1
|
Oppong BA, Rumano RP, Paskett ED. Expanding the use of patient navigation: health coaching-based navigation as a novel approach to addressing deficits in breast cancer survivorship support. Breast Cancer Res Treat 2024:10.1007/s10549-023-07213-6. [PMID: 38273216 DOI: 10.1007/s10549-023-07213-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/07/2023] [Indexed: 01/27/2024]
Abstract
Patient navigation (PN) was created to address barriers to screening and workup for cancers. Since its inception it has resulted in improved mammography utilization, diagnostic resolution, and time to breast cancer treatment initiation in medically underserved populations. Because an abundance of evidence has established PN's positive impact, its use has expanded within the breast cancer care continuum, from screening, treatment, and ultimately survivorship. Increasing applications for navigation now also include support in the treatment and survivorship phase. After treatment, populations who struggle with the complex medical systems where oncology care is often delivered, also lack the support resources needed to successfully transition to survivorship. Support in the psychosocial realm is important for these patients as they continue surveillance and adherence to maintenance medications, such as hormonal therapy.
Collapse
Affiliation(s)
- Bridget A Oppong
- The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, United States.
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, United States.
| | - Ruvarashe P Rumano
- The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, United States
- College of Public Health, The Ohio State University, Columbus, United States
| | - Electra D Paskett
- The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, United States
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, United States
| |
Collapse
|
2
|
Oppong BA, Lustberg MB, Nolan TS, Relation T, Park KU, Healy E, Trance A, Klemanski DL. Utilization of cancer survivorship services during the COVID-19 pandemic in a tertiary referral center. J Cancer Surviv 2023; 17:1708-1714. [PMID: 35895236 PMCID: PMC9326963 DOI: 10.1007/s11764-022-01231-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND All Commission on Cancer-accredited comprehensive cancer centers offer survivorship programs (SPs) to women upon completion of treatment. These SPs can include clinical and non-clinical programming such as physical rehabilitation, emotional and psychosocial support, nutrition, and exercise programming. Concern about the availability and access to these programs during the COVID-19 pandemic has been described in recent literature. We sought to identify the impact of the COVID-19 pandemic on participation in these supportive services for breast cancer patients within a single institution. METHODS The Ohio State University tertiary care center offers clinical and non-clinical breast cancer support services. Descriptive statistics were utilized to summarize referral and patient participation data from January 2019 through July 2021. Data from calendar year 2019 was used as a normative comparison for pre-COVID-19. In-person and telehealth use was tracked longitudinally. RESULTS During the lockdown due to the COVID-19 pandemic (March through May 2020), provider referrals to SPs declined by 10%, while the overall total for the calendar year modestly increased from 1195 in 2019 to 1210 in 2020, representing a 1.3% increase. Psycho-oncology referrals increased from 280 to 318 (13.5%). The most significant change of participation rates in non-clinical SPs during the pandemic was utilization of exercise content, which increased by 220% from 2019 to 2020. The total proportion of breast cancer participants choosing an exercise program increased from 16.8% in 2019 to 42.2% in 2021, making it the most selected program area overall. Previously, nutrition was the most selected program area as it comprised 42.5% of overall utilization in 2019. CONCLUSION The pandemic's potential to place barriers to participation in SPs is a legitimate concern. We found a modest decline in provider referrals to clinical services during the lockdown period, while patient-directed participation increased with more survivors engaging in exercise-based programs. Transitioning to virtual platforms served to maintain access for patients. IMPLICATIONS FOR CANCER SURVIVORS As we grapple with the COVID-19 pandemic, patients with cancer deserve increased attention due to the expected stressors associated with the diagnosis. Those in the survivorship stage utilize services for psychosocial support, and the observed increase in utilization of SPs suggests an elevated need for connectivity. To meet this need, telehealth platforms have been expanded to allow for continued participation. It remains to be seen whether this will be sustained post-COVID-19 or whether reduced human contact will create new needs for programming.
Collapse
Affiliation(s)
- Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA.
| | - Maryam B Lustberg
- Department of Medical Oncology, The Ohio State University, Columbus, OH, USA
| | - Timiya S Nolan
- Martha S. Pitzer Center for Women, Children & Youth, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Theresa Relation
- MetroHealth Systems and Case Western Reserve University, Cleveland, OH, USA
| | - Ko Un Park
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Erin Healy
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, USA
| | - Annie Trance
- Cancer Support Services, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital, Columbus, OH, USA
| | - Dori L Klemanski
- Cancer Support Services, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital, Columbus, OH, USA
| |
Collapse
|
3
|
Li AE, Jhawar S, Grignol V, Agnese D, Oppong BA, Beyer S, Bazan JG, Skoracki R, Shen C, Park KU. Implementation of a Breast Intraoperative Oncoplastic Form to Aid Management of Oncoplastic Surgery. J Surg Res 2023; 290:9-15. [PMID: 37163831 DOI: 10.1016/j.jss.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Oncoplastic breast conservation surgery (BCS) uses concurrent reduction and/or mastopexy with lumpectomy to improve aesthetic outcomes. However, tissue rearrangement can shift the original tumor location site in relation to external breast landmarks, resulting in difficulties during re-excision for a positive margin and accurate radiation targeting. We developed the Breast Intraoperative Oncoplastic (BIO) form to help depict the location of the tumor and breast reduction specimen. This study seeks to assess physician perspectives of the implementation outcomes. METHODS From February 2021 to April 2021, the BIO form was used in 11 oncoplastic BCS cases at a single institution. With institutional review board approval, surgical oncologists (SOs), plastic surgeons (PSs), and radiation oncologists (ROs) were administered a 12-question validated survey on Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM), using a 5-point Likert scale during initial implementation and at 6-month reassessment. RESULTS Twelve physicians completed the survey initially (4 SOs, 4 PSs, and 4 ROs). The mean scores for Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure were high (4.44, 4.56, and 4.56, respectively). Twelve completed the second survey (5 SOs, 3 PSs, and 4 ROs). The mean scores were marginally lower (4.06, 4.21, and 4.25). There were no significant differences when stratified by number of years in practice or specialty. Free text comments showed that 75% of physicians found the form helpful in oncoplastic BCS. CONCLUSIONS The data indicate high feasibility, acceptability, and appropriateness of the BIO form. Results of this study suggest multidisciplinary benefits of implementing the BIO form in oncoplastic BCS.
Collapse
Affiliation(s)
- Amy E Li
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sachin Jhawar
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Valarie Grignol
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Doreen Agnese
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sasha Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jose G Bazan
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Roman Skoracki
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Chengli Shen
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Ko Un Park
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.
| |
Collapse
|
4
|
Owusu-Brackett N, Aduwo J, Relation TS, Bhattacharyya O, Li Y, Fisher JL, Oppong BA. Trends in utilization of contralateral prophylactic mastectomy among different age, racial and ethnic groups. Gland Surg 2023; 12:1224-1232. [PMID: 37842536 PMCID: PMC10570976 DOI: 10.21037/gs-22-759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/20/2023] [Indexed: 10/17/2023]
Abstract
Background The use of contralateral prophylactic mastectomy (CPM) has increased over the last two decades with variations in the frequency of reconstruction. The objective of this cohort study is to elucidate the use of CPM and reconstruction among underrepresented racial and ethnic groups and women over 65 years. Methods Women over 18 years, diagnosed with stages I to III breast cancer who underwent mastectomy from 2004-2017 were identified in the National Cancer Database (NCDB) and grouped into CPM vs. non-CPM. Multivariable analyses were used to examine the associations between CPM and reconstruction with sociodemographic and clinical factors. Results A total of 571,649 patients were identified. Patients who underwent CPM were under 50 years (45.9%), White (88.4%) and with private insurance (73.5%). On multivariable analysis, women over 65 years [odds ratio (OR): 0.18, P<0.001], non-White (Black, OR: 0.56, P<0.001) and without private insurance (uninsured, OR: 0.50, P<0.001) had decreased odds of CPM. Women over 65 years (OR: 0.11, P<0.001), non-White (Asian/Pacific Islander, OR: 0.58, P<0.001) and without private insurance (Medicaid, OR: 0.41, P<0.001) had decreased odds of reconstruction. Conclusions Non-White women and women over the age of 65 years were less likely to have CPM or reconstruction than their White counterparts from 2004 to 2017. Research is needed to understand factors impacting decision-making.
