Citations

Abstract Ovarian cancer (OCa) is fifth leading cause of death among women. Most of OCa patients diagnosed with high stage invasive disease. Although, majority experience remission after surgical debulking and adjuvant chemotherapy, about 80% of patients relapse and/or develop chemoresistant disease. More efficient diagnostics and therapies are needed to improve outcome in ovarian cancer. We used an integrated approach to characterize genomic rearrangements in serous OCa inordet to identify potentially targetable alterations and test treatments with corresponding drugs using matching mouse avatar models. Mate-pair next generation sequencing protocol and BIMA2 algorithm were used to identify chromosomal rearrangements, including gene fusions and copy number changes, in primary tumors. Further analysis was then performed to determine alterations that may also be therapeutically targeted. Total of 25 primary tumors were analyzed, out of which four were selected for genomically guided treatments in corresponding mouse avatars. The tumors propagated in the selected mouse lines were also sequenced and showed identical to original patient tumor landscape of rearrangements. In addition, the selected targetable alterations were validated in both patient and avatar tumor DNA. For several of the analyzed cases pre-surgical and postsurgical blood was available for detection of selected alterations in cell free circulating tumor DNA. The analysis revealed presence of selected rearrangements in pre-surgical blood of all tested cases and in a number of those that showed presence of the disease after surgery. In summary, we showed that the whole genome sequencing of DNA rearrangements in conjunction with analyses of therapeutic targets and treatment testing in mouse avatars, developed using primary tumors, is a promising approach to aid treatment decisions for individual ovarian cancer patients. Note: This abstract was not presented at the conference. Citation Format: Faye R. Harris, Geoffrey C. Halling, Marc A. Becker, Paul Haluska, Jr., George Vasmatzis, Irina V. Kovtun. Individualized approach for ovarian cancer: Identification of potential therapeutic targets based on genomic analyses, testing efficiency of treatments, and monitoring. [abstract]. In: Proceedings of the AACR Precision Medicine Series: Integrating Clinical Genomics and Cancer Therapy; Jun 13-16, 2015; Salt Lake City, UT. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(1_Suppl):Abstract nr 13.

Abstract Introduction: Efforts to improve clear cell renal cell carcinoma (ccRCC) mortality have focused primarily on evaluating prognostic biomarkers in primary tumors in order to identify indicators of response to treatment and targets for novel therapies. To date little attention has been paid to the status of these biomarkers in the more therapeutically-relevant metastatic tumor. Thus, we evaluated concordance of expression of four key prognostic ccRCC biomarkers (BAP1, PBRM1, Ki-67 and TOPOIIa) in a large cohort of patient-matched primary ccRCC and metastatic tumors. Methods: We identified 114 patients treated surgically for ccRCC between 1990 and 2005 who had synchronous (M1) or metachronous (M0) metastases, underwent metastasectomy for at least one metastatic lesion and had archived tissue available from the primary and at least one metastatic tumor. We performed IHC on all primary and metastatic tumors for BAP1, PBRM1, Ki-67, and TOPOIIa using previously-published protocols. BAP1 and PBRM1 expression was categorized as positive or negative and Ki-67 and TOPOIIa was quantified as the number of positive cells per mm2. For BAP1 and PBRM1, we calculated the concordance between patient-matched primary and metastatic tumors as the percentage of pairs where the primary and metastatic tumor had the same designation (i.e., positive or negative). For TOPOIIa and Ki-67, we assessed concordance using Spearman correlation coefficient. Analysis of variance was used to evaluate if concordance between primary-metastatic tumor pairs for TOPOIIa and Ki-67 was associated with metastatic site, metastatic timing (M0/M1), metastatic tumor grade, metastatic tumor necrosis, and metastatic tumor sarcomatoid differentiation. Results: There were a total of 161 patient-matched metastatic tumors available for the 114 patients: 78 patients had only a single metastasis while 36 patients had two or more metastases. While sites of metastases varied, pulmonary metastases were the most common (44% of all metastases). Loss of BAP1 expression was observed in19% of the primary ccRCC and 98.6% of the tumor pairs had concordant BAP1 status between the paired primary and metastatic tumors. Loss of PBRM1 was observed in 56% of the primary ccRCC tumors and 89.3% of tumor pairs showed concordant PBRM1 status. By comparison, median expression of Ki-67 was 65.0mm2 in the primary ccRCC tumors and the Pearson correlation with the patient-matched metastatic tumors was 0.43. The difference in Ki-67 expression between