Provider use of a participatory decision-making style with African American patients with glaucoma

Not all segments of the U.S. population have equally benefited from the advances in our knowledge and treatment of cancer. As a result, some population groups experience a disproportionally high cancer burden, leading to excessively high cancer mortality rates in the African American community when compared with other communities. For example, African American patients have the highest prostate and breast cancer mortalities among all U.S. racial and ethnic groups. This survival disparity has been attributed to a number of factors including differences in insurance status and medical care. However, other observations suggest that disparities in prostate and breast cancer survival between African American and European American patients can persist in randomized clinical trials (1), indicating that intrinsic differences in tumor biology may contribute to this survival health disparity. Moreover, African American breast cancer patients represent more frequently than European American patients with a high grade and estrogen receptor-negative disease, and the aggressive basal-like and triple-negative breast cancer subtypes are more common among them than women from other population groups. This pattern is reminiscent of disease presentation in West Africa (2), indicating that women of African ancestry tend to develop a different tumor biology than women of European descent. In two studies, we examined the tumor biology of prostate and breast cancer comparing African American patients with European American patients using large scale gene expression profiling and found significant differences in gene expression that are consistent with race/ethnic differences in the tumor microenvironment and immunobiology (3, 4). Intriguingly, an interferon gene signature was detected in African American prostate and breast tumors that may relate to an unknown etiologic agent in disease pathology. We think that tumor-induced mechanisms, environmental stimuli, and ancestry-driven intrinsic factors are candidate exposures that induce the interferon-related gene signature and the observed differences in the tumor microenvironment between African American patients and European American patients. The interferon signature may also influence therapeutic outcome because it has great homology with a recently discovered interferon-related DNA damage resistance signature, which predicts resistance to chemotherapy and radiation in breast cancer and perhaps other epithelial cancers (5, 6). In my presentation, I will discuss this signature and candidate factors that may induce it, and thereby affect tumor biology. Recently, metabolomics emerged as a new discovery tool with the promise of identifying druggable metabolic dependencies of cancer cells. This research discovered new essential metabolomic pathways for tumor growth in human cancer and showed that resistance to chemotherapy can be metabolite-based. In a project that received startup funds through a NCI Director Innovation Award, we and collaborators at the Baylor College of Medicine assessed the abundance of 352 known and 184 unknown metabolites in 67 human breast tumors and 65 adjacent non-cancerous tissues (65 pairs) using an untargeted approach for metabolite discovery by Metabolon, Inc., and validated key metabolites in 70 ER-negative tumors and 36 adjacent non-cancerous tissues with targeted assays at two other laboratories. This work revealed that metabolite profiles were greatly different between tumor and non-cancerous tissue and by ER status and grade, but were not obviously associated with disease stage, body mass and menopausal status, and were only modestly affected by neoadjuvant therapy and sociodemographic variables. Further analyses identified a poor survival tumor subtype with distinct DNA methylation, high tissue 2-hydroxyglutarate, and a heightened occurrence in African American breast cancer patients. Lastly, using unsupervised hierarchical clustering, both ER-negative tumors and triple-negative/basal-like tumors separated into metabolite-defined subclusters that did not randomly represent the two patient groups. Instead, distinct clusters emerged that were significantly enriched for either African American or European American patients. In my presentation, I will discuss these findings and their relationship with MYC activation and a stem cell-like gene expression signature in breast tumors. References 1 Albain,K.S., Unger,J.M., Crowley,J.J., Coltman,C.A., Jr. and Hershman,D.L. Racial disparities in cancer survival among randomized clinical trials patients of the Southwest Oncology Group, J Natl Cancer Inst., 101: 984-992, 2009. 2 Huo,D., Ikpatt,F., Khramtsov,A., Dangou,J.M., Nanda,R., Dignam,J., Zhang,B., Grushko,T., Zhang,C., Oluwasola,O., Malaka,D., Malami,S., Odetunde,A., Adeoye,A.O., Iyare,F., Falusi,A., Perou,C.M. and Olopade,O.I. Population differences in breast cancer: survey in indigenous African women reveals over-representation of triple-negative breast cancer, J.Clin Oncol., 27: 4515-4521, 2009. 3 Wallace,T.A., Prueitt,R.L., Yi,M., Howe,T.M., Gillespie,J.W., Yfantis,H.G., Stephens,R.M., Caporaso,N.E., Loffredo,C.A. and Ambs,S. Tumor immunobiological differences in prostate cancer between African-American and European-American men, Cancer Res., 68: 927-936, 2008. 4 Martin,D.N., Boersma,B.J., Yi,M., Reimers,M., Howe,T.M., Yfantis,H.G., Tsai,Y.C., Williams,E.H., Lee,D.H., Stephens,R.M., Weissman,A.M. and Ambs,S. Differences in the Tumor Microenvironment between African-American and European-American Breast Cancer Patients, PLoS.ONE., 4: e4531, 2009. 5 Khodarev,N.N., Beckett,M., Labay,E., Darga,T., Roizman,B. and Weichselbaum,R.R. STAT1 is overexpressed in tumors selected for radioresistance and confers protection from radiation in transduced sensitive cells, Proc Natl Acad Sci U.S.A, 101: 1714-1719, 2004. 6 Weichselbaum,R.R., Ishwaran,H., Yoon,T., Nuyten,D.S., Baker,S.W., Khodarev,N., Su,A.W., Shaikh,A.Y., Roach,P., Kreike,B., Roizman,B., Bergh,J., Pawitan,Y., Van de Vijver,M.J. and Minn,A.J. An interferon-related gene signature for DNA damage resistance is a predictive marker for chemotherapy and radiation for breast cancer, Proc.Natl.Acad.Sci.U.S.A, 105: 18490-18495, 2008. Citation Format: Stefan Ambs. Distinct immune and metabolic signatures in prostate and breast tumors of African American patients. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr PL01-01. doi:10.1158/1538-7755.DISP13-PL01-01

