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Health Disparities in Breast Cancer > Final Study Guide 2023 > Flashcards

Final Study Guide 2023 Flashcards

1
Q

Lifetime risk of breast cancer for US women?

A

12%

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2
Q

What percent of all breast cancers occur in males?

A

Less than 1%

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3
Q

What percent of women have metastatic disease at time of breast cancer diagnosis?

A

6% - Black women are more likely to be diagnosed at later stages and with more aggressive cancers

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4
Q

What are hormone-related risk factors for breast cancer?

A

Hormone replacement therapy

Early menarche, late menopause, and late age at first birth also

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5
Q

Why did a disparity in mortality for breast cancer between Black and White people emerge after 1983?

A

Mammography screening and adjuvant endocrine therapy were introduced in the 1980s, significantly reducing mortality - however, there were/are racial disparities in access to these interventions

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6
Q

(T/F) Black men have a higher risk of getting breast cancer compared to men

A

True

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7
Q

(T/F) Higher BMI is associated with breast cancer incidence

A

True

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8
Q

Which subtype of breast cancer is most aggressive?

A

TNBC/Basal-like

followed by HER2, Luminal B, Normal-like, and Luminal A

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9
Q

What type of cell does breast cancer arise from the most?

A

Most breast cancers are derived from the epithelial lining of ducts or lobules (ductal/lobular carcinoma)

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10
Q

Chest radiation increases risk of which subtype of breast cancer?

A

TNBC

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11
Q

Which subtype is associated with TNBC?

A

Basal-like

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12
Q

Which population is TNBC most common in?

A

TNBC occurs more frequently in African Americans (somatic gene profile differences)

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13
Q

Do individuals with lower SES have higher rates of TNBC?

A

Yes, low SES populations have higher TNBC rates. Also linked with younger onset of cancer, later stage at diagnosis

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14
Q

Does lobular in situ carcinoma become cancerous?

A

Lobular in situ carcinoma does NOT become cancerous, but is a risk factor for breast cancer

Patients offered chemoprevention but no difference in screenings

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15
Q

Is DNA microarray analysis used to determine treatment decisions?

A

DNA microarray analysis is used to detect gene mutations

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16
Q

Genes/mutations related to breast cancer?

A

BRCA1/2, RKIP, BACH1, MLH1/PMS2, MSH2/MSH6, PTEN, TP53

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17
Q

Is Tamoxifen chemotherapy?

A

No, Tamoxifen is a hormone therapy that acts as an ER antagonist breast tissue

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18
Q

Neoadjuvant chemotherapy refers to…?

A

Giving chemo before surgery, often to shrink inoperable tumors

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19
Q

What are some common chemotherapeutics for metastatic breast cancer?

A

Cisplatin, gemcitabine, paclitaxel, docetaxel, doxorubicin, etc.

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20
Q

Hormone receptor positive breast cancer benefits most from which therapy?

A

HR+ breast cancer responds best to hormone therapy (e.g. targeting estrogen/progesterone receptors)

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21
Q

HER2+ tumors respond best to…?

A

HER2 tumors respond best to biologic therapies, e.g. trastuzumab (mAB binding HER2 to inhibit cell growth)

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22
Q

Systemic therapy refers to which kind of treatment?

A

Systemic therapies affect the entire body, e.g. chemotherapies that travel through systemic circulation

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23
Q

Breast cancer metastasizes primarily to which tissues?

A

Liver, lungs, and bones

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24
Q

What drives survival? Primary breast cancer or metastatic disease?

A

Metastasis is the primary cause of death in most cancer cases, so eliminating metastatic disease is essential to survival

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25
Q

Should women with BRCA1 be recommended to have their ovaries removed?

A

Prophylactic oophorectomy is recommended for ages 35-40 in BRCA1 patients. Can reduce risk of ovarian/breast cancer and improve survival

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26
Q

What is the lifetime risk of breast cancer in women with BRCA1?

A

The lifetime risk for BRCA1 of breast cancer is 55-72%

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27
Q

When should a physician suspect a hereditary cancer syndrome?