Collapse
Affiliation(s)
- Nicci Owusu-Brackett
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Jessica Aduwo
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Theresa S. Relation
- Department of Surgery, MetroHealth Systems Case Western Reserve University, Cleveland, OH, USA
| | | | - Yaming Li
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
| | - James L. Fisher
- James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Bridget A. Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| |
Collapse
|
5
|
Bhattacharyya O, Relation T, Fisher JL, Li Y, Oppong BA. County characteristics associated with refusing breast cancer surgery: Evidence from the Surveillance, Epidemiology, and End Results program. Surgery 2023; 174:457-463. [PMID: 37296055 DOI: 10.1016/j.surg.2023.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Individuals' communities impact cancer disparities and are intimately related to social determinants of health. Studies show that personal factors affect treatment refusals for a potentially curable cancer, but few studies have investigated whether community-based characteristics affect the receipt of surgery. METHODS We used Surveillance Epidemiology and End Results Program registries from 2010 to 2015 to examine differences in rates of surgery refusal among non-Hispanic White, non-Hispanic Black, and Hispanic women diagnosed with nonmetastatic breast cancer. The community factor measures were based on county-level factors. Sociodemographic and community differences were analyzed using Pearson's χ2 tests and analysis of variance. Multivariate logistic regression of predictors of surgery refusal and the Cox proportional hazard model of disease-specific mortality were performed. RESULTS Surgery refusers among non-Hispanic Black and Hispanic all races lived in counties with lower rates of educational attainment, median family and household income, and higher rates of poverty, unemployment, foreign-born, language isolation, urban population, and women more than 40 years old having mammography in last 2 years. Multivariate analysis shows surgery refusal rates increased in counties having a high percentage of urban population and declined in counties with an increased percentage of less than high school level education, unemployment, and median household income. Breast cancer-specific mortality increased significantly with surgery refusal. CONCLUSION Residence in counties with the lowest socioeconomic status and disproportionately populated by racial and ethnic minorities is associated with surgery refusal. Given the high mortality associated with refusing surgery, culturally sensitive education on the benefits of care may be appropriate.
Collapse
Affiliation(s)
- Oindrila Bhattacharyya
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH; The William Tierney Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN
| | - Theresa Relation
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH; MetroHealth Systems Case Western Reserve University, Cleveland, OH
| | - James L Fisher
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Yaming Li
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - Bridget A Oppong
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH.
| |
Collapse
|
6
|
Owusu-Brackett N, Oppong BA. Can targeted axillary dissection reliably advise de-escalation of completion axillary lymph node dissection? Gland Surg 2023; 12:730-732. [PMID: 37441015 PMCID: PMC10333758 DOI: 10.21037/gs-23-106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/12/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Nicci Owusu-Brackett
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| |
Collapse
|
7
|
Oppong BA, Rolle AA, Ndumele A, Li Y, Fisher JL, Bhattacharyya O, Adeyanju T, Paskett ED. Are there differences in outcomes by race among women with metastatic triple-negative breast cancer? Breast Cancer Res Treat 2022; 196:399-408. [PMID: 36152139 DOI: 10.1007/s10549-022-06736-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Black women have higher breast cancer mortality rates than other groups, with Triple-negative breast cancer (TNBC) being more common among AAs with a worse prognosis. Our study seeks to explore differences among Non-Hispanic Black (NHB) vs. White (NHW) women, with Stage IV TNBC, focusing on survival and treatment patterns. METHODS SEER database was queried for TNBC patients diagnosed with metastatic disease from 2012 to 2016. Neighborhood socioeconomic status (nSES) was defined using the Yost index based on income, education, housing, and employment. Univariate and multivariate analyses were performed to evaluate receipt of surgery, radiation, and chemotherapy. Overall survival was evaluated using Kaplan-Meier curve and Cox proportional hazards model analysis. RESULTS 25,761 TNBC cases were identified with 1420 being metastatic (5.5%). Bone was the most common site for metastasis, with patients' age being 63.7 years for NHW vs. 59.5 years for NHB. NHB women had the highest percentage of low nSES (62.3% vs 29.3%; p value = 0.001). On univariate analysis, fewer NHBs received radiation compared to NHWs (27.1 vs. 32.6%; p value = 0.040). On multivariate analysis, all women were less likely to undergo treatment if unmarried (p value < 0.01). NHB women had lower median survival compared to NHW women (13 vs. 15 months; p value < 0.01). Receipt of surgery and chemotherapy reduced the risk of mortality (p value < 0.01). CONCLUSION NHB women had lower median survival with metastatic TNBC. Race was associated with different treatment utilization. With a mortality differential between NHW and NHB women with metastatic TNBC, more investigation is needed to inform strategies to reduce this disparity.
Collapse
Affiliation(s)
- Bridget A Oppong
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
| | | | - Amara Ndumele
- Wexner College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Yaming Li
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - James L Fisher
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Oindrila Bhattacharyya
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Toyin Adeyanju
- Department of Medicine, and Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- Department of Medicine, and Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
| |
Collapse
|
8
|
Hamad A, Eskander MF, Shen C, Bhattacharyya O, Fisher JL, Oppong BA, Obeng-Gyasi S, Tsung A. In search of lost time: Delays in adjuvant therapy for pancreatic adenocarcinoma among under-resourced patient populations. Surgery 2022; 172:982-988. [PMID: 35595567 DOI: 10.1016/j.surg.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The initiation of adjuvant chemotherapy for pancreatic adenocarcinoma within 12 weeks after surgery is recommended by the National Comprehensive Cancer Network. This study seeks to identify factors associated with delayed adjuvant chemotherapy and whether delays impact survival in under-resourced populations. METHODS Patients with nonmetastatic pancreatic adenocarcinoma who received a definitive resection followed by adjuvant chemotherapy between 2006 and 2017 were queried from the National Cancer Database. Multivariate logistic regression models were constructed to determine the relationship between socioeconomic/clinical variables and delayed adjuvant chemotherapy. Kaplan Meier curves compared survival between under-resourced patients receiving delayed versus timely adjuvant chemotherapy. RESULTS Among 25,008 patients, timely adjuvant chemotherapy varied by stage (stage 1: 67.9% vs stage 2: 75.8% vs stage 3: 89.2%; P < .001). Older age (odds ratio 1.02, 95% confidence interval 1.02-1.03; P < .001), Non-Hispanic Black race (odds ratio 1.25, 95% confidence interval 1.11-1.41; P < .001), increasing comorbidity score (odds ratio 1.18, 95% confidence interval 1.12-1.23; P < .001), 30-day readmission (odds ratio 1.45, 95% confidence interval 1.28-1.63; P < .001), and undergoing a Whipple (odds ratio 1.30, 95% confidence interval 1.16-1.44; P < .001) were associated with delayed adjuvant chemotherapy. Conversely, the highest neighborhood median income quartile (odds ratio 0.84, 95% confidence interval 0.73-0.97; P = .021), private insurance (odds ratio 0.59, 95% confidence interval 0.46-0.76; P < .001), Medicare (odds ratio 0.68, 95% confidence interval 0.52-0.88; P = .003), and receipt of neoadjuvant therapy (odds ratio 0.05, 95% confidence interval 0.04-0.06; P < .001) were associated with timely adjuvant chemotherapy. Non-Hispanic Black patients and patients with the lowest neighborhood education had worse overall survival when receiving delayed versus timely adjuvant chemotherapy. CONCLUSION Timely adjuvant chemotherapy for pancreatic adenocarcinoma was only achieved in 73.3% of patients. Age, race, comorbidities, median income, and insurance were identified as barriers. Delayed adjuvant chemotherapy was associated with worse survival among under-resourced populations.
Collapse
Affiliation(s)
- Ahmad Hamad
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH. https://twitter.com/ahmadhamad4
| | - Mariam F Eskander
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH; Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ. https://twitter.com/mariameskmd
| | - Chengli Shen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | | | - James L Fisher
- The Ohio State University College of Medicine, Columbus, OH
| | - Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH. https://twitter.com/mdBridget
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH. https://twitter.com/GyasiSamilia
| | - Allan Tsung
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH.
| |
Collapse
|
9
|
Relation T, Bhattacharyya O, Oppong BA. ASO Author Reflections: Surgery Refusal in Breast Cancer Has a Disproportionate Impact on Black and Hispanic Women. Ann Surg Oncol 2022; 29:6644-6645. [PMID: 35581513 DOI: 10.1245/s10434-022-11906-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Theresa Relation
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA.,MetroHealth Systems and Case Western Reserve University, Cleveland, OH, USA
| | - Oindrila Bhattacharyya
- Department of Economics, Indiana University Purdue University, Indianapolis, IN, USA.,The William Tierney Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
10
|
Relation T, Ndumele A, Bhattacharyya O, Fisher JL, Li Y, Obeng-Gyasi S, Eskander MF, Tsung A, Oppong BA. Surgery Refusal Among Black and Hispanic Women with Non-Metastatic Breast Cancer. Ann Surg Oncol 2022; 29:6634-6643. [PMID: 35513589 DOI: 10.1245/s10434-022-11832-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 04/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies have shown a lower receipt of treatment among minority women with non-metastatic breast cancer. Those who refuse surgery have increased disease-specific mortality, contributing to disproportionately higher breast cancer mortality in non-Hispanic black (NHB) and Hispanic women. This study aimed to assess surgery refusal in these groups, identify factors associated with surgery refusal, and characterize the association between surgery refusal and survival. METHODS Surveillance, Epidemiology, and End Results (SEER) Program data from 2005 to 2015 for NHB and Hispanic women with a diagnosis of non-metastatic breast cancer (n = 113,987) was divided into data of those who underwent surgery and data of those who refused surgery. Sociodemographic and tumor clinical/pathologic differences were analyzed by multivariate logistic regression of predictors of surgery refusal and Cox-proportional hazard model of disease-specific mortality. RESULTS Of 799 patients who refused surgery, 562 were NHB and 237 were Hispanic. The percentage of patients refusing surgery increased from 0.6% in 2005 to 0.9% in 2015. The women who refused surgery were more likely to be older than 81 years, less likely to be married, and more likely to be uninsured or have Medicaid. The refusers presented with more advanced disease and more frequent estrogen receptor-positivity (ER+) and progesterone receptor-positivity (PR+) subtype on histology. Breast cancer-specific mortality increased significantly with surgery omission. Surgery refusal was independently associated with NHB race. CONCLUSION Surgery refusal among NHB and Hispanic women with potentially curable non-metastatic breast cancer is rising, especially among NHB women, women older than 60 years, single women, and women with a later stage of disease at diagnosis. Additional studies are needed to analyze qualitative data in these populations and their underlying health beliefs, communication needs, and possible use of alternative medicine.