<div>Abstract<p>Women of African descent have the highest breast cancer mortality in the United States and are more likely than women from other population groups to develop an aggressive disease. It remains uncertain to what extent breast cancer in Africa is reminiscent of breast cancer in African American or European American patients. Here, we performed whole-exome sequencing of genomic DNA from 191 breast tumor and non-cancerous adjacent tissue pairs obtained from 97 African American, 69 European American, 2 Asian American, and 23 Kenyan patients. Our analysis of the sequencing data revealed an elevated tumor mutational burden in both Kenyan and African American patients, when compared with European American patients. <i>TP53</i> mutations were most prevalent, particularly in African American patients, followed by <i>PIK3CA</i> mutations, which showed similar frequencies in European American, African American, and the Kenyan patients. Mutations targeting <i>TBX3</i> were confined to European Americans and those targeting the <i>FBXW7</i> tumor suppressor to African American patients whereas mutations in the <i>ARID1A</i> gene that are known to confer resistance to endocrine therapy were distinctively enriched among Kenyan patients. A Kyoto Encyclopedia of Genes and Genomes pathway analysis could link <i>FBXW7</i> mutations to an increased mitochondrial oxidative phosphorylation capacity in tumors carrying these mutations. Finally, Catalogue of Somatic Mutations in Cancer (COSMIC) mutational signatures in tumors correlated with the occurrence of driver mutations, immune cell profiles, and neighborhood deprivation with associations ranging from being mostly modest to occasionally robust. To conclude, we found mutational profiles that were different between these patient groups. The differences concentrated among genes with low mutation frequencies in breast cancer.</p>Significance:<p>The study describes differences in tumor mutational profiles between African American, European American, and Kenyan breast cancer patients. It also investigates how these profiles may relate to the tumor immune environment and the neighborhood environment in which the patients had residence. Finally, it describes an overrepresentation of <i>ARID1A</i> gene mutations in breast tumors of the Kenyan patients.</p></div>

