6534 Background: Social determinants of health (SDOH) can predispose underserved communities to poor cancer outcomes. The CDC has created a Social Vulnerability Index (SVI) score for US counties that integrates four SDOH: socioeconomic status, household composition & disability, minority status & language, and housing type & transportation. Scores range from 0 to 1, with higher values signifying more vulnerability. SVI is a significant determinant of overall mortality, but its association with cancer mortality is unclear. This study aimed to investigate if there is a relationship between SVI and cancer mortality. Methods: CDC WONDER (Wide-Ranging Online Data for Epidemiological Research) was used to estimate age-adjusted mortality rates per 100,000 person-years with 95% CIs for adults > 18 years of age from 3,030 (96%) US counties between 2014-2018 for a composite of three cancers (lung, breast, and colon cancer), individual cancer subtypes, and demographic groups (sex, ethnicity/race, urban/rural classification). Age-adjusted mortality rates were compared across SVI quartiles: 1st (least vulnerable) to 4th (most vulnerable). Linear regression was used to identify the association between the 4th vs. 1st SVI quartile and the odds of being above the median mortality rate for composite cancers, individual cancer subtypes, and demographic groups. Results: Overall, age-adjusted composite cancer mortality rate per 100,000 person-years was 122.9 (lung cancer 82.8, breast cancer 38.1, colon cancer 21.9). The largest concentration of most vulnerable US counties and composite cancer mortality was in the southeastern US. Age-adjusted composite cancer mortality rates increased from 1st to 4th SVI quartiles. Counties in the 4th SVI quartile vs. 1st SVI quartile were significantly more likely to be above the median mortality rate for composite cancer (OR 6.46 [95% CI, 5.16 - 8.08]), lung cancer (6.88 [5.46 - 8.66]), breast cancer (2.77 [2.17 - 3.54]), and colon cancer (6.20 [4.82 - 7.97]). Among all races, non-Hispanic Black adults in the 4th SVI quartile vs. 1st SVI quartile were significantly more likely to be above the median mortality rate for composite cancer (OR 9.46 [95% CI, 6.19 - 14.4]), lung cancer (13.8 [7.87 - 24.1]), breast cancer (5.53 [3.16 - 9.68]), and colon cancer (6.34 [3.69 - 10.9]). Moreover, rural counties in the 4th SVI quartile vs. 1st SVI quartile were between 2- to 8-times more likely to be above the median mortality rate for composite cancer and individual cancer subtypes. Conclusions: This study highlights the most socially vulnerable US counties have higher cancer mortality rates than the least vulnerable US counties. Furthermore, non-Hispanic Black adults and rural counties in the most socially vulnerable category have higher cancer mortality rates than those in the least socially vulnerable category. Additional work is needed to understand how SVI can be used for better resource allocation to help mitigate cancer mortality.
Chronic myeloid leukemia (CML) is a clonal myeloproliferative neoplasm (MPN) that accounts for 10% of pregnancy-associated leukemias. The Philadelphia chromosome balanced translocation, t (9:22) (q34; q11.2), is the classic mutation seen in CML. The BCR-ABL oncoprotein encoded by this mutation is a constitutively active tyrosine kinase. Tyrosine kinase inhibitor (TKI) therapy is considered a first-line treatment for CML. However, the literature has revealed risks of teratogenicity with TKI therapy during pregnancy. Understanding the risks and benefits of TKI therapy and alternative therapies such as interferon-alpha (IFN-α) will help clinicians and pregnant patients develop a personalized CML treatment plan. This manuscript presents a case series detailing the management of five pregnancies in two pregnant patients with CML and a literature review of CML management in pregnancy.
3139 Background: Breast cancer (BC) is a malignancy with a wide array of histopathological characteristics and tumor heterogeneity leading to major clinical implications for management. With the recent approval of antibody-drug conjugates (ADCs) for human epidermal growth factor receptor 2 (HER2)-low advanced BC, there is increased significance for characterizing the spectrum of HER2 expression in the curative setting. Methods: We conducted a single institution retrospective review of patients with BC who received neoadjuvant systemic therapy (NAST) followed by definitive surgical resection from 2008 to 2022. The initial tumor biopsies were tested for estrogen receptor (ER), progesterone receptor (PR), and HER2 status per ASCO/CAP guidelines and repeated on the residual tumor tissue after NAST. HER2 status was categorized into HER2-negative (IHC 0), HER2-low (IHC 1 or IHC 2/ Fluorescence in situ hybridization [FISH] negative), and HER2-positive (IHC 2/ FISH positive or IHC 3). Concordance and discordance with HER2 status in the pre and post NAST tumor samples were analyzed using descriptive statistics. Results: Of 340 patients with BC who received NAST, 55 patients with residual disease had pre and post treatment biomarker data available for analysis. Prevalence of HER2-low was 70.9 % (39/55) in the pretreatment tumors while it was 58.2% (32/55) in the post treatment tumors. 40% of tumors (22/55) had HER2 discordance while 60% (33/55) demonstrated concordance with HER2 expression after NAST. Among the changes in HER2 status, a shift from HER2-low to HER2-negative status occurred most frequently in 18.2% of tumors (10/55). In tumors with HER2 discordance, 36.4% (8/22) were also noted to have changes in ER or PR status while this was seen in 48.5% (16/33) of tumors with HER2 concordance. For rates of recurrence, 22.7% (5/22) of patients in the HER2 discordant group had relapsed compared to 18.2% (6/33) patients in the HER2 concordant group. Conclusions: Dynamics of HER2 expression is increasingly important in the rapidly changing therapeutic landscape of BC. Our study shows high prevalence of HER2-low expression in tumors with residual disease after NAST and frequent conversion of HER2-low to HER2-negative status with NAST. Further studies are warranted to determine the clinical and therapeutic relevance of biomarker evolution and tumor heterogeneity in the curative setting. [Table: see text]
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