Tuberculosis and Risk of Emphysema among US Adults in the NHANES I Epidemiologic Follow-Up Study Cohort, 1971-1992

(1) Background: History of TB is a known risk factor for long-term respiratory impairment affecting lung functions in both restrictive and obstructive lung disease. (2) Methods: We analyzed data from the NHANES I Epidemiologic Follow-up Study (NHEFS), a longitudinal study conducted on a noninstitutionalized adult US population aged 25-74 years. Approximately 93 percent of the original NHANES I cohort was successfully traced by the end of the survey period and was available for analysis. The final adjusted model included age groups, gender, family income, lifetime smoking, body mass index (BMI), and frequency of alcohol consumption as potential confounders. (3) Results: The estimated hazards ratio of developing emphysema during follow-up for individuals with a past diagnosis of TB was 54% lower (95% CI = 0.35, 0.61) that that in individuals with no past TB, after controlling for potential confounders and using proportional hazards regression appropriate to the complex sample design. The association, however, was not statistically significant (HR = 0.86, p-value = 0.38) when only a self-reported history of TB was considered as the exposure in an unadjusted model. (4) Conclusions: Tuberculosis (self-reported or LTBI) was strongly (but inversely) associated with emphysema incidence. The association was not statistically significant with only a self-reported history of TB as exposure.

Increased Utilization of Low-Dose CT for Lung Cancer Screening at an Arkansas Community Oncology Clinic

BACKGROUND

Low-dose CT (LDCT) is underused in Arkansas for lung cancer screening, a rural state with a high incidence of lung cancer. The objective was to determine whether offering free LDCT increased the number of high-risk individuals screened in a rural catchment area.

METHODS

There were 5,402 patients enrolled in screening at Highlands Oncology, a community oncology clinic in Northwest Arkansas, from 2013 to 2020. Screenings were separated into time periods: period 1 (10 months for-fee), period 2 (10 months free with targeted advertisements and primary care outreach), and period 3 (62 months free with only primary care outreach). In all, 5,035 high-risk participants were eligible for analysis based on National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Enrollment rates, incidence densities (IDs), Cox proportional hazard models, and Kaplan-Meier curves were performed to investigate differences between enrollment periods and high-risk groups.

RESULTS

Patient volume increased drastically once screenings were offered free of charge (period 1 = 4.6 versus period 2 = 66.0 and period 3 = 69.8 average patients per month). Incidence density per 1,000 person-years increased through each period (IDPeriod 1 = 17.2; IDPeriod 2 = 20.8; IDPeriod 3 = 25.5 cases). Cox models revealed significant differences in lung cancer risk between high-risk groups (P = .012) but not enrollment periods (P = .19). Kaplan-Meier lung cancer-free probabilities differed significantly between high-risk groups (log-rank P = .00068) but not enrollment periods (log-rank P = .18).

CONCLUSIONS

This study suggests that eligible patients are more receptive to free LDCT screening, despite most insurances not having a required copay for eligible patients.

Impact of Dietary Quality on Genital Oncogenic Human Papillomavirus Infection in Women

BACKGROUND

Most cervical cancers are directly linked to oncogenic or high-risk human papillomavirus (HR-HPV) infection. This study evaluates associations between diet quality and genital HPV infection in women.

METHODS

This study included 10 543 women from the 2003-2016 National Health and Nutrition Examination Survey. The outcome was the genital HPV infection status (HPV-negative, low-risk [LR] HPV, and HR-HPV). Dietary quality was evaluated using the Healthy Eating Index (HEI), in which a higher score indicates a better diet quality.

RESULTS

Women who did not consume total fruits (15.8%), whole fruits (27.5%), or green vegetables and beans (43%) had a significantly higher risk of HR-HPV infection than women who complied with the Dietary Guidelines for Americans (HR-HPV odds ratio = 1.76, 1.63, and 1.48 for a HEI score of 0 vs 5, respectively) after adjusting confounding factors. Similar results of these food components on LR-HPV infection were found. In addition, intake of whole grains and dairy was inversely associated with LR-HPV infection.

CONCLUSIONS

This study showed that women who did not eat fruits, dark-green vegetables, and beans had a higher risk of genital HR-HPV infection. Intake of these food components is suggested for women to prevent HPV carcinogenesis.

Association of DNA methylation signatures with cognitive performance among smokers and ex-smokers

INTRODUCTION

Alterations in DNA methylation profiles have been associated with cancer, and can be influenced by environmental factors such as smoking. A small but growing literature indicates there are reproducible and robust differences in methylation levels among smokers, never smokers, and ex-smokers. Here, we compared differences in salivary DNA methylation levels among current and ex-smokers (at least 2 years abstinent).

METHODS

Smokers (n=26) and ex-smokers (n=30) provided detailed smoking histories, completed the Paced Auditory Serial Addition Test (PASAT), and submitted a saliva sample. Whole-genome DNA methylation from saliva was performed, and ANCOVA models and a receiver operating characteristic (ROC) curve were used for the differences between groups and the performance of significant CpG sites.

RESULTS

After controlling for race, age, and gender, smokers had significantly lower methylation levels than ex-smokers in two CpG sites: cg05575921 (AHRR) and cg21566642 (ALPPL2). Based on the ROC analyses, both CpGs had strong classification potentials (cg05575921 AUC=0.97 and cg21566642 AUC=0.93) in differentiating smoking status. Across all subjects, the percent methylation of cg05575921 (AHRR) and cg21566642 (ALPPL2) positively correlated with the length of the last quit attempt (r=0.65 and 0.64, respectively, p<0.001) and PASAT accuracy (r=0.29 and 0.30, respectively, p<0.05).

CONCLUSIONS

In spite of the small sample size and preliminary research, our results replicate previously reported differences in AHRR hypomethylation among smokers. Furthermore, we show that the duration of smoking abstinence is associated with a recovery of methylation in ex-smokers, which may be linked to a reduced risk of smoking-associated diseases. The association with cognitive performance suggests that the hypomethylation of AHRR in saliva may reflect systemic exposure to cigarette-related toxicants that negatively affect cognitive performance, and should be validated in larger studies.

[Safety and efficacy of the early administration of levosimendan in patients with acute non-ST-segment elevation myocardial infarction and elevated NT-proBNP levels: An Early Management Strategy of Acute Heart Failure (EMS-AHF)]

Objectives: To investigated the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and elevated levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) with levosimendan within 24 hours of first medical contact (FMC). Methods: This multicenter, open-label, block-randomized controlled trial (NCT03189901) investigated the safety and efficacy of levosimendan as an early management strategy of acute heart failure (EMS-AHF) for patients with NSTEMI and high NT-proBNP levels. This study included 255 patients with NSTEMI and elevated NT-proBNP levels, including 142 males and 113 females with a median age of 65 (58-70) years, and were admitted in the emergency or outpatient departments at 14 medical centers in China between October 2017 and October 2021. The patients were randomly divided into a levosimendan group (n=129) and a control group (n=126). The primary outcome measure was NT-proBNP levels on day 3 of treatment and changes in the NT-proBNP levels from baseline on day 5 after randomization. The secondary outcome measures included the proportion of patients with more than 30% reduction in NT-proBNP levels from baseline, major adverse cardiovascular events (MACE) during hospitalization and at 6 months after hospitalization, safety during the treatment, and health economics indices. The measurement data parameters between groups were compared using the t-test or the non-parametric test. The count data parameters were compared between groups using the χ² test. Results: On day 3, the NT-proBNP levels in the levosimendan group were lower than the control group but were statistically insignificant [866 (455, 1 960) vs. 1 118 (459, 2 417) ng/L, Z=-1.25,P=0.21]. However, on day 5, changes in the NT-proBNP levels from baseline in the levosimendan group were significantly higher than the control group [67.6% (33.8%,82.5%)vs.54.8% (7.3%,77.9%), Z=-2.14, P=0.03]. There were no significant differences in the proportion of patients with more than 30% reduction in the NT-proBNP levels on day 5 between the levosimendan and the control groups [77.5% (100/129) vs. 69.0% (87/126), χ²=2.34, P=0.13]. Furthermore, incidences of MACE did not show any significant differences between the two groups during hospitalization [4.7% (6/129) vs. 7.1% (9/126), χ²=0.72, P=0.40] and at 6 months [14.7% (19/129) vs. 12.7% (16/126), χ²=0.22, P=0.64]. Four cardiac deaths were reported in the control group during hospitalization [0 (0/129) vs. 3.2% (4/126), P=0.06]. However, 6-month survival rates were comparable between the two groups (log-rank test, P=0.18). Moreover, adverse events or serious adverse events such as shock, ventricular fibrillation, and ventricular tachycardia were not reported in both the groups during levosimendan treatment (days 0-1). The total cost of hospitalization [34 591.00(15 527.46,59 324.80) vs. 37 144.65(16 066.90,63 919.00)yuan, Z=-0.26, P=0.80] and the total length of hospitalization [9 (8, 12) vs. 10 (7, 13) days, Z=0.72, P=0.72] were lower for patients in the levosimendan group compared to those in the control group, but did not show statistically significant differences. Conclusions: Early administration of levosimendan reduced NT-proBNP levels in NSTEMI patients with elevated NT-proBNP and did not increase the total cost and length of hospitalization, but did not significantly improve MACE during hospitalization or at 6 months.

Interactions of SNPs in Folate Metabolism Related Genes on Prostate Cancer Aggressiveness in European Americans and African Americans

Background: Studies showed that folate and related single nucleotide polymorphisms (SNPs) could predict prostate cancer (PCa) risk. However, little is known about the interactions of folate-related SNPs associated with PCa aggressiveness. The study’s objective is to evaluate SNP–SNP interactions among the DHFR 19-bp polymorphism and 10 SNPs in folate metabolism and the one-carbon metabolism pathway associated with PCa aggressiveness. Methods: We evaluated 1294 PCa patients, including 690 European Americans (EAs) and 604 African Americans (AAs). Both individual SNP effects and pairwise SNP–SNP interactions were analyzed. Results: None of the 11 individual polymorphisms were significant for EAs and AAs. Three SNP–SNP interaction pairs can predict PCa aggressiveness with a medium to large effect size. For the EA PCa patients, the interaction between rs1801133 (MTHFR) and rs2236225 (MTHFD1), and rs1801131 (MTHFR) and rs7587117 (SLC4A5) were significantly associated with aggressive PCa. For the AA PCa patients, the interaction of DHFR-19bp polymorphism and rs4652 (LGALS3) was significantly associated with aggressive PCa. Conclusions: These SNP–SNP interactions in the folate metabolism-related genes have a larger impact than SNP individual effects on tumor aggressiveness for EA and AA PCa patients. These findings can provide valuable information for potential biological mechanisms of PCa aggressiveness.

Human papillomavirus vaccination coverage among sexually active young adults aged 18 to 26 at a sexually transmitted infections clinic

BACKGROUND

Human papillomavirus (HPV) vaccination is the most effective biomedical intervention for HPV infections. HPV vaccination rate among sexually active young adults is largely unknown.

METHODS

Patients aged 18-26 years, who attended the Rhode Island Sexually Transmitted Infections Clinic between 2013-2018, were included in the study. We extracted demographics, behavioral characteristics, and HPV vaccination status from electronic medical records. Exploratory logistic regressions were conducted to identify factors associated with vaccination status.

RESULTS

Among 2729 eligible individuals, the median age was 23 years (interquartile range: 22-25). Only 8.1% of males and 24.8% of females received at least one dose of HPV vaccine. Females were 144% (crude odds ratio [cOR]: 2.44, 95% confidence interval [CI]: 2.03, 2.94) more likely to receive at least one dose of HPV vaccine than males. Being Black/African American (B/AA) or Hispanic/Latino (H/L) was associated with a 21% (cOR: 0.79, 95% CI: 0.62, 1.00) and 34% (cOR: 0.66, 95% CI: 0.53, 0.81) decrease in the odds of vaccination, respectively.

