How do clownfish earn their stripes?

The distinctive white stripes in clownfish form at different rates depending on their sea anemone hosts, a PNAS study finds

OKINAWA INSTITUTE OF SCIENCE AND TECHNOLOGY (OIST) GRADUATE UNIVERSITY

Research News

 

IMAGE: AMPHIPRION PERCULA, A SPECIES OF CLOWNFISH PHOTOGRAPHED IN KIMBE BAY, PAPUA NEW GUINEA. view more 

CREDIT: TANE SINCLAIR-TAYLORClownfish species develop their characteristic white stripes, or bars, during the process of metamorphosis

• Researchers have now discovered that the white bars form at different speeds depending on the sea anemone the clownfish live in
• Thyroid hormones, which are important for metamorphosis, control the speed the white bars form
• Levels of thyroid hormones are higher in clownfish that live in the giant carpet anemone compared to clownfish living in the magnificent sea anemone
• Clownfish living in the giant carpet anemone also show increased activity of duox, a gene involved in forming thyroid hormones

Charismatic clownfish, the coral reef fish made famous by the film Finding Nemo, are instantly recognizable by their white stripes. These stripes, which scientists call bars, appear as clownfish mature from larvae into adults in a process called metamorphosis, but how these distinctive patterns form has long remained a mystery.

Now, a new study has found that the speed at which these white bars form depends on the species of sea anemone in which the clownfish live. The scientists also discovered that thyroid hormones, which play a key role in metamorphosis, drive how quickly their stripes appear, through changes in the activity of a gene called duox.

"Metamorphosis is an important process for clownfish - it changes their appearance and also the environment they live in, as clownfish larvae leave life in the open ocean and settle in the reef," said senior author Professor Vincent Laudet, who leads the Marine Eco-Evo-Devo Unit at the Okinawa Institute of Science and Technology Graduate university (OIST). "Understanding how metamorphosis changes depending on the sea anemone host can help us answer questions not only about how they adapt to these different environments, but also how they might be affected by other environmental pressures, like climate change."

In the study, published 24th May, 2021 in PNAS, a team of researchers from the Centre for Island Research and Environmental Observatory (CRIOBE) in France first surveyed the clownfish species, Amphiprion percula, in Kimbe bay, Papua New Guinea.

The clownfish there can live either in the magnificent sea anemone, Heteractis magnifica, or the more toxic giant carpet anemone, Stichodactyla gigantea.

During the survey, the team noticed that juvenile clownfish that lived in the giant carpet anemone gained their adult white bars faster than clownfish living in the magnificent sea anemone.

"We were really interested in understanding not only why bar formation occurs faster or slower depending on the sea anemone, but also what drives these differences," said first author Dr. Pauline Salis, a postdoctoral researcher at the Observatoire Océanologique de Banyuls-sur-Mer, Sorbonne Université Paris, who studies color patterning in coral reef fish.

In the lab, the team worked with the clownfish, Amphiprion ocellaris, a close relative of Amphiprion percula. They focused on thyroid hormones, which are known to trigger metamorphosis in frogs.

The researchers treated larval clownfish with different doses of thyroid hormones. The higher the dose of thyroid hormones, the faster the clownfish developed the white bars, the team reported. Conversely, when the researchers treated the clownfish with a drug that stopped thyroid hormones from being produced, bar formation was delayed.

The white bars form due to pigment cells, called iridophores, which express a specific subset of genes. Thyroid hormones accelerated white bar formation by activating these iridophore genes, the research team found.

Next, the scientists tested whether these observations held true the field. When the CRIOBE lab returned to Kimbe Bay, they transported juvenile clownfish from both species of sea anemone back to Dr. Salis in France.

Levels of thyroid hormones were much higher in the clownfish from the giant carpet anemone than in the clownfish from the magnificent sea anemone, Dr. Salis confirmed.

To gain insight into what caused these higher levels of thyroid hormones, the team measured the activity of most genes in the clownfish genome.

"The big surprise was that out of all these genes, only 36 genes differed between the clownfish from the two sea anemone species," said Prof. Laudet. "And one of these 36 genes, called duox, gave us a real eureka moment."

Duox, which makes the protein dual oxidase, plays an important role in the formation of thyroid hormones, previous research has shown. The duox gene showed higher levels of activity in clownfish from the giant carpet anemone, compared to clownfish from the magnificent sea anemone.