Collapse
Affiliation(s)
- Theresa Relation
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Amara Ndumele
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Oindrila Bhattacharyya
- Department of Economics, Indiana University Purdue University, Indianapolis, IN, USA.,The William Tierney Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - James L Fisher
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Yaming Li
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Mariam F Eskander
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Allan Tsung
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
11
|
Oppong BA, Bhattacharyya O, Li Y, Obeng-Gyasi S, Sheppard VB. Receipt of breast conservation over mastectomy in Black women- does breast cancer subtype matter? J Natl Med Assoc 2022; 114:298-307. [PMID: 35272849 DOI: 10.1016/j.jnma.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Breast conservation surgery (BCS) and mastectomy have equivalent survivability. However, perception of surgical benefit may be affected by breast cancer subtypes, impacting procedure choice. We evaluate surgical management among non-Hispanic Black (NHB) and White (NHW) breast cancer patients based on subtypes. METHODS Queried the National Cancer Database (NCDB) including BCS eligible women with T1 (<2cm) breast cancer between 2011 and 2016. We selected NHB and NHW women and evaluated differences in sociodemographic variables and treatment including surgery. To determine factors associated with receipt of BCS, a multivariable logistic regression analysis was performed adjusting for age, race, surgery type and breast cancer subtypes. RESULTS Analyzed 390,278 women with 89.7% NHW and 10.3% NHB, of mean age 63 years. 55.4% vs. 53.5% of NHW compared to NHB women had BCS (p<.001) as initial cancer therapy. Statistically significant differences between NHB and NHW in surgery were found on univariate analysis in all breast cancer subtypes except Luminal B. NHB women with TNBC and Luminal A subtypes were more likely to undergo BCS on multivariate analysis. CONCLUSIONS Significant differences are found in the surgical management of breast cancer with Black women more likely to receive BCS, less likely to undergo mastectomy compared to White counterparts even with TNBC or her-2+ subtypes. Understanding surgical decision making and how knowledge of subtype is applied deserves further study in women of diverse racial and ethnic groups.
Collapse
Affiliation(s)
- Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA.
| | - Oindrila Bhattacharyya
- Indiana University Purdue University Indianapolis, Department of Economics, Indianapolis, IN, USA; Regenstrief Institute Inc., The William Tierney Center for Health Services Research, Indianapolis, IN, USA
| | - Yaming Li
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
12
|
Relation T, Obeng-Gyasi S, Bhattacharyya O, Li Y, Eskander MF, Tsung A, Oppong BA. Racial Differences in Response to Neoadjuvant Chemotherapy: Impact on Breast and Axillary Surgical Management. Ann Surg Oncol 2021; 28:6489-6497. [PMID: 33586065 PMCID: PMC8491425 DOI: 10.1245/s10434-021-09657-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/09/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC), an increasingly used method for breast cancer patients, has the potential to downstage patient tumors and thereby have an impact on surgical options for treatment of the breast and axilla. Previous studies have identified racial disparities in tumor heterogeneity, nodal recurrence, and NAC completion. This report compares the effects of NAC response among non-Hispanic white women and black women in relation to surgical treatment of the breast and axilla. METHODS A retrospective review of 85,303 women with stages 1 to 3 breast cancer in the National Cancer Database who received NAC between 1 January 2010 and 31 December 2016 was conducted. Differences in sociodemographic and clinical variables between black patients and white patients with breast cancer were tested. RESULTS The study identified 68,880 non-Hispanic white and 16,423 non-Hispanic black women who received NAC. The average age at diagnosis was 54.8 years for the white women versus 52.5 years for the black women. A higher proportion of black women had stage 3 disease, more poorly differentiated tumors, and triple-negative subtype. The black women had lower rates of complete pathologic response, more breast-conservation surgery, and higher rates of axillary lymph node dissection, but fewer sentinel lymph node biopsies. Axillary management for the women who were downstaged showed more use of axillary lymph node dissection for black women compared with sentinel lymph node biopsy. CONCLUSIONS The black patients were younger at diagnosis, had more advanced disease, and were more likely to have breast-conservation surgery. De-escalating axillary surgery is being adopted increasingly but used disproportionately for white women.
Collapse
Affiliation(s)
- Theresa Relation
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | | | - Yaming Li
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Mariam F Eskander
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Allan Tsung
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
13
|
Ndumele A, Kerger A, Tozbikian G, Obeng‐Gyasi S, Oppong BA. Ductal carcinoma in situ (DCIS) presenting as a cystic retroareolar lesion in an African American man. Clin Case Rep 2021; 9:e04166. [PMID: 34194764 PMCID: PMC8222763 DOI: 10.1002/ccr3.4166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) in males is rare, and there are limited data aimed at understanding the adequate workup, imaging, and follow-up for men who present with breast masses. Attention should be given to black men who have a higher cancer risk and worse prognosis than white male counterparts.
Collapse
Affiliation(s)
- Amara Ndumele
- The Ohio State University Wexner College of MedicineColumbusOHUSA
| | - Amy Kerger
- Department of RadiologyThe Ohio State UniversityColumbusOHUSA
| | - Gary Tozbikian
- Department of PathologyThe Ohio State UniversityColumbusOHUSA
| | - Samilia Obeng‐Gyasi
- Division of Surgical OncologyDepartment of SurgeryThe Ohio State UniversityColumbusOHUSA
| | - Bridget A. Oppong
- Division of Surgical OncologyDepartment of SurgeryThe Ohio State UniversityColumbusOHUSA
| |
Collapse
|
14
|
Hamad A, Eskander M, Li Y, Bhattacharyya O, Fisher JL, Oppong BA, Obeng-Gyasi S, Tsung A. Impact of Medicaid expansion on pancreatic cancer care: A difference-in-difference analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18567 Background: The Affordable Care Act (ACA) increased insurance coverage for low-income individuals, which should potentially lead to better access to care and improved oncological outcomes. This study seeks to evaluate the impact of Medicaid expansion (ME) on care for pancreatic ductal adenocarcinoma (PDAC). Methods: Patients who were uninsured or on Medicaid and diagnosed with PDAC between 2004 and 2017 were queried from the National Cancer Database (NCDB). Two different expansion cohorts were included: early expansion states and 2014 expansion states. For early expansion states, the time period of pre-expansion was 2004-2009 and post-expansion was 2010-2017. As for the 2014 expansion states, the pre-expansion period was from 2004-2013 and post-expansion period was from 2014-2017. Patients in non-expansion states formed the control group. A difference-in-difference (DID) analysis was used to assess the association of ME with stage of diagnosis, treatment and survival for each expansion cohort. Results: In both early and January 2014 expansion states, there was an increase in overall Medicaid coverage (Early: DID = 0.29, 2014: DID = 0.37; P < 0.001), in particular for non-Hispanic Black and Hispanic Black patients (Non-Hispanic Black: Early: DID = 0.11, 2014: DID = 0.11; P < 0.001, Hispanic-Black: 2014: DID = 0.20; P = 0.003). There were no differences in early stage diagnosis (Early: DID = 0.02, 2014: DID = -0.02; P > 0.05). There was an increase in the number of patients receiving surgery (Early: DID = 0.05; P = 0.001, 2014: DID = 0.03; P = 0.029) but no difference in time to surgery among patients receiving surgery upfront (Early: DID = 1.75, 2014: DID = 0.38; P > 0.05). There was no difference in 30-day readmission post-surgery (Early: DID = 0.003; 2014: DID = -0.00007; P > 0.05) or 90-day mortality (Early: DID = -0.007, 2014: DID = -0.035; P > 0.05). Moreover, there was no difference in receipt of chemotherapy (Early: DID = 0.01, 2014: DID = 0.005; P > 0.05) or time to chemotherapy for patients receiving neoadjuvant chemotherapy (Early: Early: DID = 9.62, 2014: DID = 0.01; P > 0.05). Finally, there was no difference in receipt of palliative care among stage IV patients in both cohorts (Early: DID = -0.004, 2014: DID = 0.004; P > 0.05). Conclusions: This study suggests that after ME, PDAC patients were more likely to be insured and had increased access to surgical care. Future, studies should evaluate the implications of improved surgical access on clinical outcomes such as mortality.
