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PURPOSE Timely lung cancer surgery is a metric of high-quality cancer care and improves survival for early-stage non–small-cell lung cancer. Historically, Black patients experience longer delays to surgery than White patients and have lower survival rates. Antiracism interventions have shown benefits in reducing racial disparities in lung cancer treatment. METHODS We conducted a secondary analysis of Accountability for Cancer Care through Undoing Racism and Equity, an antiracism prospective pragmatic trial, at five cancer centers to assess the impact on overall timeliness of lung cancer surgery and racial disparities in timely surgery. The intervention consisted of (1) a real-time warning system to identify unmet care milestones, (2) race-specific feedback on lung cancer treatment rates, and (3) patient navigation. The primary outcome was surgery within 8 weeks of diagnosis. Risk ratios (RRs) and 95% CIs were estimated using log-binomial regression and adjusted for clinical and demographic factors. RESULTS A total of 2,363 patients with stage I and II non–small-cell lung cancer were included in the analyses: intervention (n = 263), retrospective control (n = 1,798), and concurrent control (n = 302). 87.1% of Black patients and 85.4% of White patients in the intervention group ( P = .13) received surgery within 8 weeks of diagnosis compared with 58.7% of Black patients and 75.0% of White patients in the retrospective group ( P < .01) and 64.9% of Black patients and 73.2% of White patients ( P = .29) in the concurrent group. Black patients in the intervention group were more likely to receive timely surgery than Black patients in the retrospective group (RR 1.43; 95% CI, 1.26 to 1.64). White patients in the intervention group also had timelier surgery than White patients in the retrospective group (RR 1.10; 95% CI, 1.02 to 1.18). CONCLUSION Accountability for Cancer Care through Undoing Racism and Equity is associated with timelier lung cancer surgery and reduction of the racial gap in timely surgery.

Background: Representation of Black individuals with cancer in biospecimen research remains disproportionately low compared to white counterparts. Clinicians and research staff are responsible for informing, inviting, and consenting patients to participate in such research. We sought to understand clinician and research staff perspectives on engaging Black patients in biospecimen research. Methods: We conducted 10 in-depth interviews with purposively sampled clinicians and research staff at a large academic cancer center in North Carolina between January and August 2022. Participants underwent semi-structured interviews (duration 45-60 minutes) and were asked open ended questions about biospecimen research barriers in general, barriers specific to people who identify as Black or African American, and considerations when discussing biospecimen research with Black patients. Interview transcripts were analyzed using thematic analysis. Results: Perceived patient related barriers to biospecimen donation included pain from sample collection, invasive sample collection, lack of to time or transportation, medical research mistrust, health literacy, and limited knowledge of opportunities for involvement. Many felt that these barriers were faced by both Black and non-Black patients. However, some felt for Black patients, these barriers existed within the context of historical injustices in medicine, current bias in health care and socioeconomic inequities, while others felt socioeconomic status not race was more of a concern. Clinician and research staff identified barriers to discussing biospecimen research included lack of time given busy clinical practice and concern with patients’ physical and emotional state. Patients’ race was not considered a barrier. When asked about considerations for discussing biospecimen research specifically with Black patients, participants felt time to establish rapport and trust, readiness to discuss historical injustices in biomedical research, reminding participants research is voluntary, and having in person discussions were important. Few felt that patient race was not relevant to these discussions. Conclusion: Some clinicians and research staff acknowledge that historical injustices and current racial bias in biomedical research and health care contribute to low representation of Black individuals in biospecimen research, while others did not. Further research is needed to assess whether race and/or racism agnostic approaches versus acknowledgement of structural racism’s influence on biomedical research and health care have an impact on fair representation of Black individuals in biospecimen research. Sponsored by the Lung Cancer Research Foundation Research Grant on Disparities in Lung Cancer Citation Format: Aaron Carpenter, Hayley N. Morris, Annabella Opoku, Alison Hilton, Jessica Carda-Auten, Randall Teal, Jeenn A. Barreiro-Rosado, Lauren Matthews, Oluwatumilara Akeke, Ashley Rankin Collins, Marjory Charlot. Research team perspectives on engaging Black patients with cancer in biospecimen research. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5535.

