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Sprague BL, Nowak SA, Ahern TP, Herschorn SD, Kaufman PA, Odde C, Perry H, Sowden MM, Vacek PM, Weaver DL. Long-term Mammography Screening Trends and Predictors of Return to Screening after the COVID-19 Pandemic: Results from a Statewide Registry. Radiol Imaging Cancer 2024; 6:e230161. [PMID: 38578209 DOI: 10.1148/rycan.230161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Purpose To evaluate long-term trends in mammography screening rates and identify sociodemographic and breast cancer risk characteristics associated with return to screening after the COVID-19 pandemic. Materials and Methods In this retrospective study, statewide screening mammography data of 222 384 female individuals aged 40 years or older (mean age, 58.8 years ± 11.7 [SD]) from the Vermont Breast Cancer Surveillance System were evaluated to generate descriptive statistics and Joinpoint models to characterize screening patterns during 2000-2022. Log-binomial regression models estimated associations of sociodemographic and risk characteristics with post-COVID-19 pandemic return to screening. Results The proportion of female individuals in Vermont aged 50-74 years with a screening mammogram obtained in the previous 2 years declined from a prepandemic level of 61.3% (95% CI: 61.1%, 61.6%) in 2019 to 56.0% (95% CI: 55.7%, 56.3%) in 2021 before rebounding to 60.7% (95% CI: 60.4%, 61.0%) in 2022. Screening adherence in 2022 remained substantially lower than that observed during the 2007-2010 apex of screening adherence (66.1%-67.0%). Joinpoint models estimated an annual percent change of -1.1% (95% CI: -1.5%, -0.8%) during 2010-2022. Among the cohort of 95 644 individuals screened during January 2018-March 2020, the probability of returning to screening during 2020-2022 varied by age (eg, risk ratio [RR] = 0.94 [95% CI: 0.93, 0.95] for age 40-44 vs age 60-64 years), race and ethnicity (RR = 0.84 [95% CI: 0.78, 0.90] for Black vs White individuals), education (RR = 0.84 [95% CI: 0.81, 0.86] for less than high school degree vs college degree), and by 5-year breast cancer risk (RR = 1.06 [95% CI: 1.04, 1.08] for very high vs average risk). Conclusion Despite a rebound to near prepandemic levels, Vermont mammography screening rates have steadily declined since 2010, with certain sociodemographic groups less likely to return to screening after the pandemic. Keywords: Mammography, Breast, Health Policy and Practice, Neoplasms-Primary, Epidemiology, Screening Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Brian L Sprague
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Sarah A Nowak
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Thomas P Ahern
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Sally D Herschorn
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Peter A Kaufman
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Catherine Odde
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Hannah Perry
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Michelle M Sowden
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Pamela M Vacek
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Donald L Weaver
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center (B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.), Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
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Rohan KJ, Terman JM, Iyiewuare P, Perez J, Camuso JA, Postolache TT, DeSarno MJ, Vacek PM. Prospectively assessed summer mood status in major depression, recurrent with seasonal pattern: Evidence for SAD's construct validity. J Affect Disord 2024; 349:32-38. [PMID: 38160889 PMCID: PMC10923172 DOI: 10.1016/j.jad.2023.12.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/05/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Seasonal patterns are often undetectable in population-based depression studies, calling into question the existence of winter seasonal affective disorder (SAD). If SAD has construct validity, individuals with SAD should show spontaneous depression remission in the summer. Data are sparse on prospectively assessed summer mood status in confirmed SAD patients. METHOD We conducted prospective summer followup of community adults who, the winter before, were diagnosed with Major Depression, Recurrent with Seasonal Pattern on the Structured Clinical Interview for DSM-IV Axis I Disorders, developed a current SAD episode on the Structured Interview Guide for the Hamilton Rating Scale for Depression-Seasonal Affective Disorder Version (SIGH-SAD), and enrolled in a clinical trial comparing group cognitive-behavioral therapy for SAD and light therapy. In July/August after treatment, 143/153 (93.5 %) participants provided data on the SIGH-SAD, the Beck Depression Inventory-Second Edition, and the Longitudinal Interval Followup Evaluation (LIFE). RESULTS Summer mean depression scores were in the normal range, with the substantial majority in remission across different measures. On the LIFE, 113/143 (79.0 %) experienced complete summer remission, 19/143 (13.3 %) experienced partial summer remission, and 11/143 (7.7 %) had major depression in the summer. Depression scores were significantly lower at summer than post-treatment in both treatments, indicating incomplete treatment response. LIMITATIONS This was a single-site study with a relatively homogeneous sample. CONCLUSIONS Supporting construct validity for SAD, the substantial majority experienced complete summer remission, with a minority in partial remission and a very small minority in episode. Both treatments left residual symptoms at treatment endpoint compared to summer.
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Affiliation(s)
- Kelly J Rohan
- Department of Psychological Science, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, USA.
| | - Julia M Terman
- Department of Psychological Science, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, USA
| | - Praise Iyiewuare
- Department of Psychological Science, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, USA
| | - Jessica Perez
- Department of Psychological Science, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, USA
| | - Julia A Camuso
- Department of Psychological Science, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, USA
| | - Teodor T Postolache
- Department of Psychiatry, University of Maryland School of Medicine, 685 West Baltimore Street, MSTF Building Room 930, Baltimore, MD 21201, USA; Rocky Mountain MIRECC for Suicide Prevention, 1700 N Wheeling Street, G-3-116M, Aurora, CO 80045, USA
| | - Michael J DeSarno
- Biomedical Statistics Research Core, University of Vermont Larner College of Medicine, 25 Hills Building, 111 Colchester Avenue, Burlington, VT 05401-0134, USA
| | - Pamela M Vacek
- Biomedical Statistics Research Core, University of Vermont Larner College of Medicine, 25 Hills Building, 111 Colchester Avenue, Burlington, VT 05401-0134, USA
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Reist H, Vacek PM, Endres N, Tourville TW, Failla M, Geeslin A, Geeslin M, Borah A, Krug M, Choquette R, Toth M, Beynnon BD. Risk Factors for Concomitant Meniscal Injury With Sport-Related Anterior Cruciate Ligament Injury. Orthop J Sports Med 2023; 11:23259671231196492. [PMID: 37693810 PMCID: PMC10492489 DOI: 10.1177/23259671231196492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background Previous studies of concomitant meniscal injury in athletes with anterior cruciate ligament (ACL) injury have examined age, sex, body mass index (BMI), injury mechanism, and time from injury to surgery as potential risk factors. Purpose To identify additional risk factors for concomitant meniscal injury, including preinjury joint laxity and lower extremity alignment, in athletes with sport-related ACL injury. Study Design Cross-sectional study; Level of evidence, 3. Methods This study included 180 participants aged 13 to 26 years who underwent ACL reconstruction (ACLR) after a first-time ACL injury sustained during participation in sport. Contralateral lower extremity alignment and joint laxity were used as surrogate measures for the injured knee before trauma. Concomitant meniscal tear patterns were identified at the time of ACLR. Sex-specific analyses were conducted. Results Concomitant meniscal injury was observed in 60.6% of the subjects. The prevalence of concomitant injury was higher in male than female participants (69.9% vs 54.2%; P = .035) due to a higher prevalence of lateral meniscal injuries (56.2% vs 38.3%; P = .018). Among male patients, there was a significant difference in the prevalence of concomitant lateral meniscal tear according to sport participation (≥9 vs <9 h/week: 67.4% vs 35.7%; P = .032). Among male patients, the likelihood of concomitant injury to both the lateral and medial menisci increased by 28.8% for each 1-mm decrease in navicular drop. Among female patients, the likelihood of concomitant injury to the lateral meniscus increased by 15% per degree increase in genu recurvatum and 14% per degree decrease in standing quadriceps angle, with similar effects on the likelihood of concurrent injury to both the lateral and medial menisci. Conclusion Measures of lower extremity alignment and genu recurvatum previously identified as risk factors for ACL injury were also associated with concomitant meniscal injury in female patients while other risk factors, including BMI and joint laxity, were not. Increased time spent participating in sport and navicular drop were associated with concomitant meniscal injury in male patients.
