Background: Young-onset breast cancer is associated with higher mortality due to multiple factors including tumor biology and delayed presentation. Young women with breast cancer with longer treatment delays have decreased survival time, with the impact on survival being more prominent in Black women. The factors contributing to the racial survival disparity are complex and are likely an interplay between tumor biology, genomics, patterns of care and socioeconomic factors. This study looked at socioeconomic and clinical factors that may affect timely access to care for breast cancer in young Black women, and thus impact survival. Methods: Data from the Black Women Etiology and Survival of Triple-negative Breast Cancers (BEST) Study, a population-based cohort of Black women diagnosed with breast cancer ≤ 50 years old between 2009 and 2015 from the Florida and Tennessee State Cancer Registries was used. The time to treatment (in days) was used as the exposure variable and defined as the time from breast cancer diagnosis to the date of first treatment. The primary outcome was determined by distant or local recurrence or death. Pearson chi-square test was conducted to assess the association between clinical and socioeconomic factors with time to treatment. The socioeconomic variables studied were insurance, income and education. Clinical factors evaluated were the stage of breast cancer at diagnosis, hormone subtype, neoadjuvant chemotherapy and type of surgery. Survival analysis and Cox proportional hazard model were performed to analyze the 10-year overall survival and recurrence rate while adjusting for income, breast cancer stage and hormone subtype. Results: There was a statistically significant association between time to treatment and hormone receptor subtype (p=0.04). More than 60% of women with triple-negative breast cancer (TNBC), and 57% of women with HER2+ breast cancer received treatment within a month of their breast cancer diagnosis. There was also a significant association between the time to treatment and type of surgery received (p=0.03). 64% of patients who had lumpectomies received treatment in ≤30 days, compared to 54% of patients who had a mastectomy. Survival analysis showed the highest mortality in patients with time to treatment >90 days, followed by patients who received treatment in ≤30 days. The study did not find a statistically significant association between insurance, income, or education on the timeliness of treatment for breast cancer. Conclusion: In our study of young Black women, delayed breast cancer treatment resulted in lower survival. While those with TNBC and HER2+ disease were more likely to receive treatment ≤30 days, i.e. neoadjuvant chemotherapy to assess response to chemotherapy and the amount of residual disease at the time of the surgery, the enrichment for aggressive disease is likely the reason for the low survival observed in this group. Timely access to treatment for breast cancer impacts survival and strategies to decrease treatment delays are crucial to reducing breast cancer mortality. Citation Format: Kikelola Oyeleye, Rebecca Lee, Sonya Reid, Tuya Pal, Anne Weidner, Lindsay Venton. Association between socioeconomic and clinical factors on timely access to care among young Black women with breast cancer [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 A070.

Cardiac amyloidosis remains a rare disease caused by the extracellular deposition of abnormal proteinsamyloids in the myocardium. These protein structures in the myocardium are associated with high morbidity and mortality, with prognosis hinging on early detection and treatment. Three main types of cardiac amyloidosis have been identified: light chain (AL), familial or senile (ATTR), and secondary amyloidosis which is associated with chronic inflammation. Cardiac amyloidosis classically presents as diastolic heart failure with symptoms of volume overload low voltage on electrocardiogram (ECG) and echocardiographic features of diastolic dysfunction and paradoxical left ventricular hypertrophy (paradoxical with respect to low voltage on ECG). Early suspicion should trigger additional laboratory and imaging workup to facilitate early detection. Early detection remains critical to prognosis. Herein, we present two patients admitted to a safety-net hospital within one month of each other with distinct presentations yet important, overlapping characteristics that led to the diagnosis of AL amyloidosis in both patients.

10553 Background: Hereditary breast cancers (HBC) represent 5-10% of breast cancer, predominantly due to pathogenic/likely pathogenic (P/LP) variants in the BRCA1 and BRCA2 genes and other high (e.g., PALB2) and moderate (e.g., ATM and CHEK2) penetrance genes. There remains a paucity of data evaluating the role of germline-somatic interactions and possible confounders on breast cancer outcomes. Furthermore, current knowledge about HBC is predominantly defined in the context of European ancestry. We sought to characterize differences in clinicopathological features and somatic mutations across P/LP variants in a racially diverse HBC cohort. Methods: Among females with breast cancer and a confirmed P/LP variant in BRCA1, BRCA2, PALB2, CHEK2, and/or ATM currently enrolled through existing Vanderbilt-based studies (ICARE: Inherited Cancer Registry and BEST: Black Women: Etiology and Survival of Triple Negative Breast Cancers (TNBC)), we abstracted data from medical records and performed tumor sequencing using the Tempus xT assay (a 596-gene DNA next-generation sequencing panel and whole-transcriptome RNA sequencing). Interim differences in clinicopathological features were analyzed using Pearson’s chi-square test and the frequency of somatic mutations reported by gene. Results: To date, we have data from 91 females with breast cancer (77% White and 23% Black) and a P/LP variant (36 BRCA1, 27 BRCA2, 13 PALB2, 11 CHEK2 and 4 ATM). The median age at diagnosis was 44 (38-50), 85% had localized breast cancer (Stage I-II), and 69% had Grade 3 tumors. Significantly more Black participants were BRCA1 carriers (p = 0.008), with no significant racial differences observed in other genes. There were significant differences in IHC subtype by gene (p < 0.001); with higher frequency of TNBC in BRCA1 carriers (64%) whereas BRCA2, PALB2, CHEK2, and ATM carriers were more likely to have HR+, HER2- breast cancer (67%, 54%, 73%, 75%, respectively). Of the 85% who received chemotherapy, significantly higher rates were observed in BRCA1 carriers (p = 0.02). Most participants opted to proceed with a risk reducing mastectomy (69%) with no difference across genes (p = 0.91). Higher rates of somatic TP53 mutations were observed among BRCA1, BRCA2, PALB2 carriers (89%, 56%, 46%) but not as frequent among ATM (25%) and CHEK2 (9%) carriers. Conclusions: These preliminary results show that among a diverse cohort of females with HBC, BRCA1 mutations were overrepresented among Black females and those with TNBC. BRCA1, BRCA2, and PALB2 carriers had a higher prevalence of somatic TP53 mutations, which are typically associated with more aggressive tumor biology and worse survival outcomes. Current efforts underway include full genomic and transcriptomic analysis, through which we will be able to improve our understanding of breast cancer clinicopathological characteristics and survival outcomes among a diverse cohort of females with HBC.