Background: Participation of racially diverse populations in research is necessary to advance cancer care. However, representation of Black individuals in biospecimen cancer research remains low and requires being asked to engage in research. We sought to understand the experiences, beliefs, and knowledge about biospecimen research among Black patients with lung cancer. Methods: Semi-structured interviews with a purposive sample of 15 Black patients diagnosed with lung cancer were conducted between January and August 2022 at a large academic center in North Carolina. Interviews were digitally recorded and transcribed and analyzed using thematic analysis. Results: Themes related to who should initiate discussions about biospecimen donation, what should be considered before donation, and communication strategies to increase participation of Black patients with cancer in biospecimen research emerged from the interviews. Most participants indicated that discussions about biospecimen donation should be initiated by trusted and knowledgeable members of the medical team and most expressed trusting their providers. Some also expressed the importance of including family members in discussions about medical and research decisions. Some participants felt it was important to consider if donating specimens would cause pain or would require additional procedures. Recommended communication strategies to facilitate participation included use of simple and easily understood language in addition to messaging related to how biospecimen donation would benefit others. Participants also felt cultural humility, respect, and empathy during research recruitment would help enhance enrollment of Black participants in biospecimen research. Of note, all participants reported never being asked to participate in biospecimen research and felt that underrepresentation of Black participants may be due to not being asked. Conclusion: Black participants in this study have not been asked to participate in biospecimen research but are willing to be engaged in conversations about research from their medical team. Simply being asked, trusting their medical provider, cultural humility, and framing the message on how the research will benefit others are some of the recommended strategies to enhance research participation among Black patients. Future research should incorporate these strategies into an intervention to assess the impact on recruiting Black individuals in biomedical research. Sponsored by the Lung Cancer Research Foundation Research Grant on Disparities in Lung Cancer Citation Format: Jeenn A. Barreiro-Rosa, Oluwatumilara Akeke, Annabella Opoku, Alison Hilton, Jessica Carda-Auten, Randall Teal, Aaron Carpenter, Hayley N. Morris, Lauren Matthews, Ashley Rankin Collins, Marjory Charlot. “Simply ask and explain”: perspectives from Black patients with lung cancer on strategies to address racial disparities in biospecimen research participation. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5534.

PURPOSE There is increasing interest in implementing digital systems for remote monitoring of patients’ symptoms during routine oncology practice. Information is limited about the clinical utility and user perceptions of these systems. METHODS PRO-TECT is a multicenter trial evaluating implementation of electronic patient-reported outcomes (ePROs) among adults with advanced and metastatic cancers receiving treatment at US community oncology practices (ClinicalTrials.gov identifier: NCT03249090 ). Questions derived from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) are administered weekly by web or automated telephone system, with alerts to nurses for severe or worsening symptoms. To elicit user feedback, surveys were administered to participating patients and clinicians. RESULTS Among 496 patients across 26 practices, the majority found the system and questions easy to understand (95%), easy to use (93%), and relevant to their care (91%). Most patients reported that PRO information was used by their clinicians for care (70%), improved discussions with clinicians (73%), made them feel more in control of their own care (77%), and would recommend the system to other patients (89%). Scores for most patient feedback questions were significantly positively correlated with weekly PRO completion rates in both univariate and multivariable analyses. Among 57 nurses, most reported that PRO information was helpful for clinical documentation (79%), increased efficiency of patient discussions (84%), and was useful for patient care (75%). Among 39 oncologists, most found PRO information useful (91%), with 65% using PROs to guide patient discussions sometimes or often and 65% using PROs to make treatment decisions sometimes or often. CONCLUSION These findings support the clinical utility and value of implementing digital systems for monitoring PROs, including the PRO-CTCAE, in routine cancer care.

Background Participating in clinical trials is a metric of high-quality cancer care and improves survival. However, Black individuals with cancer are less likely to be enrolled in clinical trials and experience a disproportionate burden of cancer mortality compared to Whites. Patient-engaged research is one potential strategy to address racial inequities in clinical trials, but little is known about best practices for engaging Black individuals and communities impacted by cancer in research partnerships. Methods We used a community engaged research approach to establish a patient advisory council (PAC) representative of the patient population served by a safety net hospital cancer center. We outline the process of establishing the PAC and the lessons learned. Results The inaugural PAC included 7 members representative of the cancer center’s patient demographics. PAC members developed a patient centered vision, mission and action plan. PAC and community-academic research partners experienced the transformative power of centering the lived experiences of patients of color to promote health equity in cancer research. Conclusion Establishing a patient advisory council at a safety net hospital cancer care center provided a platform for engaging a hardly reached population in patient centered research. Supplementary Information The online version contains supplementary material available at 10.1186/s40900-021-00317-7., Plain English summary Participating in clinical trials is an important measure of high-quality cancer care and improves survival. However, Black individuals with cancer are less likely to participate in clinical trials and are more likely to die from cancer compared to Whites. Including Black patients as research partners is one way to improve racial equity in clinical trial participation. We established a patient advisory council (PAC) including patients and caregivers with similar racial demographics as the patients receiving care at a safety net hospital cancer center. PAC members partnered with the research team to develop a vision, mission, and action plan to improve research participation among patients of color. PAC members used their lived experiences and training from the research team to help develop a strategy to improve representation of patients of color in cancer research. This paper is focused on the PAC development process. Supplementary Information The online version contains supplementary material available at 10.1186/s40900-021-00317-7.