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Affiliation(s)
- Hailee Reist
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Pamela M. Vacek
- Department of Medical Biostatistics, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Nathan Endres
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Timothy W. Tourville
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Mathew Failla
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Andrew Geeslin
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Matthew Geeslin
- Department of Radiology, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Andy Borah
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mickey Krug
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Rebecca Choquette
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mike Toth
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Medicine, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Bruce D. Beynnon
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
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Lester-Coll NH, Skelly J, Vacek PM, Sprague BL. Trends and costs of stereotactic body radiation therapy in metastatic non-small cell lung cancer. J Thorac Dis 2022; 14:2579-2590. [PMID: 35928617 PMCID: PMC9344414 DOI: 10.21037/jtd-21-1835] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Nataniel H. Lester-Coll
- Division of Radiation Oncology, University of Vermont Larner College of Medicine, Burlington, VT, USA
- University of Vermont Cancer Center, Burlington, VT, USA
| | - Joan Skelly
- Medical Biostatistics Unit, University of Vermont, Burlington, VT, USA
| | - Pamela M. Vacek
- University of Vermont Cancer Center, Burlington, VT, USA
- Medical Biostatistics Unit, University of Vermont, Burlington, VT, USA
| | - Brian L. Sprague
- University of Vermont Cancer Center, Burlington, VT, USA
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA
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Rohan KJ, Franzen PL, Roeckelin KA, Siegle GJ, Kolko DJ, Postolache TT, Vacek PM. Elucidating treatment targets and mediators within a confirmatory efficacy trial: study protocol for a randomized controlled trial of cognitive-behavioral therapy vs. light therapy for winter depression. Trials 2022; 23:383. [PMID: 35550645 PMCID: PMC9096056 DOI: 10.1186/s13063-022-06330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/23/2022] [Indexed: 12/05/2022] Open
Abstract
Background This study is a confirmatory efficacy trial of two treatments for winter seasonal affective disorder (SAD): SAD-tailored group cognitive-behavioral therapy (CBT-SAD) and light therapy (LT). In our previous efficacy trial, post-treatment outcomes for CBT-SAD and LT were very similar, but CBT-SAD was associated with fewer depression recurrences two winters later than LT (27.3% in CBT-SAD vs. 45.6% in LT). CBT-SAD engaged and altered a specific mechanism of action, seasonal beliefs, which mediated CBT-SAD’s acute antidepressant effects and CBT-SAD’s enduring benefit over LT. Seasonal beliefs are theoretically distinct from LT’s assumed target and mechanism: correction of circadian phase. This study applies the experimental therapeutics approach to determine how each treatment works when it is effective and to identify the best candidates for each. Biomarkers of LT’s target and effect include circadian phase angle difference and the post-illumination pupil response. Biomarkers of CBT-SAD’s target and effect include decreased pupillary and sustained frontal gamma-band EEG responses to seasonal words, which are hypothesized as biomarkers of seasonal beliefs, reflecting less engagement with seasonal stimuli following CBT-SAD. In addition to determining change mechanisms, this study tests the efficacy of a “switch” decision rule upon recurrence to inform clinical decision-making in practice. Methods Adults with SAD (target N = 160) will be randomzied to 6-weeks of CBT-SAD or LT in winter 1; followed in winter 2; and, if a depression recurrence occurs, offered cross-over into the alternate treatment (i.e., switch from LT➔CBT-SAD or CBT-SAD➔LT). All subjects will be followed in winter 3. Biomarker assessments occur at pre-, mid-, and post-treatment in winter 1, at winter 2 follow-up (and again at mid-/post-treatment for those crossed-over), and at winter 3 follow-up. Primary efficacy analyses will test superiority of CBT-SAD over LT on depression recurrence status (the primary outcome). Mediation analyses will use parallel process latent growth curve modeling. Discussion Consistent with the National Institute of Mental Health’s priorities for demonstrating target engagement at the level of Research Domain Criteria-relevant biomarkers, this work aims to confirm the targets and mechanisms of LT and CBT-SAD to maximize the impact of future dissemination efforts. Trial registration ClinicalTrials.gov identifier: NCT03691792. Registered on October 2, 2018.
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Affiliation(s)
- Kelly J Rohan
- Department of Psychological Science, University of Vermont, 2 Colchester Avenue, Burlington, VT, 05405-0134, USA.
| | - Peter L Franzen
- Department of Psychiatry, University of Pittsburgh, Thomas Detre Hall, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Kathryn A Roeckelin
- Department of Psychology, University of Pittsburgh, 4110 Sennott Square, 210 S Bouquet Street, Pittsburgh, PA, 15260, USA
| | - Greg J Siegle
- Department of Psychiatry, University of Pittsburgh, Thomas Detre Hall, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - David J Kolko
- Department of Psychiatry, University of Pittsburgh, Thomas Detre Hall, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Teodor T Postolache
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201-1559, USA
| | - Pamela M Vacek
- Biomedical Statistics Research Core, University of Vermont Larner College of Medicine, 25 Hills Building, 111 Colchester Avenue, Burlington, VT, 05401-0134, USA
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Pius AK, Beynnon BD, Fiorentino N, Gardner-Morse M, Vacek PM, DeSarno M, Failla M, Slauterbeck JR, Sturnick DR, Argentieri EC, Tourville TW. Articular cartilage thickness changes differ between males and females 4 years following anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:65-73. [PMID: 34288090 DOI: 10.1002/jor.25142] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 11/09/2020] [Revised: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament injury and reconstruction (ACLR) affects articular cartilage thickness profiles about the tibial, femoral, and patellar surfaces; however, it's unclear whether the magnitudes of change in cartilage thickness, as well as the locations and areas over which these changes occur, differ between males and females. This is important to consider as differences exist between the sexes with regard to knee biomechanics, patellofemoral pain, and anatomic alignment, which influence risk of an index and repeated injury. Subjects underwent ACLR with a bone-patella tendon-bone autograft. At 4-year follow-up, they had asymptomatic knees; however, significant ACL injured-to-contralateral normal knee differences in articular cartilage thickness values were observed. Both thickening and thinning of cartilage occurred about the tibiofemoral and patellofemoral joints, relative to matched control subjects with normal knees. Further, the location of the areas and magnitudes of thickening and thinning were different between females and males. Thickening (swelling) of articular cartilage is an early finding associated with the onset of posttraumatic osteoarthritis (PTOA). Therefore, the increases in cartilage thickness that were observed in this cohort may represent early signs of the onset of PTOA that occur prior to the patient developing symptoms and radiographic evidence of this disease. The different locations of areas that underwent a change in cartilage thicknesses between males and females suggest that each sex responds differently to knee ligament trauma, reconstruction, rehabilitation, and return to activity, and indicates that sex-specific analysis should be utilized in studies of PTOA.
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Affiliation(s)
- Alexa K Pius
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Bruce D Beynnon
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.,Department of Mechanical Engineering, University of Vermont, Burlington, Vermont, USA.,Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, USA
| | - Niccolo Fiorentino
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.,Department of Mechanical Engineering, University of Vermont, Burlington, Vermont, USA.,Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, USA
| | - Mack Gardner-Morse
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Pamela M Vacek
- Department of Medical Biostatistics, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mike DeSarno
- Department of Medical Biostatistics, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mat Failla
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - James R Slauterbeck
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Daniel R Sturnick
- Department of Biomechanics, Hospital for Special Surgery, New York, USA
| | - Erin C Argentieri
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, USA
| | - Timothy W Tourville
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
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7
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Bodelon C, Mullooly M, Pfeiffer RM, Fan S, Abubakar M, Lenz P, Vacek PM, Weaver DL, Herschorn SD, Johnson JM, Sprague BL, Hewitt S, Shepherd J, Malkov S, Keely PJ, Eliceiri KW, Sherman ME, Conklin MW, Gierach GL. Mammary collagen architecture and its association with mammographic density and lesion severity among women undergoing image-guided breast biopsy. Breast Cancer Res 2021; 23:105. [PMID: 34753492 PMCID: PMC8579610 DOI: 10.1186/s13058-021-01482-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022] Open
Abstract
Background Elevated mammographic breast density is a strong breast cancer risk factor with poorly understood etiology. Increased deposition of collagen, one of the main fibrous proteins present in breast stroma, has been associated with increased mammographic density. Collagen fiber architecture has been linked to poor outcomes in breast cancer. However, relationships of quantitative collagen fiber features assessed in diagnostic biopsies with mammographic density and lesion severity are not well-established. Methods Clinically indicated breast biopsies from 65 in situ or invasive breast cancer cases and 73 frequency matched-controls with a benign biopsy result were used to measure collagen fiber features (length, straightness, width, alignment, orientation and density (fibers/µm2)) using second harmonic generation microscopy in up to three regions of interest (ROIs) per biopsy: normal, benign breast disease, and cancer. Local and global mammographic density volumes were quantified in the ipsilateral breast in pre-biopsy full-field digital mammograms. Associations of fibrillar collagen features with mammographic density and severity of biopsy diagnosis were evaluated using generalized estimating equation models with an independent correlation structure to account for multiple ROIs within each biopsy section. Results Collagen fiber density was positively associated with the proportion of stroma on the biopsy slide (p < 0.001) and with local percent mammographic density volume at both the biopsy target (p = 0.035) and within a 2 mm perilesional ring (p = 0.02), but not with global mammographic density measures. As severity of the breast biopsy diagnosis increased at the ROI level, collagen fibers tended to be less dense, shorter, straighter, thinner, and more aligned with one another (p < 0.05). Conclusions Collagen fiber density was positively associated with local, but not global, mammographic density, suggesting that collagen microarchitecture may not translate into macroscopic mammographic features. However, collagen fiber features may be markers of cancer risk and/or progression among women referred for biopsy based on abnormal breast imaging. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-021-01482-z.
