Benign gynecologic conditions are associated with ovarian cancer risk in African-American women: a case-control study

BACKGROUND

The association between common benign gynecologic conditions and ovarian cancer remains under-studied in African Americans. Therefore, we examine the association between self-reported history of benign gynecologic conditions and epithelial ovarian cancer risk in African-American women.

METHODS

Data from a large population-based, multi-center case-control study of epithelial ovarian cancer in African-American women were analyzed to estimate the association between self-reported history of endometriosis, pelvic inflammatory disease (PID), fibroid, and ovarian cyst with epithelial ovarian cancer. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the associations between individual and composite gynecologic conditions and ovarian cancer.

RESULTS

600 cases and 752 controls enrolled in the African American Cancer Epidemiology Study between 1 December 2010 and 31 December 2015 comprised the study population. After adjusting for potential confounders, a history of endometriosis was associated with ovarian cancer (OR 1.78; 95% CI 1.09-2.90). A non-significant association of similar magnitude was observed with PID (OR 1.33; 95% CI 0.82-2.16), while no association was observed in women with a history of fibroid or ovarian cyst. A positive trend was observed for an increasing number of reported gynecologic conditions (p = 0.006) with consistency across histologic subtypes and among both oral contraceptive users and non-users.

CONCLUSION

A self-reported history of endometriosis among African-American women was associated with increased risk of ovarian cancer. Having multiple benign gynecologic conditions also increased ovarian cancer risk.

Cancer incidence and mortality rates and trends in Trinidad and Tobago

BACKGROUND

Cancer is the second leading cause of death in the Caribbean, including the islands of Trinidad and Tobago (TT). The population of TT consists of over 1.3 million people with diverse ancestral and sociocultural backgrounds, both of which may influence cancer incidence and mortality. The objective of this study was to examine incidence and mortality patterns and trends in TT.

METHODS

Cancer surveillance data on 29,512 incident cancer cases reported to the Dr. Elizabeth Quamina Cancer Registry (population-based cancer registry of TT) between 1995 and 2009 were analyzed. Age-standardized rates, overall and by sex, ancestry, and geography, were reported.

RESULTS

The highest incidence and mortality rates were observed for cancers related to reproductive organs in women, namely, breast, cervical, and uterine cancers, and prostate, lung and colorectal cancers among men. Average incidence rates were highest in areas covered by the Tobago Regional Health Authority (TRHA) (188 per 100,000), while average mortality rates were highest in areas covered by the North West Regional Health Authority (108 per 100,000). Nationals of African ancestry exhibited the highest rates of cancer incidence (243 per 100,000) and mortality (156 per 100,000) compared to their counterparts who were of East Indian (incidence, 125 per 100,000; mortality, 66 per 100,000) or mixed ancestry (incidence, 119 per 100,000; mortality, 66 per 100,000).

CONCLUSIONS

Our findings highlight the need for national investment to improve the understanding of the epidemiology of cancer in Trinidad and Tobago, and to ultimately guide much needed cancer prevention and control initiatives in the near future.

Abstract C24: Determinants of delays in care-seeking for ovarian cancer symptoms in African American women

Introduction: Ovarian cancer is the most deadly gynecologic cancer, and the mortality burden is disproportionately higher among African American women. Women diagnosed with stage IV disease have less than a 30% 5-year survival rate, compared to 90% 5-year survival in stage I disease, which highlights the importance of early diagnosis. Lack of financial means and limited access to care may contribute to delays in symptomatic women seeking treatment, with consequent later stage at diagnosis. However, several studies, performed in samples predominantly comprised of White women, suggest insurance and income do not sufficiently reflect access to care. Here, we examine whether delay in care-seeking (captured through duration of symptoms prior to diagnosis) among African American women is more strongly influenced by socioeconomic status, access to care, or social access barriers (discrimination and trust in physicians).

Methods: This analysis includes data from 550 African American women with ovarian cancer enrolled in the African American Cancer Epidemiology Study (AACES). AACES is a case-control study spanning 11 geographic regions in the United States: North Carolina, South Carolina, Georgia, Alabama, Tennessee, Louisiana, Texas, New Jersey, Ohio, Chicago, and Detroit. Included in the phone-administered AACES survey were questions about symptoms associated with ovarian cancer such as abdominal lumps, changes in bowel habits, and abnormal vaginal bleeding, in the year prior to ovarian cancer diagnosis. If a woman indicated she had a symptom, duration of the symptom was recorded in months. Logistic regression was used to estimate the odds ratios between predictors of accessing care and the outcome of treatment delay. The outcome was defined as having any of the 10 symptoms for at least eight months prior to diagnosis (i.e., those exceeding the seven-month mean symptom duration in this population). Models were adjusted for region, age at diagnosis, histotype, first-degree family history of breast or ovarian cancer, marital status, body mass index, Charlson comorbidity score, pelvic-inflammatory disease history, education, and income. Access to care variables included regular source of health care, insurance, regular physician relationship, and experiencing a barrier to accessing health care. Perceived discrimination was evaluated using the mean response score for questions from Williams' Everyday Discrimination Scale. Trust in physicians was modeled using the mean response score from the Anderson Dedrick Trust in Physicians Scale.

Results: 41% (n=227) of women reported having at least one symptom for eight months prior to diagnosis. After adjustment for confounders, trust in physicians was inversely associated with longer duration of symptoms. A one-unit increase in the mean trust score was associated with 0.73 times the odds of women reporting undiagnosed symptoms in the previous 8 months (OR 0.73 CI 0.55-0.96). Conversely, a one-unit increase in frequency of mean everyday discrimination score was associated with 1.56 times the odds of 8 months of undiagnosed symptoms (OR 1.56 CI 1.14-2.15), after adjustment for confounders. Access to care measures and socioeconomic variables were not associated with longer symptom length in this study population.

Conclusions: Various studies have considered access to care mainly in terms of availability of health insurance. Our results suggest perceived discrimination and lack of trust in physicians are important barriers to African American women seeking treatment for their ovarian cancer symptoms, even after controlling for socioeconomic status, insurance, and source of care.

Citation Format: Megan Mullins, Michele L. Cote, Sarah Abbott, Anthony J. Alberg, Elisa V. Bandera, Jill Barnholtz-Sloan, Melissa Bondy, Fabian Camacho, Ellen Funkhouser, Patricia G. Moorman, Lauren C. Peres, Ann G. Schwartz, Paul D. Terry, Frances Wang, Joellen M. Schildkraut, Edward S. Peters. Determinants of delays in care-seeking for ovarian cancer symptoms in African American women [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 C24.

Abstract C42: Correlates of health-related quality of life among African-American survivors of ovarian cancer: Results from the AACES Study

Background: The incidence of epithelial ovarian cancer (EOC) is lower among African-American (AA) women compared to European American (EA) women (9.8 vs. 13.0 cases/100,000), but AA women have markedly worse outcomes. The purpose of this study is to describe the health-related quality of life (HRQL) in AA women with EOC and its correlates using data from a multisite population-based case-control study of invasive EOC in AA women, the African American Cancer Epidemiology Study (AACES).

Methods: 215 cases completed a first annual follow-up questionnaire, including the HRQL and psychosocial surveys <18 months post diagnosis. The primary HRQL outcome was assessed with SF-8 component scores for physical (PCS) and mental (MCS) health. Correlates examined were patient, disease and treatment characteristics, modified Charlson index, perceived social support, perceived discrimination, leisure-time physical activity, the Life Orientation Test (LOTR), and phobic anxiety (Crown-Crisp Inventory, CCI-PA). Ordinary least squares regression was used to estimate linear trend effects for all predictors adjusting for age at diagnosis, comorbidity, BMI, stage and income.

Results: Higher household family income, lower phobic anxiety, higher social support, and higher leisure physical activity levels were associated with higher MCS and PCS (p < 0.01). Higher perceived discrimination was associated with both lower MCS and PCS, while higher optimism (LOTR) was associated with higher MCS. In multivariable analyses including all predictors, CCI-PA and LOTR remained significant predictors of MCS (p < 0.01), and BMI, phobic anxiety, and social support predicted PCS (p < 0.001).

Conclusion: Prediagnosis characteristics and exposures of AA women with EOC are important predictors of HRQL after cancer diagnosis, and in AACES were more important than tumor characteristics. Cancer survivorship programs that enhance patients' social support and physical activity could have important benefits by reducing emotional distress and increasing perceived vitality.

