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Background: Literature on colorectal cancer outcomes in individuals of Middle Eastern and North African (MENA) descent is limited. To address this gap, we estimated five-year colorectal cancer–specific survival by race and ethnicity, including MENA individuals, in a diverse, population-based sample in California. Methods: We identified adults (ages 18–79 years) diagnosed with a first or only colorectal cancer in 2004 to 2017 using the California Cancer Registry (CCR), including non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Hispanic, and MENA individuals. For each racial/ethnic group, we calculated five-year colorectal cancer–specific survival and used Cox proportional hazards regression models to examine the association of race/ethnicity and survival, adjusting for clinical and socio demographic factors. Results: Of 110,192 persons diagnosed with colorectal cancer, five-year colorectal cancer–specific survival was lowest in Black (61.0%) and highest in MENA (73.2%) individuals. Asian (72.2%) individuals had higher survival than White (70.0%) and Hispanic (68.2%) individuals. In adjusted analysis, MENA [adjusted HR (aHR), 0.82; 95% confidence interval (CI), 0.76–0.89], Asian (aHR, 0.86; 95% CI, 0.83–0.90), and Hispanic (aHR, 0.94; 95% CI, 0.91–0.97) race/ethnicity were associated with higher, and Black (aHR, 1.13; 95% CI, 1.09–1.18) race/ethnicity was associated with lower survival compared with non-Hispanic White race/ethnicity. Conclusions: To our knowledge, this is the first study to report colorectal cancer survival in MENA individuals in the United States. We observed higher survival of MENA individuals compared with other racial/ethnic groups, adjusting for sociodemographic and clinical factors. Impact: Future studies are needed to identify factors contributing to cancer outcomes in this unique population.

Background: In May 2021, the U.S. Preventive Services Task Force began recommending initiating colorectal cancer screening at age 45 (vs. 50) years. Methods: We estimated prevalence of colorectal cancer screening (by colonoscopy, sigmoidoscopy, CT colonography, or stool-based tests) in adults ages 50 to 75 years using data from the National Health Interview Survey in 2000, 2003, 2005, 2008, 2010, 2013, 2015, and 2018. For each survey year, we estimated prevalence by age, race/ethnicity, educational attainment, family income, and health insurance. We also compared increases in prevalence of screening from 2000 to 2018 in 5-year age groups (50–54, 55–59, 60–64, 65–69, and 70–75 years). Results: Overall, prevalence of colorectal cancer screening increased from 36.7% in 2000 to 66.1% in 2018. Screening prevalence in 2018 was lowest for age 50 to 54 years (47.6%), Hispanics (56.5%), Asians (57.1%), and participants with less than a high school degree (53.6%), from low-income families (56.6%), or without insurance (39.7%). Increases in prevalence over time differed by five-year age group. For example, prevalence increased from 28.2% in 2000 to 47.6% in 2018 (+19.4%; 95% CI, 13.1–25.6) for age 50 to 54 years but from 46.4% to 78.0% (+31.6%; 95% CI, 25.4%–37.7%) for age 70 to 75 years. This pattern was consistent across race/ethnicity, educational attainment, family income, and health insurance. Conclusions: Prevalence of colorectal cancer screening remains low in adults ages 50 to 54 years. Impact: As new guidelines are implemented, care must be taken to ensure screening benefits are realized equally by all population groups, particularly newly eligible adults ages 45 to 49 years. See related commentary by Brawley, p. 1671