Equity in vaccine outreach and delivery has been prioritized given the disproportionate harms of the COVID-19 pandemic on communities of color and those with lower socioeconomic status. Health systems have largely communicated availability or signup for vaccines to patients through electronic patient portal messages, emails, or online materials; however, rates of portal use and internet access are limited among rural populations, individualswith lower socioeconomic status, and racial and ethnic minority patients. For purposes of this analysis, these groups are referred collectively as marginalized populations. Reliance on these media as the primary means for communication may inadvertently widen vaccination disparities.

Background Women with obesity are at higher risk for high-grade and/or advanced-stage breast cancer in comparison with women without obesity. Many women with a high body mass index (BMI) at breast cancer diagnosis experience further weight gain during and after treatment. This study investigated Black and White patient perspectives on conversations with their oncologists about weight and weight management. Methods Focus groups using a virtual platform (Zoom) were conducted with women after primary treatment for stage I to III breast cancer who were 21 years or older and had a BMI ≥ 30 kg/m2 : 2 with Black women (n = 12) and 2 with White women (n = 14). Results Participants asked that their oncologists be "transparent" about weight gain as a potential side effect of their cancer treatment and how excess weight might affect their prognosis and survival. They asked to be "seen as an individual" to facilitate both person-centered and culturally appropriate conversations about behavioral changes needed for weight management. Participants urged clinicians to take the lead in initiating conversations about weight to underscore its importance in cancer care and survivorship. They welcomed actionable recommendations about nutrition and exercise from either the oncology clinician or a specialist. Participants offered specific suggestions on how clinicians could initiate weight-related conversations, beginning with questions eliciting patients' perspectives on their weight and lifestyle. Conclusions Many women with early-stage breast cancer and obesity have concerns about weight and weight gain and urge their oncologists to use an active and personalized approach in recommending and supporting efforts at weight management. Lay summary Focus group discussions with Black and White women with early-stage breast cancer and obesity have elicited patient perspectives on conversations with their oncologists about weight and weight management. Many patients have concerns about weight and weight gain and urge their oncologists to use an active and personalized approach in recommending and supporting efforts at weight management.

The COVID-19 pandemic and the simultaneous increased focus on structural racism and racial/ethnic disparities across the United States have shed light on glaring inequities in U.S. health care, both in oncology and more generally. In this article, we describe how, through the lens of fundamental ethical principles, an ethical imperative exists for the oncology community to overcome these inequities in cancer care, research, and the oncology workforce. We first explain why this is an ethical imperative, centering the discussion on lessons learned during 2020. We continue by describing ongoing equity-focused efforts by ASCO and other related professional medical organizations. We end with a call to action—all members of the oncology community have an ethical responsibility to take steps to address inequities in their clinical and academic work—and with guidance to practicing oncologists looking to optimize equity in their research and clinical practice.

Background Insufficient social support is associated with increased mortality among older adults. Lung cancer is primarily a disease of older adults and is the leading cause of all cancer deaths. We assessed the association of social support with outcomes among older adults with lung cancer. Materials and methods Adults age 65 and older with lung cancer with a completed geriatric assessment (GA) were assessed. Emotional social support (ES) and tangible (material, instrumental) support (TS) measures and patient characteristics were obtained from the GA. The electronic health record was used to extract clinical variables. Simple linear regression models evaluated the association between social support scales with patient and clinical factors. Results 79 adults were assessed. White race was positively associated with ES score (p=.04), while higher BMI (p=.03), depression (p=.03) and anxiety (p=.02) were associated with worse ES. Higher BMI was associated with higher/better TS score (p=.02) while living alone was associated with lower/worse TS score (p=.03). Completion of platinum-based doublet chemotherapy with immunotherapy as planned was associated with higher ES scores (p=.02) and higher TS scores (p=.02). Disease progression was associated with lower ES scores (p=.03). Conclusion Social support may influence clinical outcomes in older adults with lung cancer. As lung cancer often portends to poor prognosis, social support may be an important prognostic indicator.