Further experiments in collaboration with Professor David Parichy from the University of Virginia, U.S., confirmed that duox is important for developing iridophore pigment cells. When the duox gene is inactivated in mutant zebrafish, development of the iridophore pigment cells is delayed, the study found.

Taken together, the data suggests that increased activity of duox in clownfish living in the giant carpet anemone result in higher levels of thyroid hormones, and thus the faster rate of white bar formation as iridophore pigment cells develop quicker.

However, the research raises still more questions for the scientists to answer, including the ecological reason for this variation in the rate of white bar formation.

It may be because the giant carpet anemone is more toxic, with thyroid hormone levels increasing as a response to stress, the researchers speculated.

"Here at OIST, we're starting to delve into some possible explanations," said Prof. Laudet. "We suspect that these changes in white bar formation are just the tip of the iceberg, and that many other differences are present that help the clownfish adapt to the two different sea anemone hosts."

CAPTION

During metamorphosis, the clownfish, Amphiprion percula, turns a vibrant orange and develops three white bars in succession, from head to tail. The rate at which the bars form depends on the sea anemone that the clownfish live in. Clownfish living in the long-tentacled anemone, Heteractis magnifica, (left) have fewer stripes than clownfish of the same age and size living in the shorter, carpet-style anemone, Stichodactyla gigantea (right). The image shows the typical appearance of clownfish aged 150-200 days.

CREDIT

Fiona Lee, Academia Sinica, Taiwan

CAPTION

Clownfish larvae treated with thyroid hormones formed a higher number of bands at an earlier stage of development, compared to control larvae that weren't treated with thyroid hormones. The image shows a control clownfish larvae (top) and a larvae five days after it was given a dose of thyroid hormones (bottom).

CREDIT

Pauline Salis, first author

USAGE RESTRICTIONS

Milky Way not unusual, astronomers find

Detailed cross-section of another galaxy reveals surprising similarities to our home

ARC CENTRE OF EXCELLENCE FOR ALL SKY ASTROPHYSICS IN 3D (ASTRO 3D)

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IMAGE: GALAXY UGC 10738, SEEN EDGE-ON THROUGH THE EUROPEAN SOUTHERN OBSERVATORY'S VERY LARGE TELESCOPE IN CHILE, REVEALING DISTINCT THICK AND THIN DISCS. view more 

CREDIT: JESSE VAN DE SANDE/EUROPEAN SOUTHERN OBSERVATORY

The first detailed cross-section of a galaxy broadly similar to the Milky Way, published today, reveals that our galaxy evolved gradually, instead of being the result of a violent mash-up. The finding throws the origin story of our home into doubt.

The galaxy, dubbed UGC 10738, turns out to have distinct 'thick' and 'thin' discs similar to those of the Milky Way. This suggests, contrary to previous theories, that such structures are not the result of a rare long-ago collision with a smaller galaxy. They appear to be the product of more peaceful change.

And that is a game-changer. It means that our spiral galaxy home isn't the product of a freak accident. Instead, it is typical.

The finding was made by a team led by Nicholas Scott and Jesse van de Sande, from Australia's ARC Centre of Excellence for All Sky Astrophysics in 3 Dimensions (ASTRO 3D) and the University of Sydney.

"Our observations indicate that the Milky Way's thin and thick discs didn't come about because of a gigantic mash-up, but a sort-of 'default' path of galaxy formation and evolution," said Dr Scott.

"From these results we think galaxies with the Milky Way's particular structures and properties could be described as the 'normal' ones."

This conclusion - published in The Astrophysical Journal Letters- has two profound implications.

"It was thought that the Milky Way's thin and thick discs formed after a rare violent merger, and so probably wouldn't be found in other spiral galaxies," said Dr Scott.

"Our research shows that's probably wrong, and it evolved 'naturally' without catastrophic interventions. This means Milky Way-type galaxies are probably very common.

"It also means we can use existing very detailed observations of the Milky Way as tools to better analyse much more distant galaxies which, for obvious reasons, we can't see as well."

The research shows that UGC 10738, like the Milky Way, has a thick disc consisting mainly of ancient stars - identified by their low ratio of iron to hydrogen and helium. Its thin disc stars are more recent and contain more metal.

(The Sun is a thin disc star and comprises about 1.5% elements heavier than helium. Thick disc stars have three to 10 times less.)

