Abstract PS5-12-04: Initial factors affecting recruitment of Black women in the U.S. Mid-South region diagnosed with or at elevated risk for de novo metastatic breast cancer

Abstract Background: Data from the Surveillance, Epidemiology, and End Results program, supported by internal findings from the West Cancer Center and Research Institute (WCCRI), show that Black women are nearly twice as likely as White women to be diagnosed with advanced-stage or de novo metastatic breast cancer (dnMBC). Disparities in dnMBC incidence and mortality remain particularly pronounced among Black women living in the southern United States, contributing to poorer clinical outcomes and higher mortality. The multilevel, culturally specific factors that shape these disparities remain inadequately understood. We designed this mixed methods study, utilizing clinical and self-report quantitative data, patient interviews, and shadowing, to explore how socioecological factors influence healthcare-seeking behaviors and potential challenges to accessing appropriate healthcare. Methods: The observational study employs a multimodal research design informed by the socio-ecological model and critical race theory to achieve three objectives: a) explore barriers that influence screening behaviors and healthcare utilization among Mid-Southern Black women with or at high risk for dnMBC; b) identify unreported structural barriers in social and clinical environments; and c) explore clinician perceptions of healthcare quality received by Black patients. A total of 150 participants will be enrolled—75 with dnMBC and 75 identified as high-risk (e.g., self-report of known mutations or known family history of breast cancer via blood relative or self-report of more than two lifetime breast biopsies). Data collection methods include semistructured interviews with photo elicitation, field observations, and ethnographic “go-alongs” in participants’ homes, neighborhoods, and clinical settings. Eligible patients are identified through the WCCRI electronic medical record (EMR) and screened against inclusion criteria. Race- and gender-concordant study staff contact eligible individuals in Arkansas, Tennessee, and Mississippi via phone and/or email using an IRB-approved script. Results: As of June 20, 2025, 219 WCCRI patients have been screened, with 30 of the planned 150 participants enrolled (dnMBC: n = 19; high-risk: n = 11). Participants averaged 21 days between the date of consent and first study activity (dnMBC=21.54; high risk=20.29). Recruitment challenges include structural and contextual issues (e.g., EMR screening tool, social determinants of health (SDoH), and engagement approaches). Specifically, the EMR screening tool failed to distinguish between eligible living and deceased patients, resulting in 31 ineligible cases (five high-risk, 26 dnMBC). Patients were later identified as deceased after exhaustive verification with hospice care teams, funeral homes, and obituary searches. SDoH challenges were participant work obligations, caregiver responsibilities, and social support needs. Additionally, high-risk patients who attend clinic visits less frequently were less reachable via the EMR, which resulted in the addition of community-centric recruitment strategies. Early recruitment successes include sample diversity (e.g., participant age, income), geographic dispersion, and low study attrition. Conclusions: The ACCESS study seeks to uncover the underlying drivers of dnMBC disparities among Black women in the U.S. Mid-South region. Preliminary findings highlight the willingness of this population to engage in research when approached by race- and gender-concordant researchers and the complex, often unseen challenges that justify the study's focus and innovative study design. Early challenges affirm the critical need for tailored, community-informed approaches in disparity-focused cancer research. Citation Format: A. N. Curry, Y. Hull, B. Johnson, F. Mzayek, C. Hogea, S. Meyers, G. A. Vidal, J. N. Anderson. Initial factors affecting recruitment of Black women in the U.S. Mid-South region diagnosed with or at elevated risk for de novo metastatic breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-12-04.