primary-metastatic tumor pairs was associated with necrosis in the metastatic tumor (p=0.014). Median expression of TOPOIIa was 2.6mm2 in the primary ccRCC tumors and the Pearson correlation with the patient-matched metastatic tumors was 0.25. The difference in TOPOIIa expression between primary-metastatic tumor pairs was associated with metastatic site (p=0.0006) and metastases to the heart were significantly different than pulmonary metastases (p<0.0001). Additionally, synchronous metastases had larger differences from their patient-matched primary tumors in comparison to metachronous metastases (p=0.012), as did necrotic metastases (p=0.028). Conclusion: We observed high concordance for loss of BAP1 and PBRM1 expression between primary ccRCC and metastatic tumors in the same patient. Conversely, we noted high discordance in protein expression of Ki-67 and TOPOIIa between patient-matched primary-metastatic tumor pairs. Moreover, this discordance varied by key pathological features. Our results suggest that using the status of a biomarker in primary ccRCC as a guide for the status in metastatic tumors is not always appropriate and needs to be evaluated on a marker-by-marker basis. Citation Format: Jeanette E. Eckel-Passow, Daniel J. Serie, John C. Cheville, Thai H. Ho, Sue M. Harrington, Tracy Hilton, Christine Lohse, Amanda Shreders, Payal Kapur, James Brugarolas, R Houston Thompson, Bradley C. Leibovich, Eugene D. Kwon, Richard W. Joseph, Alexander S. Parker. Concordance of BAP1, PBRM1, Ki-67, and TOPOIIa protein expression in primary clear cell renal cell carcinoma tumors and patient-matched metastatic tumors. [abstract]. In: Proceedings of the AACR Precision Medicine Series: Integrating Clinical Genomics and Cancer Therapy; Jun 13-16, 2015; Salt Lake City, UT. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(1_Suppl):Abstract nr 10.

Abstract Gene expression profiling has identified molecular subtypes that classify invasive breast cancers into distinct categories that vary in their clinical behavior and response to treatment. These subtypes highlight the many possible biologically and clinically distinct types of breast cancer. Immunohistochemical (IHC) staining of tumor sections using antibody panels has been used as a surrogate for the molecular subtypes identified through gene expression profiling, resulting in a set of intrinsic molecular subtypes. Given the heterogeneity within breast cancer, one might expect that different risk factors influence specific subtypes of breast cancer through various etiologic pathways. We evaluated whether percent mammographic density (MD), the proportion of fibroglandular or white tissue on a mammogram and one of the strongest and most consistent risk factors for breast cancer, is associated equally with all intrinsic molecular subtypes. Data were pooled from six cohort or case-control studies including 3389 women with invasive breast cancer and 9860 without, who underwent screening mammography. Percent MD was assessed from digitized film-screen mammograms (for cases, at a median 4 years prior to diagnosis) using a computer-assisted threshold technique, and categorized as 0-10%, 11-25%, 26-50% and 51%+. Receptor status was abstracted from clinical pathology records and supplemented by IHC staining of tumor sections or microarrays. With estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER2) information, we classified tumors into the intrinsic molecular subtypes: Luminal A ( ER+ and/or PR+ and HER2- and grade 1 or 2), Luminal B (ER+ and/or PR+ and HER2+ or Luminal A and grade 3), HER2 expressing (HER2+/ER-/PR-) and triple negative (ER-/PR-/HER2-). For cancers found to be triple negative (TN), we also stained for epidermal growth factor receptor (EGFR) and cytokeratins (CK) 5/6 to differentiate basal-like tumors (positive for EGFR and/or CK 5/6) from the unclassifieds (negative on both EGFR and CK 5/6). We used polytomous logistic regression to calculate the odds (OR) of each of the intrinsic subtypes of breast cancer by categories of percent MD, adjusting for age, BMI and study. Contrasts were constructed and tested within the polytomous model framework to investigate differences in the strength of association of percent MD across subtypes. On average, cases were slightly older (56.4 years [SD=11.3]) than controls (55.8 [10.9]). Of the 3389 invasive breast cancer cases, 2146 (63%) were classified as Luminal A, 709 (21%) as Luminal B, 169 (5%) as HER-2 expressing, and 365(11%) as triple negative (TN). Of the TN tumors, 203 had tumor tissue available and were evaluated for CK 5/6 and EGFR, with 167 (82%) classified as basal-like and 36 (18%) as unclassified. Percent (%) MD was associated with breast cancer risk across all intrinsic subtypes. For Luminal A, compared to women with 11-25% MD (reference), women with 0-10% MD had a reduced risk of breast cancer (OR=0.64 [95% confidence interval (CI): 0.55, 0.74]) while women with 26-50% MD had an OR=1.5 (1.3,1.7) and women with 51%+ MD had the highest risk, OR=2.4 (2.0, 2.8). Similar associations were seen for Luminal B, HER2 expressing, and TN across percent MD categories. The small differences among the percent MD-breast cancer associations observed for the different subtypes were not statistically significant, either when comparing the four (Luminal A, Luminal B, HER-2 expressing and TN; p=0.61) or five categories of subtypes (Luminal A, Luminal B, HER-2 expressing, basal-like, unclassified; p=0.66). Our results suggest percent MD is a risk factor for all intrinsic molecular subtypes. Additional study is needed to examine whether these results hold for younger and older aged women. Understanding the importance of mammographic density measures for subtypes of breast cancer has significance for development of subtype-specific risk models. Citation Format: Celine Vachon, Rulla Tamimi, Yunn-Yi Chen, Christopher Scott, Kimberly Bertrand, Matthew Jensen, Daniel Visscher, Aaron Norman, Fergus Couch, John Shepherd, Bo Fan, Fang-Fang Wu, Lin Ma, Andrew Beck, Steve Cummings, V. Shane Pankratz, Karla Kerlikowske. Mammographic density: A risk factor for all breast cancers or only specific subtypes? [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr IA22.

Abstract Approximately 27,000 new cases of multiple myeloma (MM) will be diagnosed and more than 11,000 deaths will occur from it in 2015. Overall, 5-year relative survival rates have improved from 26.5% in 1975 to 44.9% in 2010, and this has been attributed to the introduction of novel therapeutic agents, widespread utilization of autologous stem cell transplant (ASCT), and improvement in supportive care modalities. However, studies evaluating the role of race/ethnicity in MM have shown marked disparities in incidence and outcomes of MM among patients of different racial subgroups. Traditionally, it has been known that African-Americans (AA) have a higher incidence of MM than Whites and that it occurs in AA at a younger age. Despite this difference in incidence, AA patients are known to have a better overall survival (OS) than Whites. Recent population-based outcomes analyses of MM patients beyond just Whites and AA has shown that Asians have the best median OS, while Hispanics have the worst, in a population that is more representative of the current US racial/ethnic mix. Additionally, the cumulative survival benefit over time as per a recent report was most pronounced among Whites (1.3 years) and least among Asians (0.5 years), suggesting a possible differential access as well as utilization of therapeutic modalities. Thus, despite overall improvement in MM outcomes over years, racial disparities exist. While majority of the data so far has reported the existence of these outcome disparities, a few reports have explored the potential causes of these differences. With regards to disease biology, there is some data suggesting that MM patients belonging to different races may have variability in the incidence of high-risk mutations, with AA MM patients having a lower incidence of such mutations, supporting the better OS seen in AA patients as compared to Whites. Another suggestion supporting differences in an interaction between biologic and environmental factors in MM patients is the variability in incidence of second primary malignancies in patients after they have developed MM, which may affect their outcome and OS. Other causes of outcome disparities may include a differential access to certain treatment options, especially more complex ones like stem cell transplants, as well as certain novel therapeutic agents that may depend on the patient's insurance payer status, which brings up differences in socioeconomic status, education level and barriers in accessing healthcare. It has also been reported recently that access to comprehensive cancer centers has benefitted Whites more than racial minorities. While access issues are being reported for MM patients belonging to different races, it has been suggested that outcome disparities by race are not noted in equal access healthcare systems. The potential shortcomings for these studies in equal access healthcare systems though, have been small size, mostly single-institution and focusing primarily on Whites and AA, without much representation yet of Hispanics and Asians, despite these two racial subgroups being the fastest growing ones in the US. Outcome disparities in MM by patient race have been established. The factors affecting these outcome disparities may be complex and interrelated, making it difficult to identify specific factors that may be modifiable. Yet, it is important to explore outcome disparities and their potential causes, especially in large cohorts prospectively, so that healthcare resources may be utilized efficiently and furthermore, the disadvantaged population subgroups may be benefitted by targeted interventions. Citation Format: Sikander Ailawadhi. Outcome disparities in multiple myeloma: The role of race/ethnicity. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr IA07.