Collapse
Affiliation(s)
- Ahmad Hamad
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mariam Eskander
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Yaming Li
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - James L Fisher
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Allan Tsung
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| |
Collapse
|
15
|
Oppong BA, Obeng-Gyasi S, Relation T, Adams-Campbell L. Call to action: breast cancer screening recommendations for Black women. Breast Cancer Res Treat 2021; 187:295-297. [PMID: 33770312 DOI: 10.1007/s10549-021-06207-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
African-American/Black women have more aggressive breast cancer subtypes, are diagnosed at younger ages, and have an increasing incidence rate. These disparities have resulted in Black women continuing to experience the highest mortality rate from breast cancer of any US racial or ethnic group. However, national screening mammography guidelines do not reflect the high-risk status of Black women. Here we review breast cancer screening guidelines and address the lack of inclusion of the specific needs of Black women. In order to equitably care for the health needs of Black women, high-risk designation would improve access to earlier screening and supplemental imaging including breast MRI.
Collapse
Affiliation(s)
- Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA.
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Theresa Relation
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | | |
Collapse
|
16
|
Gil LA, Eskander MF, Obeng-Gyasi S, Oppong BA, Li Y, Tsung A. HSR21-049: Fragmentation of Care in the Multidisciplinary Management of Pancreatic Cancer: Luxury or Liability? J Natl Compr Canc Netw 2021. [DOI: 10.6004/jnccn.2020.7773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
17
|
Relation T, Oppong BA. ASO Author Reflections: Disparities in Outcome and Surgical Management Following Neoadjuvant Chemotherapy for Breast Cancer. Ann Surg Oncol 2021; 28:6498-6499. [PMID: 33660126 PMCID: PMC7927762 DOI: 10.1245/s10434-021-09680-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Theresa Relation
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
18
|
Jackson DK, Li Y, Eskander MF, Tsung A, Oppong BA, Bhattacharyya O, Paskett ED, Obeng-Gyasi S. Racial disparities in low-value surgical care and time to surgery in high-volume hospitals. J Surg Oncol 2020; 123:676-686. [PMID: 33616989 DOI: 10.1002/jso.26320] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/07/2020] [Accepted: 11/16/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The objective of this study is to examine racial differences in receipt of low-value surgical care and time to surgery (TTS) among women receiving treatment at high-volume hospitals. METHODS Stage I-III non-Hispanic Black (NHB) and Non-Hispanic White (NHW) breast cancer patients were identified in the National Cancer Database. Low-value care included (1) sentinel lymph node biopsy (SLNB) among T1N0 patients age ≥70 with hormone receptor-positive cancers, (2) axillary lymph node dissection (ALND) in patients meeting ACOSOG Z0011 criteria, and (3) contralateral prophylactic mastectomy (CPM) with unilateral cancer. TTS was days from biopsy to surgery. Bivariate and logistic regression analyses were used to compare the groups. RESULTS Compared to NHWs, NHBs had lower rates of SLNB among women age ≥70 with small hormone-positive cancers (NHB 58.5% vs. NHW 62.2% p < .001) and CPM (NHB 26.3% vs. NHW 36%; p < .001). ALND rates for patients meeting ACOSOG Z0011 criteria were similar between both groups (p = .13). The odds of surgery >60 days were higher among NHBs (odds ratio, 1.77; 95% confidence interval, 1.64-1.91; NHW ref). CONCLUSIONS NHBs treated at high-volume hospitals have higher rates of surgical delay but are less likely to undergo low-value surgical procedures compared to NHW women.
Collapse
Affiliation(s)
| | - Yaming Li
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Mariam F Eskander
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Allan Tsung
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Oindrila Bhattacharyya
- Department of Economics, Indiana University Purdue University, Indianapolis, Indiana, USA
| | - Electra D Paskett
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
19
|
Snead F, Slade AN, Oppong BA, Sutton AL, Sheppard VB. Narrowing Racial Gaps in Breast Cancer: Factors Affecting Probability of Adjuvant Radiation Therapy. Adv Radiat Oncol 2020; 5:17-26. [PMID: 32051886 PMCID: PMC7004948 DOI: 10.1016/j.adro.2019.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/21/2019] [Accepted: 07/15/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Adjuvant radiation therapy has historically been underused by black patients with breast cancer compared with white patients. We prospectively investigated factors, including sociocultural, psychosocial, and health care factors, that may be associated with the use or omission of adjuvant radiation therapy by both racial groups. METHODS AND MATERIALS Women with primary invasive, nonmetastatic breast cancer were recruited from hospitals and through community outreach efforts in the Washington, DC, and Detroit, Michigan, areas between July 2006 and April 2011. Data were collected via telephone interviews regarding psychosocial (eg, self-efficacy) and health care factors (eg, communication) at the time they received a diagnosis. Clinical data were extracted from their medical charts after the completion of treatment. We examined the association among multiple demographic, socio-cultural, healthcare process factors and the use of radiotherapy. Logistic multivariable regression models identified associations with radiotherapy receipt. RESULTS Among 395 eligible and consenting women, 315 had complete baseline data, and 217 were in the final analytical sample, having met criteria for adjuvant breast or chest wall radiation therapy after breast conservation surgery or mastectomy. Among women eligible for radiation, all were insured, 59% were black, the mean age was 55.4 years, and the majority had stage I or II disease. Overall, approximately 70% percent of women received adjuvant radiation therapy. On multivariable analyses, the likelihood of receiving adjuvant radiation therapy was higher for those who were black with any level of indication for radiation therapy (odds ratio 2.21; P < .01), those for whom comorbidities were present, and those who demonstrated positive sociocultural factors such as self-efficacy and high reported rates of provider communication about radiation therapy (odds ratio 1.20; P < .05). Among women with strong indications for radiation therapy, there was no significant association with race on multivariable analysis. CONCLUSIONS Our findings suggest that among women with any indication for radiation therapy, black patients were more likely to receive radiation therapy compared with white patients. Furthermore, data suggest improved provider communication and self-efficacy are important predictors of receipt of radiation therapy. Further studies exploring the effects of provider communication and sociocultural factors to diverse patient populations may be warranted.
Collapse
Affiliation(s)
- Felicia Snead
- University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, Pennsylvania
| | | | | | | | | |
Collapse
|
20
|
McClenathan MM, Lu J, Oppong BA, Adams-Campbell LL, Dash C. Abstract P1-02-07: Adherence to breast cancer screening recommendations among underserved participants in an urban safety net mammography clinic. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-02-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The Georgetown Lombardi Comprehensive Cancer Center's Capital Breast Care Center (CBCC) is a safety net mammography screening center that uses a community-based patient navigation program to provide underserved minority women guidelines-concordant mammography screening. Given that screening navigation is designed to eliminate some established barriers such as, access, transportation, and cost, we retrospectively examined patient adherence rates to regular (annual/biennial) mammography screening. We also investigated whether patient demographics are associated with adherence to breast cancer screening.
Methods: Data were derived from medical records of patients that received a baseline mammogram at CBCC in 2011 (n = 1,637) and were followed up for 4 years. Within the study time period of 2011-2015, patients were of age 40-74 and had not received a prior breast cancer diagnosis. 10 definitive cases of breast cancer were newly diagnosed in this population during the follow-up period and were excluded from the analysis. Adherence was then calculated based on the American College of Radiology (annual screening starting at 40) and the United States Preventive Services Task Force guidelines (biennial screening starting at 50).
Results: In 2011, the mean age of women screened at CBCC was 51.25 years with 45% being 40-50 years of age. CBCC has a predominantly minority population with 48% of the women identifying as Black/African American (AA) and 41% identifying as Hispanic in 2011. Over the 4 year follow up period, 41.11% of the patients screened in 2011 did not return for another screen. The adherence rate for annual screening in the 40-74 age group was 3.3% (3.0% in Black/AA; 4.2% in Hispanic) over the 4-year follow-up. The adherence rate for biennial screening among the 50-74-year-old age group was 21% overall (20% among Black/AA; 26% among Hispanics). Approximately 40% of the participants with baseline screenings in 2011 received at least one additional screening over the 4 year follow up but their mammography schedules were not guidelines concordant and they were labeled as “partially adherent” for this analysis.
Conclusion: While the number of partially adherent patients was consistent with previous population-based adherence studies, the proportion of non-adherent patients was higher compared with other population-based studies in primarily Non-Hispanic White populations. Our analysis highlights the importance of focusing on adherence to guidelines and not just mammography initiation in underserved minority populations through educational interventions targeted to patients and providers.
Citation Format: McClenathan MM, Lu J, Oppong BA, Adams-Campbell LL, Dash C. Adherence to breast cancer screening recommendations among underserved participants in an urban safety net mammography clinic [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-02-07.
Collapse
Affiliation(s)
- MM McClenathan
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Reston Hospital Center, HCA Virginia Health System, Reston, VA
| | - J Lu
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Reston Hospital Center, HCA Virginia Health System, Reston, VA
| | - BA Oppong
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Reston Hospital Center, HCA Virginia Health System, Reston, VA
| | - LL Adams-Campbell
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Reston Hospital Center, HCA Virginia Health System, Reston, VA
| | - C Dash
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; Reston Hospital Center, HCA Virginia Health System, Reston, VA
| |
Collapse
|
21
|
Oppong BA, Greenwald H, Dash C, Makambi K, Coleman T, Adams-Campbell L. Abstract B22: Trends in mammography utilization at a safety net breast cancer screening center. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1538-7755.disp17-b22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Breast cancer screening uptake patterns vary based on race and ethnicity, insurance status, socioeconomic status, and age. Among uninsured and resource-poor populations, community-based safety net clinics have emerged as important providers of these breast cancer screening services. The Capital Breast Care Center (CBCC) was established in 2004 to deliver breast and cervical cancer screening to all women in the District of Columbia (DC) metropolitan region. CBCC serves a large Black and Hispanic population with representation of many diverse ethnic groups within these racial categories. Here, we examine the population of women presenting to CBCC for screening mammograms from 2010 to 2016, evaluating patterns of changes in utilization of the services along sociodemographic and economic lines among the women.
