Background During the 2019 coronavirus (COVID-19) pandemic, in-person medical visits changed due to social distancing guidelines. Breast cancer (BC) patients, needing ongoing treatment or surveillance, faced increased challenges in accessing care. Telehealth became essential for providing convenient and cost-effective care while minimizing COVID-19 transmission. BC survivors, however, often value in-person visits for clinical exams. This study aimed to compare telehealth participation between patients with a history of BC and women without cancer history. Methods Adults aged 18 and older, including cancer patients, survivors, caregivers, and healthy volunteers, primarily from Ohio, were recruited with attention and inclusion of underserved and minority populations to complete a survey about COVID-19-related beliefs, practices, and knowledge. Recruitment involved (1) re-contacting participants from previous OSU studies (2) outreach via community partners and listservs to invite additional participants and caregivers. Sociodemographic characteristics by BC status were calculated using Chi square tests. Univariable and multivariable logistic regressions modeled association between the outcome of interest, telehealth participation, and BC status accounting for race, ethnicity, age, education, marital status, rurality, and insurance status. Results The final sample included 2265 participants, with 43.7% having a history of BC. Significant demographic differences were observed between participants with and without a history of breast cancer. Those with a previous BC diagnosis were younger on average (55.6 vs. 57.9 years, p < .001), had higher levels of educational attainment (p < .001), were less often married and more often divorced/widowed/separated (p = .037), and were more likely to have private insurance only and less likely to have both public and private coverage (p < .001). Telehealth use was lower during COVID-19 among BC survivors (41.5%) vs. those without cancer (63.9%) (p < 0.001). In a multivariable model, factors that were statistically significantly associated with increased utilization of telehealth were Black race (OR = 1.90, p-value 0.036), having some college education (OR = 1.50, p-value 0.034), being married (OR = 1.61, p-value 0.009), and being currently employed (OR = 1.25, p-value 0.050). BC diagnosis or survivor status was associated with decreased odds of telehealth use (OR: 0.72, p = 0.023). Among breast cancer patients with complete data (n = 645 of the 989 total), more than half used telehealth, with video visits being slightly more common than phone visits. Logistic regression analyses revealed increased telehealth use among patients with a history of BC was associated with age > 70, while decreased participation in telehealth was associated with higher educational status and having undergone surgical treatment. Conclusion We found that Black race, having some college education, being married, and being employed were significantly associated with increased telehealth participation during the COVID-19 pandemic. Interestingly, BC diagnosis was associated with reduced odds of telehealth use. Subgroup analyses of patients with a history of BC showed decreased use of telehealth to be associated with higher education and recent surgery for BC. Further investigation is needed to understand the acceptability and barriers to telehealth among BC survivors, as this modality continues to play an expanding role in oncology care delivery in the post-pandemic era.

Objective:The aim of the study was to evaluate the effect of health insurance status on rate of molecular testing (MT) and subsequent thyroidectomy in patients with indeterminate thyroid nodules in a real-world high-volume clinical setting. Methods:This is a single-center, retrospective study of patients who underwent fine-needle aspiration and had Bethesda III-IV cytology results between 2014 and 2022. We excluded patients with prior thyroid cancer, thyroidectomy, or incomplete insurance data. We utilized multivariable logistic regression to identify significant predictors of MT utilization and surgical intervention; specifically examining the role of insurance status and clinical symptoms. Results:A total of 448 patients were included (median age: 52 years, 79% women) with 79% of patients undergoing MT; with an associated 27-percentage-point (34% vs 61%, P < .001) reduction in thyroidectomy. Lack of MT was the strongest predictor of surgery (adjusted odds ratios [aOR]: 4.50, 95% confidence interval [CI]: 2.71-7.47, P < .001). However, uninsured/self-pay patients had 68% lower odds of MT (aOR: 0.32, 95% CI: 0.12-0.88, P = .026) and approximately 19-percentage-point higher thyroidectomy rate compared to insured patients (59% vs 40%). Thyroid-related compression symptoms were also significantly associated with increased rate of thyroidectomy (aOR: 1.86, P = .007) and an appropriate reduction in MT utilization (aOR: 0.62, P = .046). Conclusion:Despite high MT penetration at an academic medical center, lack of health insurance poses a critical barrier to evidence-based risk stratification leading to higher rates of diagnostic lobectomy. While symptoms appropriately drove surgical management, expanding affordable MT access may mitigate barriers to care for patients with thyroid nodules.