Although such discs have been previously observed in other galaxies, it was impossible to tell whether they hosted the same type of star distribution - and therefore similar origins. Scott, van de Sande and colleagues solved this problem by using the European Southern Observatory's Very Large Telescope in Chile to observe UGC 10738, situated 320 million light years away.

The galaxy is angled "edge on", so looking at it offered effectively a cross-section of its structure.

"Using an instrument called the multi-unit spectroscopic explorer, or MUSE, we were able to assess the metal ratios of the stars in its thick and thin discs," explained Dr van de Sande.

"They were pretty much the same as those in the Milky Way - ancient stars in the thick disc, younger stars in the thin one. We're looking at some other galaxies to make sure, but that's pretty strong evidence that the two galaxies evolved in the same way."

Dr Scott said UGC 10738's edge-on orientation meant it was simple to see which type of stars were in each disc.

"It's a bit like telling apart short people from tall people," he said. "It you try to do it from overhead it's impossible, but it if you look from the side it's relatively easy."

Co-author Professor Ken Freeman from the Australian National University said, "This is an important step forward in understanding how disk galaxies assembled long ago. We know a lot about how the Milky Way formed, but there was always the worry that the Milky Way is not a typical spiral galaxy. Now we can see that the Milky Way's formation is fairly typical of how other disk galaxies were assembled".

ASTRO 3D director, Professor Lisa Kewley, added: "This work shows how the Milky Way fits into the much bigger puzzle of how spiral galaxies formed across 13 billion years of cosmic time."

Other co-authors are based at Macquarie University in Australia and Germany's Max-Planck-Institut fur Extraterrestrische Physik.

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36 dwarf galaxies had simultaneous 'baby boom' of new stars

Surprising finding challenges current theories on how galaxies grow

RUTGERS UNIVERSITY

Research News

 

IMAGE: THREE DOZEN DWARF GALAXIES FAR FROM EACH OTHER HAD A SIMULTANEOUS "BABY BOOM " OF NEW STARS. view more 

CREDIT: RUTGERS UNIVERSITY-NEW BRUNSWICK

Three dozen dwarf galaxies far from each other had a simultaneous "baby boom" of new stars, an unexpected discovery that challenges current theories on how galaxies grow and may enhance our understanding of the universe.

Galaxies more than 1 million light-years apart should have completely independent lives in terms of when they give birth to new stars. But galaxies separated by up to 13 million light-years slowed down and then simultaneously accelerated their birth rate of stars, according to a Rutgers-led study published in the Astrophysical Journal.

"It appears that these galaxies are responding to a large-scale change in their environment in the same way a good economy can spur a baby boom," said lead author Charlotte Olsen, a doctoral student in the Department of Physics and Astronomy in the School of Arts and Sciences at Rutgers University-New Brunswick.

"We found that regardless of whether these galaxies were next-door neighbors or not, they stopped and then started forming new stars at the same time, as if they'd all influenced each other through some extra-galactic social network," said co-author Eric Gawiser, a professor in the Department of Physics and Astronomy.

The simultaneous decrease in the stellar birth rate in the 36 dwarf galaxies began 6 billion years ago, and the increase began 3 billion years ago. Understanding how galaxies evolve requires untangling the many processes that affect them over their lifetimes (billions of years). Star formation is one of the most fundamental processes. The stellar birth rate can increase when galaxies collide or interact, and galaxies can stop making new stars if the gas (mostly hydrogen) that makes stars is lost.

Star formation histories can paint a rich record of environmental conditions as a galaxy "grew up." Dwarf galaxies are the most common but least massive type of galaxies in the universe, and they are especially sensitive to the effects of their surrounding environment.

The 36 dwarf galaxies included a diverse array of environments at distances as far as 13 million light-years from the Milky Way. The environmental change the galaxies apparently responded to must be something that distributes fuel for galaxies very far apart. That could mean encountering a huge cloud of gas, for example, or a phenomenon in the universe we don't yet know about, according to Olsen.

The scientists used two methods to compare star formation histories. One uses light from individual stars within galaxies; the other uses the light of a whole galaxy, including a broad range of colors.

"The full impact of the discovery is not yet known as it remains to be seen how much our current models of galaxy growth need to be modified to understand this surprise," Gawiser said. "If the result cannot be explained within our current understanding of cosmology, that would be a huge implication, but we have to give the theorists a chance to read our paper and respond with their own research advances."