Introduction: Previous studies reported that African American prostate cancer (PCa) patients have a higher risk of disease progression and poorer overall survival compared to White PCa patients. In this study, we aim to examine a potential racial difference in PCa outcomes among unfavorable-intermediate and high-risk patients who underwent external beam radiation therapy (EBRT), in a longitudinal cohort of patients with comparable access to cancer care at military treatment facilities. Materials and Methods: Male patients who underwent EBRT for newly diagnosed National Comprehensive Cancer Network-defined unfavorable-intermediate or high-risk PCa, and enrolled in the Center for Prostate Disease Research Multicenter National Database between 2007-2017 were included (self-reported African American, n=249; White, n=633). Multivariable Cox regression analyses were conducted to examine differences in overall survival, biochemical recurrence free survival (BRFS), and distant metastasis-free survival (DMFS) between African American and White prostate cancer patients. Adjusted variables include age at diagnosis, number of comorbidities, smoking status, body mass index (BMI), prostate-specific antigen (PSA), Gleason score, clinical T stage, and receipt of hormone treatment. Results: Compared to White PCa patients, African American patients were likely to be diagnosed at younger age (68 vs White: 71 years), had higher PSA at diagnosis (21 vs. 15 ng/mL), higher BMI, a higher number of comorbidities, and received more aggressive treatment [EBRT ≥75 Gy or EBRT with Brachy]. Among unfavorable intermediate or high-risk PCa patients who were treated with EBRT, there were no differences between African American and White patients in overall survival (p=0.74), DMFS (p=0.57), and BRFS (p=0.52). Higher PSA at diagnosis was a strong predictor for poorer overall survival (p=0.02), BRFS (p<0.001) and DMFS (p=0.004). Conclusions: With comparable access to cancer care, we observed no differences in prostate cancer outcomes between African American and White patients who underwent radiation therapy. Disclaimer: The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions or policies of USUHS, HJF, the DoD or the Departments of the Army, Navy or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. Citation Format: Jongeun Rhee, Natasza Posielski, Jiji Jiang, Andie Florio, Sally Elsamanoudi, Gregory T. Chesnut. Prostate cancer outcomes in a cohort of unfavorable-intermediate and high-risk patients who underwent external beam radiation therapy at military treatment facilities from 1990 to 2017: Comparing African American and White patients [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C060.

The purpose of this preliminary study was to describe the extent to which providers used collaborative goal setting and individualized assessment with patients who were newly prescribed glaucoma medications. English-speaking glaucoma suspect patients from six ophthalmology clinics who were newly prescribed glaucoma medications had their medical visits videotaped and were interviewed after the visits. The videotapes were transcribed and coded to examine provider use of collaborative goal setting and individualized assessment. Fifty-one patients seeing 12 ophthalmologists participated. Providers gave patients glaucoma treatment options during 37% of the visits; only five providers gave patients treatment options Providers asked for patient treatment preferences in less than 20% of the visits; only two providers asked for patient treatment preferences. Providers were significantly more likely to ask African American patients for their preferences or ideas concerning treatment than non-African American patients (Pearson χ² = 4.1, p = 0.04). Providers were also significantly more likely to ask African American patients about their confidence in using glaucoma medication regularly than non-African American patients (Pearson χ² = 8.2, p = 0.004). Providers asked about patient views about glaucoma in less than 20% of the visits; five providers asked patients their views on glaucoma and its treatment. Providers were significantly more likely to ask African American patients about their views on glaucoma than non-African American patients (Pearson χ² = 5.62, p = 0.02). Eye care providers often did not use collaborative goal setting or conduct individualized assessments of patient views on glaucoma when prescribing treatment for the first time.