Neoadjuvant chemotherapy (NAC) has become an integral component of modern breast cancer management, particularly for patients with triple-negative and HER2-positive disease. As pathologic complete response (pCR) rates improve with current systemic therapies, the optimal role of adjuvant radiotherapy (RT) after NAC has become an area of active investigation. This review summarizes current evidence, evolving guidelines, and ongoing clinical trials evaluating RT de-escalation and treatment personalization after NAC. Response to NAC is strongly associated with clinical outcomes and increasingly informs locoregional treatment decisions. The phase III NSABP B-51/RTOG 1304 trial demonstrated low recurrence rates and no significant benefit at 5 years from regional nodal irradiation (RNI) in patients with cT1-3N1 disease who achieved ypN0 status after NAC, findings now incorporated into updated NCCN and ASTRO-ASCO-SSO guideline recommendations. Additional studies, including RAPCHEM and retrospective analyses, support selective de-escalation of RNI in carefully selected patients, while ongoing trials continue to evaluate omission of whole-breast irradiation (WBI) and optimization of axillary management. Emerging data also highlight the increasing complexity of integrating RT with modern adjuvant systemic therapies, including immunotherapy, HER2-targeted agents, CDK4/6 inhibitors, and PARP inhibitors. Advances in systemic therapy and improved response assessment are driving a transition toward more individualized, response-adapted RT strategies after NAC. Ongoing trials, including Alliance A011202, ADARNAT, ATNEC, DESCARTES, and ROSALIE, will further define the optimal integration, sequencing, and de-escalation of RT in the post-NAC setting.