"The James Webb Space Telescope, scheduled to be launched by NASA this October, will be the ideal way to add that new data to find out just how far outwards from the Milky Way this 'baby boom' extended," Olsen added.

Rutgers co-authors include Professor Kristen B. W. McQuinn; Grace Telford, a postdoctoral associate; and Adam Broussard, a doctoral student. Scientists at the University of Toronto, the Harvard-Smithsonian Center for Astrophysics, Johns Hopkins University and NASA's Goddard Space Flight Center contributed to the study.

CAPTION

Rutgers' unexpected discovery challenges current theories on how galaxies grow and may enhance our understanding of the universe.

CREDIT

Rutgers University-New Brunswick

WHY YOU NEVER FORGET A FACE

The brain learns faces fastest in person

The brain signal linked to face familiarity is strongest after getting to know someone in-person

SOCIETY FOR NEUROSCIENCE

Research News

 

IMAGE: EXPERIMENTAL PARADIGM AND EEG ANALYSIS METHODS. view more 

CREDIT: AMBRUS ET AL., JNEUROSCI 2021

The neural representation of a familiar face strengthens faster when you see someone in person, according to a new study published in JNeurosci.

The brain loves faces -- there's even an interconnected network of brain areas dedicated to face-processing. Despite all the research on how the brain sees faces, little is known about how the neural representation of a face changes as it becomes familiar.

To track how familiarity brain signals change, Ambrus et al. measured participants' brain activity with EEG before and after getting to know different faces. Participants were exposed to faces in one of three ways: perceptual exposure (a sorting game), media exposure (watching a TV show), and in-person (chatting with lab members). A jolt of brain activity appeared on the EEG around 400 milliseconds after viewing a face; the strength of the signal was tied to the familiarity of the face. The type of exposure affected how much the signal changed: in-person exposure strengthened it the most, followed by media exposure. Perceptual exposure had very little impact on the familiarity signal. These results emphasize the importance of in-person interactions when getting to know new people.

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Paper title: Getting to Know You: Emerging Neural Representations During Face Familiarization

About JNeurosci

JNeurosci, the Society for Neuroscience's first journal, was launched in 1981 as a means to communicate the findings of the highest quality neuroscience research to the growing field. Today, the journal remains committed to publishing cutting-edge neuroscience that will have an immediate and lasting scientific impact, while responding to authors' changing publishing needs, representing breadth of the field and diversity in authorship.

About The Society for Neuroscience

The Society for Neuroscience is the world's largest organization of scientists and physicians devoted to understanding the brain and nervous system. The nonprofit organization, founded in 1969, now has nearly 37,000 members in more than 90 countries and over 130 chapters worldwide.

 

Study reveals inequities in breast cancer screening during COVID-19 pandemic

Women of color, rural women disproportionally affected by missed screening mammograms

WASHINGTON STATE UNIVERSITY

Research News

 

SPOKANE, Wash.-- Breast cancer screening took a sizeable hit during the COVID-19 pandemic, suggests new research that showed that the number of screening mammograms completed in a large group of women living in Washington State plummeted by nearly half. Published today in JAMA Network Open, the study found the steepest drop-offs among women of color and those living in rural communities.

"Detecting breast cancer at an early stage dramatically increases the chances that treatment will be successful," said lead study author Ofer Amram, an assistant professor in the Washington State University Elson S. Floyd College of Medicine whose research focuses on health inequities. "Our study findings suggest that health care providers need to double down on efforts to maintain prevention services and reach out to these underserved populations, who faced considerable health disparities even before the pandemic."

The study was conducted by researchers at Washington State University Health Sciences Spokane in partnership with MultiCare, a not-for-profit health care system that encompasses 230 clinics and eight hospitals across Washington state. The research team used medical record data from MultiCare patients who had screening mammograms completed between April and December of 2019 and during the same months in 2020, after the World Health Organization declared COVID-19 a global pandemic in March 2020

The researchers saw the number of completed screening mammograms across Washington state fall from 55,678 in 2019 to 27,522 in 2020, a 49% decrease. When they analyzed the data by race, they saw a similar decrease in screening of 49% for white women but observed significantly larger decreases in non-white women. For example, breast cancer screening declined by 64% in Hispanic women and 61% in American Indian and Alaska Native women. The researchers also looked at geographical location and found that screening mammograms in rural women were reduced by almost 59%, whereas the number of mammograms completed in urban women fell by about 50%.

