Adherence rates to endocrine therapy among African American women with stage I-III, hormone receptor-positive breast cancer treated at Grady Memorial Hospital in Atlanta, Georgia.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11582-e11582
Author(s):  
Megan Jean McKee ◽  
Danny Nguyen ◽  
Seham Al Haddad ◽  
Elsa Paplomata ◽  
Marjorie Adams Curry ◽  
...  
Keyword(s):  
Breast Cancer ◽  
African American ◽  
African American Women ◽  
Endocrine Therapy ◽  
Metastatic Disease ◽  
Breast Cancer Mortality ◽  
Benign Disease ◽  
Memorial Hospital ◽  
Adherence Rate ◽  
Caucasian Women

e11582 Background: Breast cancer mortality has historically been higher in African American (AA) women compared to Caucasian women. Controlling for tumor characteristics, biological markers and comorbidities does not account for the disparity. Previous studies have shown that AA women are more likely to have a high 21-gene recurrence score compared to Caucasian women. Another potential variable affecting treatment outcomes is adherence to adjuvant endocrine therapy (ET). We conducted a retrospective review of pharmacy records at Grady Memorial Hospital (GMH) to examine the non-adherence rate among predominantly AA patients (pts). Methods: Pharmacy database records were examined for pts filling prescriptions for tamoxifen, anastrozole, or letrozole at GMH in Atlanta, Georgia from 2004-2009. Baseline characteristics were obtained by chart review. Pts were excluded if they had metastatic disease, DCIS, less than 60 days of eligible prescription, were male, deceased during the study period, benign disease, or no documentation of breast cancer in the electronic medical record (EMR). Non-adherence was defined as those filling less than 80% of eligible days covered by her prescription. Results: 679 pts were identified who filled prescriptions for tamoxifen, anastrozole, or letrozole at Grady pharmacy from 2004-2009. Pts who were excluded had metastatic disease (152), DCIS (101), had less than 60 days of eligible prescription (65), had no documentation of breast cancer in the EMR (25), were male (6), deceased before 2009 (5), or had benign disease (9). Of the 316 pts eligible for the study, median age was 60 (26 to 94) at time of diagnosis, 86% were AA, and 39% were node positive. 167 pts filled prescriptions for tamoxifen, 95 for anastrozole, and 54 for letrozole. The non-adherence rate for tamoxifen was 50%, anastrozole 38%, and letrozole 48%. Overall non-adherence rate was 46%. Conclusions: The overall non-adherence rate to adjuvant ET among a predominately AA population seen in a county hospital was similar to previously reported rates. Non-adherence to ET in this underserved AA pt population does not fully account for disparate outcomes.

scholarly journals Who Can Help Us on This Journey? African American Woman with Breast Cancer: Living in a City with Extreme Health Disparities

2020 ◽  
Vol 17 (4) ◽  
pp. 1126
Author(s):  
Shelley White-Means ◽  
Jill Dapremont ◽  
Barbara D Davis ◽  
Tronlyn Thompson
Keyword(s):  
Breast Cancer ◽  
African American ◽  
African American Women ◽  
Thematic Analysis ◽  
Critical Role ◽  
Breast Cancer Mortality ◽  
American Woman ◽  
Community Based ◽  
American Women ◽  
Cancer Support

This qualitative descriptive research study looks at the services that community-based breast cancer support agencies provide to underserved and African American women who are at risk for or diagnosed with breast cancer in Memphis, Tennessee. We seek their understanding of breast cancer mortality disparities in Memphis. Data were collected using semi-structured in-depth focus groups with five breast cancer support agencies. Categories and patterns were established using thematic analysis and a deductive a priori template of codes. Thematic analysis is a method for identifying, analyzing, and reporting themes within the data. The main themes identified within support agencies for African American women with breast cancer who live in Memphis were barriers to the use of services, education, health system support, and emotional support. Numerous sub themes included cost of medications, support group supplemental programming, eligibility for mobile services, patient/provider communication, optimism about the future, and family advice. Procrastinating, seeking second options, fearfulness, insurance, childcare, and transportation were barriers to care. Community-based breast cancer support agencies play a critical role as connectors for women with breast cancer who live in medically underserved areas and must find their way within a fragmented medical care system.