Methods: Prospectively collected demographic data were abstracted from the electronic medical records including age, race, menopausal status, insurance status, highest education attainment, and screening outcome. Percentages of women who sought mammography screening were computed for each year by categories of selected characteristics. Time trends in screening were tested with the Cochran-Armitage trend test.
Results: From 2010 to 2016, 8448 women were screened at CBCC with 106 diagnoses of breast cancer. African-American and Hispanic women accounted for about 90%. Trends in the racial/ethnic composition of the women screened shifted, with African American women decreasing while the proportion of Latina patients increased (p-value <0.0001). The uninsured population increased covered under the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) as decreases were seen in women with private commercial insurance, Medicaid, and Medicare (p-value <0.0001). The number of DC residents decreased as more patients traveled from Maryland and Virginia (p-value <0.0001). There was no significant trend in proportion of women who had screening and were diagnosed with breast cancer.
Conclusion: In this analysis of asymptomatic women presenting for breast cancer screening, over a 7-year period there were significant trends in an increase in Hispanic women, those residing in Virginia, and those screened using the NBCCEDP. These analyses of the population of women selecting CBCC for mammography screening may reflect both local and national demographic shifts. Assessment of patient trends can improve preventative/public health efforts and intervention services offered at community clinics.
Citation Format: Bridget A. Oppong, Holly Greenwald, Chiranjeev Dash, Kepher Makambi, Tesha Coleman, Lucile Adams-Campbell. Trends in mammography utilization at a safety net breast cancer screening center [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B22.
Collapse
|
22
|
Oppong BA, Sen Gupta S, Gary M, Wehner P, Mete M, Zhao D, Seevaratnam S, Rudra S, Willey SC. 21-gene recurrence assay in patients receiving intraoperative radiotherapy: are "favorable" characteristics a surrogate for low recurrence? Gland Surg 2018; 6:675-681. [PMID: 29302485 DOI: 10.21037/gs.2017.07.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Intraoperative radiotherapy (IORT) has gained momentum for early stage and favorable breast cancers (BC). The 21-gene recurrence assay guides treatment of hormone positive and node-negative BC. Methods Analysis of 82 invasive BC treated with breast conservation surgery (BCS) and IORT 2013-2015. Data collection included patient demographics, tumor characteristics, nodal status, recurrence test (RS) and adjuvant therapy. Results The mean age was 68 years. Tumors were stage Ia (86.6%), 3.6% Ib and 9.8% IIa. Of 50 patients (61.0%) with RS testing, 72% (n=36) were low risk (RS 0-17), with 28% (n=14) at intermediate risk (RS 18-30). The 39% (n=32) of patients without RS testing, were more likely to have smaller tumors (1.3 vs. 0.9 cm) and age >70 (P<0.05). Conclusions Most patients selected for IORT based on clinical features were indeed low risk based on RS. Given the limited long-term clinical outcome and safety data of this technique, additional investigation is needed.
Collapse
Affiliation(s)
- Bridget A Oppong
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Surupa Sen Gupta
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Monique Gary
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Patricia Wehner
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Mihriye Mete
- Department of Biostatics, MedStar Health Research Institute, Hyattsville, MD, USA
| | - Danjing Zhao
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Sonali Rudra
- Department of Radiation Oncology, MedStar Georgetown University, Washington, DC, USA
| | - Shawna C Willey
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
23
|
Sheppard VB, de Mendoza AH, He J, Jennings Y, Edmonds MC, Oppong BA, Tadesse MG. Initiation of Adjuvant Endocrine Therapy in Black and White Women With Breast Cancer. Clin Breast Cancer 2017; 18:337-346.e1. [PMID: 29422259 DOI: 10.1016/j.clbc.2017.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/20/2017] [Accepted: 12/01/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Adjuvant endocrine therapy reduces risk of recurrence and mortality in women with hormone receptor-positive breast cancer, yet many women never initiate it. We examined the influence of race, sociocultural factors, and process-of-care factors on initiation of adjuvant endocrine therapy in a racially diverse sample. PATIENTS AND METHODS Eligible women were originally recruited for the Narrowing the Gaps in Adjuvant Therapy Study (2006-2011). Sociocultural and process-of-care factors were collected via telephone surveys before adjuvant therapy. Clinical factors were abstracted from charts. Penalized LASSO (least absolute shrinkage and selection operator) logistic regression model was used to identify variables associated with initiation. RESULTS Of the 270 women, 55.6% were black and the rest were white. Most women (74.8%) initiated therapy. A significant interaction (P = .008) was found between race and age. Black women aged ≤ 50 years had the lowest initiation (59.7%) compared to black women > 50 years (87.1%), white women ≤ 50 years (73.7%), or white women > 50 years (72.0%). Multivariate analysis found that younger black women exhibited a marginally higher risk of noninitiation compared to older black women. Additionally, ratings of financial access, presence of comorbidities, and levels of communication were all associated with endocrine therapy initiation. CONCLUSION Black women ≤ 50 years of age and women with financial constraints may be important subgroups for interventions. Patient-provider communication appears to be an important leverage point to foster therapy uptake.
Collapse
Affiliation(s)
- Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA.
| | | | - Jun He
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Yvonne Jennings
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Megan C Edmonds
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Bridget A Oppong
- Georgetown University Medical Center, Georgetown University, Washington, DC
| | - Mahlet G Tadesse
- Department of Mathematics and Statistics, Georgetown University, Washington, DC
| |
Collapse
|
24
|
Oppong BA, Dash C, Oneill S, Makambi K, Coleman T, Adams-Campbell LL. Abstract A02: Comparative analysis of breast density among Black, White, and Hispanic women presenting for screening mammography. Cancer Res 2017. [DOI: 10.1158/1538-7445.newfront17-a02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Data on ethnic variations in breast density are limited and often not inclusive of underrepresented minorities, including Black and Hispanic women. As breast density is associated with elevated breast cancer risk, investigating racial and ethnic difference may elucidate the observed differences in breast cancer risk among different populations.
Methods: We reviewed breast density recorded at the initial mammographic screening study in women presenting to the Capital Breast Care Center (CBCC) and Georgetown University Hospital (GUH) from 2010 to 2014. Patient demographics including race, age at screening, education and menopausal status were abstracted in addition to body mass index (BMI). From imaging reports, we recorded the BI-RADS density categories: 1-fatty, 2-scattered fibroglandular densities, 3-heterogeneously dense and 4-extremely dense. Multivariable unconditional logistic regression was used to identify predictors of breast density.
Results: Density categorization was recorded for 2,146 women over the five-year period, with 940 (43.8%) Black, 893 (41.6%), Hispanic and 314 (14.6%) White. Analysis of subject characteristics by low density (categories 1 and 2) and high density (categories 3 and 4) show that high category is observed in younger, Hispanic, nulliparous, premenopausal and non-obese women (P-values <.0001). Obese women are 70% less likely to have high breast density compared to non-obese women. Being Hispanic, premenopausal, and non-obese were predictive of high mammographic density on logistic regression.
Conclusion: In this analysis of density distribution in a diverse sample of women presenting for mammography, Hispanic women have the highest breast density, followed by Black women with Whites having the lowest. Unique in our findings is women who identify as Hispanic having the highest breast density and lower rates of obesity. Further investigation of the impact of obesity on breast density in minority women, especially in the understudied Hispanic group is needed.
Citation Format: Bridget A. Oppong, Chiranjeev Dash, Suzanne Oneill, Kepher Makambi, Tesha Coleman, Lucile L. Adams-Campbell. Comparative analysis of breast density among Black, White, and Hispanic women presenting for screening mammography [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr A02.
