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Background: New York State law mandates that women with dense breasts receive a written notification of their breast density (BD) and its implications, but data on the impact of dense breast notification (DBN) on BD awareness and knowledge in diverse populations remain limited. Methods: Between 2016 and 2018, we collected survey and mammographic data from 666 women undergoing screening mammography in New York City (ages 40–60, 80% Hispanic, 69% Spanish-speaking) to examine the impact of prior DBN on BD awareness by sociodemographic and breast cancer risk factors, and describe BD knowledge by sources of information. Results: Only 24.8% of the overall sample and 34.9% of women receiving DBN had BD awareness. In multivariable models adjusting for DBN, awareness was significantly lower in women who were Spanish-speaking [OR, 0.16; 95% confidence interval (CI), 0.09–0.30 vs. English speakers], were foreign-born (OR, 0.31; 95% CI, 0.16–0.58 vs. U.S.-born), and had lower educational attainment (e.g., high school degree or less; OR, 0.14; 95% CI, 0.08–0.26 vs. college or higher degree). Women receiving DBN were more likely to be aware of BD (OR, 2.61; 95% CI, 1.59–4.27) but not more knowledgeable about the impact of BD on breast cancer risk and detection. However, women reporting additional communication about their BD showed greater knowledge in these areas. Conclusions: DBN increases BD awareness disproportionately across sociodemographic groups. Impact: Efforts to improve communication of DBN must focus on addressing barriers in lower socioeconomic and racially and ethnically diverse women, including educational and language barriers.

Mammographic breast density (MBD) has been shown to be a strong, independent risk factor for breast cancer (BC) irrespective of race/ethnicity. Given the risk association of MBD and its potential to mask tumors on a mammogram, state and federal laws have mandated that women receive information regarding their personal MBD in their mammography reports. However, concerns have been raised regarding the impact of MBD notification on patient anxiety, especially written information for women who experience health disparities such as racial/ethnic minorities, lower health literacy, limited English proficiency and lower socioeconomic status. We performed a randomized controlled clinical trial to examine the impact of three different written and interpersonal approaches to MBD notification on patient anxiety, BC worry, and self-perceived BC risk, among Latinas receiving routine mammography screening at a federally qualified medical center (FQHC). We hypothesized that interpersonal education would reduce anxiety and worry, relative to the written notifications alone. The study was performed at the Baseline Clinic of Mountain Park Health Center, a FQHC in Phoenix, AZ. Women between ages 40 and 74 years presenting for screening mammogram were eligible. After providing signed informed consent, participants were randomized equally to usual care (UC- mailed notification letter); enhanced care (notification letter and MBD educational brochure designed for this study): interpersonal care (notification letter, brochure, promotora education via telephone). A stratified block randomization procedure was used with age > 50 years (yes vs no), ethnicity (Hispanic vs non-Hispanic), and language preference (Spanish vs. English) as strata. Study participants completed surveys at the time of enrollment/pre-intervention (T0), at two weeks to six months after intervention was delivered (T1), and about one year after randomization (T2). Anxiety state was measured using the state anxiety subscale of the State-Trait Anxiety Inventory scale (STAI-S) (range from 20-80). BC worry was probed using the question: “How frequently do you worry about getting breast cancer someday”. The self-perceived lifetime risk of BC was rated between 0% (no chance of BC) to 100% (definitely will get BC). The proportion of participants with an increase or persistence of higher level for each outcome between time points was compared between the three study groups. The study was approved by the Mayo Clinic Institutional Review Board. 1332 Latina women were enrolled and randomized between October 2016 and October 2019. All completed the baseline (T0) survey, 928 completed T1, 632 completed T2, and 516 completed both T1 and T2 surveys. At study entry, majority of the participants were young (64.1% between age 40-49 years), had no family history of breast cancer (81.0%), had less than high school education (68.8%), and were married or partnered (67.8%). At T0, the mean (SD) anxiety STAI score was 32.5 (11.1); 51.8% with moderate or severe anxiety (score > 30). With regard to BC worry, 41.3% reported worrying “sometimes”, “often”, or “almost all the time”. Further, 25.4% reported a self-perceived lifetime risk of developing BC of >10% while only 6.6% had a Gail model estimated lifetime risk score of >10%. There was no significant difference in changes in anxiety, BC worry or self-perceived risk from T0 to either T1 or T2 surveys between the intervention groups. In summary, this study found high levels of baseline anxiety and BC worry (despite the majority being 40-49 years old and having no family history of BC) which persisted regardless of how notification and education were delivered. Future work is needed to improve the understanding of factors that could lower anxiety and BC worry and improve risk perception in this population. Citation Format: Karthik Ghosh, Sarah Jenkins, Jennifer Ridgeway, Jessica D. Austin, Bijan Borah, Bhavika K. Patel, Deborah Rhodes, Aaron Norman, Edna P. Ramos, Matt Jewett, Crystal Gonzalez, Valentina Hernandez, Davinder Singh, Vera Suman, Celine Vachon. Breast Density Notification: Impact on anxiety, breast cancer worry, and self-perceived risk among Latinas at a federally qualified medical center. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-38.