Background: Combination immunotherapy (IO) and chemotherapy (CT) for triple-negative breast cancer (TNBC) improves overall survival (OS) over CT alone in both the neoadjuvant and metastatic setting. Large-scale real-world analysis of IO +/- CT for TNBC has been limited to date. We present prescribing patterns and OS of initial chemo-immunotherapy treatments in a large US population-based cohort of TNBC patients. Methods: Patients with TNBC diagnosed from 2018-2020 were identified in the National Cancer Database (NCDB), a US-wide oncology outcomes database. Those with undocumented staging and stage 0 disease were excluded. The primary outcome, OS, was evaluated by initial treatment: chemotherapy/IO (CT/IO), chemotherapy/no IO (CT), IO/no chemotherapy (IO), or no chemotherapy/no IO (NT), using cox proportional hazards models and Kaplan-Meier methods. The secondary objective was real world practice patterns. Categorical variables were compared between the groups using a Chi-square test. Age was compared using a Kruskal-Wallis test. Results: 58,128 new TNBC diagnoses were identified in NCDB between 2018-2020, with 6.7% de novo metastatic. IO use steadily increased over time (2018 = 19.5%, 2019 = 31.0%, 2020 = 49.5%). Academic research programs most commonly used IO. Most patients received CT (73.3%, n = 32,858), with 5.6% (n=3276) receiving CT/IO, 0.1% (n=66) receiving IO, and 20.5% (n=11,926) NT following initial diagnosis. CT +/- IO use was associated with younger age, whereas IO alone or NT was more common in older patients (median age: CT/IO = 55 years [y], CT = 58y, IO = 71y, NT = 72y; p< 0.001). Treatment with CT/IO or CT was most common among private insurers (57.6% and 53.3%, respectively) whereas Medicare was the most common payor for IO or NT (59.1% and 64.1%, respectively; p<0.001). Proportionally, stage I TNBC received less treatment (CT/IO 13.3%, CT 34.1%, IO 18.2%, NT 55.3%; p< 0.001) and single agent IO treatment was more common in stage IV TNBC (CT/IO 24.3%, CT 4.9%, IO 53.0%, NT 8.4%; p< 0.001). Pathologic complete response (pCR) rates after neoadjuvant chemotherapy (NACT; n = 27,900) differed by treatment group, with pCR most common following CT (CT/IO 27.6%, CT 29.6%, IO 16.7%, NT 1.8%; p<0.001). OS was similar among treatment groups in the full TNBC population, with median survival for NT at 36 months. Race differed significantly between treatment (p<0.001). Among White patients with TNBC (70.9%), 72.1% received CT/IO and 70.5% received CT. However, among Black patients with TNBC (11.9%), 19.4% received CT/IO and 23.6% received CT. OS was highest in the CT group, whereas the IO only group had the worst survival outcome – even worse than NT (hazard ratio (HR) CT 0.52, IO 2.22, NT 1.17; ref CT/IO, p< 0.001 each HR). Nonetheless, Black race was associated with worse OS than White race and the addition of IO to CT did not fully mitigate the OS racial gap (HR Black CT/IO 1.38, White CT 0.52, Black CT 0.65; ref White CT/IO, p< 0.001 each HR). Conclusions: This large NCDB cohort analysis of newly diagnosed TNBC cases revealed practice patterns for initial TNBC treatment varies widely. Furthermore, this analysis captured new TNBC diagnoses from 2018 to 2020 and describes significant off-label use of IO+/- CT in both the NACT (Keynote-522 FDA approval 2021) and metastatic (ImPassion130 FDA accelerated approval 2019) settings with some relation to the payor. In addition, single agent IO use was higher than expected for stage IV and resulted in worse OS, again raising concerns of off-label use of the tumor agnostic IO approvals (tumor mutation burden-high, microsatellite instability). Finally, racial discrepancies of use and efficacy of IO was present. Further studies and interventions are needed to address TNBC treatment disparities. Citation Format: Dionisia Quiroga, Julie A Stephens, Gilbert Bader, Mathew A Cherian, Ashley P Davenport, Kai CC Johnson, Sagar Sardesai, Daniel Stover, Robert Wesolowski, Nicole Williams, Nerea Lopetegui-Lia, Arya M Roy, Samilia Obeng-Gyasi, Bridget A Oppong, Sachin R Jhawar, Margaret E Gatti-Mays. Real-world first-line immunotherapy use and overall survival rates for triple-negative breast cancer: analyses from a 2018-2020 US population-based cohort [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P3-10-03.

PURPOSE:With advancements in breast cancer treatment, survivorship has increased, leading to 3.8 million survivors in the US. These women have diverse supportive care needs, often addressed through survivorship programs (SPs), which provide clinical and nonclinical support services. SPs aim to deliver a holistic approach to comprehensive breast cancer treatment and recurrence prevention. Historically, disparities in SP utilization exist among minority and elderly women. This study aims to explore trends varying in SP participation by age and race within a single institution. METHODS:A retrospective analysis of breast cancer patients' survivorship needs at a tertiary referral academic cancer center program was conducted. Data were collected from programs between 2019 and 2022, including demographics and referrals to clinical resources such as Adolescent/Young Adult care, Fertility preservation, Palliative care, Psychosocial support, and Survivorship. Participation in nonclinical areas, including Art, Education, Exercise, Mind-Body-Spirit, and Nutrition, was also evaluated. Descriptive statistics summarized patterns based on age, race, and ethnicity. RESULTS:From 2019 to 2022, 2198 patients attended SPs, with Nutrition and Exercise being the most popular. Most attendees were 60-69 years old and White. Black attendees declined from 9.9% (2019) to 5.7% (2022). Clinical resources showed the highest referral rate to survivorship clinics. Black patients saw an increase in palliative care referrals, rising from 11% to 21%. CONCLUSION:Data reveal differences in clinical referrals by age and race, with fewer referrals for older women and more for Black patients. Participation in nonclinical SPs was similar across groups. Future program development will focus on inclusivity and equitable access.