Citation Format: Roger T. Anderson, Fabian Camacho, Elisa Bandera, Ellen Funkhouser, Patricia Moorman, Lisa Paddock, Lauren C. Peres, Edward Peters, Sarah E. Abbott, Anthony J. Alberg, Jill Barnholtz-Sloan, Melissa Bondy, Michele L. Cote, Ann Schwartz, Paul Terry, Joellen Schildkraut. Correlates of health-related quality of life among African-American survivors of ovarian cancer: Results from the AACES Study [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 C42.

Cyclin E overexpression as a biomarker for combination treatment strategies in inflammatory breast cancer

Inflammatory breast cancer (IBC) is a virulent form of breast cancer, and novel treatment strategies are urgently needed. Immunohistochemical analysis of tumors from women with a clinical diagnosis of IBC (n = 147) and those with non-IBC breast cancer (n = 2510) revealed that, whereas in non-IBC cases cytoplasmic cyclin E was highly correlated with poor prognosis (P < 0.001), in IBC cases both nuclear and cytoplasmic cyclin E were indicative of poor prognosis. These results underscored the utility of the cyclin E/CDK2 complex as a novel target for treatment. Because IBC cell lines were highly sensitive to the CDK2 inhibitors dinaciclib and meriolin 5, we developed a high-throughput survival assay (HTSA) to design novel sequential combination strategies based on the presence of cyclin E and CDK2. Using a 14-cell-line panel, we found that dinaciclib potentiated the activity of DNA-damaging chemotherapies treated in a sequence of dinaciclib followed by chemotherapy, whereas this was not true for paclitaxel. We also identified a signature of DNA repair–related genes that are downregulated by dinaciclib, suggesting that global DNA repair is inhibited and that prolonged DNA damage leads to apoptosis. Taken together, our findings argue that CDK2-targeted combinations may be viable strategies in IBC worthy of future clinical investigation.

Association of genetic variants with fatigue in patients with malignant glioma

Background

Fatigue is a consistently reported, severe symptom among patients with gliomas throughout the disease trajectory. Genomic pathways associated with fatigue in glioma patients have yet to be identified.

Methods

Clinical factors (performance status, tumor details, age, gender) were collected by chart review on glioma patients with fatigue ("I have lack of energy" on Functional Assessment of Cancer Therapy-Brain), as well as available genotyping data. Candidate genes in clock and inflammatory pathways were identified from a literature review, of which 50 single nucleotide polymorphisms (SNPs) in 7 genes were available. Clinical factors and SNPs identified by univariate analyses were included in a multivariate model for moderate-severe fatigue.

Results

The study included 176 patients (median age = 47 years, 67% males). Moderate-severe fatigue was reported by 43%. Results from multivariate analysis revealed poor performance status and 2 SNPs were associated with fatigue severity. Moderate-severe fatigue was more common in patients with poor performance status (OR = 3.52, P < .01). For each additional copy of the minor allele in rs934945 (PER2) the odds of fatigue decreased (OR = 0.51, P < .05). For each additional copy of the minor allele in rs922270 (ARTNL2) the odds of fatigue increased (OR = 2.38, P < .01). Both of these genes are important in the circadian clock pathway, which has been implicated in diurnal preference, and duration and quality of sleep. No genes in the inflammatory pathway were associated with fatigue in the current study.

Conclusions

Identifying patients at highest risk for fatigue during treatment allows for improved clinical monitoring and enrichment of patient selection for clinical trials.

Tubal ligation and ovarian cancer risk in African American women

PURPOSE

Tubal ligation has been associated with reduced risk of epithelial ovarian cancer (EOC) in studies of primarily white women, but less is known about the association in African American (AA) women. We sought to evaluate the associations among 597 invasive ovarian cancer cases and 742 controls of AA descent recruited from the African American Cancer Epidemiology Study, a population-based case-control study in 11 geographical areas in the US.

METHODS

Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for potentially confounding factors.

RESULTS

An inverse association between tubal ligation and EOC was observed that was not statistically significant (OR 0.88, 95% CI 0.68-1.14). However, an inverse association with EOC risk was observed among women who had a tubal ligation at age 35 years or older (OR 0.64; 95% CI 0.41-0.98), but not among those who had a tubal ligation before age 35 (OR 0.98; 95% CI 0.74-1.29) (p for interaction = 0.08). The association also varied considerably by tumor subtype. A strong inverse association was observed for endometrioid tumors (OR 0.31, 95% CI 0.14-0.70), whereas associations with mucinous (OR 0.87, 95% CI 0.36-2.12) and serous (OR 0.94, 95% CI 0.71-1.24) tumors were weaker and not statistically significant. A statistically non-significant positive association for clear cell tumors (OR 1.84, 95% CI 0.58-5.82) was based on a low number of cases.

CONCLUSIONS

Our findings show that tubal ligation may confer a reduced risk for EOC among AA women that is comparable to the associations that have been previously observed in primarily white populations.

Abstract 1315: Estimating sex-specific effects of genetic loci associated with glioma risk

BACKGROUND: Incidence of glioma varies significantly by sex, and most glioma histologies occur with greater incidence in males. Previous analyses have examined the impact of estrogen exposure as a risk factor for these tumors, but have found results of varying significance and low effect size. There may be differences in effect of previously discovered risk alleles that contribute to sex differences.

METHODS: Using data collected for three previous glioma GWAS in European-ancestry populations (MD Anderson Cancer Center, the San Francisco Adult Glioma Study, and the Glioma International Case Control Study) we assessed sex-specific effects for 14 previously identified and 13 newly identified glioma risk SNPs (27 total) overall and for glioblastoma (GBM) and non-GBM tumors separately. There were 3,892 male cases (59% GBM), 4,522 male controls, 2,500 female cases (52% GBM) and 4,940 female controls. Sex-specific odds ratios (ORM and ORF), 95% confidence intervals (95% CI) and p values (pM and pF) were generated using stratified logistic regression models. Data from each study were analyzed separately and combined using inverse variance weighted meta-analysis. Results were considered statistically significant at p&lt;6.2x10-4.

RESULTS: In GBM, rs11979158 (7p11.2, pM=1.01x10-10, ORM=1.43 [95% CI: 1.28-1.59]; pF=3.43x10-3, ORF=1.22 [95% CI: 1.07-1.39]) and rs2562152 (16p13.3, pM=5.59x10-4, ORM=1.23 [95% CI: 1.09-1.39]; pF=1.22x10-1, ORF=1.12 [95% CI: 0.97-1.29]) had significant effect in males only. In non-GBM gliomas, rs12076373 (1q44, pM=3.56x10-7, ORM=1.41, 95% CI: 1.23-1.61; pF=1.76x10-2, ORF=1.20, 95% CI: 1.03-1.38), rs11979158 (7p11.2, pM=1.77x10-5, ORM=1.32 [95% CI: 1.16-1.49]; pF=2.73x10-1, ORF=1.08 [95% CI: 0.94-1.24]), and rs3751667 (16p13.3, pM=9.44x10-7, ORM=1.30 [95% CI: 1.17-1.44]; pF=5.18x10-2, ORF=1.13 [95% CI: 1.00-1.28]) had significant effect in males only. Effect size for rs55705857 (8q24.21) varied significantly by sex, with ORM=2.63 (95% CI: 2.24-3.09, pM=4.42x10-32), as compared to ORF=3.95 (95% CI: 3.28-4.76, pF=1.82x10-47). A sensitivity analysis was performed due to allele frequency heterogeneity by study and results did not change.

CONCLUSIONS: Sex differences and other demographic differences in cancer susceptibility can provide important clues to etiology, and these differences can be leveraged for discovery in genetic association studies. Significant differences in effect size may suggest variation in genetic effect of risk alleles or in unidentified risk factors that vary in prevalence or effect by sex. There may also be differences in the distribution of molecular subtypes within each histology by sex. Further investigation using an agnostic approach may further elucidate the relationship between effect of risk alleles and sex.