Purpose: As part of an ongoing effort to support the equitable delivery of cancer care to historically underserved communities in New York City (NYC), we examined the impact of COVID-19 on community outreach organizations working with an NCI-comprehensive cancer center Methods: We conducted 16 semi-structured interviews (30–90 minutes; July-September 2020) with stakeholders (SH) including patient navigators, patient advocates, faith-based leaders, community health, and non-profit organizations in NYC – the epicenter of the COVID-19 pandemic in the US. Using thematic analysis, we characterized experiences and challenges in supporting cancer care delivery during COVID-19. Results: Per SH, COVID-19 required organizations to shift priorities to address day-to-day needs exacerbated by COVID-19 (food insecurity, financial/housing instability, misinformation, emotional distress). Organizations adapted by leveraging existing partnerships, including the cancer center, and partnering with new local/state organizations to broaden their work scope (e.g., COVID-19 testing centers, food pantries, technology training), and disseminate reliable COVID-19 information to communities. All organizations transitioned to virtual platforms creating challenges for those with limited technical resources and often excluded older or isolated populations; thus, many organizations retained a socially distanced in-person component to remain visible and trustworthy within the community. Importantly, SH emphasized the importance of cancer center support via proactive involvement and communication with community members, providing a supportive infrastructure (funding, technical support, personnel), and incorporating community voices into new programs and projects during and beyond the COVID-19 pandemic. Conclusion: In addition to or in lieu of cancer care delivery efforts, community organizations are compelled to develop innovative approaches that address the more immediate needs of the community resulting from COVID-19. Cancer centers can support their community partners by being responsive and flexible to the community needs, building trust within the community, and strengthening community organizational capacity to reduce the long-term damage of COVID-19 and achieve equity.

Introduction. Vulnerable populations, such as minorities, under-, and uninsured patients receiving care from safety-net settings, are more likely to receive a late-stage cancer diagnosis, resulting in higher mortality rates. Studies have shown that being connected to a primary care provider can play a vital role in timely diagnosis of early-stage cancer. Yet, vulnerable populations often have difficulty accessing primary care services and resources in most safety-net settings where care is fragmented. Receiving care in an integrated health system may help to reduce stage disparities by providing the infrastructure to support continuity and coordination of care. Yet, the degree to which vulnerable patients are connected to a primary care provider within an integrated setting is uncertain. A better understanding of the role of primary care connectedness among vulnerable patient populations receiving care in an integrated, safety-net hospital setting is needed to address the issue of stage disparity. We hypothesize that vulnerable patients connected to a primary care provider prior to their cancer diagnosis will have increased odds of early-stage cancer diagnosis. Methods. As part of an ongoing prospective study, we examined a cross-sectional sample of 66 patients diagnosed with Stage I-III colorectal and breast cancer receiving care within an integrated, safety-net hospital system during the years 2017 and 2018. We analyzed medical records data to generate descriptive statistics to characterized patient demographics, cancer-related demographics, and primary care connectedness - defined as having a primary care provider listed in the medical record prior to diagnosis. Using logistic regression, we calculated the odds of early-stage disease, according to the American Joint Commission on Cancer (AJCC) (stages I and II vs. III) as a function of primary care connectedness. Results. The majority of the sample was non-white (58%) and nearly half reported having no insurance (47%). Females comprised nearly 80% of the sample and one-third of the sample was diagnosed with colorectal cancer. In addition, nearly 60% had a primary care provider listed in the medical record prior to their cancer diagnosis and 60% received an early-stage diagnosis. Preliminary findings from the logistic regression support our hypothesis that vulnerable patients connected to a primary care provider prior to a cancer diagnosis had significantly higher odds of early-stage diagnosis (OR = 3.9, 95% CI 1.2-13.0). Conclusion. Being connected to a primary care provider may help to reduce stage disparities among vulnerable populations receiving care from an integrated safety-net setting. Integrated safety-net settings may facilitate early-stage diagnosis through clear referral pathways that ensure more timely diagnosis after screening abnormalities and prevent diagnostic delay. Citation Format: Jessica D Austin, Matthieu Chansard, Simon C Lee, Bijal A Balasubramanian. Influence of primary care connectedness on early-stage cancer diagnosis among vulnerable patients in an integrated, safety-net setting [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C096.