Background:Literature on colorectal cancer outcomes in individuals of Middle Eastern and North African (MENA) descent is limited. To address this gap, we estimated five-year colorectal cancer–specific survival by race and ethnicity, including MENA individuals, in a diverse, population-based sample in California.Methods:We identified adults (ages 18–79 years) diagnosed with a first or only colorectal cancer in 2004 to 2017 using the California Cancer Registry (CCR), including non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Hispanic, and MENA individuals. For each racial/ethnic group, we calculated five-year colorectal cancer–specific survival and used Cox proportional hazards regression models to examine the association of race/ethnicity and survival, adjusting for clinical and socio demographic factors.Results:Of 110,192 persons diagnosed with colorectal cancer, five-year colorectal cancer–specific survival was lowest in Black (61.0%) and highest in MENA (73.2%) individuals. Asian (72.2%) individuals had higher survival than White (70.0%) and Hispanic (68.2%) individuals. In adjusted analysis, MENA [adjusted HR (aHR), 0.82; 95% confidence interval (CI), 0.76–0.89], Asian (aHR, 0.86; 95% CI, 0.83–0.90), and Hispanic (aHR, 0.94; 95% CI, 0.91–0.97) race/ethnicity were associated with higher, and Black (aHR, 1.13; 95% CI, 1.09–1.18) race/ethnicity was associated with lower survival compared with non-Hispanic White race/ethnicity.Conclusions:To our knowledge, this is the first study to report colorectal cancer survival in MENA individuals in the United States. We observed higher survival of MENA individuals compared with other racial/ethnic groups, adjusting for sociodemographic and clinical factors.Impact:Future studies are needed to identify factors contributing to cancer outcomes in this unique population.

Supplementary Table 1 provides treatment quality metrics for colon and rectal cancers using adherence to National Comprehensive Cancer Network guidelines.

PDF - 133KB, Covariance matrix for overdue subgroup (n=418).

PDF - 134KB, Covariance matrix for never screened subgroup (n=1,277).

Background: Few studies have examined the psychometric properties and invariance of scales measuring constructs relevant to colorectal cancer screening (CRCS). We sought to: (i) evaluate the factorial validity of four core constructs associated with CRCS (benefits, barriers, self-efficacy, and optimism); and (ii) examine measurement invariance by screening status (currently screened, overdue, never screened).Methods: We used baseline survey data from a longitudinal behavioral intervention trial to increase CRCS among U.S. veterans. Respondents were classified as currently screened (n = 3,498), overdue (n = 418), and never screened (n = 1,277). The measurement model was developed using a random half of the sample and then validated with the second half of the sample and the full baseline sample (n = 5,193). Single- and multi-group confirmatory factor analysis was used to examine measurement invariance by screening status.Results: The four-factor measurement model demonstrated good fit. Factor loadings, item intercepts, and residual item variance and covariance were invariant when comparing participants never screened and overdue for CRCS, indicating strict measurement invariance. All factor loadings were invariant among the currently screened and overdue groups. Only the benefits scale was invariant across current screeners and never screeners. Non-invariant items were primarily from the barriers scale.Conclusion: Our findings provide additional support for the construct validity of scales of CRCS benefits, barriers, self-efficacy, and optimism. A greater understanding of the differences between current and never screeners may improve measurement invariance.Impact: Measures of benefits, barriers, self-efficacy, and optimism may be used to specify intervention targets and effectively assess change pre- and post-intervention across screening groups. Cancer Epidemiol Biomarkers Prev; 22(12); 2295–302. ©2013 AACR.

Background A growing number of women newly diagnosed with breast cancer have survived a previous cancer. Although little is known about their prognosis, this population is frequently excluded from clinical trials. Additional evidence about the survival of this population is needed, so that trial sponsors and investigators can create evidence-based trial eligibility criteria. Among women newly diagnosed with breast cancer, we examined the impact of previous cancer on overall and cancer-specific survival. Methods This population-based cohort study included patients age ≥66 years and diagnosed with breast cancer between 2005-2015 in linked SEER-Medicare data. Separately by breast cancer stage, we estimated overall survival using Cox regression and cause-specific survival using competing risk regression for women with and without previous cancer, adjusting for numerous covariates and competing risk of death from previous cancer, other causes, or the incident breast cancer. Results Of 138,576 women diagnosed with incident breast cancer, 10,822 (8%) had a previous cancer of another organ site. Many of these (n=5,014, 46.3%) were diagnosed ≤5 years of breast cancer. For all breast cancer stages except IV in which there was no significant survival difference, women with vs. without previous cancer had worse overall survival. This survival disadvantage was driven by deaths due to the previous cancer and other causes. In contrast, women with previous cancer generally had favorable breast-cancer specific survival; however this varied somewhat by stage and over time. Conclusions Many women newly diagnosed with breast cancer are already cancer survivors. These women had generally worse overall survival, worse survival from other causes, but their disease-specific survival varied depending on their breast cancer stage and over time. Citation Format: Sandi L Pruitt, Hong Zhu, Daniel Heitjan, David E Gerber, Bhumika Maddineni, Danyi Xiong, Ethan Halm, Caitlin Murphy. Survival among female breast cancer patients who have survived a previous cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS11-31.