Citation Format: Quinn T. Ostrom, Ben Kinnersley, Margaret Wrensch, Jeanette E. Eckel-Passow, Georgina Armstrong, Terri Rice, Yanwen Chen, John Wiencke, Lucie McCoy, Helen Hansen, Christopher Amos, Jonine L. Bernstein, Elizabeth B. Claus, Dora Il'yasova, Christoffer Johansen, Daniel Lachance, Rose Lai, Ching C. Lau, Ryan T. Merrell, Sara H. Olson, Siegal Sadetzki, Joellen Schildkraut, Sanjay Shete, Richard S. Houlston, Robert B. Jenkins, Beatrice Melin, Melissa Bondy, Jill S. Barnholtz-Sloan. Estimating sex-specific effects of genetic loci associated with glioma risk [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1315. doi:10.1158/1538-7445.AM2017-1315

Abstract 1307: Identification of novel epithelial ovarian cancer loci in women of African ancestry from the Ovarian Cancer Association Consortium

Epithelial ovarian cancer (EOC) is a rare but deadly disease for which there is notably poorer survival in women of African Ancestry (AA) compared to women of European Ancestry (EA). Previous EA-based genome-wide association studies (GWAS) have identified 30 common, low penetrant EOC susceptibility alleles. Using the custom-designed 533,631 SNP Illumina OncoArray and imputation to ~12 million genetic variants in the 1000 Genomes Phase 3, we conducted a GWAS in 755 AA EOC cases, including 537 high-grade serous ovarian cancer (HGSOC) cases, and 1,235 AA controls from the Ovarian Cancer Association Consortium (OCAC). We identified novel susceptibility loci with suggestive evidence of association with EOC, based on a threshold of P&lt;1x10-6, at three distinct loci including 10p15.1 (lead SNP rs4525119, intronic to AKR1C3, P=4.9 x 10-7, minor allele frequency [MAF]=0.33), 3p25.3 (lead SNP rs7643459, intronic to LOC101927394, P=8.4 x 10-7, MAF=0.36), and 4q13.3 (lead SNP rs4286604, 15 kb 3’ of UGT2A1, P=8.5x10-7, MAF=0.27). In analysis of HGSOC, we identified suggestive evidence of association at six distinct loci including 5q11.2 (lead SNP rs37792, 132 kb 5’ of FST, P=6.0x10-8, MAF=0.34), Xq27.2 (lead SNP rs57403204, 81 kb 3' of MAGEC1, P=1.7x10-7, MAF=0.06), 10p15.1 (lead SNP rs79079890, LOC105376360 intronic, P=3.0x10-7, MAF=0.03), 17p25.1 (lead SNP rs66459581, 5 kb 5’ of PRPSAP1, P=5.1x10-7, MAF=0.23), 15p12 (lead SNP rs116046250, GABRG3 intronic, P=8.7x10-7, MAF=0.05), and 4q21.21 (lead SNP rs192876988, 30 kb 3’ of GK2, P=9.2x10-7, MAF=0.05). These SNPs showed no evidence of association with risk in the OCAC EA GWAS including up to 23,543 EOC cases and 29,444 controls. Of the SNPs identified with suggestive evidence of association in our GWAS, two are located near genes known to regulate hormones and previously reported in relation to diseases of the ovary (AKR1C3 and FST), two have been linked to cancer (AKR1C3 and MAGEC1) and one represents testis-specific expression (GK2). Of the 30 SNPs identified previously in a EA EOC GWAS, we observed nominally significant associations (P&lt;0.05) with consistent direction of effect for eight SNPs in AA women. Our investigation presents evidence of (1) variants for EOC shared among EA and AA women and (2) novel EOC risk loci of importance for AA women.

Citation Format: Ani Manichaikul, Lauren C. Peres, Xin-Qun Wang, Kate Lawrenson, Sarah Abbott, Ann G. Schwartz, Anna H. Wu, Edward Peters, Patricia G. Moorman, Michele L. Cote, Melissa Bondy, Linda Kelemen, Ellen L. Goode, Jill Barnholtz-Sloan, Simon A. Gather, Andrew Berchuck, Jennifer A. Doherty, Paul Pharoah, Joellen Schildkraut. Identification of novel epithelial ovarian cancer loci in women of African ancestry from the Ovarian Cancer Association Consortium [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1307. doi:10.1158/1538-7445.AM2017-1307

Premenopausal Hysterectomy and Risk of Ovarian Cancer in African-American Women

Although the inverse association between hysterectomy and epithelial ovarian cancer (EOC) was considered well established, investigators in recent studies including women diagnosed after 2000 have observed modest increases in risk. Most studies have been conducted in white women with little representation of African-American women. We examined the relationship between premenopausal hysterectomy and EOC in African-American women and explored whether hormone therapy (HT) modified this association in 614 cases and 743 controls enrolled in the African American Cancer Epidemiology Study (2010-2015). Premenopausal hysterectomy was inversely associated with the odds of EOC (odds ratio (OR) = 0.75, 95% confidence interval (CI): 0.56, 1.01). Qualitative interaction by estrogen-only HT was present; among never users of estrogen-only HT, premenopausal hysterectomy was associated with a significantly decreased odds of EOC (OR = 0.65, 95% CI: 0.46, 0.92), whereas among users of estrogen-only HT, a positive association was observed (OR = 1.71, 95% CI: 0.76, 3.84). In a population of African-American women diagnosed after 2000, our overall results are consistent with the inverse association observed in the era before 2000, yet the effect modification by HT suggests that HT use among women who have had hysterectomies may negate the protective effects of hysterectomy on EOC, creating the appearance of a null or slightly increased risk.

Abstract 1289: Evaluation of vitamin D receptor regulated genes reveals EGFR polymorphism is associated with high-grade serous ovarian cancer in African American women

Few studies have evaluated genetic risk factors for ovarian cancer in African American women. In a previous study with small sample sizes, Vitamin D Receptor (VDR) variants were shown to increase risk of epithelial ovarian cancer (EOC) in that population. This study sought to replicate those findings and assess gene variants from the VDR regulatory pathway. We assessed SNPs (genotyped+imputed) from 5 gene regions which included VDR and genes regulated by VDR, including UGT1A, UGT2B, CYP3A4/5 and EGFR in 755 EOC cases and 1,235 controls among women of African ancestry from the Ovarian Cancer Association Consortium (OCAC). We also performed analyses restricted to 537 patients with HGSOC represented in the overall analysis of EOC. SNPs were genotyped using the custom-designed 533,631 SNP Illumina OncoArray with imputation to the 1,000 Genomes Phase 3 v5 reference set for genotyped and imputed SNPs evaluated at the 5 gene regions (918 SNPs in UGT1A, 6302 SNPs in UGT2B, 410 SNPs in CYP3A4/5, and 824 SNPs in EGFR). Logistic regression was performed using an additive 1 degree of freedom model for genetic inheritance with adjustment for two principal components of ancestry to estimate odds ratios (OR) and 95 % confidence intervals (CI). For each gene region, we applied a gene-specific Bonferroni-threshold for statistical significance defined as 0.05 / number of SNPs examined for that gene. Based on this significance threshold, a statistically significant association with HGSOC was identified in the EGFR region for the imputed SNP, rs114972508 (per allele OR = 2.32, 95% CI = 1.58, 3.40 p=1.6e-05, imputation R-squared=0.89). We further identified suggestive associations (P &lt; 1.0e-06) with EOC for 10 imputed SNPs located within the UGT2B4 gene. We did not replicate previous associations in the 282 SNPs examined in the VDR gene for EOC overall or among HGSOC. In summary, we identified statistically significant association for variants from the EGFR region, and suggestive evidence of association for variants within the UGT2B region in genetic association analyses of ovarian cancer in women of African Ancestry. Data from in vitro experiments suggest that EGFR transcription and proliferative function is suppressed via VDR binding. Thus EGFR association with HGSOC may be a marker of VDR activity. UGT2B4 variants have not been previously explored in ovarian cancer but shown to be nominally associated with breast cancer in women of African ancestry. UGT2B4 enzymes, part of the phase II liver detoxification pathway, are important in the clearance of steroid hormones, bile acid and drug metabolism. Alterations in EGFR and UGT2B4 could perturb enzyme efficacy and proliferation in ovaries and impact susceptibility to ovarian cancer. Future studies will be needed to validate the associations of the imputed SNPs and to determine the impact of EGFR and UGT variants on cancer development.

