The COVID-19 pandemic resulted in the rapid development and distribution of vaccines as a critical strategy to control the spread of the virus. This paper explores COVID-19 vaccine uptake in the state of Ohio, with a particular focus on the difference between metro and non-metro residents. Survey data collected as part of the IMPACT-Ohio Project were used for this study. From August 2021 to February 2023, 3,806 individuals who resided in 12 Ohio counties (six metro and six non-metro counties) responded to the survey. Chi-square tests compared the relationships between various demographic, socio-economic and clinical characteristics among metro and non-metro region respondents. Binary logistic regression modeled the probability of receipt of COVID-19 vaccine and compared those Ohioans who lived in metro (RUCC codes 1–3) vs non-metro (RUCC codes 4–9) counties with adjustment of various covariates. Participants residing in metro counties were almost two times more likely to receive the COVID-19 vaccine compared to those living in non-metro counties adjusting for demographic, socioeconomic and clinical characteristics (aOR: 1.89, 95

BACKGROUND:The impact of COVID-19 on physical function (PF) outcomes among older adults remains unclear. We examined the long-term association between COVID, PF, and Activities of Daily Living (ADLs) among women from the Women's Health Initiative (WHI). METHODS:Participants from the WHI who completed the COVID-19 survey (2021-2022) and annual survey (2022) were included. Self-reported data on COVID-19 testing and symptoms (2021-2022) were used. PF score and ADLs were evaluated pre- and post-COVID-19 survey by the 36-Item Short Form Survey PF subscale, the Lawton Instrumental Activities of Daily Living, and the Katz Index of Independence in ADL. Multivariable linear regression and logistic regression were used and adjusted for pre-COVID functioning to examine the association between COVID status, PF, and ADLs. The interaction between pre-COVID functioning and COVID status was tested. RESULTS:Among the 13,933 WHI participants, 71.4% were aged ≥ 80 years, and 88.6% were Non-Hispanic White. Only 8.7% tested positive for COVID-19 (n = 1210), with 35.1% having long COVID (n = 425). The most common long COVID symptoms were fatigue (18.2%), malaise (12.2%), memory problems (12.1%), and brain fog (11.2%). Women who tested COVID+ had lower PF scores (60 vs. 65, p = 0.045) and were less likely to be able to do all ADLs without help (74% vs. 79.2%, p = 0.015) compared to those who never tested COVID+. After controlling for covariates, post-COVID PF scores did not differ by COVID status (p = 0.30), although pre-COVID PF scores were significantly linked to post-COVID scores (p < 0.001). Similarly, the odds of being able to do all ADLs without any help did not differ by COVID status (p = 0.31), with pre-COVID ADLs significantly associated with post-COVID ADLs (p < 0.001). CONCLUSIONS:In older women, after accounting for pre-COVID functional status, the association between long COVID and lower functioning became nonsignificant. Our findings highlight the importance of preserving physical functioning among older women.