Mammography screening and detection of early stage breast cancer in Hispanic and African American women at a Minnesota safety net healthcare system.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18074-e18074
Author(s):  
Daniel Fellows Pease ◽  
David T. Gilbertson ◽  
Andres Wiernik
Keyword(s):  
Breast Cancer ◽  
African American ◽  
African American Women ◽  
Healthcare System ◽  
Early Stage ◽  
Screening Mammography ◽  
Advanced Stage ◽  
American Women ◽  
Younger Age ◽  
Caucasian Women

e18074 Background: Approximately 12% of breast cancer cases occur in women younger than 50 years, per SEER data from 2012. Hispanic women are known to present at a younger age and African American women with more advanced stage disease. In this study, we describe the impact of age and race on the initial presentation of breast cancer among minority women treated at the Hennepin Healthcare System (HHS) in the state of Minnesota. Methods: A single-institution retrospective analysis of data from our electronic health record of all breast cancer diagnoses from 2010-2015. Cases were compared by age ( < 50 or > 50 years), race (Caucasian, African American, Hispanic, other), stage (AJCC 7th edition), and method of diagnosis (self-reported mass or screening mammography). Results: A total of 315 breast cancer diagnoses occurred at HHS from 2010-2015. In our cohort, 29% of all breast cancer cases were diagnosed in women < 50yrs. Hispanic and African American women had higher rates of diagnosis at < 50yrs compared to Caucasian women (38.9% vs 37.1% vs 18.1 respectively, p < 0.05). Early stage cancer (stage 0 or I) accounted for most diagnoses in those > 50yrs (54.8%), while advanced stage (stage II-IV) was more prevalent in the < 50yrs age group (59.5%) (p < 0.05). Of all women diagnosed with breast cancer, 63% presented with a self-reported mass and 37% were diagnosed by screening mammography. Hispanics and African American women had a higher rate of presentation with a self-reported mass (74% and 66% respectively) compared to Caucasian women (55%). Women with breast cancer < 50yrs were more likely to present with a self-reported mass than women > 50yrs (80% vs 55%, p < 0.05). 92% of Hispanic and 80% of African American women < 50yrs presented with a self-reported mass, compared to 62% of Caucasian women (p = 0.095). Conclusions: At our institution, Hispanic and African American women are diagnosed at a significantly younger age than Caucasian women, and those diagnosed at a younger age have more advanced disease. Presenting with a self-reported mass is very common for young non-Caucasian women. Whether screening mammography can be better utilized to change these trends requires further study.

scholarly journals ZDHHC3 as a Risk and Mortality Marker for Breast Cancer in African American Women

2017 ◽  
Vol 16 ◽  
pp. 117693511774664 ◽  
Author(s):  
Nick Kinney ◽  
Robin T Varghese ◽  
Ramu Anandakrishnan ◽  
Harold R “Skip” Garner
Keyword(s):  
Breast Cancer ◽  
African American ◽  
African American Women ◽  
Messenger Rna ◽  
White Women ◽  
African American Woman ◽  
Breast Cancer Mortality ◽  
American Woman ◽  
Ribosomal Gene ◽  
American Women

African American woman are 43% more likely to die from breast cancer than white women and have increased the risk of tumor recurrence despite lower incidence. We investigate variations in microsatellite genomic regions—a type of repetitive DNA—and possible links to the breast cancer mortality gap. We screen 33 854 microsatellites in germline DNA of African American women with and without breast cancer: 4 are statistically significant. These are located in the 3′ UTR (untranslated region) of gene ZDHHC3, an intron of transcribed pseudogene INTS4L1, an intron of ribosomal gene RNA5-8S5, and an intergenic region of chromosome 16. The marker in ZDHHC3 is interesting for 3 reasons: (a) the ZDHHC3 gene is located in region 3p21 which has already been linked to early invasive breast cancer, (b) the Kaplan-Meier estimator demonstrates that ZDHHC3 alterations are associated with poor breast cancer survival in all racial/ethnic groups combined, and (c) data from cBioPortal suggest that ZDHHC3 messenger RNA expression is significantly lower in African Americans compared with whites. These independent lines of evidence make ZDHHC3 a candidate for further investigation.

scholarly journals CmP signaling network unveils novel biomarkers for triple negative breast cancer in African American women