A

Cancer in 2 or more relatives on the same side of the family, early diagnosis age, multiple primary tumors, bilateral/multifocal/rare tumors, clustering of certain tumor types consistent w/ a specific cancer syndrome, evidence of autosomal dominant transmission, part of a popn w/ higher risk for certain cancer gene mutations

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28
Q

What percent of women with breast cancer have no identifiable risk factors?

A

75% of women have no identifiable risk factors

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29
Q

High penetrance breast cancer susceptibility genes include?

A

BRCA1, BRCA2, PTEN, TP53

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30
Q

(T/F) Afro-Caribbean backgrounds are more likely to carry BRCA mutations

A

True

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31
Q

Which countries/regions have the highest incidence of breast cancer?

A

Australia and New Zealand, followed by Western EU, Northern EU, NA…

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32
Q

Which US population has the highest incidence of breast cancer?

A

In US women, White followed closely by Black, then Asian/Pacific Islander, Hispanic, AI/AN

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33
Q

What kind of populations experience cancer health disparities?

A

Racial/ethnic minorities, individuals of different ancestry, low SES, disabled, limited/lacking health insurance, certain geographic (rural areas, Midwest/South), LGBT+, immigrants, refugees/asylum seekers, adolescents/young adults, elderly

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34
Q

In the US population, what percent identify as a sexual minority?

A

5.6% of the US in 2021 identified as belonging to the Sexual and Gender Minority populations

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35
Q

Which group of women are most likely to get severe peripheral neuropathy after treatment with paclitaxel?

A

Higher BMI/diabetics are more likely to get severe peripheral neuropathy

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36
Q

Characteristics of cancer diagnosis among racial/ethnic minority patients?

A

Often diagnosed with later stages and with more aggressive subtypes

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37
Q

(T/F) Does earlier testing reduce breast cancer deaths?

A

True, in a study of Black women over 40 earlier testing was found to reduce breast cancer deaths

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38
Q

(T/F) Black Americans are more likely to receive a recommendation for colorectal screening

A

False, Black Americans are less likely to receive a recommendation for colorectal screening

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39
Q

What cancers are more prevalent in Asians/Pacific Islanders than Whites?

A

Nasopharyngeal, stomach, liver cancers are more prevalent

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40
Q

Can Hep B be transmitted to a fetus?

A

Hep B can easily be transmitted from mother to baby at birth, or even from mother to fetus in the womb

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41
Q

Leukemia and liver cancer are __________ in Hispanics

A

More common

42
Q

Who has higher mortality from cervical cancer: Blacks, Hispanics, non-Hispanic Whites?

A

Blacks and Hispanics have higher mortality from cervical cancer compared to NHWs

43
Q

Black men who recently migrated from Africa are _______ to die from liver cancer compared to Black men who lived in the US

A

More likely, immigrants suffer from higher cancer incidence/mortality

44
Q

(T/F) Bisexual women are more likely to be diagnosed with cancer than heterosexual women

A

True

45
Q

What population is best represented in GWAS studies of cancer?

A

In 2009, 96% of GWAS participants were of EU descent. Asian representation has increased as of 2016, but other groups are still poorly represented

46
Q

What protein is a key metastasis suppressor and what downstream changes occur?

A

RKIP is a key metastasis suppressor that regulates Raf and GPCR signaling via a phosphorylation switch. RKIP influences cell growth, survival, proliferation, and metastasis

47
Q

Spatial transcriptomics allow scientists to figure out…?

A

Spatial transcriptomics allow scientists to capture the positional context of transcriptional activity for tissues/single cells, e.g. determining sub cellular location of mRNA

48
Q

Do metastasis suppressor genes affect tumor growth?

A

Yes, RKIP plays a role in tumor growth

49
Q

How are BACH1 and TNBC related?

A

BACH1, a key metastasis promoter, can distinguish survival in TNBC

50
Q

How do cancer cells primarily generate energy and biosynthetic intermediates?

A

Through aerobic glycolysis (Warburg effect) rather than oxidative phosphorylation. Caused by low-oxygen environs of tumor or possibly damage to mitochondria

51
Q

How is BACH1 related to Metformin resistance and oxidative phosphorylation?

A

BACH1 promotes an anaerobic energy profile. Loss of BACH1 sensitizes cells to Metformin treatment because Metformin inhibits ETC Complex 1 and loss of BACH1 increases tumor reliance on oxidative phosphorylation

52
Q

Is there over expression of BACH1 in some cancers?