Citation Format: Delores J. Grant, Ani Manichaikul, Lauren C. Peres, Xin-Qun Wang, Ann G. Schwartz, Anna Wu, Edward Peters, Patricia Moorman, Michele L. Cote, Melissa Bondy, Linda E. Kelemen, Jill Barnholtz-Sloan, Temitope O. Keku, Cathrine Hoyo, Andrew Berchuck, Paul Pharoah, Joellen M. Schildkraut, African American Cancer Epidemiology Study (AACES) and the Ovarian Cancer Assoc Consortium (OCAC). Evaluation of vitamin D receptor regulated genes reveals EGFR polymorphism is associated with high-grade serous ovarian cancer in African American women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1289. doi:10.1158/1538-7445.AM2017-1289

Dietary Quality and Ovarian Cancer Risk in African-American Women

This study evaluated 3 index-based dietary patterns-Healthy Eating Index (HEI)-2005, HEI-2010, and Alternate Healthy Eating Index (AHEI)-2010-in relation to ovarian cancer risk in African-American women. The study was conducted among 415 ovarian cancer cases and 629 age- and site-matched controls of African-American descent recruited from the population-based African American Cancer Epidemiology Study. Multivariable unconditional logistic regression models were used to estimate odds ratios and 95% confidence intervals between quartiles of dietary quality indices and ovarian cancer risk, adjusting for potential confounders. We found that higher AHEI-2010 scores, but not HEI-2005 or HEI-2010 scores, were associated with lower risk of ovarian cancer (comparing the highest quartile (4th) vs. lowest (1st), odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.45, 0.98; P for trend = 0.05). When stratified by menopausal status, no noteworthy associations were observed among premenopausal women. However, among postmenopausal women, greater adherence to HEI-2010 (quartile 4 vs. quartile 1, OR = 0.57, 95% CI: 0.36, 0.92; P for trend = 0.03) and AHEI-2010 (quartile 4 vs. quartile 1, OR = 0.49, 95% CI: 0.31, 0.78; P for trend = 0.01) were inversely associated with ovarian cancer. Our findings indicate that adherence to an overall healthy dietary pattern may reduce ovarian cancer risk in African-American women, and particularly among postmenopausal African-American women.

Cigarette smoking and the association with serous ovarian cancer in African American women: African American Cancer Epidemiology Study (AACES)

BACKGROUND

Smoking is a risk factor for mucinous ovarian cancer (OvCa) in Caucasians. Whether a similar association exists in African Americans (AA) is unknown.

METHODS

We conducted a population-based case-control study of incident OvCa in AA women across 11 geographic locations in the US. A structured telephone interview asked about smoking, demographic, health, and lifestyle factors. Odds ratios and 95% confidence intervals (OR, 95% CI) were estimated from 613 cases and 752 controls using unconditional logistic regression in multivariable adjusted models.

RESULTS

Associations were greater in magnitude for serous OvCa than for all OvCa combined. Compared to never smokers, increased risk for serous OvCa was observed for lifetime ever smokers (1.46, 1.11-1.92), former smokers who quit within 0-2 years of diagnosis (5.48, 3.04-9.86), and for total pack-years smoked among lifetime ever smokers (0-5 pack-years: 1.79, 1.23-2.59; >5-20 pack-years: 1.52, 1.05-2.18; >20 pack-years: 0.98, 0.61-1.56); however, we observed no dose-response relationship with increasing duration or consumption and no significant associations among current smokers. Smoking was not significantly associated with mucinous OvCa. Associations for all OvCa combined were consistently elevated among former smokers. The proportion of ever smokers who quit within 0-2 years was greater among cases (23%) than controls (7%).

CONCLUSIONS

Cigarette smoking may be associated with serous OvCa among AA, which differs from associations reported among Caucasians. Exposure misclassification or reverse causality may partially explain the absence of increased risk among current smokers and lack of dose-response associations. Better characterization of smoking patterns is needed in this understudied population.

Supplemental Selenium May Decrease Ovarian Cancer Risk in African-American Women

Background: To our knowledge, no previous study has evaluated the associations of antioxidant intake with the risk of ovarian cancer in African-American women, who are known to have high mortality from the disease.Objective: We sought to evaluate these associations among 406 ovarian cancer cases and 632 age- and site-matched controls of African-American descent recruited from AACES (African American Cancer Epidemiology Study), a population-based, case-control study in 11 geographical areas within the United States.Methods: Multivariable logistic regression models were used to estimate ORs and 95% CIs adjusted for a wide range of potentially confounding factors, including age, region, education, parity, oral contraceptive use, menopause, tubal ligation, family history, body mass index (BMI), smoking status, total energy, and physical activity.Results: Women with the highest intakes of supplemental selenium (>20 μg/d) had an ∼30% lower risk of ovarian cancer than those with no supplemental intake (OR: 0.67; 95% CI: 0.46, 0.97; P-trend = 0.035). This inverse association was stronger in current smokers (OR: 0.13; 95% CI: 0.04, 0.46; P-trend = 0.001). There was no association with dietary selenium. The associations with carotenoid intakes were weak and nonsignificant (P = 0.07-0.60). We observed no association with dietary or supplemental intake of vitamin C or vitamin E. There were no appreciable differences in results between serous and nonserous tumors.Conclusions: These findings provide the first insights, to our knowledge, into the potential association between antioxidants and ovarian cancer in African-American women, indicating potential inverse associations with supplemental selenium.

Abstract B51: Dairy, calcium, vitamin D and ovarian cancer risk in African-American women

Background: Ovarian cancer is the leading cause of death from gynecologic cancers in the US. Currently there is no reliable screening available for ovarian cancer. Most cases are diagnosed at an advanced stage, with a poor survival rate. Therefore, a better understanding of the etiology and prevention is especially important for ovarian cancer. It has been hypothesized lactose in dairy may have a direct toxicity effect on oocytes, while the other two abundant nutrients from dairy foods, calcium and vitamin D, may have anti-tumorigenic properties. In addition to food and supplemental intakes, vitamin D in humans can also be achieved through skin synthesis upon sun exposure. However, darker skin color may reduce the penetration of ultraviolet-B, resulting in the lower cutaneous synthesis of vitamin D. This, together with the tendency of African Americans (AAs) to have lower consumption of vitamin D and calcium from dietary and supplemental sources, place AA women at risk for vitamin D and calcium deficiency.

Objective: To evaluate intakes of dairy foods, lactose, calcium, and vitamin D exposure (through diet, supplement and sunlight) and the risk of ovarian cancer among AA women.

Methods: We evaluated these associations among 490 ovarian cancer cases and 656 controls of AA descent recruited from the African American Cancer Epidemiology Study, a population-based case-control study in 11 geographical areas in the US. Cases were identified through rapid case ascertainment and age- and site-frequency matched controls were identified by random-digit-dialing. Information on risk factors related to ovarian cancer was collected by a computer-assisted telephone interview. Daily hours spent outdoors in daylight were asked separately on weekdays or weekends, and in summer or the rest of the year. Dietary information was assessed via a self-administered Block 2005 food frequency questionnaire (FFQ). Supplemental intake of calcium or vitamin D including multivitamin sources was also collected. Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for relevant sociodemographic, reproductive, and lifestyle risk factors.

Results: In the multivariable- and mutually-adjusted model, whole milk consumption was significantly associated with increased ovarian cancer risk (OR=1.85 comparing consumers with above-median intake vs. non-consumers, 95% CI: 1.05-3.27; p-trend: 0.023). No association was observed for skim/low-fat milk, cheese or yogurt. Lactose intake was found to increase ovarian cancer risk [OR=1.97 comparing the highest quartile (Q4) vs. lowest (Q1), 95% CI: 1.25-3.10; p-trend: 0.008]. Calcium intake was consistently associated with a decreased risk, with a similar OR for calcium from food, supplement, or total from both sources when comparing the highest to the lowest intake category. For example, total calcium intake was associated with a 49% decreased OR comparing Q4 vs. Q1 (95% CI: 0.30-0.86; p-trend: 0.009). Although we found no association with total and dietary vitamin D intakes, more daylight hours spent outdoors in summer months predicted a lower risk of ovarian cancer (OR=0.71 comparing Q4 vs. Q1, 95% CI: 0.51-0.99; p-trend: 0.049).

Conclusion: Our findings suggest, for the first time, that sun exposure in summer months and a high-calcium, low-lactose diet may decrease the risk of ovarian cancer in AA women. Considering that there is no effective screening tool for ovarian cancer and the poorer survival of AA patients, if replicated in future studies these results open up potential preventive strategies through lifestyle or dietary modifications.

