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Chow CP, Hill DA, Dehority W, Greene EA. Understanding the Procedural Skills Needed in Rural Pediatric Practices: A Survey of Rural Pediatric Providers in the State of New Mexico. J Med Educ Curric Dev 2024; 11:23821205241229772. [PMID: 38327826 PMCID: PMC10848801 DOI: 10.1177/23821205241229772] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES There is little data evaluating procedural skills in current rural pediatric practices. In order to prepare a cadre of pediatricians to work in rural settings, we require an understanding of the unique procedural skills needed by rural pediatric providers. Our objective was to determine how often pediatricians performed various procedural skills, determine the importance of these skills to current practice, and how they differ between rural and urban pediatric providers. METHODS A survey evaluating pediatrician utilization of the 13 required Accreditation Council Graduate Medical Education procedural skills in current practice was developed and distributed to pediatric providers in New Mexico. Descriptive statistics were used to profile participants and describe survey responses. Chi-square tests were used to evaluate differences by urban setting or IHS. Fisher's exact test was employed to assess differences if cell sizes were less than five. All p-values were two sided with alpha=.05. Benjamini-Hochberg method was used to control for type 1 errors. RESULTS Fifty-two of 216 pediatric providers responded. The majority surveyed performed each of the 13 procedures less than monthly but competency in many of these procedures is important. Thirty-two respondents submitted free-text responses recommending competence with tracheostomy changes, gastrostomy-tube changes/cares, and circumcision. CONCLUSION Majority of surveyed pediatricians performed the required procedures less than monthly but deemed several procedures to be important. Rural pediatricians recommended specific procedural skills needed in rural practice. All trainees receive procedural skills training. However, trainees interested in rural practice may need additional training in specific skills different than their non-rural counterparts.
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Affiliation(s)
- Christal P. Chow
- Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, USA
| | - Deirdre A. Hill
- Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Walter Dehority
- Department of Pediatrics, Vanderbilt University, Nashville, USA
| | - E. Anne Greene
- Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, USA
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Disch K, Hill DA, Snow H, Dehority W. Clinical outcomes of pediatric osteomyelitis. BMC Pediatr 2023; 23:54. [PMID: 36732705 PMCID: PMC9896664 DOI: 10.1186/s12887-023-03863-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Osteomyelitis in children may produce severe sequelae. However, the frequency and distribution of such complications by type of osteomyelitis (chronic or acute) is not well described. METHODS We searched the HealthFacts® database (containing medical information on 68 million individual patients in the United States) with 238 International Classification of Diseases (ICD) version 10 codes for acute osteomyelitis and chronic osteomyelitis appearing in 2015. Outcomes were recorded for each subject, including development of limb length discrepancies, pathologic fractures, mortality, and need for multiple surgeries or prolonged orthopedic care (one to two years following diagnosis). Gender, age and season of diagnosis were also assessed. Chi-square tests were used to compare differences between categorical variables, and t-tests between continuous variables. RESULTS Eight hundred sixty-nine subjects were included (57.4% male). Children with chronic osteomyelitis were older than those with acute osteomyelitis (median 9.5 years vs 12.0, respectively, p = .0004). Diagnoses were more common in winter (p = .0003). Four subjects died while hospitalized during the study period (two with acute osteomyelitis, two with chronic osteomyelitis). Limb length discrepancies were rare and similarly distributed between infection types (≤ 1.3% of subjects, p = .83). Subjects with chronic osteomyeltis were more likely to require long-term orthopedic follow-up (14.0% vs. 4.8% for acute osteomyelitis, p < .0001), suffer from pathologic fractures (1.5% vs < 1.0%, p = .003) and to require multiple surgeries (46.0% vs. 29.3%, p = .04). CONCLUSIONS Though infrequent, serious outcomes from osteomyelitis are more common with chronic osteomyelitis than acute osteomyelitis.
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Affiliation(s)
- Kylie Disch
- grid.266832.b0000 0001 2188 8502The University of New Mexico School of Medicine, Albuquerque, USA
| | - Deirdre A. Hill
- grid.266832.b0000 0001 2188 8502Department of Internal Medicine, The University of New Mexico School of Medicine, Albuquerque, USA
| | - Harry Snow
- grid.266832.b0000 0001 2188 8502Clinical and Translational Science Center, The University of New Mexico School of Medicine, Albuquerque, USA
| | - Walter Dehority
- Department of Pediatrics, Division of Infectious Diseases, The University of New Mexico School of Medicine, MSC10 5590, 1 University of New Mexico, Albuquerque, 87131-0001, USA.
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Davis A, Fullerton L, Hill DA, Snow H, Dehority W. The Association of Antimicrobial Prophylaxis With Return Visits After Dog Bites in Children. Pediatr Emerg Care 2023; 39:87-90. [PMID: 36719389 DOI: 10.1097/pec.0000000000002894] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Dog bites occur frequently in the United States, yet there are no clear guidelines for prescribing antibiotic prophylaxis in healthy children after a dog bite. The aim of our study was to assess antibiotic prophylaxis and subsequent rates of infection after dog bites in children. We hypothesized a negative association between prophylactic prescription of any antimicrobial and return visit within 14 days for infection. METHODS In this retrospective cohort study, we assessed the frequency of antibiotic prophylaxis prescribed after dog bite injuries in patients 0 to 18 years old and subsequent return visits for infection using 2016 to 2017 medical and pharmacy claims derived from the IBM MarketScan Research Databases. We used the International Classification of Diseases-10 code W54 for dog bites then used keyword searches to find diagnoses (including infection), wound descriptions, and medications. RESULTS Over the 2-year period, 22,911 patients were seen for dog bites that were not coded as infected. The majority, 13,043 (56.9%), were prescribed an antibiotic at the initial visit and 9868 (43.1%) were not. Of those prescribed antibiotics, 98 (0.75%; 95% confidence interval [CI], 0.60-0.90) returned with an infection, compared with 59 (0.60%; 95% CI, 0.44-0.75) of those not prescribed antibiotics. Receiving an antibiotic prescription at the initial visit was associated with a reduced rate of return for wound infection only among children whose wounds were repaired or closed. Children not receiving a prescription whose wounds were repaired were more than twice as likely to return with an infection in the subsequent 14 days as children whose wounds were not repaired (odds ratio, 2.2; 95% CI, 1.2-4.0). CONCLUSIONS Most children are prescribed antibiotics at an initial emergency department visit after a dog bite. However, very few return for infection independent of antimicrobial prophylaxis, which suggests antibiotics are overprescribed in this setting.
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Affiliation(s)
- Ashley Davis
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine
| | | | - Deirdre A Hill
- Department of Internal Medicine, University of New Mexico School of Medicine
| | - Harry Snow
- Clinical and Translational Science Center, University of New Mexico Health Sciences Center
| | - Walter Dehority
- Division of Infectious Diseases, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
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Garbrecht E, Packard B, Nguyen PAH, Elghazali NA, Salas C, Hill DA, Canavan HE, Decker M. Ex Vivo Toxicity of Commonly Used Topical Antiseptics and Antibiotics on Human Chondrocytes. Orthopedics 2022; 45:e263-e268. [PMID: 35485887 DOI: 10.3928/01477447-20220425-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Topical povidone-iodine, chlorhexidine, bacitracin, and vancomycin are commonly used antiseptic and antimicrobial agents to reduce risk and treat surgical site infections in numerous orthopedic procedures. Chondrocytes potentially may be exposed to these agents during operative procedures. The impact of these topical agents on chondrocyte viability is unclear. The goal of this study is to determine human chondrocyte viability ex vivo after exposure to commonly used concentrations of these topical antiseptic and antimicrobial agents. Human osteochondral plugs were harvested from the knee joint of a human decedent within 36 hours of death. Individual human osteochondral plugs were exposed to normal saline as a control; a range of concentrations of povidone-iodine (0.25%, 0.5%, and 1%), chlorhexidine (0.01% and 0.5%), and bacitracin (10,000 units/L, 50,000 units/L, and 100,000 units/L) for 1-minute lavage; or a 48-hour soak in vancomycin (0.16 mg/mL, 0.4 mg/mL, and 1.0 mg/mL) with nutrient media. Chondrocyte viability was evaluated with a live/dead viability assay at 0, 2, 4, and 6 days after exposure to bacitracin at 0, 3, and 6 days). Control subjects showed greater than 70% viability at all time points. Povidone-iodine, 0.5% chlorhexidine, and vancomycin showed significant cytotoxicity, with viability dropping to less than 40% by day 6. Chondrocytes exposed to 0.01% chlorhexidine maintained viability. Chondrocytes exposed to bacitracin showed viability until day 3, when there was a large drop in viability. Commonly used topical concentrations of povidone-iodine, vancomycin, and bacitracin are toxic to human chondrocytes ex vivo. A low concentration of chlorhexidine appears safe. Caution should be used when articular cartilage may be exposed to these agents during surgery. [Orthopedics. 2022;45(5):e263-e268.].
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Lorona NC, Cook LS, Tang MTC, Hill DA, Wiggins CL, Li CI. Antihypertensive medications and risks of recurrence and mortality in luminal, triple-negative, and HER2-overexpressing breast cancer. Cancer Causes Control 2021; 32:1375-1384. [PMID: 34347212 DOI: 10.1007/s10552-021-01485-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/03/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Antihypertensives are commonly prescribed medications and their effect on breast cancer recurrence and mortality is not clear, particularly among specific molecular subtypes of breast cancer: luminal, triple-negative (TN), and HER2-overexpressing (H2E). METHODS A population-based prospective cohort study of women aged 20-69 diagnosed with a first primary invasive breast cancer between 2004 and 2015 was conducted in the Seattle, Washington and Albuquerque, New Mexico greater metropolitan areas. Multivariable-adjusted Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for risks of breast cancer recurrence, breast cancer-specific mortality, and all-cause mortality associated with hypertension and antihypertensives. RESULTS In this sample of 2,383 luminal, 1,559 TN, and 615 H2E breast cancer patients, overall median age was 52 (interquartile range, 44-60). Hypertension and current use of antihypertensives were associated with increased risks of all-cause mortality in each subtype. Current use of angiotensin-converting enzyme inhibitors was associated with increased risks of both recurrence and breast cancer-specific mortality among luminal patients (HR: 2.5; 95% CI: 1.5, 4.3 and HR: 1.9; 95% CI: 1.2, 3.0, respectively). Among H2E patients, current use of calcium channel blockers was associated with an increased risk of breast cancer-specific mortality (HR: 1.8; 95% CI: 0.6, 5.4). CONCLUSION Our findings suggest that some antihypertensive medications may be associated with adverse breast cancer outcomes among women with certain molecular subtypes. Additional studies are needed to confirm these findings.
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Affiliation(s)
- Nicole C Lorona
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, Seattle, WA, M4-C308, USA.
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Linda S Cook
- Department of Internal Medicine, University of New Mexico and the University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Mei-Tzu C Tang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, Seattle, WA, M4-C308, USA
| | - Deirdre A Hill
- Department of Internal Medicine, University of New Mexico and the University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Charles L Wiggins
- Department of Internal Medicine, University of New Mexico and the University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Christopher I Li
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, Seattle, WA, M4-C308, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Mohammad LM, Abbas M, Shuttleworth CW, Ahmadian R, Bhat A, Hill DA, Carlson AP. Spreading depolarization may represent a novel mechanism for delayed fluctuating neurological deficit after chronic subdural hematoma evacuation. J Neurosurg 2020; 134:1294-1302. [PMID: 32217801 DOI: 10.3171/2020.1.jns192914] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 10/27/2019] [Accepted: 01/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Most patients with chronic subdural hematoma (cSDH) recover after surgical evacuation with a straightforward course. There is a subset of patients who develop transient and fluctuating deficits not explained by seizures, stroke, or mass effect after evacuation. The objective of this study was to investigate whether these postoperative neurological deficits may be related to temporary brain dysfunction caused by cortical spreading depolarizations (SDs). METHODS The authors conducted a prospective observational study of 40 patients who underwent cSDH evacuation. At the time of surgery, a 1 × 6 subdural electrode strip was placed on the cortex parallel to the subdural drain. Clinical outcomes were assessed utilizing the Markwalder Grading Scale, need for clinical EEG for new deficit, and presence of new deficits. RESULTS Definitive SD was detected in 6 (15%) of 40 patients. Baseline and cSDH characteristics did not differ between patients with and without SD. More patients experienced postoperative neurological deterioration if they had SD (50%) compared to those without SD (8.8%; p = 0.03). Only 2 patients in the entire cohort demonstrated early neurological deterioration, both of whom had SD. One of these cases demonstrated a time-locked new focal neurological deficit (aphasia) at the start of a series of multiple clusters of SD. CONCLUSIONS This is the first observation of SD occurring after cSDH evacuation. SD occurred at a rate of 15% and was associated with neurological deterioration. This may represent a novel mechanism for otherwise unexplained fluctuating neurological deficit after cSDH evacuation. This could provide a new therapeutic target, and SD-targeted therapies should be evaluated in prospective clinical trials.
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Affiliation(s)
| | | | | | - Rosstin Ahmadian
- 4University of New Mexico School of Medicine, Albuquerque, New Mexico
| | | | - Deirdre A Hill
- 5Internal Medicine, University of New Mexico School of Medicine; and
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Hill DA, Argyropoulos C, Roumelioti ME, Unruh M. Abstract P5-07-14: Chronic kidney disease in breast cancer treatment and survival. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-07-14] [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: Presence of chronic kidney disease (CKD Stages 3-5) prior to breast cancer diagnosis may increase the risk of mortality among women with invasive breast cancer. However, the evidence base is limited, and the magnitude of this mortality risk is unknown. Breast cancer therapy may also be altered by presence of CKD. We sought to understand the role of CKD in breast cancer survival, with particular attention to receipt of recommended treatment.
Methods: All women diagnosed with invasive breast cancer from 1992-2016 in 18 SEER-Medicare sites (age 66 or older; n= 168701) were evaluated for breast cancer-specific mortality (BCSM) using multivariate Cox models, with estimation of hazard ratios (HR) and 95% confidence intervals (CI). All analyses were adjusted for age, race/ethnicity, diagnosis year, tumor characteristics, and socioeconomic factors, and also for diabetes, myocardial infarction, and congestive heart failure prior to diagnosis. Separate analyses were run according to receipt vs non-receipt of standard of care for breast cancer treatment (defined according to National Comprehensive Cancer Network (NCCN) guidelines.