CONCLUSIONS

HPV vaccination rate was low among sexually active young adults. Gender and racial/ethnic disparities existed in HPV vaccination. Interventions are needed to promote HPV vaccination among sexually active young adults, especially B/AA and H/L communities.

Maternal Periconceptional Folic Acid Supplementation and DNA Methylation Patterns in Adolescent Offspring

BACKGROUND

Folate, including the folic acid form, is a key component of the one-carbon metabolic pathway used for DNA methylation. Changes in DNA methylation patterns during critical development periods are associated with disease outcomes and are associated with changes in nutritional status in pregnancy. The long-term impact of periconceptional folic acid supplementation on DNA methylation patterns is unknown.

OBJECTIVES

To determine the long-term impact of periconceptional folic acid supplementation on DNA methylation patterns, we examined the association of the recommended dosage (400 μg/d) and time period (periconceptional before pregnancy through first trimester) of folic acid supplementation with the DNA methylation patterns in the offspring at age 14-17 y compared with offspring with no supplementation.

METHODS

Two geographic sites in China from the 1993-1995 Community Intervention Program of folic acid supplementation were selected for the follow-up study. DNA methylation at 402,730 CpG sites was assessed using saliva samples from 89 mothers and 179 adolescents (89 male). The mean age at saliva collection was 40 y among mothers (range: 35-54 y) and 15 y among adolescents (range: 14-17 y). Epigenome-wide analyses were conducted to assess the interactions of periconceptional folic acid exposure, the 5,10-methylenetetrahydrofolate reductase (MTHFR)-C677T genotype, and epigenome-wide DNA methylation controlling for offspring sex, geographic region, and background cell composition in the saliva.

RESULTS

In the primary outcome, no significant differences were observed in epigenome-wide methylation patterns between adolescents exposed and those non-exposed to maternal periconceptional folic acid supplementation after adjustment for potential confounders [false discovery rate (FDR) P values < 0.05]. The MTHFR-C677T genotype did not modify this lack of association (FDR P values < 0.05).

CONCLUSIONS

Overall, there were no differences in DNA methylation between adolescents who were exposed during the critical developmental window and those not exposed to the recommended periconceptional/first-trimester dosage of folic acid.

Abstract P035: Associations between meat and fish intake and aggressive prostate cancer in the North Carolina-Louisiana Prostate Cancer Project (PCaP)

Objective: Results of studies examining the association between intake of meat or fish and prostate cancer have been mixed. However, few of the previous studies have included a racially diverse population or focused on aggressive prostate cancer. We aimed to examine the association between intake of meat and fish and aggressive prostate cancer in the North Carolina-Louisiana Prostate Cancer Project, a case-only study of Black and White men in the United States. Methods: Meat and fish intakes in the year prior to diagnosis were estimated using an interviewer-administered modified version of the National Cancer Institute Diet History Questionnaire in 909 Black and 991 White men with a recent histologically confirmed diagnosis of prostate cancer. High aggressive prostate cancer (n=332) was defined as Gleason sum ≥8, or PSA&gt; 20ng/ml, or Gleason sum ≥7 AND clinical stage T3-T4, and the comparison group was all other prostate cancer cases (n=1,568). Logistic regression was used to determine the odds ratio (OR) and 95% confidence intervals (95% CI) for high aggressive prostate cancer by tertile of meat and fish intake variables, with adjustment for age, energy intake, race, study site, education, family history of prostate cancer, prostate cancer screening history, Charlson comorbidity index, NSAIDs use, smoking status, alcohol intake, and intake of vegetables, fruits, and milk. Results: We observed increased odds of aggressive prostate cancer among men in the second tertile compared to the first tertile for total red meat (OR:1.23. 95% CI: 0.91 – 1.68) and unprocessed red meat (OR:1.30. 95% CI: 0.96 – 1.76), though confidence intervals were imprecise and associations in the top tertile were weaker. For processed meat, a non-statistically significant increased odds of aggressive prostate cancer was observed among men in the third tertile compared to the first tertile (OR:1.27. 95% CI: 0.91 – 1.78). ORs for higher intake of fish and poultry were in the inverse direction but were weak and not statistically significant. Conclusions: In this racially diverse case-only study, we observed weak positive associations between red and processed meat and aggressive prostate cancer, and little evidence of an association with fish or poultry intake. While high temperature cooking and charring of meat is known to increase carcinogen formation, one limitation of our study was the lack of information on cooking methods or doneness of the meat consumed. Additional research is warranted among racially diverse populations that considers cooking methods and doneness preferences.

Citation Format: Jessica Sainyo, Susan E. Steck, L. Joseph Su, Lenore Arab, Jeannette T. Bensen, Elizabeth T.H. Fontham, James L. Mohler. Associations between meat and fish intake and aggressive prostate cancer in the North Carolina-Louisiana Prostate Cancer Project (PCaP). [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P035.

An Online Survey and Focus Groups for Promoting Cancer Prevention Measures

In order to design a cancer prevention promotion program in the region, suggestions were solicited at a medical center. We hypothesized that a majority would be native to state, and would be able to articulate about the barriers that may exist. Through online survey and focus groups, suggestions were sought, and the knowledge and the compliance with cancer prevention recommendations were assessed to determine the participants' qualifications as potential educators. Sixty-five point two percent of participants (n = 1018) graduated from high school in Arkansas. The most commonly given suggestions were to provide education to increase awareness, to use social media for promotion, to improve access, and to reduce costs. Self-reported adherence rates to breast, cervical, and colorectal cancer screening were 82.6% (n = 954), 75.8% (n = 541), and 76.7% (n = 453), respectively. Having a personal history of cancer significantly increased colorectal cancer screening uptake (p = 0.04), but paradoxically decreased mammography uptake (p = 0.007). Salary of $40,000 and more and having a Bachelor's degree or higher were associated with higher compliance of Papanicolaou test only (p = 0.007 and p = 0.001, respectively). A majority (67.7%, n = 1056) of respondents expressed willingness to contribute to promoting cancer prevention measures, and 38.3% (n = 559) were willing to participate in focus groups. However, only 6.3% (n = 35) actually participated. The participants' knowledge and compliance appeared to be sufficient, but their follow through in focus group participation was poor.

What's in Between the Lines: Assessing the Readability, Understandability, and Actionability in Breast Cancer Survivorship Print Materials

Educational print materials for young women breast cancer survivors (YBCS) are supplemental tools used in patient teaching. However, the readability of the text coupled with how well YBCS understand or act upon the material are rarely explored. The purpose of this study was to assess the readability, understandability, and actionability of commonly distributed breast cancer survivorship print materials. We used an environmental scan approach to obtain a sample of breast cancer survivorship print materials available in outpatient oncology clinics in the central region of a largely rural Southern state. The readability analyses were completed using the Flesch-Kincaid (F-K), Fry Graph Readability Formula (Fry), and Simple Measure of Gobbledygook (SMOG). Understandability and actionability were analyzed using Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). The environmental scan resulted in a final sample of 14 materials. The mean readability of the majority of survivorship materials was "difficult," but the majority scored above the recommended 70% in both understandability and actionability. The importance of understandability and actionability may outweigh readability results in cancer education survivorship material. While reading grade level cannot be dismissed all together, we surmise that patient behavior may hinge more on other factors such as understandability and actionability. Personalized teaching accompanying print material may help YBCS comprehend key messages and promote acting upon specific tasks.

Abstract 1450: Interactions of DNMTs genetic variants associated with breast cancer risk

Background: DNA methyltransferases (DNMTs) control DNA methylation and impact gene expression. Many studies have demonstrated that genetic variants in DNMT genes play a role in cancer development, including breast cancer. However, the impact of SNP-SNP interactions for DNMTs associated with breast cancer risk is unclear. The objective is to evaluate SNP-SNP interactions associated with breast cancer risk.

Methods: We selected 14 SNPs in 3 DNMT genes (DNMT1, DNMT3A, and DNMT3B) for the 4,195 women (1:2 match for breast cancer cases and controls), including 1,085 African Americans (AAs) and 3,110 European Americans (EAs) in the Arkansas Rural Community Health (ARCH) cohort. We included different inheritance models (dominant, recessive, and additive) for individual SNP effects, using logistic regressions with breast cancer status (yes/no) as the outcome. Two-way SNP-SNP interactions associated with breast cancer risk were analyzed using the SNP Interaction Pattern Identifier (SIPI) approach developed by our research team.

Results: Out of the 14 DNMTs SNPs, we found two SNPs (rs7605753 and rs10196635 in DNMT3A) were individually associated with breast cancer risk (p&lt;0.05) in EAs, however, none was statistically significant in AAs. Interestingly, we applied the SIPI approach, targeting SNP-SNP interactions,19 SNP-SNP interaction pairs for EAs, and 6 pairs for AAs associated with breast cancer risk. These promising SNP interaction pairs had an interaction p-value less than 0.05, far less than the p-values of the 2 constituent SNPs. Also, these promising SNP-SNP interaction pairs are different between races. For example, the EA women with the CC + AT/TT genotype in rs12991495 + rs10196635 (both in DNMT3A) had a higher risk of breast cancer risk than other genotype combinations (Odds ratio [OR]=2.2, p=0.011). On the other hand, the AA women with the TT+AA genotype in the SNP pair of rs2304429 (DNMT3A) + rs2290684 (DNMT1) tend to have a higher breast cancer risk than other genotype combinations in the same pair (OR=4.3, p=0.034). Notably, the individual effects of the two constituent SNPs are not significant (p=0.537 and 0.547).

Conclusion: Our findings support that the SNPs in DNMT genes play an essential role in breast cancer risk. SIPI is an excellent tool to evaluate SNP-SNP interactions, which can better predict breast cancer risk.

Citation Format: Hui-Yi Lin, L. Joseph Su, Lora J. Rogers, Gail A. Runnells, Ping-Ching Hsu, Shelbie D. Stahr, Tung-Chin Chiang. Interactions of DNMTs genetic variants associated with breast cancer risk [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1450.

Abstract 3680: Distinctive metabolomics profiles associated with African American current smokers who have high aggressive prostate cancer

Background: Smoking has not been an established risk factor for prostate cancer (PCa), and has not been emphasized in PCa prevention. However, recent studies have shown increasing evidence that there is a higher risk of biochemical recurrence, PCa mortality, and metastasis among current smokers, presenting an urgent need in re-evaluating the association between smoking and aggressive PCa. This study aimed to determine whether smoking increase the likelihood of developing a more aggressive prostate cancer.

Methods: Equal numbers of African Americans (AAs) and European Americans (EAs) by smoking status (never/former/current) matched with PCa aggressiveness, BMI, 5-year age group, and year of baseline recruitment, totaling 480 participants, were included in the metabolomics study. For metabolomics analysis, fold change and BH-adjusted p-value from t-test adjusted for age for univariate analysis, and PCA adjusted for age and PLS-DA supervised statistical analysis for multivariate analysis were employed to decipher the underlying metabolomic patterns, and identify significantly dysregulated metabolites for the variables of interest.

Results: AA participants were significantly younger (mean=61.4, SD=7.7) compared with EAs (mean=63.5, SD=7.5). Current smokers had a 2.4 times higher risk of high aggressive PCa. When stratified by race, the risk diminished for EAs but increased for AAs. Global metabolic profiles detected a total of 1,487 compounds of known identity. After excluding metabolites with missing values in more than 20% of the samples and with small standard variation, we observed a distinct cluster of participants from AA aggressive PCa patients and current smokers that were separated from EAs and never smokers. With BH-adjusted p-value &lt; 0.05 and fold change &gt; 2, we identified 10 significantly dysregulated metabolites between AA and EA among high aggressive PCa and current smokers. Further, 36 metabolites between current and never smokers among AA high aggressive PCa were significantly dysregulated, but none of them are annotated as tobacco metabolites.