Collapse
Affiliation(s)
- Bridget A. Oppong
- 1Department of Surgery, Georgetown University Hospital, Washington, DC,
| | - Chiranjeev Dash
- 2Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC,
| | - Suzanne Oneill
- 2Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC,
| | - Kepher Makambi
- 3Department of Biostatics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC,
| | - Tesha Coleman
- 4Capital Breast Care Center, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | | |
Collapse
|
25
|
Oppong BA, Dash C, O'Neill S, Li Y, Makambi K, Pien E, Makariou E, Coleman T, Adams-Campbell LL. Breast density in multiethnic women presenting for screening mammography. Breast J 2017; 24:334-338. [PMID: 29063662 DOI: 10.1111/tbj.12941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/27/2017] [Accepted: 04/05/2017] [Indexed: 01/14/2023]
Abstract
Data on ethnic variations in breast density are limited and often not inclusive of underrepresented minorities. As breast density is associated with elevated breast cancer risk, investigating racial and ethnic difference may elucidate the observed differences in breast cancer risk among different populations. We reviewed breast density from initial screening of women from the Capital Breast Care Center and Georgetown University Hospital from 2010 to 2014. Patient demographics including race, age at screening, education, menopausal status, and body mass index were abstracted. We recorded the BI-RADS density categories: (1) "fatty," (2) "scattered fibroglandular densities," (3) "heterogeneously dense," and (4) "extremely dense." Multivariable unconditional logistic regression was used to identify predictors of breast density. Density categorization was recorded for 2146 women over the 5-year period, comprising Blacks (n = 940), Hispanics (n = 893), and Whites (n = 314). Analysis of subject characteristics by breast density showed that high category is observed in younger, Hispanic, nulliparous, premenopausal, and nonobese women (t-test or chi-square test, P-values <.0001). Obese women are 70% less likely to have high density. Being Hispanic, premenopausal, and nonobese were predictive of high density on logistic regression. In this analysis of density distribution in a diverse sample, Hispanic women have the highest breast density, followed by Blacks and Whites. Unique in our findings is women who identify as Hispanic have the highest breast density and lower rates of obesity. Further investigation of the impact of obesity on breast density, especially in the understudied Hispanic group is needed.
Collapse
Affiliation(s)
- Bridget A Oppong
- Department of Surgery, Georgetown University Hospital, Washington, DC, USA.,Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Chiranjeev Dash
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Suzanne O'Neill
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Yinan Li
- Department of Biostatics, Bioinformatics, and Biomathematics, Georgetown University Hospital, Washington, DC, USA
| | - Kepher Makambi
- Department of Biostatics, Bioinformatics, and Biomathematics, Georgetown University Hospital, Washington, DC, USA
| | - Edward Pien
- Department of Radiology, Georgetown University Hospital, Washington, DC, USA
| | - Erini Makariou
- Department of Radiology, Georgetown University Hospital, Washington, DC, USA
| | - Tesha Coleman
- Capital Breast Care Center, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | | |
Collapse
|
26
|
Oppong BA, Dash C, Li Y, Makambi K, Coleman T, Adams-Campbell L. Abstract P5-10-10: Predictors of breast density among Black and Hispanic women presenting for mammographic screening. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-10-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Increased breast density has been associated with elevated breast cancer risk and complicating mammographic interpretation. Although previous studies have investigated population variations in breast density, Black and Hispanic women are often underrepresented in these analyses. Moreover, it is unclear how breast density differs between these ethnicities. We report on the mammographic density distribution of Black and Hispanic women having breast cancer screening at the Capital Breast Care Center (CBCC) and analyze factors associated with high breast density.
Methods: Retrospective data from electronic medical records at a population-based mammography screening center were abstracted. From 2010 to 2014, data from women undergoing their first breast cancer screening were reviewed. Patient demographics including race, age at screening, education and menopausal status were abstracted in addition to body mass index (BMI) and Breast Imaging-Reporting and Data System (BI-RADS) density category:1- “fatty”, 2- “scattered fibroglandular densities”, 3- “heterogeneously dense” and 4- “extremely dense”. Logistic regression was used to investigate factors associated with breast density.
Results: Density categorization was recorded for 1747 women over the five-year period, with 855 (49%) Black and 892 (51%) Hispanic. Patient characteristics associated with high density (categories 3 and 4) were younger age, Hispanic ethnicity, nulliparity, premenopausal status, and BMI < 30 kg/m2. On multivariate logistic regression, Hispanic ethnicity, premenopausal status, and BMI < 30 kg/m2 were predictive of high mammographic density.
Conclusion: In a sample of women presenting for mammographic screening at CBCC, Hispanic women were more likely to have higher breast density compared to Black women. After controlling for ethnicity, postmenopausal and obese women were less likely to have dense breasts. Additional investigation is needed to further study the impact of obesity on breast density in underserved minority women.
Citation Format: Oppong BA, Dash C, Li Y, Makambi K, Coleman T, Adams-Campbell L. Predictors of breast density among Black and Hispanic women presenting for mammographic screening [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-10-10.
Collapse
Affiliation(s)
- BA Oppong
- MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Georgetown University, Washington, DC; Capital Breast Care Center, Washington, DC
| | - C Dash
- MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Georgetown University, Washington, DC; Capital Breast Care Center, Washington, DC
| | - Y Li
- MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Georgetown University, Washington, DC; Capital Breast Care Center, Washington, DC
| | - K Makambi
- MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Georgetown University, Washington, DC; Capital Breast Care Center, Washington, DC
| | - T Coleman
- MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Georgetown University, Washington, DC; Capital Breast Care Center, Washington, DC
| | - L Adams-Campbell
- MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Georgetown University, Washington, DC; Capital Breast Care Center, Washington, DC
| |
Collapse
|
27
|
Oppong BA, Dash C, Coleman T, Torres T, Adams-Campbell LL. Time to Diagnostic Evaluation After Mammographic Screening in an Urban Setting. J Womens Health (Larchmt) 2016; 25:1225-1230. [PMID: 27182625 DOI: 10.1089/jwh.2015.5661] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Capital Breast Care Center (CBCC), a screening facility established to serve minority women, developed a culturally sensitive patient care paradigm that would address concerns of adherence to follow-up of abnormal results after initial mammogram. Women with abnormal mammograms are assigned a Black or Latina navigator who facilitates the additional workup needed by scheduling follow-up, arranging transportation, providing counsel/emotional support, and even accompanying them to diagnostic imaging or biopsy appointment. We present data on follow-up rates after breast cancer screening. METHODS All patients seen at CBCC are entered into a prospectively collected database. We calculated intervals (in days) between the screening and diagnostic visits. Descriptive statistics and median time to follow-up are reported. Differences between Black and Hispanic women on time interval were tested by t-test. RESULTS From January 2010 to December 2012, 4605 digital screening mammograms were performed. Fifty-two percent of the women self-identified as Black, 41% as Hispanic, 4% White, 2% Asian, and 1% as "other." Of the screening studies, 451 (9.8%) required additional workup, out of which 362 (80%) of the women returned for the recommended diagnostic imaging. The median interval between screening and diagnostic imaging was 39 days (range: 6-400). Of the 162 women recommended to have a core needle biopsy, 81.5% underwent biopsy within a median of 21 days (range: 0-221 days). CONCLUSION At the CBCC, time to patient follow-up after initial mammographic screening is within the CDC-recommended performance standard of less than 60 days. For a population that historically has low rates of clinical follow-up, we attribute this reduction in delays to breast cancer diagnostic resolution to a culturally sensitive patient navigation program. Additional studies are needed to assess how the existing navigation program can be individualized/tailored to target the remaining 20% of women who did not adhere to the recommended workup.
Collapse
Affiliation(s)
- Bridget A Oppong
- 1 Breast Division, Department of Surgery, MedStar Georgetown University Hospital , Washington, District of Columbia.,2 Georgetown University Lombardi Comprehensive Cancer Center , Washington, District of Columbia
| | - Chiranjeev Dash
- 2 Georgetown University Lombardi Comprehensive Cancer Center , Washington, District of Columbia
| | - Tesha Coleman
- 3 Capital Breast Care Center, Georgetown Lombardi Comprehensive Cancer Center , Washington, District of Columbia
| | - Tanya Torres
- 3 Capital Breast Care Center, Georgetown Lombardi Comprehensive Cancer Center , Washington, District of Columbia
| | - Lucile L Adams-Campbell
- 2 Georgetown University Lombardi Comprehensive Cancer Center , Washington, District of Columbia
| |
Collapse
|
28
|
Goldfarb SB, Kamer SA, Oppong BA, Eaton A, Patil S, Junqueira MJ, Olcese C, Kelvin JF, Gemignani ML. Fertility Preservation for the Young Breast Cancer Patient. Ann Surg Oncol 2016; 23:1530-6. [PMID: 26790670 DOI: 10.1245/s10434-015-5036-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND The American Society of Clinical Oncology (ASCO) guidelines include incorporation of fertility preservation guidelines in the care of breast oncology patients. This study aimed to examine the baseline knowledge and preferences concerning fertility preservation among women of childbearing age with newly diagnosed breast cancer at the time of their initial visit to Memorial Sloan Kettering Cancer Center (MSKCC). METHODS A questionnaire on reproductive history, fertility knowledge, and preservation options was administered to women 18-45 years of age with newly diagnosed breast cancer at MSKCC between May and September 2011. RESULTS The inclusion criteria were met by 60 women eligible for analysis who had a median age of 40 years (range 20-45 years). The findings showed that 50 % of the women either desired children in the future or were unsure whether they wanted children, with 9 % reporting that they received information about fertility preservation options before their MSKCC visit. Women who had never been pregnant were more likely than those with prior pregnancies to consider having children in the future (p = 0.001) and to contemplate fertility preservation options both before (p = 0.001) and after (p = 0.0002) cancer treatment. CONCLUSION Early referral allows patients to take advantage of fertility preservation options while preventing delay in the initiation of systemic therapy. Referral by the breast surgical oncologist at the time of the initial visit has the potential to increase fertility knowledge because it appears that many women have not yet received fertility information at this early treatment stage.