Background: Proportion of time covered (PTC, or “covered time”) is a longitudinal measure of adherence to preventive health services, the use of which has increased in recent years. This measure is helpful for evaluating the success of delivering screening interventions over time. However, there are challenges and nuances in computing and interpreting PTC. Methods: In this manuscript, we describe some desired properties of PTC measures, challenges in achieving those, and potential solutions using hypothetical examples. Results: We propose a modified PTC measure (mPTC) to complement the standard, existing PTC measure. The mPTC measure focuses on screening completion rather than initiation when a screening modality requires more than one step; is affected less by loss to follow-up, death, or cancer during covered time than the standard PTC measure; and is not sensitive to screening episode results. We propose weighting strategies to ensure that the average PTC and mPTC are more heavily influenced by individuals who were observed for longer and are thus more informative. We further describe how PTC and mPTC measures can incorporate test indication to focus specifically on screening. Conclusions: We recommend that studies of covered time present ample descriptive information, calculate both PTC and mPTC, describe how symptoms and indication are handled, and present multiple complementary measures, such as the proportion never screened and the proportion in need of screening. Impact: Common approaches, terminology, and reporting practices for covered time measures have the potential to improve the study of longitudinal cancer screening adherence.

Background: Colorectal cancer screening with fecal immunochemical testing (FIT) can reduce colorectal cancer–related mortality. Effectiveness of FIT may be compromised when patients do not adhere to a regular schedule. However, having no standard measure of repeat FIT presents challenges for assessing effectiveness across populations and settings. We compared three measures of repeat FIT in a large, integrated health care system in Dallas, Texas. Methods: We identified 18,257 patients age-eligible (50–60 years) for FIT in January 1–December 31, 2010 and followed over four rounds of screening. Measures included: (i) repeat FIT in prior screeners, or completion of FIT within 9–15 months of the previous; (ii) yes–no patterns, whereby patients were assigned yes or no in 9–15 month windows; and 3) proportion of time covered (PTC), or the amount of time patients were up-to-date with screening relative to time eligible. Results: Repeat FIT varied by measure. Using a prior screeners measure, 15.8% of patients with a normal FIT in round 1 completed repeat FIT in round 2. Repeat FIT was notably higher (52.3%) using PTC. The most common yes–no pattern was YNNN or “one-and-done,” and only 9.4% of patients completed two consecutive FITs across all rounds (YYNN). Conclusions: Different measures of repeat FIT yielded a range of estimates, making comparison across studies difficult. Researchers should weigh the advantages and disadvantages of each measure and select the most appropriate to their research question. Impact: Our study highlights the need for future research of repeat FIT measures that best approximate screening effectiveness.

Screening with fecal occult blood tests (FOBT) reduces colorectal cancer mortality. Failure to complete repeat tests may compromise screening effectiveness. We conducted a systematic review of repeat FOBT across diverse health care settings. We searched MEDLINE, Embase, and the Cochrane Library for studies published from 1997 to 2017 and reported repeat FOBT over ≥2 screening rounds. Studies (n = 27 reported in 35 articles) measured repeat FOBT as (i) proportion of Round 1 participants completing repeat FOBT in Round 2; (ii) proportion completing two, consecutive FOBT; or (iii) proportion completing ≥3 rounds. Among those who completed FOBT in Round 1, 24.6% to 89.6% completed repeat FOBT in Round 2 [median: 82.0%; interquartile range (IQR): 73.7%–84.6%]. The proportion completing FOBT in two rounds ranged from 16.4% to 80.0% (median: 46.6%; IQR: 40.5%–50.0%), and in studies examining ≥3 rounds, repeat FOBT ranged from 0.8% to 64.1% (median: 39.2%; IQR: 19.7%–49.4%). Repeat FOBT appeared higher in mailed outreach (69.1%–89.6%) compared with opportunistic screening (24.6%–48.6%). Few studies examined correlates of repeat FOBT. In summary, we observed a wide prevalence of repeat FOBT, and prevalence generally declined in successive screening rounds. Interventions that increase and maintain participation in FOBT are needed to optimize effectiveness of this screening strategy.

