Women of Latin American origin in the United States are more likely to be diagnosed with advanced breast cancer and have a higher risk of mortality than non-Hispanic White women. Studies in U.S. Latinas and Latin American women have reported a high incidence of HER2 positive (þ) tumors; however, the factors contributing to this observation are unknown. Genomewide genotype data for 1,312 patients from the Peruvian Genetics and Genomics of Breast Cancer Study (PEGEN-BC) were used to estimate genetic ancestry. We tested the association between HER2 status and genetic ancestry using logistic and multinomial logistic regression models. Findings were replicated in 616 samples from Mexico and Colombia. Average Indigenous American (IA) ancestry differed by subtype. In multivariate models, the odds of having an HER2 þ tumor increased by a factor of 1.20 with every 10% increase in IA ancestry proportion (95% CI, 1.07-1.35; P ¼ 0.001). The association between HER2 status and IA ancestry was independently replicated in samples from Mexico and Colombia. Results suggest that the high prevalence of HER2 þ tumors in Latinas could be due in part to the presence of population-specific genetic variant(s) affecting HER2 expression in breast cancer. Significance: The positive association between Indigenous American genetic ancestry and HER2 þ breast cancer suggests that the high incidence of HER2 þ subtypes in Latinas might be due to population and subtype-specific genetic risk variants.

Purpose Complementary and alternative medicine (CAM) use is common amongst cancer patients. However, there is growing concern about its safety and efficacy. Online crowdfunding campaigns represent a unique avenue to understand the cancer patient's perspective for using CAM or declining conventional cancer therapy (CCT). Methods Five hundred GoFundMe campaigns from 2012 to 2019 detailing financial need for cancer treatment were randomly selected and reviewed for endorsement of CAM use, reasons for using CAM, and reasons for declining CCT. Descriptive statistics were used to compare patient and campaign characteristics between 250 CAM users and 250 non-CAM users. Results Compared to non-CAM users, CAM users were more likely to be female (70% vs. 54%, p < 0.01), to report more stage IV cancer (54% vs. 12%, p < 0.01), and to have a history of delayed, missed, or misdiagnosis (10% vs. 4%, p < 0.01). Reasons for using CAM include endorsing curative/therapeutic effects 212 (85%), pain/stress reduction 137 (55%), and dissatisfaction with current or past medical treatment options 105 (42%). 87 (35%) CAM users that declined CCT reported that they wanted to try to fight off cancer using CAM first 57 (61%), that CCT was too "toxic" to the body 39 (42%), and cancer was already too advanced, so that CCT would be futile or too aggressive 25 (27%). Conclusion Cancer patients on GoFundMe using CAM highly value quality of life, comfort, and autonomy. Physicians should educate themselves on CAM to set realistic expectations and provide comprehensive counseling of the risks and benefits of CAM usage to patients who choose to use CAM to either augment or completely replace CCT.

Latina women in the U.S. have relatively low breast cancer incidence compared to Non-Latina White (NLW) or African American women but are more likely to be diagnosed with the more aggressive “triple negative” breast cancer (TNBC). Latinos in the U.S. are a heterogeneous group originating from different countries with different cultural and ancestral backgrounds. Little is known about the distribution of tumor subtypes in Latin American regions. Clinical records of 303 female Peruvian patients, from the Peruvian National Cancer Institute, were analyzed. Participants were diagnosed with invasive breast cancer between 2010 and 2015 and were identified as residing in either the Selva or Sierra region. We used Fisher’s exact test for proportions and multivariable Cox Proportional Hazards Models to compare overall survival between regions. Women from the Selva region were more likely to be diagnosed with TNBC than women from the Sierra region (31% vs. 14%, p = 0.01). In the unadjusted Cox model, the hazard of mortality was 1.7 times higher in women from the Selva than the Sierra (p = 0.025); this survival difference appeared to be largely explained by differences in the prevalence of TNBC. Our results suggest that the distribution of breast cancer subtypes differs between highly Indigenous American women from two regions of Peru. Disentangling the factors that contribute to this difference will add valuable information to better target prevention and treatment efforts in Peru and improve our understanding of TNBC among all women. This study demonstrates the need for larger datasets of Latin American patients to address differences between Latino subpopulations and optimize targeted prevention and treatment.