Abstract Breast cancer diagnosis and death has risen in low to middle income countries (LMIC) in the past 20 years. Early detection, diagnosis and treatment in the LMIC setting are thought to impact morbidity and survivorship. The population of South Florida is composed of a significant portion of Afro-Caribbean immigrants from LMICs. We compared a cohort of recent Haitian immigrants with residents in Haiti who had a diagnosis of breast cancer to evaluate the effects of geographical location on presentation, treatment and outcomes. Methods: Retrospective cohort study. Participants were Haitian females with breast cancer that were living in Miami and presented to the University of Miami/Jackson Memorial Hospital (UM/JMH) between 2008 and 2014 and patients living in Haiti and presented to the Breast Cancer Treatment program at the Hospital Bernard Mevs Project Medishare (HBMPM) from 2013 to 2015 with a new diagnosis or who had been diagnosed as far back as 2008 and were presenting for continuation of care. The main outcome was the relationship between cohort location and breast cancer characteristics and cancer–specific survival by log-rank. Cox proportional hazards regression was used to compare breast cancer–specific survival overall and analyzed by stage and other significant explanatory factors. Results: 102 patients from UM/JMH and 94 patients from HBMPM were included in the analysis. The cohort in Haiti presented after longer median duration of symptoms (20 vs 3 months, p<0.001) and more advanced stage (31% Vs 20% with locally advance and 27% vs 19% with metastatic disease). The median age of diagnosis was 55 years in Miami compared to 50 years in Haiti (p=0.03). In Miami all patients had estrogen receptor (ER) and her-2 status ascertained at diagnosis, whereas only 52% and 27% of the Haitian cohort had them. Tumor characteristics in Miami vs Haiti in patients with reported status: ER + 74% (n=102) vs 55% (n=49), p=0.02, her-2+ 20% (n=102) vs 28% (n=25), p=0.36, triple negative 27% (n=102) vs 28% (n=25),p=0.49. Treatment modalities and censoring was available for all the patients in Miami and 72 patients in Haiti. In Haiti, radiation therapy was not widely available compared to Miami. Once patients had known ER and her-2 status, there was no difference in treatment with hormonal therapy (p=0.97) but none of the patients in Haiti received her-2 directed therapy (p<0.001). 50% of the patients with unknown ER status in Haiti received Tamoxifen. Twice as many Haitian women died after a median follow-up of 23 months (12% vs 24%), with median survival of 53 months for Haitians in Haiti (not reached for Miami cohort). Breast cancer specific survival was significantly different in the two cohorts (p<0.000). After exploratory analysis, the risk of death was higher for Haitians in Haiti than Haitians in Miami [HR 3.13 (CI 1.50-6.51)] and was higher for more advanced disease [HR 2.58 (CI 1.67-3.99)]. No other variable or interaction reached statistical significance in our model. Conclusion: Haitian women diagnosed with breast cancer in Haiti experience a significantly worse outcome than Haitians living in Miami that appears to be related to a more advanced stage, younger age, more ER negative tumors and lack of timely effective treatments including restricted access to trastuzumab and radiation. In addition there is a difference in the age of breast cancer onset (Caucasian 62, African American 58, Haitian American 55, Haitian 50) and ER positivity (Caucasian 70%, African American 48%, Haitian American 74%, Haitian 55%) depending on race and ethnic group that raises the question of whether there are disparities within subgroups of women of African origin who have breast cancer. Confounding epigenetic-related variables may impact survival and they need further exploration in these populations. Citation Format: Alexandra Gomez, Vincent DeGennaro, Jr., Sophia George, Estefania Santamaria, Gustavo Westin, Gabriel Dieudina, Judith Hurley. Presentation, treatment, and outcomes of Haitian women with breast cancer in Miami and Haiti: Disparities in breast cancer. A retrospective cohort study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C55.