Background: Incidence rates of colorectal cancer (CRC) have increased markedly in Generation X, implicating exposures increasingly prevalent in their early life. Bendectin was a common anti-nauseant prescribed in early pregnancy during the 1960s and parallels increasing rates of young-onset CRC. Initially approved in 1956, Bendectin contained doxylamine (antihistamine), pyridoxine (vitamin B6), and dicyclomine (antispasmodic) but was reformulated in 1976 to contain only doxylamine and pyridoxine. Bendectin was removed from the market in 1983 after a series of lawsuits. In utero exposure to Bendectin has been implicated in birth defects and childhood leukemia, but little is known about its effects on health of adult offspring. Methods: We examined the effect of in utero exposure to Bendectin on risk of CRC in adult offspring in the Child Health and Development Studies, a population-based cohort of women receiving prenatal care between June 1959 and September 1966, with deliveries through June 1967 (n=18,751 live births excluding neonatal deaths among 14,507 mothers). Diagnosed conditions and prescribed medications were abstracted from mothers' medical records beginning 6 months prior to pregnancy through delivery. We identified mothers who received Bendectin in early pregnancy (day 1 - 140 of gestation). Incident cases of CRC in offspring were ascertained through 2018 by linkage with the California Cancer Registry. We used Cox proportional hazards models to estimate hazard ratios (HR), with follow-up accrued from birth through CRC diagnosis, death, or last contact. To address the possibility of confounding by indication, we also examined the effect of nausea and hyperemesis on risk of CRC in offspring. Results: About 6% of mothers (n=890) received Bendectin in early pregnancy. We identified 68 cases of CRC in offspring, diagnosed at ages 23 - 56 years (median age 50 years). In utero exposure to Bendectin was associated with increased risk of CRC in offspring (HR 2.93, 95% CI 1.45, 5.92). Dicyclomine was also associated with increased risk (HR 34.88, 95% CI 4.31, 282.50) when used alone as an antispasmodic (tradename Bentyl). There was no association with risk of CRC in offspring and other anti-nauseants containing meclizine only (HR 1.05, 95% CI 0.38, 2.89) or pyridoxine only (HR 2.20, 95% CI 0.31, 15.85) or with mothers' nausea (HR 0.62, 95% CI 0.23, 1.70). Conclusions: Our findings suggest in utero exposure to Bendectin, and specifically dicyclomine, increases risk of young-onset CRC. These results provide compelling evidence that events in utero are important risk factors of this disease. Bendectin was commonly prescribed in pregnancy during the 1960s, and there may be other medications prescribed during this time that contribute to increasing incidence rates of young-onset CRC. Citation Format: Caitlin C. Murphy, Piera M. Cirillo, Nickilou Y. Krigbaum, Barbara A. Cohn. In utero exposure to anti-nauseants and risk of young-onset colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 858.

Colorectal cancer (CRC) incidence and mortality have changed strikingly in the U.S. over the past three decades. Incidence and mortality rates have decreased among older adults since the early 1990s, largely due to improvements in average-risk screening. By contrast, incidence rates have rapidly increased in younger (age Citation Format: Caitlin C. Murphy. Colorectal cancer mortality along the U.S.-Mexico border [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA10.

