Abstract B27 Background Women’s beliefs about the causes of cancer may influence the preventive actions they undertake to reduce their risk. Little is known about the beliefs women have about the causes breast and colorectal cancer. The purpose of this study is to describe and compare causal beliefs about breast and colorectal cancer among unaffected women in the general population. Methods A total of 439 unaffected women in the general population were recruited to complete a web-based survey assessing causal beliefs for either breast (N = 211) or colorectal cancer (N = 228). Results Heredity was ranked as the most important causal factor, followed by diet or eating habits for both cancer sites. Women endorsed the following causes of breast or colorectal cancer respectively: heredity (84.4%, 78.5%), diet or eating habits (46.4%, 69.7%), pollution in the environment (57.6%, 40.3%), aging (48.8%, 57.5%), alcohol (29.9%, 40.8%), smoking (58.3%, 50.8%), stress (27.5%, 29.4%), and lack of exercise (35.7%, 44.3%). Other factors such as prior surgery on the breast (23.7%) and colon (32.9%), or changes in one’s immune system (60.6% - breast; 59.2% - colon) were also endorsed by some women. Significant differences between cancer sites were noted, in particular, for heredity, diet, pollution, aging, alcohol, and lack of exercise. Conclusions Both genetic and non-genetic risk factors are endorsed by unaffected women as causes of breast and colorectal cancer. Notably, causal beliefs differ for breast and colorectal cancer. Misconceptions about the causes of these cancers may be important targets for risk communication efforts. Citation Information: Cancer Prev Res 2008;1(7 Suppl):B27.
To identify racial disparities in cell-free fetal DNA (cffDNA) first-line aneuploidy screening use among advanced maternal age women at a safety net hospital.This retrospective cohort study of women 35 and older who delivered at Boston Medical Center from 2012 to 2015 compared to women who used cffDNA for first-line aneuploidy screening to those who did not. Maternal conventional demographics and social determinants of health were collected. We investigated the relationship between race and odds of cffDNA use, adjusting for covariates by stepwise logistic regression.We identified 1223 women. Seventy-two percent were publicly insured. Upon adjusting for parity, prenatal care site, year of delivery, and insurance status, odds of cffNDA use remained lower for Black and Hispanic women (adjusted odds ratio [aOR] 0.47, 95% confidence interval [CI] 0.30, 0.71 and aOR 0.34 [0.21, 0.55]) compared to White women. Language proved to be an effect modifier among Hispanic women that attenuated but did not resolve the disparity in use among Hispanic compared to White women. Racial differences in cffDNA use persisted across the study period.Disparity in cffDNA screening uptake exists by race in this diverse urban population. The gap in utilization between Hispanic and White women may be related to primary preferred language.
Abstract Background: Under-representation of minority populations in research utilizing biospecimens can prohibit advancements in cancer research, treatment and survivorship from reaching those who are most vulnerable, potentially increasing cancer health disparities. Barriers and facilitators to biospecimen provision among under-represented populations are not well understood. This study examined predictors of biospecimen provision in a large cohort of black women. Methods: The Black Women's Health Study (BWHS), an ongoing prospective cohort study of African American women from across the U.S. followed since 1995, initiated a four-year effort in 2013 to collect blood biospecimens. Of 48,956 BWHS participants invited to provide a blood sample, 27% (n=13,037) did so. We used logistic regression analyses to estimate multivariable odds ratios (OR) and 95% confidence intervals (CI) for associations of participant characteristics with sample provision, adjusted for age and education. Results: The strongest predictors of providing a blood sample were having had a physical exam in the past two years (OR 3.90 [95% CI 3.70-4.11]), and, independently, mammographic screening in the past two years (OR 1.88 [1.76-2.01]). Other predictors included educational status (OR 1.30 [1.21-1.39] for >16 vs. ≤12 years of education) and having a family history of cancer (OR 1.16 [1.11-1.21]). Women had lower odds of giving a blood sample if they reported more frequent experiences of racism in their daily lives (OR 0.83 [0.77-0.89] for highest vs. lowest level of racism score) or lived in a rural vs. urban area (OR 0.75 [0.69-0.80]). History of cancer was not associated with sample provision. Because interaction with the health care system was such a strong predictor, we repeated analyses restricted to those who had not reported a recent physical exam. No new associations emerged, but both mammographic screening (OR 4.23 [3.81-4.70]) and daily racism (OR 0.64 [0.55-0.75]) became stronger predictors in this group. Conclusions: Recent utilization of the health care system and higher levels of education were the strongest predictors of agreement to provide a blood sample for research in this cohort of black women, while living in a rural area and having more frequent experiences of racism, a unique characteristic of this population, were barriers. Innovative recruitment efforts may be necessary for greater inclusion of individuals who are less educated and infrequent users of the health care system. In addition, the persistent reality of racism in the U.S. may continue to play a role in the under-representation of black Americans in cancer research utilizing biospecimens. Citation Format: Lauren E. Barber, Julie R. Palmer, Kimberly A. Bertrand, Catharine Wang. Predictors of blood biospecimen provision among African American women [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 C040.
With the availability of raw DNA generated from direct-to-consumer (DTC) testing companies, there has been a proliferation of third-party online services that are available to interpret the raw data for both genealogy and/or health purposes. This study examines the current landscape and downstream clinical implications of consumer use of third-party services.Study participants were recruited online from social media platforms. A total of 321 survey respondents reported using third-party services for raw DNA interpretation.Participants were highly motivated to explore raw DNA for ancestral information (67%), individual health implications (62%), or both (40%). Participants primarily used one of seven companies to interpret raw DNA; 73% used more than one. Company choice was driven by the type of results offered (51%), price (45%), and online reviews (31%). Approximately 30% of participants shared results with a medical provider and 21% shared with more than one. Outcomes of sharing ranged from disinterest/discounting of the information to diagnosis of genetic conditions. Participants were highly satisfied with their decision to analyze raw DNA (M = 4.54/5), yet challenges in understanding interpretation results were reported irrespective of satisfaction ratings.Consumers face challenges in understanding the results and may seek out clinical assistance in interpreting their raw DNA results.
To determine the specific components of family history and personal characteristics related to disease perceptions about breast, colon, and ovarian cancers.
Population screening of family cancer history to identify women at risk for a hereditary breast cancer syndrome is feasible and effectively identifies high‐risk women who are eligible for genetic counseling referral. However, uptake of counseling is low among referred women, and there is a critical need to develop multilevel interventions that promote uptake of genetic counseling in diverse groups of patients identified through population‐based screening.
Researchers and practitioners in health behavior and health education (HBHE) can play a pivotal leadership role in the integration of genomic advances to improve the public's health. The purpose of this article is to outline research and practice opportunities at the intersection of genomics and HBHE. We begin this article by briefly summarizing the existing evidence in the literature pertaining to the public's use of genetic services, the effectiveness of genetic counseling, and the impact of genetic testing. Following this, we outline and expand on several areas that we believe are ripe for further exploration, understanding, and public health application:(a) public understanding of genetic information, (b) interventions for health behavior change, and (c) public health assurance and advocacy. This analysis has identified the need to consider potential application efforts in genomics and HBHE from an ecological perspective, with an emphasis on multiple levels of intervention and analysis.