Background Safety net hospitals provide care mostly to low-income, uninsured, and vulnerable populations, in whom delays in cancer screening are established barriers. Socioeconomic barriers might pose important challenges to the success of a lung cancer screening program at a safety net hospital. We aimed to determine screening follow-up compliance, rates of diagnostic and treatment procedures, and the rate of cancer diagnosis in patients classified as category 4 by the Lung CT Screening Reporting and Data System (Lung-RADS 4). Methods We conducted a retrospective review of all patients enrolled in our multidisciplinary lung cancer screening program between March 2015 and July 2016. Demographics, smoking status, Lung-RADS score, and number of diagnostic and therapeutic interventions and cancer diagnoses were captured. Results A total of 554 patients were screened over a 16-month period. The mean patient age was 63 years (range, 47-85 years), and 60% were male. The majority (92%; 512 of 554) were classified as Lung-RADS 1 to 3, and 8% (42 of 554) were classified as Lung-RADS 4. Among the Lung-RADS 4 patients, 98% (41 of 42) completed their recommended follow-up; 29% (12 of 42) underwent a diagnostic procedure, for an overall diagnostic intervention rate of 2% (12 of 554). Eleven of these 12 patients had cancer, and 1 patient had sarcoidosis. The overall rate of surgical resection was 0.9% (5 of 554), and the rate of diagnostic intervention for noncancer diagnosis was 0.1% (1 of 554). Conclusions Implementation of a multidisciplinary lung cancer screening program at a safety net hospital is feasible. Compliance with follow-up and interventional recommendations in Lung-RADS 4 patients was high despite anticipated social challenges. Overall diagnostic and surgical resection rates and interventions for noncancer diagnosis were low in our initial experience.

Participatory research approaches can help ensure research is culturally relevant and aligned with stakeholder priorities, but barriers exist between researchers and community stakeholders, particularly in communities of color. We developed a measurement tool for assessing oncology researcher and provider readiness to undertake patient-engaged research, and piloted this measurement tool among oncology researchers and providers at the hospital's cancer care center. A survey was developed by drawing from existing PCORI assessments as well as creating original questions, in an effort to develop an evidence-based survey tailored to this project. A total of 23 researchers and providers responded to the survey. The majority of respondents indicated that they were moderately or very familiar with the concept of patient-centered outcomes research. Most respondents had little to no experience engaging in participatory research and endorsed several barriers to engaging patients in the research process, including lack of experience and time. A mechanism for preparing and supporting researchers and providers is needed if cancer centers are to implement patient-powered research agendas as recommended by PCORI.

Breast cancer mortality is higher in Black women than in White women. The prevalence of type 2 diabetes mellitus is also higher, yet data on whether diabetes affects breast cancer mortality in this population are lacking. We investigated the relation of diabetes at the time of breast cancer diagnosis to breast cancer mortality in the Black Women's Health Study, a prospective cohort study.1,621 Black women with invasive breast cancer diagnosed in 1995-2013 were followed by mailed questionnaires and searches of the National Death Index. Multivariable Cox regression analysis was used to compute hazard ratios (HRs) for diabetes in relation to breast cancer mortality and all-cause mortality, with adjustment for age, stage, treatment modality, estrogen receptor (ER) status, and body mass index.There were 368 deaths during follow-up, of which 273 were due to breast cancer. Breast cancer mortality was significantly increased in women who had been diagnosed with diabetes at least 5 years before breast cancer occurrence, HR 1.86 (95% CI 1.20-2.89), with elevations observed for both ER+ and ER- breast cancer. All-cause mortality was also higher in diabetics, with HRs of 1.54 (95% CI 1.12-2.07) overall and 2.26 (95% CI 1.62-3.15) for ≥5-year duration of diabetes relative to non-diabetics.Our results present the first solid evidence of a positive association of type 2 diabetes with breast cancer mortality in Black women. Given the higher prevalence and earlier onset of type 2 diabetes in Black women, it is likely that diabetes contributes to racial disparities in breast cancer mortality.