Abstract Background/Purpose: Cancer registry data suggests that Duval County (greater Jacksonville, FL) has the highest breast cancer mortality rate for African American (AA) women in the southeastern US. Recent research revealed that race, residence, and insurance were associated with significantly poorer breast cancer outcomes in this area. Therefore we conducted a series of focus groups with AA breast cancer survivors from the urban core of Jacksonville, FL to directly address the disparities observed in our quantitative data. Methods: A series of focus groups were conducted to obtain qualitative data topics that included: breast cancer beliefs; delays to diagnosis and treatment; disparities; and health behaviors. Results: A total of 56 AA breast cancer survivors living in the urban core, with either Medicaid or who were uninsured, participated in the focus groups. Mean age was 62 years, with an average of 3.4 years since diagnosis. Only 21% of women were employed. Participants reported their mean time to see a doctor initially for their breast cancer was 39 days, and mean time to first treatment was 178 days. Participants responded that fear, financial limitations, and personal beliefs played the biggest roles in delays to diagnosis and treatment. Participants responded that poor health behaviors, genetics, lack of education, and personal beliefs accounted for both causing breast cancer, and the disparities observed in breast cancer mortality, and felt that environmental factors from living in the urban core also contribute. Conclusions: Our findings highlight several areas for potential intervention to reduce disparities in breast cancer. Citation Format: Sarah Osian, Monica Albertie, David Monticalvo, Steven Ames, Laila Samiian, Gerardo Colon-Otero. Examining reasons for breast cancer disparities in African American women in Duval County, FL. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C06.

Abstract Background: African immigrants in the US have substantially higher prevalences of viral hepatitis and hepatocellular carcinoma than the general population. In Minnesota, which has the third largest state population of African immigrants in the US, the incidence and mortality for hepatocellular carcinoma among Blacks is 3 times higher than Caucasians (The 2012 Minnesota Department of Health Cancer Report). Most African immigrants are unaware of their risk for hepatocellular carcinoma which contributes to substantial liver health disparities. Limited research exists on the burden of viral hepatitis and hepatocellular carcinoma among African immigrants. Thus, we conducted a pilot study to evaluate the knowledge, attitudes, and behaviors (KAB) of African immigrants related to liver disease. Methods: The study used a community-engaged research framework. The research team consisted of stakeholders from an academic medical center and Ethiopian, Liberian, and Kenyan community-based organizations and faith-based centers. A semi-structured focus group guide was developed using a KAB approach with open-ended questions. Content analysis was used to thematically code the transcribed data. Qualitative analysis software (ATLAS.TI) was used to organize codes and highlight major themes contributing to liver health disparities. Results: We enrolled 63 participants and conducted 9 focus groups (1 in Amharic, 2 in Oromo, and 6 in English) in Rochester and Minneapolis, Minnesota. The mean age was 47±19; 32 participants (51%) were male; the median years lived in the US was 12 years. General knowledge of the modes of transmission of viral hepatitis and of the prevention and development of liver cancer was minimal. Themes related to barriers to viral hepatitis screening and vaccination included perceived cultural stigma and use of traditional remedies. Common sources of general health information included internet, pamphlets, friends, family, spiritual leaders and healthcare professionals. Healthcare professionals are the source for information on screening, prevention, transmission and treatment of viral hepatitis and liver cancer. Most participants sought healthcare at reputable medical institutions. Media sources and community-based events at faith-centers were preferred modes of information dissemination on viral hepatitis and liver cancer screening and prevention. Conclusions: Participants identified several factors contributing to the increased burden of hepatocellular carcinoma in Minnesota including lack of knowledge of disease transmission and progression, cultural stigma/taboos, and lack of preventive care. Culturally and linguistically appropriate interventions are needed to increase awareness, prevention, early detection, and treatment of viral hepatitis and liver cancer among African immigrants in Minnesota. Citation Format: Essa A. Mohamed, Nasra H. Giama, Hassan M. Shaleh, Linda M. Kerandi, Abdul M. Oseini, Hager F. Ahmed Mohammed, Henry M. Kerandi, Dekermue Togbah, Abdiwahab O. Ali, Ibrahim A. Waaeys, Hamdi A. Ali, Safra A. Mohamed, Hawa M. Ali, Joyce E. Balls-Berry, Lewis R. Roberts. Evaluating knowledge, attitudes, and behaviors about viral hepatitis and hepatocellular carcinoma among recent African immigrants in Minnesota: A community-engaged qualitative study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C01.

