The Bethesda System for Reporting Thyroid Cytopathology in the African American population: A tertiary centre experience.

BACKGROUND: The reported risk of malignancies (ROM) remains controversial for fine needle aspiration (FNA) of thyroid nodules in the African American (AA) population. Herein, the ROM along with frequency was assessed for each of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) diagnostic categories. MATERIALS AND METHODS: The electronic pathology archive of a large academic hospital was retrospectively searched for cytopathology reports of thyroid nodules in AA patients (2010-2019) and Non-African American (NAA) control cases. The patients' demographic, thyroid nodule characteristics, FNA results using TBSRTC and surgical diagnoses were recorded, whenever available. RESULTS: Three hundred ninety-one cases were identified, 317 females (81.1%) and 74 males (18.9%) with median age 50.0 (SD = 14.4). The mean size of the nodules was 2.1 cm (SD = 1.4). The Bethesda categories were: 5.4% (I), 35.0% (II), 35.3% (III), 7.7% (IV), 3.3% (V) and 13.3% (VI). The overall ROM of thyroid nodules was 43.8% (89/203) on surgical follow-up (203/391). The ROM in each Bethesda categories were: 33.3% (I), 11.6% (II), 35.2% (III), 15.8% (IV), 83.3% (V) and 100% (VI) on surgical follow-up. The frequency of thyroid nodules was higher in AA females; however, the ROM was higher in AA males (48.3%) compared with AA females (41.2%). CONCLUSION: The ROM in Categories I, II and III was higher than those reported in the TBSRTC while being similar in Categories IV, V and VI. The overall risk of thyroid malignancy in our AA patient population was higher than those in the literature. The overall ROM of thyroid nodules in AA males was higher than of AA females.

Oncologists' perceptions of tumor genomic profiling and barriers to communicating secondary hereditary risks to African American cancer patients.

BACKGROUND: Tumor genomic profiling (TGP) identifies targets for precision cancer treatments, but also secondary hereditary risks. Oncologists are poorly trained to communicate the results of TGP, especially among patients with lower health literacy, poorer genetics knowledge, and higher mistrust. African American (AA) patients are especially vulnerable to poor understanding due to significant cancer disparities and lower uptake of TGP. The goal of this research is to inform the development of an internet-based brief educational support for oncologists to prepare them to provide better decisional support related to TGP for their AA cancer patients. METHODS: This mixed-methods study used semi-structured interviews of oncologists to inform development of an online survey with a convenience sample of US-based oncologists (n = 50) to assess perceptions of the challenges of TGP and communicating results to AA patients. RESULTS: Most interviewed oncologists felt it was important to consider racial/cultural differences when communicating about hereditary risks. Cost, family dynamics, discrimination concerns, and medical mistrust were identified as particularly salient. Survey respondents' views related to AAs and perceptions of TGP were strongly associated with years since completing training, with recent graduates expressing stronger agreement with statements identifying barriers/disadvantages to TGP for AA patients. CONCLUSIONS: Oncologists who had more recently completed training expressed more negative perceptions of TGP and more perceived challenges in communicating about TGP with their AA patients. Focused training for oncologists that addresses barriers specific to AAs may be helpful in supporting improved communication about TGP and improved decisional support for AA patients with cancer considering TGP to evaluate their tumors.

Counting the genetic ancestors from source populations in members of an admixed population.

In a genetically admixed population, admixed individuals possess genealogical and genetic ancestry from multiple source groups. Under a mechanistic model of admixture, we study the number of distinct ancestors from the source populations that the admixture represents. Combining a mechanistic admixture model with a recombination model that describes the probability that a genealogical ancestor is a genetic ancestor, for a member of a genetically admixed population, we count genetic ancestors from the source populations-those genealogical ancestors from the source populations who contribute to the genome of the modern admixed individual. We compare patterns in the numbers of genealogical and genetic ancestors across the generations. To illustrate the enumeration of genetic ancestors from source populations in an admixed group, we apply the model to the African-American population, extending recent results on the numbers of African and European genealogical ancestors that contribute to the pedigree of an African-American chosen at random, so that we also evaluate the numbers of African and European genetic ancestors who contribute to random African-American genomes. The model suggests that the autosomal genome of a random African-American born in the interval 1960-1965 contains genetic contributions from a mean of 162 African (standard deviation 47, interquartile range 127-192) and 32 European ancestors (standard deviation 14, interquartile range 21-43). The enumeration of genetic ancestors can potentially be performed in other diploid species in which admixture and recombination models can be specified.

Investigation of Novel Urinary Biomarkers in Hepatocellular Carcinoma Risk in a Predominantly African American Population: A Case-Control Study.

