EP357/#634 Country of birth influences survival outcomes in caribbean black women with endometrial cancer

ObjectivesPrior studies have demonstrated survival differences between Black women with endometrial cancer (EC) born in the US (USB) and the Caribbean. Haitian-born (HB) and Jamaican-born (JB) women represent the largest proportion of Caribbean immigrants to the US, but these populations have not been specifically studied. Our objective was to determine if country of birth influences overall survival (OS) outcomes in Black women with EC.MethodsUsing the Florida Cancer Data System (FCDS), women with EC diagnosed from 1981–2016 were identified. Demographic and clinical information were abstracted. Women who self-identified as Black and born in the US, Jamaica, or Haiti were included. Statistical analyses were performed using chi-square, Cox proportional hazards models, and the Kaplan-Meier methods with significance set at p<0.05.Results3434 women met inclusion criteria. Compared to USB, JB and HB had more high-grade histologies, more advanced disease, were uninsured or government-insured, and received more chemotherapy (all p<0.05) (table 1). In multivariate analyses, age (HR 1.02, p=0.008), distant disease (HR 2.32, p<0.001), high-grade histology (HR 2.15, p<0.001), surgery (HR 0.23, p<0.001), and chemotherapy (HR 0.67, p=0.01) were independently associated with OS. In addition, relative to HB women, USB (HR 0.59, p=0.004), and JB (HR 0.54, p=0.026) had improved OS. Among patients with serous EC, HB women had markedly worse median OS (18.5 months) compared to USB (32.2 months) and JB (41 months) (p=0.027) (figure 1).Abstract EP357/#634 Table 1Cohort summary considering only USB black and Caribbean born Black women, clinical-pathologic and demographic comparisonAbstract EP357/#634 Figure 1Overall survival in Black women with serous endometrial cancer by country of birthConclusionsCountry of birth affects EC survival, with Haitian women demonstrating worse outcomes. Understanding the biologic and social etiologies of these findings is necessary

Abstract B81: Changing fertility factors affecting breast cancer in the Bahamas

Abstract Introduction: There are many factors that affect breast and ovarian cancer incidence. Genetics, obesity, parity, age at menarche, age at first pregnancy, and family size are all determinants of breast and ovarian cancer risk and factors that differ between well-resourced countries and low- and middle-income countries (LMIC). These factors can be subject to rapid change. In addition, there are risks that are associated with the development of breast and ovarian cancer that are associated with race and ethnic group that are less well understood. The Caribbean is home to more than 20 million women, the majority of whom are of African ancestry. The demographics of the Caribbean basin in terms of finance, diet, and exposures are rapidly changing and these factors will, no doubt, be reflected in the rates of breast and ovarian cancer diagnosis. In this article, we propose to examine the changing factors that affect the development of breast and ovarian cancer in women with breast and ovarian cancer of Afro-Caribbean origin. Methods: This prospective study was approved by the University of Miami IRB and the Ministry of Health in the Bahamas. We recruited breast and ovarian cancer patients from public and private clinics in the Bahamas between September 2008 and January 2010. Women were eligible if they had been diagnosed with breast or ovarian cancer, and if at least one parent was born in the Bahamas. Data were analyzed from 250 women from 229 families. The cohort was divided into four groups depending on the year that they were born: 1970. Data analysis was conducted using the c2 test or ANOVA with adjustment for clustered data. Results: Data analysis was conducted on the 250 patients, and the groups were broken down as follows: fifty-six patients were born before 1950, ninety-one were born between 1950-1959, seventy-one between 1960-1969, and thirty-two in or after 1970. The mean age of diagnosis of their first cancer decreased from 57 years (born before 1950) to 31 years (born in or after 1970, p<0.0001). Patients born before 1950 had more siblings (p=0.045), more pregnancies (p<0.0001), and more children (p<0.0001). They had their menarche at an older age (13.8 years vs to 12.7 years, p=0.028) and their first pregnancy at a younger age (21.6 years vs 24.8 years, p=0.021) when compared to the patients born in or after 1970. There was no difference in their body mass index or family history of breast and ovarian cancer. 3.6% of the women were diagnosed with ovarian cancer. At the time of enrollment to study, 21% of the cohort had a TAH-BSO. 59.4% of women born in the 1950s underwent a TAH-BSO. Multivariate analysis of women diagnosed with breast or ovarian cancer, born in the 1960s or 1970s, had a significant odds ratio of having a BRCA mutation, OR 2.88 (1.26, 6.57), p=0.012 and OR 4.06 (1.62, 10.36), p=0.003, respectively. Conclusions: The Bahamas has undergone a rapid change from a developing country fertility pattern in the 1950s and by 1970 to a developed country's fertility pattern, in one generation. These changes influence breast and ovarian cancer risk and are associated with younger age of onset of breast cancer. We documented that 2.8% of Bahamian women without breast or ovarian cancer who had a family history of breast cancer had a deleterious mutation in BRCA 1 or 2. 40% of the 1,857 unaffected women who were offered genetic testing had a family history; thus, the prevalence of these mutations in the population is approximately 1% overall. However, the incidence of ovarian cancer is low. The unintended consequence of TAH-BSO for birth control and menorrhagia is a decrease in expected rates of both breast cancer and ovarian cancer. Citation Format: Sophia HL George, Ana Sandoval Leon, Talia Donenberg, Raleigh Bulter, Darron Halliday, DuVaughn Curling, Theodore Turnquest, John Lunn, Mohammad R. Akbari, Steven Narod, Judith Hurley. Changing fertility factors affecting breast cancer in the Bahamas [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B81