Early-onset colorectal cancer (EOCRC) has increased in the last several decades and now accounts for 10% of new CRC diagnoses in the U.S. Most EOCRC cases are sporadic, with no identified molecular causes that differ from late-onset CRC (LOCRC), suggesting that modifiable environmental factors may have an enhanced role in EOCRC. Despite observed links between supplement and medication use and overall CRC risk, few studies have examined usage in EOCRC, compared usage with LOCRC, or assessed their potential protective effects for EOCRC. To address this gap, we evaluated self-reported supplement and medication use in sporadic EOCRC, compared to LOCRC incidence. We utilized baseline data from the Ohio Colorectal Cancer Prevention Initiative (OCCPI), a statewide initiative to increase access to germline genetic testing for patients with newly diagnosed CRC. OCCPI enrolled 3310 patients from 2013-2016. The current study included 1408 individuals with germline negative CRC and completed baseline questionnaires (n=1408). Model covariates included year of cancer diagnosis, sex, race, education, marital status, employment status, insurance type, and history of other cancer. The primary exposures of interest were the supplements: vitamins A, B-complex, C, D, E, and K, beta-carotene, calcium, iron, magnesium, potassium, selenium, zinc, and fish oil, and the following medications: ACE inhibitors, beta blockers, calcium blocker, digoxin, coumadin, diuretics, anti-diabetic medication, antacids, antidepressants, acetaminophen, and nonsteroidal anti-inflammatory drugs. The outcome of interest was odds of EOCRC, with LOCRC as reference, adjusting for multiple comparisons. Among 260 EOCRC and 1148 LOCRC cases, those with EOCRC were significantly more likely to have graduated college (43.6% v. 30.4%), be single/never married (12.4% v. 6.8%), currently employed (72.3% v. 33.6%), and have private insurance (83.7% v. 40.3%). Individuals with EOCRC were more likely to report having a history of asthma (p=0.003) and less likely to report a history of comorbidities, specifically diverticulitis (p<0.001), heart attack (p<0.001), hepatitis B or C (p=0.04), high cholesterol (p<0.001), stroke (p=0.001), and other cancer(s) (p<0.001). Preliminary analyses suggest that current use of vitamin D (aOR, 0.48; 95%CI, 0.25-0.93) and metformin (aOR, 0.24; 95%CI, 0.19-0.59), was associated with lower odds of developing EOCRC, compared to LOCRC, while current (aOR, 0.39; 95%CI, 0.23-0.67) and past (aOR, 0.48; 95%CI, 0.27-0.86) use of aspirin was associated with lower odds of EOCRC. Current use of antidepressants (aOR, 2.53; 95%CI, 1.55-4.14) was associated with higher odds of developing EOCRC, compared to LOCRC. Further analyses are ongoing. In conclusion, EOCRC patients differ demographically and in supplement and medication use from those with LOCRC. These findings suggest that these exposures may influence EOCRC risk, warranting further investigation. Holli A. Loomans-Kropp, Yevgeniya Gokun, Rand Akasheh, Rachel Pearlman, Cecilia DeGraffinreid, Jo Freudenheim, Peter Shields, Electra D. Paskett. Supplement And Medication Use in Early-Onset Colorectal Cancer: An Analysis of the Ohio Colorectal Cancer Prevention Initiative [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: The Rise in Early-Onset Cancers—Knowledge Gaps and Research Opportunities; 2025 Dec 10-13; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(23_Suppl):Abstract nr PR016.

Abstract Background Early detection of breast cancer through mammography screening reduces mortality risk. Disruptions during the COVID-19 pandemic in the United States worsened disparities in mammography use, and it is unclear if the impact persisted after the rollout of COVID-19 vaccine in 2021. We aim to describe disparities among minority and underserved women in breast cancer screening before and during the initial phase of the COVID-19 pandemic and assess any changes in screening patterns following the rollout of COVID-19 vaccines in the United States. Methods We used Behavioral Risk Factor Surveillance System (BRFSS) data for years before (2018), during (2020), and after (2022) the COVID-19 vaccine rollout in the United States. We estimated the proportion of women aged 50–74 years who were non-adherent to the United States Preventive Services Taskforce screening guidelines (no mammography in the past two years) by select sociodemographic and behavioral factors. Weighted frequencies, Chi-square tests with Rao-Scott correction, and log-binomial regression models with a Poisson family were used to estimate prevalence ratios (PR) for non-adherence by selected factors to identify sub-populations more likely to be non-adherent. Results A total of 116,756, 102,778, and 110,456 women were included in the analytic samples from 2018, 2020, and 2022, respectively. The prevalence of non-adherence to breast cancer screening guidelines was 21.1%, 20.6%, and 21.6%, in 2018, 2020, and 2022, respectively. Comparing 2018 to 2022, the proportion of non-adherent women significantly increased among those who did not graduate high school (26.7% vs 34.7%), those without health insurance (45.3% vs 61.9%), and women with incomes below $15,000 (28.1% vs 35.1%). Insurance status had the largest impact on screening adherence, with uninsured women more than twice as likely to be non-adherent compared to insured women both before (PR = 2.15, 95% CI: 1.94, 2.38) and after the COVID-19 vaccine rollout (2.24, 95% CI: 2.05, 2.45). Prevalence ratios of nonadherence significantly increased between 2018 and 2020, then returned back to pre-pandemic levels in 2022 among those living in non-metropolitan versus metropolitan areas, never married versus married, self-employed versus employed, and those reporting poor versus excellent health. Hispanics were more likely than non-Hispanics to be non-adherent in 2020 and 2022, but no difference was seen in 2018. Conclusions Persistent disparities in breast cancer screening adherence among eligible women in the United States were observed throughout the phases of the COVID-19 pandemic. Although overall adherence remained stable, certain subgroups, such as those with lower education, no health insurance, Hispanic, rural residence, and lower income, experienced worsening adherence. Health insurance status was the most significant factor associated with non-adherence, highlighting the need for targeted interventions among those who are uninsured. Citation Format: Gregory Chang C Chang, James L. Fisher, Electra D. Paskett. Disparities in mammography screening adherence throughout phases of the COVID-19 Pandemic: Results from the 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A119.