Conclusion: Our study presented distinctive metabolomics profiles specific to AA current smokers who had high aggressive PCa. Furthermore, the distinctive patterns were not driven by the tobacco metabolites, with the potential to identify metabolites that might help to understand the relationships between smoking and aggressive PCa in AA.

Citation Format: Se-Ran Jun, L. Joseph Su, Eryn Matich, Ping-Ching Hsu. Distinctive metabolomics profiles associated with African American current smokers who have high aggressive prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3680.

Recreational and occupational physical activity in relation to prostate cancer aggressiveness: the North Carolina-Louisiana Prostate Cancer Project (PCaP)

PURPOSE

To examine associations between recreational and occupational physical activity and prostate cancer aggressiveness in a population-based, case-only, incident prostate cancer study.

METHODS

Data were analyzed from the cross-sectional North Carolina-Louisiana Prostate Cancer Project of African-American (n = 1,023) and European-American (n = 1,079) men newly diagnosed with prostate cancer (CaP). High-aggressive CaP was defined as Gleason sum ≥ 8, or prostate-specific antigen > 20 ng/ml, or Gleason sum ≥ 7 and clinical stage T3-T4. Metabolic equivalent tasks (MET) were estimated from self-reported recreational physical activity in the year prior to diagnosis assessed retrospectively via a validated questionnaire and from occupational physical activity based on job titles. Associations between physical activity variables and high-aggressive prostate cancer were estimated using logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for multiple confounders.

RESULTS

There was suggestive evidence that walking for 75-150 min/week for exercise is associated with lower odds of high-aggressive prostate cancer compared to no walking (OR = 0.69, 95% CI 0.47-1.01). Physical activity at the current job was associated with 24% lower odds of high-aggressive prostate cancer (highest vs. lowest tertile OR = 0.76, 95% CI 0.56-1.04). However, total MET-h/week of recreational physical activity and accumulation of high-level physical activity at the longest-held job were not associated with high-aggressive prostate cancer. Results did not vary by race.

CONCLUSIONS

The odds of high-aggressive prostate cancer were lower among men who walk for exercise and those engaged in occupations with high activity levels.

Association Between Household Income and Self-Perceived Health Status and Poor Mental and Physical Health Among Cancer Survivors

Background: Health-related quality of life (HRQoL) is multidimensional and is composed of, at a minimum, self-perceived health status, physical functioning, and psychological well-being. HRQoL measures reflect the extent of disability and dysfunction associated with a chronic disease such as cancer. The objective of this study is to examine factors associated with HRQoL among cancer survivors.

Methods: Data from the 2009 Behavioral Risk Factor Surveillance System survey was used to examine factors associated with HRQoL among participants who reported having ever been diagnosed with cancer. Four questions associated with HRQoL included self-perceived health status, number of bad physical health days, and number of bad mental health days per month. Least square regression and logistic regression models, adjusted for confounding variables, were used for an ordinal and dichotomous [5 (bad) vs. 1–4 (excellent, very good, good, fair)] scale of HRQoL, respectively.

Results: Fifty nine thousand one hundred seventy three participants reported having ever been diagnosed with cancer. Adjusted mean self-perceived health status (5-point scale) among survivors of thyroid, colon, lung, cervical, breast, prostate, and ovarian cancer was 3.83 (0.05), 4.02 (0.04), 4.36 (0.06), 3.77 (0.03), 3.88 (0.03), 3.78 (0.04), and 3.96 (0.05), respectively. After adjusting for confounders, a positive dose-response effect was observed between income range and all three HRQoL measures across all seven cancer sites. Income was consistently and inversely associated with a higher chance for reporting poorer HRQoL [OR: 0.64, 95% CI: 0.57–0.71], [OR: 0.63, 95% CI: 0.48–0.82], [OR: 0.67, 95% CI: 0.56–0.80], [OR: 0.69, 95% CI: 0.56–0.86], [OR: 0.55, 95% CI: 0.49–0.62], [OR:0.55, 95% CI: 0.44–0.69], [OR: 0.75, 95% CI: 0.62–0.91] among those with thyroid, colon, lung, cervical, breast, prostate, and ovarian cancer, respectively.

Discussion: This study found that income range was associated with HRQoL among cancer survivors. It is plausible that financial resources may lessen the overall burden of cancer survivors, which could improve health-related quality of life among cancer survivors.

Aspirin, ibuprofen, and reduced risk of advanced colorectal adenoma incidence and recurrence and colorectal cancer in the PLCO Cancer Screening Trial

BACKGROUND

Studying the differential impact of aspirin and other nonsteroidal anti-inflammatory drugs across the stages of colorectal neoplasia from early adenoma to cancer is critical for understanding the benefits of these widely used drugs.

METHODS

With 13 years of follow-up, the authors prospectively evaluated the association between aspirin and ibuprofen use and incident distal adenoma (1221 cases), recurrent adenoma (862 cases), and incident colorectal cancer (CRC; 2826 cases) among men and women in the population-based Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. With multivariable-adjusted models, odds ratio (ORs) and 95% confidence intervals (CIs) for adenoma incidence and recurrence and hazard ratios (HRs) and 95% CIs for incident CRC were determined.

RESULTS

The authors observed a significantly reduced risk of incident adenoma with ibuprofen use (≥30 vs <4 pills per month: OR, 0.76 [95% CI, 0.60-0.95]; Ptrend = .04), particularly advanced adenoma (OR, 0.48 [95% CI, 0.28-0.83]; Ptrend = .005). Among those with a previous adenoma detected through screening, aspirin use was associated with a decreased risk of advanced recurrent adenoma (≥30 vs <4 pills per month: OR, 0.56 [95% CI, 0.36-0.87]; Ptrend = 0.006). Both aspirin (HR, 0.88 [95% CI, 0.81-0.96]; Ptrend <.0001) and ibuprofen use (HR, 0.81 [95% CI, 0.70-0.93); Ptrend = 0.003) ≥30 versus <4 pills per month were significantly associated with reduced CRC risk.

CONCLUSIONS

In this large prospective study with long-term follow-up, a beneficial role for not only aspirin, but also ibuprofen, in preventing advanced adenoma and curbing progression to recurrence and cancer among older adults was observed.

Abstract P164: Risk Factors Of Undiagnosed Diabetes And Hypertension In Arkansas

Introduction: Hypertension and diabetes are issues in the US especially in the south. In Arkansas, an estimated 797,000 adults have prediabetes and are at risk for diabetes. We aimed to assess cardiometabolic risk factors and impact of nutrition-related indicators in self-identified diabetes and hypertension patients and those at risk.

Method: Data were analyzed from the 2008 Arkansas Cardiovascular Health Examination Survey (n=1,383), which used probability sampling to obtain a representative sample of Arkansas residents. A self-report survey was administered on health history, socioeconomic status (SES), lifestyle, and diet. Blood biomarkers were measured and compared for those who self-reported diabetes or hypertension with those who were at risk.

Results: We used t-tests for continuous variables and chi-square test for categorical variables with statistical significance at p<0.05. We hypothesized that participants with undiagnosed diabetes or hypertension had less access to care (SES as a surrogate) and worse health behavior than the diagnosed groups. Significant differences in SES, behaviors, nutrients, and biomarkers were observed between healthy vs. both diagnosed and undiagnosed groups. Surprisingly, we found that undiagnosed groups had higher average food security than the diagnosed groups. Also, some of the health behaviors including alcohol consumption were 5-6 fold higher among the undiagnosed and healthy groups as compared to currently diagnosed diabetes group. Moderate physical activity was about 2 fold higher among the healthy (5.5 hours/week) as compared to undiagnosed hypertension group (3 hours/week). In addition, the currently diagnosed groups seem to have some improved dietary habits based on higher levels of vegetable and fruit consumption and lower blood cholesterol. We have also found that both the healthy and undiagnosed diabetes groups had above normal or high triglyceride levels.

Conclusion: Undiagnosed diabetes and hypertension do not have serious symptoms, but are dangerous health conditions. From our findings, targeted education should be implemented among all people, especially on access to food, vegetable and fruit consumption, alcohol use, physical activity, cholesterol and triglyceride levels.

Association between pesticide exposure and colorectal cancer risk and incidence: A systematic review

BACKGROUND

Studies investigating the association between pesticide exposure and colorectal cancer (CRC) risk have been inconclusive.

OBJECTIVES

Investigate the association between pesticide exposure and CRC risk through a systematic literature review.

METHODS

CRC has the fourth-highest rate of cancer-caused death in the US after lung cancer, breast cancer in women, and prostate cancer in men. Here we have conducted a systematic literature search on studies examining the association between any pesticide exposure and CRC risk using PubMed, MEDLINE via EBSCO host, and Embase according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

RESULTS

Following the review, 139 articles were included for qualitative evaluation. Study participants were farmers, pesticide applicators, pesticide manufacturers, spouses of pesticide applicators, farm residents, Korean veterans of the Vietnam War, rural communities, and those who consumed food with pesticide residues. The studies' results were split between those with significant positive (39 significant results) and inverse (41 significant results) associations when comparing pesticide exposure and CRC risk.

DISCUSSION

From our literature review, we have identified a similar number of significant positive and inverse associations of pesticide exposure with CRC risk and therefore cannot conclude whether pesticide exposure has a positive or inverse association with CRC risk overall. However, certain pesticides such as terbufos, dicamba, trifluralin, S-ethyl dipropylthiocarbamate (EPTC), imazethapyr, chlorpyrifos, carbaryl, pendimethalin, and acetochlor are of great concern not only for their associated elevated risk of CRC, but also for the current legal usage in the United States (US). Aldicarb and dieldrin are of moderate concern for the positive associations with CRC risk, and also for the illegal usage or the detection on imported food products even though they have been banned in the US. Pesticides can linger in the soil, water, and air for weeks to years and, therefore, can lead to exposure to farmers, manufacturing workers, and those living in rural communities near these farms and factories. Approximately 60 million people in the US live in rural areas and all of the CRC mortality hotspots are within the rural communities. The CRC mortality rate is still increasing in the rural regions despite the overall decreasing of incidence and mortality of CRC elsewhere. Therefore, the results from this study on the relationship between pesticide exposure and CRC risk will help us to understand CRC health disparities.

Low‑Level Environmental Heavy Metals are Associated with Obesity Among Postmenopausal Women in a Southern State

Both arsenic and cadmium are reported to be toxic to humans. The use of saliva as a biomarker of low-level exposures to these elements has not been adequately explored, and the putative relationship between exposure and obesity is unclear. This cross-sectional study aims to investigate the relationship between salivary arsenic and cadmium concentrations and their association with obesity. Arsenic and cadmium concentrations were analyzed in human saliva samples by Inductively Coupled Plasma-Mass Spectrometry on 270 randomly selected women who participated in the Arkansas Rural Community Health Study. Multivariable logistic regression was performed to evaluate the association between heavy metal concentrations and obesity. Stratified logistic regression was performed based on menopausal status. Generalized linear models were used to evaluate weight gain velocity. Significant positive associations were observed in postmenopausal women for both arsenic (OR = 4.43, 95% CI 1.91-10.28) and cadmium (OR = 2.72, 95% CI 1.23-5.99) concentrations, as well as significant trends among tertiles (p < 0.01 and p = 0.01, respectively). No relationship with obesity was evident among premenopausal women for either metal. A dose-response relationship was observed between increasing weight gain velocity and increasing metal concentrations. At concentrations well below governmental and industrial standards for acute toxicity, significant associations between obesity and concentration of these heavy metals are evident. The rate at which individuals gain weight is affected by metal concentrations and may play a role in the rapid increase in weight in postmenopausal women. These results might explain, in part, the missing variability in the increasing obesity pandemic in certain population exposed to these environmental toxicants.