Background Racial disparities in patient-reported outcomes (PROs; e.g., symptoms, financial burden) among patients with cancer are well documented. Prior studies have attributed such disparities to patient- and provider-level factors, but less is known about the contribution of practice-level factors. Hospital racial composition of patients has been linked to disparities in care quality and outcomes, but questions remain regarding whether oncology practice racial composition mediates racial disparities. Using 2017-2020 data from the Patient-Reported Outcomes to Enhance Cancer Treatment (PRO-TECT) trial (ClinicalTrials.gov NCT03249090), we examined racial disparities in PROs among patients with metastatic cancer, and whether oncology practice racial composition accounted for observed disparities. Methods Our sample included 1099 patients (n=198 Black; n=901 White) from 51 community oncology practices across the US. Predictors of interest were patient race (Black vs. White) and practice-reported racial composition (Black patient population >20% vs. ≤20%). Patient-reported outcome metrics included pain, appetite loss, fatigue, nausea, dyspnea, insomnia, constipation, diarrhea, and financial burden, measured at baseline and at 1- and 3-month follow-up using the EORTC Quality of Life Core Questionnaire (QLQ-C30). Raw EORTC QLQ-C30 scores were standardized to range from 0 (best) to 100 (worst). We estimated multilevel linear mixed models predicting each PRO as a function of patient race, adjusting for clinical and sociodemographic factors, followed by further adjustment for practice racial composition. Results Twelve out of fifty-one (23.5%) practices reported a Black racial composition of >20%, with 41.6% of Blacks and 14.5% Whites receiving care at these practices. Across all practices, Blacks reported worse pain (β=5.5, p=0.02), nausea (β=2.5, p=0.04) and financial burden (β=7.6, p20% reported more pain (β=5.5, p=0.01), appetite loss (β=8.1, p Citation Format: Cleo A. Samuel, Olive Mbah, Wendi Elkins, Marjory Charlot, Amylou Dueck, Brenda F. Ginos, Jennifer Jansen, Deborah Schrag, Patty Spears, Angela Stover, Ethan Basch. Separate and unequal: Examining the role of race and site of care on patient-reported outcomes among patients with metastatic cancer (AFT-39) [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-119.

BACKGROUND Patient navigation improves the timely diagnosis of cancer among minorities, but little is known about the effects of patient and navigator race and language concordance on health outcomes. METHODS The authors investigated the effects of patient and navigator race and language concordance on the time to diagnosis of cancer screening abnormalities among participants in the Boston Patient Navigation Research Program, a clinical effectiveness trial for women who had breast or cervical cancer screening abnormalities identified from January 1, 2007 to December 31, 2008. Hazard ratios and 95% confidence intervals were estimated using proportional hazards regression adjusting for clinical and demographic factors. RESULTS In total, 1257 women had breast cancer screening abnormalities (n = 655) or cervical cancer screening abnormalities (n = 602) identified, and 56% were nonwhite. Language concordance was associated with timelier resolution for all patients in the cervical cancer screening abnormalities group during the first 90 days (adjusted hazard ratio, 1.46; 95% confidence interval, 1.18-1.80), and specifically for Spanish speakers during the first 90 days (adjusted hazard ratio, 1.43; 95% confidence interval, 1.10-1.84), but no difference was observed after 90 days for women who had cervical cancer screening abnormalities or at any time for those who had breast cancer screening abnormalities. Race concordance was associated with significant decreases in the time to diagnosis for minority women with breast and cervical cancer screening abnormalities in analyses stratified by race, but no differences were observed in analyses that included all women. CONCLUSIONS Patient navigator race and language concordance improved the timeliness of care in a minority population. Patient navigators who are racially/ethnically diverse and multilingual may help address barriers to care and improve cancer outcomes for low-income minorities. Cancer 2015;121:1477–1483. © 2015 American Cancer Society.

Background While racial disparity in colorectal cancer survival have previously been studied, whether this disparity exists in patients with metastatic colorectal cancer receiving care at safety net hospitals (and therefore of similar socioeconomic status) is poorly understood. Methods We examined racial differences in survival in a cohort of patients with stage IV colorectal cancer treated at the largest safety net hospital in the New England region, which serves a population with a majority (65%) of non-Caucasian patients. Data was extracted from the hospital’s electronic medical record. Survival differences among different racial and ethnic groups were examined graphically using Kaplan-Meier analysis. A univariate cox proportional hazards model and a multivariable adjusted model were generated. Results Black patients had significantly lower overall survival compared to White patients, with median overall survival of 1.9 years and 2.5 years respectively. In a multivariate analysis, Black race posed a significant hazard (HR 1.70, CI 1.01–2.90, p = 0.0467) for death. Though response to therapy emerged as a strong predictor of survival (HR = 0.4, CI = 0.2-0.7, p = 0.0021), it was comparable between Blacks and Whites. Conclusions Despite presumed equal access to healthcare and socioeconomic status within a safety-net hospital system, our results reinforce findings from previous studies showing lower colorectal cancer survival in Black patients, and also point to the importance of investigating other factors such as genetic and pathologic differences.