Results: Median follow-up was 63 months (26 months with CKD). Women with CKD were at increased risk of BCSM (CKD Stage 3: HR 1.2; 95% CI 1.0-1.5; CKD Stage 4 HR 1.7; 95% CI 1.3-2.2; CKD Stage 5/End Stage Renal Disease HR 1.5; 95% CI 1.1-2.1), compared to women without CKD. In analyses of any CKD, restricted to women who met NCCN guideline therapy recommendations, women had an elevated risk of BCSM regardless of whether they did (HR 1.6; 95% CI 1.1-2.1) or did not (HR 1.4; 95% CI 1.0-1.8) receive recommended chemotherapy, and whether they did (HR 1.6; 95% CI 1.1-2.3) or did not (HR 1.3; 95% CI 0.9-2.0) receive recommended radiotherapy.
Discussion: Women with CKD have an increased risk of breast cancer mortality regardless of receipt of guideline-based treatment. CKD is underascertained in Medicare claims data, thus the reported results (likely underestimates) will be presented with sensitivity analyses. CKD may influence breast cancer outcomes due to associated systemic inflammation and comorbid conditions, as well as release of soluble mediators such as cytokines, chemokines, growth factors, and factors involved in remodeling of the extracellular matrix and epithelial-mesenchymal transition. As such factors involved in CKD progression also influence cancer, increased understanding may provide clues to ameliorate adverse outcomes in both disease entities.
Citation Format: Deirdre A Hill, Christos Argyropoulos, Maria-Eleni Roumelioti, Mark Unruh. Chronic kidney disease in breast cancer treatment and survival [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-07-14.
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Affiliation(s)
| | | | | | - Mark Unruh
- University of New Mexico, Albuquerque, NM
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Adler Jaffe S, Myers O, Meisner ALW, Wiggins CL, Hill DA, McDougall JA. Relationship between Insurance Type at Diagnosis and Hepatocellular Carcinoma Survival. Cancer Epidemiol Biomarkers Prev 2020; 29:300-307. [PMID: 31796525 PMCID: PMC7992905 DOI: 10.1158/1055-9965.epi-19-0902] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 07/31/2019] [Revised: 10/01/2019] [Accepted: 11/26/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND For individuals with hepatocellular carcinoma (HCC), type of insurance may be an important prognostic factor because of its impact on access to care. This study investigates the relationship between insurance type at diagnosis and stage-specific survival. METHODS This retrospective cohort analysis used data from 18 Surveillance, Epidemiology, and End Results Program cancer registries. Individuals ages 20 to 64 years, diagnosed with primary HCC between 2010 and 2015, with either private, Medicaid, or no insurance were eligible for cohort inclusion. Adjusted Cox proportional-hazards regression models were used to generate HRs and 95% confidence intervals (CI) for associations between insurance type at diagnosis and overall survival. All models were stratified by stage at diagnosis. RESULTS This analysis included 14,655 cases. Compared with privately insured individuals with the same stage of disease, those with Medicaid had a 43% (HR = 1.43; 95% CI, 1.13-1.32), 22% (HR = 1.22; 95% CI, 1.13-1.32), and 7% higher risk of death for localized, regional, and distant stage, respectively. Uninsured individuals had an 88% (HR = 1.88; 95% CI, 1.65-2.14), 59% (HR = 1.59; 95% CI, 1.41-1.80), and 35% (HR = 1.35; 95% CI, 1.18-1.55) higher risk of death for localized, regional, and distant stage, respectively, compared with privately insured individuals. CONCLUSIONS Disparities in survival exist by the type of insurance that individuals with HCC have at the time of diagnosis. IMPACT These findings support the need for additional research on access to and quality of cancer care for Medicaid and uninsured patients.
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Affiliation(s)
| | - Orrin Myers
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Angela L W Meisner
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
- New Mexico Tumor Registry, Albuquerque, New Mexico
| | - Charles L Wiggins
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
- New Mexico Tumor Registry, Albuquerque, New Mexico
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Deirdre A Hill
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Jean A McDougall
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
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Hill DA, Prossnitz ER, Royce M, Nibbe A. Temporal trends in breast cancer survival by race and ethnicity: A population-based cohort study. PLoS One 2019; 14:e0224064. [PMID: 31647839 PMCID: PMC6812853 DOI: 10.1371/journal.pone.0224064] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 10/05/2019] [Indexed: 01/21/2023] Open
Abstract
Introduction Differences in breast cancer survival by race and ethnicity are often assumed to be a fairly recent phenomenon, and are hypothesized to have arisen due to gaps in receipt of screening or therapy. The emergence of these differences in calendar time have implications for identification of their origin. We sought to determine whether breast cancer survival differences by race or ethnicity arose in tandem with the advent of screening or therapeutic advances. Materials and methods A cohort of women diagnosed with invasive breast cancer from 1975–2009 in 18 population-based registries were followed for five-year breast cancer cause-specific survival. Differences in survival according to race/ethnicity and estrogen receptor status were quantified in Cox proportional hazards models, with estimation of hazard ratios (HR), 95% confidence intervals (CI), and absolute risk differences. For 2010, we also assessed differences in survival by breast cancer subtypes defined by hormone receptor and Her2/neu status. Results Among over 930,000 women, initial differences in five-year breast cancer-specific survival by race became apparent among 1975–1979 diagnoses and continued to be evident, with stronger disparities apparent in those of Black vs. White Non-Hispanic (WNH) race and among estrogen-receptor positive vs. negative disease. Within breast cancer subtype, all included race/ethnic groups experienced disparate survival in comparison with WNH women for triple-negative disease. Black women had a consistent gap in absolute survival of .10-.12, compared with WNH women, from 1975–1979 through all included time periods, such that 5- year survival of Black women diagnosed in 2005–09 lagged more than 20 years behind that of WNH women. Discussion Survival differed by race for diagnoses that predate the introduction of mammographic screening and most therapeutic advances. Absolute differences in survival by race and ethnicity have remained almost constant over 40 years of observation, suggesting early origins for some contributors.
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Affiliation(s)
- Deirdre A. Hill
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
- * E-mail:
| | - Eric R. Prossnitz
- Department of Molecular Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Melanie Royce
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Andrea Nibbe
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
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Chen H, Cook LS, Tang MTC, Hill DA, Wiggins CL, Li CI. Relationship between Diabetes and Diabetes Medications and Risk of Different Molecular Subtypes of Breast Cancer. Cancer Epidemiol Biomarkers Prev 2019; 28:1802-1808. [PMID: 31395589 DOI: 10.1158/1055-9965.epi-19-0291] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/13/2019] [Accepted: 08/01/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Type II diabetes and certain diabetes treatments have been observed to impact breast cancer risk. However, their associations with different breast cancer molecular subtype defined by estrogen receptor (ER)/progesterone receptor (PR)/HER2 status are unclear. METHODS We conducted a retrospective multi-center population-based case-case study consisting of 4,557 breast cancer cases to evaluate the impact of type II diabetes and diabetes medications on the risk of different breast cancer molecular subtypes [ER+/HER2-, ER+/HER2+, triple negative (ER-/PR-/HER2-), and HER2 overexpressing (H2E, ER-/PR-/HER2+)]. Using ER+/HER2- cases as the reference group, we estimated ORs and corresponding 95% confidence intervals (CI) for each subtype using polytomous logistic regression. RESULTS Compared with those without a diabetes history, women with type II diabetes had a 38% (95% CI, 1.01-1.89) increased odds of triple-negative breast cancer (TNBC). Current and longer term recent metformin use (13-24 months of treatment within the 24-month period prior to breast cancer diagnosis) was associated with elevated odds of TNBC (OR = 1.54; 95% CI, 1.07-2.22 and OR = 1.80; 95% CI, 1.13-2.85, respectively). CONCLUSIONS The odds of having a triple-negative rather than ER+/HER2- breast cancer is greater for women with type II diabetes, and particularly for those who were users of metformin. This finding is supported by some preclinical data suggesting that diabetes may be more strongly associated with risk of triple-negative disease. IMPACT Our study provides novel evidence regarding potential differential effects of type II diabetes and metformin use on risk of different molecular subtypes of breast cancer.
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Affiliation(s)
- Hongjie Chen
- Department of Epidemiology, University of Washington, Seattle, Washington.
| | - Linda S Cook
- Department of Internal Medicine and the University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, New Mexico
| | - Mei-Tzu C Tang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Deirdre A Hill
- Department of Internal Medicine and the University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, New Mexico
| | - Charles L Wiggins
- Department of Internal Medicine and the University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, New Mexico
| | - Christopher I Li
- Department of Epidemiology, University of Washington, Seattle, Washington.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Lorona NC, Cook LS, Tang MTC, Hill DA, Wiggins CL, Li CI. Recent Use of Oral Contraceptives and Risk of Luminal B, Triple-Negative, and HER2-Overexpressing Breast Cancer. Horm Cancer 2019; 10:71-76. [PMID: 30989580 PMCID: PMC6550997 DOI: 10.1007/s12672-019-00362-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/19/2019] [Accepted: 03/28/2019] [Indexed: 12/13/2022]
Abstract
Oral contraceptive use is a well-established risk factor for breast cancer and is common among reproductive-aged women in the USA. Its relationship with less common, more aggressive, molecular subtypes is less clear. A population-based case-case analysis was conducted comparing three less common molecular subtypes to luminal A breast cancer among 1701 premenopausal cases aged 21-49 diagnosed with a first primary invasive breast cancer between 2004 and 2015. Medical record reviews and structured interviewer-administered questionnaires were used to collect data on oral contraceptive use. Multinomial logistic regression was used to estimate odds ratios (OR) and corresponding 95% confidence intervals (95% CI) for recency of oral contraceptive use for each subtype of breast cancer. Current use of oral contraceptives and use within 5 years before diagnosis was associated with lower odds of H2E tumors compared with luminal A tumors [OR = 0.5, 95% CI: 0.3, 0.9 and OR = 0.5, 95% CI: 0.4, 0.8, respectively] with increasing duration associated with decreasing odds (p for trend < 0.05). Oral contraceptive use was not associated with risks of TN or luminal B breast cancer. Oral contraceptive use may be more strongly positively associated with risks of luminal A, luminal B, and TN breast cancer than with risk of H2E tumors. These findings contribute to the etiological understanding of different molecular subtypes of breast cancer.
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Affiliation(s)
- Nicole C Lorona
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M4-C308, Seattle, WA, 98109, USA.
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Linda S Cook
- Department of Internal Medicine, University of New Mexico and the University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Mei-Tzu C Tang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M4-C308, Seattle, WA, 98109, USA
| | - Deirdre A Hill
- Department of Internal Medicine, University of New Mexico and the University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Charles L Wiggins
- Department of Internal Medicine, University of New Mexico and the University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Christopher I Li
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M4-C308, Seattle, WA, 98109, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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12
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Hill DA, Friend S, Lomo L, Wiggins C, Barry M, Prossnitz E, Royce M. Breast cancer survival, survival disparities, and guideline-based treatment. Breast Cancer Res Treat 2018; 170:405-414. [PMID: 29569018 PMCID: PMC6002943 DOI: 10.1007/s10549-018-4761-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 01/31/2018] [Accepted: 03/16/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE The role of appropriate therapy in breast cancer survival and survival disparities by race/ethnicity has not been fully elucidated. We investigated whether lack of guideline-recommended therapy contributed to survival differences overall and among Hispanics relative to non-Hispanic white (NHW) women in a case-cohort study. METHODS The study included a 15% random sample of female invasive breast cancer patients diagnosed from 1997 to 2009 in 6 New Mexico counties and all deaths due to breast cancer-related causes. Information was obtained from comprehensive medical chart reviews. National Comprehensive Cancer Network (NCCN®) guideline-recommended treatment was assessed among white women aged < 70 who were free of contraindications for recommended therapy, had stage I-III tumors, and survived ≥ 12 months. Hazard ratios (HRs) and 95% confidence intervals (CIs) for breast cancer death were estimated using Cox proportional hazards models. RESULTS Included women represented 4635 patients and 449 breast cancer deaths. Women who did not receive radiotherapy (HR 2.3; 95% CI 1.2-4.4) or endocrine therapy (HR 2.0; 95% CI 1.0-4.0) as recommended by guidelines had an increased risk of breast cancer death, relative to those treated appropriately. Receipt of guideline-recommended therapy did not differ between Hispanic and NHW women for chemotherapy (84.2% vs. 81.3%, respectively), radiotherapy (89.2% vs. 91.1%), or endocrine therapy (89.2% vs. 85.8%), thus did not influence Hispanic survival disparities. CONCLUSIONS Lack of guideline-recommended radiotherapy or endocrine therapy contributed to survival as strongly as other established prognostic indicators. Hispanic survival disparities in this population do not appear to be attributable to treatment differences.
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Affiliation(s)
- Deirdre A Hill
- Internal Medicine Department, University of New Mexico School of Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA.