Independent and Joint Effects of Testosterone Replacement Therapy and Statins use on the Risk of Prostate Cancer Among White, Black, and Hispanic Men

The associations of testosterone therapy (TTh) and statins use with prostate cancer remain conflicted. However, the joint effects of TTh and statins use on the incidence of prostate cancer, stage and grade at diagnosis, and prostate cancer-specific mortality (PCSM) have not been studied.We identified White (N = 74,181), Black (N = 9,157), and Hispanic (N = 3,313) men diagnosed with prostate cancer in SEER-Medicare 2007-2016. Prediagnostic prescription of TTh and statins was ascertained for this analysis. Weighted multivariable-adjusted conditional logistic and Cox proportional hazards models evaluated the association of TTh and statins with prostate cancer, including statistical interactions between TTh and statins.We found that TTh (OR = 0.74; 95% CI, 0.68-0.81) and statins (OR = 0.77; 95% CI, 0.0.75-0.88) were inversely associated with incident prostate cancer. Similar inverse associations were observed with high-grade and advanced prostate cancer in relation to TTh and statins use. TTh plus statins was inversely associated with incident prostate cancer (OR = 0.53; 95% CI, 0.48-0.60), high-grade (OR = 0.43; 95% CI, 0.37-0.49), and advanced prostate cancer (OR = 0.44; 95% CI, 0.35-0.55). Similar associations were present in White and Black men, but among Hispanics statins were associated with PCSM.Prediagnostic use of TTh or statins, independent or combined, was inversely associated with incident and aggressive prostate cancer overall and in NHW and NHB men. Findings for statins and aggressive prostate cancer are consistent with previous studies. Future studies need to confirm the independent inverse association of TTh and the joint inverse association of TTh plus statins on risk of prostate cancer in understudied populations. PREVENTION RELEVANCE: The study investigates a potential interaction between TTh and statin and its effect on incident and aggressive prostate cancer in men of different racial and ethnic backgrounds. These results suggest that among NHW and non-Hispanic Black men TTh plus statins reduced the odds of incident prostate cancer, high-grade and advance stage prostate cancer.

Abstract PO-038: Colorectal cancer health disparity among African Americans: A qualitative study at the community level, exploring the connection between low access to resources, diet, and colorectal health

Background: Colorectal cancer (CRC) is the third leading cause of cancer death in the United States (US) but can be prevented with routine screening. A significant racial disparity exists among African Americans (AAs) with higher CRC incidence and mortality rates than other races, in particular in some rural areas, such as the lower Mississippi Delta regions including 17 counties in Arkansas. However, this disparity cannot be explained solely by lack of screening. Previous studies have suggested that this health disparity may be related to limited access to healthy food, lack of physical activity, and lack of facilities for cancer screening. Additional research in Arkansas is needed on the determinants of these disparities to develop actionable prevention strategies. Methods: An engagement approach known as a community review board (CRB) was used in this study. A CRB is a one-time meeting with community member experts who have personal experience with the research issue, and these experts provide feedback on the study. Two CRBs consisting of AAs age 45-75 were conducted, in urban, central (Little Rock, n=6) and rural, lower Delta (Helena, n=10) Arkansas communities, to better understand these communities’ perspectives on CRC and screening. We also discussed the community members’ willingness to participate in a study to look at the association between diet and food security with CRC and the barriers to participate. Differences in the viewpoints of the two CRBs were compared and documented. Results: Both rural and urban CRB respondents indicated their willingness to believe and listen to other community members, and generally do not go to the doctor unless they are sick. A lower percentage of our rural CRB participants (30%) had been screened for CRC as compared to our urban CRB participants (83%). When invited to participate in research studies, rural CRB respondents preferred to learn about the results of the study in a public, community forum. These older AA community members, both rural and urban, thought communities could benefit from more information disseminated related to these topics. Additionally, the rural CRB participants were more comfortable discussing CRC incidence and mortality with family compared to urban CRB participants.

Conclusions: From this study, those in this rural community are more comfortable discussing CRC in the community-based discussion and with their family, and this may be related to the fact that they live in a CRC mortality hotspot in the Delta region. In addition, because members of these communities, both rural and urban, mentioned the need for more available information about CRC and screening we will hold virtual community forums with residents of Little Rock and Phillips County to discuss CRC, screening, and diet to inform and learn more from these Arkansas communities. We will also use the community members’ feedback to improve our research project in which we will analyze the association between food security, diet, and CRC.

Citation Format: Eryn K. Matich, Rachel Hale, Nicola Spencer, M. Kathryn Stewart, L. Joseph Su, Ping-Ching Hsu. Colorectal cancer health disparity among African Americans: A qualitative study at the community level, exploring the connection between low access to resources, diet, and colorectal health [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-038.

Abstract PO-161: Racial differences in the association of one-carbon metabolism polymorphisms and prostate cancer aggressiveness

Introduction: Prostate Cancer (PCa) disproportionately affects African Americans, as AA men are more commonly diagnosed with aggressive PCa and twice as likely to have mortality from the disease compared to European Americans (EA). The one- carbon metabolism pathway has been extensively studied for cancer development, yet little research has been reported on its association with aggressiveness of cancer at diagnosis. The purpose of our study is to determine whether there is difference by race for the impact of a DHFR 19bp polymorphism together with multiple single nucleotide polymorphisms (SNPs) in one-carbon metabolism genes on a cohort of men diagnosed with either low-aggressive or high-aggressive PCa. Methods: DNA samples from a population-based study of 1,498 PCa subjects in the North Carolina- Louisiana Prostate Cancer Project were analyzed. The DHFR 19bp polymorphism was targeted by utilizing two TaqMan TAMRA probes, one with a FAM fluorescent probe to identify the insertion allele and one with a VIC fluorescent probe to identify the deletion allele. Six SNPs were genotyped via TaqMan SNP genotyping assays by Applied Biosystems. Chi-Square analyses were performed to examine differences in genotype between race. A multivariable logistic regression model adjusted for confounders was utilized to estimate the association of the 19bp DHFR polymorphism and one-carbon metabolism SNPs with PCa aggressiveness. Results: A total of 152 participants were excluded due to insufficient DNA samples, resulting in a sample of 1,346 participants. The analysis consisted of 993 low-aggressive and 345 high aggressive PCa cases. Chi-square analyses revealed significant frequency differences between AAs and EAs for the 19bp DHFR deletion polymorphism (31.2% vs 17.6%), as well as MTHFR rs1801131, MTHFR rs1801133, MTR rs1805087, MTHFD1 rs2236225, and MTHFD2 rs7587117 (P values &lt; 0.0001). After adjusting for confounders, the cohort was stratified based on DHFR polymorphism status. Among subjects with the 19bp DHFR double deletion, individuals with heterozygous MTR rs1805087 (AG) were significantly less likely to have aggressive PCa (OR = 0.27 [0.10, 0.74]) when compared to individuals with the GG genotype. Among the group that had at least one copy of wild-type DHFR, heterozygous individuals (GA) at MTHFD1 rs2236225 had a significantly lower chance of aggressive PCa diagnosis (OR = 0.60 [0.38, 0.95]) compared to individuals with the AA genotype. Conclusion: Substantial differences exist between AAs and EAs in regard to polymorphisms within the one-carbon metabolism pathway. There appears to be significant interaction among genes involved that can be attributable to the racial distribution of genetic polymorphisms. Studies examining the association between folate metabolism and PCa should consider the modulation effect of gene-gene interaction when analyzing the polymorphisms collectively.

Citation Format: C. Tyler Ratliff, Lora J. Rogers, L. Joseph Su. Racial differences in the association of one-carbon metabolism polymorphisms and prostate cancer aggressiveness [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-161.

Abstract B26: Combinational effect of sulforaphane (SFN) and epigenetic demethylation agent 5-aza-2’-deoxycytidine (DAC) on metastatic melanoma

UV exposure-induced oxidative stress is implicated as the driving mechanism of melanoma development. Increased oxidative stress results in imbalanced reactive oxygen species (ROS) that damage DNA and dysregulated epigenetic modifications and leads to melanoma progression. Sulforaphane (SFN) is the natural bioactivated product of the cruciferous vegetable family (e.g., broccoli and Brussels sprouts) and is known to play a dual role in cytoprotection and to induce apoptosis in the tumor via antioxidant regulation and histone modification of epigenetic enzymes. We investigated the combinational effect of 5-aza-2’-deoxycytidine (DAC), an FDA-approved DNA-modification epigenetic drug and SFN in melanoma cells. We found further cell growth inhibition and an increased number of altered gene expression profiles, increased survival-related cytokine expression, as well as unique histones post-translational modifications (PTMs) upon combinational treatments compared to single treatment in vitro. These results set the stage for animal studies. The long-term goal of the current study is to find an optimal dietary dose of antioxidants from SFN to reduce the burden of oxidative stress, which may contribute to melanoma recurrence, a constant problem with current treatments. In addition to recurrence, a reduced dose of epigenetic drugs applied may minimize the side effects of single-high-dose treatment.

Citation Format: Tung-chin Chiang, L. Joseph Su, Brian S. Koss, Charity Washam, Stephanie Byrum, Aaron Storey, Alan J. Koss. Combinational effect of sulforaphane (SFN) and epigenetic demethylation agent 5-aza-2’-deoxycytidine (DAC) on metastatic melanoma [abstract]. In: Proceedings of the AACR Special Conference on Melanoma: From Biology to Target; 2019 Jan 15-18; Houston, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(19 Suppl):Abstract nr B26.

Biomarkers of inflammation, hypercoagulability and endothelial injury predict early asymptomatic doxorubicin-induced cardiotoxicity in breast cancer patients

Doxorubicin (DOX)-induced cardiotoxicity is a major limitation to its clinical application. Cardiotoxicity of DOX is dose-dependent that begins with the first dose. Oxidative stress and inflammation are involved in DOX-related cardiotoxicity. This study aimed to determine whether multiple markers of inflammation, hypercoagulability and endothelial injury correlate with the risk of early DOX-induced cardiotoxicity in breast cancer patients. Blood samples of 51 breast cancer patients treated with DOX-based chemotherapy were collected before (baseline) and after the first cycle of chemotherapy. The risk of cardiotoxicity was defined as an asymptomatic reduction of cardiac left ventricle ejection fraction (LVEF) >10% at completion of chemotherapy versus baseline. Plasma samples were examined for multiple biomarkers of inflammation, hypercoagulability and endothelial dysfunction, including C-reactive protein (CRP), thrombomodulin (TM), thrombin-antithrombin complex (TAT), myeloperoxidase (MPO), von Willebrand factor (vWF) and P-selectin. Surrogate markers of neutrophil extracellular traps (NETs) nucleosomes and double stranded DNA (dsDNA) were also measured. Patients with abnormal decline of LVEF >10% (n=21) had significantly elevated levels of MPO and TM both at baseline, and after the first dose of DOX-based chemotherapy relative to patients with normal LVEF (n=30) after adjusting for race, age, BMI and type of breast cancer. The first dose of DOX also induced significantly higher circulating levels of TAT complex and nucleosomes in patients at risk of cardiotoxicity in comparison with patients without. The comparison between the means of the biomarkers in after-before DOX-based chemotherapy of the two groups of patients showed significant differences for MPO, TAT complex and CRP. The results from this study suggest that the risk of DOX-induced cardiotoxicity in breast cancer is associated with endothelial dysfunction, inflammation and prothrombotic state before and after the first dose of chemotherapy.