MicroRNAs (miRNAs) have been shown to be reliable early biomarkers in a variety of cancers including that of lung. We ascertained whether the biomarker potential of miRNAs could be validated in microscopically normal and easily accessible buccal epithelial brushings from cigarette smokers as a consequence of lung cancer linked ‘field carcinogenesis’. We found that compared to neoplasia-free subjects, a panel of 68 miRNAs were upregulated and 3 downregulated in the normal appearing buccal mucosal cells collected from patients harboring lung cancer (n=76). The performance characteristics of selected miRNAs (with ≥1-fold change) were excellent with an average under the receiver operator characteristic curve (AUROC) of >0.80. Several miRNAs also displayed gender specificity between the groups. These results provide the first proof-of-concept scenario in which minimally intrusive cheek brushings could provide an initial screening tool in a large at-risk population.

Although a number of studies have found an inverse association between body mass index (BMI) and risk of lung cancer, there is little information on this relation in African Americans, who experience a higher incidence of lung cancer.We assessed the relation of BMI to incidence of lung cancer in the Black Women's Health Study, an ongoing prospective follow-up of 59,000 women in the USA. Cox proportional hazard models were used to estimate hazard ratios for various levels of BMI relative to BMI 18.5-24.9 kg/m2 ("normal weight") with adjustment for age, education, pack-years of smoking, and other covariates. Two other anthropometric measures, waist circumference (WC) and waist/hip ratio (WHR), were also assessed. A total of 323 primary lung cancer cases were identified from 1995 to 2011.The hazard ratio (HR) for BMI ≥ 30 relative to BMI 18.5-24.9 was 0.69 (95% CI 0.51-0.92). As expected, cigarette smoking was strongly associated with increased risk of lung cancer. In analyses stratified by smoking status, the HR for BMI ≥ 30 relative to BMI 18.5-24.9 was 0.62 (0.38-1.00) among current smokers, 0.90 (0.56-1.42) among former smokers, and 0.83 (0.41-1.70) among never smokers (p for interaction = 0.28). Control for pack-years of smoking or age started smoking had little effect on the hazard ratios. WC and WHR were not materially associated with lung cancer risk.Our results indicate that high BMI is associated with a lower risk of lung cancer in African American women, particularly among current smokers.

Background: The evidence on the relation of family history of cancers other than breast cancer to breast cancer risk is conflicting, and most studies have not assessed specific breast cancer subtypes. Methods: We assessed the relation of first-degree family history of breast, prostate, lung, colorectal, ovarian, and cervical cancer and lymphoma or leukemia, to the risk of estrogen receptor–positive (ER+), ER−, and triple-negative breast cancer in data from the African American Breast Cancer Epidemiology and Risk Consortium. Multivariable logistic regression models were used to calculate ORs and 95% confidence intervals (CI). Results: There were 3,023 ER+ and 1,497 ER− breast cancer cases (including 696 triple-negative cases) and 17,420 controls. First-degree family history of breast cancer was associated with increased risk of each subtype: OR = 1.76 (95% CI, 1.57–1.97) for ER+, 1.67 (1.42–1.95) for ER−, and 1.72 (1.38–2.13) for triple-negative breast cancer. Family history of cervical cancer was associated with increased risk of ER− (OR = 2.39; 95% CI, 1.36–4.20), but not ER+ cancer. Family history of both breast and prostate cancer was associated with increased risk of ER+ (3.40; 2.42–4.79) and ER− (2.09; 1.21–3.63) cancer, but family history of both breast and lung cancer was associated only with ER− cancer (2.11; 1.29–3.46). Conclusions: A family history of cancers other than breast may influence the risk of breast cancer, and associations may differ by subtype. Impact: Greater surveillance and counseling for additional screening may be warranted for women with a family history of cancer. Cancer Epidemiol Biomarkers Prev; 25(2); 366–73. ©2015 AACR.