Background: Few studies have examined the psychometric properties and invariance of scales measuring constructs relevant to colorectal cancer screening (CRCS). We sought to: (i) evaluate the factorial validity of four core constructs associated with CRCS (benefits, barriers, self-efficacy, and optimism); and (ii) examine measurement invariance by screening status (currently screened, overdue, never screened). Methods: We used baseline survey data from a longitudinal behavioral intervention trial to increase CRCS among U.S. veterans. Respondents were classified as currently screened (n = 3,498), overdue (n = 418), and never screened (n = 1,277). The measurement model was developed using a random half of the sample and then validated with the second half of the sample and the full baseline sample (n = 5,193). Single- and multi-group confirmatory factor analysis was used to examine measurement invariance by screening status. Results: The four-factor measurement model demonstrated good fit. Factor loadings, item intercepts, and residual item variance and covariance were invariant when comparing participants never screened and overdue for CRCS, indicating strict measurement invariance. All factor loadings were invariant among the currently screened and overdue groups. Only the benefits scale was invariant across current screeners and never screeners. Non-invariant items were primarily from the barriers scale. Conclusion: Our findings provide additional support for the construct validity of scales of CRCS benefits, barriers, self-efficacy, and optimism. A greater understanding of the differences between current and never screeners may improve measurement invariance. Impact: Measures of benefits, barriers, self-efficacy, and optimism may be used to specify intervention targets and effectively assess change pre- and post-intervention across screening groups. Cancer Epidemiol Biomarkers Prev; 22(12); 2295–302. ©2013 AACR.

Background: Adjuvant hormonal therapy (AHT) significantly improves the overall and disease-free survival of breast cancer patients with hormone receptor-positive disease. Despite the benefits of AHT, many patients do not initiate or complete therapy as recommended. Further, adherence and patterns of AHT use in low-income and minority populations has not been well-studied. This study 1) estimated the prevalence of AHT initiation among breast cancer patients receiving care at a large safety-net healthcare system from 2008 to 2012; and 2) examined patient sociodemographic, tumor/treatment, and health history characteristics associated with AHT initiation. Methods: Patients diagnosed with stages I-III hormone receptor-positive breast cancer were identified from an academic cancer registry at Dallas' Parkland Health and Hospital System (Parkland), one of the largest integrated safety-net healthcare systems in the U.S. We excluded patients who had a prior diagnosis of breast cancer, previously used AHT, did not receive definitive treatment and/or cancer-directed surgery at Parkland, or had commercial or Medicaid insurance. Uninsured residents of Dallas County are eligible for Parkland HEALTHplus, an income-based medical assistance program that covers prescriptions filled and dispensed by Parkland outpatient pharmacies. In addition, Parkland oncology and primary care clinics use the same, comprehensive electronic medical record (EMR). Thus, Parkland's payor and clinical informatics infrastructure provides a unique opportunity to examine initiation of AHT in uninsured, low-income, and minority populations. We extracted and linked pharmacy claims, cancer registry, and patient EMR data to determine the prevalence of AHT Initiation. Initiation was defined as a new AHT prescription within 18 months of the incident breast cancer diagnosis. Descriptive statistics were used to examine characteristics of the study population by AHT initiation, and log-binomial regression was used to identify correlates of initiation. Results: We identified 291 breast cancer patients eligible for the study. Most patients were Hispanic (42.6%), not married (66.3%), and postmenopausal (63.9%). The mean age was 52.9 years. The majority (72.2%) of patients had one or more comorbid conditions, and the most prevalent comorbidities were hypertension (51.2%), hyperlipidemia (25.1%), and diabetes (20.3%). Overall, 239 (82%) patients initiated AHT within 18 months of diagnosis, and 52 (18%) did not initiate therapy. Among initiators, tamoxifen (42.3%) and anastrozole (55.2%) were the most commonly prescribed types of AHT. The mean retail price of tamoxifen and anastrozole was $126.80 and $472.20, respectively, with a mean copay of $4.90 for tamoxifen and $6.00 for anastrozole. In univariable analysis, patients who were Hispanic (RR 1.29, 95% CI 1.04—1.61) and other (RR 1.31, 95% CI 1.02—1.68) race/ethnicity, diagnosed in year 2008 (vs. 2012, RR 1.24, 95% CI 1.07—1.44), and received primary care at Parkland prior to diagnosis (RR 1.14, 95% CI 1.01—1.28) were more likely to initiate AHT. Current smokers (vs. never, RR 0.78, 95% CI 0.65—0.94) were less likely to initiate AHT. No variables remained statistically significant in the final multivariable model. Conclusion: This study is an important first step in understanding AHT adherence behaviors in low-income and uninsured breast cancer patients. Our results suggest the majority of patients receiving care in a safety-net setting initiate AHT, and there are few differences in initiation by patient characteristics. Safety-net systems that provide access to AHT (e.g., through reduced prescription copays) may have a positive impact on disparities in AHT initiation rates among breast cancer patients. Future work is needed to determine if pharmacy benefits improve completion of the AHT regimen. Citation Format: Caitlin C. Murphy, Jasmin A. Tiro, Gary Jean, Bijal A. Balasubramanian, Robin T. Higashi, Brian Le, Hugh Teng, Carlos A. Alvarez. Initiation of adjuvant hormonal therapy among uninsured stage I-III breast cancer patients treated in a safety-net healthcare system. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C59.