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA.
| | - Sarah Friend
- Department of Hematology/Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Lesley Lomo
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Charles Wiggins
- Internal Medicine Department, University of New Mexico School of Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Marc Barry
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Eric Prossnitz
- Internal Medicine Department, University of New Mexico School of Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Melanie Royce
- Internal Medicine Department, University of New Mexico School of Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
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13
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Iorgulescu JB, Ferris S, Agarwal A, Casavilca Zambrano S, Hill DA, Schmidt R, Perry A. Non-meningothelial meningeal tumours with meningioangiomatosis-like pattern of spread. Neuropathol Appl Neurobiol 2018; 44:743-746. [PMID: 29495087 DOI: 10.1111/nan.12481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/22/2018] [Indexed: 01/14/2023]
Affiliation(s)
- J B Iorgulescu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S Ferris
- Division of Neuropathology, Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - A Agarwal
- Department of Pathology, Mercy Hospital, St. Louis, MO, USA
| | - S Casavilca Zambrano
- Department of Pathology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - D A Hill
- Department of Pathology, Children's National Medical Center, Washington, DC, USA
| | - R Schmidt
- Division of Neuropathology, Department of Pathology, Washington University School of Medicine, St. Louis, MO, USA
| | - A Perry
- Division of Neuropathology, Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
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14
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Hill DA, Haas JS, Wellman R, Hubbard RA, Lee CI, Alford-Teaster J, Wernli KJ, Henderson LM, Stout NK, Tosteson ANA, Kerlikowske K, Onega T. Utilization of breast cancer screening with magnetic resonance imaging in community practice. J Gen Intern Med 2018; 33:275-283. [PMID: 29214373 PMCID: PMC5834962 DOI: 10.1007/s11606-017-4224-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/29/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Breast cancer screening with magnetic resonance imaging (MRI) may be a useful adjunct to screening mammography in high-risk women, but MRI uptake may be increasing rapidly among low- and average-risk women for whom benefits are unestablished. Comparatively little is known about use of screening MRI in community practice. OBJECTIVE To assess relative utilization of MRI among women who do and do not meet professional society guidelines for supplemental screening, and describe utilization according to breast cancer risk indications. DESIGN Prospective cohort study conducted between 2007 and 2014. PARTICIPANTS In five regional imaging registries participating in the Breast Cancer Surveillance Consortium (BCSC), 348,955 women received a screening mammogram, of whom 1499 underwent screening MRI. MAIN MEASURES Lifetime breast cancer risk (< 20% or ≥ 20%) estimated by family history of two or more first-degree relatives, and Gail model risk estimates. Breast Imaging Reporting and Data System breast density and benign breast diseases also were assessed. Relative risks (RR) for undergoing screening MRI were estimated using Poisson regression. KEY RESULTS Among women with < 20% lifetime risk, which does not meet professional guidelines for supplementary MRI screening, and no first-degree breast cancer family history, screening MRI utilization was elevated among those with extremely dense breasts [RR 2.2; 95% confidence interval (CI) 1.7-2.8] relative to those with scattered fibroglandular densities and among women with atypia (RR 7.4; 95% CI 3.9-14.3.) or lobular carcinoma in situ (RR 33.1; 95% CI 18.0-60.9) relative to women with non-proliferative disease. Approximately 82.9% (95% CI 80.8%-84.7%) of screening MRIs occurred among women who did not meet professional guidelines and 35.5% (95% CI 33.1-37.9%) among women considered at low-to-average breast cancer risk. CONCLUSION Utilization of screening MRI in community settings is not consistent with current professional guidelines and the goal of delivery of high-value care.
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Affiliation(s)
- Deirdre A Hill
- Department of Internal Medicine and Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA. .,Department of Internal Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10-5550, 87131-0001, Albuquerque, NM, USA.
| | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Jennifer Alford-Teaster
- Departments of Biomedical Data Science and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Anna N A Tosteson
- Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Management and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology/Biostatistics, University of California, San Francisco, CA, USA
| | - Tracy Onega
- Departments of Biomedical Data Science and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Management and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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15
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Miles R, Wan F, Onega TL, Lenderink-Carpenter A, O'Meara ES, Zhu W, Henderson LM, Haas JS, Hill DA, Tosteson ANA, Wernli KJ, Alford-Teaster J, Lee JM, Lehman CD, Lee CI. Underutilization of Supplemental Magnetic Resonance Imaging Screening Among Patients at High Breast Cancer Risk. J Womens Health (Larchmt) 2018; 27:748-754. [PMID: 29341851 DOI: 10.1089/jwh.2017.6623] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 11/13/2022] Open
Abstract
BACKGROUND Women at high lifetime breast cancer risk may benefit from supplemental breast magnetic resonance imaging (MRI) screening, in addition to routine mammography screening for earlier cancer detection. MATERIALS AND METHODS We performed a cross-sectional study of 422,406 women undergoing routine mammography screening across 86 Breast Cancer Surveillance Consortium (BCSC) facilities during calendar year 2012. We determined availability and use of on-site screening breast MRI services based on woman-level characteristics, including >20% lifetime absolute risk using the National Cancer Institute risk assessment tool. Multivariate analyses were performed to determine sociodemographic characteristics associated with on-site screening MRI use. RESULTS Overall, 43.9% (2403/5468) of women at high lifetime risk attended a facility with on-site breast MRI screening availability. However, only 6.6% (158/2403) of high-risk women obtained breast MRI screening within a 2-year window of their screening mammogram. Patient factors associated with on-site MRI screening use included younger (<40 years) age (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.34-4.21), family history (OR = 1.72, 95% CI: 1.13-2.63), prior breast biopsy (OR = 2.09, 95% CI: 1.22-3.58), and postsecondary education (OR = 2.22, 95% CI: 1.04-4.74). CONCLUSIONS While nearly half of women at high lifetime breast cancer risk undergo routine screening mammography at a facility with on-site breast MRI availability, supplemental breast MRI remains widely underutilized among those who may benefit from earlier cancer detection. Future studies should evaluate whether other enabling factors such as formal risk assessment and patient awareness of high lifetime breast cancer risk can mitigate the underutilization of supplemental screening breast MRI.
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Affiliation(s)
- Randy Miles
- 1 Department of Radiology, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Fei Wan
- 2 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Tracy L Onega
- 3 Dartmouth Institute for Health Policy and Clinical Practice , Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon , New Hampshire
| | | | - Ellen S O'Meara
- 2 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Weiwei Zhu
- 2 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Louise M Henderson
- 5 Department of Radiology, University of North Carolina , Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer S Haas
- 6 Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - Deirdre A Hill
- 7 Department of Internal Medicine, University of New Mexico , Albuquerque, New Mexico
| | - Anna N A Tosteson
- 3 Dartmouth Institute for Health Policy and Clinical Practice , Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon , New Hampshire
| | - Karen J Wernli
- 2 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Jennifer Alford-Teaster
- 3 Dartmouth Institute for Health Policy and Clinical Practice , Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon , New Hampshire
| | - Janie M Lee
- 8 Department of Radiology, University of Washington School of Medicine , Seattle, Washington
| | - Constance D Lehman
- 9 Department of Radiology, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Christoph I Lee
- 10 Department of Radiology, University of Washington School of Medicine ; Department of Health Services, University of Washington School of Public Health ; Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
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16
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Hill DA, Barry M, Wiggins C, Nibbe A, Royce M, Prossnitz E, Lomo L. Estrogen receptor quantitative measures and breast cancer survival. Breast Cancer Res Treat 2017; 166:855-864. [PMID: 28825224 DOI: 10.1007/s10549-017-4439-6] [Citation(s) in RCA: 14] [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: 05/02/2017] [Accepted: 08/03/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE While the estrogen receptor (ER) is the single most widely used biomarker to evaluate breast cancer outcomes, aspects of ER marker biology remain poorly understood. We sought to determine whether quantitative measures of ER, such as protein expression and intensity, were associated with survival, or with survival disparities experienced by Hispanic women. METHODS A case-cohort study included a 15% random sample of invasive breast cancer cases diagnosed from 1997 to 2009 in six New Mexico counties and all deaths due to breast cancer-related causes. Pathology reports and tissue microarrays served as sources of ER information. Analyses were restricted to women with ≥1% ER immunohistochemical staining. Hazard ratios (HR) and 95% confidence intervals (CI) for breast cancer death were estimated using Cox proportional hazards models. RESULTS Included women represented 4336 ER+ breast cancer cases and 448 deaths. Median follow-up was 93 months. ER percent expression was not associated with breast cancer survival after adjustment for standard prognostic factors (p trend = 0.76). ER intensity remained a strong and independent risk factor for breast cancer survival in multivariate analyses: Women whose tumors expressed ER at intensity = 2 (HR 0.6; 95% CI 0.4-1.0) or 3 (HR 0.5; 95% CI 0.2-0.9) had a reduced risk of breast cancer mortality, compared to ER intensity = 1 (p trend = 0.02). Neither ER protein expression nor intensity influenced Hispanic survival disparities. CONCLUSIONS Estrogen receptor percent positive staining is not independently related to breast cancer survival after adjustment for other survival-related factors. ER intensity, in contrast, demonstrates promise for prognostic utility.
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Affiliation(s)
- Deirdre A Hill
- Internal Medicine Department and Comprehensive Cancer Center, 1 University of New Mexico, MSC 10 5550, Albuquerque, NM, 87131-0001, USA.
| | - Marc Barry
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Charles Wiggins
- Internal Medicine Department and Comprehensive Cancer Center, 1 University of New Mexico, MSC 10 5550, Albuquerque, NM, 87131-0001, USA
| | - Andrea Nibbe
- Internal Medicine Department and Comprehensive Cancer Center, 1 University of New Mexico, MSC 10 5550, Albuquerque, NM, 87131-0001, USA
| | - Melanie Royce
- Internal Medicine Department and Comprehensive Cancer Center, 1 University of New Mexico, MSC 10 5550, Albuquerque, NM, 87131-0001, USA
| | - Eric Prossnitz
- Department of Molecular Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Lesley Lomo
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
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17
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Saeed AI, Qeadan F, Sood A, VanderJagt DJ, Mishra SI, Hill DA, Peikert T, Sopori ML. A novel cytokine profile associated with cancer metastasis to mediastinal and hilar lymph nodes identified using fine needle aspiration biopsy - A pilot study. Cytokine 2016; 89:98-104. [PMID: 27599390 DOI: 10.1016/j.cyto.2016.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 01/09/2016] [Revised: 08/10/2016] [Accepted: 08/14/2016] [Indexed: 12/14/2022]
Abstract
Cancer metastasis to the lymph nodes is indicative of a poor prognosis. An endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) biopsy is increasingly being used to sample paratracheal lymph nodes for simultaneous cancer diagnosis and staging. In this prospective, single-center study, we collected dedicated EBUS-FNA biopsies from 27 patients with enlarged paratracheal and hilar lymph nodes. Cytokines were assayed using Bio-Plex Pro human cancer biomarker panels (34 cytokines), in a Bio-Rad 200 suspension array system. A mean cytokine value was taken from each subject with more than 1 lymph node station EBUS-FNA biopsies. Malignant and benign histologic diagnoses were established in 16 and 12 patients, respectively. An initial analysis using the Kruskal-Wallis test with Sidak correction for multiple comparisons, showed significant elevation of sVEGFR-1, IL-6, VEGF-A, Angiopoeintin-2, uPA, sHER-2/neu and PLGF in malignant lymph node samples compared to benign samples. The univariate logistic regression analyses revealed that 6 cytokines were significant predictors and 1 cytokine (PLGF) was marginally significant for discrimination between benign and malignant samples. The prediction power of these cytokines as biomarkers were very high according to the area under the ROC curve. Multiple logistic regression for subsets of the seven cytokine combined; provided an almost complete discrimination between benign and malignant samples (AUC=0.989). For screening and diagnostic purposes, we presented the optimal discrimination cut-off for each cytokine: sVEGFR-1 (2124.5pg/mL), IL-6 (40.2pg/mL), VEGF-A (1060.1pg/mL), Angiopoeintin-2 (913.7pg/mL), uPA (248.1pg/mL), sHER-2/neu (5010pg/mL) and PLGF (93.4pg/mL). For the very first time, a novel cytokine profile associated with cancer metastasis to the paratracheal lymph nodes were reported.
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Affiliation(s)
- Ali I Saeed
- Department of Internal Medicine, Pulmonary Critical Care and Sleep Medicine, University of New Mexico, Albuquerque, NM, United States; Department of Internal Medicine, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Fares Qeadan
- Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Akshay Sood
- Department of Internal Medicine, Pulmonary Critical Care and Sleep Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Dorothy J VanderJagt
- Department of Biochemistry and Molecular Biology, University of New Mexico, Albuquerque, NM, United States
| | - Shiraz I Mishra
- Departments of Pediatrics and Family and Community Medicine, University of New Mexico, University of New Mexico Cancer Center, Albuquerque, NM, United States
| | - Deirdre A Hill
- Cancer Research and Treatment Center, Departments of Internal Medicine, Division of Epidemiology, University of New Mexico, Albuquerque, NM, United States
| | - Tobias Peikert
- Department of Internal Medicine, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mohan L Sopori
- Lovelace Respiratory Research Institute, Albuquerque, NM, United States
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18
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Chen L, Li CI, Tang MTC, Porter P, Hill DA, Wiggins CL, Cook LS. Reproductive Factors and Risk of Luminal, HER2-Overexpressing, and Triple-Negative Breast Cancer Among Multiethnic Women. Cancer Epidemiol Biomarkers Prev 2016; 25:1297-304. [PMID: 27307466 PMCID: PMC5010505 DOI: 10.1158/1055-9965.epi-15-1104] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 10/20/2015] [Accepted: 01/21/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Reproductive factors are among the most well-established risk factors for breast cancer. However, their associations with different breast cancer subtypes defined by joint estrogen receptor (ER)/progesterone receptor (PR)/HER2 status remain unclear. METHODS We assessed relationships between reproductive factors and risks of luminal A (ER(+)/HER2(-)), luminal B (ER(+)/HER2(+)), triple-negative (TN; ER(-)/PR(-)/HER2(-)), and HER2-overexpressing (H2E; ER(-)/HER2(+)) breast cancers in a population-based case-case study consisting of 2,710 women ages 20-69 years diagnosed between 2004 and 2012. ORs and 95% confidence intervals (CI) were estimated with luminal A cases serving as the reference group using polytomous logistic regression. RESULTS Earlier age at first full-term pregnancy and age at menopause were positively associated with odds of TN breast cancer (Ptrend: 0.003 and 0.024, respectively). Parity was associated with a 43% (95% CI, 1.08-1.89) elevated odds of H2E breast cancer, and women who had ≥3 full-term pregnancies had a 63% (95% CI, 1.16-2.29, Ptrend = 0.013) increased odds of this subtype compared with nulliparous women. Breast feeding for ≥36 months was associated with a 49% (OR 0.51; 95% CI, 0.27-0.99) lower odds of TN breast cancer. CONCLUSION Our results suggest that reproductive factors contribute differently to risks of the major molecular subtypes of breast cancer. IMPACT African American and Hispanic women have higher incidence rates of the more aggressive TN and H2E breast cancers and their younger average age at first pregnancy, higher parity, and less frequent breast feeding could in part contribute to this disparity. Cancer Epidemiol Biomarkers Prev; 25(9); 1297-304. ©2016 AACR.