Introduction: African Americans are at increased risk of hepatocellular carcinoma (HCC) compared to other racial and ethnic groups. We investigated the associations of four urinary biomarkers of prostaglandin E2 (PGE-M), prostacyclin (PGI-M), and thromboxane (11dTxB2) synthesis and the ratio of PGI-M to 11dTXB2 with HCC risk in a cohort of predominantly African American populations. Methods: We conducted a nested case-control study (50 cases; 43 with HCC, 151 controls) in the Southern Community Cohort Study (SCCS), a large prospective cohort study including over 80,000 study participants, of whom two-thirds are African Americans. Urine samples were collected at enrollment and subsequently analyzed to assess biomarker levels. Multivariable regression models adjusted for age, race, sex, BMI, smoking status, NSAID use, education level, income, and alcohol consumption were used to assess the relationship between the biomarker and HCC risk. Results: Only 11dTxB2 (OR = 11.50; 95% CI [2.34-56.47] for highest tertile vs. lowest tertile, p = 0.004) and the PGI-M/11dTXB2 ratio of the second quartile (0.25-0.49) (OR = 5.16; 95% CI [1.44-18.47]; p = 0.01) were significantly associated with increased risk of liver cancer. Conclusion: 11dTXB2 and PGI-M/11dTXB2 ratio may be urinary markers of HCC risk, particularly among African Americans, and future prospective studies are needed to evaluate this finding further and to develop accessible methods.

Gastric intestinal metaplasia development in African American predominant United States population.

BACKGROUND: Gastric cancer significantly contributes to cancer mortality globally. Gastric intestinal metaplasia (GIM) is a stage in the Correa cascade and a premalignant lesion of gastric cancer. The natural history of GIM formation and progression over time is not fully understood. Currently, there are no clear guidelines on GIM surveillance or management in the United States. AIM: To investigate factors associated with GIM development over time in African American-predominant study population. METHODS: This is a retrospective longitudinal study in a single tertiary hospital in Washington DC. We retrieved upper esophagogastroduodenoscopies (EGDs) with gastric biopsies from the pathology department database from January 2015 to December 2020. Patients included in the study had undergone two or more EGDs with gastric biopsy. Patients with no GIM at baseline were followed up until they developed GIM or until the last available EGD. Exclusion criteria consisted of patients age < 18, pregnancy, previous diagnosis of gastric cancer, and missing data including pathology results or endoscopy reports. The study population was divided into two groups based on GIM status. Univariate and multivariate Cox regression was used to estimate the hazard induced by patient demographics, EGD findings, and Helicobacter pylori (H. pylori) status on the GIM status. RESULTS: Of 2375 patients who had at least 1 EGD with gastric biopsy, 579 patients were included in the study. 138 patients developed GIM during the study follow-up period of 1087 d on average, compared to 857 d in patients without GIM (P = 0.247). The average age of GIM group was 64 years compared to 56 years in the non-GIM group (P < 0.001). In the GIM group, adding one year to the age increases the risk for GIM formation by 4% (P < 0.001). Over time, African Americans, Hispanic, and other ethnicities/races had an increased risk of GIM compared to Caucasians with a hazard ratio (HR) of 2.12 (1.16, 3.87), 2.79 (1.09, 7.13), and 3.19 (1.5, 6.76) respectively. No gender difference was observed between the study populations. Gastritis was associated with an increased risk for GIM development with an HR of 1.62 (1.07, 2.44). On the other hand, H. pylori infection did not increase the risk for GIM. CONCLUSION: An increase in age and non-Caucasian race/ethnicity are associated with an increased risk of GIM formation. The effect of H. pylori on GIM is limited in low prevalence areas.

Examining Alcohol Interventions Across the Lifespan among the African Diaspora: A Systematic Review.

AIMS: Racial/ethnic and cultural identity influences alcohol use consumption and help-seeking behaviors. The purpose of this systematic review was to assess alcohol prevention programs and interventions targeting African Americans/Blacks among the African Diaspora across the lifespan. METHODS: According to PRISMA guidelines, literature searches were conducted via electronic databases, grey literature, and hand searches of relevant journal articles evaluating primary outcome data to reduce alcohol use. To be included in this systematic review, intervention and prevention studies required a population of more than 50% African descent and provided information about statistical significance (p < .05) indicating changes in alcohol as a primary outcome. RESULTS: Search strategy identified 5691 citations and the full-text of 148 studies were screened. A total of 23 articles met the inclusion criteria. Studies were geographically located in the United States and African countries. Interventions were implemented in community, patient-care, school, and workplace settings. Adult studies evaluated pharmacological and/or behavioral interventions while utilizing validated instruments and procedures to assess alcohol outcomes. Strategies to change alcohol behavior included psychotherapy, brief motivational interviewing (BMI), and counseling. Adolescent studies utilized family-based, computer-assisted technology, and career development interventions to reduce alcohol use. CONCLUSIONS: The systematic review identified a range of intervention articles addressing the reduction of alcohol use for African Americans/Blacks that may be used in various settings and by different age groups. Best practices and strategies designed to address socio-cultural factors by promoting protective and risk-reducing factors of alcohol use and successful alcohol interventions are needed.