Citation Format: Bo Qin, Patricia G. Moorman, Anthony J. Alberg, Jill S. Barnholtz-Sloan, Melissa Bondy, Michele L. Cote, Ellen Funkhouser, Edward S. Peters, Ann G. Schwartz, Paul Terry, Joellen M. Schildkraut, Elisa V. Bandera. Dairy, calcium, vitamin D and ovarian cancer risk in African-American women. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B51.

Cytoplasmic Cyclin E Predicts Recurrence in Patients with Breast Cancer

Purpose: Low molecular weight cyclin E (LMW-E) detected by Western blot analysis predicts for reduced breast cancer survival; however, it is impractical for clinical use. LMW-E lacks a nuclear localization signal that leads to accumulation in the cytoplasm that can be detected by IHC. We tested the hypothesis that cytoplasmic staining of cyclin E can be used as a predictor of poor outcome in different subtypes of breast cancer using patient cohorts with distinct clinical and pathologic features.Experimental Design: We evaluated the subcellular localization of cyclin E in breast cancer specimens from 2,494 patients from 4 different cohorts: 303 from a prospective study and 2,191 from retrospective cohorts [NCI, MD Anderson Cancer Center (MDA), and the United Kingdom (UK)]. Median follow-up times were 8.0, 10.1, 13.5, and 5.7 years, respectively.Results: Subcellular localization of cyclin E on IHC was associated with full-length (nuclear) and low molecular weight isoforms (cytoplasmic) of cyclin E on Western blot analysis. In multivariable analysis, cytoplasmic cyclin E staining was associated with the greatest risk of recurrence compared with other prognostic factors across all subtypes in three (NCI, MDA, and UK) of the cohorts. In the MDA cohort, cytoplasmic cyclin E staining outperformed Ki67 and all other variables as prognostic factors.Conclusions: Cytoplasmic cyclin E identifies patients with the highest likelihood of recurrence consistently across different patient cohorts and subtypes. These patients may benefit from alternative therapies targeting the oncogenic isoforms of cyclin E. Clin Cancer Res; 23(12); 2991-3002. ©2016 AACR.

Dietary inflammatory index and risk of epithelial ovarian cancer in African American women

Chronic inflammation has been implicated in the development of epithelial ovarian cancer (EOC); yet the contribution of inflammatory foods and nutrients to EOC risk has been understudied. We investigated the association between the dietary inflammatory index (DII), a novel literature-derived tool to assess the inflammatory potential of one's diet, and EOC risk in African American (AA) women in the African American Cancer Epidemiology Study, the largest population-based case-control study of EOC in AA women to date. The energy-adjusted DII (E-DII) was computed per 1,000 kilocalories from dietary intake data collected through a food frequency questionnaire, which measured usual dietary intake in the year prior to diagnosis for cases or interview for controls. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression for the association between the E-DII and EOC risk. 493 cases and 662 controls were included in the analyses. We observed a 10% increase in EOC risk per a one-unit change in the E-DII (OR = 1.10, 95% CI = 1.03-1.17). Similarly, women consuming the most pro-inflammatory diet had a statistically significant increased EOC risk in comparison to the most anti-inflammatory diet (OR_{Quartile4/Quartile1}  = 1.72; 95% CI = 1.18-2.51). We also observed effect modification by age (p < 0.05), where a strong, significant association between the E-DII and EOC risk was observed among women older than 60 years, but no association was observed in women aged 60 years or younger. Our findings suggest that a more pro-inflammatory diet was associated with an increased EOC risk, especially among women older than 60 years.

Analyzing semi-competing risks data with missing cause of informative terminal event

Cancer studies frequently yield multiple event times that correspond to landmarks in disease progression, including non-terminal events (i.e., cancer recurrence) and an informative terminal event (i.e., cancer-related death). Hence, we often observe semi-competing risks data. Work on such data has focused on scenarios in which the cause of the terminal event is known. However, in some circumstances, the information on cause for patients who experience the terminal event is missing; consequently, we are not able to differentiate an informative terminal event from a non-informative terminal event. In this article, we propose a method to handle missing data regarding the cause of an informative terminal event when analyzing the semi-competing risks data. We first consider the nonparametric estimation of the survival function for the terminal event time given missing cause-of-failure data via the expectation-maximization algorithm. We then develop an estimation method for semi-competing risks data with missing cause of the terminal event, under a pre-specified semiparametric copula model. We conduct simulation studies to investigate the performance of the proposed method. We illustrate our methodology using data from a study of early-stage breast cancer. Copyright © 2016 John Wiley & Sons, Ltd.

Dairy, calcium, vitamin D and ovarian cancer risk in African-American women

BACKGROUND

No previous study has evaluated the associations of dairy products, lactose, calcium and vitamin D with the risk of ovarian cancer in African-American women, who are known to have high mortality from the disease, as well as to be at risk for calcium and vitamin D deficiency.

METHODS

We evaluated these associations among 490 ovarian cancer cases and 656 age- and site-matched controls of African-American descent recruited into the African American Cancer Epidemiology Study, a population-based case-control study in 11 geographical areas in the US. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

An increased ovarian cancer risk was observed for whole milk consumption and lactose intake (highest quartile vs lowest: OR=1.97, 95% CI: 1.25-3.10;P-trend: 0.008). Calcium intake was associated with a decreased risk of ovarian cancer (OR=0.51, 95 CI%: 0.30-0.86; P-trend: 0.009), but vitamin D intake was not. Longer sun exposure in summer months was found to predict a lower risk (OR=0.71, 95% CI: 0.51-0.99; P-trend: 0.049).

CONCLUSIONS

Our findings suggest that a high-calcium, low-lactose diet, and sun exposure in summer months may reduce the risk of ovarian cancer in African-American women.

Socioeconomic Status in Relation to the Risk of Ovarian Cancer in African-American Women: A Population-Based Case-Control Study

We investigated the association between socioeconomic status and ovarian cancer in African-American women. We used a population-based case-control study design that included case patients with incident ovarian cancer (n = 513) and age- and area-matched control participants (n = 721) from 10 states who were recruited into the African American Cancer Epidemiology Study from December 2010 through December 2014. Questionnaires were administered via telephone, and study participants responded to questions about several characteristics, including years of education, family annual income, and risk factors for ovarian cancer. After adjustment for established ovarian cancer risk factors, women with a college degree or more education had an odds ratio of 0.71 (95% confidence interval (CI): 0.51, 0.99) when compared with those with a high school diploma or less (P for trend = 0.02); women with family annual incomes of $75,000 or more had an odds ratio of 0.74 (95% CI: 0.47, 1.16) when compared with those with incomes less than $10,000 (P for trend = 0.055). When these variables were dichotomized, compared with women with a high school diploma or less, women with more education had an adjusted odds ratio of 0.72 (95% CI: 0.55, 0.93), and compared with women with an income less than $25,000, women with higher incomes had an adjusted odds ratio of 0.86 (95% CI: 0.66, 1.12). These findings suggest that ovarian cancer risk may be inversely associated with socioeconomic status among African-American women and highlight the need for additional evidence to more thoroughly characterize the association between socioeconomic status and ovarian cancer.

Reproductive factors and ovarian cancer risk in African-American women

PURPOSE

Reproductive characteristics, the most established ovarian cancer risk factors, differ markedly between African-American and white women. Studies in predominantly white populations suggest that associations between reproductive characteristics and ovarian cancer vary by timing of the events and menopause status. This analysis examined associations between number, duration, and timing of reproductive events and epithelial ovarian cancer among African-American women.

METHODS

Data from a multicenter case-control study of ovarian cancer in African-American women (641 cases/752 controls) were used to examine associations with oral contraceptive (OC) use and pregnancy characteristics. Odds ratios (ORs) and 95% confidence intervals (CIs) associated with reproductive characteristics were calculated with logistic regression models.

RESULTS

OC use (OR = 0.7, 95% CI 0.5-0.9), parity (OR = 0.5, 95% CI 0.3-0.6), and breastfeeding for >12 months (OR = 0.3, 95% CI 0.2-0.5) were inversely associated with ovarian cancer. More recent pregnancies and OC use had stronger associations with ovarian cancer than pregnancies or OC use that occurred earlier in life, especially among premenopausal women.

