Evaluation of multiple community-based approaches to improve Latinas’ breast cancer (BC) screening utilization has resulted in inconsistent findings. Factors contributing to this variation include heterogeneity in approaches (e.g., types of conceptual frameworks) and study quality (e.g., lack of measurement of spillover effects). This pilot study sought to clarify which approach may be most effective by evaluating the relative efficacy of two conceptual approaches using an area-level design with 145 Latinas nonadherent to U.S. Preventive Services Taskforce (USPSTF) BC screening guidelines. Each study arm included identical intervention format and duration (e.g., three group-based sessions, logistic assistance (LA) via five monthly calls and referral to free/low-cost screening programs). However, study content differed. While educate+LA addressed participants’ BC prevention and screening behavior, empower+LA addressed participants’ and their social networks’ BC screening. After adjusting for age, insurance status, and baseline mammography intention, when compared with educate+LA participants, empower+LA participants were more likely to report obtaining mammograms, engaging more individuals about BC, initiating BC conversations in public settings, and discussing mammography specifically. Our study has important implications regarding the utility of evaluating behavioral interventions overall in terms of behavioral and spillover network effects.

No abstract

Background: A breast cancer diagnosis is a stressful life event that can reduce quality of life and put a patient at increased risk for additional health problems and may also affect survivorship more generally. Greater levels of psychosocial stress (PSS) have been reported among non-Latina (nL) Black and Latina women when compared to nL White patients, and the absence of adequate social support among cancer patients has been associated with greater psychosocial stress. The goal of these analyses was to examine whether there existed a racial/ethnic disparity in three validated measures of psychosocial stress and how racial disparities are explained by distal mechanisms (i.e., SES) and proximal mechanisms (i.e., unmet social support needs) among recently diagnosed urban breast cancer patients in the Breast Cancer Care in Chicago (BCCC) study (2005-2008). Methods: The BCCC was a cross-sectional study of 989 recently diagnosed breast cancer patients, including 397 non-Latina White (white), 411 non-Latina Black (black), and 181 Latina patients diagnosed with a first primary breast cancer (in situ or invasive) aged 30-79. Income, education and tract level disadvantage and affluence were summed to create a standardized socioeconomic status (SES) score. Low SES was defined as less than one standard deviation below the sample mean. Three measures of PSS were defined based on the Cohen perceived stress subscale (inter-item reliability or alpha = 0.74), UCLA felt loneliness scale (alpha=0.79), and the Cockburn psychological consequences scale (alpha=0.93). High PSS was defined as >1 standard deviation above the mean for each. Unmet emotional, spiritual, informational, financial, and practical support were based on questions regarding support needed and received. We conducted structural equations models in M-Plus in order to disentangle the separate mediating roles of SES and unmet social support needs on disparities in PSS. Results: Black and Latina patients reported greater levels of loneliness (32% vs. 23% vs. 16%, p<0.001), stress (23% and 21% vs. 12%, p=0.001) and psychological consequences (24% and 23% vs. 12%, p<0.001) compared to white patients. Black and Latina patients also reported greater levels of unmet emotional, informational, financial and practical need (p=0.001 for all). In mediation models, all of the disparity in the three PSS outcomes could be explained by SES, with a substantial portion of the mediating influence of SES being further transmitted by unmet financial and practical support needs. Neither tumor nor treatment characteristics appeared to mediate the disparity in PSS. Conclusions: A substantial disparity in distress among breast cancer patients exists and underlying inequities in SES appear to be a “root” cause of the PSS disparity, as opposed to being driven by tumor and treatment differences. Results suggest that providing equitable financial (e.g., health insurance coverage) and practical (e.g., navigation) resources could narrow the racial/ethnic gap in PSS. This abstract is also being presented as Poster C094. Citation Format: Carola T. Sánchez Díaz, Garth H. Rauscher, Yamile Molina. The mediating role of unmet social support needs on the racial/ethnic disparity in psychosocial stress among breast cancer patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR17.

