e20583 Background: Breast cancer (BC) patients commonly employ lifestyle modifications (LM) such as complementary and alternative medicine (CAM), but limited information exists among women who are high risk for BC (HRBC). This study's aims were to estimate the prevalence of LM use among HRBC patients, describe communication patterns, and determine correlations with quality of life (QoL) measures. METHODS Women enrolled in a multi-modality screening study for HRBC patients (≥20% lifetime risk) were distributed a questionnaire asking about the use of CAM therapies and other LM, timing of use, reasons, costs, and communication patterns. QoL measures included the Short-Form 36 (SF-36) and Beck Depression Inventory (BDI). Demographic variables and those instruments with significant correlations (p<0.05) were included in a multivariate model. RESULTS A total of 173 HRBC patients are enrolled on this study and 123 have completed the survey. General characteristics of these women include a median age of 45 years, 91% Caucasian, 30% have a gene mutation (e.g. BRCA1/2), and 33% have had breast and/or ovarian cancer. Ninety-nine percent reported a lifetime prevalence of LM and CAM, and nearly half of subjects (48%) did so for cancer-related reasons. The most popular LM were exercise (83%), massage (68%), yoga (44%), vitamin E (38%), and chiropractic medicine (36%). The most common cancer-related changes were low fat diet (15%), exercise (11%), and meditation (10%). Half of subjects (48%) did not discuss any of these LM with their physicians, and the most common reason was their physician did not ask. In the multivariate model for cancer-related LM, subjects having a history of BC or ovarian cancer were 6.2 times (p<0.001) more likely to use LM and CAM. Subjects with a below average SF-36 general health subscale score were 3.4 times (p<0.05) more likely to pursue non-biologically based CAM, and those with an elevated BDI (score>9) were 6.2 times (p<0.05) less likely to pursue dietary changes. CONCLUSIONS LM including CAM are highly prevalent among women at HRBC. Oncologists should inquire about LM and CAM use and explore reasons for this including QoL. No significant financial relationships to disclose.

Abstract #4039 Introduction: The importance of hormone receptor status in assigning treatment and the potential use of HER2 targeted therapy have made it imperative for laboratories to improve detection techniques. As inter-laboratory variability in immunohistochemical (IHC) tests may also affect epidemiologic studies of breast cancer subtypes in different countries, we conducted a validation study of breast cancer biomarkers between a well-established laboratory in the US and a field laboratory at the Institute for Medical Research and Training at the University College Hospital in Ibadan Nigeria.
 Method: 232 breast tumor blocks were evaluated for ER, PR, and HER2 at both laboratories using tissue micro arrays (TMA) technique. Web-based conferences were held periodically to discuss IHC staining protocols, standardize scoring systems and to resolve discrepant cases. Pathologists used whole slide imaging for joint review and kappa statistic (κ) was used to indicate concordance between the two laboratories. Fluorescence in situ hybridization was carried out to confirm HER2 status in all cases.
 Results: Initially, concordance analysis revealed an agreement of 91% (κ=0.52) for ER, 85% (κ=0.49) for PR, and 80% (κ=0.39) for HER2 between the two labs. Antigen retrieval techniques and scoring methods were identified as important reasons for discrepancy. After quality assurance and training, the agreement improved to 92% (κ=0.53) for ER, 88% (κ=0.64) for PR, and 94% (κ=0.75) for HER2. To date, florescence in situ hybridization (FISH) has been completed for 67 cases to confirm HER2 status, out of which 16 (24%) were shown to amplify the HER2 gene, 6 out of the 12 discordant HER2 results were resolved by FISH.
 Conclusion: We found web-based conference with TMA and digital microscopy a useful and cost-effective tool for quality assurance of IHC, consultation and collaboration between distant laboratories. Quality improvement exercises in testing of tumor biomarkers will reduce misclassification in epidemiologic study of breast cancer subtypes and provide much needed capacity building in resource poor field sites.
 Acknowledgement
 This study was carried out with the support of Breast SPORE NCI P50 CA125183, Breast Cancer Research Foundation and the Lee Jeans Entertainment Industry Fund. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4039.