Background: Breast cancer treatment includes neoadjuvant chemotherapy (NAC), offered to patients with locally advanced breast cancer and who may benefit from down-staging before conservation therapy. NAC allows for evaluation of treatment response with pathologic complete response (pCR) acting as a marker of survival. Black women receive NAC more frequently as they often present with more advanced stage tumors and the triple negative subtype. Furthermore, Black women without pCR following NAC are at greater risk of mortality. Obesity is a prognostic factor for breast cancer. Non-Hispanic Black women have the greatest prevalence of obesity in most states. Patients with higher Body Mass Index (BMI) have previously been shown to have lower rates of chemotherapy response. Data on racial and ethnic differences in pCR rates are limited and whether obesity is a confounding factor requires investigation. Methods: Retrospective review of patients diagnosed with non-metastatic breast cancer who completed NAC and had surgery at Ohio State University James Comprehensive Cancer Center between January 1, 2005, and December 31, 2019, were analyzed. Clinical stage was calculated based on tumor size and nodal status. Operative treatment received was recorded to determine pathologic stage and chemotherapy response. The study endpoint, pCR, was assessed after definitive surgery. BMI categories were based on World Health Organization classification and obese defined as 30kg/m2. For the data analysis, we included self-reported Black and White women, excluding patients classified as “Other” race. Preliminary analyses included the distribution of sample descriptive characteristics. Differences by race and demographic characteristics were compared using Pearson’s chi-square test for categorical variables and t-test or Wilcoxon rank-sum test for continuous variables. Univariate analysis and multivariable logistic regression for pCR by age, race, BMI, menopausal status, insurance status and employment status were performed. Results: A final sample of 882 met criteria (11.7% Black and 88.3% white women, 1% Hispanic ethnicity). Median age of diagnosis is 51, with median 147.4 months of follow-up. 64% of the sample had clinical stage 2 disease, 22% were triple negative, 62% Her-2 positive subtypes. For tumor characteristics 67% of Black women and 59% white women had high grade tumor. Black women also had more triple negative disease (30% vs. 21%), more advanced stage at presentation (27% vs. 21%). More white women were employed and had private insurance compared to Black women, who predominantly had public insurance. The median BMI was higher among Black women (31.5) than white women (28.6). 52% of white women vs. 47% Black had mastectomy over lumpectomy. 67% of white women had radiation vs. 61% of Black women. Overall, 33% of Black and white women had pCR, with 67% having no pCR. Race and BMI were not significant predictors of PCR rates on univariate or multivariable analysis. Age < 40 is the only variable associated with pCR (OR 1.645, [95 CI 1.117-2.420] p-value: 0.012). Conclusions: BMI was not a significant predictor of pCR in this limited retrospective review. However, further exploration with a larger sample evaluating differences in pCR by BMI can lead to a better understanding of the association between obesity and pCR. Though race was not significant in predicting pCR, there is also room for further research considering socioeconomic disparities and obesity rates by race. Table 1. Table 1. Predictors for pCR. Table 1. Multivariable logistic regression for pCR adjusted by age, race, BMI, menopause status, insurance status, employment status. Univariate analysis for predictors of pCR performed for race and BMI. Citation Format: Ruvarashe Rumano, Michael Grimm, Marilly Palettas, Julie Stephens, Nicole Williams, Sagar Sardesai, Dionisia Quiroga, Bhuvaneswari Ramaswamy, Electra Paskett, Bridget Oppong. Differences in breast tumor response to neoadjuvant chemotherapy by race- Is obesity the key? [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-01-06.