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Affiliation(s)
- Lu Chen
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Christopher I Li
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mei-Tzu C Tang
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Peggy Porter
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Deirdre A Hill
- Department of Internal Medicine, University of New Mexico (UNM) and the UNM Comprehensive Cancer Center, Albuquerque, New Mexico
| | - Charles L Wiggins
- Department of Internal Medicine, University of New Mexico (UNM) and the UNM Comprehensive Cancer Center, Albuquerque, New Mexico
| | - Linda S Cook
- Department of Internal Medicine, University of New Mexico (UNM) and the UNM Comprehensive Cancer Center, Albuquerque, New Mexico
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Abstract
The first eight to ten TEmnp resonances have been identified in one large (6.1 X 7.3 X 13.0 m) and one small (1.0 X 0.6 X 2.0 m) TEM cell. The resonant frequencies fit a new equivalent coaxial box model with the effective length of the box depending on the mode. Weakly propagating TEmn modes were also detected at frequencies above their respective first-resonance frequencies. A biological body or metal box at the center of the test zone interacts strongly with the TE10p and TE11p resonances, but not with the TE01p resonances. These interactions cause bandwidth limitations in the use of TEM cells for bioeffects dosimetry studies, EMC testing, and probe calibration work.
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20
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Chen L, Cook LS, Tang MTC, Porter PL, Hill DA, Wiggins CL, Li CI. Body mass index and risk of luminal, HER2-overexpressing, and triple negative breast cancer. Breast Cancer Res Treat 2016; 157:545-54. [PMID: 27220749 DOI: 10.1007/s10549-016-3825-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 03/03/2016] [Accepted: 05/05/2016] [Indexed: 12/27/2022]
Abstract
Triple negative (TN, tumors that do not express estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2)) and HER2-overexpressing (H2E, ER-/HER2+) tumors are two particularly aggressive subtypes of breast cancer. There is a lack of knowledge regarding the etiologies of these cancers and in particular how anthropometric factors are related to risk. We conducted a population-based case-case study consisting of 2659 women aged 20-69 years diagnosed with invasive breast cancer from 2004 to 2012. Four case groups defined based on joint ER/PR/HER2 status were included: TN, H2E, luminal A (ER+/HER2-), and luminal B (ER+/HER2+). Polytomous logistic regression was used to estimate odds ratios (ORs) and associated 95 % confidence intervals (CIs) where luminal A patients served as the reference group. Obese premenopausal women [body mass index (BMI) ≥30 kg/m(2)] had an 82 % (95 % CI 1.32-2.51) increased risk of TN breast cancer compared to women whose BMI <25 kg/m(2), and those in the highest weight quartile (quartiles were categorized based on the distribution among luminal A patients) had a 79 % (95 % CI 1.23-2.64) increased risk of TN disease compared to those in the lowest quartile. Among postmenopausal women obesity was associated with reduced risks of both TN (OR = 0.74, 95 % CI 0.54-1.00) and H2E (OR = 0.47, 95 % CI 0.32-0.69) cancers. Our results suggest obesity has divergent impacts on risk of aggressive subtypes of breast cancer in premenopausal versus postmenopausal women, which may contribute to the higher incidence rates of TN cancers observed among younger African American and Hispanic women.
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Affiliation(s)
- Lu Chen
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Mail Stop M4-C308, P.O. Box 19024, Seattle, WA, 98109, USA.
| | - Linda S Cook
- Department of Internal Medicine, University of New Mexico and the University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Mei-Tzu C Tang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Mail Stop M4-C308, P.O. Box 19024, Seattle, WA, 98109, USA
| | - Peggy L Porter
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Mail Stop M4-C308, P.O. Box 19024, Seattle, WA, 98109, USA.,Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Deirdre A Hill
- Department of Internal Medicine, University of New Mexico and the University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Charles L Wiggins
- Department of Internal Medicine, University of New Mexico and the University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Christopher I Li
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Mail Stop M4-C308, P.O. Box 19024, Seattle, WA, 98109, USA
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21
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Friend SC, Royce ME, Kang H, Lomo L, Barry M, Wiggins C, Prossnitz E, Hill DA. Abstract P1-09-05: Survival disparities: Quality of care apparently not the answer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-09-05] [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
Introduction: In New Mexico (NM), Hispanic women have a 1.6-fold increased risk of breast cancer-specific death compared to non-Hispanic white women. In previous studies, race/ethnic minority women have been less likely to receive recommended adjuvant treatments, including radiation in women undergoing breast conservation, and hormonal therapy.
Objective: To determine whether non-receipt of recommended therapies contributed to disparate survival.
Methods: We conducted a case-cohort study of breast-cancer-specific survival within a population-based cohort of first invasive breast cancer diagnosed in white females from 1997-2009 in six NM counties, identified through Surveillance Epidemiology End Results (SEER). We selected fifteen percent of all women diagnosed with breast cancer and all breast cancer deaths. After IRB approval, data were collected from comprehensive medical chart reviews, supplemented by SEER information. Receipt of standard of care, vs. not, was defined based on age, diagnosis year and tumor characteristics, according to changes in treatment guidelines. Women who had a reported contraindication or refused therapy were omitted from assessment of quality of care for that therapy. Cox proportional hazards models for case-cohort were conducted using weighted estimates, with calculation of robust variance and hazard ratios (HR) and 95% confidence intervals (CI), using an alpha level of .05. Analyses were restricted to women of age 70 or less who survived at least 12 months. The proportional hazards assumption was verified by Schoenfeld residuals. All analyses were adjusted for age.
Results: Comprehensive medical records reviews were completed for 91% of eligible women (674 cohort members, 519 breast cancer deaths; median follow up 7.8 years). All others were omitted from analysis. Of women eligible for guideline-based treatment, receipt of guideline-appropriate therapy did not differ by Hispanic ethnicity for any treatment, and Hispanic women were slightly more likely overall to receive appropriate therapy (difference not significant). Among guideline-eligible women, at least 91% received radiotherapy, 78% received chemotherapy, 82% received endocrine therapy, and 89% received anti-HER2 targeted agents. After adjustment for other treatment, lack of receipt of guideline-appropriate therapy was related to an increased risk of breast cancer death for endocrine (HR 1.76; 95% CI 1.09-2.84) and radiation therapy (HR 2.05; 95% CI 1.14-3.69). The few HER2-positive women not treated precluded further assessment. After accounting for endocrine and radiation therapy the survival disparity HR of 1.6 in Hispanic women was reduced to 1.57 suggesting only 2% of the disparity was due to differences in receipt of these treatments.
Conclusion: Limitations include likely undercounts of appropriate therapy, thus proportions cited are minimal estimates. Appropriate therapy includes only documented receipt as therapy completion could not always be assessed. Hispanic women have a disproportionately higher breast cancer mortality despite apparently receiving adjuvant therapies to a similar degree as non-Hispanic white women. Equalizing standard of care and attempting to reduce treatment disparities may not be sufficient to address the disproportionate mortality in Hispanic women.
Citation Format: Friend SC, Royce ME, Kang H, Lomo L, Barry M, Wiggins C, Prossnitz E, Hill DA. Survival disparities: Quality of care apparently not the answer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-09-05.
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Affiliation(s)
- SC Friend
- Cancer Research and Treatment Center and School of Medicine, University of New Mexico, Albuquerque, NM; University of New Mexico, Albuquerque, NM
| | - ME Royce
- Cancer Research and Treatment Center and School of Medicine, University of New Mexico, Albuquerque, NM; University of New Mexico, Albuquerque, NM
| | - H Kang
- Cancer Research and Treatment Center and School of Medicine, University of New Mexico, Albuquerque, NM; University of New Mexico, Albuquerque, NM
| | - L Lomo
- Cancer Research and Treatment Center and School of Medicine, University of New Mexico, Albuquerque, NM; University of New Mexico, Albuquerque, NM
| | - M Barry
- Cancer Research and Treatment Center and School of Medicine, University of New Mexico, Albuquerque, NM; University of New Mexico, Albuquerque, NM
| | - C Wiggins
- Cancer Research and Treatment Center and School of Medicine, University of New Mexico, Albuquerque, NM; University of New Mexico, Albuquerque, NM
| | - E Prossnitz
- Cancer Research and Treatment Center and School of Medicine, University of New Mexico, Albuquerque, NM; University of New Mexico, Albuquerque, NM
| | - DA Hill
- Cancer Research and Treatment Center and School of Medicine, University of New Mexico, Albuquerque, NM; University of New Mexico, Albuquerque, NM
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Patel SG, Ahnen DJ, Kinney AY, Horick N, Finkelstein DM, Hill DA, Lindor NM, MaCrae F, Lowery JT. Knowledge and Uptake of Genetic Counseling and Colonoscopic Screening Among Individuals at Increased Risk for Lynch Syndrome and their Endoscopists from the Family Health Promotion Project. Am J Gastroenterol 2016; 111:285-93. [PMID: 26856748 PMCID: PMC5193129 DOI: 10.1038/ajg.2015.397] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/10/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Individuals whose families meet the Amsterdam II clinical criteria for hereditary non-polyposis colorectal cancer are recommended to be referred for genetic counseling and to have colonoscopic screening every 1-2 years. To assess the uptake and knowledge of guideline-based genetic counseling and colonoscopic screening in unaffected members of families who meet Amsterdam II criteria and their treating endoscopists. METHODS Participants in the Family Health Promotion Project who met the Amsterdam II criteria were surveyed regarding their knowledge of risk-appropriate guidelines for genetic counseling and colonoscopy screening. Endoscopy/pathology reports were obtained from patients screened during the study to determine the follow-up recommendations made by their endoscopists. Survey responses were compared using Fisher's Exact and the χ(2) test. Concordance in participant/provider-reported surveillance interval was assessed using the kappa statistic. RESULTS Of the 165 participants, the majority (98%) agreed that genetics and family history are important predictors of CRC, and 63% had heard of genetic testing for CRC, although only 31% reported being advised to undergo genetic counseling by their doctor, and only 7% had undergone genetic testing. Only 26% of participants reported that they thought they should have colonoscopy every 1-2 years and 30% of endoscopists for these participants recommended 1-2-year follow-up colonoscopy. There was a 65% concordance (weighted kappa 0.42, 95% CI 0.24-0.61) between endoscopist recommendations and participant reports regarding screening intervals. CONCLUSIONS A minority of individuals meeting Amsterdam II criteria in this series have had genetic testing and reported accurate knowledge of risk-appropriate screening, and only a small percentage of their endoscopists provided them with the appropriate screening recommendations. There was moderate concordance between endoscopist recommendations and participant knowledge suggesting that future educational interventions need to target both health-care providers and their patients.
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Affiliation(s)
- Swati G Patel
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Veterans Administration Medical Center, Denver, Colorado, USA
| | - Dennis J Ahnen
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Gastroenterology of the Rockies, Boulder, Colorado, USA
| | - Anita Y Kinney
- Department of Internal Medicine, University of New Mexico, Albequerque, New Mexico, USA
| | - Nora Horick
- Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts, USA
| | - Dianne M Finkelstein
- Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts, USA
- Harvard University, Boston, Massachusetts, USA
| | - Deirdre A Hill
- Department of Internal Medicine, Division of Epidemiology, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Finlay MaCrae
- Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital Department of Medicine, University of Melbourne, Victoria, Australia
| | - Jan T Lowery
- University of Colorado School of Public Health, Aurora, Colorado, USA
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Haas JS, Hill DA, Wellman RD, Hubbard RA, Lee CI, Wernli KJ, Stout NK, Tosteson ANA, Henderson LM, Alford-Teaster JA, Onega TL. Disparities in the use of screening magnetic resonance imaging of the breast in community practice by race, ethnicity, and socioeconomic status. Cancer 2015; 122:611-7. [PMID: 26709819 DOI: 10.1002/cncr.29805] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [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: 06/23/2015] [Revised: 10/09/2015] [Accepted: 10/29/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Uptake of breast magnetic resonance imaging (MRI) coupled with breast cancer risk assessment offers the opportunity to tailor the benefits and harms of screening strategies for women with differing cancer risks. Despite the potential benefits, there is also concern for worsening population-based health disparities. METHODS Among 316,172 women aged 35 to 69 years from 5 Breast Cancer Surveillance Consortium registries (2007-2012), the authors examined 617,723 negative screening mammograms and 1047 screening MRIs. They examined the relative risks (RRs) of MRI use by women with a <20% lifetime breast cancer risk and RR in the absence of MRI use by women with a ≥20% lifetime risk. RESULTS Among women with a <20% lifetime risk of breast cancer, non-Hispanic white women were found to be 62% more likely than nonwhite women to undergo an MRI (95% confidence interval, 1.32-1.98). Of these women, those with an educational level of some college or technical school were 43% more likely and those who had at least a college degree were 132% more likely to receive an MRI compared with those with a high school education or less. Among women with a ≥20% lifetime risk, there was no statistically significant difference noted with regard to the use of screening MRI by race or ethnicity, but high-risk women with a high school education or less were less likely to undergo screening MRI than women who had graduated from college (RR, 0.40; 95% confidence interval, 0.25-0.63). CONCLUSIONS Uptake of screening MRI of the breast into clinical practice has the potential to worsen population-based health disparities. Policies beyond health insurance coverage should ensure that the use of this screening modality reflects evidence-based guidelines.
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Affiliation(s)
- Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Department of Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deirdre A Hill
- Department of Internal Medicine and Cancer Research Center and School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | | | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | | | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Anna N A Tosteson
- Department of Medicine, Department of Community and Family Medicine, The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer A Alford-Teaster
- Department of Medicine, Department of Community and Family Medicine, The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Tracy L Onega
- Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Onega T, Goldman LE, Walker RL, Miglioretti DL, Buist DS, Taplin S, Geller BM, Hill DA, Smith-Bindman R. Facility Mammography Volume in Relation to Breast Cancer Screening Outcomes. J Med Screen 2015; 23:31-7. [PMID: 26265482 DOI: 10.1177/0969141315595254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To clarify the relationship between facility-level mammography interpretive volume and breast cancer screening outcomes. METHODS We calculated annual mammography interpretive volumes from 2000-2009 for 116 facilities participating in the U.S. Breast Cancer Surveillance Consortium (BCSC). Radiology, pathology, cancer registry, and women's self-report information were used to determine the indication for each exam, cancer characteristics, and patient characteristics. We examined the effect of annual total volume and percentage of mammograms that were screening on cancer detection rates using multinomial logistic regression adjusting for age, race/ethnicity, time since last mammogram, and BCSC registries. "Good prognosis" tumours were defined as screen-detected invasive cancers that were <15 mm, early stage, and lymph node negative at diagnosis. RESULTS From 3,098,481 screening mammograms, 9,899 cancers were screen-detected within one year of the exam. Approximately 80% of facilities had annual total interpretive volumes of >2,000 mammograms, and 42% had >5,000. Higher total volume facilities were significantly more likely to diagnose invasive tumours with good prognoses (odds ratio [OR] 1.32; 95% confidence interval [CI] 1.10-1.60, for total volume of 5,000-10,000/year v. 1,000-2,000/year; p-for-trend <0.001). A concomitant decrease in tumours with poor prognosis was seen (OR 0.78; 95%CI 0.63-0.98 for total volume of 5,000-10,000/year v. 1,000-2,000/year). CONCLUSIONS Mammography facilities with higher total interpretive volumes detected more good prognosis invasive tumours and fewer poor prognosis invasive tumours, suggesting that women attending these facilities may be more likely to benefit from screening.