CONCLUSIONS

This study provides the first thorough documentation that pregnancy, breastfeeding, and OC use are inversely associated with ovarian cancer in African-American women, similar to what has been observed in white women. The associations with timing of the exposures suggest that these factors have both short- and long-term effects.

Abstract 3407: Gene expression subtypes of high grade serous ovarian cancer in African American women

Ovarian cancer accounts for 5% of cancer deaths and is the fifth leading cause of cancer death in women in the United States. While incidence is higher in European American (EA) than African American (AA) women, five-year survival is worse for AA women (36%) than EA women (44%). Access to appropriate surgery and treatment is a major contributor but does not completely explain this disparity. The Cancer Genome Atlas (TCGA) identified four gene expression-based subtypes of the most common and lethal histotype, high grade serous carcinoma (HGSC): mesenchymal, proliferative, differentiated, and immunoreactive. We sought to characterize similarities and differences in gene expression-based subtypes arising in AA and EA women to determine whether there are underlying biologic features that may influence survival. We performed two distinct analyses, first using TCGA data and second using cases from the population-based African American Cancer Epidemiology Study (AACES). For both we summarized differential expression patterns for each subtype with moderated t statistic vectors for &gt;10,000 genes using Significance Analysis of Microarrays. We calculated Pearson's correlations of these vectors to determine concordance of expression patterns between subtypes across EA and AA women. In TCGA, we observed correlations of subtype-specific expression patterns between the 24 AA and 475 EA tumors of 0.52-0.60 for each of the four subtypes. Thus, while analogous subtypes can be identified in AA and EA women, the magnitude of these correlations suggests that there are potential differences in gene expression patterns between AA and EA tumors that are assigned to the same subtype. We generated additional data from 58 AACES HGSC cases using the Affymetrix Human Transcriptome Array 2.0. Instead of assigning these tumors to previously-defined subtypes, we clustered samples to identify four subtypes de novo. We observed concordance with two of the TCGA subtypes; correlations for the mesenchymal-like and proliferative-like subtypes were 0.56-0.65. The mesenchymal-like subtype was more common in these AA women than in the TCGA EA women (33% versus 25%), and the proliferative-like subtype was marginally less common (14% versus 19%). Concordance for the differentiated-like subtype was considerably lower, at 0.21, and this subtype was less common in AA than EA women (19% versus 34%). Another subtype comprising 34% of the AA samples was only weakly correlated (-0.21-0.10) with any of the TCGA subtypes, suggesting that it is a novel subtype. The limited data available on HGSC in AA women suggest that at least two subtypes are comparable to those in EA women but differ in prevalence, and that there may be a novel subtype in AA women that does not strongly correspond to those described in EA women.

Citation Format: Jennifer A. Doherty, Casey S. Greene, James E. Rudd, Laura J. Tafe, Anthony J. Alberg, Elisa V. Bandera, Jill Barnholtz-Sloan, Melissa Bondy, Michele L. Cote, Ellen Funkhouser, Patricia G. Moorman, Edward S. Peters, Ann G. Schwartz, Paul Terry, Rex Bentley, Andrew Berchuck, Jeffrey R. Marks, Joellen M. Schildkraut. Gene expression subtypes of high grade serous ovarian cancer in African American women. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3407.

Abstract 3446: Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and the risk of glioma: Results from the Glioma International Case Control Study

Background: Numerous epidemiologic studies have examined the association between aspirin (ASA), non-steroid anti-inflammatory drugs (NSAIDs) and the development of glioma, but the results have been inconsistent. The goal of this study was to evaluate the relationship between the intake of these drugs and glioma risk in a large, international case-control study.

Methods: Between 2010 and 2015, the Glioma International Case-Control Study (GICC) recruited newly diagnosed glioma cases and matched controls in 14 different sites across five countries. Each subject was interviewed using a standardized questionnaire to obtain NSAIDs and ASA use. We examined the associations between ever use (at least &gt; 6 months), duration of drug use and glioma histology. Ever use data on 4533 glioma cases and 4171 controls was combined using maximum likelihood estimation/restricted maximum likelihood meta-analysis methods. Furthermore, based on a priori hypotheses, we performed subgroup analyses based on gender and glioma histological grades.

Results: Use of ASA for &gt; 6 months was associated with a 33% lower glioma risk compared to those who never took it (adjusted Meta-OR 0.67, 95% CI 0.54-0.83). Duration of intake showed a significant trend test (p &lt; 0.0001), with ORs became lower for increasing number of years of ASA use. In subgroup analyses, intake of ASA was significantly associated with glioma risk in both men and women (adjusted Meta-OR = 0.65, 95% CI 0.51-0.84 for men; adjusted Meta-OR = 0.74, 95% CI 0.58-0.93 for women). ASA intake was protective for grade IV glioma (glioblastoma) and grade II/III glioma (adjusted meta-OR 0.63, 95% CI 0.5-0.8 for glioblastoma; adjusted meta-OR 0.67, 95% CI 0.50 - 0.89 for grade II/III glioma). For NSAIDs intake, ever use &gt; 6 months was not associated with glioma risk (adjusted meta-OR 0.87, 95% CI 0.71-1.07). However, NSAIDs use was protective for women (adjusted meta-OR 0.72, 95% CI 0.55-0.93) in subgroup analyses but not for men (adjusted meta-OR 1.03; 95% CI 0.86-1.23). The interaction between gender, NSAIDs and glioma risk was significant (p-value 0.0076).. Sensitivity analyses excluding those who took ASA or NSAIDs within the past 12 months for headache, and the removal of proxy respondents did not change our results.

Conclusion: ASA was associated with a significant protective effect for glioma, but NSAIDs were only associated with reduced glioma risk in women. Given the possibility of recall bias in case-control studies of brain tumors, we may verify dosage and duration of drug intake in those countries with electronic pharmacy records within the GICC.

Citation Format: Rose K. Lai, Renke Zhou, E. Susan Amirian, Christoffer Johansen, Michael E. Scheurer, Georgina N. Armstrong, Ching C. Lau, Elizabeth B. Claus, Jill S. Barnholtz-Sloan, Dora Il’yasova, Joellen Schildkraut, Francis Ali-Osman, Siegal Sadetzki, Richard Houlston, Robert B. Jenkins, Daniel Lachance, Sara H. Olson, Jonine L. Bernstein, Ryan T. Merrell, Margaret R. Wrensch, Faith G. Davis, Sanjay Shete, Christopher I. Amos, Beatrice S. Melin, Melissa Bondy. Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and the risk of glioma: Results from the Glioma International Case Control Study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3446.

Abstract 1754: Body powder use and ovarian cancer: the African American Cancer Epidemiology Study

Findings of epidemiologic studies indicate an increased risk of ovarian cancer among women who use powders applied to perineal areas. Although African American (AA) women have a high prevalence of powder use, this relationship has not been thoroughly investigated in this group of women. The objective of the present study was to evaluate the relationship between use of genital and non-genital powder in invasive epithelial ovarian cancer (EOC). Subjects are women enrolled in the African American Epidemiology Cancer Study (AACES), an ongoing, population-based case-control study of EOC in AA women in 11 geographic locations in the U.S. Newly diagnosed EOC cases were identified by SEER and state cancer registries, gynecologic oncology departments or hospitals, and were between the ages of 20-79 years. AA controls were identified through random digit dialing and frequency matched to cases on state of residence and five year age groups. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between genital powder and non-genital powder exposure and risk of EOC, while controlling for several confounders, including age at diagnosis/interview, study site, education, tubal ligation, parity, BMI, duration of oral contraceptive use, first degree family history of breast or ovarian cancer, and interview year. Due to experimental models suggesting a relationship with inert particulates and estrogen, we also examined potential effect modification of this relationship by hormone therapy use among postmenopausal women. Body powder use was common in this study population (62.8% of cases and 52.9% of controls). Any genital powder use was associated with a 44% increased risk of EOC (OR = 1.44, 95% CI = 1.11-1.86) and a dose-response relationship was present for duration of body powder use applied to genital areas, p&lt;0.05. A 31% increased EOC risk was observed for non-genital powder use (OR = 1.31, 95% CI = 0.95-1.79), and this relationship was strongest among non-serous cases (OR = 2.28, 95% CI = 1.39-3.74). Although not statistically significant, hormone therapy may be a potential modifier of the effect of body powder use on EOC risk. Among ever users of hormone therapy, any genital powder use was associated with over a 2-fold increase in risk (OR = 2.68, 95% CI = 1.33-5.40), while an OR of 1.24 (95% CI = 0.87-1.79) was present for never users of hormone therapy. Having an upper respiratory condition was associated with both genital and non-genital powder use suggesting a systemic inflammatory response may explain the associations we observed with EOC for non-genital powder use. In conclusion, body powder use was prevalent among AA women and strongly associated with EOC risk.

