Citations

Abstract Background: Genomic testing is a cornerstone of precision oncology, yet certain communities remain underrepresented in its uptake. Limited genetic literacy, medical mistrust, and access barriers persist, particularly among populations at higher risk for prostate cancer. Community-driven approaches are urgently needed to promote equitable engagement in precision cancer care. Methods: To explore community perspectives and inform intervention development, a 31-member Community Advisory Board (CAB) was convened cross Duval County (FL), Maricopa County (AZ), and Olmsted County (MN). CAB members, representing racially, ethnically, and geographically diverse stakeholders, participated in small-group discussions (n=5) using a mixed-methods framework. Qualitative and quantitative data were collected to assess knowledge, perceptions, and barriers to genetic testing for prostate cancer. Results: Three overarching themes emerged: (1) limited awareness of the existence and purpose of genetic testing for prostate cancer; (2) the need for culturally tailored messages and trusted community messengers to raise awareness; and (3) persistent structural and informational barriers to accessing care. Participants emphasized the role of non-clinical, community-trusted individuals in delivering messages that resonate and build trust within their communities. Conclusions: Findings highlight the critical importance of community-engaged, culturally responsive strategies to advance genomic literacy and reduce disparities in prostate cancer care. This formative work will directly inform the design of a targeted, community-based educational intervention to improve equitable access to genomic testing among underserved populations. Funding: This work was supported by National Cancer Institute Grant 1K01CA23019301 Citation Format: Ewan K. Cobran, Jocelyn Turner, Laureen Husband. Advancing equitable access to prostate cancer genomic testing through community-informed and culturally tailored strategies [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B059.

Abstract A blood-based multi-cancer early detection (MCED) test has demonstrated feasibility as a screening tool in large-scale clinical trials. The PATHFINDER 2 (PF2) study (NCT05155605) evaluates safety and performance of the MCED test in a diverse intended-use population. To gauge generalizability of study results, we assessed participant (ppt) baseline characteristics vs general US population data from the National Health and Nutrition Examination Survey (NHANES). PF2, a prospective, multicenter, interventional study, enrolled ppts aged ≥50 y from diverse clinical settings in North America. Enrollment targets for sex and race/ethnicity were established from the 2019 American Community Survey (US Census Bureau). Recruitment strategies were implemented to maximize enrollment for groups historically underrepresented in clinical studies. Exclusion criteria included clinical suspicion of cancer or cancer diagnosis/treatment within 3 y. Data on baseline characteristics and key cancer risk factors were collected at enrollment. We compared the PF2 study population to a nationally representative sample of US adults aged ≥50 y from 2017-2020 NHANES data. NHANES data were weighted using complex, multistage probability sampling to generate a nationally representative sample. There were 35,878 ppts enrolled in PF2; 35,307 clinically eligible and evaluable ppts were included in this analysis. Mean age was 64 y for both PF2 and NHANES; 56.2% were females in PF2 vs 53.6% (95% CI 52.0-55.3%) in NHANES. Race/ethnicity distribution for PF2 vs NHANES was 7.4 vs 11.0% (8.9-13.1%) Hispanic, 74.6 vs 69.7% (65.0-74.5%) non-Hispanic (NH) White, 8.6 vs 10.3% (7.6-13.1%) NH Black, and 5.8 vs 5.1% (3.5-6.8%) NH Asian. In terms of lifestyle characteristics for PF2 vs NHANES, 58.9 vs 29.2% (25.8-32.7%) had at least a bachelor’s degree, 74.8 vs 63.8% (60.6-67.0%) were married/living with a partner, 69.3 vs 53.8% (50.9-56.7%) had never smoked, 66.5 vs 70.4% (68.0-72.8%) were overweight/obese, and 24.2 vs 28.4% (26.4-30.3%) reported never using alcohol. PF2 enrolled a diverse ppt population that is reasonably reflective of the demographics of the US population aged ≥50 y. As is typical for clinical trials, a higher percentage of PF2 vs NHANES ppts reported lifestyle characteristics associated with better health. As the study population largely reflects the MCED test intended-use population, safety and performance results from PF2 are expected to reflect real-world clinical experience. Citation Format: Shirish Gadgeel, Nima Nabavizadeh, Dax Kurbegov, Charles McDonnell, III, James W. Lillard, Jr., Marc Matrana, Alan Roth, Andrea Johnston, Sami Tahhan, Rami Owera, Matthew Margolis, Anuraag Kansal, Margarita Lopatin, Margaret McCusker, Karthik V. Giridhar. Baseline participant characteristics from PATHFINDER 2, a prospective interventional study of a multi-cancer early detection test in a population setting [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C145.