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Affiliation(s)
- Tracy Onega
- Department of Biomedical Data Science, Department of Epidemiology, The Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | | | - Rod L Walker
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Diana L Miglioretti
- Group Health Research Institute, Group Health Cooperative, Seattle, WA Department of Public Health Sciences, University of California, Davis, CA
| | - Diana Sm Buist
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | | | - Berta M Geller
- Department of Radiology and Office of Health Promotion Research, University of Vermont, Burlington, VT
| | - Deirdre A Hill
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
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Birmingham WC, Hung M, Boonyasiriwat W, Kohlmann W, Walters ST, Burt RW, Stroup AM, Edwards SL, Schwartz MD, Lowery JT, Hill DA, Wiggins CL, Higginbotham JC, Tang P, Hon SD, Franklin JD, Vernon S, Kinney AY. Effectiveness of the extended parallel process model in promoting colorectal cancer screening. Psychooncology 2015; 24:1265-1278. [PMID: 26194469 DOI: 10.1002/pon.3899] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 04/27/2015] [Accepted: 06/10/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Relatives of colorectal cancer (CRC) patients are at increased risk for the disease, yet screening rates still remain low. Guided by the Extended Parallel Process Model, we examined the impact of a personalized, remote risk communication intervention on behavioral intention and colonoscopy uptake in relatives of CRC patients, assessing the original additive model and an alternative model in which each theoretical construct contributes uniquely. METHODS We collected intention-to-screen and medical record-verified colonoscopy information on 218 individuals who received the personalized intervention. RESULTS Structural equation modeling showed poor main model fit (root mean square error of approximation (RMSEA) = 0.109; standardized root mean residual (SRMR) = 0.134; comparative fit index (CFI) = 0.797; Akaike information criterion (AIC) = 11,601; Bayesian information criterion (BIC) = 11,884). However, the alternative model (RMSEA = 0.070; SRMR = 0.105; CFI = 0.918; AIC = 11,186; BIC = 11,498) showed good fit. Cancer susceptibility (B = 0.319, p < 0.001) and colonoscopy self-efficacy (B = 0.364, p < 0.001) perceptions predicted intention to screen, which was significantly associated with colonoscopy uptake (B = 0.539, p < 0.001). CONCLUSIONS Our findings provide support of the utility of Extended Parallel Process Model for designing effective interventions to motivate CRC screening in persons at increased risk when individual elements of the model are considered. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Man Hung
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | | | - Scott T Walters
- Department of Behavioral and Community Health, University of North Texas, Houston, TX, USA
| | | | - Antoinette M Stroup
- New Jersey State Cancer Registry, Rutgers University, New Brunswick, NJ, USA
| | | | - Marc D Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Jan T Lowery
- University of Colorado Cancer Center, Denver, CO, USA
| | - Deirdre A Hill
- University of New Mexico Cancer Research and Treatment Center, Albuquerque, NM, USA
| | - Charles L Wiggins
- University of New Mexico Cancer Research and Treatment Center, Albuquerque, NM, USA
| | | | - Philip Tang
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Shirley D Hon
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Jeremy D Franklin
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Sally Vernon
- Division of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | - Anita Y Kinney
- University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM, USA
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Lee CI, Bogart A, Hubbard RA, Obadina ET, Hill DA, Haas JS, Tosteson ANA, Alford-Teaster JA, Sprague BL, DeMartini WB, Lehman CD, Onega TL. Advanced Breast Imaging Availability by Screening Facility Characteristics. Acad Radiol 2015; 22:846-52. [PMID: 25851643 PMCID: PMC4465038 DOI: 10.1016/j.acra.2015.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/06/2014] [Revised: 02/12/2015] [Accepted: 02/13/2015] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES To determine the relationship between screening mammography facility characteristics and on-site availability of advanced breast imaging services required for supplemental screening and the diagnostic evaluation of abnormal screening findings. MATERIALS AND METHODS We analyzed data from all active imaging facilities across six regional registries of the National Cancer Institute-funded Breast Cancer Surveillance Consortium offering screening mammography in calendar years 2011-2012 (n = 105). We used generalized estimating equations regression models to identify associations between facility characteristics (eg, academic affiliation, practice type) and availability of on-site advanced breast imaging (eg, ultrasound [US], magnetic resonance imaging [MRI]) and image-guided biopsy services. RESULTS Breast MRI was not available at any nonradiology or breast imaging-only facilities. A combination of breast US, breast MRI, and imaging-guided breast biopsy services was available at 76.0% of multispecialty breast centers compared to 22.2% of full diagnostic radiology practices (P = .0047) and 75.0% of facilities with academic affiliations compared to 29.0% of those without academic affiliations (P = .04). Both supplemental screening breast US and screening breast MRI were available at 28.0% of multispecialty breast centers compared to 4.7% of full diagnostic radiology practices (P < .01) and 25.0% of academic facilities compared to 8.5% of nonacademic facilities (P = .02). CONCLUSIONS Screening facility characteristics are strongly associated with the availability of on-site advanced breast imaging and image-guided biopsy service. Therefore, the type of imaging facility a woman attends for screening may have important implications on her timely access to supplemental screening and diagnostic breast imaging services.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109; Department of Health Services, University of Washington School of Public Health, Seattle, Washington.
| | - Andy Bogart
- Group Health Research Institute, Seattle, Washington
| | | | - Eniola T Obadina
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109
| | - Deirdre A Hill
- Department of Internal Medicine, Cancer Research and Treatment Center, University of New Mexico, Albuquerque, New Mexico
| | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Dana Farber Harvard Cancer Institute, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - Anna N A Tosteson
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
| | - Jennifer A Alford-Teaster
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire; Department of Community and Family Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
| | - Brian L Sprague
- Department of Surgery and Office of Health Promotion Research, University of Vermont, Burlington, Vermont
| | - Wendy B DeMartini
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Constance D Lehman
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109
| | - Tracy L Onega
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire; Department of Community and Family Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
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Steffen LE, Boucher KM, Damron BH, Pappas LM, Walters ST, Flores KG, Boonyasiriwat W, Vernon SW, Stroup AM, Schwartz MD, Edwards SL, Kohlmann WK, Lowery JT, Wiggins CL, Hill DA, Higginbotham JC, Burt R, Simmons RG, Kinney AY. Efficacy of a Telehealth Intervention on Colonoscopy Uptake When Cost Is a Barrier: The Family CARE Cluster Randomized Controlled Trial. Cancer Epidemiol Biomarkers Prev 2015; 24:1311-8. [PMID: 26101306 DOI: 10.1158/1055-9965.epi-15-0150] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/02/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We tested the efficacy of a remote tailored intervention Tele-Cancer Risk Assessment and Evaluation (TeleCARE) compared with a mailed educational brochure for improving colonoscopy uptake among at-risk relatives of colorectal cancer patients and examined subgroup differences based on participant reported cost barriers. METHODS Family members of colorectal cancer patients who were not up-to-date with colonoscopy were randomly assigned as family units to TeleCARE (N = 232) or an educational brochure (N = 249). At the 9-month follow-up, a cost resource letter listing resources for free or reduced-cost colonoscopy was mailed to participants who had reported cost barriers and remained nonadherent. Rates of medically verified colonoscopy at the 15-month follow-up were compared on the basis of group assignment and within group stratification by cost barriers. RESULTS In intent-to-treat analysis, 42.7% of participants in TeleCARE and 24.1% of participants in the educational brochure group had a medically verified colonoscopy [OR, 2.37; 95% confidence interval (CI) 1.59-3.52]. Cost was identified as a barrier in both groups (TeleCARE = 62.5%; educational brochure = 57.0%). When cost was not a barrier, the TeleCARE group was almost four times as likely as the comparison to have a colonoscopy (OR, 3.66; 95% CI, 1.85-7.24). The intervention was efficacious among those who reported cost barriers; the TeleCARE group was nearly twice as likely to have a colonoscopy (OR, 1.99; 95% CI, 1.12-3.52). CONCLUSIONS TeleCARE increased colonoscopy regardless of cost barriers. IMPACT Remote interventions may bolster screening colonoscopy regardless of cost barriers and be more efficacious when cost barriers are absent.
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Affiliation(s)
- Laurie E Steffen
- University of New Mexico Cancer Center, Albuquerque, New Mexico. Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Kenneth M Boucher
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah. Department of Oncologic Sciences, University of Utah, Salt Lake City, Utah
| | | | - Lisa M Pappas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Scott T Walters
- Department of School of Public Health Behavioral and Community Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Kristina G Flores
- University of New Mexico Cancer Center, Albuquerque, New Mexico. Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine, School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | | | - Sally W Vernon
- Division of Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, Houston, Texas
| | - Antoinette M Stroup
- Department of Epidemiology, Rutgers School of Public Health, Piscataway Township, New Jersey. Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Marc D Schwartz
- Department of Oncology, Georgetown University, Washington, DC. Lombardi Comprehensive Cancer Center, Washington, DC
| | - Sandra L Edwards
- Division of Epidemiology, Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Wendy K Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jan T Lowery
- Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado
| | - Charles L Wiggins
- University of New Mexico Cancer Center, Albuquerque, New Mexico. Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine, School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Deirdre A Hill
- University of New Mexico Cancer Center, Albuquerque, New Mexico. Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine, School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - John C Higginbotham
- Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, Alabama
| | - Randall Burt
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Anita Y Kinney
- University of New Mexico Cancer Center, Albuquerque, New Mexico. Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine, School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
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28
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Lee CI, Bogart A, Germino JC, Goldman LE, Hubbard RA, Haas JS, Hill DA, Tosteson AN, Alford-Teaster JA, DeMartini WB, Lehman CD, Onega TL. Availability of Advanced Breast Imaging at Screening Facilities Serving Vulnerable Populations. J Med Screen 2015; 23:24-30. [PMID: 26078275 DOI: 10.1177/0969141315591616] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 01/14/2015] [Accepted: 05/26/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Among vulnerable women, unequal access to advanced breast imaging modalities beyond screening mammography may lead to delays in cancer diagnosis and unfavourable outcomes. We aimed to compare on-site availability of advanced breast imaging services (ultrasound, magnetic resonance imaging [MRI], and image-guided biopsy) between imaging facilities serving vulnerable patient populations and those serving non-vulnerable populations. SETTING 73 imaging facilities across five Breast Cancer Surveillance Consortium regional registries in the United States during 2011 and 2012. METHODS We examined facility and patient characteristics across a large, national sample of imaging facilities and patients served. We characterized facilities as serving vulnerable populations based on the proportion of mammograms performed on women with lower educational attainment, lower median income, racial/ethnic minority status, and rural residence.We performed multivariable logistic regression to determine relative risks of on-site availability of advanced imaging at facilities serving vulnerable women versus facilities serving non-vulnerable women. RESULTS Facilities serving vulnerable populations were as likely (Relative risk [RR] for MRI = 0.71, 95% Confidence Interval [CI] 0.42, 1.19; RR for MRI-guided biopsy = 1.07 [0.61, 1.90]; RR for stereotactic biopsy = 1.18 [0.75, 1.85]) or more likely (RR for ultrasound = 1.38 [95% CI 1.09, 1.74]; RR for ultrasound-guided biopsy = 1.67 [1.30, 2.14]) to offer advanced breast imaging services as those serving non-vulnerable populations. CONCLUSIONS Advanced breast imaging services are physically available on-site for vulnerable women in the United States, but it is unknown whether factors such as insurance coverage or out-of-pocket costs might limit their use.
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Affiliation(s)
- Christoph I Lee
- Dept of Radiology, University of Washington School of Medicine; 825 Eastlake Avenue East, Seattle, WA 98109 Dept of Health Services, University of Washington School of Public Health; 825 Eastlake Avenue East, Seattle, WA 98109
| | - Andy Bogart
- Group Health Research Institute; 1730 Minor Avenue #1600, Seattle, WA, 98101
| | - Jessica C Germino
- Dept of Radiology, University of Washington School of Medicine; 825 Eastlake Avenue East, Seattle, WA 98109
| | - L Elizabeth Goldman
- Dept of Internal Medicine, University of California, San Francisco School of Medicine; 1001 Potrero Ave, Box 1364, San Francisco, CA 94110
| | - Rebecca A Hubbard
- Dept of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania; 423 Guardian Drive, Philadelphia, PA 19104
| | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital; Dept of Medicine, Harvard Medical School; Dana Farber Harvard Cancer Institute; Dept of Social and Behavioral Sciences, Harvard School of Public Health; 1620 Tremont Street, Boston, MA 02120
| | - Deirdre A Hill
- Dept of Internal Medicine, Cancer Research and Treatment Center, University of New Mexico; 1201 Camino de Salud NE, 1 University of New Mexico, Albuquerque, NM, 87102
| | - Anna Na Tosteson
- Depts of Medicine and Community & Family Medicine, Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine; One Medical Center Drive, Lebanon, NH 03756
| | - Jennifer A Alford-Teaster
- Depts of Medicine and Community & Family Medicine, Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine; One Medical Center Drive, Lebanon, NH 03756
| | - Wendy B DeMartini
- Dept of Radiology, University of Wisconsin School of Medicine and Public Health; 600 Highland Avenue, Madison WI 53792
| | - Constance D Lehman
- Dept of Radiology, University of Washington School of Medicine; 825 Eastlake Avenue East, Seattle, WA 98109
| | - Tracy L Onega
- Depts of Medicine and Community & Family Medicine, Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine; One Medical Center Drive, Lebanon, NH 03756
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29
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Pugh TJ, Yu W, Yang J, Field AL, Ambrogio L, Carter SL, Cibulskis K, Giannikopoulos P, Kiezun A, Kim J, McKenna A, Nickerson E, Getz G, Hoffher S, Messinger YH, Dehner LP, Roberts CWM, Rodriguez-Galindo C, Williams GM, Rossi CT, Meyerson M, Hill DA. Exome sequencing of pleuropulmonary blastoma reveals frequent biallelic loss of TP53 and two hits in DICER1 resulting in retention of 5p-derived miRNA hairpin loop sequences. Oncogene 2014; 33:5295-302. [PMID: 24909177 PMCID: PMC4224628 DOI: 10.1038/onc.2014.150] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 04/13/2014] [Accepted: 04/14/2014] [Indexed: 01/21/2023]
Abstract
Pleuropulmonary blastoma is a rare childhood malignancy of lung mesenchymal cells that can remain dormant as epithelial cysts or progress to high-grade sarcoma. Predisposing germline loss-of-function DICER1 variants have been described. We sought to uncover additional contributors through whole exome sequencing of 15 tumor/normal pairs, followed by targeted resequencing, miRNA analysis and immunohistochemical analysis of additional tumors. In addition to frequent biallelic loss of TP53 and mutations of NRAS or BRAF in some cases, each case had compound disruption of DICER1: a germline (12 cases) or somatic (3 cases) loss-of-function variant plus a somatic missense mutation in the RNase IIIb domain. 5p-Derived microRNA (miRNA) transcripts retained abnormal precursor miRNA loop sequences normally removed by DICER1. This work both defines a genetic interaction landscape with DICER1 mutation and provides evidence for alteration in miRNA transcripts as a consequence of DICER1 disruption in cancer.