Additionally, the research team analyzed the data by insurance type and found that compared to women who were on commercial or government-run health insurance plans, screening reductions were greater in women using Medicaid or who self-paid for treatment, which Amram said are indicators of lower socioeconomic status.

"We know that the COVID-19 virus has had disproportionate impacts on certain populations, including racial and ethnic minority groups," said Pablo Monsivais, senior author on the study and an associate professor in the WSU Elson S. Floyd College of Medicine. "What our study adds is that some of the secondary effects of the COVID-19 pandemic are also disproportionately impacting those populations, so it's a double whammy."

While previous studies have looked at missed cancer screening during the pandemic, Monsivais said this study is the first to examine racial and socioeconomic differences, specifically. The research team's goal is to find ways to eliminate barriers to cancer screening, which would help reduce cancer-related health disparities. Their next step is to conduct a follow-up study to identify which social and economic factors interfered with access to cancer screening during the pandemic. In addition to breast cancer, that study will also look at missed colon cancer and lung cancer screening in both women and men.

Factors that may have played a role in reduced cancer screening include job loss, loss of employer-provided health insurance, and caregiver stress due to school- or daycare closures or other circumstances. Fear of contracting COVID-19 may have also played into this, said study co-author Jeanne Robison, an oncology nurse practitioner and lead researcher on this project with MultiCare Cancer and Blood Specialty Centers in Spokane, Washington.

"One of the things we have seen this past year is that women who were pretty good about keeping up with screening remained fearful about going in even after health care facilities had opened back up for routine screening," Robison said. "I've had to talk some of my patients into coming in, however, because even when protocols were in place to safely offer breast cancer screening, there remained a perceived risk."

A drop in primary care visits during the pandemic may have also been a factor, she said, as primary care providers often play a key role in reminding women of the timing and importance of breast cancer screening. And although increased access to virtual visits may have mitigated this drop, there may have been barriers to virtual care delivery that disproportionally impacted certain groups of people, which the researchers' follow-up study will help determine.

###

In addition to Amram, Monsivais, and Robison, authors on the paper included Solmaz Amiri and John Roll at the WSU Elson S. Floyd College of Medicine and Bethann Pflugeisen with the MultiCare Institute for Research & Innovation.

The study was supported by a grant from the Andy Hill Cancer Research Endowment Fund.

Socioeconomic and Racial Inequities in Breast Cancer Screening During the COVID-19 Pandemic in Washington State

Ofer Amram, PhD^1,2; Jeanne Robison, PhD^3,4; Solmaz Amiri, DDes¹; et alBethann Pflugeisen, MSc³; John Roll, PhD¹; Pablo Monsivais, PhD, MPH¹

Author Affiliations Article Information

JAMA Netw Open. 2021;4(5):e2110946. doi:10.1001/jamanetworkopen.2021.10946

 May 24, 2021

Introduction

The COVID-19 pandemic has disrupted preventive care, including cancer screening. Studies from the United States and Europe have shown that cancer screening dropped dramatically during the pandemic,^1,2 with breast cancer screening and diagnostic mammograms falling by 58% and 38%, respectively.^1,2 A United Kingdom modeling study estimated that delayed and missed screenings would likely increase breast cancer deaths, a leading cancer among women, by 7.9% to 9.6%.^2,3 The adverse impact of COVID-19 on screening may differ among sociodemographic groups, given the disproportionate impact the pandemic has had on underserved racial and ethnic groups and other vulnerable population groups.⁴ In this report, we used clinical data to examine differences in breast cancer screenings before and during the COVID-19 pandemic overall and among sociodemographic population groups.

Methods

Data

Data included completed screening mammograms within a large statewide nonprofit community health care system in Washington State between April 1, 2018, and December 31, 2020. This health care system included more than 230 primary care, specialty care, and urgent care clinics, and 8 hospitals across Washington State. The MultiCare institutional review board approved this study protocol and granted waivers of individual consent based on removal of individually identifying data. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

Measures and Statistical Analysis

Sociodemographic data included patients’ race and ethnicity, insurance, and zip code of residence. Rural-urban commuting area codes differentiated between urban vs rural residence. Inclusion criteria included women who had at least 1 screening mammogram within the health system in 2018 or 2019. Frequency analysis and χ² tests were performed using a significance level of P < .05 to test for differences in screening in 2019 and 2020. Testing was 2-sided. Statistical analysis was performed using R statistical software version 4.03 (R Project for Statistical Computing).