Abstract Background: Black women continue to face disproportionate mortality and long-term challenges after breast cancer treatment, including gaps in follow-up care, culturally relevant support, and access to survivorship resources. Digital tools designed with Black survivors in mind remain limited, despite their potential to reduce disparities in post-treatment engagement. Objective: To address these gaps, we developed HERCaRE (Health Equity Resources for Breast Cancer Responsive Education), a progressive web application (PWA) designed to deliver culturally responsive survivorship education and engagement tools to Black breast cancer survivors. HERCaRE was designed to meet the need for a culturally responsive, easily accessible resource that empowers survivors to engage more confidently in their post-treatment care. Methods: The concept for HERCaRE was informed by a previous pilot study on virtual breast health education, in which participants expressed the need for more sustained and accessible support for survivors. Building on that insight, the platform was developed with advisory input from Black breast cancer survivors and community advocates through informal, discussion-based feedback. While not a formal co-design process, this input helped ensure cultural relevance in tone, structure, and visual language. HERCaRE includes three core features: educational modules on key survivorship topics, interactive behavior-prompting activities, and a notes section for self-reflection and goal tracking. The platform is grounded in the Health Promotion Model and RE-AIM framework, providing a foundation for future implementation and evaluation. The platform is currently being prepared for pilot testing, which will assess usability, perceived relevance, and engagement frequency among Black breast cancer survivors. Mixed-method surveys and platform analytics will guide refinement ahead of broader implementation. Preliminary Insights: Early input emphasized the importance of affirming, plain-language content and simple navigation. Activities were designed to promote exploration of the educational material and personal health behaviors through simple, self-guided prompts. Current efforts are focused on content finalization, participant recruitment, and platform readiness for testing. Conclusion: HERCaRE offers a responsive, theory-informed approach to digital survivorship support for Black women. While still in the pre-implementation phase, its development reflects a commitment to accessible design, cultural alignment, and future scalability. The platform lays important groundwork for reducing disparities in survivorship care and expanding digital health tools that center the needs of historically underserved populations. HERCaRE’s modular design and emphasis on user experience position it for adaptation across diverse clinical and community settings, including integration into survivorship programs serving other medically underserved populations. Citation Format: Manisha Salinas, Timethia Bonner, Laura Pacheco-Spann, Oluwadamilola Oladeru, Dianne Townsend, Che Ngufor. A culturally tailored digital health platform to improve breast cancer survivorship for Black women: HERCaRE [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B048.

Abstract Multiple Myeloma (MM) is an incurable plasma cell malignancy that progresses from the precursor condition monoclonal gammopathy of undetermined significance (MGUS). African Americans (AA) have the highest incidence of MGUS and MM of any population group in the U.S., with ∼1.5-2-fold higher age-adjusted incidence than European Americans (EA) for reasons that remain unclear. Despite the increased incidence, MM tumors in AA patients show fewer TP53 deletions/mutations and high-risk cytogenetic features compared to EA patients. Studies also show that, with equal access to care, AA patients have better overall survival (OS) independent of age. Given recent studies demonstrating accelerated biological aging in AA individuals, we hypothesize that immunosenescence that occurs with aging reduces the immune pressure on MM cells, resulting in the increased emergence of less aggressive tumors. To test this, we utilized viably frozen bone marrow samples from the Mayo Clinic Myeloma Biobank. We profiled samples from 128 individuals (N= 53 and 75 AA vs. EA, respectively) with either newly diagnosed MM (NDMM) or treated MM (N= 27 and 38 AA vs. EA, respectively), MGUS (N=18 and 23 AA vs. EA, respectively), or healthy controls (N= 8 and 14 AA vs. EA, respectively) by mass cytometry (CyTOF) (N= 17 MGUS, 55 MM and 22 healthy controls) using the CyTOF Human Immune Profile Assay or by single cell RNA-sequencing (scRNA-seq, N= 24 MGUS/SMM and 10 MM). Profiling of the CD45+ non-tumor lymphocytes by scRNA-seq revealed AA patients exhibited increased T cell populations (odds ratio (OR)=2.3), including a reduction in CD8+ effector memory (OR=0.94) and an increase in CD8+ cytotoxic effector (OR=1.02) in a multivariate model adjusting for age and sex. Analysis by CyTOF confirmed an increase in overall CD3+ T cells (49.5% vs. 35.3%, p=0.0001) including increases in CD8+ terminal effector (9.5% vs. 5.2%, p=0.021) and CD4+ terminal effector T cells (5.5% vs. 2.7%, p=5.7x10^-6) among AA patients, and this difference remained after adjusting for age and sex. Within the CD8+ terminal effector T cells, we also noted increases in CD57+/CD28- senescent T cells, consistent with immune exhaustion that occurs with biological aging. We are currently working to assess whether AA patients with MGUS and MM exhibit accelerated biological aging as measured by frailty index, peripheral senescence associated secretory phenotypes, and PBMC epigenetic clock scores. We plan to extend our analysis of the immune microenvironment to assess patient T cell function ex vivo. Finally, we will evaluate whether MM cells from AA patients exhibit increased sensitivity to control cytotoxic T cell induced cell death in vitro compared to cells from EA patients. The results from this study will allow further understanding of components causing the increased risk for MM development seen in AA individuals. Citation Format: Alani Perkin, Megan Moore Weivoda, Linda Baughn. Immunosenescence driven T-cell remodeling may underlie increased risk of Multiple Myeloma in African Americans [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A051.