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Affiliation(s)
- T J Pugh
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - W Yu
- Department of Integrative Systems Biology, George Washington University, Washington, DC, USA
- Center for Genetic Medicine Research and Department of Pathology, Children's National Medical Center, Washington, DC, USA
| | - J Yang
- Department of Integrative Systems Biology, George Washington University, Washington, DC, USA
- Center for Genetic Medicine Research and Department of Pathology, Children's National Medical Center, Washington, DC, USA
| | - A L Field
- Department of Integrative Systems Biology, George Washington University, Washington, DC, USA
- Center for Genetic Medicine Research and Department of Pathology, Children's National Medical Center, Washington, DC, USA
| | - L Ambrogio
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - S L Carter
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - K Cibulskis
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - A Kiezun
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - J Kim
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - A McKenna
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - E Nickerson
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - G Getz
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - S Hoffher
- Department of Integrative Systems Biology, George Washington University, Washington, DC, USA
- Center for Genetic Medicine Research and Department of Pathology, Children's National Medical Center, Washington, DC, USA
| | - Y H Messinger
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - L P Dehner
- Department of Pathology and Immunology, Washington University Medical Center, St Louis, MO, USA
| | - C W M Roberts
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
- Dana-Farber/Children's Cancer Center, Boston, MA, USA
| | - C Rodriguez-Galindo
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
- Dana-Farber/Children's Cancer Center, Boston, MA, USA
| | - G M Williams
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - C T Rossi
- Department of Integrative Systems Biology, George Washington University, Washington, DC, USA
| | - M Meyerson
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - D A Hill
- Department of Integrative Systems Biology, George Washington University, Washington, DC, USA
- Center for Genetic Medicine Research and Department of Pathology, Children's National Medical Center, Washington, DC, USA
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30
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Houssami N, Abraham LA, Onega T, Collins LC, Sprague BL, Hill DA, Miglioretti DL. Accuracy of screening mammography in women with a history of lobular carcinoma in situ or atypical hyperplasia of the breast. Breast Cancer Res Treat 2014; 145:765-73. [PMID: 24800915 PMCID: PMC4111461 DOI: 10.1007/s10549-014-2965-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 11/20/2013] [Accepted: 04/11/2014] [Indexed: 11/29/2022]
Abstract
Women with lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), atypical ductal hyperplasia (ADH), or atypical hyperplasia (AH) are at increased breast cancer (BC) risk. We investigated the accuracy and outcomes of mammography screening in women with histology-proven LCIS, ALH, ADH, or AH history who had screening through Breast Cancer Surveillance Consortium-affiliated mammography facilities. Screens from two cohorts, defined by LCIS/ALH or ADH/AH history, were compared to two cohorts without such history mammogram-matched for age-group, breast density, family history, screen-year, and mammography registry. Overall 359 BCs (277 invasive BC) occurred within 1 year from screening among 52,380 screens. In the LCIS/ALH cohort [versus comparator screens] cancer incidence rates, cancer detection rates (CDR), and interval cancer rates (ICR) were significantly higher (all P < 0.001); although ICR was 4.4/1,000 screens [versus 0.9/1,000; P < 0.001] the proportion that were interval cancers did not differ between compared cohorts (P = 0.43); screening sensitivity was 76.1 % [versus 82.3 %; P = 0.43], however, specificity was significantly lower at 85.1 % [versus 90.7 %; P < 0.0001]. In the ADH/AH cohort [versus comparator] cancer rates and CDR were significantly higher (P < 0.001); although ICR was 2.6/1,000 screens [versus 0.9/1,000; P = 0.002] the proportion that were interval cancers did not differ between cohorts (P = 0.74); screening sensitivity was 81.0 % [versus 82.6 %; P = 0.74] and specificity was lower at 86.2 % [versus 90.2 %; P < 0.0001]. Mammography screening sensitivity in LCIS/ALH and ADH/AH cohorts did not significantly differ from that of matched screens, however, specificity was lower, and ICRs were higher (reflecting underlying cancer rates). Adjunct screening may be of value in these women if it reduces ICR without substantially reducing specificity.
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Affiliation(s)
- Nehmat Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia,
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31
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Hill DA, Horick NK, Isaacs C, Domchek SM, Tomlinson GE, Lowery JT, Kinney AY, Berg JS, Edwards KL, Moorman PG, Plon SE, Strong LC, Ziogas A, Griffin CA, Kasten CH, Finkelstein DM. Long-term risk of medical conditions associated with breast cancer treatment. Breast Cancer Res Treat 2014; 145:233-43. [PMID: 24696430 DOI: 10.1007/s10549-014-2928-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/18/2014] [Indexed: 11/30/2022]
Abstract
Early and late effects of cancer treatment are of increasing concern with growing survivor populations, but relevant data are sparse. We sought to determine the prevalence and hazard ratio of such effects in breast cancer cases. Women with invasive breast cancer and women with no cancer history recruited for a cancer research cohort completed a mailed questionnaire at a median of 10 years post-diagnosis or matched reference year (for the women without cancer). Reported medical conditions including lymphedema, osteopenia, osteoporosis, and heart disease (congestive heart failure, myocardial infarction, coronary heart disease) were assessed in relation to breast cancer therapy and time since diagnosis using Cox regression. The proportion of women currently receiving treatment for these conditions was calculated. Study participants included 2,535 women with breast cancer and 2,428 women without cancer (response rates 66.0 % and 50.4 %, respectively) Women with breast cancer had an increased risk of lymphedema (Hazard ratio (HR) 8.6; 95 % confidence interval (CI) 6.3-11.6), osteopenia (HR 2.1; 95 % CI 1.8-2.4), and osteoporosis (HR 1.5; 95 % CI 1.2-1.9) but not heart disease, compared to women without cancer Hazard ratios varied by treatment and time since diagnosis. Overall, 49.3 % of breast cancer cases reported at least one medical condition, and at 10 or more years post-diagnosis, 37.7 % were currently receiving condition-related treatment. Responses from survivors a decade following cancer diagnosis demonstrate substantial treatment-related morbidity, and emphasize the need for continued medical surveillance and follow-up care into the second decade post-diagnosis.
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Affiliation(s)
- Deirdre A Hill
- Department of Internal Medicine and Cancer Research and Treatment Center, University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131-0001, USA,
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32
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Kinney AY, Boonyasiriwat W, Walters ST, Pappas LM, Stroup AM, Schwartz MD, Edwards SL, Rogers A, Kohlmann WK, Boucher KM, Vernon SW, Simmons RG, Lowery JT, Flores K, Wiggins CL, Hill DA, Burt RW, Williams MS, Higginbotham JC. Telehealth personalized cancer risk communication to motivate colonoscopy in relatives of patients with colorectal cancer: the family CARE Randomized controlled trial. J Clin Oncol 2014; 32:654-62. [PMID: 24449229 PMCID: PMC3927734 DOI: 10.1200/jco.2013.51.6765] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [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] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The rate of adherence to regular colonoscopy screening in individuals at increased familial risk of colorectal cancer (CRC) is suboptimal, especially among rural and other geographically underserved populations. Remote interventions may overcome geographic and system-level barriers. We compared the efficacy of a telehealth-based personalized risk assessment and communication intervention with a mailed educational brochure for improving colonoscopy screening among at-risk relatives of patients with CRC. METHODS Eligible individuals age 30 to 74 years who were not up-to-date with risk-appropriate screening and were not candidates for genetic testing were recruited after contacting patients with CRC or their next of kin in five states. Enrollees were randomly assigned as family units to either an active, personalized intervention that incorporated evidence-based risk communication and behavior change techniques, or a mailed educational brochure. The primary outcome was medically verified colonoscopy within 9 months of the intervention. RESULTS Of the 481 eligible and randomly assigned at-risk relatives, 79.8% completed the outcome assessments within 9 months; 35.4% of those in the personalized intervention group and 15.7% of those in the comparison group obtained a colonoscopy. In an intent-to-treat analysis, the telehealth group was almost three times as likely to get screened as the low-intensity comparison group (odds ratio, 2.83; 95% CI, 1.87 to 4.28; P < .001). Persons residing in rural areas and those with lower incomes benefitted at the same level as did urban residents. CONCLUSION Remote personalized interventions that consider family history and incorporate evidence-based risk communication and behavior change strategies may promote risk-appropriate screening in close relatives of patients with CRC.
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Affiliation(s)
- Anita Y. Kinney
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Watcharaporn Boonyasiriwat
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Scott T. Walters
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Lisa M. Pappas
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Antoinette M. Stroup
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Marc D. Schwartz
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Sandra L. Edwards
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Amy Rogers
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Wendy K. Kohlmann
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Kenneth M. Boucher
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Sally W. Vernon
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Rebecca G. Simmons
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Jan T. Lowery
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Kristina Flores
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Charles L. Wiggins
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Deirdre A. Hill
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Randall W. Burt
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Marc S. Williams
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - John C. Higginbotham
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
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Lowery JT, Horick N, Kinney AY, Finkelstein DM, Garrett K, Haile RW, Lindor NM, Newcomb PA, Sandler RS, Burke C, Hill DA, Ahnen DJ. A randomized trial to increase colonoscopy screening in members of high-risk families in the colorectal cancer family registry and cancer genetics network. Cancer Epidemiol Biomarkers Prev 2014; 23:601-10. [PMID: 24501379 DOI: 10.1158/1055-9965.epi-13-1085] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Individuals with a strong family history of colorectal cancer have significant risk for colorectal cancer, although adherence to colonoscopy screening in these groups remains low. This study assessed whether a tailored telephone counseling intervention can increase adherence to colonoscopy in members of high-risk families in a randomized, controlled trial. METHODS Eligible participants were recruited from two national cancer registries if they had a first-degree relative with colorectal cancer under age 60 or multiple affected family members, which included families that met the Amsterdam criteria for hereditary non-polyposis colon cancer (HNPCC), and if they were due for colonoscopy within 24 months. Participants were randomized to receive a tailored telephone intervention grounded in behavioral theory or a mailed packet with general information about screening. Colonoscopy status was assessed through follow-up surveys and endoscopy reports. Cox proportional hazards models were used to assess intervention effect. RESULTS Of the 632 participants (ages 25-80), 60% were female, the majority were White, non-Hispanic, educated, and had health insurance. Colonoscopy adherence increased 11 percentage points in the tailored telephone intervention group, compared with no significant change in the mailed group. The telephone intervention was associated with a 32% increase in screening adherence compared with the mailed intervention (HR, 1.32; P = 0.01). CONCLUSIONS A tailored telephone intervention can effectively increase colonoscopy adherence in high-risk persons. This intervention has the potential for broad dissemination to healthcare organizations or other high-risk populations. IMPACT Increasing adherence to colonoscopy among persons with increased colorectal cancer risk could effectively reduce incidence and mortality from this disease.
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Affiliation(s)
- Jan T Lowery
- Authors' Affiliations: Colorado School of Public Health, University of Colorado; University of Colorado Cancer Center, Division of Cancer Prevention and Control, Aurora; Department of Medicine, Department of Veterans Affairs Eastern Colorado Health Care System and University of Colorado School of Medicine, Denver, Colorado; Massachusetts General Hospital Biostatistics Center; Harvard University, Boston, Massachusetts; Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine; Cancer Center, University of New Mexico, Albuquerque, New Mexico; Stanford University, Population Sciences, Stanford, California; Department of Health Science Research, Mayo Clinic Arizona, Scottsdale, Arizona; Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; and Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
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Simmons RG, Lee YCA, Stroup AM, Edwards SL, Rogers A, Johnson C, Wiggins CL, Hill DA, Cress RD, Lowery J, Walters ST, Jasperson K, Higginbotham JC, Williams MS, Burt RW, Schwartz MD, Kinney AY. Examining the challenges of family recruitment to behavioral intervention trials: factors associated with participation and enrollment in a multi-state colonoscopy intervention trial. Trials 2013; 14:116. [PMID: 23782890 PMCID: PMC3691526 DOI: 10.1186/1745-6215-14-116] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 04/02/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Colonoscopy is one of the most effective methods of cancer prevention and detection, particularly for individuals with familial risk. Recruitment of family members to behavioral intervention trials remains uniquely challenging, owing to the intensive process required to identify and contact them. Recruiting at-risk family members involves contacting the original cancer cases and asking them to provide information about their at-risk relatives, who must then be contacted for study enrollment. Though this recruitment strategy is common in family trials, few studies have compared influences of patient and relative participation to nonparticipation. Furthermore, although use of cancer registries to identify initial cases has increased, to our knowledge no study has examined the relationship between registries and family recruitment outcomes. METHODS This study assessed predictors of case participation and relative enrollment in a recruitment process that utilized state cancer registries. Participation characteristics were analyzed with separate multivariable logistic regressions in three stages: (1) cancer registry-contacted colorectal cancer (CRC) cases who agreed to study contact; (2) study-contacted CRC cases who provided at-risk relative information; and (3) at-risk relatives contacted for intervention participation. RESULTS Cancer registry source was predictive of participation for both CRC cases and relatives, though relative associations (odds ratios) varied across registries. Cases were less likely to participate if they were Hispanic or nonwhite, and were more likely to participate if they were female or younger than 50 at cancer diagnosis. At-risk relatives were more likely to participate if they were from Utah, if another family member was also participating in the study, or if they had previously had a colonoscopy. The number of eligible cases who had to be contacted to enroll one eligible relative varied widely by registry, from 7 to 81. CONCLUSIONS Family recruitment utilizing cancer registry-identified cancer cases is feasible, but highly dependent on both the strategies and protocols of those who are recruiting and on participant characteristics such as sex, race, or geography. Devising comprehensive recruitment protocols that specifically target those less likely to enroll may help future research meet recruitment goals. TRIAL REGISTRATION Family Colorectal Cancer Awareness and Risk Education Project NCT01274143.