BACKGROUND:Poverty, unemployment, and lack of insurance contribute to surgery refusal in breast cancer treatment. This study evaluates surgery refusal before and after the Affordable Care Act (ACA) and Medicaid expansion. METHODS:A retrospective analysis of breast cancer patients from the National Cancer Database (2006-2021) divided patients into pre-expansion (2006-2009), ACA (2010-2013), and ACA ​+ ​Medicaid expansion (2014-2021) cohorts. Clinical and therapy data were analyzed. RESULTS:Of 2,555,859 patients, 16,756 (0.65 ​%) refused surgery. The refusal rate increased from 0.28 ​% in 2006 to 0.77 ​% in 2021. Surgery refusers were older and from lower-income quartiles. After adjusting for socioeconomic and pathological factors, the odds of refusal in the ACA ​+ ​Medicaid cohort were 2.8 times higher than in the pre-ACA cohort (p ​< ​0.001). CONCLUSIONS:Black race, older age, and lower income were linked to surgery refusal. Surprisingly, refusal rates increased after ACA and Medicaid expansion, suggesting factors beyond insurance influence decisions.

BACKGROUND:Surgical health care disparities remain pervasive in the US, with historically marginalized communities disproportionately suffering from numerous health disorders and experiencing excess mortality compared to the majority community. The African American/Black community remains one of those historically challenged communities and efforts to help mitigate these health care disparities are ongoing. METHODS:To aid in this issue, The Society of Black Academic Surgeons (SBAS) convened a series of presentations and a panel discussion by leaders from SBAS to better articulate disease specific health care disparities in the Black community. This program was part of a monthly diversity, equity, and inclusion series produced by the Advances in Surgery Channel in alliance with the American College of Surgeons. Dr. Erin King-Mullins addresses the current state of colorectal cancer in the Black population. Dr. Bridget Oppong speaks about disparities and equity in breast cancer care in the Black community, and Dr. Paris Butler provides insight into racial disparities in post mastectomy breast cancer reconstruction. RESULTS:Exhaustively, SBAS members candidly provide evidence-based data describing disease specific health care disparities that disproportionately impact the Black community. Of equal import, these experts also provide strategies to mitigate disparities both locally and nationally, if properly resourced. CONCLUSIONS:Providing equitable surgical health care for historically vulnerable communities remains an unsolved challenge in the US. Amplifying these disparities and implementing strategies to alleviate them are necessary. Organized surgery's efforts in partnership with the community will be essential to addressing these longstanding issues.