Collapse
Affiliation(s)
- Shari B Goldfarb
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Sabrina A Kamer
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bridget A Oppong
- Department of Surgery, Georgetown University Hospital, Washington, DC, USA
| | - Anne Eaton
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Manuela J Junqueira
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina Olcese
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
29
|
Wallington SF, Dash C, Sheppard VB, Goode TD, Oppong BA, Dodson EE, Hamilton RN, Adams-Campbell LL. Enrolling Minority and Underserved Populations in Cancer Clinical Research. Am J Prev Med 2016; 50:111-117. [PMID: 26470805 PMCID: PMC4691547 DOI: 10.1016/j.amepre.2015.07.036] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/14/2015] [Accepted: 07/30/2015] [Indexed: 10/22/2022]
Abstract
Research suggests that community involvement is integral to solving public health problems, including involvement in clinical trials-a gold standard. Significant racial/ethnic disparities exist in the accrual of participants for clinical trials. Location and cultural aspects of clinical trials influence recruitment and accrual to clinical trials. It is increasingly necessary to be aware of defining characteristics, such as location and culture of the populations from which research participants are enrolled. Little research has examined the effect of location and cultural competency in adapting clinical trial research for minority and underserved communities on accrual for clinical trials. Utilizing embedded community academic sites, the authors applied cultural competency frameworks to adapt clinical trial research in order to increase minority participation in nontherapeutic cancer clinical trials. This strategy resulted in successful accrual of participants to new clinical research trials, specifically targeting participation from minority and underserved communities in metropolitan Washington, DC. From 2012 to 2014, a total of 559 participants enrolled across six nontherapeutic clinical trials, representing a 62% increase in the enrollment of blacks in clinical research. Embedding cancer prevention programs and research in the community was shown to be yet another important strategy in the arsenal of approaches that can potentially enhance clinical research enrollment and capacity. The analyses showed that the capacity to acquire cultural knowledge about patients-their physical locales, cultural values, and environments in which they live-is essential to recruiting culturally and ethnically diverse population samples.
Collapse
Affiliation(s)
- Sherrie F Wallington
- Georgetown-Lombardi Comprehensive Cancer Center, Washington, District of Columbia.
| | - Chiranjeev Dash
- Georgetown-Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Vanessa B Sheppard
- Georgetown-Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Tawara D Goode
- National Center for Cultural Competence, Department of Pediatrics, Georgetown University Medical Center, Washington, District of Columbia
| | - Bridget A Oppong
- Georgetown-Lombardi Comprehensive Cancer Center, Washington, District of Columbia; Georgetown University Medical Center, Department of Surgery, Washington, District of Columbia
| | - Everett E Dodson
- Georgetown-Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Rhonda N Hamilton
- Georgetown-Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | | |
Collapse
|
30
|
Oppong BA, Makambi K, Shi Y, Sheppard V, Willey S, Adams-Campbell L. Stage of Presentation at Initial Breast Cancer Diagnosis: Does Race Remain a Factor? Breast J 2015; 21:445-6. [PMID: 25958889 DOI: 10.1111/tbj.12435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Bridget A Oppong
- Department of Surgery, Medstar Georgetown University Hospital, Georgetown University, Washington, District of Columbia
| | - Kepher Makambi
- Department of Epidemiology & Biostatistics, Georgetown University, Washington, District of Columbia
| | - Yaru Shi
- Department of Epidemiology & Biostatistics, Georgetown University, Washington, District of Columbia
| | - Vanessa Sheppard
- Department of Minority Health and Health Disparities, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Shawna Willey
- Department of Surgery, Medstar Georgetown University Hospital, Georgetown University, Washington, District of Columbia
| | - Lucile Adams-Campbell
- Department of Minority Health and Health Disparities, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| |
Collapse
|
31
|
Sheppard VB, Oppong BA, Hampton R, Snead F, Horton S, Hirpa F, Brathwaite EJ, Makambi K, Onyewu S, Boisvert M, Willey S. Disparities in breast cancer surgery delay: the lingering effect of race. Ann Surg Oncol 2015; 22:2902-11. [PMID: 25652051 DOI: 10.1245/s10434-015-4397-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Delays to surgical breast cancer treatment of 90 days or more may be associated with greater stage migration. We investigated racial disparities in time to receiving first surgical treatment in breast cancer patients. METHODS Insured black (56 %) and white (44 %) women with primary breast cancer completed telephone interviews regarding psychosocial (e.g., self-efficacy) and health care factors (e.g., communication). Clinical data were extracted from medical charts. Time to surgery was measured as the days between diagnosis and definitive surgical treatment. We also examined delays of more than 90 days. Unadjusted hazard ratios (HRs) examined univariate relationships between delay outcomes and covariates. Cox proportional hazard models were used for multivariate analyses. RESULTS Mean time to surgery was higher in blacks (mean 47 days) than whites (mean 33 days; p = .001). Black women were less likely to receive therapy before 90 days compared to white women after adjustment for covariates (HR .58; 95 % confidence interval .44, .78). Health care process factors were nonsignificant in multivariate models. Women with shorter delay reported Internet use (vs. not) and underwent breast-conserving surgery (vs. mastectomy) (p < .01). CONCLUSIONS Prolonged delays to definitive breast cancer surgery persist among black women. Because the 90-day interval has been associated with poorer outcomes, interventions to address delay are needed.
Collapse
Affiliation(s)
- Vanessa B Sheppard
- Breast Cancer Program and Office of Minority Health and Health Disparities, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Oppong BA, Pharmer LA, Oskar S, Eaton A, Stempel M, Patil S, King TA. The effect of metformin on breast cancer outcomes in patients with type 2 diabetes. Cancer Med 2014; 3:1025-34. [PMID: 24944108 PMCID: PMC4303170 DOI: 10.1002/cam4.259] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/18/2014] [Accepted: 03/21/2014] [Indexed: 12/20/2022] Open
Abstract
Observational data suggest that metformin use decreases breast cancer (BC) incidence in women with diabetes; the impact of metformin on BC outcomes in this population is less clear. The purpose of this analysis was to explore whether metformin use influences BC outcomes in women with type 2 diabetes. Prospective institutional databases were reviewed to identify patients with diabetes who received chemotherapy for stages I–III BC from 2000 to 2005. Patients diagnosed with diabetes before or within 6 months of BC diagnosis were included. Males and those with type I, gestational, or steroid-induced diabetes were excluded. Patients were stratified based on metformin use, at baseline, defined as use at time of BC diagnosis or at diabetes diagnosis if within 6 months of BC diagnosis. Kaplan–Meier methods were used to estimate rates of recurrence-free survival (RFS), overall survival (OS), and contralateral breast cancer (CBC). We identified 313 patients with diabetes who received chemotherapy for BC, 141 (45%) fulfilled inclusion criteria and 76 (54%) used metformin at baseline. There were no differences in clinical presentation or tumor characteristics between metformin users and nonusers. At a median follow-up of 87 months (range, 6.9–140.4 months), there was no difference in RFS (P = 0.61), OS (P = 0.462), or CBC (P = 0.156) based on metformin use. Five-year RFS was 90.4% (95% CI, 84–97) in metformin users and 85.4% (95% CI, 78–94) in nonusers. In this cohort of patients with type 2 diabetes receiving systemic chemotherapy for invasive BC, the use of metformin was not associated with improved outcomes.
Collapse
Affiliation(s)
- Bridget A Oppong
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer CenterNew York, New York, 10065
| | - Lindsay A Pharmer
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer CenterNew York, New York, 10065
| | - Sabine Oskar
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer CenterNew York, New York, 10065
| | - Anne Eaton
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer CenterNew York, New York, 10065
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer CenterNew York, New York, 10065
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer CenterNew York, New York, 10065
| | - Tari A King
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer CenterNew York, New York, 10065
- Correspondence Tari A. King, Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065. Tel: (646) 888-5432; Fax: (646) 888-4921; E-mail:
| |
Collapse
|
33
|
Oppong BA, Dash C, Coleman T, Lindsay MT, Willey S, Adams-Campbell LL. Abstract 1372: The importance of patient navigation in a high risk screening program: the Capital Breast Care Center experience. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-1372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The Capital Breast Center (CBCC), in the Washington, DC metro area, is a screening facility established to serve minority and underserved women in an effort to address mammography underutilization. Due to widespread outreach and public service information dissemination, women are having mammograms at increasing rates. Current data from the DC Cancer Consortium show that overall, self-reported rates of cancer screening are higher than those among adults nationwide (86.5% reporting having had a mammogram within the last two years vs. 80% nationally). However, compliance or adherence to follow-up after the initial screening mammogram remains an issue. The Center for Disease Control (CDC) recommends a median of less than 60 days between abnormal mammography results and final diagnosis of breast cancer. We present data on follow-up at CBCC.
Methods: All patients screened at CBCC are entered into an electronic medical record (EMR) system starting January 2010. Prospectively collected demographic data was abstracted from the EMR including age, race, insurance status, and the date of the first abnormal screening with the following diagnostic workup. We calculated intervals (in days) between the screening and diagnostic visits. Descriptive statistics and median time to follow-up are reported as the primary outcomes of interest. Differences between Black and Hispanic women on time interval were tested by t-test.
