Background: Despite advances in breast cancer imaging, research and treatment, higher mortality among racial/ethnic minority and low-income populations persists. Consent and enrollment of diverse and vulnerable patients into breast cancer research is critical. Given this urgent need for diversity in breast cancer research, successful collection and banking of fresh biospecimens from diverse patients is key to ameliorating some of the cancer disparities. Given our access to a unique and vulnerable patient population, we developed and implemented a clinical information and biospecimen repository for patients evaluated in the breast radiology and breast oncology outpatient clinics at Boston Medical Center (BMC). Our goal was to consent patients for donation of percutaneous breast biopsy samples, surgical tissue, and blood to develop a breast cancer biospecimen bank. Our long-term goal is to provide high-yield human samples for translational research studies in breast cancer from a diverse and vulnerable patient population. Methods: We designed a multi-disciplinary team of clinical providers and basic science researchers to envision a breast cancer biospecimen bank for research. Key stakeholders were identified, workflow was arranged, IRB obtained, and research staff trained. Patients presenting with suspicious mass on breast imaging (BI-RADS 4C and 5 categories) were eligible to enroll. Two percutaneous biopsy cores were obtained for research at the time of ultrasound guided biopsy. We leveraged the Hematology Oncology translational research program at Boston Medical Center and pilot finding to launch the project. Results: Since initiation in April 2021, we approached 68 patients and consented 44, for a successful consent rate of 64.7%. Of the 44 patients consented, 22 (50.0%) identified themselves as Black/African American, 11 (25.0%) as White/Caucasian, 10 (22.73%) as Hispanic and 1 (2.27%) as Asian. Of all patients enrolled, 41 (93.2%) had a breast malignancy, of which 27 (70.7%) were hormone-sensitive and 7 (17.1%) were TNBC. Additionally, of the 44 patients on study, only 9 (20.4%) had commercial insurance or managed care plan on the day of the consent. In total, 84 percutaneous biopsy cores were collected from 42 patients. Corresponding surgical tissue, plasma, serum and PBMCs were also obtained. Conclusion: Our program demonstrates that the enrollment of diverse and vulnerable breast cancer patients onto cancer research is achievable. We successfully created a breast biopsy program to provide access to diverse human samples for breast cancer translational research studies. Currently this repository serves to address many ongoing translational projects to understand: 1) the gap in knowledge of inherent differences in tumor biology and tumor environment, 2) metabolic regulation in the breast cancer microenvironment, and 3) heterogeneity of tumors and its effects on clinical outcomes and microenvironment interactions. Citation Format: Adrian Ilinski, Kiana Mahdaviani, Michael Fishman, Michael Cassidy, Naomi Ko. Prospective breast biopsy collection at an urban safety-net hospital serving a diverse patient population [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 P2-26-01.

Background: Patients with recurrent patellar dislocations with trochlear dysplasia are commonly treated surgically with a tibial tubercle osteotomy (TTO). Recovery and rehabilitation processes are often nonoperative out of concern for fixation failure or fracture. A more accelerated rehabilitation protocol allowing for early weightbearing and quadriceps strengthening may help to improve patient outcomes as long as complications are not increased. Purpose: To evaluate the safety and effectiveness of an accelerated weightbearing and early strengthening postoperative rehabilitation program for patients who undergo TTO. Study Design: Case series; Level of evidence, 4. Methods: Included were patients who underwent unilateral/staged bilateral TTO performed by a single surgeon between August 2013 and February 2018 with ≥6 months of follow-up. The surgical indication was primarily for patients with recurrent patellar instability. In all cases, a diagnostic arthroscopy was performed to evaluate the cartilage surfaces and document patellar tracking. The TTO was performed using a freehand technique and two 3.5-mm fully threaded screws for fixation. Patients underwent an accelerated postoperative rehabilitation program that allowed for weightbearing and lower extremity strengthening starting at 4 weeks. Objective and subjective outcome measures included any postoperative complications, knee range of motion, and patient-reported outcome scores (Kujala Anterior Knee Pain Scale [AKPS] and Knee injury and Osteoarthritis Outcome Score composite [(KOOS5]). Results: A total of 51 knees in 50 patients (38 female, 12 male) with a mean age of 31.24 ± 12.57 years were included in the final analysis. Compared with preoperative values, postoperative maximum knee flexion was significantly improved (117.67° ± 32.65° vs 131.12° ± 9.02°, respectively; P = .022). Postoperative complications included 6 patients with arthrofibrosis requiring manipulation under anesthesia, 4 with removal of symptomatic hardware, 1 tibial fracture (due to a fall), and 1 conversion to patellofemoral arthroplasty. The mean postoperative AKPS and KOOS5 scores were 72.98 ± 21.51 and 75.05 ± 16.02, respectively. Conclusion: Accelerated postoperative rehabilitation in TTO patients was an effective means of treatment with good subjective and objective outcomes and complication rates lower than traditional rehabilitation protocols.