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Affiliation(s)
- Clara Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Rm 7-E238, Bethesda, MD, 20892, USA.
| | - Maeve Mullooly
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Rm 7-E238, Bethesda, MD, 20892, USA
| | - Shaoqi Fan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Rm 7-E238, Bethesda, MD, 20892, USA
| | - Mustapha Abubakar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Rm 7-E238, Bethesda, MD, 20892, USA
| | - Petra Lenz
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Rm 7-E238, Bethesda, MD, 20892, USA
| | - Pamela M Vacek
- University of Vermont College of Medicine and Vermont Cancer Center, Burlington, VT, USA
| | - Donald L Weaver
- University of Vermont College of Medicine and Vermont Cancer Center, Burlington, VT, USA
| | - Sally D Herschorn
- University of Vermont College of Medicine and Vermont Cancer Center, Burlington, VT, USA
| | - Jason M Johnson
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian L Sprague
- University of Vermont College of Medicine and Vermont Cancer Center, Burlington, VT, USA
| | - Stephen Hewitt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Rm 7-E238, Bethesda, MD, 20892, USA
| | - John Shepherd
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | | | - Patricia J Keely
- Department of Cell and Regenerative Biology and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Ave., WIMR II Rm. 4528, Madison, WI, 53705, USA
| | - Kevin W Eliceiri
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Matthew W Conklin
- Department of Cell and Regenerative Biology and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Ave., WIMR II Rm. 4528, Madison, WI, 53705, USA.
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Rm 7-E238, Bethesda, MD, 20892, USA
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8
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Krug MI, Vacek PM, Choquette R, Beynnon BD, Slauterbeck JR. Compliance and Fidelity With an Injury Prevention Exercise Program in High School Athletics. Sports Health 2021; 14:483-489. [PMID: 34490822 DOI: 10.1177/19417381211043120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Use of injury prevention programs (IPPs) by high school athletes has increased but their success in reducing injury depends on program compliance and fidelity of exercise performance. HYPOTHESIS Compliance with the 11+ IPP and exercise performance fidelity by high school athletic teams depend on sex, sport, and level of play. STUDY DESIGN Secondary analyses of data from a randomized controlled trial (RCT). LEVEL OF EVIDENCE Level 2. METHODS The 11+ IPP was implemented by 100 male and female high school athletic teams (American football, soccer, basketball, and lacrosse). Team compliance and fidelity with the program were evaluated by direct observation of warm-up routines and a weekly online survey completed by coaches. Differences in compliance and fidelity due to sport, sex, and level of play were assessed by analysis of variance. RESULTS Coaches reported that their teams performed the full IPP an average of 1.45 times per week, and 28% of observed warm-ups included all exercises in the IPP. Compliance differed by sport but not by level of play or the athletes' sex. At the end of the season, cueing was observed 19% of the time and differed by sport. Good technique was observed 66% of the time and varied by level of play. CONCLUSION Team compliance with the IPP varied by sport and was below the recommended number of sessions per week needed to reduce injury. Removal of implementation barriers and improved support from coaches are needed at all levels of play for IPPs to be effective. CLINICAL RELEVANCE Clinical and sports practitioners intending to implement an IPP at the high school level should anticipate and address barriers that affect program compliance and fidelity of exercise performance. Frequent follow-up and instruction may be necessary for successful adoption of the IPP.
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Affiliation(s)
- Mickey I Krug
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Pamela M Vacek
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - Rebecca Choquette
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Bruce D Beynnon
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - James R Slauterbeck
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont
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9
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Rohan KJ, Meyerhoff J, Roecklein KA, DeSarno MJ, Vacek PM. Predictive validity of the Seasonal Beliefs Questionnaire for discriminating between seasonal and nonseasonal major depressive disorder. Psychol Assess 2021; 33:369-374. [PMID: 33734753 PMCID: PMC8352370 DOI: 10.1037/pas0000984] [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] [Indexed: 11/08/2022]
Abstract
The Seasonal Beliefs Questionnaire (SBQ) is a 26-item self-report measure of a winter seasonal affective disorder (SAD)-specific cognitive vulnerability consisting of maladaptive thoughts about the seasons, light availability, and weather conditions. In a known groups comparison, currently depressed adults with SAD had significantly higher SBQ scores than currently depressed adults with nonseasonal major depressive disorder (MDD) and healthy controls, and the MDD group had significantly higher SBQ scores than controls. Using that database, this study explored the predictive validity of using an SBQ cutoff score to differentiate SAD from MDD. Receiver operator characteristic curve analyses used SBQ total score to predict SAD versus MDD, SAD versus control, and MDD versus control status. The SBQ subscale combined score, derived from multivariable logistic regression with SBQ subscales, was examined as an alternative predictor. SBQ total score with a cutpoint of 132 had good predictive ability for distinguishing SAD from MDD (C-statistic = .792, sensitivity = .798, specificity = .794). The SBQ subscale combination score slightly improved predictive ability for the SAD/MDD distinction (C-statistic = .813), with better sensitivity (.930) but worse specificity (.571). In contrast, the score on a generic measure of depressogenic cognitive vulnerability, the Dysfunctional Attitudes Scale, was poor for differentiating SAD from MDD. SBQ total score was excellent in discriminating SAD cases from controls with a cutpoint of 121 (C-statistic = .962, sensitivity = .939, specificity .873), but had poor sensitivity for discriminating MDD cases from controls. Results support using the SBQ to screen for probable SAD in practice settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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10
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Schiffers C, van de Wetering C, Bauer RA, Habibovic A, Hristova M, Dustin CM, Lambrichts S, Vacek PM, Wouters EF, Reynaert NL, van der Vliet A. Downregulation of epithelial DUOX1 in chronic obstructive pulmonary disease. JCI Insight 2021; 6:142189. [PMID: 33301419 PMCID: PMC7934842 DOI: 10.1172/jci.insight.142189] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterized by small airway remodeling and alveolar emphysema due to environmental stresses such as cigarette smoking (CS). Oxidative stress is commonly implicated in COPD pathology, but recent findings suggest that one oxidant-producing NADPH oxidase homolog, dual oxidase 1 (DUOX1), is downregulated in the airways of patients with COPD. We evaluated lung tissue sections from patients with COPD for small airway epithelial DUOX1 protein expression, in association with measures of lung function and small airway and alveolar remodeling. We also addressed the impact of DUOX1 for lung tissue remodeling in mouse models of COPD. Small airway DUOX1 levels were decreased in advanced COPD and correlated with loss of lung function and markers of emphysema and remodeling. Similarly, DUOX1 downregulation in correlation with extracellular matrix remodeling was observed in a genetic model of COPD, transgenic SPC-TNF-α mice. Finally, development of subepithelial airway fibrosis in mice due to exposure to the CS-component acrolein, or alveolar emphysema induced by administration of elastase, were in both cases exacerbated in Duox1-deficient mice. Collectively, our studies highlight that downregulation of DUOX1 may be a contributing feature of COPD pathogenesis, likely related to impaired DUOX1-mediated innate injury responses involved in epithelial homeostasis.