2021 ◽  
Author(s):  
Johnathan Abou-Fadel ◽  
Brian Grajeda ◽  
Xiaoting Jiang ◽  
Alyssa-Marie Cailing-De La O ◽  
Esmeralda Flores ◽  
...  
Keyword(s):  
Breast Cancer ◽  
African American ◽  
African American Women ◽  
Triple Negative Breast Cancer ◽  
Breast Cancer Cells ◽  
Triple Negative ◽  
Breast Cancer Mortality ◽  
Signaling Network ◽  
American Women ◽  
Novel Biomarkers

Breast cancer is the most commonly diagnosed cancer worldwide and remains the second leading cause of cancer death. While breast cancer mortality has steadily declined over the past decades through medical advances, an alarming disparity in breast cancer mortality has emerged between African American women (AAW) and Caucasian American women (CAW); and new evidence suggests more aggressive behavior of triple-negative breast cancer (TNBC) in AAW may contribute to racial differences in tumor biology and mortality. Progesterone (PRG) is capable of exerting its cellular effects through either its classic, non-classic or combined responses through binding to either classic nuclear PRG receptors (nPRs) or non-classic membrane PRG receptors (mPRs), warranting both pathways an equally important status in PRG-mediated signaling. In our previous report, we demonstrated that the CCM signaling complex (CSC) consisting of CCM1, CCM2, and CCM3 proteins can couple both nPRs and mPRs signaling cascades to form a CSC-mPRs-PRG-nPRs (CmPn) signaling network in nPR positive(+) breast cancer cells. In this report, we furthered our research by establishing the CSC-mPRs-PRG (CmP) signaling network in nPR(-) breast cancer cells, demonstrating that a common core mechanism exists, regardless of nPR(+/-) cell type. This is the first report stating that inducible expression patterns exist between CCMs and major mPRs in TNBC cells. Furthermore, we firstly show mPRs in TNBC cells are localized in the nucleus and participate in nucleocytoplasmic shuttling in a coordinately synchronized fashion with CCM proteins under steroid actions, following the same cellular distribution as other well-defined steroid hormone receptors. Finally, for the first time, we deconvoluted the CmP signalosome by using multi-omics approaches, which helped us understand key factors within the CmP network, and identify 21 specific biomarkers with potential clinical applications associated with AAW-TNBC tumorigenesis. These novel biomarkers could have immediate clinical implications to dramatically improve health disparities among AAW-TNBCs.

scholarly journals Benefits and Costs of Interventions to Improve Breast Cancer Outcomes in African American Women

2004 ◽  
Vol 22 (13) ◽  
pp. 2554-2566 ◽  
Author(s):  
Jeanne S. Mandelblatt ◽  
Clyde B. Schechter ◽  
K. Robin Yabroff ◽  
William Lawrence ◽  
James Dignam ◽  
...  
Keyword(s):  
Breast Cancer ◽  
African American ◽  
African American Women ◽  
White Women ◽  
Breast Cancer Mortality ◽  
Status Quo ◽  
Intensive Treatment ◽  
Baseline Risk ◽  
American Women ◽  
Use Of Resources

Purpose Historically, African American women have experienced higher breast cancer mortality than white women, despite lower incidence. Our objective was to evaluate whether costs of increasing rates of screening or application of intensive treatment will be off-set by survival benefits for African American women. Methods We use a stochastic simulation model of the natural history of breast cancer to evaluate the incremental societal costs and benefits of status quo versus targeted biennial screening or treatment improvements among African Americans 40 years of age and older. Main outcome measures were number of mammograms, stage, all-cause mortality, and discounted costs per life year saved (LYS). Results At the current screening rate of 76%, there is little incremental benefit associated with further increasing screening, and the costs are high: $124,053 and $124,217 per LYS for lay health worker and patient reminder interventions, respectively, compared with the status quo. Using reminders would cost $51,537 per LYS if targeted to virtually unscreened women or $78,130 per LYS if targeted to women with a two-fold increase in baseline risk. If all patients received the most intensive treatment recommended, costs increase but deaths decrease, for a cost of $52,678 per LYS. Investments of up to $6,000 per breast cancer patient could be used to enhance treatment and still yield cost-effectiveness ratios of less than $75,000 per LYS. Conclusion Except in pockets of unscreened or high-risk women, further investments in interventions to increase screening are unlikely to be an efficient use of resources. Ensuring that African American women receive intensive treatment seems to be the most cost-effective approach to decreasing the disproportionate mortality experienced by this population.

scholarly journals Exploring the Perceptions of African American Breast Cancer Survivors on Endocrine Therapy: A Mixed Methods Study (Preprint)