Abstract LB-182: Combination of sulforaphane and 5-aza-2′-deoxycytidine slows the growth and upregulates the chemoattractant CCL5 in metastatic melanoma

UV exposure-induced oxidative stress is implicated as a driving mechanism for melanoma. Increased oxidative stress results in DNA damage and epigenetic dysregulation. We previously found that a low dose of the antioxidant sulforaphane (SFN) in combination with the epigenetic drug 5 –aza –2 ′–deoxycytidine (DAC) slowed cell growth in melanoma at a greater rate than DAC alone. Here, we report a multi –omics analysis with combination and single drug treatment. We observed a significant increase in global protein abundance with an altered level of expression in the combination treatment as compared to individual treatment. Proteins associated with methylation patterns and with reactive oxidative species were found dysregulated in combination treatment. A comparison analysis of proteomic and transcriptomic data with Ingenuity Pathway Analysis showed common canonical pathways involved in phosphorylation (ERK/MAPK signaling) and immune response with combination treatment. The global DNA methylation pattern was analyzed to explore the impact of combination and single drug treatment on methylation status. Interestingly, we observed an increase in the levels of a critical immuno-regulator cytokine, C –C motif ligand 5 (CCL5), which functions as a chemoattractant for natural killer (NK) cells. Animal studies showed the level of CCL5in blood and tumor was increased with DAC and SFN combination treatment compared to that of control, which coincided with tumor reduction. Our data demonstrate the impact of SFN on the effectiveness of the FDA –approved drug DAC to reduce metastatic melanoma tumors.

Citation Format: Tung-Chin Chiang, Brian Koss, Aaron J. Storey, Jovanny Zabaleta, Samrat Roy Choudhury, Bradley D. Shields, Elizabeth C. Draper, L Joseph Su, Alan J. Tackett. Combination of sulforaphane and 5-aza-2′-deoxycytidine slows the growth and upregulates the chemoattractant CCL5 in metastatic melanoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-182.

Abstract LB-174: Genome-wide DNA methylation signatures predict the early asymptomatic doxorubicin-induced cardiotoxicity in breast cancer

Background: Doxorubicin (DOX)-induced cardiotoxicity is cumulative-dose-dependent that begins with the first dose, but epigenetic changes after the first dose have not been examined. This study had two aims: Aim 1: to examine whether DNA methylation profile of peripheral blood cells (PBCs) induced by the first cycle of DOX-based chemotherapy can predict the risk of cardiotoxicity; and Aim 2 to determine if there are pretreatment methylation signatures at baseline to predict the risk of cardiotoxicity. Methods: Whole-genome DNA methylation of PBCs from 19 breast cancer patients was examined prior to the start of DOX-based chemotherapy and after the first cycle using Infinium HumanMethylation 450 BeadChip. ChAMP R package was used for the data normalization by the BMIQ algorithm and the COMBAT algorithm to adjust for batch effects. Chemotherapy-induced cardiotoxicity was determined by the assessment of left ventricle ejection fraction (LVEF) with multigated acquisition (MUGA) scan before chemotherapy and at its completion, and any LVEF decline by &gt;10% was considered abnormal. Results: Pre- and post- DOX treatment were compared between patients with abnormal LVEF decline and those who maintained normal LVEF to assess the differences in the cytosine methylation states. The multiple correction testing resulted in a total of 515 differentially methylated CpGs between the patients with abnormal versus normal LVEF post-DOX treatment. There were 379 differentially methylated CpGs at baseline and 136 CpGs after the first cycle which significantly correlated with LVEF status after applying the Holm-Bonferroni method for multiple testing correction. The intersection of the probes resulted in 38 differentially methylated genes (DMG) that when used in hierarchical clustering, correctly clustered baseline samples into those that would result in normal and abnormal LVEF after treatment. DMG genes included SEPT5, IRF6, KCNQ1, NELL1, SIX6, HOXC9 and BCAN. IRF6, which encodes interferon regulatory factor 6, was identified as being significant in the subsequent analysis at the probe and region level. Comparisons of the samples before and after DOX treatment did not result in any probes associated with the treatment that were significant after multiple testing correction. Conclusions: The results from this study provide evidence that DNA methylation profile of peripheral blood cells has the potential to predict the risk of DOX-induced cardiotoxicity. The important finding was that the extent of methylation at baseline correlated with the post-DOX LVEF reduction, indicating that it may have the potential to predict the subsequent development of cardiotoxicity. Further studies with larger cohort of patients are needed to confirm these findings as well as narrowing down candidate methylation markers that can be implemented in a blood test. These finding may help guide treatment or identify patients that need to be followed closely to mitigate heart damage after DOX treatment.

Citation Format: Michael A. Bauer, Issam Makhoul, Ping-Ching Hsu, Jeanne Wei, L. Joseph Su, Annjanette Stone, Weleetka Carter, Valentina K. Todorova. Genome-wide DNA methylation signatures predict the early asymptomatic doxorubicin-induced cardiotoxicity in breast cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-174.

Abstract PR14: Dietary folate and prostate cancer tumor aggressiveness differences between African Americans and European Americans

Introduction: Folate is a water-soluble B vitamin, which is involved in DNA synthesis and repair and in regulation of gene expression through DNA methylation as a methyl donor. Despite the confirmed beneficial effect on the prevention of neural tube defect, concerns have been raised on high intakes of folate and its synthetic form, folic acid, may promote carcinogenesis or cancer progression. African American (AA) males tend to have a more aggressive prostate cancer tumor diagnosis compared to European American (EA) males.

Objective: This aim of this study is to examine the association between folic acid intake in the year prior to PCa diagnosis among AAs and EAs. Using a population-based case-only study, an examination of folic acid was conducted to evaluate the effects of dietary folate on prostate cancer aggressiveness.

Methods: Data from the North Carolina-Louisiana Prostate Cancer Project (PCaP) questionnaire were used to evaluate 1,497 participants (AA n = 722 and EA n = 775) with a low or high aggressiveness prostate cancer to assess dietary folate intake one year prior to PCa diagnosis using the National Cancer Institute Dietary History Questionnaire. High-aggressive disease was defined as Gleason sum ≥8, or prostate-specific antigen (PSA) &gt;20 ng/mL, or Gleason score ≥7 and clinical stage T3-T4, while low-aggressive disease was defined as Gleason sum &lt;7 and stage T1—T2 and PSA &lt;10 ng/mL. All four variables for dietary folate (natural folate, synthetic folate, folate, and dietary folates) were examined. Multivariate logistic regression was used to assess dietary folate and prostate cancer aggressiveness. Confounding variables considered for this analysis include age, BMI, total energy (kcal), education level, and first-degree family history of PCa. Additionally, dietary folate was categorized into tertiles. Models were stratified by race and the dose-response relationship was evaluated.

Results: Folate intakes, regardless natural folate (mean = 354.5 vs 304.1), synthetic folate (176.3 vs 157.5), or total dietary folate equivalent (654.0 vs 571.5), were higher among AA than EA, respectively. Based on the tertile categorization, the highest dietary folate was significantly associated with high-aggressive prostate cancer when compared to the lowest intake group among AA and EA combined (odds ratio (OR) = 1.41, 95% confidence interval (CI) = 1.04 – 1.90) after adjusted for confounders. Stratified model by race showed that there is an increased trend in PCa aggressiveness and increased folate intake (2nd tertile OR = 1.03, 95%CI = 0.67 – 1.56; 3rd tertile OR = 1.41, CI = 1.11 – 2.48), p-value for trend = 0.01. The association was not observed among EA. The trend is very similar regardless of natural or synthetic folate.

Conclusion: It appeared that AA with high folic acid intake had a greater chance of being diagnosed with high-aggressiveness PCa, while the association was not observed among EA. The finding suggests that the metabolism of folate may be different between AA and EA, possibly due to genetic polymorphisms.

This abstract is also being presented as Poster C034.

Citation Format: Daniela Ramirez Aguilar, Susan E Steck, Hui-Yi Lin, LJ Su. Dietary folate and prostate cancer tumor aggressiveness differences between African Americans and European Americans [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr PR14.

Abstract C062: Racial differences in genome-wide DNA methylation profiles by county poverty levels among women residing in Arkansas

Introduction and Purpose: DNA methylation is a potential biomarker of cellular stress and biologic aging, above that of chronologic age. Aberrant DNA methylation patterns have been associated with overall health and life expectancies and can be susceptible to biologic and environmental influences and stressors. DNA methylation has been shown to be modified by adverse living conditions in urban neighborhoods, but there is little knowledge of how adverse rural environments impact these biomarkers. An algorithm has been developed and validated that quantifies epigenetic age, and this measure has been strongly associated with health and life expectancy but has not been explored in rural and rural minority populations who have documented overall health disparities. The goal of this pilot study is to examine the impact of adverse rural neighborhoods on biomarkers of DNA methylation and epigenetic aging.

Methods: Genome-wide DNA methylation was assessed using the Illumina 850K EPIC Beadchip, and the DNA methylation age estimation was derived using the algorithms Horvath developed based on the DNA methylation levels. Percent poverty rate at the census level was obtained according to their zip code data by ArcGIS. Ten women of self-reported African American (AA) descent each from counties with high poverty rates (&gt;20% of the population) and those with low poverty rates (&lt;10%) were randomly selected based on the 2008-2012 US Census American Community Survey, as well as ten women each of European American (EA) descent from counties with high or low poverty rates. Ingenuity Pathway Analysis (IPA) was performed to identify biologic pathways that were differentially methylated between residents of counties with high or low poverty rates and by race.

Results: Among AA women, hypermethylation was more common in AA residents of counties with low compared to high poverty rates (70% vs 30%). The top canonical pathways impacted by differential methylation were related to glucocorticoid receptor, p53, and estrogen-dependent breast cancer signaling in AA women. EA women living in low-poverty counties exhibited less hypermethylation of CpGs than those living in high-poverty counties (27% vs. 73%). The top canonical pathways were related to hereditary breast cancer, glucocorticoid receptor, androgen and PI3K/AKT signaling. Epigenetic age of the 39 women in the study was highly correlated with their chronologic age (r=0.82, p=1.71e-10). When epigenetic age acceleration was considered, however, no significant differences by race and/or poverty levels were apparent.

Conclusions: The finding of this pilot study suggests that living in adverse neighborhoods may impact DNA methylation patterns in breast cancer-related pathways when compared to living in affluent ones, and the pattern appears to be different on race. Larger studies should confirm our findings.

Citation Format: Ping-Ching Hsu, Susan Kadlubar, Daniel Acheampong, Lora Rogers, Gail Runnells, Pearl McElfish, Mario Schootman, L. Joseph Su. Racial differences in genome-wide DNA methylation profiles by county poverty levels among women residing in Arkansas [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C062.

Abstract B036: Self-perceived health status, poor physical and mental health days among cancer survivors with different socioeconomic status

Background: Health-related quality of life (HRQOL) is multidimensional and is composed of, at a minimum, self-perceived health status, physical functioning and psychological well-being. HRQOL measures reflect the extent of disability and dysfunction associated with a chronic disease such as cancer. Self-perceived health status is a good proxy for disease burden among cancer patients.

Purpose: This study used a nationally representative population survey to examine socioeconomic status disparities in HRQOL among survivors of thyroid, colon, lung, cervical, breast, prostate or ovarian cancer.

Methods: Data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) survey conducted by the CDC were used to examine factors associated with HRQOL among participants reported ever having been diagnosed with cancer. Typically, the cancer survivorship module is an optional component of the survey. However, the 2009 survey considered the cancer survivorship questions to be a core or required component of the survey. The BRFSS is a cross-sectional survey that assessed overall HRQOL, self-perceived health status, number of bad physical health and bad mental health days per month. Least square regression and logistic regression models, adjusting for confounding variables (e.g., age, gender, race/ethnicity, education level, and number of comorbidities), were used for ordinal and dichotomous (5 (bad) vs 1-4 (excellent, very good, good, fair)) scale of HRQOL, respectively.

Results: Among 432,607 surveyed, 59,173 reported ever been diagnosed with cancer. The seven most reported cancers were the focus of this study. Mean score for self-perceived health status (5-point scale) among survivors of thyroid, colon, lung, cervical, breast, prostate, and ovary was 2.83 (1.10), 3.15 (1.12), 3.68 (1.12), 2.98 (1.17), 2.93 (1.09), 2.94 (1.10), and 3.16 (1.18), respectively. After adjusting for confounders, a positive dose-response effect was observed between income level and all three HRQOL measures across all seven cancer sites. Income was consistently and inversely associated with a higher chance for reporting poorer HRQOL [OR: 0.64, 95% CI: 0.57-0.71], [OR: 0.63, 95% CI: 0.48-0.82], [OR: 0.67, 95% CI: 0.56-0.80], [OR: 0.69, 95% CI: 0.56-0.86], [OR: 0.55, 95% CI: 0.49-0.62], [OR:0.55, 95% CI: 0.44-0.69], [OR: 0.75, 95% CI: 0.62-0.91] among those with breast, thyroid, colon, lung, cervical, prostate, breast, and ovarian cancer, respectively. Race or ethnicity was not associated with in HRQOL among cancer survivors in the adjusted models.

Conclusion: This study found income, but not race or ethnicity, is associated with HRQOL among cancer survivors, after adjusting for confounders in this nationally representative survey population. Household income appears to be a strong predictor of HRQOL among cancer survivors. Despite potential survival bias in this cross-sectional survey, it is possible that financial resources may lessen the overall burden of cancer survivors.

Citation Format: Sarah N. O'Connor, L. Joseph Su. Self-perceived health status, poor physical and mental health days among cancer survivors with different socioeconomic status [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B036.

Abstract D097: Association between high mammographic density and environmental chromium and arsenic exposure in a pilot study of women living in rural communities

Background Environmental contamination with heavy metals, such as metalloid arsenic (As), cadmium (Cd), and chromium (Cr), in soil in the Mississippi River Delta region has been documented by the US Geological Survey. Rural residents are more likely to be exposed throughout their life than those who live in urban cities because much of the vegetation grown in this area has a potentially higher content of these heavy metals. At the same time, this region also experiences higher breast cancer (BC) disparity when compared to the other parts of the country. Mammographic density (MD) is one of the strongest risk factors for nonfamilial BC and it is also related to long-term prospective increases in tumor incidence, independent of its masking effects on detection. High MD thus is directly related to breast carcinogenesis. Methods Urine samples and lifestyle factors were obtained from a subcohort of women recruited through a mobile mammography unit into the Arkansas Rural Community Health Study cohort. Mammography at enrollment is available on everyone in this subcohort. Urinary samples were analyzed for heavy metal exposure, including As, Cd, and Cr concentration using Fisher-Thermo inductively coupled plasma mass spectrometry (ICP-MS). All samples were analyzed in duplicates and concentrations were presented as microgram/gram creatinine. Mammographic density was assessed by staff radiologist based on the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) and verified with the LIBRA software, developed by the University of Pennsylvania. MD was categorized as dichotomous high (C and D) and low (A and B). Multivariable logistic regression was used to calculate odds ratios (OR) and 95% confidence interval (CI). Results Among 189 subjects who have completed follow-up interviews and contributed blood and urine samples, wee analyzed urine samples for heavy metal concentration, adjusted for urinary creatinine value and specific gravity. The mean (standard deviation) concentration of Cr, As and Cd were 0.27 (0.04), 0.28 (0.38) and 0.13 (0.11) ppb, respectively. We evaluated the association between MD and three major heavy metals of interest. When comparing the highest tertile urine Cr to the lowest tertile, Cr is positively associated with high MD (OR = 5.50, 95%CI = 1.08, 27.98) after adjusting for age, BMI, race, education, hormonal use, age at menarche, age at last menstrual cycle, and family history of breast cancer. Urine As is also positively associated with high MD (OR = 2.39, 95%CI = 0.98, 5.87, p = 0.06), adjusted for age and BMI. Cd was not significantly associated with MD with the current sample size. Conclusion Cr, As, and Cd are considered as Group 1 carcinogens according to the International Agency for Research on Cancer. This study suggests that there is a significantly increased odds of high MD even at very low levels of exposure to environmental Cr and As. Identifying sources of these contaminants would reduce the risk of breast cancer in rural communities.

Citation Format: L. Joseph Su, Tung-Chin Chiang, Lora J Rogers, Gail A Runnells, Susan A Kadlubar, Zoey Crystal, Christopher Wardell, Sharp Malak. Association between high mammographic density and environmental chromium and arsenic exposure in a pilot study of women living in rural communities [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D097.

Genome-wide DNA methylation signatures to predict pathologic complete response from combined neoadjuvant chemotherapy with bevacizumab in breast cancer

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT00203502.

Mobile Mammography Screening as an Opportunity to Increase Access of Rural Women to Breast Cancer Research Studies

Objectives

Rural women are underrepresented in cancer research. We hypothesized that providing access to a research study to rural, medically underserved women who were receiving their breast cancer screening using a mobile mammography unit would increase the representation of rural women in a cancer cohort study.

Design

This study is a cross-sectional study using a cohort of women who have been recruited to a breast cancer study in Arkansas.

Setting

Recruiters accompanied a mobile mammography unit, the MammoVan, to implement a novel method for reaching and recruiting underrepresented rural Arkansas women into the study. Participants include 5850 women recruited from 2010 through 2012 as part of the Arkansas Rural Community Health (ARCH) study.

Results

Participants recruited during their mammography screening on the MammoVan tended to be more rural, less educated, and more likely to be non-Hispanic than those recruited in other venues. A significant difference was not noted for race or age.

Conclusion

Collaboration with the MammoVan greatly aided the recruitment of rural participants. These strategies can facilitate the representation of this historically underserved and understudied rural population in future research studies.

Association between breast cancer risk and leisure physical activity in a rural cohort population

BACKGROUND

Physical activity has been identified as a modifiable risk factor for breast cancer. Varying definitions of physical activity have made the evaluation difficult to analyze. In a state with high prevalence of obesity and elevated rates of breast cancer incidence and mortality, physical activity may be an important element for risk reduction. Women's participation in physical activity and the relation to breast cancer incidence has rarely been determined in the southern states where obesity are prevalent.

METHODS

Associations between various levels of physical activity and incident breast cancer cases among 21,665 subjects residing in Arkansas from 2007-2018 were completed. Multivariate logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI), adjusting for various risk factors such as age, alcohol use, education, region, ethnicity, age at menarche, ever had children, and history of breastfeeding and family history of breast cancer. Stratification on menopausal status was performed to observe any breast cancer differences within the different biological pathways.

RESULTS

Among premenopausal subjects, inverse associations were observed among increase time in walking (OR =0.63, 95% CI: 0.36-1.11 and OR =0.47, 95% CI: 0.26-0.83) and overall weekly physical activity (OR =0.89, 95% CI: 0.50-1.57 and OR =0.52, 95% CI: 0.30-0.90) and breast cancer. No association was evident between the risk for breast cancer and physical activity among postmenopausal subjects. The relationship between physical activity and risk for breast cancer differed between menopausal statuses. The most apparent association was seen among premenopausal subjects with an increase in walking (P=0.01).

CONCLUSIONS

Although physical activity has been demonstrated to have a beneficial effect on breast cancer prevention among postmenopausal women, results from this study do not sufficiently support the hypothesis in this population. Results varied among menopausal status as well as among different definitions of physical activity. Further investigation is needed to identify factors contributing to de-attenuating the relationships.

Individual- and county-level determinants of high breast cancer incidence rates

Background

Age-adjusted breast cancer rates vary across and within states. However, most statistical models inherently identify either individual- or area-level determinants to explain geographic disparities in breast cancer rates and ignore the effects of the other level of determinants. We present a micro-macro modelling approach that incorporates both levels of determinants to better explain this variability and to discover opportunities to reduce breast cancer rates.

Methods

Individual-level data about breast cancer risk factors from eligible Arkansas Rural Community Health (ARCH) study participants (n=13,554) was supplemented with publicly available county-level data using a novel micro-macro statistical approach. This model uses individual-level data to account for aggregation-induced biases, to predict county-level breast cancer incidence rates across Arkansas.

Results

County-level breast cancer incidence rates ranged from 80.9 to 161.6 per 100,000 population. The best-fit model, which included individual-level predicted risk based on the Gail/CARE models, county-level population density (log transformed), and lead exposure (log transformed), explained 14.1% of the county variance.

Conclusions

Our results support theoretical models that maintain that area-level determinants of breast cancer incidence are key risk factors in addition to established individual risks.

Abstract 4180: Association between genetic polymorphisms of DNMT genes and breast cancer in a nested case-control study of African Americans

Introduction/Purpose. DNA methylation plays a significant role in both the development and progression of various cancers. Although aberrant DNA methylation of CpG islands is a common epigenetic alternation found in cancers, the interpretation of observed DNA methylation and cancer risk remains a challenge. DNA methylation is typically mediated by DNA Methyltransferases (DNMTs). This study took advantage of the infrastructure and existing data and samples of Arkansas Rural Community Health (ARCH) Study cohort to conduct a pilot nested case-control study of breast cancer among African Americans examining the relationship between breast cancer and DNMT single nucleotide polymorphisms (SNPs).

Methods: ARCH Study cohort consists of 26,387 women aged 18 to 85 recruited from all 75 counties in Arkansas between 2007 and 2014. All cohort participants donated a saliva sample for DNA and completed a short questionnaire at baseline. 309 African American breast cancer cases and 530 age-group, race, and recruitment year frequency-matched controls were selected for this analysis. Genotyping of DNMT1, DNMT3A, and DNMT3B were conducted using Tagman method. Multivariable logistic regression (odds ratio (OR), 95% confidence interval (CI) was used to examine the association between breast cancer and each SNP while considering the factors of age, education, and status of obesity, child birth, breast feeding, and menstrual-stop as potential confounding variables. Hardy-Weinberg equilibrium for the loci examined were evaluated. Haplotype analyses were conducted.

Results: Among 16 SNPs evaluated, heterozygous genotypes rs7575625 in DNMT1 and rs7605753 in DNMT3A were positively associated with breast cancer risk; rs12991495 in DNMT3A and rs17123590 and rs2424910 in DNMT3B were inversely associated with breast cancer. Haplotype AGA of rs8101626, rs2290684, and rs11880388 in DNMT1, which accounts for 43.9% population, differed significantly as a risk factor between cases and controls after adjusting for confounders (OR = 2.05; 95%CI=1.34, 3.12). Haplotype AGGGGT of rs2304429, rs12991495, rs7605753, rs11892646, rs7575625, and rs10196635 in DNMT3A differed significantly as a risk factor between cases and controls (OR = 4.06; 95%CI=1.93, 8.52); while haplotype rs2424905, rs2424910, rs17123590, rs6088008, and rs6058896 in DNMT3B was inversely associated with breast cancer (OR = 0.02; 95%CI=0.001, 0.29).

Conclusions: Despite the knowledge of DNMTs on DNA methylation, very few studies examined its role in breast cancer, in particular among underserved and minority population. This study took advantage of the existing sample and data of African Americans in a cohort population and demonstrated DNMT genetic polymorphisms are associated with breast cancer. Further evaluation of methylation patterns could provide knowledge on the mechanistic pathways for the association observed.