Racial disparities in triple-negative breast cancer (TNBC) outcomes have been reported. However, the biological mechanisms underlying these disparities remain unclear. We integrated imaging mass cytometry and spatial transcriptomics, to characterize the tumor microenvironment (TME) of African American (AA) and European American (EA) patients with TNBC. The TME in AA patients was characterized by interactions between endothelial cells, macrophages, and mesenchymal-like cells, which were associated with poor patient survival. In contrast, the EA TNBC-associated niche is enriched in T-cells and neutrophils suggestive of an exhaustion and suppression of otherwise active T cell responses. Ligand-receptor and pathway analyses of race-associated niches found AA TNBC to be “immune cold” and hence immunotherapy resistant tumors, and EA TNBC as ‘inflamed’ tumors that evolved a distinctive immunosuppressive mechanism. Our study revealed the presence of racially distinct tumor-promoting and immunosuppressive microenvironments in AA and EA patients with TNBC, which may explain the poor clinical outcomes. Statement of Significance We have uncovered distinct tumor-promoting and immunosuppressive microenvironments that may contribute to the observed disparities in patient outcomes. Our findings lay the groundwork for developing race-specific therapeutic interventions, potentially improving outcomes for patients with TNBC. Given that chemotherapy and anti-PD1 therapy are currently available treatments for TNBC, our finding of race-specific spatial multicellular niche-associated cell-cell interactions suggest that these treatments may have racially distinct response profiles among TNBC patients. Hence, our novel insights on molecular and cellular interactions in TNBC stratified by race has the potential to inform personalized treatment strategies. Citation Format: Qian Zhu, Akhila Balasubramanian, Jaya Ruth Asirvatham, Badrajee Piyarathna, Jaspreet Kaur, Nada Mohamed, Ling Wu, Megha Chatterjee, Stacy Wang, Niloufar Pourfarrokh, Uttam Rasaily, Yitian Xu, Junjun Zheng, Deborah Jebakumar, Arundathi Rao, Shu-hsia Chen, Yi Li, Eric Chang, Xiaoxian Li, Ritu Aneja, Xiang H.-F. Zhang, Arun Sreekumar. Integrative spatial omics reveals distinct tumor-promoting multicellular niches and immunosuppressive mechanisms in African American and European American patients with TNBC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 5320.

Survival Disparity of African American Versus Non–African American Patients With ESRD Due to SLE

Hospice provides supportive care to terminally ill patients at the end of life. However, some enrollees leave hospice before death in search of therapies that may prolong survival. Because of a greater preference for life-sustaining therapies at the end of life, African American patients may be more likely than white patients to withdraw from hospice to seek life-prolonging therapies. In a secondary data analysis of African American and white patients discharged from VITAS hospice programs between January 1, 1999, and December 31, 2003, we used logistic regression to examine the association between race and discharge disposition defined as hospice revocation to pursue aggressive care (eg, emergency medical care, chemotherapy, or invasive medical intervention) vs all other discharges. We used a Cox proportional hazards model to examine survival at 1 year after hospice revocation in a subgroup of enrollees from Florida hospice programs. Of the 166 197 enrollees, 2.8% revoked hospice to pursue aggressive care, and African American patients were more likely than white patients to do so (4.5% vs 2.5%; P< .001). In multivariate analysis, African American patients had a 70% higher odds of leaving hospice to pursue life-prolonging therapies (odds ratio, 1.70; 95% confidence interval, 1.57-1.84). In the subgroup analysis, 48.4% of the enrollees who revoked hospice to pursue life-prolonging therapies were still alive at 1 year. African American patients were more likely than white patients to revoke hospice to pursue life-prolonging therapies. Models of health care that couple curative and palliative therapies may be more attractive to African American patients and more effective at maximizing continuity throughout life-limiting illness.