Background: Although the incidence and mortality of colorectal cancer (CRC) in the U.S. has declined over the past two decades, CRC disproportionately affects blacks, who have higher incidence and mortality compared with whites. CRC disparities are partly attributable to differences in risk factors, screening and early detection, and tumor biology; however, variations in treatment may also contribute to mortality differentials. Few studies have evaluated how disparities in CRC treatment have changed over time and across different settings. Using the National Cancer Institute's (NCI) Patterns of Care studies, we examined patterns in the use of adjuvant chemotherapy and differences for non-Hispanic whites and blacks in a population-based sample of stage III colon cancer patients during the period 1990-2010. Methods: Patients diagnosed with stage III colon cancer were randomly sampled from the Surveillance, Epidemiology, and End Results (SEER) program in 1990-91, 1995, 2000, 2005, and 2010. There was oversampling by race in 1995, 2000, 2005, and 2010. Patients were categorized as non-Hispanic white (n=869) or black (n=385). Treatment data were obtained from medical record review with physician verification. All patients in these analyses underwent cancer-directed surgery. Patients who received or were recommended any chemotherapy agents as part of primary therapy were considered to have received chemotherapy. Log-binomial regression models with stratum-specific sample weights were used to estimate the association between race and receipt of adjuvant chemotherapy. Potential confounders included age at diagnosis, sex, insurance, comorbidity, and year of diagnosis. Effect measure modification by insurance was assessed using single referent models. Results: There were few differences in sociodemographic characteristics among whites and blacks in the total study population (n=1,254). A similar proportion of white and black patients had high-risk features (e.g., poorly differentiated histology, bowel obstruction, positive surgical margins). Receipt of adjuvant chemotherapy increased among both white and black patients from 1990/91 (white: 57%, black: 45%) to 2005 (white: 72%, black: 71%) and decreased in 2010 (white: 65%, black: 53%). There were marked racial disparities in receipt of adjuvant chemotherapy in 1990/91 and again in 2010. After adjusting for potential confounders, black patients were less likely to receive adjuvant chemotherapy compared to whites (RR 0.82, 95% CI [0.73, 0.93]). A similar trend was observed when the analysis was limited to “healthy” patients age Conclusions: The gap in the proportion of white and black stage III colon cancer patients who received adjuvant chemotherapy narrowed after 1990/91, but our findings suggest the disparity reemerged in 2010. The disparity persisted after adjusting for multiple confounders and across insurance types. Recent decreases in chemotherapy use may be due, in part, to the economic downturn and a shift toward greater use of Medicaid coverage. This shift followed the 2008 financial crisis, which may have also resulted in barriers to treatment access. Receipt of chemotherapy decreased more substantially in black patients compared to whites in 2010. Programs to address this treatment disparity are needed to improve quality of care, increase survival, and reduce disparities related to CRC mortality. Citation Format: Caitlin C. Murphy, Linda C. Harlan, Joan L. Warren, Ann M. Geiger. Racial disparities in the receipt of adjuvant chemotherapy among stage III colon cancer patients. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B56.