Objective To explore the relationship between frailty, age, and detrusor overactivity (DO) in older adults presenting to an academic urology practice. Materials and Methods This study uses the University of California, San Francisco Geriatric Urology Database to examine all adults ages ≥65 years who underwent urodynamic testing from December 2015 to April 2019. All subjects had a timed up and go test (TUGT) as a measure of frailty and were categorized as fast (≤10 seconds), intermediate (11‐14 seconds), or slow (≥15 seconds), corresponding to not frail, pre‐frail, and frail, respectively. Urodynamic studies were reviewed for the presence of DO. Univariate and multivariate logistic regression were used to examine the relationship between frailty, age, and the presence of DO. Results In total, 549 older adults underwent urodynamics during the study period, and 48.5% had a study that demonstrated DO. Individuals with DO tended to be older (18.4% vs 11.0% were ≥80 years; P = .01) and more frail (19.5% vs 13.4% with TUGT ≥5 seconds; P < .01). Multivariate regression demonstrated that DO was associated with both pre‐frail and frail TUGT times (adjusted odds ratio [aOR], 2.1; 95% confidence interval [CI], 1.3‐3.4; P < .01 for TUGT 11‐14 seconds, and aOR, 2.1; 95% CI, 1.1‐4.0; P = .02 for TUGT ≥15 seconds). Age was not found to be significantly associated with DO (P's > .05). Conclusions Frailty, not age, is associated with DO among older adults undergoing urodynamics. Further research on the role of frailty in the evaluation and management of older adults with DO is warranted to best serve the needs of this population.

Introduction Gender-affirming mastectomy (GAM) is the most commonly performed gender-affirming surgery. Unfortunately, many areas of sexual health for transmasculine people are understudied. In particular, there are few studies that assess how chest and nipple stimulation, or lack of sensation, affect the sexual health and satisfaction of trans patients after GAM. Objective This study aims to 1) assess the importance of chest and nipple stimulation for trans patients before any chest surgery, 2) evaluate how GAM affects patients’ sexual health postoperatively, and 3) investigate how chest and nipple sensation change after GAM. Methods This is a prospective study performed at one institution. All participants are patients recruited at their GAM consultation or follow-up appointment. Pre-operative and post-operative surveys were developed based on previous validated Patient Reported Quality of Life Survey with multiple rounds of editing by two gender affirming surgeons. Surveys were distributed through Qualtrics (Qualtrics XM, Seattle, Washington). Results Since July 2021, 144 unique surveys (45 unique pre-operative and 99 unique post-operative) have been completed. The three most common gender identities are man (43%), non-binary (25%), and transgender man (9%). Eighty-four to 89% of pre-operative patients reported being able to sense normal pressure, light touch, and temperature on their chests. Sixty-two percent of preoperative patients were not concerned about potential loss of nipple sensation after surgery. Compared to their sensation before top surgery, 43 – 65% of post-operative patients reported they had decreased sensation of normal pressure, light touch, and temperature on their chests and nipples. Regarding sexual satisfaction levels, 76% of pre-operative patients reported that nipple stimulation is sometimes, rarely, or never involved in their sexual activities. Seventy-six percent of preoperative patients also stated that nipple and chest stimulation is slightly important or not at all important to their sexual activity. Compared to their sexual health pre-operatively, 59% of post-operative patients reported that the importance of their nipple and chest stimulation stayed the same, is little less, or much less important to their sexual life after the operation. After surgery, 40% of patients thought their sexual satisfaction was much or a little better. Less than 1% of patients reported that their sexual satisfaction was much worse. One hundred percent of post-operative patients were satisfied having undergone GAM and agreed that top surgery had changed their life for the better. Conclusions Sexual health of patients undergoing GAM has rarely been studied before. This study shows that nipple stimulation for the majority of top surgery patients is not heavily involved in their sexual activities and may actually decrease after surgery. Although most patients report decreased sensation postoperatively, patients’ overall sexual satisfaction does not change and for some may even improve after surgery. GAM can immensely improve quality of life while preserving or even improving patients’ sexual health. Disclosure No