Background: African American (AA) women and patients with Triple Negative Breast Cancer (TNBC) have poor outcomes. It is unclear whether these worse outcomes in AA women are due to a higher frequency of TNBC in AA women. The purpose of our study was to determine difference in outcomes between AA and Caucasian (CA) female with TNBC. Methods: A retrospective study of women diagnosed with ER, PR and HER2 (1+) negative breast cancer between January 1/2001 and December 31/2013 at Vidant Medical Center (East Carolina University) in Greenville, North Carolina was undertaken. Patient demographics and tumor characteristics were analyzed to determine impact on overall survival. Results: In our institution, 4,434 women were diagnosed with breast cancer in this study period, of which 378 had TNBC. Our TNBC population was predominantly AA (53%). AA patients were younger (54.1 years vs 58.7 years, p=0.005), less often postmenopausal (62.6% vs 74.5%, p=0.013), more likely to have Medicaid (24.3% vs 7.9%, p &amp;lt;0.001), and to have received chemotherapy (80% vs 69%, p=0.017) compared to CA women. There was no difference in stage at diagnosis between AA and CA patients (p=0.12). By univariate analysis, improved survival in TNBC was associated with non-Medicaid status (p=0.01), early stage at diagnosis (p=0.001), N stage (&amp;lt;0.001), and tumor grade (p&amp;lt;0.001). A Cox regression analysis demonstrated that only insurance status (p=0.007) and N Stage (p=0.01) predicted outcomes in TNBC. Survival in TNBC was not affected by race (p=0.7). Conclusions: Poorer outcomes in AA women cannot be attributed to the higher frequency of TNBC. Improved access to healthcare, with broader insurance coverage, may help minimize disparities in outcome by diagnosing TNBC at an earlier stage.Background: African American (AA) women and patients with Triple Negative Breast Cancer (TNBC) have poor outcomes. It is unclear whether these worse outcomes in AA women are due to a higher frequency of TNBC in AA women. The purpose of our study was to determine difference in outcomes between AA and Caucasian (CA) female with TNBC. Methods: A retrospective study of women diagnosed with ER, PR and HER2 (1+) negative breast cancer between January 1/2001 and December 31/2013 at Vidant Medical Center (East Carolina University) in Greenville, North Carolina was undertaken. Patient demographics and tumor characteristics were analyzed to determine impact on overall survival. Results: In our institution, 4,434 women were diagnosed with breast cancer in this study period, of which 378 had TNBC. Our TNBC population was predominantly AA (53%). AA patients were younger (54.1 years vs 58.7 years, p=0.005), less often postmenopausal (62.6% vs 74.5%, p=0.013), more likely to have Medicaid (24.3% vs 7.9%, p &amp;lt;0.001), and to have received chemotherapy (80% vs 69%, p=0.017) compared to CA women. There was no difference in stage at diagnosis between AA and CA patients (p=0.12). By univariate analysis, improved survival in TNBC was associated with non-Medicaid status (p=0.01), early stage at diagnosis (p=0.001), N stage (&amp;lt;0.001), and tumor grade (p&amp;lt;0.001). A Cox regression analysis demonstrated that only insurance status (p=0.007) and N Stage (p=0.01) predicted outcomes in TNBC. Survival in TNBC was not affected by race (p=0.7). Conclusions: Poorer outcomes in AA women cannot be attributed to the higher frequency of TNBC. Improved access to healthcare, with broader insurance coverage, may help minimize disparities in outcome by diagnosing TNBC at an earlier stage. Citation Format: Mosquera C, Amin R, Wong JH. Effect of race on triple negative breast cancer outcomes [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-26.