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Affiliation(s)
- Caspar Schiffers
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.,Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Cheryl van de Wetering
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.,Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Robert A Bauer
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Aida Habibovic
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Milena Hristova
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Christopher M Dustin
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Sara Lambrichts
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Pamela M Vacek
- Department of Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Emiel Fm Wouters
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands.,Ludwig Boltzman Institute for Lung Health, Vienna, Austria
| | - Niki L Reynaert
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Albert van der Vliet
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
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11
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Rohan KJ, Camuso J, Perez J, Iyiewuare P, Meyerhoff J, DeSarno MJ, Vacek PM. Detecting Critical Decision Points during Cognitive-Behavioral Therapy and Light Therapy for Winter Depression Nonremission and Recurrence. J Behav Cogn Ther 2020; 30:241-252. [PMID: 36186272 PMCID: PMC9524476 DOI: 10.1016/j.jbct.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Using data from a clinical trial comparing cognitive-behavioral therapy (CBT-SAD) and light therapy (LT) for winter seasonal affective disorder (SAD; N = 177), we explored critical decision points, or treatment weeks, that predict likelihood of nonremission at post-treatment and depression recurrence following treatment. In receiver operator characteristic (ROC) curve analyses, we used weekly Structured Clinical Interview for the Hamilton Rating Scale for Depression-SAD Version (SIGH-SAD) scores during treatment to predict nonremission at post-treatment (Week 6) and recurrence one winter later (Winter 1), two winters later (Winter 2), and any recurrence. Although several C-statistics of ≥ .70 were found, only Week 4 SIGH-SAD scores in CBT-SAD for nonremission had enough predictive ability to inform clinical decision-making (C-statistic = .80; sensitivity = .91; specificity = .68). Week 4 of CBT-SAD may be a critical time point to identify likely nonremitters who need tailoring of intervention, based on SIGH-SAD cutpoint score ≥ 13. This study illustrates how clinical trial data can inform detecting optimal decision points in treatment for identifying patients unlikely to remit, a critical first step to developing adaptive treatment strategies using decision rules to operationalize when and for whom treatment should change to maximize clinical benefit.
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Affiliation(s)
- Kelly J. Rohan
- Department of Psychological Science, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, U.S.A
| | - Julia Camuso
- Department of Psychological Science, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, U.S.A
| | - Jessica Perez
- Department of Psychological Science, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, U.S.A
| | - Praise Iyiewuare
- Department of Psychological Science, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, U.S.A
| | - Jonah Meyerhoff
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago IL, 60611, U.S.A
| | - Michael J. DeSarno
- Biomedical Statistics Research Core, University of Vermont Larner College of Medicine, 25 Hills Building, 111 Colchester Avenue, Burlington, VT 05401-0134, U.S.A
| | - Pamela M. Vacek
- Biomedical Statistics Research Core, University of Vermont Larner College of Medicine, 25 Hills Building, 111 Colchester Avenue, Burlington, VT 05401-0134, U.S.A
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12
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Sprague BL, Vacek PM, Mulrow SE, Evans MF, Trentham-Dietz A, Herschorn SD, James TA, Surachaicharn N, Keikhosravi A, Eliceiri KW, Weaver DL, Conklin MW. Collagen Organization in Relation to Ductal Carcinoma In Situ Pathology and Outcomes. Cancer Epidemiol Biomarkers Prev 2020; 30:80-88. [PMID: 33082201 DOI: 10.1158/1055-9965.epi-20-0889] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/25/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is widespread interest in discriminating indolent from aggressive ductal carcinoma in situ (DCIS). We sought to evaluate collagen organization in the DCIS tumor microenvironment in relation to pathologic characteristics and patient outcomes. METHODS We retrieved fixed tissue specimens for 90 DCIS cases within the population-based Vermont DCIS Cohort. We imaged collagen fibers within 75 μm of the tumor/stromal boundary on hematoxylin and eosin-stained slides using multiphoton microscopy with second-harmonic generation. Automated software quantified collagen fiber length, width, straightness, density, alignment, and angle to the tumor/stroma boundary. Factor analysis identified linear combinations of collagen fiber features representing composite attributes of collagen organization. RESULTS Multiple collagen features were associated with DCIS grade, necrosis pattern, or periductal fibrosis (P < 0.05). After adjusting for treatments and nuclear grade, risk of recurrence (defined as any second breast cancer diagnosis) was lower among cases with greater collagen fiber width [hazard ratio (HR), 0.57 per one standard deviation increase; 95% confidence interval (CI), 0.39-0.84] and fiber density (HR, 0.60; 95% CI, 0.42-0.85), whereas risk was elevated among DCIS cases with higher fiber straightness (HR, 1.47; 95% CI, 1.05-2.06) and distance to the nearest two fibers (HR, 1.47; 95% CI, 1.06-2.02). Fiber length, alignment, and fiber angle were not associated with recurrence (P > 0.05). Five composite factors were identified, accounting for 72.4% of the total variability among fibers; three were inversely associated with recurrence (HRs ranging from 0.60 to 0.67; P ≤ 0.01). CONCLUSIONS Multiple aspects of collagen organization around DCIS lesions are associated with recurrence risk. IMPACT Collagen organization should be considered in the development of prognostic DCIS biomarker signatures.
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Affiliation(s)
- Brian L Sprague
- Department of Surgery, Office of Health Promotion Research, University of Vermont Larner College of Medicine, Burlington, Vermont. .,University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont.,Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Pamela M Vacek
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont.,Department of Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - Sophie E Mulrow
- Department of Surgery, Office of Health Promotion Research, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Mark F Evans
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont.,Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Amy Trentham-Dietz
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin.,Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sally D Herschorn
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont.,Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Ted A James
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nuntida Surachaicharn
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Adib Keikhosravi
- Department of Biomedical Engineering, Laboratory for Optical and Computations Instrumentation, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kevin W Eliceiri
- Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Biomedical Engineering, Laboratory for Optical and Computations Instrumentation, University of Wisconsin-Madison, Madison, Wisconsin
| | - Donald L Weaver
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont.,Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Matthew W Conklin
- Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin. .,Department of Cell and Regenerative Biology, University of Wisconsin-Madison, Madison, Wisconsin
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13
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Mullooly M, Fan S, Pfeiffer RM, Sprague B, Vacek PM, Weaver DL, Shepherd JA, Mahmoudzadeh AP, Wang J, Malkov S, Johnson JM, Herschorn SD, Gierach GL. Abstract NG15: Investigation of relationships between breast cancer risk factors and bilateral mammographic breast density asymmetry among women undergoing diagnostic image-guided breast biopsies. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ng15] [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: The etiology of breast cancer remains an area of ongoing investigation. Improving our understanding of factors associated with breast cancer development will strengthen the utility of risk prediction strategies and improve risk stratification. Mammographic breast density remains one of the most influential breast cancer risk factors, with 4 to 6 fold elevated risk observed among women with the highest compared to the lowest levels. These associations have consistently been observed irrespective of the method (visual or automated), used to quantify breast density, showing the robustness of the associations. An understudied breast cancer risk factor is the bilateral asymmetry of mammographic features, with prior studies suggesting that women with higher levels of breast asymmetry may be at elevated breast cancer risk. Increasingly, studies are recognizing the potential of bilateral breast asymmetry defined by mammographic breast density in determining breast cancer risk. Recently, Eriksson and colleagues highlighted a strong influence of breast asymmetry within a model they developed to predict short-term breast cancer risk among women attending breast screening. They observed that the contribution to the model of asymmetry in mammographic breast density, microcalcifications, and masses between the breasts was as substantial as the total number of microcalcifications and masses found within a mammogram, indicating that differences between the breasts may be an important risk marker. To help further understand associations between breast cancer risk factors and asymmetry of breast density, particularly among women at elevated risk for breast cancer, we evaluated risk factor relationships with the bilateral asymmetry of volumetric measures of global and local breast density across the spectrum of premalignant and invasive breast cancer diagnoses. Methods: This study included 882 women enrolled as part of the National Cancer Institute's Breast Radiology Evaluation and Study of Tissues (BREAST)-Stamp Project (2007-2010). The BREAST-Stamp Project is a cross-sectional molecular epidemiologic study that aims to understand how novel breast density measures are related to breast cancer etiology. Women were enrolled if they were referred for diagnostic image-guided breast biopsy following an abnormal mammogram at the University of Vermont Medical Center, and had not previously been diagnosed or treated for cancer, undergone breast surgery within one year or received chemoprevention. Risk factor data were collected at study enrolment via interview and self-administered questionnaires. Breast density measures were estimated using Single X-ray Absorptiometry (SXA), a technique in which an SXA breast density phantom was affixed to the compression paddle of the mammography machine during routine mammography so that it was included in the X-ray field. It served as a reference standard to estimate volumetric breast density. Breast density was assessed using pre-biopsy craniocaudal full-field digital mammograms of both the ipsilateral (affected) and contralateral (unaffected) breast. Firstly, global density from each laterality was determined as percent fibroglandular volume (%FGV). Secondly, localized volumetric density measures were estimated following identification of the biopsy site on the ipsilateral pre-biopsy mammogram by the study radiologist and identifying the corresponding site on the contralateral mammogram. The SXA estimated %FGV in a perilesional volume twice the size of, but excluding, the biopsy target, centered at the biopsy site. Previous estimates of reproducibility for the SXA test phantoms demonstrated a repeatability SD of 2%, with a ±2% accuracy