Background: Application of genomic assays in clinically low-risk hormone receptor positive breast cancer (HR+BC) is understudied as patients with small (T1mi/a/b) node-negative (N0/N1mi) disease were often excluded from prospective trials. However, use of these tests in real world clinical practice, including OncotypeDx, occurs not infrequently, leading clinicians to question the reliability of the results produced whenever they are performed. Methods: We aimed to help address this question by conducting a large, retrospective analysis of available survival data within the National Cancer Database (NCDB) for patients with small, node-negative disease. Where OncotypeDx recurrence score (RS) results were available, we categorized patients into low (RS <11), intermediate (RS 11-25), & high risk (RS 26-100) groupings. Additionally, we categorized patients based receipt of adjuvant chemotherapy. The primary outcome of Overall survival (OS) was explored for patients with high-risk disease via univariate analysis (cox proportional hazard models & Kaplan Meier survival estimates). Secondary outcomes included univariate analysis of OS based on OncotypeDx testing (regardless of chemotherapy receipt or risk group) & OS between low, intermediate, & high-risk patients, independent of chemotherapy use. Results: In total, of the 308513 patients with T1mi/a/b N0/N0(i+)/N1mi HR+BC identified within the NCDB between the years 2010-2020, 18372 (6.0%) had received chemotherapy. Among those chemotherapy recipients who underwent OncotypeDx testing (n=8700), 363 were low risk (4.2%), 3475 were intermediate risk (39.9%), & 4862 were high risk (55.9%). Conversely, 81223 patients with T1mi/a/b N0 HR+BC underwent OncotypeDx testing without receipt of chemotherapy during this period. Of those, 29954 were low risk (36.9%), 48569 were intermediate risk (59.8%), & 2700 were high risk (3.3%). When comparing OS among high-risk patients where chemotherapy was omitted versus administered, a significant reduction in OS was noted with omission (HR 1.73, 95% CI 1.44-2.10, p<0.001), with 5-year OS being 94.9% vs 96.8%, respectively. When comparing OS for patients who underwent OncotypeDx testing versus those who did not, regardless of chemotherapy receipt, there was a significant improvement in OS for those tested (HR 0.45, 95% CI 0.43-0.47, p<0.001), with 5-year OS being 97.2% versus 93.7%, respectively. Furthermore, when comparing OS among low, intermediate, & high-risk patients, regardless of chemotherapy receipt, a significant difference between groups was noted (p<0.001), with high-risk being least favorable. Conclusions: The findings above suggest that risk stratification may be advantageous, even among otherwise clinically low-risk individuals with HR+BC. Multivariable analysis is further planned to better examine the association between OncotypeDx risk categories & pathologic features such as tumor size, nodal findings, tumor grade, estrogen receptor expression levels, progesterone receptor expression levels, & the presence of lymphovascular invasion. Clinical factors, such as age, race, ethnicity, & receipt of endocrine therapy will also be examined. Citation Format: Kai Johnson, Julie A Stephens, Brittany Sandoval, Andrea House, Blair Hoeting, Sachin R Jhawar, Dionisia Quiroga, Gilbert Bader, Ashley P Davenport, Nicole Williams, Mathew A Cherian, Sagar Sardesai, Daniel G Stover, Margaret Gatti-Mays, Samilia Obeng-Gyasi, Bridget A Oppong, Doreen Agnese, Robert Wesolowski. Impact of OncotypeDx Risk Categorization & Receipt of Chemotherapy on Survival Outcomes Among Patients with Small (T1mi/a/b) Node-Negative (N0/N0(i+)/N1mi) Hormone Receptor Positive (HR+) Breast Cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P1-11-06.

1637 Background: Following breast cancer diagnosis, 25% of survivors experience psychosocial needs like depression, anxiety, and fear of recurrence. Integrative survivorship support services address these needs, but participation is lower among Black women, who report higher psychosocial distress. Patient navigation has emerged as a strategy to reduce these barriers. This study piloted a navigation-based intervention aimed at improving psychosocial symptom management over 6 months. Methods: A single-arm feasibility trial was conducted with Black breast cancer survivors from November 2022-June 2024. Women aged 18+ with non-metastatic breast cancer were recruited. A trained lay navigator provided personalized support and resource facilitation to address psychosocial and healthcare challenges. Interactions were analyzed qualitatively to assess preliminary impact. Surveys administered at baseline and post-intervention included the Life and Longevity after Cancer, Patient Reported Outcomes Measurement Information System, and Breast Cancer Survivorship Experience Survey, with responses measured on a Likert scale. Quantitative data were analyzed descriptively. Results: Of 21 Black women who consented (mean age 64), 18 began the study while 3 did not proceed beyond consent. Of these, 44.4% completed all six months, while 61.1% completed three months. Eight participants completed post-surveys. All participants found the study easy to join, 5/8 found its length appropriate, and 6/8 were satisfied with session intervals. All would recommend the program, and 4 preferred in-person sessions. Participants reported confidence in accessing future support programs. Key benefits included managing stress, family stressors, and improving community support. Qualitative analysis of 108 transcripts from 17 participants identified six themes: managing health challenges, communication, emotional well-being, resilience in daily life, program support, and future planning. Survey results showed improvements in well-being and self-efficacy. LILAC scores increased from 52.7 to 63.9, PROMIS physical scores rose from 12.4 to 13.3, and mental scores improved from 13.3 to 15.6. Self-efficacy decreased slightly in BCSES scores from 53.6 to 52.5. Conclusions: Among Black breast cancer survivors, 61% completed biweekly sessions during the first 3 months, with a drop in participation after transitioning to monthly sessions. Participants reported benefits in addressing distress and accessing support programs. Future efforts should focus on tailored strategies to enhance engagement and retention.