Multitarget stool DNA (mt-sDNA) is an approved method for colon cancer screening that is especially relevant for patients who cannot undergo colonoscopy. Although the test performance has been evaluated in a large clinical trial, it was limited to a predominantly white population. Given differences in the epidemiology and biology of colon cancer in African American individuals, the authors sought to compare the performance of mt-sDNA between racial groups. The authors prospectively identified patients aged ≥40 years who were referred for colonoscopy at an academic medical center and 2 satellite facilities. Prior to the colonoscopy, the authors collected stool for mt-sDNA and fecal immunochemical testing (FIT). They compared the sensitivity, specificity, and receiver operating characteristic curve between African American and white patients for the detection of advanced lesions or any adenoma. A total of 760 patients were included, 34.9% of whom were African American. The prevalence of any adenoma (38.9% for African American patients and 33.9% for white patients) and that for advanced lesions (6.8% and 6.7%, respectively) were similar between groups. The overall sensitivities of mt-sDNA for the detection of advanced lesions and any adenoma were 43% and 19%, respectively, and the specificities were 91% and 93%, respectively. In general, mt-sDNA was more sensitive and less specific than FIT. When stratified by race, the sensitivity, specificity, and receiver operating characteristic curve area were similar between African American and white patients for both mt-sDNA and FIT. Test performance characteristics of mt-sDNA were comparable in African American and white patients. Given the lower uptake of colonoscopy in African American individuals, mt-sDNA may offer a promising screening alternative in this patient population.

To compare elderly African American and white patients with osteoarthritis of the knee or hip with respect to their perceptions of the efficacy of traditional and complementary treatments and their self-care practices. An observational, cross-sectional study design using structured questionnaires was employed. The sample consisted of 593 patients (44% African American and 56% white). The 2 groups were comparable with respect to age, disease severity or functional status, and comorbidities. African Americans were more likely than whites to report lower educational level and household income. African Americans were also more likely than whites to perceive various traditional and complementary care modalities as efficacious. However, they were less likely than whites to perceive joint replacement therapy as efficacious (odds ratio 0.52, 95% confidence interval 0.28-0.98). African American patients were more likely than white patients to rely on self-care measures for their arthritis. African American and white patients with osteoarthritis of the knee or hip differ with respect to their perceptions of traditional and complementary treatments for arthritis and their self-care practices.

To compare the composition of cytokines in African American and Caucasian patients with systemic sclerosis (SSc; scleroderma) and in healthy individuals, particularly the expression and function of hepatocyte growth factor (HGF). Bronchoalveolar lavage (BAL) fluid samples were analyzed using cytokine array techniques. HGF in plasma and cell culture medium samples was measured by enzyme-linked immunosorbent assay. Connective tissue growth factor (CTGF), type I collagen expression, and c-Met receptor phosphorylation were studied by immunoblotting. Overall greater expression of cytokines in BAL fluid from African American patients as compared with Caucasian patients was observed. Significant increases in HGF concentrations were detected in BAL fluid, plasma, and fibroblast culture medium from Caucasian SSc patients. In contrast, African American SSc patients did not demonstrate an increase in HGF. Recombinant HGF readily abolished CTGF expression and collagen accumulation in lung fibroblasts isolated from Caucasian SSc patients. Pretreatment of lung fibroblasts with neutralizing anti-c-Met antibody abolished the effects of HGF on CTGF expression and collagen accumulation, suggesting that the antifibrotic activity of HGF is mediated via c-Met receptor tyrosine kinase. Whereas recombinant HGF rapidly induced c-Met receptor phosphorylation in lung fibroblasts from Caucasian patients, c-Met receptor phosphorylation was significantly reduced in lung fibroblasts from African American subjects. Moreover, recombinant HGF failed to prevent CTGF expression and collagen accumulation in lung fibroblasts derived from African American subjects. Ethnic differences exist in terms of antifibrotic HGF expression in lung fibroblasts derived from Caucasian and African American subjects. Reduced levels of HGF as well as a deficiency in c-Met receptor function appear to be present in African American patients with SSc. These findings may explain in part the greater disease severity and worse prognosis observed in African Americans with SSc.