A

Many cancers have over expression of BACH1 in ~50% of patients

53
Q

BACH1’s role in regulation of hypoxia and metastasis

A

Hypoxia is a major driver of metastasis. BACH1 is an oxygen sensor that regulates hypoxia response, and can promote motility, invasion, cell-ECM interactions, and metastasis

54
Q

What are some physiological responses to acute stress?

A
  1. Increased energy mobilization (increasing BP, HR, RR, glucose in blood)
  2. Cognitive/sensory shifts (aspects of memory improve, senses sharpen)
55
Q

Social circumstances can lead to what kind of changes in a person?

A

Social circumstances can lead to psychological changes, leading to neuroendocrine changes, which can affect cell survival/tumor growth through changes in protein/gene expression

56
Q

Why is unrelenting stress biologically harmful?

A

Chronic stress increases stress reactivity, inflammation, hypertension, reproductive abnormalities, metabolic diseases, etc. Disturbance of homeostatic processes

57
Q

Social isolation as a chronic stressor in female mice results in?

A

Acquired vigilant behavioral phenotype, increased cortisol response to acute stressors, increased mammary tumor growth

58
Q

Prior to development of cancer, isolated mice have up regulation of what genes?

A

Hexokinase (HK2), ATP Citrate-Lyase (ACLY), acetyl-CoA carboxylase alpha (ACACA) - metabolic genes involved in energy mobilization

59
Q

Where do metabolic changes occur in stressed mice?

A

ONLY in adipocytes from mammary glands

60
Q

Factors like low SES, low self esteem/limited social support, and racial discrimination link what with breast cancer?

A

These are contributing factors to low grade chronic stress, which is linked with breast cancer

61
Q

What’s the relationship between social isolation, the glucocorticoid response, and mammary stem cells?

A

Social isolation increases stress reactivity (manifesting in the glucocorticoid response) and mammary stem cell popns. More undifferentiated cells of origin are theorized to turn into more aggressive cancers

62
Q

Term for heightened response to secondary stress, increased vigilance in socially isolated animals

A

Increased stress reactivity, represented by cortisol serum levels

63
Q

How could chronic stress contribute to metastasis?

A

Chronic stress results in increased lysophosphatidic choline (LPC), which is converted to lysophosphatidic acid (LPA). LPA signaling is involved in migration, invasion, proliferation, and survival in cancer

64
Q

Social isolation is associated with a significant decrease in ductal epithelium forming. What is the implication of this?

A

Reduced mammary gland differentiation (aka MaSC/progenitor preservation), which could generate more aggressive cancers

65
Q

Can progenitors not used to make ductal cells come back and increase the risk of cancer later in life?

A

Possibly, depending on preservation of progenitors. Puberty/early adulthood may be a critical developmental window for mammary cancer risk later

66
Q

Relationship between social isolation and breast cancer development

A

Changes in stress exposure and reproductive maturity affect mammary gland development and breast cancer risk

67
Q

What is the Stress Process Model?

A

This model provides a means to understand how stress affects health. Different social statuses contribute to different levels of stress exposure which leads to different psychological outcomes

68
Q

Is there an association between low SES and higher cortisol levels?

A

Low SES contributes to chronic stress, leading to higher stress reactivity, so likely higher cortisol

69
Q

How does the prevalence of hypertension compare between Black and White women?

A

Hypertension is more prevalent in Black women and an indicator of chronic stress

70
Q

How is stress measured in the blood?

A

Corticosterone (aka cortisol) levels

71
Q

What is allostatic load?

A

The cumulative burden of chronic stress and life events - involves the interaction of different physiological systems at different levels of activity - “wear and tear”

72
Q

Cervical cancer can arise from?

A

HPV infections, some of which turn into precancers

73
Q

(T/F) HPV vaccination can prevent cancers in boys

A

True. HPV vaccination also protects against anal, mouth, throat, neck, and head cancers in women and men

74
Q

What is an intervention method that results in higher HPV vaccine uptake?

A

Self-persuasion intervention strategy - direct individuals to generate their own arguments for a health behavior

75
Q

What are the main reasons for vaccine hesitancy?