Cancer disparities arise from structural racism in the United States, which affects overall standard of living due to unequal access to crucial resources. Barriers in access to clinical care among under-served populations in combination with a vast underrepresentation at a scientific research level further perpetuate inequalities in cancer treatment. Specifically, Black women in the US are approximately twice as likely as Caucasian women to die of Triple-Negative Breast Cancer (TNBC), a particularly aggressive breast cancer subset, lacking expression of estrogen receptors, progesterone receptors, and human epidermal growth factor receptor-2. Our previous work and that of others has shown racial differences in TNBC tumor biology, with preference of basal-like subtypes in African American (AA) women. Herein, we present the Women’s Health Initiative for Triple-Negative Breast Cancer Equity (WHITNEY) study, a first of its kind, coordinated effort between Massachusetts General Hospital, and Boston Medical Center, the largest safety-net hospital in New England. The WHITNEY study seeks to understand factors contributing to biological differences and outcome of TNBC diagnoses in AA women. Response to neoadjuvant chemotherapy (NACT) response is a strong predictor of TNBC outcomes and failure to achieve a pathological complete response (pCR) in the breast following NACT is associated with a high probability of metastatic relapse. As Black women with TNBC have lower pCR rates, WHITNEY has collected pre-treatment biopsies from AA and other TNBC patients undergoing NACT to understand actionable insights into the biological differences in TNBC. Our prior published work has suggested that intratumoral heterogeneity is greater in TNBCs among AA patients than others, and that epigenetic silencing of key tumor suppressors is selectively increased in these TNBCs. Core needle baseline biopsies were obtained from consented patients diagnosed with TNBC at either MGH or BMC. We utilized single-cell RNA sequencing, spatial transcriptomics, genomic and epigenetic profiling to characterize minor cell subpopulations that drive poor outcomes among African American TNBC patients. Here, we outline our preliminary tissue collection, processing and analysis methods used in the WHITNEY study to better understand the biology of TNBC in African American women. Citation Format: Malalage N. Peiris, Emma Kelly, Christina Ennis, Kiana Mahdaviani, Aylin Dedeoglu, Adrian Ilinski, Esther Rheinbay, Ruben Dries, Naomi Ko, Leif Ellisen. Unraveling the biology of TNBC in African American women through the WHITNEY study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C051.

Background: Racial and ethnic minorities are underrepresented in cancer biospecimen research. Advancements in precision medicine without inclusion of minority groups is likely to exacerbate disparities in cancer care and treatment outcomes. There is a paucity of literature comparing enrollment into cancer biobanks by race, and little is known about specific reasons why patients decline participation. Methods: Between January and December 2021, eligible participants for biospecimen research studies were surveyed for reasons for consenting to or declining participation. Consent rates for participation were compared by gender, race, and age. Open responses were reviewed for themes. Results: Survey responses from 67 participants were analyzed. Twenty-four participants (35.8%) self-identified as White and 43 (64.2%) as non-White. Forty-five (67.2%) respondents reported agreeing to biospecimen research while 21 (31.3%) reported declining. White participants reported significantly higher participation rates compared to non-White participants (87.5% vs. 55.8%, p = 0.012). The majority of respondents (65.7%) reported learning about biospecimen research studies from a research assistant, and 12 participants (18%) reported that a provider recommended participation. Reasons for declining included “going through a lot”, “I do not want to make additional visits for the study” and “my doctor did not recommend it.” Discussion: Our findings suggest that most patients will consent to biospecimen research, however racial minorities are more likely to decline. Qualitative responses suggest that increased provider engagement and use of low-literacy and bilingual education materials may improve participation. Citation Format: Tina Y. Zhang, Anne K. Buck, David Li, Adrian Ilinski, Nina Modanlo, Kiana Mahdaviani, Naomi Y. Ko. A mixed methods study of racial ethnic minority enrollment in biospecimen research [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B093.