.33-0.16.67). Among those with Stage 3 and 4 BCa, Blacks and Hispanics were still more likely to receive chemotherapy (OR for Blacks: 1.93, 95% CI: 1.16-3.20 and OR for Hispanics: 3.95, 95% CI: 1.03-15.15). Differences in hormonal therapy were also found with Blacks and Hispanics being more likely to receive hormone therapy for ER and/or PR positive disease (OR for Blacks: 3.12, 95% CI: 1.27-7.69 and OR for Hispanics: 8.33, 95% CI: 2.27-33.33). Studies that identify driving factors behind these racial-related treatment differences are warranted. Citation Format: Brittany N. Barley, Sara Horton, Jacqueline Dunmore-Griffith, Luisel Ricks-Santi. Racial-specific differences in breast cancer treatment. [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 C48. doi:10.1158/1538-7755.DISP13-C48

Abstract P5-12-05: Racial and gender disparity in breast cancer: A review on African American men

Background: Secondary to their comparable racial and socio-demographic background, African American (AA) men and women with breast cancer are expected to have similar outcomes. However, there is a paucity of data demonstrating gender-specific differences in breast cancer across racial/ethnic groups. Our objective is to investigate potential differences between AA men, AA women and White men with breast cancer by evaluating risk factors using a population-based tumor registry. Methods: A retrospective review of the Surveillance Epidemiology and End Results (SEER) database from 1988 to 2008 was conducted. We identified AA men and AA women aged 20 years or older with a primary breast cancer diagnosis or in whom the index breast cancer is the first cancer. A similar group of White men were included to serve for comparison. All available treatment modalities were reviewed. Bivariate analysis of patient characteristics, tumor grade, stage, hormonal assay, and treatment modality was performed using Chi squared test. Survival was estimated and Cox proportional model was used to investigate survival differences comparing AA men, AA women and White men (with AA men as reference), adjusting for age, year of diagnosis, tumor characteristics, as well as treatment received. Subset analyses were done within stage strata. Results: We reviewed 62 758 patient records comprising 506 (0.81%) AA male, 59 234 (94.38%) AA female and 3 018 (4.81%) White males. Most were 50 years or older (57.5%), married (39.4%), had invasive ductal carcinoma (61.9%) and localized disease (42.5%). Mean age at diagnosis was 59 (±11), 55 (±12) and 63 (±11) years for AA males, AA females and White males, respectively. Men were more likely to have moderately differentiated tumors (37.6% and 40.4% for AA males and White males, respectively) compared to AA women who were more likely to have poorly differentiated tumors (39.2%) (p Conclusion: Using a large population-based database, our study demonstrates absence of gender specific difference in breast cancer survival among African Americans. However, AA men were found to have larger tumors, worse stage, and despite presenting with similar grade and receiving similar treatment as White males, had worse outcome. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-12-05.

Abstract 654: The effect of lung cancer screening awareness on smoking behavior among U.S. adults

Proceedings: AACR 103rd Annual Meeting 2012‐‐ Mar 31‐Apr 4, 2012; Chicago, IL Background: Emphasizing the risk of lung cancer can encourage smoking cessation, but use of spiral low-dose CT scans reduced lung cancer mortality in a recent randomized screening trial. It is unknown if awareness of lung cancer screening will influence smoking behavior. Aim: To evaluate the awareness of lung cancer screening and to determine if awareness of lung cancer screening affects smoking cessation-related behavior among current smokers. Methods: We identified 7,282 adult respondents who answered questions concerning their smoking-related behavior in the 2007 Health Information National Trends Survey (HINTS). We used logistic regression models to evaluate the association of smoking status with awareness of lung cancer screening and we also investigated the association of lung cancer screening awareness with smoking cessation behaviors among current smokers. Results: The mean age of responders was 54.1 years and 61.2% were females. There were 3,813 (52.4%) never smokers; 2,222 (30.5%) former smokers; and 1,247 (17.2%) current smokers. Overall, 2,183 (30.6%) of respondents had heard of a lung cancer screening test (29.6% never smokers, 33.4% former smokers, and 28.5% current smokers; P value = 0.002). Chest X-ray (64.4%) and CT scan (5.7%) were among the screening tests that they have heard of. Among current smokers, awareness of lung cancer screening had no effect on smoking cessation behavior after adjusting for age, sex, race, education, income and marital status (Table). Conclusion: Awareness of lung cancer screening tests did not affect smoking cessation behavior of current smokers. However, smoking cessation should be recommended for all current smokers and those with a history of smoking should be informed about lung cancer screening with CT scan. ![Figure][1] Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 654. doi:1538-7445.AM2012-654 [1]: pending:yes

Abstract 3884: DNA mismatch repair defects, MSI, does not play major role in colon carcinogenesis in young African Americans

Back ground: African Americans (AAs) are known to display a higher rate and even earlier age of colorectal cancer (CRC) than in the general population. Genetically, 10-12% microsatellite instability (MSI) cases involved in CRC development. However, if it occurs below the age of 50 it could be suspicious of Lynch syndrome. Aims and methods: We aimed to assess the role of MSI in pathogenesis of sporadic colorectal cancer in young African American. The CRC patients in this study were less than 50 years and referred to Howard University Hospital from 2005 to 2008. The medical records (n=50) as well as the pathology reports were reviewed. The MSI status was assessed in a multiplex PCR targeting 5 markers: BAT25, BAT26, NR21, NR27 and NR24. The PCR products were analysed in an Applied Biosystems Gene Scan 3130 machine. Samples with two or more instable markers were labeled MSI-H, with one instable marker: MSI-L and no stable marker: MSS. The presence or absence of expression of four DNA MMR proteins: MLH1, PMS2, MSH2 and MSH6 were evaluated using immunohistochemistry on a Tissue Microarray (TMA, n=26, duplicate) consisting (stage1: 3; stage 2: 6; stage3: 5; stage4: 4).TMA IHC staining were read by two different pathologists who were not aware of the patient clinical status and were scored thus in an objective manner. Two patients were MSI-L and one MSI-H. The response to 5-FU based therapy was reported. Results: Twenty six patients [age, median: 44.5; age range: 26-49; male, 17 (65.4%)] were enrolled in the study. Seven out of 13 available data had family history of CRC. Fourteen CRC cases were left sided. MSI analysis revealed that out of 24 patients: one was MSI-H and two were MIS-L and the rest were MSS. The MSI high patient and one of the MSI low had family history of CRC. MLH1, PMS2, MSH2 and MSH6 were not expressed in 7 (26.9%), 1 (3.8%), 0 (0%) and 5 (19.2%) of tumors, respectively. IHC confirmed the MSI-H tumor. There was a recurrence with lung and brain metastases at 72 months in one of the MSI-L patients following adjuvant chemotherapy with 5 Fluorouracil and Leucovorin. Discussion: Our results show that MSI is not a major pathway in tumorgenesis of sporadic CRCs in young AAs and we may need to study chromosomal instability or CpG Island methylator phenotype as alternative pathways which occur in African Americans and make them present the disease at younger age and advanced stage. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3884. doi:10.1158/1538-7445.AM2011-3884