Abstract Introduction: Understanding how communities access and engage with health information is essential for effective health communication. Health literacy—the ability to read, understand, and use healthcare information—plays a crucial role in making informed health decisions. With the rise of digital technologies, internet access and online engagement have become key tools for obtaining health information. However, variations in health literacy and digital engagement can limit some populations' ability to fully access these resources. This study examined health literacy, cancer information-seeking behaviors, internet access, and digital engagement among adults in the Mayo Clinic Comprehensive Cancer Center catchment areas to inform more effective and region-specific health communication strategies. Methods: This study focused on adult residents within the Mayo Clinic Comprehensive Cancer Center catchment areas, covering 75 counties across Arizona, Florida, and the Midwest (Minnesota, Wisconsin, and Iowa). Data were collected through partnerships with the University of Florida and Mayo Clinic Survey Research Centers, and the "Boots on the Ground" approach involving community health workers. Methods included phone calls, online submissions, and community outreach for an anonymous survey. Validated measures assessed health literacy, information access, and digital engagement. Descriptive analyses were performed using valid responses, excluding non-responses and "Prefer not to answer" options to ensure interpretive accuracy. Results: Data from 2,681 respondents highlighted consistent barriers to cancer prevention with regional differences. In Arizona, 42.6% of respondents need help reading medical materials, but only 3.1% reported lacking confidence in obtaining cancer-related information. In contrast, 63.1% felt very or completely confident in accessing cancer advice. The primary sources of health information were doctors (17.6%), internet searches (11.4%), and family (9.8%). In Florida, 38.4% need assistance, but only 2.7% lack confidence, and 68.2% feel very or completely confident. Doctors (18%) and internet searches (13.1%) were top sources. In the Midwest, 38.5% struggle with medical documents, and 3.1% reported lacking confidence, while 66.4% felt very or completely confident. Internet access is widespread across all regions, with smartphones being the dominant device. Daily internet use for communication, browsing, and engagement with health apps and social networks remains high. Conclusion: Although many respondents face challenges with reading health-related materials, most report high confidence in obtaining cancer information, suggesting a gap between functional health literacy and perceived ability to access information. The widespread use of mobile devices and near-universal internet access offers a valuable opportunity to enhance health communication through digital tools. These findings emphasize the importance of tailored digital outreach to bridge literacy gaps and ensure underserved populations can access reliable health information. Citation Format: Tingyu Zou, Monica L. Albertie, Emelina Asto-Flores, Manisha Salinas, Farhia Omar, Adeline Abbenyi, Noreen Stephenson-Hubert, Nuwanthi Heendeniya, Kathleen Yost, Folakemi T. Odedina. Health literacy and digital engagement across US Regions: Insights from the mayo clinic catchment areas [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B030.