2020 ◽  
Author(s):  
Sara Belle Donevant ◽  
Sue P Heiney ◽  
Cassandra Wineglass ◽  
Benjamin Schooley ◽  
Akanksha Singh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
African American ◽  
Side Effects ◽  
Cancer Survivors ◽  
African American Women ◽  
Endocrine Therapy ◽  
Quantitative Data ◽  
Breast Cancer Survivors ◽  
Culturally Sensitive ◽  
American Women

BACKGROUND Although the incidence of breast cancer is lower in African American women than white women, they have decreased survival rate. This problem may be due to poor adherence to endocrine therapy which decreases the likelihood of recurrence. Accessible and culturally sensitive interventions to improve survival may decrease mortality. OBJECTIVE The purpose of this article is to describe the process of obtaining qualitative and quantitative data to guide the development of the proposed mHealth app, STORY+. METHODS We recruited 20 African American women with breast cancer. We used quantitative data collection and qualitative interviewing to collect data about their experiences with managing endocrine therapy and its side effects, understanding the value and purpose of endocrine therapy, and using technology in the breast cancer journey. RESULTS We found the women only had general knowledge of the purpose of endocrine therapy but were committed to adherence due to their health care provider’s recommendation. These women used their smartphones far more than a computer. The smartphone provided social connection, information, and practical ways to adhere to treatment. Most participants want a culturally sensitive app to assist them with adherence and connect them with other women that were diagnosed with breast cancer and were African American, not white. CONCLUSIONS Further research is needed to develop a culturally sensitive app for African American women with breast cancer to improve adherence to endocrine therapy. Our work strongly suggests this population would use the app to connect with other African American breast cancer survivors and manage endocrine therapy including side effects.

scholarly journals African American Women: Surviving Breast Cancer Mortality against the Highest Odds

2015 ◽  
Vol 13 (1) ◽  
pp. 6 ◽  
Author(s):  
Shelley White-Means ◽  
Muriel Rice ◽  
Jill Dapremont ◽  
Barbara Davis ◽  
Judy Martin
Keyword(s):  
Breast Cancer ◽  
African American ◽  
African American Women ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
American Women

Ethnic disparity of treatment initiation in women diagnosed with breast cancer.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 189-189
Author(s):  
M. Omaira ◽  
M. Mozayen ◽  
R. Mushtaq ◽  
K. Katato
Keyword(s):  
Breast Cancer ◽  
African American ◽  
African Americans ◽  
African American Women ◽  
Treatment Initiation ◽  
Age At Diagnosis ◽  
Significant Delay ◽  
American Women ◽  
Caucasian Women ◽  
The Impact

189 Background: Despite the major advances in early detection and treatment of breast cancer (BC), African American women, continued to have a higher mortality rates than Caucasians. Many studies have failed to identify a key factor to explain racial disparities in breast cancer outcome. These disparities persist even after controlling for insurance and socioeconomic settings. Data about delays in treatment initiation are limited and inconclusive. We intend to compare the time from diagnosis to the initiation of treatment between African American and Caucasian women diagnosed with BC in a single community-based cancer registry. Methods: Women aged 18 to 64 years with breast cancer were identified, between 1993 and 2009, using data from the Tumor Registry at Hurley Medical Center in Flint, Michigan. Patient’s characteristics obtained include age at diagnosis, race, stage, date of diagnosis, and date of treatment initiation. All patients were previously insured or became insured after diagnosis. Time from diagnosis to the initiation of treatment was calculated in days and compared between African American and Caucasian women using t-test. Results: A total of 1016 patients have been identified with diagnosis of BC. 23 patients were excluded due to missing data. 993 patients were analyzed. African Americans were 355 (36%), Caucasians 617 (62%), and other ethnicities 21 (2%). Mean age at diagnosis was (48.9) for African Americans versus (51.45) for Caucasians (p = 0.005). African American women were more likely to present with advanced stage (III, IV) than Caucasians (18% versus 12%, p = 0.009). African American women had significant delay in the treatment initiation of BC compared to Caucasians (31.11 versus 21.52 days, p < 0.0001). Conclusions: African American women were diagnosed with breast cancer at younger age and more advanced disease than Caucasians. African American women experienced significant delay in the initiation of therapy after diagnosis compared to Caucasians. However, the impact of an average delay of 10 days in treatment on overall survival is unknown. The exact explanation of this disparity is yet to be determined.

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