for the entire thickness and density ranges. Breast density asymmetry was defined as an absolute bilateral difference in measures when subtracting the breast density measures of the contralateral breast from the ipsilateral measures. Spearman's correlations (rho) examined associations between breast density measures of the left and right breasts. To determine relationships between breast cancer risk factors (defined as categorical variables) and measures of bilateral breast density asymmetry, analysis of covariance (ANCOVA) models (PROC GLM) were used. Analyses were conducted at the per woman level using SAS. Probability values of <0.05 were considered statistically significant, and all tests were two-tailed. Results:We initially investigated asymmetry within each woman by examining correlations between breast density measures in the left and right breasts. Strong, positive correlations between the ipsilateral and contralateral breast were observed for each breast density measure (rho for global %FGV=0.89, p-value<0.0001; rho for local %FGV=0.79, p-value<0.0001). Breast asymmetry was observed in the majority of the study population. For global %FGV, 76% of women had a bilateral difference ≥2%, with 43% of women having higher %FGV in their ipsilateral affected breast and 33% having higher in their contralateral unaffected breast. For localized %FGV, the majority of women had differences between their two breasts (89%), with 61% of women having higher localized %FGV in their ipsilateral affected breast compared to the remaining 28% who had higher localized breast density in their unaffected breast. We next examined relationships between breast cancer risk factors and breast asymmetry. Overall, no associations were observed between any of the risk factors examined, including age, race, body mass index, education, menopausal status, menopausal hormone therapy use with absolute bilateral differences in global or localized %FGV. Among the study population, most women had a benign breast disease diagnosis, with 33% and 43% being diagnosed with benign non-proliferative and benign proliferative lesions, respectively. Of the study population, 15% were diagnosed with invasive breast cancer. Overall, no differences were observed in bilateral differences in global %FGV according to diagnosis; however, higher mean bilateral differences in localized %FGV were observed for women with invasive compared to other diagnoses including benign and in-situ lesions (p=0.056). Discussion and conclusions: Our findings showed that breast asymmetry, defined by bilateral differences in global and localized mammographic breast density, was mostly unrelated to breast cancer risk factors among women undergoing an image guided breast biopsy. We observed that localized measures, defined according to within-woman bilateral differences in localized %FGV surrounding a suspicious lesion as compared with localized %FVG in a comparable location in the contralateral breast, may be an indication of cancer. This investigation is currently ongoing and efforts are underway to replicate findings using evolving image analysis methods such as Volpara Density Maps, an FDA-approved breast imaging tool which provides volumetric estimates of local glandular tissue distribution. Further, the ascertainment of 10-year follow-up data within this study population is in progress, which will facilitate prospective investigations of the relationship between breast asymmetry and breast cancer risk. Ongoing work will also extend our understanding of whether breast asymmetry is related to individualized breast cancer risk, defined using tailored breast cancer risk assessment tools. In conclusion, further understanding of breast asymmetry is needed to better exploit how bilateral differences in mammographic features may be used to inform breast cancer etiology as well as future breast cancer risk.
Citation Format: Maeve Mullooly, Shaoqi Fan, Ruth M. Pfeiffer, Brian Sprague, Pamela M. Vacek, Donald L. Weaver, John A. Shepherd, Amir Pasha Mahmoudzadeh, Jeff Wang, Serghei Malkov, Jason M. Johnson, Sally D. Herschorn, Gretchen L. Gierach. Investigation of relationships between breast cancer risk factors and bilateral mammographic breast density asymmetry among women undergoing diagnostic image-guided breast biopsies [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr NG15.
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Affiliation(s)
- Maeve Mullooly
- Royal College of Surgeons in Ireland, Dublin, Ireland, National Cancer Institute, Rockville, MD, University of Vermont Medical Center, Burlington, VT, University of Hawaii Cancer Center, Honolulu, HI, University of California, San Francisco, San Francisco, CA, Hokkaido University Graduate School of Medicine, Sapporo, Japan, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shaoqi Fan
- Royal College of Surgeons in Ireland, Dublin, Ireland, National Cancer Institute, Rockville, MD, University of Vermont Medical Center, Burlington, VT, University of Hawaii Cancer Center, Honolulu, HI, University of California, San Francisco, San Francisco, CA, Hokkaido University Graduate School of Medicine, Sapporo, Japan, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ruth M. Pfeiffer
- Royal College of Surgeons in Ireland, Dublin, Ireland, National Cancer Institute, Rockville, MD, University of Vermont Medical Center, Burlington, VT, University of Hawaii Cancer Center, Honolulu, HI, University of California, San Francisco, San Francisco, CA, Hokkaido University Graduate School of Medicine, Sapporo, Japan, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian Sprague
- Royal College of Surgeons in Ireland, Dublin, Ireland, National Cancer Institute, Rockville, MD, University of Vermont Medical Center, Burlington, VT, University of Hawaii Cancer Center, Honolulu, HI, University of California, San Francisco, San Francisco, CA, Hokkaido University Graduate School of Medicine, Sapporo, Japan, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pamela M. Vacek
- Royal College of Surgeons in Ireland, Dublin, Ireland, National Cancer Institute, Rockville, MD, University of Vermont Medical Center, Burlington, VT, University of Hawaii Cancer Center, Honolulu, HI, University of California, San Francisco, San Francisco, CA, Hokkaido University Graduate School of Medicine, Sapporo, Japan, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Donald L. Weaver
- Royal College of Surgeons in Ireland, Dublin, Ireland, National Cancer Institute, Rockville, MD, University of Vermont Medical Center, Burlington, VT, University of Hawaii Cancer Center, Honolulu, HI, University of California, San Francisco, San Francisco, CA, Hokkaido University Graduate School of Medicine, Sapporo, Japan, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John A. Shepherd
- Royal College of Surgeons in Ireland, Dublin, Ireland, National Cancer Institute, Rockville, MD, University of Vermont Medical Center, Burlington, VT, University of Hawaii Cancer Center, Honolulu, HI, University of California, San Francisco, San Francisco, CA, Hokkaido University Graduate School of Medicine, Sapporo, Japan, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amir Pasha Mahmoudzadeh
- Royal College of Surgeons in Ireland, Dublin, Ireland, National Cancer Institute, Rockville, MD, University of Vermont Medical Center, Burlington, VT, University of Hawaii Cancer Center, Honolulu, HI, University of California, San Francisco, San Francisco, CA, Hokkaido University Graduate School of Medicine, Sapporo, Japan, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeff Wang
- Royal College of Surgeons in Ireland, Dublin, Ireland, National Cancer Institute, Rockville, MD, University of Vermont Medical Center, Burlington, VT, University of Hawaii Cancer Center, Honolulu, HI, University of California, San Francisco, San Francisco, CA, Hokkaido University Graduate School of Medicine, Sapporo, Japan, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Serghei Malkov
- Royal College of Surgeons in Ireland, Dublin, Ireland, National Cancer Institute, Rockville, MD, University of Vermont Medical Center, Burlington, VT, University of Hawaii Cancer Center, Honolulu, HI, University of California, San Francisco, San Francisco, CA, Hokkaido University Graduate School of Medicine, Sapporo, Japan, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason M. Johnson
- Royal College of Surgeons in Ireland, Dublin, Ireland, National Cancer Institute, Rockville, MD, University of Vermont Medical Center, Burlington, VT, University of Hawaii Cancer Center, Honolulu, HI, University of California, San Francisco, San Francisco, CA, Hokkaido University Graduate School of Medicine, Sapporo, Japan, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sally D. Herschorn
- Royal College of Surgeons in Ireland, Dublin, Ireland, National Cancer Institute, Rockville, MD, University of Vermont Medical Center, Burlington, VT, University of Hawaii Cancer Center, Honolulu, HI, University of California, San Francisco, San Francisco, CA, Hokkaido University Graduate School of Medicine, Sapporo, Japan, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gretchen L. Gierach
- Royal College of Surgeons in Ireland, Dublin, Ireland, National Cancer Institute, Rockville, MD, University of Vermont Medical Center, Burlington, VT, University of Hawaii Cancer Center, Honolulu, HI, University of California, San Francisco, San Francisco, CA, Hokkaido University Graduate School of Medicine, Sapporo, Japan, The University of Texas MD Anderson Cancer Center, Houston, TX
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14
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Davey AP, Vacek PM, Caldwell RA, Slauterbeck JR, Gardner-Morse MG, Tourville TW, Beynnon BD. Risk Factors Associated With a Noncontact Anterior Cruciate Ligament Injury to the Contralateral Knee After Unilateral Anterior Cruciate Ligament Injury in High School and College Female Athletes: A Prospective Study. Am J Sports Med 2019; 47:3347-3355. [PMID: 31689130 PMCID: PMC9295727 DOI: 10.1177/0363546519886260] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence of contralateral anterior cruciate ligament (CACL) injuries after recovery from a first-time anterior cruciate ligament (ACL) disruption is high in women; however, little is known about the risk factors associated with this trauma. HYPOTHESIS Patient characteristics, strength, anatomic alignment, and neuromuscular characteristics of the contralateral uninjured leg at the time of the first ACL trauma are associated with risk of subsequent CACL injury, and these risk factors are distinct from those for a first-time ACL injury. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Sixty-one women who suffered a first-time noncontact ACL injury while participating in high school or college sports and underwent measurement of potential risk factors on their contralateral limb soon after the initial ACL injury and before reconstruction were followed until either a CACL injury or an ACL graft injury occurred, or until the last date of contact. RESULTS Follow-up information was available for 55 (90.0%) of the 61 athletes and 11 (20.0%) suffered a CACL injury. Younger age, decreased participation in sport before the first ACL disruption, decreased anterior stiffness of the contralateral knee, and increased hip anteversion were associated with increases in the risk of suffering a CACL injury. CONCLUSION A portion of CACL injury risk factors were modifiable (time spent participating in sport and increasing anterior knee stiffness with bracing), while others were nonmodifiable (younger age and increased hip anteversion). The relationship between younger age at the time of an initial ACL injury and increased risk of subsequent CACL trauma may be explained by younger athletes having more years available to be exposed to at-risk activities compared with older athletes. A decrease of anterior stiffness of the knee is linked to decreased material properties and width of the ACL, and this may explain why some women are predisposed to bilateral ACL trauma while others only suffer the index injury. The risk factors for CACL injury are unique to women who suffer bilateral ACL trauma compared with those who suffer unilateral ACL trauma. This information is important for the identification of athletes who may benefit from risk reduction interventions.