Abstract Purpose: American Indian (AI) women have lower rates of cancer, but later stages of diagnosis and higher mortality than the US general population. We hypothesized that mediators found within different theoretical models of health behavior differentiate women who adhere to mammographic screening guidelines from those who do not. Such mediators may be useful in the design of interventions to increase adherence. Experimental Procedures: As a community-based participatory research project, tribal health, Indian Health Service representatives, and community representatives worked with the Mayo Clinic team to design a survey derived from 53 interviews with documented adherent and non-adherent women from one Bemidji Area tribe. The survey explored demographic characteristics and six theoretical mediators: Health Literacy, Social Networks, Planned Behavior, Social Norms, Social Support, and Health Beliefs. The survey was mailed to 1200 women with the goal of obtaining 600 responses. Women completing the survey were provided a modest gift card through an impartial third party who not know their names or responses. Responses were analyzed using Fisher's Exact Test or the Chi-square test where appropriate. Summary of Data: To date, we have achieved a 30% response rate (91 self-described non-adherent and 91 self-described adherent breast cancer screening (mammography) respondents). Mediators from the six theoretical models and demographic features do differentiate AI adherent and non-adherent screeners and may be useful for developing interventions to expand screening adherence. Among significant differences were the following with which adherence associates: (1) Demographic (≤0.01): being married, full-time employed, living at greater distances from health care facility, surgical menopause, and having had a breast biopsy. (2) Health Literacy (≤ 0.001): accurate conceptual understanding of annual mammogram, ultrasound, and family history as a risk factor. (To accommodate the survey format, we replaced the usual measures of health literacy (Short Test of Functional Health Literacy and Rapid Estimate of Adult Literacy in Medicine) for understanding of basic breast screening and breast cancer concepts.) (3) Social Networks (≤ 0.03): having mothers who have encouraged good health. (4) Planned Behavior (≤ 0.001): behavioral beliefs, and intentions. a.) Behavioral Beliefs : looking forward to getting my mammogram; getting my scheduled mammogram rather than accepting an invitation to be with friends; viewing my mammogram as very important. b) Intentions: expecting to screen in each of the next five years, and getting my next mammogram when it is scheduled. (5) Social Norms (≤ 0.001): role of family as a positive influence on my life. (6) Social Support (≤ 0.001): availability of family to comfort one in times of worry. (7) Health Beliefs (≤ 0.001): discounting physical limitations and exam discomfort as justifications for avoiding screening and believing there are no justifications for avoiding mammogram; knowing: how to prepare for a mammogram, what happens during the mammogram process, knowing a mammograms importance, knowing what to do if one feels something unusual in the breast, and knowing someone who has been diagnosed with breast cancer. Conclusions: No single theoretical model appears to differentiate adherent from non-adherent screeners, but mediators associated with each of the various models do differentiate these screeners. These differentiating mediators should be considered for how they might guide development of interventions to improve screening behavior. The self-report nature of the survey demands that results be considered as tentative and limited, in any case, to the respondents of this tribe. Citation Format: Wesley O. Petersen, Ann M. Nicometo, Corinna Sabaque. Do demographic characteristics and theoretical mediators of health behavior differentiate American Indian adherent mammographic screeners from non-adherent screeners? [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B98.