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Affiliation(s)
- Rebecca G Simmons
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Yuan-Chin Amy Lee
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
| | - Antoinette M Stroup
- Utah Cancer Registry, 650 Komas Drive, Suite 106B, Salt Lake City, UT, 84108, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Sandra L Edwards
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Amy Rogers
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Christopher Johnson
- Cancer Data Registry of Idaho, 615 N. 7th Street, PO Box 1278, Boise, ID, 83701, USA
| | - Charles L Wiggins
- New Mexico Tumor Registry, University of New Mexico Cancer Center, MSC 11 6020, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Deirdre A Hill
- Department of Internal Medicine, Division of Epidemiology and Biostatistics and University of New Mexico Cancer Research and Treatment Center, University of New Mexico School of Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Rosemary D Cress
- California Cancer Registry, 1825 Bell Street, Suite 102, Sacramento, CA, 95825, USA
| | - Jan Lowery
- University of Colorado Cancer Center, 13001 E. 17th St., MS F-538, Aurora, CO, 80045, USA
| | - Scott T Walters
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd, EAD 709, Fort Worth, TX, 76107, USA
| | - Kory Jasperson
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - John C Higginbotham
- Institute for Rural Health, University of Alabama, Tuscaloosa Campus, 850 5th Avenue East, Tuscaloosa, AL, 35401, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger Research, Weis Center for Research, 100 N Academy Ave. Mail Stop 26-20, Danville, PA, 17822, USA
| | - Randall W Burt
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Marc D Schwartz
- Georgetown University, Harris Building, 3300 Whitehaven St., N.W., Washington DC, 20007, USA
- Lombardi Comprehensive Cancer Center, 3970 Reservoir Rd NW E501, Washington, DC, 20007, USA
| | - Anita Y Kinney
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
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Phipps AI, Doherty JA, Voigt LF, Hill DA, Beresford SAA, Rossing MA, Chen C, Weiss NS. Long-term use of continuous-combined estrogen-progestin hormone therapy and risk of endometrial cancer. Cancer Causes Control 2011; 22:1639-46. [PMID: 21909949 DOI: 10.1007/s10552-011-9840-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
Abstract
The daily administered dose of progestin in continuous-combined estrogen-progestin therapy is provided to counteract the proliferative effect of estrogen on the postmenopausal endometrium. However, there remains some uncertainty as to whether use of such a combined regimen, over the long term, is associated with an altered risk of endometrial cancer. We pooled data from four population-based case-control studies of endometrial cancer in western Washington State. Cases, ages 45-74, were diagnosed between 1985 and 2005. Using logistic regression with the adjustment for confounding factors, women who had exclusively used continuous-combined estrogen-progestin therapy (90 endometrial cancer cases, 227 controls) were compared with women who had never used any type of hormone therapy (774 cases, 1,116 controls). Associations with duration and recency of use were evaluated overall and within strata defined by body mass index. Long-term use of continuous-combined estrogen-progestin therapy (≥10 years) was associated with a reduced risk of endometrial cancer (OR = 0.37, 95% CI: 0.21-0.66). This association was most pronounced in women with a body mass index ≥30 kg/m(2) (OR = 0.19, 95% CI: 0.05-0.68). Associations did not differ according to recency of use. These results suggest that long duration of use of continuous-combined estrogen-progestin therapy is associated with a reduced risk of endometrial cancer.
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Affiliation(s)
- Amanda I Phipps
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, WA 98109, USA.
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Pocobelli G, Doherty JA, Voigt LF, Beresford SA, Hill DA, Chen C, Rossing MA, Holmes RS, Noor ZS, Weiss NS. Pregnancy history and risk of endometrial cancer. Epidemiology 2011; 22:638-45. [PMID: 21691206 PMCID: PMC3152311 DOI: 10.1097/ede.0b013e3182263018] [Citation(s) in RCA: 13] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epidemiologic studies are consistent in finding that women who have had at least one birth are less likely to develop endometrial cancer. Less clear is whether timing of pregnancies during reproductive life influences risk, and the degree to which incomplete pregnancies are associated with a reduced risk. METHODS We evaluated pregnancy history in relation to endometrial cancer risk using data from a series of 4 population-based endometrial cancer case-control studies of women 45-74 years of age (1712 cases and 2134 controls) during 1985-2005 in western Washington State. Pregnancy history and information on other potential risk factors were collected by in-person interviews. RESULTS Older age at first birth was associated with a reduced risk of endometrial cancer after adjustment for number of births and age at last birth (test for trend P = 0.004). The odds ratio comparing women at least 35 years of age at their first birth with those younger than 20 years was 0.34 (95% confidence interval = 0.14-0.84). Age at last birth was not associated with risk after adjustment for number of births and age at first birth (test for trend P = 0.830). Overall, a history of incomplete pregnancies was not associated with endometrial cancer risk to any appreciable degree. CONCLUSIONS In this study, older age at first birth was more strongly associated with endometrial cancer risk than was older age at last birth. To date, there remains some uncertainty in the literature on this issue.
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Affiliation(s)
- Gaia Pocobelli
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, USA.
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Ziogas A, Horick NK, Kinney AY, Lowery JT, Domchek SM, Isaacs C, Griffin CA, Moorman PG, Edwards KL, Hill DA, Berg JS, Tomlinson GE, Anton-Culver H, Strong LC, Kasten CH, Finkelstein DM, Plon SE. Clinically relevant changes in family history of cancer over time. JAMA 2011; 306:172-8. [PMID: 21750294 PMCID: PMC3367662 DOI: 10.1001/jama.2011.955] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Knowledge of family cancer history is important for assessing cancer risk and guiding screening recommendations. OBJECTIVE To quantify how often throughout adulthood clinically significant changes occur in cancer family history that would result in recommendations for earlier or intense screening. DESIGN AND SETTING Descriptive study examining baseline and follow-up family history data from participants in the Cancer Genetics Network (CGN), a US national population-based cancer registry, between 1999 and 2009. PARTICIPANTS Adults with a personal history, family history, or both of cancer enrolled in the CGN through population-based cancer registries. Retrospective colorectal, breast, and prostate cancer screening-specific analyses included 9861, 2547, and 1817 participants, respectively; prospective analyses included 1533, 617, and 163 participants, respectively. Median follow-up was 8 years (range, 0-11 years). Screening-specific analyses excluded participants with the cancer of interest. MAIN OUTCOME MEASURES Percentage of individuals with clinically significant family histories and rate of change over 2 periods: (1) retrospectively, from birth until CGN enrollment and (2) prospectively, from enrollment to last follow-up. RESULTS Retrospective analysis revealed that the percentages of participants who met criteria for high-risk screening based on family history at ages 30 and 50 years, respectively, were as follows: for colorectal cancer, 2.1% (95% confidence interval [CI], 1.8%-2.4%) and 7.1% (95% CI, 6.5%-7.6%); for breast cancer, 7.2% (95% CI, 6.1%-8.4%) and 11.4% (95% CI, 10.0%-12.8%); and for prostate cancer, 0.9% (95% CI, 0.5%-1.4%) and 2.0% (95% CI, 1.4%-2.7%). In prospective analysis, the numbers of participants who newly met criteria for high-risk screening based on family history per 100 persons followed up for 20 years were 2 (95% CI, 0-7) for colorectal cancer, 6 (95% CI, 2-13) for breast cancer, and 8 (95% CI, 3-16) for prostate cancer. The rate of change in cancer family history was similar for colorectal and breast cancer between the 2 analyses. CONCLUSION Clinically relevant family history of colorectal, breast, and prostate cancer that would result in recommendations for earlier or intense cancer screening increases between ages 30 and 50 years, although the absolute rate is low for prostate cancer.
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Hill DA, Nibbe A, Royce ME, Wallace AM, Kang H, Wiggins CL, Rosenberg RD. Method of detection and breast cancer survival disparities in Hispanic women. Cancer Epidemiol Biomarkers Prev 2010; 19:2453-60. [PMID: 20841385 DOI: 10.1158/1055-9965.epi-10-0164] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [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
BACKGROUND Hispanic women in New Mexico (NM) are more likely than non-Hispanic women to die of breast cancer-related causes. We determined whether survival differences between Hispanic and non-Hispanic women might be attributable to the method of detection, an independent breast cancer prognostic factor in previous studies. METHODS White women diagnosed with invasive breast cancer from 1995 through 2004 were identified from NM Surveillance Epidemiology End Results (SEER) files (n = 5,067) and matched to NM Mammography Project records. Method of cancer detection was categorized as "symptomatic" or "screen-detected." The proportion of Hispanic survival disparity accounted for by included variables was assessed using Cox models. RESULTS In the median follow-up of 87 months, 490 breast cancer deaths occurred. Symptomatic versus screen-detection was classifiable for 3,891 women (76.8%), and was independently related to breast cancer-specific survival [hazard ratio (HR), 1.6; 95% confidence interval (95% CI), 1.3-2.0]. Hispanic women had a 1.5-fold increased risk of breast cancer-related death, relative to non-Hispanic women (95% CI, 1.2-1.8). After adjustment for detection method, the Hispanic HR declined from 1.50 to 1.45 (10%), but after inclusion of other prognostic indicators the Hispanic HR equaled 1.23 (95% CI, 1.01-1.48). CONCLUSIONS Although the Hispanic HR declined 50% after adjustment, the decrease was largely due to adverse tumor prognostic characteristics. IMPACT Reduction of disparate survival in Hispanic women may rely not only on increased detection of tumors when asymptomatic but on the development of greater understanding of biological factors that predispose to poor prognosis tumors.
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Affiliation(s)
- Deirdre A Hill
- University of New Mexico Cancer Research and Treatment Center and Department of Internal Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
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Gerone PJ, Hill DA, Appell LH, Baron S. Inhibition of respiratory virus infections of mice with aerosols of synthetic double-stranded ribonucleic Acid. Infect Immun 2010; 3:323-7. [PMID: 16557972 PMCID: PMC416150 DOI: 10.1128/iai.3.2.323-327.1971] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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
Aerosols of double-stranded complexes of polyinosinic and polycytidylic acids (poly I:C) were useful in protecting mice infected with aerosols of influenza (A(2)/Taiwan/64) and parainfluenza type 1 (Sendai) viruses. Administration of poly I:C as an aerosol offers an advantage, particularly in therapy, by eliminating the risk of pulmonary dissemination of viral infections due to intranasally instilled fluids. Treatment of mice with aerosols of poly I:C reduced the infection rate with influenza virus but did not inhibit virus multiplication in the lungs of most of those animals where infection became established. Sendai virus infection rates were undiminished in mice treated with poly I:C, but lung-virus titers were significantly suppressed as compared with those of untreated animals. The maximum poly I:C doses (40 mug) administered by aerosol produced no evidence of toxicity in the mice.
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Affiliation(s)
- P J Gerone
- Biological Sciences Laboratories, Fort Detrick, Frederick, Maryland 21701
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Saltzman BS, Doherty JA, Hill DA, Beresford SA, Voigt LF, Chen C, Weiss NS. Diabetes and endometrial cancer: an evaluation of the modifying effects of other known risk factors. Am J Epidemiol 2008; 167:607-14. [PMID: 18071194 DOI: 10.1093/aje/kwm333] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [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] [Indexed: 12/11/2022] Open
Abstract
To determine whether risk of endometrial cancer among women with type 2 diabetes differs with respect to other endometrial cancer risk factors, the authors used data from a population-based case-control study (1,303 cases and 1,779 controls) conducted in western Washington State during 1985-1999. History of type 2 diabetes was associated with endometrial cancer (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.2, 2.3), more strongly among women with a recent diabetes diagnosis (<5 years) (OR = 2.6, CI: 1.5, 4.7) than among those with a more distant diagnosis (> or =5 years) (OR = 1.3, CI: 0.8, 1.9). Type 2 diabetes was associated with endometrial cancer among women with a body mass index (BMI) (weight (kg)/height (m)(2)) less than 35 but not among women with a BMI of 35 or more. The observed associations persisted after finer adjustment for BMI to control for residual confounding. History of diabetes was associated with a twofold increased risk of endometrial cancer among hypertensive women, but no association was observed among nonhypertensive women. The risk associated with type 2 diabetes appeared not to vary greatly with respect to other endometrial cancer risk factors. These results support the hypothesis that type 2 diabetes is associated with endometrial cancer irrespective of the presence of other risk factors for this disease, except possibly hypertension and extreme obesity.