Abstract Context Evidence supports osteopathic manipulative medicine (OMM) as an effective manual therapy, although it remains underutilized by Doctors of Osteopathic Medicine (DOs). Objectives Understanding barriers preventing the broader adoption of OMM is essential to expanding access to it as a noninvasive treatment option. We set out to survey both DOs and non-DO clinicians to identify perceived barriers to OMM. Methods Survey items were adapted from prior studies utilizing an iterative refinement process that included cycles of pilot testing with revisions. Participants were recruited internally from Mayo Clinic Midwest – a large, multistate, healthcare system in the Midwest region of the United States – utilizing internal email. Participants were given a descriptive survey that was developed with support from the Mayo Clinic Survey Research Center. Results The survey was sent out to a total of 952 individuals, including 184 DOs and 768 non-DO clinicians (MD, Bachelor of Medicine, Bachelor of Surgery [MBBS], nurse practitioners, and physician assistants). Respondents included 76 DOs (41.3 % response rate) and 91 non-DOs (11.8 % response rate). Of the 76 DO respondents, 21 (27.6 %) reported utilizing OMM clinically. Commonly reported barriers include time limitations, poor public perception, and lack of training in residency, and time is allocated to other professional interests. Conclusions Within a large health system that includes primary care and specialty care, few DOs practice OMM, citing time constraints, lack of residency training, and competing professional interests as primary barriers. These challenges might successfully be addressed through targeted osteopathic manipulative treatment (OMT) education in residency programs, enhanced compensation, and improved referral pathways.

ABSTRACT Introduction Publication bias (PB) threatens the validity of meta‐analyses by distorting effect size estimates, potentially leading to misleading conclusions. With advanced pattern recognition and multimodal capabilities, large language models (LLMs) may be able to evaluate PB and make the systematic review process more efficient. Methods We evaluated the ability of two state‐of‐the‐art multimodal LLMs, GPT‐4o and Llama 3.2 Vision, to detect PB using funnel plots alone and in combination with quantitative inputs. We simulated meta‐analyses under varying conditions, including the absence of PB, different levels of presence of PB, varying total number of studies within a meta‐analysis, and differing degrees of between‐study heterogeneity. Results Neither GPT‐4o nor Llama 3.2 Vision consistently detected the presence of PB across various settings. Under no‐publication‐bias conditions, GPT‐4o achieved a higher specificity outperforming Llama 3.2 Vision, with the difference most shown in the meta‐analyses with 20 or more studies. The inclusion of quantitative inputs alongside funnel plots did not significantly improve performance. Additionally, between‐study heterogeneity and patterns of non‐reported studies had minimal impact on the models’ assessments. Conclusions The ability of LLMs to detect PB without fine‐tuning is limited at the present time. This study highlights the need for specialized model adaptation before LLMs can be effectively integrated into meta‐analysis workflows. Future research can focus on targeted refinements to enhance LLM performance and utility in evidence synthesis.

Campylobacter species are considered to be the leading bacterial cause of human gastroenteritis globally. Consumption of undercooked or contaminated food, such as chicken, is the main cause of human campylobacteriosis. Despite this significant zoonotic link, comparative data on virulence determinants in Campylobacter isolates across avian and human sources remain limited. This study aimed to characterize the prevalence and expression of virulence determinants in Campylobacter jejuni and Campylobacter coli isolates from chicken and human sources in Ismailia governorate, Egypt. A total of twenty C. jejuni and C. coli isolates (ten of each species) were screened for 14 virulence genes using PCR. All isolates harbored virB11, iam, racR, and tetO. Chicken isolates exhibited a significantly higher prevalence: C. jejuni (chicken): pldA, dnaJ, flaA (100%), cdtB (80%), ciaB (60%), and wlaN (0%); C. coli (chicken): pldA, dnaJ (100%), flaA (60%), cdtB (60%), ciaB (40%), and wlaN (20%). In contrast, human isolates showed a markedly lower prevalence: C. jejuni (human): dnaJ, flaA, and cdtB (20%); C. coli (human): dnaJ, flaA, and cdtB (40%). Crucially, pldA, ciaB, and wlaN were absent in all human isolates. plda and dnaJ genes showed statistically significant prevalence differences. qPCR revealed a significant upregulation (p < 0.05) of dnaJ, virB11, flaA, and iam in chicken isolates compared to human isolates, with log2 fold changes of 3.52, 2.84, 2.43, and 1.90 for C. jejuni and 3.06, 2.38, 1.51, and 1.32 for C. coli. Differential expressions of racR, cdtB, and tetO were not significant, with log2 fold changes ranging from −0.51 to 0.14. Ganglioside mimicry genes (Cst11, wlaN, Waac, ggt, and cgtB) and the carbon storage regulator gene (csrA) were absent in all human isolates. These findings underscore the significant variability in virulence gene profiles in chicken and human C. jejuni and C. coli isolates and highlight the importance of molecular characterization in the risk assessment and epidemiological surveillance of Campylobacter infections.