196 Background: The utility of prostate-specific antigen velocity (PSAV) to predict clinical progression in patients with localized prostate cancer (PC) on active surveillance remains unclear, and in African American (AA) patients on active surveillance remains undefined. Methods: We performed a cohort analysis using the national US Veterans Affairs Informatics and Computing Infrastructure (VINCI). We identified 5296 patients diagnosed with localized prostate cancer (PC) from 2001 to 2015 managed with active surveillance. Follow-up extended through March 31, 2020. We defined low-risk PC as ISUP grade group 1 (GG1) clinical tumor stage ≤ 2A, and PSA level ≤ 10 ng/dl; and active surveillance as no definitive treatment within the first year after diagnosis with at least one additional staging biopsy after diagnostic biopsy. The primary outcome was grade progression on repeat biopsy/prostatectomy defined as GG2 or GG3. The secondary outcome was incident metastases. Cumulative incidence functions and multivariable Cox proportional hazards models were used to test associations between PSAV and outcomes. Results: The final cohort included 3919 Non-Hispanic White patients (NHW) (74%) and 1377 AA (26%) patients. GG2 progression on repeat biopsy occurred in 2062 (38.9%) patients, with a cumulative incidence (CI) of 43.2 % and GG3 progression occurred in 728 (13.7%) patients, with a CI of 18% at seven years. Fifty-four (0.8%) patients developed metastases, with a CI of 1.4% at ten years. In unadjusted analyses, compared to NHW patients, AA patients were significantly more likely to progress to GG2 (52.8% vs 39.8%, p&lt;0.001), and GG3 (22.2% vs 16.8%, p=0.01). On MV analysis, PSAV was a significant predictor of GG2 (HR 1.32 [1.26-1.39]), GG3 (1.5 [1.40-1.62]), and metastases (1.38 [1.10-1.74]). A significant interaction term between race and PSAV indicated the need for different PSAV thresholds for AA and NHW men. Based on maximally selected rank statistics, optimal thresholds for separating outcomes were different in AA vs NHW men. (0.44 vs. 1.18). Conclusions: In this analysis of PSAV in low-risk prostate cancer patients on AS—to our knowledge, the largest to date for AA patients—we observed that PSAV is a robust predictor of upgrading on restaging biopsy as well as metastasis. Compared to NHW patients, AA patients were more likely to progress at lower values of PSAV and therefore merit close follow-up on active surveillance protocols.

Background: Despite worse cardiovascular outcomes, previous studies have demonstrated that African American (AA) patients have lower coronary calcium score (CCS) compared to Caucasians (CA). The aim of this analysis is to assess the racial differences in coronary plaque burden and composition in symptomatic patients undergoing coronary CT Angiography (CCTA). Methods: A total of 838 symptomatic patients (47% male, mean age: 57±12years) underwent CCS and CCTA for evaluation of chest pain syndrome. Each coronary artery segment was evaluated for the presence of and type (calcified, non-calcified, mixed) of atherosclerotic plaque. Presence and extent of atherosclerotic plaque was compared between AA and CA patients using multivariate regression. Results: African American patients (n=325) were more often males with higher prevalence of diabetes (23% vs. 18%, p=0.044) and hypertension. They less often had any detectable coronary calcifications (46% vs. 55%, p=0.01) as well as lower median CCS score (0 vs. 10, p&lt;0.0001). In univariate analysis, AA patients had a lower prevalence of calcified plaque (34% vs. 42%, p=0.033) with no differences in non-calcified and mixed plaques (Figure). This continued to be significant after adjusting for potential confounders. (OR of AA having more than 2 calcified plaques compared to CA: 0.52, 95%-CI: 0.34 - 0.83, p=0.007). Conclusion: Our analysis suggests that in comparison to Caucasians, symptomatic African-American patients have lower burden of calcified plaque without increase in the presence of non-calcified plaque or mixed plaques as detected by CCTA.