Citation Format: Lauren C. Peres, Sarah E. Abbott, Anthony J. Alberg, Elisa V. Bandera, Jill Barnholtz-Sloan, Melissa Bondy, Michele L. Cote, Ellen Funkhouser, Edward S. Peters, Ann G. Schwartz, Paul D. Terry, Sydnee Crankshaw, Fabian Camacho, Frances Wang, Patricia G. Moorman, Joellen M. Schildkraut. Body powder use and ovarian cancer: the African American Cancer Epidemiology Study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1754.

Semiparametric model for semi-competing risks data with application to breast cancer study

For many forms of cancer, patients will receive the initial regimen of treatments, then experience cancer progression and eventually die of the disease. Understanding the disease process in patients with cancer is essential in clinical, epidemiological and translational research. One challenge in analyzing such data is that death dependently censors cancer progression (e.g., recurrence), whereas progression does not censor death. We deal with the informative censoring by first selecting a suitable copula model through an exploratory diagnostic approach and then developing an inference procedure to simultaneously estimate the marginal survival function of cancer relapse and an association parameter in the copula model. We show that the proposed estimators possess consistency and weak convergence. We use simulation studies to evaluate the finite sample performance of the proposed method, and illustrate it through an application to data from a study of early stage breast cancer.

Mode of Delivery in Premature Neonates: Does It Matter?

OBJECTIVE

Despite the current prevalence of preterm births, no clear guidelines exist on the optimal mode of delivery. Our objective was to investigate the effects of mode of delivery on neonatal outcomes among premature infants in a large cohort.

STUDY DESIGN

We applied a retrospective cohort study design to a database of 6,408 births. Neonates were stratified by birth weight and a composite score was calculated to assess neonatal outcomes. The results were then further stratified by fetal exposure to antenatal steroids, birth weight, and mode of delivery.

RESULTS

No improvement in neonatal outcome with cesarean delivery (CD) was noted when subjects were stratified by mode of delivery, both in the presence or absence of antenatal corticosteroid administration. In the 1,500 to 1,999 g subgroup, there appears to be an increased risk of respiratory distress syndromes in neonates born by CD.

CONCLUSION

In our all-comers cohort, replicative of everyday obstetric practice, CD did not improve neonatal outcomes in preterm infants.

Obesity, weight gain, and ovarian cancer risk in African American women

Although there is growing evidence that higher adiposity increases ovarian cancer risk, little is known about its impact in African American (AA) women, the racial/ethnic group with the highest prevalence of obesity. We evaluated the impact of body mass index (BMI) 1 year before diagnosis and weight gain since age 18 years on ovarian cancer risk in a population-based case-control study in AA women in 11 geographical areas in the US. Cases (n = 492) and age and site matched controls (n = 696) were identified through rapid case ascertainment and random-digit-dialing, respectively. Information was collected on demographic and lifestyle factors, including self-reported height, weight at age 18 and weight 1 year before diagnosis/interview. Multivariable logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CI), adjusting for potential covariates. Obese women had elevated ovarian cancer risk, particularly for BMI ≥ 40 kg/m(2) compared to BMI <25 (OR = 1.72, 95% CI: 1.12-2.66; p for trend: 0.03). There was also a strong association with weight gain since age 18 (OR: 1.52; 95% CI: 1.07-2.16; p for trend: 0.02) comparing the highest to lowest quartile. In stratified analyses by menopausal status, the association with BMI and weight gain was limited to postmenopausal women, with a 15% (95% CI: 1.05-1.23) increase in risk per 5 kg/m(2) of BMI and 6% (95% CI: 1.01-1.10) increase in risk per 5 kg of weight gain. Excluding hormone therapy users essentially did not change results. Obesity and excessive adult weight gain may increase ovarian cancer risk in post-menopausal AA women.

Analgesic medication use and risk of epithelial ovarian cancer in African American women

BACKGROUND

Existing literature examining analgesic medication use and epithelial ovarian cancer (EOC) risk has been inconsistent, with the majority of studies reporting an inverse association. Race-specific effects of this relationship have not been adequately addressed.

METHODS

Utilising data from the largest population-based case-control study of EOC in African Americans, the African American Cancer Epidemiology Study, the relationship between analgesic use (aspirin, non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen) and risk of EOC was estimated by multivariate logistic regression. The association of frequency, duration, and indication of analgesic use on EOC risk was also assessed.

RESULTS

Aspirin use, overall, was associated with a 44% lower EOC risk (OR=0.56; 95% CI=0.35-0.92) and a 26% lower EOC risk was observed for non-aspirin NSAID use (OR=0.74; 95% CI=0.52-1.05). The inverse association was strongest for women taking aspirin to prevent cardiovascular disease and women taking non-aspirin NSAIDs for arthritis. Significantly decreased EOC risks were observed for low-dose aspirin use, daily aspirin use, aspirin use for <5 years, and occasional non-aspirin NSAID use for a duration of ⩾5 years. No association was observed for acetaminophen use.

CONCLUSIONS

Collectively, these findings support previous evidence that any NSAID use is inversely associated with EOC risk.

Abstract A73: Obesity, weight gain, and ovarian cancer risk in African American women

Background: There is growing evidence that obesity increases ovarian cancer risk. However, little is known about the impact of body fatness and weight gain in African American women, the racial/ethnic group with the highest prevalence of obesity according to national data.

Methods: We evaluated the association between ovarian cancer risk and body mass index (BMI) at age 18, recent BMI, and weight gain since age 18 years in the African American Cancer Epidemiology Study (AACES), an ongoing, population-based case-control study of ovarian cancer in African American women in 11 geographical areas in the US. Cases (n=492) and age and site matched controls (n=696) were identified through rapid case ascertainment and random-digit-dialing, respectively. A computer-assisted telephone interview was used to collect information on ovarian cancer risk factors, including self-reported height, weight at age 18, and weight one year before diagnosis/interview. Multivariable logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CI), adjusting for potential covariates, including age, region, education, parity, tubal ligation, oral contraceptive use, age at menarche, menopausal status, and family history of breast/ovarian cancer.

Results: Sixty two percent of the cases and fifty six percent of the controls were obese (BMI≥30). Obese women had elevated ovarian cancer risk, particularly for recent BMI≥40 compared to BMI &lt;25 (OR=1.72, 95% CI: 1.12, 2.66; p for trend: 0.03). No relationship was observed for BMI at age 18. However, there was a strong association with weight gain since age 18 years (OR: 1.68; 95% CI: 1.19-2.39; p for trend: 0.006) comparing the highest to lowest quartile. In stratified analyses by menopausal status, the association with recent BMI persisted in postmenopausal women (OR: 1.94; 95% CI: 1.14-3.30), but was weak and not statistically significant in pre-menopausal women (OR: 1.28; 95% CI: 0.56-2.92). Excluding postmenopausal hormone therapy users essentially did not change results. There was also a strong association with weight gain among postmenopausal women with 14% increased risk per 10 kg of weight gain (OR: 1.14: 95% CI: 1.05-1.23).

Conclusion: Our findings suggest that obesity and excessive adult weight gain may increase ovarian cancer risk in post-menopausal African American women.

Citation Format: Elisa V. Bandera, Bo Qin, Anthony J. Alberg, Jill Barnholtz-Sloan, Melissa Bondy, Michelle Cote, Ellen Funkhouser, Edward Peters, Ann Schwartz, Paul Terry, Patricia G. Moorman, Joellen Schildkraut. Obesity, weight gain, and ovarian cancer risk in African American women. [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 A73.

Abstract B43: A preponderance of post-menopausal HER2+ breast cancer in the Vietnamese population

Background: Though breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death in women worldwide, relatively little is understood about the differences in prevalence and biology between various populations. For example, breast cancer is far less common in Asia than in North America, and the biology of breast cancer is likely different between these groups as well. There is some limited data to suggest that Asian breast cancer patients may have 35-40% rate of HER2+ breast cancer [1,2], as compared to 15-23% within the general American population [3,4].