Results

Among the 55 678 screenings in April to December 2019, 45 572 patients were non-Hispanic White (81.8%), 54 620 patients lived in urban areas (98.1%), and 22 761 patients were commercially insured (40.9%); the mean (SD) age was 62.0 (11.3) years. From 2019 to the same period in 2020, there was a 49% decrease in screenings (55 678 screenings in 2019 vs 27 522 screenings in 2020), with some differences apparent in the demographic characteristics between the 2 years (Table). We observed greater and significant reductions in the number of screenings from 2019 to 2020 for women who were Hispanic (1727 vs 619; −64.2%), American Indian/Alaska Native (215 vs 84; −60.9%), mixed race (1892 vs 828; −56.2%), Native Hawaiian or Pacific Islander (365 vs 166; −54.5%), Asian (2779 vs 1265; −54.5%), and Black (2320 vs 1069; −53.9%) compared with women who were White (45 572 vs 23 163; −49.2%) (Figure). Women living in rural areas experienced greater reduction in screenings compared with their urban counterparts. In terms of insurance, women who self-paid for treatment and who were insured by Medicaid experienced the largest reduction in screening, whereas those with commercial insurance or Medicare showed smaller reductions (Table).

Discussion

This study found a substantial overall decline in breast cancer screening in women living in Washington State during the COVID-19 pandemic, as well as inequities in this decline. This study has several limitations. First, the analyses were of aggregate data; we did not link individual records across years. Second, the demographic characteristics of this sample are slightly less diverse and more affluent than Washington State. Third, data reflect patient interactions with a single health care system; we weren’t able to link these interactions to an underlying population base. However, the substantial drop in screenings in 2020 was not likely to be explained by a drop in underlying population base or eligibility; nor was it likely the result of a shift to different health care networks, given that this clinical network is one of the largest health care systems in Washington State.

The larger decline in screening among women from underserved racial/ethnic groups and lower socioeconomic status might be explained by several factors. Increasing unemployment during the pandemic shutdown among those already living in poverty may have further reduced access to health insurance, while school closures led to competing demands at home.⁵ In addition, limited access to health and screening services among rural women may have increased during the pandemic.⁶ To address the decline in breast cancer screening during the pandemic, there is a need to address barriers to screening, especially for higher-risk women. Our findings suggest another inequity in the COVID pandemic due to greater reduction in utilization of cancer screening services for women with lower socioeconomic status, who are in underserved racial/ethnic groups, and live in rural communities.

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Article Information

Accepted for Publication: March 29, 2021.

Published: May 24, 2021. doi:10.1001/jamanetworkopen.2021.10946

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Amram O et al. JAMA Network Open.

Corresponding Author: Ofer Amram, PhD, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA 99202 (ofer.amram@wsu.edu).

Author Contributions: Dr Amram had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Amram, Robison, Amiri, Roll, Monsivais.

Acquisition, analysis, or interpretation of data: Amram, Robison, Amiri, Pflugeisen, Monsivais.

Drafting of the manuscript: Amram, Robison, Amiri, Monsivais.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Amram, Amiri, Monsivais.

Obtained funding: Amram, Amiri, Monsivais.

Administrative, technical, or material support: Robison, Pflugeisen.

Supervision: Amram, Robison.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by a grant from the Andy Hill Care Fund, Washington State’s Cancer Research Endowment. Dr Monsivais received support from the Health Equity Research Center, a strategic research initiative of Washington State University.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Centers for Disease Control and Prevention. COVID-19 racial and ethnic health disparities. Published February 11, 2020. Accessed March 21, 2021. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html

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Gezici  A, Ozay  O. How race and gender shape COVID-19 unemployment probability. Social Science Research Network. Published August 17, 2020. Accessed April 12, 2021. doi:10.2139/ssrn.3675022

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Jewett  PI, Gangnon  RE, Elkin  E,  et al.  Geographic access to mammography facilities and frequency of mammography screening.   Ann Epidemiol. 2018;28(2):65-71.e2. doi:10.1016/j.annepidem.2017.11.012PubMedGoogle ScholarCrossref