Genetic Evaluation for Hereditary Cancer Syndromes Among African Americans: A Critical Review.

While hereditary cancer syndromes have been described and studied for centuries, the completion of the human genome project fueled accelerated progress in precision medicine due to the introduction of genetic testing in the 1990s, creating avenues for tailored treatments and medical management options. However, genetic testing has not benefited everyone equitably, with nearly all of the published work based on individuals of non-Hispanic White/European ancestry. There remains a gap in knowledge regarding the prevalence, penetrance, and manifestations of common hereditary cancer syndromes in the African-American population due to significant disparities in access and uptake of genetic testing. This review summarizes the available literature on genetic testing for breast, colon, and prostate cancers in the African-American population and explores the disparities in access to genetic testing between non-Hispanic White and African-American patients. This article also addresses the barriers to genetic testing and discrepancies in the uptake of recommendations for hereditary cancer syndromes in the African-American population when compared with non-Hispanic Whites. The review offers practice implications for many healthcare providers and demonstrates gaps in the existing knowledge to be addressed in future studies to help eliminate the persisting health disparities faced by the African-American population.

Exploring the combined effects of sleep apnea and APOE-e4 on biomarkers of Alzheimer's disease.

Objective: We determined the interactive associations of apolipoprotein e4 (APOE-e4), and obstructive sleep apnea (OSA) on biomarkers of Alzheimer's disease and examined for racial/ethnic differences of this association. Methods: We used data from the National Alzheimer's Coordinating Center Uniform Dataset (NACC UDS). All participants undergo annual observations, including demographic survey, battery of neuropsychological tests, blood draw (with genotyping), and a clinical evaluation with medical and cognitive/dementia status assessment, while a subset of participants have cerebrospinal fluid (CSF) biomarkers and neuroimaging data. Biomarkers of AD were characterized as the presence of abnormally low amyloid in CSF, via validated Aß42 cut off protocols, and total segmented hippocampal volume, and volume of white matter hyper intensities (WMH). While clinical markers (to preview cognitive relationships) were characterized via the Montreal Cognitive Assessment (MOCA). Results: Biomarker and clinical marker data were derived from 1,387 participants at baseline (mean age = 69.73 ± 8.32; 58.6% female; 13.7% Black/African American), 18.4% of the sample had sleep apnea, and 37.9% were APOE-e4 carriers. Our results confirmed previous reports that OSA and APOE-e4 were independently associated with AD through abnormal levels of amyloid (F (1,306) = 4.27; p = 0.040; F (1,285) = 60.88; p < 0.000, respectively), WMH volume (F (1,306) = 4.27; p = 0.040; F (1,285) = 60.88; p < 0.000, respectively), and MOCA scores (F (1,306) = 4.27; p = 0.040; F (1,285) = 60.88; p < 0.000, respectively). No significant interaction between OSA and APOE-e4 relative to amyloid emerged, however, race stratified analyses indicated the interaction of OSA and APOE-e4 and was significantly associated with WMH and hippocampal volume in Black/African American, but not white participants. Conclusion: OSA and APOE-e4 are interactively associated with WHM in Black/African Americans. This interaction may partially explicate increased levels of risk in this population.

Diagnostic and Management Challenges of Ciliary Body Tumor in an African-American Patient.

PURPOSE: To discuss the diagnostic and management challenges of a ciliary body tumor in an African-American patient. PROCEDURES: Our 52-year-old African-American female patient, referred with a nasal ciliary body tumor in the right eye, underwent investigations including A- and B-scan ultrasonography, Optos fundus photography and fundus fluorescein angiography at clinical consultation. A diagnostic fine-needle aspiration cytology and open flap biopsy were undertaken. RESULTS: Histopathology and cytology confirmed a malignant melanoma, which is extremely rare in the African-American population. The patient was treated with brachytherapy with an iodine-131 plaque ensuring adequate coverage of the tumor site but, at the same time, taking special precaution not to disturb the biopsy site. CONCLUSIONS: The diagnosis of a ciliary body tumor, especially in an African-American patient, can be challenging despite advances in imaging systems, given the multitude of differential diagnoses. Uveal melanomas are extremely rare in African-Americans. On detailed questioning, our patient reported having mixed ancestry, with Caucasian ancestors on the mother's side and native Indian ancestors on the father's side. Information on true ethnicity should be specifically asked for as it alters the incidence rate. Biopsy provides the only option for a correct diagnosis and for developing a management plan. Fine-needle aspiration biopsy can be diagnostic, though an open flap biopsy is superior as it provides information on tissue architecture and the possibility of immunohistochemistry. Also, with plaque brachytherapy treatment, special care needs to be taken not to disturb the biopsy site to reduce the risk of seeding, and an innovative approach may need to be taken to ensure adequate radiation coverage of these anterior tumors.