Background: Previous studies have established a strong association of higher body mass index (BMI) with increased risk of postmenopausal breast cancer (BC) but with decreased risk for premenopausal BC. Additionally, a handful of studies have found higher BMI at diagnosis to be associated with increased mortality for both ER positive and negative BC subtypes, but associations have been inconsistent. We re-examined associations of BMI with tumor subtypes and BC-specific death, and whether the disproportionate prevalence of obesity in non-Hispanic (nH) black women mediated racial disparities in survival. Methods: We included 6884 breast cancer cases from the MCBCR from 2001-2014. Continuous BMI was categorized as under/normal weight (10<bmi<bmi<bmi35). We ran age and race adjusted logistic regression models for associations of BMI as a nominal categorical variable with ER subtype overall and by menopausal status. We then modeled the hazard of BC death in Cox proportional hazard regression against race/ethnicity (nH Black versus nH White) while adjusting for age at diagnosis, before and after including BMI in our models. Survival analysis models were stratified on menopausal status and ER subtype. All analyses were conducted using STATA, v.15 (Stata Corp LLC, College Station, Texas). Results: nH Black women were less likely to be normal weight (8% vs. 15%) and more likely to be overweight (17% vs. 11%) compared to nH Whites, but there was no disparity in morbid obesity in this sample (50% vs. 50%). Higher BMI was not associated with prevalence of ER subtypes. Morbid obesity was associated with BC-specific death for both pre-menopausal (HR=3.55, 95% CI: 1.62, 7.79) and postmenopausal women (HR=2.02, 95% CI: 1.30, 3.17) and for both ER positive (HR=2.58, 95%CI: 1.55, 4.31) and negative tumor subtypes (HR=0.73, 95%CI: 0.93, 3.23). There was no evidence that BMI mediated BC survival disparities in any of the strata defined by menopausal status or ER subtype. However, the association of morbid obesity with BC death was much stronger for nH White (HR=3.81, 95%CI: 2.67, 5.44) than nH Black patients (HR=1.51, 95%CI: 0.98, 2.33). Among ER positive BC patients, the association of morbid obesity with BC death was even stronger for nH White patients (HR=4.54, 95%CI: 2.81, 7.32) but disappeared among nH Black patients (HR=1.10, 95%CI: 0.63, 1.93). Conclusions: In this clinical population, morbid obesity (defined here as a BMI>35) is very prevalent (50%) and it has negative implications for survival from a BC diagnosis regardless of menopausal status or subtype. Contrary to our expectation, the association of morbid obesity with BC death was considerably larger for nH White than for nH Black patients. Patients who are morbidly obese should be targeted for more detailed follow-up to improve our understanding of the mechanisms involved in the role of morbid obesity in BC death and how these mechanisms may differ for by race. </bmi Citation Format: Carola T Sánchez Díaz, Garth H Rauscher. Racial/ethnic disparities in breast cancer survival by subtypes: The role of obesity [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 C078.

Background: Hispanics are the second largest and fastest growing ethnic minority population in the United States (US). Hispanic women experience worse breast cancer (BC) outcomes when compared to non-Hispanic Whites. In the United States, obesity and breast density are established risk factors for BC in general and for Hispanic women specifically. We sought to evaluate associations of residential disadvantage and Hispanicity with two established BC risk factors (obesity and breast density) among Hispanic women in Metro Chicago. Methods: We included 13,816 Hispanic women from the Metro Chicago Breast Cancer Registry. Obesity was defined as body mass index, categorized as: normal weight (18.5–24.9kg/m2), overweight (25–29.9 kg/m2), obese (>=30–24.9kg/m2), and morbidly obese (>= 35kg/m2). Breast density was reported by the interpreting radiologist at mammography using the BIRADS categories which were dichotomized for this analysis as dense (heterogeneously or extremely dense) vs. not dense (fatty or scattered fibroglandular). Characteristics of residential census tracts at diagnosis were obtained from the 2010 U.S. Census. Hispanicity was defined using: percent Hispanic, percent foreign-born and percent Hispanics that speak English not well and not at all. Each variable was standardized and summed to create a score (inter-item reliability=0.76), which was dichotomized at the median for some analyses. Two established tract level measures of neighborhood socioeconomic status were defined. Neighborhood disadvantage was an equally weighted sum of the proportions of families with incomes below the poverty line, families receiving public assistance, persons unemployed, and female-headed households with children. Neighborhood affluence was an equally weighted sum of the proportions of families with income of $75,000 or more, adults with college education or more, and civilian labor force employed in professional and managerial occupations score. Results: Overall, 36%, 26% and 18% of women were overweight, obese and morbidly obese, respectively, and roughly 50% had dense breasts. Women living in high hispanicity neighborhoods tended to live in more disadvantaged neighborhoods, to lack private health insurance, and to be obese (p> 0.0001 for all). Hispanicity was not associated with breast density. After adjusting by age, parity, age, health insurance, age at first birth, parity, menopause, age at menarche, we observed that greater hispanicity was associated with increased prevalence of overweight and obesity, but the association of Hispanicity with obesity was largely explained by the addition of tract disadvantage into the model. Conclusions: Our results are consistent with previous cross-sectional studies and further suggest that neighborhood disadvantage accounts for most of the association of hispanicity with being overweight. Future studies could link residential histories to evaluate the role of cumulative, longer-term residence in high Hispanicity areas on these risk factors. Citation Format: Carola T. Sanchez Diaz, Garth H. Rauscher. Associations of residential disadvantage and Hispanicity with important breast cancer risk factors among Hispanic women in Chicago [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-170.