Background:Hormone receptor (HR)-low human epidermal growth factor receptor 2 (HER2)-negative breast cancers (BC) have similar outcomes to triple-negative BC; however, there is a lack of consensus on treatment recommendations for this subset. We present results from a US National Cancer Database (NCDB) analysis of patients with stage I-III HER2-negative BC categorized into groups by estrogen and progesterone receptor (PR) expression: HR-Neg, HR-Low, HR-Intermediate (HR-Int), and HR-High. Objectives:The primary objective was to assess the effect of HR expression on neoadjuvant chemotherapy (NAC) pathologic complete response (pCR) rates. Secondary objectives included assessment of clinico-pathologic characteristics and practice patterns. Design and methods:Patients with stage I-III HER2-negative BC diagnosed in 2018 were identified in the NCDB, a nationwide oncology outcomes database in the United States. Quantitative HR expression was unavailable prior to 2018. Data were categorized into four groups by estrogen receptor (ER) and PR expression: ER <1% and PR <1% (HR-Neg); ER 1%-10% and/or PR 1%-10% (HR-Low); ER >11%-30% and/or PR >11%-30% (HR-Int); and ER >30% and/or PR >30% (HR-High). Those with undocumented HR status (3%) or without curative intent surgery (5%) were excluded. Results:Significant differences were found between HR groups with higher grade, clinical stage, and Ki-67 in HR-Low versus HR-Int or HR-High groups. pCR rates in those receiving NAC were significantly different by HR status, with higher pCR rates in HR-Low versus HR-High groups (p < 0.001). NAC utilization significantly differed between groups, with a higher proportion of patients with HR-Low BC receiving NAC than other HR-positive groups (p < 0.001). Less than half of patients with HR-Low BC received endocrine therapy compared to higher rates in the HR-Int and HR-High groups (p < 0.001). Conclusion:This large real-world analysis shows variability in NAC utilization and endocrine therapy for HR-Low and HR-Int BC, with further work needed to enhance representation of these in trials.