A

The 3 C’s: Confidence, Complacency, Convenience

76
Q

How is HPV detected?

A

Pap tests, primary HPV screening, and now HPV self sampling

77
Q

Lynch Syndrome, also known as non-polyposis colorectal cancer, is also associated with what cancers?

A

Colorectal, endometrial, ovarian, stomach, small intestine, hepatobiliary cancers

78
Q

Lynch Syndrome is due to inherited mutations in genes that affect…?

A

MLH1/PMS2, MSH2/MSH6 - dimerized pairs involved in DNA mismatch repair

79
Q

What makes a successful Advanced Care Planning discussion?

A
  1. Starting early
  2. Ongoing, routine conversations throughout care
  3. Empowering the patient
  4. Involving stakeholders (family, care team)
  5. Aligning goals and wishes
80
Q

What is needed to understand the experience of Black patients?

A

Cultural awareness, historic injustices/prior interactions with healthcare, misconceptions of role of palliative/supportive care, building trust as a process, family roles/obligations

81
Q

What is Advanced Care Planning?

A

ACP includes goals/preferences for future care (e.g. living will, DNR) and is crucial to increasing preparedness for end of life care. Reduces hospitalizations/intensive care that can be deleterious to quality of life

82
Q

What percent of Black women have ACPs?

A

Less than 25%

83
Q

What are some social determinants of health?

A

Education access/quality, healthcare access/quality, neighborhood/built environs, social/community context, economic stability

84
Q

What are some ways we can use the sociome to look at exposure to environmental factors?

A

Sociome factors can disrupt environmental security required for best health

85
Q

What is the main finding of the Reasons for Geographic and Racial Differences in Stroke study?

A

The REGARDS study showed that SDOH cluster together and greater numbers of SDOH were significantly associated with increased risk of cancer mortality

86
Q

Social Vulnerability Index uses what kind of data?

A

The SVI uses population census data

87
Q

How can segregation lead to different exposures in air pollution?

A

Air pollution levels in a region depend on land use, employment options, transportation, etc.

88
Q

Pollution is related to cancer incidence.

A

Legislation can impact air pollutants in different areas

idk i hate this section

89
Q

What does intersectionality refer to?

A

Intersectionality refers to the interconnected nature of social categorizations like race, class, gender as they apply to an individual/group, creating overlapping systems of discrimination/disadvantage

90
Q

What are factors that play into structural racism?

A

Legislation, organizations/corporations/businesses, education

91
Q

Are menthol cigarettes more or less addictive than non-menthol?

A

Mentholated cigarettes are more addictive; users show increased nicotine dependence and lower smoking cessation. Menthol use is more prevalent among Blacks than whites

92
Q

How does smoking cessation compare among Blacks vs. whites?

A

Smoking cessation is lower amongst Blacks despite higher likelihood of reporting a willingness to quit

93
Q

What percent of US citizens smoke?

A

12.5 (~15% according to slides)

94
Q

What population has the highest rates of cigarette use compared to all other racial/ethnic groups?

A

AI/AN (American Indian/Alaskan Native)

95
Q

Are high risk patients exposed to info on tobacco cessation?

A

High risk patients are often not exposed to info on tobacco cessation or recommended to quit. Tobacco companies often target these groups with advertising

96
Q

Which groups have higher rates of smoking in the US?

A

Rural popns, low SES, lacking health insurance, disabled, uneducated, LGBT, mental health conditions, AI/AN popns

97
Q

Roughly what percent of smoking cessation attempts w/o assistance are successful?

A

Around 7% of attempts without assistance are successful (~15% with assistance)

98
Q

What is a community health worker?

A

CHWs are frontline public health workers considered trusted members of the community they serve. CHWs work as a liaison/intermediary between the community and health/social services

99
Q

Are all CHWs trained in chronic health conditions?

A

Yes, CHWs are trained to assist with chronic disease management as well as cultural mediation, appropriate health education/info, and to advocate for individual/community needs

100
Q

Who declared the war on cancer?

A

Richard Nixon, signing the National Cancer Act in 1971

101
Q

political figures around breast cancer idk

A

Mary Lasker - cancer activist, lobbyist to found the NCI, turned the ASCC into the ACS through advertising/funding

Health Disparities in Breast Cancer (1 decks)

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