Introduction: Family history of breast cancer has been shown to be a strong risk factor for breast cancer in all populations studied. However, there are limited data related to risk of estrogen receptor negative (ER-) breast cancer in African American women, who have a disproportionately high incidence of ER- and triple negative (ER-, progesterone receptor negative, and HER2 receptor negative; TN) breast cancer. Even less information is available on whether a family history of other cancers also affects risk of ER- and TN breast cancer. Methods: Questionnaire data from the Black Women's Health Study, the Carolina Breast Cancer Study, the Multiethnic Cohort Study, and the Women's Circle of Health Study were pooled as part of the African American Breast Cancer Epidemiology and Risk (AMBER) Consortium. Breast cancer cases were classified as ER+, ER-, and TN based on pathology data from medical records and/or state cancer registries. Participants were asked about first degree relatives with a breast cancer diagnosis and the age at which the relative was diagnosed. Participants were also asked about first degree relatives with prostate, lung, colorectal, ovarian, or cervical cancer or with lymphoma or leukemia. Polytomous logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for various categories of positive family history relative to no first degree relative with breast cancer or no first degree relative with any of the cancers. Multivariable analyses controlled for age, study, time period, and other potential confounders. Results: The analysis included 3,023 African American women with ER+, 1,497 with ER-, and 696 with TN breast cancer and 17,420 controls. First degree family history of breast cancer, regardless of whether first degree relatives had cancers other than breast cancer, was associated with a 70% increased risk of ER+, ER- and TN breast cancer; the ORs were 1.7 (95% CI 1.6-2.0) for ER+, 1.7 (95% CI 1.4-1.9) for ER-, and 1.7 (95% CI 1.4-2.1) for TN breast cancer. The ORs were somewhat higher if the relative was diagnosed before age 50 (2.0 for ER+, 1.9 for ER-, and 1.8 for TN). Among the six other cancer sites examined, only family history of cervical cancer was significantly associated with risk; the ORs were 2.4 (1.4-4.2) for ER- and 2.9 (1.5-5.5) for TN breast cancer and there was no association with ER+ breast cancer. The OR for family history of ovarian cancer in relation to TN breast cancer was 1.6 (0.9-2.7), which is of interest because findings from The Cancer Genome Atlas (TCGA) indicate that serous ovarian cancers and basal-like breast cancers, which are mostly triple negative, have many molecular commonalities. The ORs for a family history of both breast and prostate cancer versus no family history of any of the cancers were 3.4 (2.4-4.7) for ER+ cancer, as compared with 1.6 for breast alone (p-interaction=0.01), and 2.1 (1.2-3.7) for ER- cancer, as compared with 1.5 for breast alone (p-interaction=0.08). The OR for a family history of both breast and lung cancer was 3.3 (1.9-5.9) for TN breast cancer, compared to 1.5 for breast alone (p-interaction=0.10). The ORs for family history of breast plus two other cancers were 2.4 (1.6-3.6) for ER+, 2.8 (1.6-4.7) for ER-, and 2.7 (1.3-5.7) for TN breast cancer. Conclusion: Our results confirm that having a first degree family history of breast cancer is a strong risk factor for ER+, ER-, and TN breast cancer. The findings also suggest that having relatives with other cancers in addition to a relative with breast cancer may further increase risk. Consideration of family history of other cancers may improve risk prediction models. The association observed for family history of cervical cancer and increased risk of ER- and TN breast cancer was unexpected and needs to be replicated by other studies. Citation Format: Traci N. Bethea, Lynn Rosenberg, Nelsy Castro-Webb, Kathryn L. Lunetta, Lara E. Sucheston, Edward A. Ruiz-Narvaez, Marjory Charlot, Song Y. Park, Elisa V. Bandera, Melissa A. Troester, Christine B. Ambrosone, Julie R. Palmer. Relation of family history of cancer to risk of ER+, ER-, and triple-negative breast cancer in African American women. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C49.

A number of studies have found that obesity, as measured by body mass index (BMI), is inversely related to lung cancer incidence among current and former smokers. The findings may be due to uncontrolled confounding by cigarette smoking, as smokers tend to be thinner on average than non-smokers and have a greatly increased risk of lung cancer. Recent results from the NIH-AARP Diet and Health Study, with a very large sample size, suggest that the observed association may be independent of smoking effects. The study also found the association to be stronger among women than men. Limited data are available on the relation of BMI to lung cancer incidence in African Americans. We assessed this question in the Black Women's Health Study, an ongoing prospective follow-up of 59,000 women from all regions of the U.S. Participants enrolled in the study by completing mailed questionnaires in 1995 and have been followed by biennial questionnaire since then. Self-reported weight and height at baseline were used to calculate BMI (weight in kilograms divided by height in meters2). Detailed information on cigarette smoking was ascertained on each questionnaire. Incident cases of lung cancer were ascertained by study questionnaire, cancer registry, or National Death Index. Pathology reports and/or cancer registry data were reviewed by a study oncologist to identify primary cancers. Cox proportional hazard models were used to estimate hazard ratios for the association of various levels of BMI relative to BMI 18.5-24.9 (“lean” women) in relation to lung cancer incidence. Multivariate models included adjustment for pack-years of cigarette smoking and current smoking status, as well as other variables. Among 331 incident primary lung cancer cases that occurred from 1995 to 2011, cigarette smoking, as measured by pack-years, cigarettes per day, or age started smoking, was strongly associated with increased risk of lung cancer, as expected. Baseline BMI was inversely associated with lung cancer risk: the hazard ratio for obese women (BMI ≥30) relative to lean women was 0.74 (95% confidence interval (CI) 0.55-0.99). In analyses stratified by smoking status, the HR for obese women relative to lean women was 0.60 (0.37-0.97) among current smokers, 0.88 (0.55-1.39) among former smokers, and 0.86 (95% CI 0.43-1.73) among never smokers. Of note, controlling for pack-years or age started smoking had little effect on the hazard ratios among current and former smokers. Our results suggest that obesity may be associated with a lower risk of lung cancer. These findings, from a study of African American women, confirm recent findings from the predominantly Caucasian NIH-AARP Study. Residual confounding by cigarette smoking did not appear to explain the association. Potential mechanisms will be discussed. Citation Format: Traci N. Bethea, Lynn Rosenberg, Marjory Charlot, Lucille L. Adams-Campbell, Julie R. Palmer. Body mass index in relation to incident lung cancer in African American women. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A57.