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Affiliation(s)
- Babette S Saltzman
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
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Wilburn EE, Mahan DC, Hill DA, Shipp TE, Yang H. An evaluation of natural (RRR-alpha-tocopheryl acetate) and synthetic (all-rac-alpha-tocopheryl acetate) vitamin E fortification in the diet or drinking water of weanling pigs. J Anim Sci 2007; 86:584-91. [PMID: 18156353 DOI: 10.2527/jas.2007-0377] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Three experiments conducted with weanling pigs evaluated the effects of vitamin E added to the drinking water or diet on plasma and tissue alpha-tocopherol concentrations. When natural or synthetic vitamin E was used, it was added at an IU-equivalent basis, but natural vitamin E was 73.5% (mg basis) of the synthetic vitamin E. Experiment 1 used 18-d-old weanling pigs (n = 120) in a 3 x 2 factorial arrangement of treatments in a randomized complete block design with 4 replicates. The first factor evaluated the dietary levels of natural vitamin E (RRR-alpha-tocopheryl acetate) added at 0, 50, or 300 IU/kg, whereas the second factor was the natural vitamin E added to the drinking water at 0 or 100 IU/L. Pigs were bled at periodic intervals, and 1 pig per pen was killed at the end of the 21-d trial and tissues (liver, heart, lung, and loin) were collected for alpha-tocopherol analysis. When vitamin E was not added to the diet or water, plasma alpha-tocopherol declined over the 21-d period. Although there were some interactions (P < 0.01), tissue and plasma alpha-tocopherol concentrations increased linearly when vitamin E was added to the diet or water. Experiment 2 was a 3 x 2 factorial in a randomized complete block design with 4 replicates. A total of 96 pigs weaned at 18 d of age, with an initial BW of 6.2 kg, were fed a nonvitamin E fortified diet, but natural or synthetic (all-rac-alpha-tocopheryl acetate) vitamin E was added to their drinking water at 50, 100, or 150 IU/L. Pigs were bled at 0, 3, 7, 10, 14, and 21 d postweaning, with tissues (liver, lung, heart, and loin) collected for alpha-tocopherol analysis at d 21. The results indicated that plasma alpha-tocopherol concentrations increased (P < 0.01) as vitamin E increased, with greater tissue alpha-tocopherol concentrations (P < 0.01) when natural vitamin E was provided. Experiment 3 was conducted in 2 replicates, but pigs (n = 60) were not provided vitamin E in the diet or water for 7 d postweaning, and then natural or synthetic vitamin E was added to the drinking water as in Exp. 2 (50, 100, or 150 IU/L). Pigs were bled at 0, 2, 4, 6, 8, 10, and 24 h after being provided vitamin E to evaluate the absorption from each vitamin E source and level. Plasma alpha-tocopherol increased quadratically (P < 0.01) and plateaued at 8 to 10 h for each treatment group. These results indicate that adding vitamin E to the pig's water supply at weaning was more effective in increasing plasma alpha-tocopherol than when it was added to the diet during the initial 14 d postweaning, and that natural vitamin E was a superior source compared with synthetic vitamin E.
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Affiliation(s)
- E E Wilburn
- The Ohio State University, The Ohio Agricultural Research and Development Center, Columbus 43210-1095, USA
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Hill DA. Strengthening gynecologic cancer prevention studies. Obstet Gynecol Clin North Am 2007; 34:639-50, vii. [PMID: 18061861 DOI: 10.1016/j.ogc.2007.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article describes the elements in the design of cancer-prevention trials and the skills needed to evaluate the study outcomes in this field. Efforts to prevent gynecologic malignancies face some methodological challenges common to other cancer-prevention studies, such as choice of study design, population to be studied, and agent to be administered (or intervention to be made). Flaws in making these choices or in analyzing results can lead to misattribution of effects or cause important findings to be overlooked. In addition, some investigators must address issues that have arisen in response to prevention-trial results from the past decade. Cancer prevention efforts have recently suffered some well-publicized and not-so-well publicized setbacks. The prominence of some of these findings should not overshadow well-established achievements and recent successes.
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Affiliation(s)
- Deirdre A Hill
- Department of Internal Medicine, Division of Epidemiology, University of New Mexico School of Medicine, 1 University of NM, Albuquerque, NM 87131-0001, USA.
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Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth 2007; 99:461-73. [PMID: 17704089 DOI: 10.1093/bja/aem238] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Radicular pain in the distribution of the sciatic nerve, resulting from herniation of one or more lumbar intervertebral discs, is a frequent and often debilitating event. The lifetime incidence of this condition is estimated to be between 13% and 40%. Fortunately, the majority of cases resolve spontaneously with simple analgesia and physiotherapy. However, the condition has the potential to become chronic and intractable, with major socio-economic implications. This review discusses the history, epidemiology, pathophysiology, and natural history of sciatica. A Medline search was performed to obtain the published literature on the sciatica, between 1966 and 2006. Hand searches of relevant journals were also performed. Epidemiological factors found to influence incidence of sciatica included increasing height, age, genetic predisposition, walking, jogging (if a previous history of sciatica), and particular physical occupations, including driving. The influence of herniated nucleus pulposus and the probable cytokine-mediated inflammatory response in lumbar and sacral nerve roots is discussed. An abnormal immune response and possible mechanical factors are also proposed as factors that may mediate pain. The ongoing issue of the role of epidural steroid injection in the treatment of this condition is also discussed, as well as potential hazards of this procedure and the direction that future research should take.
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Affiliation(s)
- M A Stafford
- Department of Anaesthesia, Ulster Hospital, Dundonald, Upper Newtownards Road, Belfast BT16 1RH, Ireland
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Doherty JA, Cushing-Haugen KL, Saltzman BS, Voigt LF, Hill DA, Beresford SA, Chen C, Weiss NS. Long-term use of postmenopausal estrogen and progestin hormone therapies and the risk of endometrial cancer. Am J Obstet Gynecol 2007; 197:139.e1-7. [PMID: 17689625 DOI: 10.1016/j.ajog.2007.01.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [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: 07/13/2006] [Revised: 11/07/2006] [Accepted: 01/16/2007] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess whether endometrial cancer risk among long-term users of (1) sequential estrogen plus progestin 10-24 days per month exceeds that of nonusers and (2) daily estrogen plus progestin (continuous combined hormone therapy) is below that of nonusers. STUDY DESIGN In this population-based case-control study with 1038 endometrial cancer cases diagnosed in 1985-1999 and 1453 control subjects, exclusive users of a single form of hormone therapy were compared with never users of hormone therapy. RESULTS For sequential therapy, only long-term use (> or = 6 years) was associated with increased risk (odds ratio, 2.0; 95% CI, 1.2-3.5). Continuous combined therapy was associated with decreased risk (odds ratio, 0.59; 95% CI, 0.40-0.88), with no increased risk among long-term users (odds ratio, 0.77; 95% CI, 0.45-1.3). CONCLUSION These results support the hypotheses that continuous combined therapy does not increase (and may decrease) endometrial cancer risk and that long-term sequential therapy can lead to a modest increased risk. However, the collective results of all studies of these questions and their clinical implications remain unclear.
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Affiliation(s)
- Jennifer A Doherty
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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Chubak J, Doherty JA, Cushing-Haugen KL, Voigt LF, Saltzman BS, Hill DA, Beresford SAA, Weiss NS. Endometrial cancer risk in estrogen users after switching to estrogen-progestin therapy. Cancer Causes Control 2007; 18:1001-7. [PMID: 17653829 DOI: 10.1007/s10552-007-9040-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 04/17/2007] [Accepted: 07/04/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE It is unknown whether postmenopausal unopposed estrogen users are better off, in terms of endometrial cancer risk, switching to a combined estrogen-progestin regimen or stopping hormone use altogether. METHODS We analyzed data from a series of three population-based case-control studies in western Washington state during 1985-1999, comparing proportions of "switchers" and "stoppers" in cases and controls. We also assessed whether the risk of endometrial cancer in either group of former unopposed estrogen users returned to that of never users. RESULTS After multivariate adjustment using unconditional logistic regression, women who switched to a combined regimen with a progestin added for at least ten days/month (37 cases, 47 controls) had half the risk of endometrial cancer of women who stopped hormone use altogether (86 cases, 78 controls) (adjusted odds ratio = 0.5, 95% confidence interval: 0.3-1.1). Most subgroups of former users, whether they switched or stopped, had some increased risk of endometrial cancer compared to never users. CONCLUSIONS Results from this study suggest that unopposed estrogen users may reduce their risk of endometrial cancer more by switching to a combined regimen with progestin added for at least ten days/month than by stopping hormone use altogether.
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Affiliation(s)
- Jessica Chubak
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98195, USA.
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Reese CT, Ntam C, Martin TV, Carrington S, Leotaub J, Cox L, Williams RJ, Hill DA. Internalization of near-infrared fluorescent dyes within isolated macrophage populations. Cell Mol Biol (Noisy-le-grand) 2007; 53:27-33. [PMID: 17531146] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Accepted: 03/20/2006] [Indexed: 05/15/2023]
Abstract
The development and application of microsensor technology has enhanced the ability of scientists to further understand various biological activities, such as changes in the intracellular environment after injury or toxic exposure. NIR microsensor technology may be useful in detecting the cellular injuries or adverse changes during the early onset period, allowing for the administration of therapies to initiate recovery. The development and use of Infrared (IR) and near infrared (NIR) dyes as biological micro-sensors due to their advanced spectral characteristics may be helpful. Three of the more useful NIR dye characteristics include the ability to minimize background interference by extraneous biological matrices, the ability to exhibit optimal molar absorptivity and quantum yields, and the ability to maintain normal cellular activity. Thus, the current study was designed to investigate the ability of selected NIR micro-sensor dyes to undergo cellular internalization, demonstrate intracellular NIR fluorescent signaling, and maintain normal cellular activity. The results demonstrate that the selected NIR micro-sensor dyes undergo cellular internalization. The presence of the dyes within the cells did not affect cell viability. In addition, these dyes demonstrate changes in absorbance and fluorescence after the immune cells were challenged with a stimulant. Moreover, critical cellular functions, such as tumor necrosis factor release and superoxide production were not compromised by the internalization of the fluorescent dyes. These data suggest that selected NIR micro-sensor dyes can undergo intracellular internalization within isolated macrophages without adversely affecting various parameters of normal cellular activity.
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Affiliation(s)
- C T Reese
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD 21251, USA
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Hill DA, Wang SS, Cerhan JR, Davis S, Cozen W, Severson RK, Hartge P, Wacholder S, Yeager M, Chanock SJ, Rothman N. Risk of non-Hodgkin lymphoma (NHL) in relation to germline variation in DNA repair and related genes. Blood 2006; 108:3161-7. [PMID: 16857995 PMCID: PMC1895525 DOI: 10.1182/blood-2005-01-026690] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [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] [Indexed: 01/03/2023] Open
Abstract
Chromosomal translocations, insertions, and deletions are common early events in non-Hodgkin lymphoma (NHL) carcinogenesis, and implicated in their formation are endogenous processes involved in antigen-receptor diversification, such as V(D)J recombination. DNA repair genes respond to the double- and single-strand breaks induced by these processes and may influence NHL etiology. We examined 34 genetic variants in 19 genes within or related to 5 DNA repair pathways among 1172 cases and 982 matched controls who participated in a population-based NHL study in Los Angeles, Seattle, Detroit, and Iowa from 1998 to 2000. Cases were more likely than controls to have the RAG1 820 R/R (odds ratio [OR] = 2.7; 95% confidence interval [CI] = 1.4 to 5.0) than Lys/Lys genotypes, with evidence of a gene dosage effect (P trend < .001), and less likely to have the LIG4 (DNA ligase IV) 9 Ile/Ile (OR = 0.5; 95% CI = 0.3 to 0.9) than T/T genotype (P trend = .03) in the nonhomologous end joining (NHEJ)/V(D)J pathway. These NHEJ/V(D)J-related gene variants represent promising candidates for further studies of NHL etiology and require replication in other studies.
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Affiliation(s)
- Deirdre A Hill
- Cancer Center and Department of Internal Medicine, UNM School of Medicine, 1 University of New Mexico, MSC 10 5550, Albuquerque, NM 87131-0001, USA.
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Weiss JM, Saltzman BS, Doherty JA, Voigt LF, Chen C, Beresford SAA, Hill DA, Weiss NS. Risk factors for the incidence of endometrial cancer according to the aggressiveness of disease. Am J Epidemiol 2006; 164:56-62. [PMID: 16675538 DOI: 10.1093/aje/kwj152] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [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] [Indexed: 01/18/2023] Open
Abstract
There is a wide range of aggressiveness of endometrial tumors, some being indolent and easily treated while others metastasize and prove fatal. The authors used data from three population-based, case-control studies to determine if etiologic factors differ for aggressive disease. Interview data were obtained from 1,304 female residents of western Washington State who were 45-74 years of age and diagnosed with endometrial cancer during 1985-1991, 1994-1995, and 1997-1999 and from 1,779 controls who were of similar ages and selected primarily by random digit dialing. As a means of gauging aggressiveness, tumor characteristics were abstracted from the population-based cancer registry that serves western Washington State. The risk of endometrial cancer among long-term users (> or = 8 years) of unopposed estrogens was particularly high for the least aggressive tumors (odds ratio = 18.6, 95% confidence interval: 12.2, 28.6) but was elevated for moderate and highly aggressive tumors as well (odds ratios = 6.6 and 7.1, respectively). Women who were obese, had a history of diabetes, and had fewer than two children were also at increased risk, regardless of tumor aggressiveness, while oral contraceptive users were at decreased risk of only relatively more aggressive disease. In general, a woman's risk of endometrial cancer appears to be influenced by similar risk factors regardless of disease severity.
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Affiliation(s)
- Jocelyn M Weiss
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Hill DA, Gilbert E, Dores GM, Gospodarowicz M, van Leeuwen FE, Holowaty E, Glimelius B, Andersson M, Wiklund T, Lynch CF, Van't Veer M, Storm H, Pukkala E, Stovall M, Curtis RE, Allan JM, Boice JD, Travis LB. Breast cancer risk following radiotherapy for Hodgkin lymphoma: modification by other risk factors. Blood 2005; 106:3358-65. [PMID: 16051739 PMCID: PMC1895063 DOI: 10.1182/blood-2005-04-1535] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The importance of genetic and other risk factors in the development of breast cancer after radiotherapy (RT) for Hodgkin lymphoma (HL) has not been determined. We analyzed data from a breast cancer case-control study (105 patients, 266 control subjects) conducted among 3 817 survivors of HL diagnosed at age 30 years or younger in 6 population-based cancer registries. Odds ratios (ORs) and excess relative risks (ERRs) were calculated using conditional regression. Women who received RT exposure (> or = 5 Gy radiation dose to the breast) had a 2.7-fold increased breast cancer risk (95% confidence interval (CI) 1.4-5.2), compared with those given less than 5 Gy. RT exposure (> or = 5 Gy) was associated with an OR of 0.8 (95% CI, 0.2-3.4) among women with a first- or second-degree family history of breast or ovarian cancer, and 5.8 (95% CI, 2.1-16.3) among all other women (interaction P = .03). History of a live birth appeared to increase the breast cancer risk associated with RT among women not treated with ovarian-damaging therapies. Breast cancer risk following RT varied little according to other factors. The additional increased relative risk of breast cancer after RT for HL is unlikely to be larger among women with a family history of breast or ovarian cancer than among other women.
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Affiliation(s)
- Deirdre A Hill
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
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