Background: Breast cancer (BC) with low hormone receptor (HR) expression (1-10%) is classified as HR-Low BC. We previously demonstrated that pathologic complete response (pCR) rates and biologic features of HR-Intermediate HER2-negative BC (11-30%), much like HR-Low BC, are similar to triple negative breast cancer (TNBC). Here, we report treatment patterns and overall survival (OS) for HER2-negative BC by level of HR expression from the US National Cancer Database (NCDB). Methods: Patients (pts) with stage I-III HER2-negative BC diagnosed in 2018-2020 were categorized into four groups by estrogen receptor (ER) and progesterone receptor (PR) expression: ER<1% and PR<1% (HR-Neg), ER 1-10% and/or PR 1-10% (HR-Low), ER >11-30% and/or PR>11-30% (HR-Int), ER >30% and/or PR >30% (HR-High). Pts with undocumented HR status or without curative intent surgery were excluded. The primary outcome was OS by HR expression. Key secondary outcomes were treatment patterns and OS by neoadjuvant chemotherapy (NAC) response and endocrine therapy (ET) use. Categorical variables were compared between the groups using a Chi-square test. OS survival was explored using Kaplan Meier estimates, log-rank tests and univariate/multivariable cox proportional hazard models. Results: 395,757 incident cases of early-stage HER2-negative breast cancer were identified, including 8857 (2.2%) HR-Low and 4375 (1.1%) HR-Int BC. HR-Low and HR-Int cohorts reported more advanced stage at diagnosis and were more likely to be node-positive with higher Ki-67 scores than HR-High BC (p<0.001 for all). HR-Low and HR-Int groups consisted of proportionally more Black patients than HR-High (20%, 19% vs 9%; p< 0.001). Oncotype DX results were more likely to be obtained with increasing levels of HR expression (HR-Neg 1%, HR-Low 11%, HR-Int 25%, HR-High 43%; p< 0.001). ET use was more frequent in HR-High than HR-Low or HR-Int BC (87%, 46% & 71%; p <0.001). The use of immunotherapy increased with lower expression of HR (HR-Neg 5%, HR-Low 4%, HR-Int 3%, HR-High 1%; p< 0.001). Additionally, NAC use was more frequent in HR-Low and HR-Int than HR-High (31%, 24% & 5%, p< 0.001). pCR rates were correlated with significantly higher OS at the 3 year (y) timepoint for all levels of HR expression (p< 0.001). NAC response had a significantly greater impact on 3y OS in the HR-Low (pCR 96.5%, no pCR [NR] 62.2%) and HR-Int (pCR 94.5%, NR 56.8%) groups compared to HR-High (pCR 96.7%, NR 91.5%). Multivariable analyses showed significantly worse OS in HR-Neg (hazard ratio [HazR]: 2.73), HR-Low (HazR: 2.70), and HR-Int (HazR: 2.64) compared to HR-High tumors after adjusting for age, tumor size, nodal status and grade (p< 0.001 for each). 5y OS in HR-Low, HR-Int, and HR-High groups were 78.5%, 81.4%, and 89.0% respectively. Among HR-positive BC, ET use was associated with longer OS in multivariable analyses (HazR: 0.85) with 5y OS for HR-Low (ET 82.3%, no ET 74.7%), HR-Int (ET 84.4%, no ET 73.1%), and HR-High (ET 90.0%, no ET 80.7%) groups (p< 0.001 for each). Conclusions: HR-Low and HR-Int HER2-negative BC are rare subtypes with distinct biologic features compared to HR-High BC. This real-world analysis reveals significant differences in the survival outcomes, management, and treatment responses of HR-Low and HR-Int BCs. ET use is less common with lower HR expression yet associated with improved 5y OS. The use of immunotherapy is more frequent with lower HR expression; however, requires further investigation in HR-Low and HR-Int BC. The binary categorization of HR does not adequately address disease heterogeneity. This may contribute to outcome disparities in patients with HR-Low and HR-Int, HER2-negative BC. Citation Format: Dionisia Quiroga, Julie A Stephens, Gilbert Bader, Mathew A Cherian, Ashley P Davenport, Margaret E Gatti-Mays, Kai CC Johnson, Daniel Stover, Robert Wesolowski, Nicole Williams, Nerea Lopetegui-Lia, Arya M Roy, Samilia Obeng-Gyasi, Bridget A Oppong, Sachin R Jhawar, Sagar Sardesai. Practice patterns and survival analysis of early-stage HER-negative breast cancers with low and intermediate levels of hormone receptor expression: a 2018-2020 US National Cancer Database analysis [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P2-10-07.

Patients diagnosed with small (T1a-c) node-negative triple-negative breast cancer (TNBC) comprise an understudied population. These patients have been commonly excluded from participation in large, practice-changing clinical trials that establish improvements in disease-free and overall survival due to neoadjuvant or adjuvant systemic therapies as well as innovative local therapies. Despite this, patients with small, node-negative TNBC are at higher risk for early relapse compared to patients with hormone receptor-positive breast cancer matched for the same T and N stage. We highlight retrospective and prospective studies that analyze the benefit of chemotherapy in small node-negative TNBC patients. Furthermore, we discuss current guidelines for radiation therapy, surgical management, and relevant studies examining local therapy for patients with early-stage node-negative TNBC.