Results: From January 2010 to December 2011, 2,430 digital screening mammograms were preformed. Of those who reported race(86%), 46% identified as Black, 37% as Hispanic, and 3% as “Other”. 353 (15%) of the tests yielded an abnormal result. 320 (91%) women returned for the recommended follow-up appointment for diagnostic imaging. The median interval between screening and diagnostic imaging was 40 days (Interquartile range: 28-58 days). Of the 34 women who were recommended to have a core needle biopsy after the diagnostic imaging, 28 (82%) underwent biopsy within a median of 19.00 days (interquartile range: 11-37 days). Overall, there were 5 high risk lesions (atypia) and 19 cancers (1.9 cancers per 1,000) diagnosed in the two year period. There was no statistically significant difference in the interval between screening and diagnostic evaluation or diagnostic mammogram and biopsy between Black and Hispanic women.
Conclusion: CBCC, with culturally sensitive patient navigators has managed to get patients to return for follow-up breast care in a timely manner (within the CDC recommended performance standard). For a population that is majority low income Black and Hispanic women with a high risk of noncompliance, we have minimized delays to breast cancer diagnosis by providing navigation services to all patients.
Citation Format: Bridget A. Oppong, Chiranjeev Dash, Tesha Coleman, Milajurine T. Lindsay, Shawna Willey, Lucile L. Adams-Campbell. The importance of patient navigation in a high risk screening program: the Capital Breast Care Center experience. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1372. doi:10.1158/1538-7445.AM2013-1372
Collapse
Affiliation(s)
| | | | | | | | - Shawna Willey
- 1Medstar Georgetown University Hospital, Washington, DC
| | | |
Collapse
|
34
|
Junqueira MJ, Goldfarb SB, Oppong BA, Patil S, Eaton A, Olcese C, Morgan J, Kelvin JF, Dickler MN, Gemignani M. Fertility preservation options and the young breast cancer patient: A survey. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
575 Background: Approximately 15% of breast cancers (BC) are diagnosed in reproductive aged women. Management of the disease in this age group frequently includes chemotherapy and hormonal therapy, which can both affect fertility. Considering that age at first delivery has been steadily increasing, young women may face BC before completion of childbearing. Methods: In this prospective study, women referred to our institution for surgical treatment of BC were asked, before their first visit, to fill out a questionnaire regarding their reproductive history and fertility preservation knowledge. Eligible patients included women between the ages of 18 and 45, with a newly diagnosed BC, who had not yet started treatment. Results: Sixty women were eligible with a median age of 40 (range 20-45). 98% of responders (59 out of 60) had been diagnosed within the previous 2 months. 78% (47/60) had a college or post-graduate degree. 80% (48/60) had been pregnant before, while 86.5% (45/52) reported having had children. 81% (47/58) were premenopausal, and only 3 patients reported not having had periods for more than 1 year. 50% of responders (30/60) declared no interest in future childbearing, 25% were definitely interested, and 25% were undecided. However, only 9% (5/57) reported having received information on fertility preservation options before the survey. Women who have been pregnant were significantly less likely to consider fertility preservation options prior to treatment (egg/embryo/ovarian tissue cryopreservation [6% vs. 50%, p=0.001]), or after treatment (egg/embryo donation, surrogacy or adoption [6% vs. 58%, p<0.0001]). Conclusions: This pilot study was designed to gather information on reproductive health of newly diagnosed young BC patients and to assess their willingness to consider various fertility preservation options before or after treatment. Our study population consisted of mostly women who had been pregnant and had children. We found that 50% of the women were unsure or wanted future children. Yet, only 9% had received information on fertility options at diagnosis. This pilot study highlights the need for education and/or intervention in fertility preservation options for young women with breast cancer.
Collapse
Affiliation(s)
| | | | | | - Sujata Patil
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Anne Eaton
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | | | | |
Collapse
|
35
|
Oppong BA, King TA. Recommendations for women with lobular carcinoma in situ (LCIS). Oncology (Williston Park) 2011; 25:1051-1058. [PMID: 22106556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) represent a spectrum of breast disease referred to as "lobular neoplasia" (LN). Although LN occurs relatively infrequently, it is associated with an increased risk of breast cancer, ranging from a three- to four-fold increased risk with ALH up to an eight- to ten-fold increased risk with LCIS. Initially regarded as a direct precursor to invasive lobular carcinoma, LCIS used to be treated by mastectomy. Subsequent studies demonstrating that the risk of invasive disease was conferred bilaterally and that subsequent cancers were of both the ductal and lobular phenotype led to the acceptance of LCIS as a marker of increased risk rather than a true precursor. Today, a diagnosis of LCIS remains one of the greatest identifiable risk factors for the subsequent development of breast cancer. As such, patients are offered one of three options: (1) lifelong surveillance with the goal of detecting subsequent malignancy at an early stage; (2) chemoprevention; or (3) bilateral prophylactic mastectomy. Paralleling changes in the management of invasive breast cancer, trends in the management of LCIS have moved toward more conservative management. However, we have made little progress in understanding the biology of LCIS and therefore remain unable to truly optimize recommendations for individual patients.
Collapse
Affiliation(s)
- Bridget A Oppong
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
| | | |
Collapse
|
36
|
Choi DX, Oppong BA, Skinner KA. Abstract P5-14-19: Intramammary Lymph Nodes Warrant Excision. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-14-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: 5% of screening mammograms demonstrate intramammary lymph nodes (IMLN). Prior to breast-conserving therapy (BCT), patients with breast cancer underwent total mastectomy, which removed IMLN whether they contained metastatic foci or not; since BCT, patients underwent partial mastectomy, which may or may not have removed these nodes. The authors do not support this approach and excise all ipsilateral IMLNs in patients with breast cancer. This study exams the oncologic merits of this practice.
Methods: Since 2007, the authors have kept prospective data on all patients with IMLNs. 18 patients were identified who: 1) were diagnosed with ductal carcinoma, 2) had IMLNs detected pre-or intra-operatively, 3) underwent surgery. Data on age, history, physical exam, workup, treatment, pathology, and follow-up were reviewed.
Results: All patients were female. The median age was 54 (36-92). Median 5-year and lifetime risks of developing breast cancer were: 1.6% (0.4 — 2.8) and 11.4% (2.8 — 20.1) respectively. Compared to the general population, these represented increases in 5-year and lifetime risks of 0.1 % (-1.4 — 1.4) and 1.0% (-4.7 — 8.2) respectively. 1 patient carried a mutation in BRCA1. 53% presented with a palpable mass; 47% presented with a lesion on screening mammography. Tumors and IMLNs were located in all four quadrants. In 5 patients (28%), the primary tumor and IMLN were located within different quadrants. Despite this spatial separation, in 3 of these patients, IMLNs contained metastatic foci; moreover, in 2 of these patients, the IMLN was the only positive node. 56% of all patients were initially treated with lumpectomy. Of these, 20% ultimately underwent mastectomy. Thus, 44% of all patients were treated with BCT. The median primary tumor size was 2.2 cm (0.3 — 7.8). 89% of tumors were both ER/PR-positive; 11 % were both ER/PR-negative. In 1 patient (6%), the tumor was positive for Her2/Neu overexpression. 78% of all patients underwent sentinel-node biopsy. For each, a median of 2 sentinel nodes (1 - 5) were retrieved. In 4 of these patients (29%), the sentinel node was intramammary. Moreover, among all patients with positive nodes, in a third (4 of 12), the IMLN was the only positive node. Indeed, in 42% of patients, IMLNs were directly responsible for upstaging disease. 44% of all patients and 64% of BCT patients underwent adjuvant radiation therapy. 56% of all patients underwent adjuvant chemotherapy; 56%, adjuvant hormonal therapy. At a median follow-up of 18 months (1-38), 94% remained disease free; 1 patient (6%) developed bony disease.
Conclusions: This small prospective analysis sought to answer the following: 1) can IMLNs be excised in the setting of BCT1 and 2) should IMLNs be excised? For 72% of all patients, the primary tumor and IMLN were located within the same quadrant. Therefore, excision of the former readily incorporated the latter. For other patients, numerous techniques — ultrasonography, pre-operative wire placement, or palpation through the surgical wound — facilitated localization and removal. The oncologic merits of IMLN excision are clear — in 29% of patients undergoing sentinel lymph-node biopsy, the IMLN was sentinel; in 42% of patients with positive lymph nodes, the IMLN was directly responsible for upstaging disease.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-14-19.
Collapse
|
37
|
Abstract
A history of sexual abuse has been associated with failure at weight loss. The authors sought to determine whether a history of sexual abuse influences success after gastric bypass surgery. Presurgical self-report questionnaires collected information, including sexual abuse history and previous psychiatric hospitalization, and 27% reported a history of sexual abuse. A history of sexual abuse correlated with (nonsignificantly) less loss of excess weight at 12 and 24 months after surgery. No significant difference in excess-weight loss was detected among those with history of sexual abuse. Therefore, such abuse histories should not preclude surgery for these patients.
Collapse
Affiliation(s)
- Bridget A Oppong
- Deptartment of Psychiatry, University of Rochester, School of Medicine and Dentistry, Rochester, NY 14642, USA
| | | | | |
Collapse
|