Background During the COVID-19 pandemic, enforced social distancing initiatives have highlighted differences in social distancing practices and the resulting loneliness in various populations. The objective of this study was to examine how cancer history and social distancing practices relate to loneliness during COVID-19. Methods and findings Participants from previous studies (N = 32,989) with permission to be re-contacted were invited to complete a survey online, by phone, or by mail between June and November 2020. Linear and logistic regression models were used to determine the associations between cancer history, social distancing, and loneliness. Results Among the included participants (n = 5729), the average age was 56.7 years, 35.6% were male, 89.4% were White, and 54.9% had a cancer history (n = 3147). Individuals with a cancer history were more likely to not contact people outside of their household (49.0% vs. 41.9%, p<0.01), but were less likely to feel lonely (35.8% vs. 45.3%, p<0.0001) compared to those without a cancer history. Higher adherence to social distancing behaviors was associated with higher odds of loneliness among individuals with (OR = 1.27, 95% CI: 1.17-1.38) and without a cancer history (OR = 1.15, 95% CI: 1.06-1.25). Conclusions Findings from this study can inform efforts to support the mental health of individuals susceptible to loneliness during the COVID-19 pandemic.

Purpose Women at high risk of breast cancer face complex decisions about how to manage those risks. Substantial gaps in current knowledge include how women make these decisions and how decision making may differ across sub-populations. Among these critical gaps are the questions of (a) whether racial differences exist between the experiences of high-risk women navigating breast cancer risk, and (b) what consequences those racial differences might have on women’s ability to manage their cancer risks. The present study is designed to address these questions directly. Methods Fifty semi-structured interviews were conducted with high-risk Black (n = 20) and white women (n = 30) between May 2015 and March 2016 in person in Ohio and by phone. Transcribed data were analyzed using grounded theory methods. Main findings Our analyses suggest that many of the core decision-making dynamics high-risk women navigate differ by race. The experiences of white and Black women in our study differ in terms of (a) contextualizing risk—how women make sense of their own breast cancer risk, the degree to which they worry about risk, and how they prioritize risk within the contexts of their broader lives; (b) conceptualizing risk management–how, how much, and from whom women learn about and conceptualize their options for preventing cancer and/or ensuring that cancer gets diagnosed early; and (c) constraints–the external barriers women face throughout their decision-making and risk-management processes. In sum, the Black women we interviewed reported feeling less well-situated to consider and cope actively with breast cancer risk, less well-informed about risk-management options, and more constrained in their use of these options. Conclusions High-risk women’s accounts of the complex dynamics that shape breast cancer prevention decisions suggest that these dynamics vary substantially by race, such that Black women may experience disadvantages relative to whites.