Though sexual and gender minority people experience multiple cancer disparities, they remain largely invisible in oncology clinical care. Despite repeated calls by national medical and oncology organizations to address the lack of sexual orientation and gender identity data, there remains a dearth of information to guide research, clinical care, and creation of national priorities to address important health inequities. We aimed to develop effective strategies to collect sexual orientation and gender identity data within our Midwestern Comprehensive Cancer Center based on barriers and facilitators identified by community members, staff, and clinicians. We conducted 5 focus groups of sexual and gender minority and cisgender, heterosexual community members (n = 24). We interviewed clinicians and registration staff across 3 ambulatory cancer clinics (n = 27). Rapid qualitative analysis was used to identify themes from focus groups and interviews. Focus group participants' average age was 37 years with a majority identifying as White (79%, n = 19) and non-Hispanic (92%, n = 22); most participants were women (58%, n = 14) and queer (58%, n = 14). Staff and clinicians' average age was 40 years; most identified as White (82%, n = 22), women (82%, n = 22), and straight (82%, n = 22). Qualitative themes to guide sexual orientation and gender identity data collection included comfort and trust, support services, physical space, training, data collection procedures, data access and privacy, and influence on care. To encourage patient disclosure, a supportive environment where privacy is upheld and health-care staff are trained to competently interact with lesbian, gay, bisexual, transgender, queer, plus patients is needed. We also share our process of sexual orientation and gender identity data collection implementation at our cancer hospital.

Patient navigation (PN) was created to address barriers to screening and workup for cancers. Since its inception it has resulted in improved mammography utilization, diagnostic resolution, and time to breast cancer treatment initiation in medically underserved populations. Because an abundance of evidence has established PN’s positive impact, its use has expanded within the breast cancer care continuum, from screening, treatment, and ultimately survivorship. Increasing applications for navigation now also include support in the treatment and survivorship phase. After treatment, populations who struggle with the complex medical systems where oncology care is often delivered, also lack the support resources needed to successfully transition to survivorship. Support in the psychosocial realm is important for these patients as they continue surveillance and adherence to maintenance medications, such as hormonal therapy.

To review the current management of the axilla in breast cancer. Axillary dissection is no longer indicated in patients with clinically node-negative axilla with 1–2 positive sentinel lymph nodes following upfront surgery or in patients with clinically node-negative axilla following neoadjuvant chemotherapy. Breast cancer has evolved away from routine axillary clearance to the less invasive sentinel lymph node biopsy to now complete omission of axillary sampling in select patients. We will review the most salient evidence that has shaped these practice changes over the last three decades. Current practice controversies are especially relevant for elderly populations and those receiving neoadjuvant therapy. Ongoing clinical trials will provide data to further guide breast cancer surgical management.

Introduction: Oncoplastic breast conservation surgery (BCS) uses concurrent reduction and/ or mastopexy with lumpectomy to improve aesthetic outcomes. However, tissue rear-rangement can shift the original tumor location site in relation to external breast land-marks, resulting in difficulties during re-excision for a positive margin and accurate radiation targeting. We developed the Breast Intraoperative Oncoplastic (BIO) form to help depict the location of the tumor and breast reduction specimen. This study seeks to assess physician perspectives of the implementation outcomes.Methods: From February 2021 to April 2021, the BIO form was used in 11 oncoplastic BCS cases at a single institution. With institutional review board approval, surgical oncologists (SOs), plastic surgeons (PSs), and radiation oncologists (ROs) were administered a 12-question validated survey on Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM), using a 5-point Likert scale during initial implementation and at 6-month reassessment.Results: Twelve physicians completed the survey initially (4 SOs, 4 PSs, and 4 ROs). The mean scores for Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure were high (4.44, 4.56, and 4.56, respec-tively). Twelve completed the second survey (5 SOs, 3 PSs, and 4 ROs). The mean scores were marginally lower (4.06, 4.21, and 4.25). There were no significant differences when stratified by number of years in practice or specialty. Free text comments showed that 75% of physicians found the form helpful in oncoplastic BCS.Conclusions: The data indicate high feasibility, acceptability, and appropriateness of the BIO form. Results of this study suggest multidisciplinary benefits of implementing the BIO form in oncoplastic BCS. 2023 Elsevier Inc. All rights reserved.