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Affiliation(s)
- Annabelle P. Davey
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Pamela M. Vacek
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Ryan A. Caldwell
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - James R. Slauterbeck
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mack G. Gardner-Morse
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Timothy W. Tourville
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Bruce D. Beynnon
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA.,Address correspondence to Bruce D. Beynnon, MS, PhD, McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, VT 05405-0084, USA ()
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15
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Mullooly M, Ehteshami Bejnordi B, Pfeiffer RM, Fan S, Palakal M, Hada M, Vacek PM, Weaver DL, Shepherd JA, Fan B, Mahmoudzadeh AP, Wang J, Malkov S, Johnson JM, Herschorn SD, Sprague BL, Hewitt S, Brinton LA, Karssemeijer N, van der Laak J, Beck A, Sherman ME, Gierach GL. Application of convolutional neural networks to breast biopsies to delineate tissue correlates of mammographic breast density. NPJ Breast Cancer 2019; 5:43. [PMID: 31754628 PMCID: PMC6864056 DOI: 10.1038/s41523-019-0134-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 09/30/2019] [Indexed: 01/27/2023] Open
Abstract
Breast density, a breast cancer risk factor, is a radiologic feature that reflects fibroglandular tissue content relative to breast area or volume. Its histology is incompletely characterized. Here we use deep learning approaches to identify histologic correlates in radiologically-guided biopsies that may underlie breast density and distinguish cancer among women with elevated and low density. We evaluated hematoxylin and eosin (H&E)-stained digitized images from image-guided breast biopsies (n = 852 patients). Breast density was assessed as global and localized fibroglandular volume (%). A convolutional neural network characterized H&E composition. In total 37 features were extracted from the network output, describing tissue quantities and morphological structure. A random forest regression model was trained to identify correlates most predictive of fibroglandular volume (n = 588). Correlations between predicted and radiologically quantified fibroglandular volume were assessed in 264 independent patients. A second random forest classifier was trained to predict diagnosis (invasive vs. benign); performance was assessed using area under receiver-operating characteristics curves (AUC). Using extracted features, regression models predicted global (r = 0.94) and localized (r = 0.93) fibroglandular volume, with fat and non-fatty stromal content representing the strongest correlates, followed by epithelial organization rather than quantity. For predicting cancer among high and low fibroglandular volume, the classifier achieved AUCs of 0.92 and 0.84, respectively, with epithelial organizational features ranking most important. These results suggest non-fatty stroma, fat tissue quantities and epithelial region organization predict fibroglandular volume. The model holds promise for identifying histological correlates of cancer risk in patients with high and low density and warrants further evaluation.
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Affiliation(s)
- Maeve Mullooly
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD USA
| | - Babak Ehteshami Bejnordi
- Department of Pathology, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD USA
| | - Shaoqi Fan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD USA
| | - Maya Palakal
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD USA
| | - Manila Hada
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD USA
| | - Pamela M. Vacek
- University of Vermont and University of Vermont Cancer Center, Burlington, VT USA
| | - Donald L. Weaver
- University of Vermont and University of Vermont Cancer Center, Burlington, VT USA
| | - John A. Shepherd
- University of California, San Francisco, San Francisco, CA USA
- University of Hawaii Cancer Center, Honolulu, HI USA
| | - Bo Fan
- University of California, San Francisco, San Francisco, CA USA
| | | | - Jeff Wang
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Serghei Malkov
- University of California, San Francisco, San Francisco, CA USA
| | - Jason M. Johnson
- The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Sally D. Herschorn
- University of Vermont and University of Vermont Cancer Center, Burlington, VT USA
| | - Brian L. Sprague
- University of Vermont and University of Vermont Cancer Center, Burlington, VT USA
| | - Stephen Hewitt
- Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
| | - Louise A. Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD USA
| | - Nico Karssemeijer
- Department of Pathology, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - Jeroen van der Laak
- Department of Pathology, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - Andrew Beck
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | | | - Gretchen L. Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD USA
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16
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Mullooly M, Puvanesarajah S, Fan S, Pfeiffer RM, Olsson LT, Hada M, Kirk EL, Vacek PM, Weaver DL, Shepherd J, Mahmoudzadeh A, Wang J, Malkov S, Johnson JM, Hewitt SM, Herschorn SD, Sherman ME, Troester MA, Gierach GL. Using Digital Pathology to Understand Epithelial Characteristics of Benign Breast Disease among Women Undergoing Diagnostic Image-Guided Breast Biopsy. Cancer Prev Res (Phila) 2019; 12:861-870. [PMID: 31645342 DOI: 10.1158/1940-6207.capr-19-0120] [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] [Received: 02/27/2019] [Revised: 09/09/2019] [Accepted: 10/17/2019] [Indexed: 11/16/2022]
Abstract
Delayed terminal duct lobular unit (TDLU) involution is associated with elevated mammographic breast density (MD). Both are independent breast cancer risk factors among women with benign breast disease (BBD). Prior digital analyses of normal breast tissues revealed that epithelial nuclear density (END) and TDLU involution are inversely correlated. Accordingly, we examined associations of END, TDLU involution, and MD in BBD clinical biopsies. This study included digitized images of 262 representative image-guided hematoxylin and eosin-stained biopsies from 224 women diagnosed with BBD, enrolled within the cross-sectional BREAST-Stamp project that were visually assessed for TDLU involution (TDLU count/100 mm2, median TDLU span and median acini count per TDLU). A digital algorithm estimated nuclei count per unit epithelial area, or END. Single X-ray absorptiometry of prebiopsy ipsilateral craniocaudal digital mammograms measured global and localized MD surrounding the biopsy region. Adjusted ordinal logistic regression models assessed relationships between tertiles of TDLU and END measures. Analysis of covariance examined mean differences in MD across END tertiles. TDLU measures were positively associated with increasing END tertiles [TDLU count/100 mm2, ORT3vsT1: 3.42, 95% confidence interval (CI), 1.87-6.28; acini count/TDLUT3vsT1, OR: 2.40, 95% CI, 1.39-4.15]. END was significantly associated with localized, but not, global MD. Relationships were most apparent among patients with nonproliferative BBD. These findings suggest that quantitative END reflects different but complementary information to the histologic information captured by visual TDLU and radiologic MD measures and merits continued evaluation in assessing cellularity of breast parenchyma to understand the etiology of BBD.
