ASPO Abstracts
Breast EMICS (Early Moments Informing Cancer Screening) in the time of "Omics"¬ù
Category: Molecular Epidemiology & Environment
Conference Year: 2022
Abstract Body:
Purpose of the study: The incidence of early-onset breast cancer (BC) in adults <40 years old has increased dramatically in the US over recent decades. Given the almost absence of screening in young adults, how they detect their cancers is a black box. One way to illuminate this black box is to incorporate "emics"¬ù from young adults with cancer into epidemiologic studies of cancer. "Emics"¬ù, from the field of anthropology, is the mapping of insider perspectives from individuals directly affected by the problem under consideration. Methods: The Young Survival Coalition (YSC) hosts an online forum where young adults with breast cancer "tell their story"¬ù. We qualitatively examined 800 online blog posts to determine how early-onset BC was detected. Two coders reviewed posts at the sentence level for 5 deductive codes, including: First Sign, Steps to Diagnosis, Staging & Type, Patient-Provider-System Feelings, and Healthcare Interactions. Interrater reliability was 0.70. Results: Our preliminary data suggest that the vast majority of young adults find their BC through self-detection and first seek care from OB-GYNs. They noticed breast changes such as lumps (46%), pain (34%), and discharge (11%) confirming breast self-awareness as a means to detection. Patients were not satisfied with their providers and felt ignored (10%), their treatment delayed (10%), lacked trust (11%) and felt their providers were not informed (18%). One woman said, "My doctor has not had a patient as young as me get diagnosed with cancer and has not suggested ANYONE."¬ù Conclusions: Counseling young adults about breast self-awareness in OB-GYN settings is a current guideline most salient with our "emic"¬ù data. The OB-GYN setting may be a place to implement more targeted screening for early-onset BC. These qualitative results are derived from our mixed-methods approach, designed to identify biocultural drivers of cancer prevention through incorporation of "omics"¬ù and "emics"¬ù. We previously examined the steroid metabolome with breast cancer risk and found it enhances current risk models by 11%. In the era of "omics,"¬ù when molecular markers are incorporated into cancer prevention, "emics"¬ù are equally important to identify what is feasible in "real-world"¬ù settings.
Keywords: breast cancer, cancer screening, mixed-methods, structural determinants, omics