Methods: To further examine this possibility, we reviewed our data at the Harris Health Systems' Smith Clinic in Houston, Texas from September 2010 through September 2014 to further characterize the Vietnamese breast cancer patients seen during that time. Using Fisher's Exact Test, we compared our subset of Vietnamese breast cancer patients with the publicly available SEER data from 2010[4].

Results: Among the Vietnamese patients from the Smith Clinic, we found that out of 33 patients with invasive breast cancer, 15 (45%) had HER2+ breast cancer. Interestingly, 64% of the HER2+ cohort was post-menopausal, and 50% of the post-menopausal women had HER2+ breast cancer. Compared with the 2010 SEER data that encompasses 28% of all US breast cancer patients diagnosed that year, regardless of race, the Smith Clinic Vietnamese cohort had a statistically significant higher rate of HER2+ breast cancer, with an odds ratio of 4.7 (45% vs. 15%, p &lt;0.001). Among the women greater than 50 years old in both groups, the Vietnamese women had a higher rate of HER2+ breast cancer than the same age group in the SEER data group (odds ratio 7.0, p &lt;0.001).

Conclusion: The patterns observed in this small Vietnamese cohort, and others, do not mirror those seen in the general, multi-racial American breast cancer population. The rate of HER2+ breast cancer in the Smith Clinic Vietnamese group is twice that of the general American population. Other, larger studies have supported the findings of this small group, including a 242-patient study in Vietnam which demonstrated a 41% rate of HER2+ breast cancer; 55% of post-menopausal women had HER2 mutated tumors in this group [1]. Generally, other studies have associated older age and post-menopausal status with a lower rate of HER2+ breast cancer [5,6], but the opposite is true in these Vietnamese women. This unique pattern of breast cancer in Vietnamese women may suggest an underlying genetic or environmental driver, similar to the higher rate of triple negative breast cancer in BRCA1 carriers, or HER2+ breast cancer in women with p53 mutations. We plan to conduct further epidemiologic and genetic research in a larger cohort of Vietnamese breast cancer patients to determine whether an underlying germline genetic mutation or environmental exposure may explain this unusual pattern of breast cancer.

References:

1. Thang, V.H., et al., HER2 status in operable breast cancers from Vietnamese women: Analysis by immunohistochemistry (IHC) and automated silver enhanced in situ hybridization (SISH). Acta oncologica, 2011. 50(3): p. 360-6.

2. Telli, M.L., et al., Asian ethnicity and breast cancer subtypes: a study from the California Cancer Registry. Breast cancer research and treatment, 2011. 127(2): p. 471-8.

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Citation Format: Polly Niravath, Susan G. Hilsenbeck, Melissa Bondy. A preponderance of post-menopausal HER2+ breast cancer in the Vietnamese 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 B43.

Recreational physical activity and ovarian cancer risk in African American women

The literature on recreational physical activity (RPA) and ovarian cancer risk is inconclusive and most studies of RPA and ovarian cancer have been conducted in white populations. This study is the first to investigate the association between RPA and ovarian cancer in an exclusively African American (AA) population. We analyzed data from an ongoing U.S. population-based, case-control study of AA women, which included 393 women recently diagnosed with invasive epithelial ovarian cancer (IEOC) and 611 controls. A baseline interview assessed RPA frequency, intensity, and duration. Each RPA intensity was assigned a metabolic equivalent of task (MET) value and MET-min/week were calculated. Unconditional multivariable logistic regression was performed to investigate associations between RPA and IEOC risk. Compared with sedentary women, predominantly mild intensity RPA was significantly inversely associated with IEOC risk for women reporting above median (>297) MET-min/week (odds ratio [OR] = 0.52; 95% confidence interval [CI]: 0.34, 0.78) and nonsignificantly for <297 MET-min/week (OR = 0.71; 95% CI: 0.44, 1.12). Predominantly moderate intensity RPA was associated with significantly increased risk for women reporting above median (>540) MET-min/week (OR = 1.51; 95% CI: 1.03, 2.23). Predominantly strenuous intensity RPA was nonsignificantly associated with lower IEOC risk for women reporting above median (>1800) MET-min/week (OR = 0.72; 95% CI: 0.33, 1.57). The inverse associations for mild and strenuous intensity RPA were most pronounced in obese women (body mass index >30 kg/m(2) ). The findings that mild and strenuous RPA may reduce the risk of IEOC particularly among obese women are difficult to reconcile with the increased risk observed for moderate RPA. Further research is warranted to determine whether these findings are genuine and, if so, their mechanistic basis.

The Association Between Body Mass Index and Presenting Symptoms in African American Women with Ovarian Cancer

BACKGROUND

Ovarian cancer, the most lethal gynecologic malignancy, typically comes to clinical attention due to nonspecific gastrointestinal or pelvic symptoms. African Americans with ovarian cancer have a greater mortality burden than whites and are also much more likely to be obese. The objective of this study is to explore whether the presentation and duration of symptoms differ by body mass index (BMI) in African Americans with ovarian cancer.

METHODS

We conducted a case-only analysis using data from a multicenter population-based study of invasive epithelial ovarian cancer in African American women. Information on risk factors and symptoms leading to diagnosis was obtained in a telephone interview. Frequency and duration of symptoms by BMI categories were compared using logistic regression and linear regression analyses.

RESULTS

Of the 326 women, ∼60% was obese (BMI ≥30), with 30.8% having a BMI ≥35 kg/m(2). Ninety-four percent of women reported ≥1 symptom during the year before diagnosis. We observed differences in frequency of symptoms by BMI categories, with most being reported more frequently by the heaviest women. The reported duration of symptoms was longer in women with higher BMI, with statistically significant trend tests for 6 of the 10 symptoms evaluated.

CONCLUSION

BMI appears to impact ovarian cancer symptomatology. Women with higher BMI report having symptoms for a longer period of time before diagnosis of ovarian cancer. Healthcare providers should be vigilant and consider ovarian cancer in the differential diagnosis for obese women presenting with abdominal and pelvic symptoms.

Elafin is downregulated during breast and ovarian tumorigenesis but its residual expression predicts recurrence

INTRODUCTION

Elafin is an endogenous serine protease inhibitor. The majority of breast cancer cell lines lack elafin expression compared to human mammary epithelial cells. In this study, we hypothesized that elafin is downregulated during breast and ovarian tumorigenesis.

METHODS

We examined elafin expression by immunohistochemistry (IHC) in specimens of normal breast tissue (n = 24), ductal carcinoma in situ (DCIS) (n = 54), and invasive breast cancer (n = 793). IHC analysis of elafin expression was also performed in normal fallopian tube tissue (n = 20), ovarian cystadenomas (n = 9), borderline ovarian tumors (n = 21), and invasive ovarian carcinomas (n = 216). To understand the significance of elafin in luminal breast cancer cell lines, wild-type or M25G elafin (lacking the protease inhibitory function) were exogenously expressed in MCF-7 and T47D cells.

RESULTS

Elafin expression was downregulated in 24% of DCIS and 83% of invasive breast tumors when compared to elafin expression in the normal mammary epithelium. However, the presence of elafin-positive cells in invasive breast tumors, even at low frequency, correlated with poor recurrence-free survival (RFS), reduced overall survival (OS), and clinicopathological markers of aggressive tumor behavior. Elafin-positive cells were an especially strong and independent prognostic marker of reduced RFS in IHC-defined luminal A-like tumors. Elafin was also downregulated in 33% of ovarian cystadenomas, 43% of borderline ovarian tumors, and 86% of invasive ovarian carcinomas when compared to elafin expression in the normal fallopian tube. In ovarian tumors, elafin-positive cells were correlated with reduced RFS, OS and disease-specific survival (DSS) only in stage I/II patients and not in stage III/IV patients. Notably, exogenous expression of elafin or elafin M25G in the luminal breast cancer cell lines MCF-7 and T47D significantly decreased cell proliferation in a protease inhibitory domain-independent manner.

CONCLUSIONS

Elafin predicts poor outcome in breast and ovarian cancer patients and delineates a subset of endocrine receptor-positive breast cancer patients susceptible to recurrence who could benefit from more aggressive intervention. Our in vitro results suggest that elafin arrests luminal breast cancer cells, perhaps suggesting a role in tumor dormancy.