Abstract Background: Human papillomavirus (HPV) is a causative agent in cervical cancer as well as anal, oropharyngeal, penile, and vaginal/vulvar cancers. Licensed, effective HPV vaccines have been available in the U.S. since mid-2006 for females and late 2011 for males and are recommended up to age 26. Despite this, in 2014, only 39.7% of U.S. girls and 21.6% of boys 13 to 17 years of age completed the three-dose vaccine series. ‘Lack of knowledge’ was a primary reason cited among parents for not vaccinating their children. HPV vaccination rates are lower still among 19-26 year olds, particularly among the uninsured. We assessed awareness and knowledge of HPV disease, HPV-related cancers, and HPV vaccines among working, uninsured adults and used 2014 data from the Health Information National Trends Survey (HINTS cycle 4) as a national benchmark against which to compare our data. Methods: Self-administered surveys were offered to patients attending appointments at the Volunteers in Medicine (VIM) clinic in Jacksonville, FL between September 10, 2014 and October 24, 2014. VIM provides free primary care for working individuals without insurance living and/or working in Duval County. Patients were eligible to participate if they were at least 18 years of age, not in acute distress, and had not completed a survey during pilot-testing. Surveys were available in English and Spanish and contained a validated HPV knowledge measure assessing disease knowledge and vaccine knowledge. Additionally, HPV-related cancer knowledge was assessed: 5 HPV-related (cervical, anal, throat, penile, vaginal/vulvar) and 4 not currently known to be HPV-related (lung, breast, prostate, skin). High knowledge was defined as having a knowledge score in the upper quartile of positive values. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression to assess the association of demographic characteristics with having high knowledge of HPV, HPV vaccines, and HPV-related cancer. Additional models assessed individual cancers. During the study period 356 patients were eligible to participate; of these, 55 declined (84% participation rate). Of the 301 surveys, 5 surveys were excluded from analysis due to excessive missing data; a total of 296 surveys were analyzed. Results: 50.3% of participants (n=149) had heard of HPV, 37.2% (n=110) correctly indicated that HPV is sexually transmitted, and 32.1% (n=95) had heard of the HPV vaccine. In HINTS 4, these estimates were 63.6%, 44.0%, and 62.7%, respectively. In adjusted models, high HPV disease knowledge was associated with race (OR non-white = 0.39 (0.19, 0.78)) and education (OR >high school = 2.34 (1.14, 4.84)) while high HPV vaccine knowledge was associated with race (OR non-white = 0.42 (0.21, 0.82)), education (OR >high school = 5.04 (2.30, 11.06)), and sex (OR male = 0.34 (0.12, 0.94)). Of the HPV-related cancers, 43.9% answered correctly for cervical, 9.1% for anal, 11.1% for mouth/throat, 11.5% for penile, and 30.7% for vaginal/vulvar cancer. Males were less likely than females to know that HPV is a causative agent for cervical (OR=0.41 (0.22, 0.75)) and vaginal/vulvar cancers (OR=0.43 (0.22, 0.86)). Conclusion: Using estimates obtained in HINTS 4 as a benchmark, awareness and knowledge of HPV, HPV-related cancers, and HPV vaccines were low among working, uninsured adult patients. In addition to improving access to HPV vaccination (e.g. volunteer clinics), the findings demonstrate a need for strategies to educate medically underserved adults about HPV. Maximizing access to HPV vaccination, including catch-up vaccination for adults up to age 26 are consistent with the recommendations of the President's Cancer Panel, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the Advisory Committee on Immunization Practices. Citation Format: Carmen Radecki Breitkopf, Lila Finney Rutten, Debra Jacobson, Patrick Wilson, Monica Albertie, Robert M. Jacobson, Gerardo Colon-Otero. Awareness and knowledge of HPV, HPV-related cancers, and HPV vaccines in a working, uninsured clinic population. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B91.