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Affiliation(s)
- Maeve Mullooly
- Division of Population Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | | | - Shaoqi Fan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Linnea T Olsson
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Manila Hada
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Erin L Kirk
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Pamela M Vacek
- The University of Vermont and The University of Vermont Cancer Center, Burlington, Vermont
| | - Donald L Weaver
- The University of Vermont and The University of Vermont Cancer Center, Burlington, Vermont
| | - John Shepherd
- University of Hawaii Cancer Center, Honolulu, Hawaii
| | | | - Jeff Wang
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Serghei Malkov
- University of California, San Francisco, San Francisco, California
| | - Jason M Johnson
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen M Hewitt
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Sally D Herschorn
- The University of Vermont and The University of Vermont Cancer Center, Burlington, Vermont
| | | | - Melissa A Troester
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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17
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Rando RJ, Vacek PM, Glenn RE, Kwon CW, Parker JE. Retrospective Assessment of Respirable Quartz Exposure for a Silicosis Study of the Industrial Sand Industry. Ann Work Expo Health 2019; 62:1021-1032. [PMID: 30016388 DOI: 10.1093/annweh/wxy064] [Citation(s) in RCA: 8] [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] [Received: 10/31/2017] [Accepted: 06/26/2018] [Indexed: 11/14/2022] Open
Abstract
Background In 2016, the OSHA PEL for crystalline silica was reduced, renewing interest in evaluating risk of silicosis from occupational exposures. The industrial sand industry, which deals with high-purity quartz sands, is the setting for a current epidemiologic investigation of silicosis risk and progression. In support of that investigation, respirable quartz (RQ) exposures were retrospectively estimated for 67 workers with silicosis and 167 matched control workers from 21 industrial sand plants, in which some started work as early as 1929. Methods A job exposure matrix (JEM) was constructed by integrating a modern (post-1970) RQ exposure database containing more than 40000 measurements with archival particle count exposure data from a 1947 survey. A simulation algorithm was used to develop a conversion factor to convert the archival particle count data into modern measures of RQ by randomly generating 100000 virtual dust particles of varying diameters corresponding to the size distributions of 14 archival particle size distribution samples. The equivalent respirable mass and particle counts of the virtual particles were calculated, totalled, and ratioed to derive the conversion factor. The JEM was integrated with individual job histories to calculate average and cumulative exposure for each case and control. Multiple exposure estimates were derived for unprotected exposures as well as for exposures adjusted for estimated respiratory protective equipment use and efficiency. Results The mean of the count to respirable mass conversion factors derived from 14 archival particle size samples was 157 µg m-3 per mppcf (SD: 42; range: 96-263) with no statistical difference across process areas (drying, screening, vibrating, binning, bulk loading, bagging), P = 0.29. The JEM demonstrated an industry-wide decrease in prevailing exposures to RQ of up to about 2 orders of magnitude from the distant (1929) to the recent (2012) past. Unadjusted cumulative exposures for cases and controls were statistically different (P < 0.001) with respective medians (range) of 3764 µg m-3 year (221-25121) and 1595 µg m-3 year (0-16446). Adjustment of exposure for use of respiratory protection showed modest reductions in estimated exposure: median adjusted cumulative exposures assuming a protection factor of 5 were 86% and 77% of the unadjusted values for cases and controls, respectively. Conclusions The industrial sand industry offers a unique setting for examination of silicosis risk because of the high silica content of industrial sand and a long history of radiographic silicosis surveillance of industry workers. However, the great majority of silicosis cases in this industry are found among former workers and are associated with exposures occurring in the distant past, which necessitates extensive retrospective exposure assessment and increases the likelihood of exposure misclassification. Nonetheless, the estimated cumulative exposures for silicosis cases and controls in this work were significantly different, with the median cumulative exposure for cases being more than twice that of their matched controls.
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Affiliation(s)
- Roy J Rando
- Tulane University, School of Public Health & Tropical Medicine, Department of Global Environmental Health Science, New Orleans, LA, USA
| | - Pamela M Vacek
- University of Vermont, Medical Biostatistics Unit, Larner College of Medicine, Burlington, VT, USA
| | | | - Cheol Woong Kwon
- Tulane University, School of Public Health & Tropical Medicine, Department of Global Environmental Health Science, New Orleans, LA, USA
| | - John E Parker
- West Virginia University, School of Medicine, Section of Pulmonary and Critical Care, Morgantown, WV, USA
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18
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Hada M, Oh H, Pfeiffer RM, Falk RT, Fan S, Mullooly M, Pollak M, Geller B, Vacek PM, Weaver D, Shepherd J, Wang J, Fan B, Mahmoudzadeh AP, Malkov S, Herschorn S, Brinton LA, Sherman ME, Gierach GL. Relationship of circulating insulin-like growth factor-I and binding proteins 1-7 with mammographic density among women undergoing image-guided diagnostic breast biopsy. Breast Cancer Res 2019; 21:81. [PMID: 31337427 PMCID: PMC6651938 DOI: 10.1186/s13058-019-1162-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/19/2019] [Indexed: 12/15/2022] Open
Abstract
Background Mammographic density (MD) is a strong breast cancer risk factor that reflects fibroglandular and adipose tissue composition, but its biologic underpinnings are poorly understood. Insulin-like growth factor binding proteins (IGFBPs) are markers that may be associated with MD given their hypothesized role in breast carcinogenesis. IGFBPs sequester IGF-I, limiting its bioavailability. Prior studies have found positive associations between circulating IGF-I and the IGF-I:IGFBP-3 ratio and breast cancer risk. We evaluated the associations of IGF-I, IGFBP-3, and six other IGFBPs with MD. Methods Serum IGF measures were quantified in 296 women, ages 40–65, undergoing diagnostic image-guided breast biopsy. Volumetric density measures (MD-V) were assessed in pre-biopsy digital mammograms using single X-ray absorptiometry. Area density measures (MD-A) were estimated by computer-assisted thresholding software. Age, body mass index (BMI), and BMI2-adjusted linear regression models were used to examine associations of serum IGF measures with MD. Effect modification by BMI was also assessed. Results IGF-I and IGFBP-3 were not strongly associated with MD after BMI adjustment. In multivariable analyses among premenopausal women, IGFBP-2 was positively associated with both percent MD-V (β = 1.49, p value = 0.02) and MD-A (β = 1.55, p value = 0.05). Among postmenopausal women, positive relationships between IGFBP-2 and percent MD-V (β = 2.04, p = 0.003) were observed; the positive associations between IGFBP-2 and percent MD-V were stronger among lean women (BMI < 25 kg/m2) (β = 5.32, p = 0.0002; p interaction = 0.0003). Conclusions In this comprehensive study of IGFBPs and MD, we observed a novel positive association between IGFBP-2 and MD, particularly among women with lower BMI. In concert with in vitro studies suggesting a dual role of IGFBP-2 on breast tissue, promoting cell proliferation as well as inhibiting tumorigenesis, our findings suggest that further studies assessing the role of IGFBP-2 in breast tissue composition, in addition to IGF-1 and IGFBP-3, are warranted. Electronic supplementary material The online version of this article (10.1186/s13058-019-1162-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manila Hada
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Hannah Oh
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Ruth M Pfeiffer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Roni T Falk
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shaoqi Fan
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Berta Geller
- University of Vermont and Vermont Cancer Center, Burlington, VT, USA
| | - Pamela M Vacek
- University of Vermont and Vermont Cancer Center, Burlington, VT, USA
| | - Donald Weaver
- University of Vermont and Vermont Cancer Center, Burlington, VT, USA
| | | | - Jeff Wang
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Bo Fan
- University of California San Francisco, San Francisco, CA, USA
| | | | - Serghei Malkov
- University of California San Francisco, San Francisco, CA, USA
| | - Sally Herschorn
- University of Vermont and Vermont Cancer Center, Burlington, VT, USA
| | - Louise A Brinton
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Gretchen L Gierach
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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19
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Nicklas JA, Vacek PM, Carter EW, McDiarmid M, Albertini RJ. Molecular analysis of glycosylphosphatidylinositol anchor deficient aerolysin resistant isolates in gulf war i veterans exposed to depleted uranium. Environ Mol Mutagen 2019; 60:470-493. [PMID: 30848503 DOI: 10.1002/em.22283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 06/09/2023]
Abstract