There is limited data analyzing the pharmacokinetic (PK) and pharmacodynamic (PD) properties of everolimus (EVR) between African Americans and Caucasians. The purpose of this study was to determine and compare the EVR PKs and concentration-associated efficacy and toxicity in African American and Caucasian adult kidney transplant recipients. This was a retrospective PK and PD analysis of all patients who received EVR at the Medical University of South Carolina Transplant Center between 2006 and 2012. Forty-three patients received EVR (22 African Americans, 21 Caucasians). Baseline demographics, immunosuppression, and immunologic risk were similar between races, except for preexisting hypertension, deceased donor type, and cold ischemic time, which were higher in African American patients. PK analysis revealed that African American patients received higher initial EVR doses (2.1 ± 0.8 versus 1.6 ± 0.6 mg/d, P = 0.036), leading to higher early EVR concentrations (EVR >6 ng/mL during the first 60 days: 36% versus 10%, P = 0.037). Efficacy analysis demonstrated similar EVR effects on acute rejection rates (9% versus 10%, P = 0.961), chronic allograft changes (18% versus 14%, P = 0.729), and renal function, with both groups having improved creatinine clearance with EVR therapy (ΔeGFR: 27 versus 12 mL·min·1.73 m). Toxicity analysis demonstrated that African American patients had a trend toward higher rates of EVR discontinuation (46% versus 19%, P = 0.065) and significantly more diarrhea/gastrointestinal intolerance (73% versus 38%, P = 0.022). These results demonstrate EVR therapy is effective at preventing rejection and improving graft function in both African American and Caucasian adult renal transplant patients. Conflicting with previous mammalian target of rapamycin PK/PD analyses in African American patients, this study cohort demonstrated higher early EVR levels in the African American patients.

Simple SummaryBreast cancer (BC) occurs more frequently in white (W) women than in African American (AA) women, but AA women die at a greater rate from BC than W women. Disparities exist in all aspects of the disease, from screening and early detection, to access to and completion of treatment. There are reports that adverse events from treatment also occur more frequently in AA patients. Here, we showed differences in treatments administered to AA women using the SEER-Medicare dataset. We found that AA women receive universally less treatment in every category of cancer and stage in the setting of the National Claims History database of Oncology practice providers. The drugs used to treat BC were relatively similar between the two races. Still, there were small differences in rates of administration of drugs that caused higher rates of side effects, which caused higher overall rates of adverse events in AA patients. The data suggest that the setting where AA patients receive care affects their treatment rate and adverse events. It is possible that higher rates of recorded adverse events result in lower rates of treatment or completion of treatment in AA women with BC.Despite lower incidence rates, African American (AA) patients have shorter survival from breast cancer (BC) than white (W) patients. Multiple factors contribute to decreased survival, including screening disparities, later presentation, and access to care. Disparities in adverse events (AEs) may contribute to delayed or incomplete treatment, earlier recurrence, and shortened survival. Here, we analyzed the SEER-Medicare dataset, which captures claims from a variety of venues, in order to determine whether the cancer care venues affect treatment and associated adverse events. We investigated a study population whose claims are included in the Outpatient files, consisting of hospital and healthcare facility venues, and a study population from the National Claims History (NCH) files, consisting of claims from physicians, office practices, and other non-institutional providers. We demonstrated statistically and substantively significant venue-specific differences in treatment rates, drugs administered, and AEs from treatments between AA and W patients. We showed that AA patients in the NCH dataset received lower rates of treatment, but patients in the Outpatient dataset received higher rates of treatment than W patients. The rates of recorded AEs per treatment were higher in the NCH setting than in the Outpatient setting in all patients. AEs were consistently higher in AA patients than in W patients. AA patients had higher comorbidity indices and were younger than W patients, but these variables did not appear to play roles in the AE differences. The frequency of specific anticancer drugs administered in cancer- and venue-specific circumstances and their associated AEs varied between AA and W patients. The higher AE rates were due to slightly higher frequencies in the administration of drugs with higher associated AE rates in AA patients than in W patients. Our investigations demonstrate significant differences in treatment rates and associated AEs between AA and W patients with BC, depending on the venues of care, likely contributing to differences in outcomes.