Multicenter Study of Human Papillomavirus and the Human Papillomavirus Vaccine: Knowledge and Attitudes among People of African Descent

Objective. To compare knowledge and attitudes of human papillomavirus (HPV) and the vaccine between different cultures of African descent. Methods. A cross-sectional survey of 555 African-Americans and Afro-Caribbeans residing in the US and the Bahamas (BHM) was conducted. Results. General knowledge about HPV and the HPV vaccine differed between the two countries significantly. Bahamian respondents were less likely to have higher numbers of correct knowledge answers when compared to Americans (Adjusted Odds Ratio [Adj. OR] 0.47, 95% Confidence Interval [CI] 0.30–0.75). Older age, regardless of location, was also associated with answering fewer questions correctly (Adj. OR 0.61, 95% CI 0.40–0.92). Attitudes related to HPV vaccination were similar between the US and BHM, but nearly 80% of BHM respondents felt that children should not be able to receive the vaccine without parental consent compared to 57% of American respondents. Conclusions. Grave lack of knowledge, safety and cost concerns, and influence of parental restrictions may negatively impact vaccine uptake among African-American and Afro-Caribbean persons. Interventions to increase the vaccine uptake in the Caribbean must include medical provider and parental involvement. Effective strategies for education and increasing vaccine uptake in BHM are crucial for decreasing cervical cancer burden in the Caribbean

Reproductive risk factor patterns in the Caribbean affecting breast cancer age of onset

e13632 Background: Breast cancer is the leading cause of cancer in high-income (HIC) and low to middle-income countries (LMIC); and is the most common diagnosed cancer among women. Factors affecting breast cancer incidence include obesity, parity, age of menarche, age of first pregnancy and mutations in BRCA1/2 and genes involved in the homologous recombination repair pathway. These factors differ between HICs and LMICs including countries in the Caribbean. The majority of women from the Caribbean are of African ancestry and Black women have increased morbidity and mortality rates of breast cancer. Our goal is to study how reproductive patterns affect breast cancer age at presentation in Caribbean-born women. Methods: We conducted a prospective observational study recruiting patients from The Bahamas, Barbados, Cayman Islands, Dominica, Haiti, Jamaica and Trinidad and Tobago. Women were considered eligible if they were diagnosed with primary breast cancer at any age. The cohort was divided into four groups based on the year of birth ( 1970). The following data was collected: age at diagnosis of breast cancer, family history of cancer, age of first pregnancy, number of pregnancies, number of children, number of siblings, BMI at time of enrollment, age of menarche and menopause. Data analysis was conducted using the Chi-square test, ANOVA and logistic regression model. Results: A total of 1015 were enrolled and 995 met inclusion criteria. When comparing women born 1970, there was a statistically significant difference between means for the variables: Age at Breast cancer diagnosis (60.7 vs 35, p 1970 (aOR 2.02 [1.06 – 3.88], p = 0.034) compared to < 1950. Conclusions: Our data shows that the Caribbean has undergone a rapid change in reproductive patterns in one generation. These changes provide an insight of risk factor patterns for breast cancer incidence which are associated with younger age of onset

An Assessment of Ovarian Cancer Histotypes Across the African Diaspora

ObjectiveOvarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora. MethodsPatients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student's t-test with significance set at pResultsNigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7 +/- 12.8 years) relative to USB (58.9 +/- 15.0) and CBB (59.0 +/- 13.0,p<0.001). Black women [CBB (25.2 +/- 15.0), Nigerians (29.5 +/- 15.1), and USB (33.9 +/- 17.9)] were diagnosed with GCT younger than White women (35.4 +/- 20.5, p=0.011). Black women [Nigerians (47.5 +/- 15.9), USB (50.9 +/- 18.3) and CBB (50.9 +/- 18.3)] were also diagnosed with SCST younger than White women (55.6 +/- 16.5, p<0.01). ConclusionThere is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation