EPIGENETIC AGING IN OLDER BREAST CANCER SURVIVORS: THE THINKING AND LIVING WITH CANCER (TLC) STUDY

Cancer and its treatments increase risk for age-related disease, and biological aging may be a key mechanism; however, no research to date has examined epigenetic markers of aging in long-term breast cancer survivors. We used data from a national, prospective cohort to test whether older breast cancer survivors had accelerated epigenetic aging compared to non-cancer controls. Non-metastatic breast cancer survivors ages 62–84 years who received chemotherapy with or without hormonal treatment (n=29) or hormonal treatment alone (n=51), and controls frequency-matched on age, race, education, and time between blood draws (n=101), provided two blood samples between 24- and 60-months post-diagnosis (time between samples average=1.8 years). DNA methylation profiling (Illumina Infinium EPIC array) derived epigenetic aging measures: extrinsic, intrinsic, phenotypic, Grim, and Dunedin Pace of Aging (PoAm). Mixed-effects models tested effects of treatment group and change over time on epigenetic aging, adjusting for chronologic age and comorbidities. Survivors who received chemotherapy +/- hormonal treatment had a biological age 1.9–2.6 years older than controls based on extrinsic, intrinsic, and Grim estimates (p=.045, .045, and .001, respectively). Survivors who received hormonal treatment alone had an extrinsic biological age 1.6 years older than controls (p=.032) and a faster Dunedin PoAm (p=.040). Survivors who received chemotherapy +/- hormonal treatment had a trend for accelerated extrinsic aging over time compared to controls (p=.087). Older breast cancer survivors, especially those receiving chemotherapy, showed an accelerated epigenetic aging profile compared to matched women without cancer. Future research is needed to examine associations with age-related survivorship outcomes.

Association of markers of tumor aggressivity and cognition in women with breast cancer before adjuvant treatment: The Thinking and Living with Cancer Study

PURPOSE

Tumor features associated with aggressive cancers may affect cognition prior to systemic therapy. We evaluated associations of cognition prior to adjuvant therapy and tumor aggressivity in older breast cancer patients.

METHODS

Women diagnosed with non-metastatic breast cancer (n = 705) ages 60-98 were enrolled from August 2010-March 2020. Cognition was measured post-surgery, pre-systemic therapy using self-reported (FACT-Cog Perceived Cognitive Impairment [PCI]) and objective tests of attention, processing speed, and executive function (APE domain) and learning and memory [LM domain]. Linear regression tested associations of pre-treatment tumor features and cognition, adjusting for age, race, and study site. HER2 positivity and higher stage (II/III vs. 0/I) were a priori predictors of cognition; in secondary analyses we explored associations of other tumor features and cognitive impairment (i.e., PCI score < 54 or having 2 tests < 1.5 SD or 1 test < 2 SD from the mean APE or LM domain score).

RESULTS

HER2 positivity and the hormone receptor negative/HER2 + molecular subtype were associated with lower adjusted mean self-reported cognition scores and higher impairment rates (p values < .05). Higher stage of disease was associated with lower objective performance in APE. Other tumor features were associated with cognition in unadjusted and adjusted models, including larger tumor size and lower PCI scores (p = 0.02). Tumor features were not related to LM.

CONCLUSIONS

Pre-adjuvant therapy cognition was associated with HER2 positivity and higher stage of disease and other features of aggressive tumors. Additional research is needed to confirm these results and assess potential mechanisms and clinical management strategies.

0441 Treating Insomnia Disorder in Black Women: Results from an Internet-Based, Randomized Clinical Trial of a Culturally Tailored Intervention

Introduction

Black women are at high risk for insomnia. Despite considerable interest in addressing sleep health disparities, there is very limited research investigating the efficacy of gold standard treatment (cognitive-behavioral therapy for insomnia; CBT-I) among this minority population. Further, we are not aware of any data studying whether a culturally tailored intervention would improve treatment efficacy and/or engagement among Black women.

Methods

We conducted a randomized clinical trial within a national, longitudinal cohort study (Black Women’s Health Study; BWHS). BWHS participants with elevated insomnia symptoms were randomized to receive: (1) automated Internet-delivered CBT-I (Sleep Healthy Using the Internet; SHUTi); (2) a stakeholder-informed, tailored version of SHUTi for Black women (SHUTi-BWHS); or (3) patient education about sleep (PE). Primary outcomes were insomnia severity (Insomnia Severity Index; ISI) and treatment engagement (completion of the intervention). We hypothesized that both SHUTi and SHUTi-BWHS would lead to significantly decreased insomnia severity compared to PE, and that SHUTi-BWHS participants would be more likely to complete the intervention.

Results

Three-hundred and thirty-three Black women (mean age=59.3 years) were enrolled in the trial. Those randomized to receive either SHUTi or SHUTi-BWHS had greater reductions in ISI scores at 6-month follow-up (-10.0 and -9.3 points, respectively) compared to PE (-3.6 points). More participants randomized to SHUTi-BWHS completed the intervention compared to those randomized to SHUTi (78.2% vs 64.8%; p&lt;.01). Participants who completed either SHUTi or SHUTi-BWHS showed greater reductions in insomnia severity compared to non-completers (-10.4 vs -6.2 points; p&lt;.01).

Conclusion

Both SHUTi and SHUTi-BWHS improved sleep outcomes more than an active control. The culturally tailored SHUTi-BWHS program was more effective at engaging participants with the program as a greater proportion completed the full intervention, which was associated with greater improvements in sleep outcomes. These compelling data demonstrate that offering a culturally adapted program is a possible path in efforts to address the sleep health disparities facing Black Americans.

Support (If Any)

This trial was funded by Patient-Centered Outcomes Research Institute grant AD-2017C1-6314. National Cancer Institute grant U01 CA164974 supports the BWHS infrastructure.

Experiences of racism and subjective cognitive function in African American women

INTRODUCTION

We hypothesized that frequent experiences of racism among African American women would adversely affect subjective cognitive function (SCF), based on the established association of psychological stress with memory decline.

METHODS

We used multinomial logistic regression to quantify the association between experiences of racism and SCF, based on six questions, among 17,320 participants in the prospective Black Women's Health Study.

RESULTS

The multivariable odds ratio (OR, 95% confidence interval [CI]) for poor compared to good SCF among women at the highest versus the lowest level of daily racism (eg, poorer service in stores) was 2.75 (2.34 to 3.23); for the same comparison among women at the highest level of institutional racism (eg, discriminated against in housing) relative to the lowest, the OR was 2.66 (2.24 to 3.15). The associations were mediated, in part, by depression and insomnia.

DISCUSSION

Experiences of racism, a highly prevalent psychosocial stressor among African Americans, were associated with lower SCF.

Abstract PR16: Investigating the determinants of racial disparities in ovarian cancer incidence: The OCWAA consortium

Background: The Ovarian Cancer in Women of African Ancestry consortium (OCWAA) was established to address racial disparities in epithelial ovarian cancer (EOC) risk and survival. Specifically, we aim to estimate the degrees to which racial differences in incidence and survival of EOC between African-American (AA) and white women are attributable to differences in the prevalence and timing of risk factors and in the magnitude of risk associations.

Methods: OCWAA includes four case-control studies (the African-American Cancer Epidemiology Study, the North Carolina Ovarian Cancer Study, the Los Angeles County Ovarian Cancer Study, and the Cook County Case-Control Study) and two nested case-control studies within cohort studies (the Black Women's Health Study and the Multiethnic Cohort Study). A centralized core database consisting of demographic and epidemiologic risk factors for borderline and invasive EOC, tumor characteristics and prognostic factors has been created, and the majority of data has been harmonized across studies. A histotype classification scheme was uniformly applied using a combination of morphology and grade information to best represent the most recent diagnostic guidelines for ovarian cancer as detailed in the 2014 WHO Classification of Tumors of the Female Reproductive System.

Results: A total of 1,169/2,324 AA cases and controls and 2,963/3,934 white cases and controls have been included in the OCWAA database to date. Approximately 83% of cases are invasive EOC, 15% are borderline tumors, and 2% are missing tumor behavior information. Among the invasive EOC cases, 61% are high-grade serous carcinomas. The average age at diagnosis of EOC cases is the same in AA and white women (57.2 years), and the year of diagnosis ranges from 1991 to 2016. The following risk factors showed marked prevalence differences in AA and white controls: obesity (46.3% vs 19.2%), breastfeeding (42.7% vs 54.3%), tubal ligation (31.1% vs 17.9%), postmenopausal hormone use (23.8% vs 40.8%), nulliparity (14.9% vs 19.2%), at least a college degree (35.5% vs 56.4%), and menarche age &lt;13 (51.6% vs 47.4%; p&lt;.01); p&lt;.0001 for all except where noted. In preliminary EOC risk analyses, we observed positive associations with body mass index and nulliparity and inverse associations with tubal ligation, oral contraceptive use and breastfeeding in both AA and white women. The harmonization of other factors including duration, frequency and timing of key risk factors, physical activity, comorbidities, medication use, and treatment information is ongoing.

Conclusions: OCWAA represents the largest study investigating disparities in ovarian cancer risk and survival between AA and white women. This consortium is uniquely positioned to study the epidemiology of ovarian cancer in AA, focusing on the role of lifestyle and behavioral characteristics, reproductive risk factors, treatment and other prognostic factors in explaining racial differences in ovarian cancer incidence and survival.

This abstract is also being presented as Poster C083.

Citation Format: Veronica Wendy Setiawan, Lauren Peres, Lynn Rosenberg, Traci Bethea, Patricia Moorman, Evan Myers, Anna Wu, Charlotte Joslin, Elisa Bandera, Deanna Chyn, Fabian Camacho, Joellen Schildkraut. Investigating the determinants of racial disparities in ovarian cancer incidence: The OCWAA consortium [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 PR16.

Abstract PD2-7: Vigorous exercise across the lifespan and reduced risk of estrogen receptor negative breast cancer in African American women

Background. Recreational exercise has been associated with a reduced risk of breast cancer, but evidence regarding breast cancer among African American women and about breast cancer subtypes is sparse.

Methods. We assessed lifetime vigorous exercise (average of high school, age 21, age 30, and baseline) in the Black Women's Health Study in relation to the incidence of invasive breast cancer overall (n = 1,377), estrogen receptor-positive (ER+) breast cancer (n = 556), estrogen receptor-negative (ER-) breast cancer (n = 327), and triple negative breast cancer (TN) (n = 103); analyses were based on 275,188 person years of follow-up of 44,704 African American women who were aged 30 or more at entry to the study. Cox proportional hazards models estimated incidence rate ratios (IRR) and 95% confidence intervals (CI), controlling for breast cancer risk factors.

Results. For ER- breast cancer, the IRRs for 1-2.2 hours/week, 2.3-2.9 hours/week, and 3+ hours/week relative to &lt;1 hour/week were 0.76 (95% CI 0.52-1.11), 0.78 (95% CI 0.52-1.17) and 0.53 (95% CI 0.31-0.90), respectively; the p value for trend was 0.058. The inverse association was apparent only among postmenopausal women. There was also an inverse association, although nonsignificant, of exercise with the incidence of TN breast cancer. Vigorous exercise was not associated with a reduction in ER+ breast cancer risk.

Conclusion. These results indicate that physical activity may protect against the development of ER- breast cancer in African American women. The association, if confirmed, is of great public health importance given the high mortality associated with this subtype and its higher incidence in African American women.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD2-7.

Mesd is a general inhibitor of different Wnt ligands in Wnt/LRP signaling and inhibits PC-3 tumor growth in vivo

Mesd is a specialized chaperone for Wnt co-receptor low-density lipoprotein receptor-related protein-5 (LRP5) and LRP6, which contain four β-propeller/epidermal growth factor modules, named E1 to E4 from N- to C-terminal, in their extracellular domains. Herein, we demonstrated that recombinant Mesd protein is a general Wnt inhibitor that blocks Wnt/β-catenin signaling induced not only by LRP6 E1-E2-binding Wnts but also by LRP6 E3-E4-binding Wnts. We also found that Mesd suppressed Wnt/β-catenin signaling induced by Wnt1 in prostate cancer PC-3 cells, and inhibited tumor growth in PC-3 xenograft model. Our results indicate that Mesd is a universal inhibitor of Wnt/LRP signaling on the cell surface.