Abstract 4906 AL amyloidosis is characterized by widespread, progressive deposition of fibrillar amyloid protein derived from monoclonal immunoglobulin light chains, leading to organ failure and death. This disease is typically systemic, however, it can occur as a localized form. In localized amyloidosis, the deposits occur near the site of synthesis of the precursor protein and in some cases, plasma cells have been demonstrated histologically adjacent to the deposits. For unknown reasons, the tracheobronchial tree is the most common site for localized AL amyloidosis. Localized AL amyloidosis of the breast is a rare entity that has been described in the literature in isolated case reports. It can present as a palpable mass or as calcifications on routine screening mammography. We report here a case series of seven women (median age 63 years, range 46 to75) seen and evaluated at Boston University Medical Center from 1990-2008. We evaluated 1502 new patients with AL amyloidosis in this time period, making the incidence of localized AL amyloidosis of the breast to be 0.5% at a single referral center. All seven patients had abnormal screening mammography with calcifications, and biopsies that revealed Congo red positive amyloid deposits. Histologically, the amyloid deposits appeared as amorphous material in the stroma around the ducts and lobules in most patients; one patient had amyloid deposits in the ducts only, but not in the stroma. None of the patients had clinical or laboratory evidence of other organ involvement, all had negative Congo red staining of an abdominal fat pad aspirate, and all had a negative work up for a plasma cell dyscrasia or circulating paraprotein. The patients were treated with local excision of the regions of calcification or lumpectomy. Three out of seven patients underwent routine follow up within 6-12 months from the time of diagnosis with no evidence of disease recurrence or progression to systemic AL amyloidosis. One out of seven patients had bilateral and recurrent amyloidosis of the breasts and was found to have an associated stage I invasive ductal adenocarcinoma that was treated with lumpectomy and radiation. In summary, breast amyloidosis is rare, is not associated with a systemic plasma cell dyscrasia or amyloidosis in other organs, and can be treated surgically. Disclosures No relevant conflicts of interest to declare.

Introduction We investigated clinical and pathologic features of breast cancers (BC) in an unselected series of patients diagnosed in a tertiary care hospital serving a diverse population. We focused on triple-negative (Tneg) tumours (oestrogen receptor (ER), progesterone receptor (PR) and HER2 negative), which are associated with poor prognosis. Methods We identified female patients with invasive BC diagnosed between 1998 and 2006, with data available on tumor grade, stage, ER, PR and HER2 status, and patient age, body mass index (BMI) and self-identified racial/ethnic group. We determined associations between patient and tumour characteristics using contingency tables and multivariate logistic regression. Results 415 cases were identified. Patients were racially and ethnically diverse (born in 44 countries, 36% white, 43% black, 10% Hispanic and 11% other). 47% were obese (BMI > 30 kg/m2). 72% of tumours were ER+ and/or PR+, 20% were Tneg and 13% were HER2+. The odds of having a Tneg tumour were 3-fold higher (95% CI 1.6, 5.5; p = 0.0001) in black compared with white women. Tneg tumours were equally common in black women diagnosed before and after age 50 (31% vs 29%; p = NS), and who were obese and non-obese (29% vs 31%; p = NS). Considering all patients, as BMI increased, the proportion of Tneg tumours decreased (p = 0.08). Conclusions Black women of diverse background have 3-fold more Tneg tumours than non-black women, regardless of age and BMI. Other factors must determine tumour subtype. The higher prevalence of Tneg tumours in black women in all age and weight categories likely contributes to black women's unfavorable breast cancer prognosis.