Citation Format: L Joseph Su, Hui-Yi Lin, Tung-Chin Chiang, Gail Runnells, Lora Rogers, Ping-Ching Hsu, Ronda Henry-Tillman, Susan Kadlubar. Association between genetic polymorphisms of DNMT genes and breast cancer in a nested case-control study of African Americans [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4180.

Association among plasma 1,25(OH)2 D, ratio of 1,25(OH)2 D to 25(OH)D, and prostate cancer aggressiveness

BACKGROUND

African-American (AA) men tend to present with more aggressive prostate cancer (Gleason score >7) than European-American (EA) men. Vitamin D and its metabolites are implicated in prostate cancer biology with vitamin D deficiency, indicated by its metabolite levels in serum or plasma, usually observed in AA men.

OBJECTIVE

To determine if 1, 25-dihydroxy vitamin D3 [1,25(OH)2 D] plasma levels in AA and EA prostate cancer patients alter the risk of having aggressive prostate cancer.

DESIGN

Research subjects from the North Carolina-Louisiana Prostate Cancer Project (AA n = 435 and EA n = 532) were included. Plasma metabolites 1,25(OH)2 D and 25-hydroxyvitamin D3 [25(OH)D] were measured using liquid chromatography with tandem mass spectrophotometry. Research subjects were classified into low (Gleason sum < 7, stage T1-T2, and Prostate-specific antigen (PSA) < 9 ng/mL) or high (Gleason sum > 8 or Gleason sum = 7 with 4 + 3, or PSA > 20 ng/mL, or Gleason sum = 7 and stage T3-T4) aggressive disease.

RESULTS

Research subjects in the second and third tertiles of plasma levels of 1, 25(OH)2 D had lower odds of high aggressive prostate cancer (AA [ORT2vsT1 : 0.66, 95%CI: 0.39-1.12; ORT3vsT1 : 0.83, 95%CI: 0.49-1.41] and EA [ORT2vsT1 : 0.68, 95%CI: 0.41-1.11; ORT3vsT1 : 0.67, 95%CI: 0.40-1.11]) compared with the first tertile, though confidence intervals included the null. Greater 1,25(OH)2 D/25(OH)D molar ratios were associated with lower odds of high aggressive prostate cancer more evidently in AA (ORQ4vsQ1 : 0.45, CI: 0.24-0.82) than in EA (ORQ4vsQ1 : 0.64, CI: 0.35-1.17) research subjects.

CONCLUSIONS

The 1,25(OH)2 D/25(OH)D molar ratio was associated with decreased risk of high aggressive prostate cancer in AA men, and possibly in EA men. Further studies analyzing vitamin D polymorphisms, vitamin D binding protein levels, and prostatic levels of these metabolites may be useful. These studies may provide a better understanding of the vitamin D pathway and its biological role underlying health disparities in prostate cancer.

Effect of Sulforaphane and 5-Aza-2'-Deoxycytidine on Melanoma Cell Growth

Background: UV exposure-induced oxidative stress is implicated as a driving mechanism for melanoma. Increased oxidative stress results in DNA damage and epigenetic dysregulation. Accordingly, we explored whether a low dose of the antioxidant sulforaphane (SFN) in combination with the epigenetic drug 5-aza-2’-deoxycytidine (DAC) could slow melanoma cell growth. SFN is a natural bioactivated product of the cruciferous family, while DAC is a DNA methyltransferase inhibitor. Methods: Melanoma cell growth characteristics, gene transcription profiles, and histone epigenetic modifications were measured after single and combination treatments with SFN and DAC. Results: We detected melanoma cell growth inhibition and specific changes in gene expression profiles upon combinational treatments with SFN and DAC, while no significant alterations in histone epigenetic modifications were observed. Dysregulated gene transcription of a key immunoregulator cytokine—C-C motif ligand 5 (CCL-5)—was validated. Conclusions: These results indicate a potential combinatorial effect of a dietary antioxidant and an FDA-approved epigenetic drug in controlling melanoma cell growth.

Natural history of human papillomavirus and vaccinations in men: A literature review

BACKGROUND AND AIMS

Infection with high-risk (HR) genotypes of the human papillomavirus (HPV) is necessary for and causative of almost all cervical cancers and their precursor condition, cervical intraepithelial neoplasia. These conditions have been sharply reduced by cervical cytology screening, and a further decrease is expected because of the recent introduction of prophylactic HPV vaccinations. While significant attention has been given to gynecologic HPV disease, men can be affected by HPV-related cancers of the anus, penis, and oropharynx. This literature review aims to address disparities in HPV-related disease in men, and certain HR male subpopulations, compared with women.

DISCUSSION

Overall, immunocompetent men are far less likely than women to develop anogenital HPV-related cancers, despite harboring HR HPV infections at anogenital sites. On the other hand, men who have sex with men and men living with human immunodeficiency virus infection are at considerably higher risk of HPV-related disease. Historic rates of prophylactic HPV vaccination in males have trailed those of females due to numerous multilevel factors, although, in recent years, this sex gap in vaccination coverage has been closing. In the absence of routine HPV screening in males, therapeutic vaccinations have emerged as a potential treatment modality for preinvasive neoplasia and are in various phases of clinical testing.

CONCLUSION

Successful reductions in HPV disease morbidity at the population level must acknowledge and target HPV infections in men.

County poverty levels influence genome-wide DNA methylation profiles in African American and European American women

Our pilot study examined global DNA methylation and telomere length (TL) using DNA from saliva samples provided by 39 participants in the Arkansas Rural Community Health (ARCH) Study. TL was quantified by qPCR, and DNA methylation and DNA methylation age was assessed using the Illumina 850K Epic BeadChip. Ingenuity Pathway Analysis (IPA) was performed to identify biological pathways that were DM between residents of counties with high or low poverty rates and by race [African American descent (AA) versus European American (EA) descent]. Among AA women, hypermethylation was more common in AA residents of counties with low compared to high poverty rates (70% vs. 30%). The top canonical pathways impacted by differential methylation were related to glucocorticoid receptor, p53, and estrogen-dependent breast cancer signaling in AA women. EA women living in low-poverty counties exhibited less hypermethylation of CpGs than those living in high-poverty counties (27% vs. 73%). The top canonical pathways were related to hereditary breast cancer, glucocorticoid receptor, androgen and PI3K/AKT signaling. Several genes involved in telomere maintenance were shown to be DM by county poverty levels. Therefore, the finding of this pilot study suggests county poverty levels may impact DNA methylation patterns in breast cancer-related pathways as well as genes involved in telomere maintenance. Larger studies should confirm our findings.

Body Composition, IGF1 Status, and Physical Functionality in Nonagenarians: Implications for Osteosarcopenia

OBJECTIVES

Body composition alterations occur during aging. The purpose of the present analysis was to explore the functional consequences of the overlap of sarcopenia and osteoporosis, and the potential role of insulin-like growth factor 1 (IGF1) in their development in the oldest old.

SETTING AND PARTICIPANTS

Eighty-seven nonagenarians from the Louisiana Healthy Aging Study were included.

MEASURES

The definition of sarcopenia was based on appendicular lean mass (ALM). Osteoporosis was diagnosed based on bone mineral density (BMD) T score. Four phenotypes were compared: (1) healthy body composition, that is, nonosteoporotic nonsarcopenic (CO, control group), (2) osteoporotic (O, low BMD T score), (3) sarcopenic (S, low ALM), and (4) osteosarcopenic (OS, low BMD T score and low ALM). Sex- and age-specific IGF1-Standard Deviation Scores (SDS) were calculated. The Continuous Scale-Physical Functional Performance (CS-PFP) test was performed.

RESULTS

In OS men, IGF1-SDS values (-0.61 ±0.37 vs -0.04 ± 0.52, P = .02) were lower than those in CO males (control group), whereas IGF1-SDS were similar in the 4 body composition phenotypes in women. In men only, ALM was positively associated with IGF1-SDS values (P = .01) independent of age and C-reactive protein concentration. Regarding bone health, we found no association between IGF1-SDS values and BMD. IGF1-SDS was not associated with functional performance (CS-PFP) in men and women.

CONCLUSIONS/IMPLICATIONS

IGF1 sensitivity in skeletal muscle and bone may differ by sex in the oldest old. IGF1 status did not appear to affect physical functionality. Determinants and clinical and functional characteristics of osteosarcopenia need to be further investigated in order to define conclusive diagnostic criteria.

Dietary patterns based on the Mediterranean diet and DASH diet are inversely associated with high aggressive prostate cancer in PCaP

BACKGROUND

Several foods and nutrients have been linked to the development of prostate cancer, but the association between healthy dietary patterns and prostate cancer aggressiveness is less studied. The aim of this study was to evaluate the relationship between the Mediterranean diet (MED) and Dietary Approaches to Stop Hypertension (DASH) diet scores and prostate cancer aggressiveness by race.

METHODS

Data from the population-based, case-only North Carolina-Louisiana Prostate Cancer Project (PCaP) were used to examine the association between diet quality, measured by MED and DASH scores, and prostate cancer aggressiveness in 1899 African American (AA) and European American (EA) research subjects. Dietary intake was assessed using a modified National Cancer Institute Diet History Questionnaire. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for high versus low-intermediate aggressive prostate cancer.

RESULTS

Higher MED scores were inversely associated with high aggressive prostate cancer overall (OR: 0.66; 95% CI: 0.46, 0.95 for high versus low scores); results were similar for AA and EA men. A weaker inverse association between DASH scores and prostate cancer aggressiveness was found (OR: 0.76; 95% CI: 0.55, 1.06).

CONCLUSIONS

Higher diet quality, as represented by a Mediterranean-style diet or DASH diet, may reduce the odds of high aggressive prostate cancer.

Statin use, high cholesterol and prostate cancer progression; results from HCaP-NC

BACKGROUND

Statin use is associated with lower advanced prostate cancer risk and reduced prostate cancer-specific mortality, but prior studies were conducted mainly in white men. We examined the effect of statin use on risk of prostate cancer progression in a population-based, minority-enriched cohort.

METHODS

We used data from prostate cancer cases (45% African American) diagnosed between 2004 and 2007 who participated in the Health Care Access and Prostate Cancer Treatment in North Carolina cohort (HCaP-NC). We abstracted statin use at diagnosis. Men reported if they had ever been diagnosed with high cholesterol. Multivariable Cox proportional hazards analysis was used to examine associations between statin use and risk of prostate cancer progression (biochemical recurrence or secondary treatment), overall and by race. In secondary analysis, we examined the association between high cholesterol and risk of progression, overall, and by statin use.

RESULTS

Of 669 men, 244 (36%) were statin users at diagnosis. During 3.8 years median follow-up, 138 men experienced prostate cancer progression. There was no association between statin use and risk of progression, either overall (HR 1.03; 95%CI 0.72-1.46) or stratified by race. High cholesterol was inversely associated with risk of progression, particularly among statin users (HR 0.43; 95%CI 0.20-0.94; p-interaction = 0.22) and in men with higher perceived access to care (HR 0.57; 95%CI 0.36-0.90; p-interaction = 0.03). Study limitations included a relatively small sample size, short follow-up, and lack of data regarding post diagnosis statin use.

CONCLUSIONS

Statin use at diagnosis was not associated with prostate cancer progression in the population-based, minority-enriched HCaP-NC. Greater healthcare engagement, including actively controlling serum cholesterol, may be linked to better prostate cancer-specific outcomes.

Abstract 3231: Prospective study of genomic 5-methylcytosine and LINE-1 methylation levels of leukocyte DNA and colorectal cancer risk

Global hypomethylation in peripheral blood leukocyte DNA, measured by the reduction of genome-wide methylated cytosine (5-mC) or the long interspersed nuclear element-1 (LINE-1) level, has been associated with an increased risk of colorectal cancer, mainly in retrospective studies. Little is known as to how these global methylation markers relate in individuals and their associations with colorectal cancer risk in a prospective study setting.

We studied leukocyte 5-mC and LINE-1 methylation levels in prospectively collected blood specimens from 404 cases and 528 controls who were free of colorectal cancer at blood collection from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Leukocyte 5-mC level was determined by an HPLC/Tandem Mass Spectrometry method and expressed as the relative amount of methyl- to total cytosine residues (%5-mC). LINE-1 methylation level was measured by McrBC digestion followed by real-time PCR of the undigested/unmethylated LINE1 promoter sequences. In our analysis, we excluded cases diagnosed within one year of blood draw to minimize the potential for reverse causation from prevalent disease. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for tertiles of methylation using multivariable logistic regression, adjusting for age, sex, and other potential confounders.

We observed a significant association between low LINE-1 methylation and colorectal cancer risk (1st vs. 3rd tertile: OR=1.63, 95% CI=1.10-2.41; P trend=0.01) and a near-significant association with low %5-mC methylation (OR=1.37, 95% CI=0.92-2.03; P trend=0.15). The two markers were not correlated (Spearman's r=0.01). Comparing subjects with low methylation levels (1st tertiles) at both markers with those having the highest methylation level (3rd tertile) at either marker, we observed a stronger significant association (OR=2.49, 95% CI=1.62-3.81; P trend=0.0001). Interestingly, we also found that the association between natural folate intake and colorectal cancer risk was modified by %5-mC or two markers combined (P interaction= 0.0003 and 0.02, respectively). Among individuals with the highest methylation level at either marker, high natural folate intake (3rd tertile) was associated with a reduced risk of colorectal cancer compared to low (1st tertile) folate intake (OR=0.49, 95% CI=0.25-0.96); no association was observed among individuals with lower levels of methylation. No significant risk modification was found for other suspected risk factors, such as smoking, obesity, and aspirin/ibuprofen use.

This prospective investigation showed that reduced LINE-1 methylation in leukocyte DNA, especially in conjunction with reduced 5-mC methylation, was associated with increased colorectal cancer risk. Folate may protect against colorectal carcinogenesis through mechanisms involving adequate DNA methylation in the genome.

Citation Format: Wen-Yi Huang, Mark P. Purdue, L. Joseph Su, Hormuzd A. Katki, Lee E. Moore, Srinivasan Yegnasubramanian, Sonja I. Berndt. Prospective study of genomic 5-methylcytosine and LINE-1 methylation levels of leukocyte DNA and colorectal cancer risk [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3231.

Leveraging community-based participatory research capacity to recruit Pacific Islanders into a genetics study

Pacific Islanders face many health disparities, including higher rates of cardiovascular disease, cancer, obesity, and diabetes compared to other racial and ethnic groups. Specifically, the Marshallese population suffers disproportionately from type 2 diabetes, with rates 400% higher than the general US population. As part of an ongoing community-based participatory research (CBPR) partnership, 148 participants were recruited for a study examining genetic variants to better understand diabetes. Participants provided a saliva specimen in an Oragene® DNA self-collection kit. Each participant provided approximately 2 mL volume of saliva and was asked qualitative questions about their experience. The study yielded a recruitment rate of 95.5%. Among the 148 persons who participated, 143 (96.6%) agreed to be contacted for future studies; 142 (95.9%) agreed to have their samples used for future IRB-approved studies; and 144 (97.3%) gave permission for the researchers to link information from this study to other studies in which they had participated. Qualitative responses showed that the majority of participants were willing to participate because of their desire to contribute to the health of their community and to understand the genetic influence related to diabetes. This study demonstrates willingness to participate in genetic research among Marshallese living in Arkansas. Willingness was likely enhanced because the feasibility study was part of a larger CBPR effort. This study is important to community stakeholders who have voiced a desire to collaboratively conduct genetic research related to diabetes, perinatal outcomes, and cancer.

Unit Nonresponse in a Population-Based Study of Prostate Cancer

Low unit response rates can increase bias and compromise study validity. Response rates have continued to fall over the past decade despite all efforts to increase participation. Many factors have been linked to reduced response, yet relatively few studies have employed multivariate approaches to identify characteristics that differentiate respondents from nonrespondents since it is hard to collect information on the latter. We aimed to assess factors contributing to enrollment of prostate cancer (PCa) patients. We combined data from the North Carolina-Louisiana (LA) PCa Project's LA cohort, with additional sources such as US census tract and LA tumor registry data. We included specific analyses focusing on blacks, a group often identified as hard to enroll in health-related research. The ability to study the effect of Hurricane Katrina, which occurred amidst enrollment, as a potential determinant of nonresponse makes our study unique. Older age (≥ 70) for blacks (OR 0.65) and study phase with respect to Hurricane Katrina for both races (OR 0.59 for blacks, OR 0.48 for whites) were significant predictors of participation with lower odds. Neighborhood poverty for whites (OR 1.53) also was a significant predictor of participation, but with higher odds. Among blacks, residence in Orleans parish was associated with lower odds of participation (OR 0.33) before Katrina. The opposite occurred in whites, with lower odds (OR 0.43) after Katrina. Our results overall underscore the importance of tailoring enrollment approaches to specific target population characteristics to confront the challenges posed by nonresponse. Our results also show that recruitment-related factors may change when outside forces bring major alterations to a population's environment and demographics.

Carotenoid intake and adipose tissue carotenoid levels in relation to prostate cancer aggressiveness among African-American and European-American men in the North Carolina-Louisiana prostate cancer project (PCaP)

BACKGROUND

Associations between carotenoid intake and prostate cancer (CaP) incidence have varied across studies. This may result from combining indolent with aggressive disease in most studies. This study examined whether carotenoid intake and adipose tissue carotenoid levels were inversely associated with CaP aggressiveness.

METHODS

Data on African-American (AA, n = 1,023) and European-American (EA, n = 1,079) men with incident CaP from North Carolina and Louisiana were analyzed. Dietary carotenoid intake was assessed using a detailed-food frequency questionnaire (FFQ), and abdominal adipose tissue samples were analyzed for carotenoid concentrations using high-performance liquid chromatography. Multivariable logistic regression was used in race-stratified analyses to calculate odds ratios (ORs) and 95% confidence intervals (95%CI) comparing high aggressive CaP with low/intermediate aggressive CaP.

RESULTS

Carotenoid intake differed significantly between AAs and EAs, which included higher intake of lycopene among EAs and higher β-cryptoxanthin intake among AAs. Comparing the highest and lowest tertiles, dietary lycopene was associated inversely with high aggressive CaP among EAs (OR = 0.55, 95%CI: 0.34-0.89, Ptrend  = 0.02), while an inverse association was observed between dietary β-cryptoxanthin intake and high aggressive CaP among AAs (OR = 0.56, 95%CI: 0.36-0.87, Ptrend  = 0.01). Adipose tissue α-carotene and lycopene (cis + trans) concentrations were higher among EAs than AAs, and marginally significant inverse linear trends were observed for adipose α-carotene (Ptrend  = 0.07) and lycopene (Ptrend  = 0.11), and CaP aggressiveness among EAs only.

CONCLUSIONS

These results suggest that diets high in lycopene and β-cryptoxanthin may protect against aggressive CaP among EAs and AAs, respectively. Differences in dietary behaviors may explain the observed racial differences in associations. Prostate 76:1053-1066, 2016. © 2016 Wiley Periodicals, Inc.

Knowledge of Memory Aging in Adulthood

The Knowledge of Memory Aging Questionnaire (KMAQ) measures laypersons' knowledge of memory changes in adulthood for research or educational purposes. Half of the questions pertain to normal memory aging and the other half cover pathological memory deficits due to non-normative factors, such as adult dementia. In this study, we compared memory knowledge in middle age adults (40–59 years), young-old adults (60–79 years) and very old adults (80 years and over). These data were collected as a part of the Louisiana Healthy Aging Study, a multidisciplinary population-based study that examines the determinants of healthy aging in adulthood. Results indicated that very old adults performed more poorly overall. Follow-up analyses revealed that they endorsed stereotyped views of normal memory aging more often than did the other age groups. Analyses of response accuracy by gender yielded comparable performance for men and women. Implications for research and the design of educational programs are considered.

Abstract 806: SNPs in vitamin D-related genes are associated with prostate cancer aggressiveness in the North Carolina-Louisiana Prostate Cancer Project (PCaP)

Introduction: African Americans have higher incidence of, and mortality from, prostate cancer (PCa) compared to other racial/ethnic groups. Frequency of polymorphisms in genes involved in vitamin D metabolism, transport, and activity differ by race/ethnicity. Examining the association between polymorphisms in vitamin D-related genes and PCa aggressiveness may explain differing susceptibility to aggressive PCa among individuals and across different racial/ethnic groups.

Methods: TagSNPs (n = 315) in 13 genes (VDR, GC, CYP24A1, CYP27A1, CYP27B1, CYP2R1, CYP3A4, DHCR7, CASR, NADSYN1, RXRA, RXRB, RXRG) were genotyped using Illumina GoldenGate or Sequenom assays in 524 African-American and 657 European-American men with newly-diagnosed PCa from PCaP. DNA extracted from blood samples collected at enrollment was stored at -80C prior to analyses. Research subjects were classified as high aggressive if Gleason sum ≥8, or Gleason score (4+3), or PSA &gt;20 ng/ml, or Gleason score (3+4) AND clinical stage = T3-T4. The comparison group (low aggressive) included research subjects with Gleason sum &lt;7 AND Stage T1-T2 AND PSA &lt; 9 ng/ml. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated for high aggressive PCa for each SNP using logistic regression with adjustment for age and proportion of African ancestry. Associations were considered statistically significant at p&lt;0.05. A polygenic score based on a previous study of SNP predictors of serum 25-hydroxy-vitamin D levels was calculated utilizing SNPs in the GC, CYP24A1, CYP2R1, and NADSYN1 genes.

Results: Among African Americans, 21 SNPs were associated with PCa aggressiveness. The variant allele was associated negatively or positively with high aggressive PCa in eleven and ten SNPs, respectively. For example, two SNPs in the vitamin D binding protein gene known as GC, were inversely associated (rs222054: OR, 0.55, 95%CI, 0.38-0.80; and rs16847028: OR, 0.61, 95%CI, 0.39-0.94). Among European Americans, the variant allele was inversely associated with high aggressive PCa for four SNPs in three genes (CASRrs3863977; CYP24A1rs4809960; RXRArs1007971; and RXRArs3118526), and positively associated with high aggressive PCa for three SNPs in the CYP27B1 gene (rs703842, rs4646536, and rs10877013). There was no association between higher number of ‘low vitamin D’ alleles in the four SNPs that comprised the polygenic score and PCa aggressiveness for either race.

Conclusions: Polymorphisms in genes involved in vitamin D etabolism and activity, the vitamin D binding protein and calcium sensing receptor were associated with PCa aggressiveness, and there was no overlap in SNPs between race groups. Our ongoing work will examine interaction between polymorphisms of vitamin D-related genes and vitamin D metabolite levels on PCa aggressiveness.

Citation Format: Susan E. Steck, Anna Woloszynska-Read, Samuel Antwi, Hongmei Zhang, Lenore Arab, Elizabeth T.H. Fontham, James Mohler, L. Joseph Su, Feifei Xiao, Gary Smith, Donald Trump, Candace Johnson, Jeannette Bensen. SNPs in vitamin D-related genes are associated with prostate cancer aggressiveness in the North Carolina-Louisiana Prostate Cancer Project (PCaP). [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 806.