Abstract Background: Hepatocellular Carcinoma (HCC) is the 6th most common cancer and the 2nd leading cause of cancer-related mortality in the world. Sub-Saharan Africa and Eastern Asia are regions endemic for viral hepatitis, accounting for 80% of all HCC cases worldwide. A recent hospital-based study assessing the frequency of hepatitis B (HBV), hepatitis C (HCV), and HCC among Somali immigrants seen at Mayo Clinic determined the adjusted frequency for HBsAg positivity was 10-fold higher and anti-HCV positivity was 3-fold higher as compared to non-Somali residents of Olmsted County, Minnesota. Furthermore, HCV infection was identified as the leading contributor to HCC development among Somalis. The overall goal of this study is to determine the risk factors, surveillance, treatment options, and outcomes of Somalis with HCC seen at Mayo Clinic. Methods: The Mayo Clinic Unified Data Platform Advanced Cohort Explorer (ACE) query tool was used to identify Somali patients seen at Mayo Clinic from March 1, 1998 to March 31, 2015. Clinical notes were searched in ACE using conjunction and disjunction combinations: the terms Somali, Somalia or Somalian were linked with the terms HCC, Hepatocellular Carcinoma or Liver Cancer. Diagnosis was validated using histopathology and/or imaging reports from the electronic medical record (EMR). To confirm the ethnicity of identified patients, names were screened by author HMA who is of Somali heritage. Variables abstracted from the EMR include demographics, etiology of HCC, diagnosis date, date of death or last contact, Child-Turcotte-Pugh class, Barcelona Clinic Liver Cancer (BCLC) stage, comorbid conditions, initial and subsequent treatments, HCC surveillance, cirrhosis and other malignancies. Results: 54 Somali patients diagnosed with HCC were seen at Mayo Clinic from March 1, 1998 to March 31, 2015. The mean age was 63±16.3 and 36 (67%) individuals were male. Thirty-eight (70%) of the 54 HCC patients had HCV, 14 (26%) had HBV, 1 (2%) had non-alcoholic steatohepatitis (NASH), and 1 (2%) had unknown etiology for HCC. Of those with known HCV genotypes, the most common were genotype 4 (45%) and 3 (35%). At the time of HCC diagnosis, 16 (32%) presented with BCLC stage A, 5 (10%) with stage B, 17 (34%) with stage C, and 12 (24%) with stage D. Of the 54 patients, 43 (80%) had cirrhosis, 15 (28%) had vascular invasion, and 10 (19%) had metastatic HCC. Regarding treatment, 12 (22%) patients received curative treatment while 42 (78%) received palliative treatment. Orthotopic liver transplantation (OLT) was received by 3 (6%) of Somali patients compared to 19% of non-Somali HCC patients seen at Mayo Clinic between 2007 and 2009. HCC was detected during surveillance in 11 (20%) Somali HCC patients; of the 11, 2 (4%) received semiannual surveillance. Conclusions: These findings provide a starting point to address liver cancer disparities among Somalis. HCV genotype 4 was most commonly associated with HCC development among the study population. Due to low surveillance rates, more Somalis presented with end-stage liver disease. Furthermore, advanced stage HCC was disproportionately found among Somalis compared to the general North American population. A recent study demonstrated that 11% of North American HCC patients seen at 4 major medical centers presented with stage D. By contrast, our study found 25% of Somalis had Stage D HCC. As a result, Somalis are more likely to receive palliative rather than curative treatments. Improving the identification of individuals with chronic HBV or HCV who are at increased risk for HCC and implementing more comprehensive HCC surveillance is likely to reduce the burden of HCC among this population. Citation Format: Hawa M. Ali, Nasra H. Giama, Hager Ahmed Mohammed, Essa A. Mohamed, Ju Dong Yang, Abdirashid M. Shire, Lewis R. Roberts. Hepatocellular carcinoma characteristics and outcomes among Somali immigrants. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B64.