Alliance for Clinical Trials in Oncology (Alliance) coordinated trials utilize Medidata Rave® (Rave) as the primary clinical data capture system. A growing number of innovative and complex cancer care delivery research (CCDR) trials are being conducted within the Alliance with the aims of studying and improving cancer-related care. Because these trials encompass patients, providers, practices, and their interactions, a defining characteristic of CCDR trials is multilevel data collection in pragmatic settings. Consequently, CCDR trials necessitated innovative strategies for database development, centralized data management, and data monitoring in the presence of these real-world multilevel relationships. Having real trial experience in working with community and academic centers, and having recently implemented five CCDR trials in Rave, we are committed to sharing our strategies and lessons learned in implementing such pragmatic trials in oncology. Five Alliance CCDR trials are used to describe our approach to analyzing the database development needs and the novel strategies applied to overcome the unanticipated challenges we encountered. The strategies applied are organized into 3 categories: multilevel (clinic, clinic stakeholder, patient) enrollment, multilevel quantitative and qualitative data capture, including nontraditional data capture mechanisms being applied, and multilevel data monitoring. A notable lesson learned in each category was (1) to seek long-term solutions when developing the functionality to push patient and non-patient enrollments to their respective Rave study database that affords flexibility if new participant types are later added; (2) to be open to different data collection modalities, particularly if such modalities remove barriers to participation, recognizing that additional resources are needed to develop the infrastructure to exchange data between that modality and Rave; and (3) to facilitate multilevel data monitoring, orient site coordinators to the their trial’s multiple study databases, each corresponding to a level in the hierarchy, and remind them to establish the link between patient and non-patient participants in the site-facing NCI web-based enrollment system. Although the challenges due to multilevel data collection in pragmatic settings were surmountable, our shared experience can inform and foster collaborations to collectively build on our past successes and improve on our past failures to address the gaps.

This study examines the accuracy of the self-report of up-to-date cancer screening behaviors (Mammography, Papanicolaou (Pap)/Human Papillomavirus (HPV) tests, Fecal Occult Blood Test (FOBT)/Fecal Immunochemical Test (FIT), Colonoscopy) compared to medical record documentation prior to eligibility determination and enrollment in a randomized controlled trial of an intervention to increase cancer screening among women living in rural counties of Indiana and Ohio. Women (n = 1,641) completed surveys and returned a medical record release form from November 2016-June 2019. We compared self-report to medical records for up-to-date cancer screening behaviors to determine the validity of self-report. Logistic regression models identified variables associated with accurate reporting. Women were up-to-date for mammography (75 %), Pap/HPV test (54 %), colonoscopy (53 %), and FOBT/FIT (6 %) by medical record. Although 39.6 % of women reported being up-to-date for all three anatomic sites (breast, cervix, and colon), only 31.8 % were up to date by medical records. Correlates of accurate reporting of up-to-date cancer screening varied by screening test. Approximately-one-third of women in rural counties in the Midwest are up-to-date for all three anatomic sites and correlates of the accurate reporting of screening varied by test. Although most investigators use medical records to verify completion of cancer screening behaviors as the primary outcome of intervention trials, they do not usually use medical records for the routine verification of study eligibility. Study results suggest that future research should use medical record documentation of cancer screening behaviors to determine eligibility for trials evaluating interventions to increase cancer screening.

Purpose of ReviewThe burden of breast cancer in low-income and middle-income countries transitioning to higher levels of human development is a public health crisis, set to increase dramatically in the coming decades. This paper provides an overview of the burden in human and economic terms, a summary of the costs, and cost-effective analyses for breast cancer interventions and suggests a way forward through research to better inform national, regional, and global policies for breast cancer control.Recent FindingsInequitable access to effective health services for breast cancer is striking between and within countries, where much of the costs are shouldered through out-of-pocket expenditures. A variety of factors can influence opportunities for women with breast symptoms to seek care and to access effective and affordable early detection and treatment services.SummaryResearch into disparities and solutions to overcome these, including an evidence-informed investment case for breast cancer control, can help to garner the necessary political will and sustained commitments to ensure adequate and sustainable resources are available to reduce disparities in breast cancer survival.

The number of cancer survivors and the amount of cancer survivorship research have grown substantially during the past three decades. This article provides a review of interventional and observational cancer survivorship research efforts as well as a summary of current cancer survivorship research projects being conducted by National Cancer Institute–designated cancer centers in an effort to identify areas that need further attention. Cancer Epidemiol Biomarkers Prev; 20(10); 2042–7. 2011 AACR.