During the First Gulf War (1991) over 100 servicemen sustained depleted uranium (DU) exposure through wound contamination, inhalation, and shrapnel. The Department of Veterans Affairs has a surveillance program for these Veterans which has included genotoxicity assays. The frequencies of glycosylphosphatidylinositol anchor (GPIa) negative (aerolysin resistant) cells determined by cloning assays for these Veterans are reported in Albertini RJ et al. (2019: Environ Mol Mutagen). Molecular analyses of the GPIa biosynthesis class A (PIGA) gene was performed on 862 aerolysin-resistant T-lymphocyte recovered isolates. The frequencies of different types of PIGA mutations were compared between high and low DU exposure groups. Additional molecular studies were performed on mutants that produced no PIGA mRNA or with deletions of all or part of the PIGA gene to determine deletion size and breakpoint sequence. One mutant appeared to be the result of a chromothriptic event. A significant percentage (>30%) of the aerolysin resistant isolates, which varied by sample year and Veteran, had wild-type PIGA cDNA (no mutation). As described in Albertini RJ et al. (2019: Environ Mol Mutagen), TCR gene rearrangement analysis of these isolates indicated most arose from multiple T-cell progenitors (hence the inability to find a mutation). It is likely that these isolates were the result of failure of complete selection against nonmutant cells in the cloning assays. Real-time studies of GPIa resistant isolates with no PIGA mutation but with a single TCR gene rearrangement found one clone with a PIGV deletion and several others with decreased levels of GPIa pathway gene mRNAs implying mutation in other GPIa pathway genes. Environ. Mol. Mutagen. 60:470-493, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Janice A Nicklas
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont
| | - Pamela M Vacek
- Medical Biostatistics Unit, University of Vermont College of Medicine, Burlington, Vermont
| | - Elizabeth W Carter
- Jeffords Institute for Quality, University of Vermont Medical Center, Burlington, Vermont
| | - Melissa McDiarmid
- Occupational Health Program, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- U.S. Department of Veterans Affairs, Washington, District of Columbia
| | - Richard J Albertini
- Department of Pathology, University of Vermont College of Medicine, Burlington, Vermont
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20
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Rohan KJ, Meyerhoff J, Ho SY, Roecklein KA, Nillni YI, Hillhouse JJ, DeSarno MJ, Vacek PM. A measure of cognitions specific to seasonal depression: Development and validation of the Seasonal Beliefs Questionnaire. Psychol Assess 2019; 31:925-938. [PMID: 30920245 PMCID: PMC7988399 DOI: 10.1037/pas0000715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 11/08/2022]
Abstract
We introduce the Seasonal Beliefs Questionnaire (SBQ), a self-report inventory of maladaptive thoughts about the seasons, light availability, and weather conditions, proposed to constitute a unique cognitive vulnerability to winter seasonal affective disorder (SAD; Rohan, Roecklein, & Haaga, 2009). Potential items were derived from a qualitative analysis of self-reported thoughts during SAD-tailored cognitive-behavioral therapy (CBT-SAD) and subsequently refined based on qualitative feedback from 48 SAD patients. In the psychometric study (N = 536 college students), exploratory and confirmatory factor analyses pruned the items to a 26-item scale with a 5-factor solution, demonstrating good internal consistency, convergent and divergent validity, and 2-week test-retest reliability. In a known groups comparison, the SBQ discriminated SAD patients (n = 86) from both nonseasonal major depressive disorder (MDD) patients (n = 30) and healthy controls (n = 110), whereas a generic measure of depressogenic cognitive vulnerability (the Dysfunctional Attitudes Scale [DAS]) discriminated MDD patients from the other groups. In a randomized clinical trial comparing CBT-SAD with light therapy (N = 177), SBQ scores improved at twice the rate in CBT-SAD than in light therapy. Greater change in SBQ scores during CBT-SAD, but not during light therapy, was associated with a lower risk of depression recurrence 2 winters later. In contrast, DAS scores improved comparably during CBT-SAD and light therapy, and DAS change was unrelated to recurrence following either treatment. These results support using the SBQ as a brief assessment tool for a SAD-specific cognitive vulnerability and as a treatment target in CBT-SAD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division, Veterans Affairs Boston Healthcare System
| | - Joel J Hillhouse
- Department of Community and Behavioral Health, East Tennessee State University
| | - Michael J DeSarno
- Medical Biostatistics Unit, University of Vermont College of Medicine
| | - Pamela M Vacek
- Medical Biostatistics Unit, University of Vermont College of Medicine
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Albertini RJ, Nicklas JA, Vacek PM, Carter EW, McDiarmid M. Longitudinal study of t-cell somatic mutations conferring glycosylphosphatidylinositol-anchor deficiency in gulf war I veterans exposed to depleted uranium. Environ Mol Mutagen 2019; 60:494-504. [PMID: 30848527 DOI: 10.1002/em.22281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/20/2018] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 06/09/2023]
Abstract
Fifty Veterans of the first Gulf War in 1991 exposed to depleted uranium (DU) were studied for glycosylphosphatidylinositol-anchor (GPIa) deficient T-cell mutants on three occasions during the years 2009, 2011, and 2013. GPIa deficiency was determined in two ways: cloning assays employing aerolysin selection and cytometry using the FLAER reagent for positive staining of GPIa cell surface proteins. Subsequent molecular analyses of deficient isolates recovered from cloning assays (Nicklas JA et al. [2019]: Environ Mol Mutagen) revealed apparent incomplete selection in some cloning assays, necessitating correction of original data to afford a more realistic estimate of GPIa deficient mutant frequency (MF) values. GPIa deficient variant frequencies (VFs) determined by cytometry were determined in the years 2011 and 2013. A positive but nonsignificant association was observed between MF and VF values determined on the same blood samples during 2013. Exposure to DU had no effect on either GPIa deficient MF or VFs. Environ. Mol. Mutagen. 60:494-504, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Richard J Albertini
- Department of Pathology, University of Vermont College of Medicine, Burlington, Vermont
| | - Janice A Nicklas
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont
| | - Pamela M Vacek
- Medical Biostatistics Unit, University of Vermont College of Medicine, Burlington, Vermont
| | - Elizabeth W Carter
- Jeffords Institute for Quality, University of Vermont Medical Center, Burlington, Vermont
| | - Melissa McDiarmid
- Occupational Health Program, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- U.S. Department of Veterans Affairs, Washington, DC
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22
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Lonza GC, Gardner-Morse MG, Vacek PM, Beynnon BD. Radiographic-based measurement of tibiofemoral joint space width and magnetic resonance imaging derived articular cartilage thickness are not related in subjects at risk for post traumatic arthritis of the knee. J Orthop Res 2019; 37:1052-1058. [PMID: 30908712 PMCID: PMC6499682 DOI: 10.1002/jor.24283] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/12/2019] [Indexed: 02/04/2023]
Abstract
Joint space width (JSW), measured as the distance between the femoral and tibial subchondral bone margins on two-dimensional weight-bearing radiographs, is the initial imaging modality used in clinical settings to diagnose and evaluate the progression of osteoarthritis (OA). While, JSW is the only structural outcome approved by the FDA for studying the treatment of this disease in phase III clinical trials, recent reports suggest that magnetic resonance imaging (MRI)-based measurements of OA changes are superior due to increased sensitivity and specificity to the structural changes associated with progression of this disease. In the current study, we examined the relationship between radiographic JSW and MRI-derived articular cartilage thickness in subjects 4 years post anterior cruciate ligament reconstruction (ACLR) who were at increased risk for the onset and early progression of post-traumatic OA, and in uninjured subjects with normal knees (Control). In both ACLR and Control groups, there were large measurement biases, wide limits of agreement, and poor correlation between the two measurement techniques. Clinical significance: The finding from this study suggest that the two methods of examining changes associated with the onset and early progression of PTOA either characterize different structures about the knee and should not be used interchangeably, or two-dimensional JSW measurements are not sensitive to small changes in articular cartilage thickness. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Geordie C. Lonza
- Department Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont
| | - Mack G. Gardner-Morse
- Department Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont
| | - Pamela M. Vacek
- Department of Biostatistics, Robert Larner M.D. College of Medicine, University of Vermont, Room 438A Stafford Hall, 95 Carrigan Drive, Burlington 05405-0084, Vermont
| | - Bruce D. Beynnon
- Department Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont
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23
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Vacek PM, Glenn RE, Rando RJ, Parker JE, Kanne JP, Henry DA, Meyer CA. Exposure‒response relationships for silicosis and its progression in industrial sand workers. Scand J Work Environ Health 2018; 45:280-288. [PMID: 30448860 DOI: 10.5271/sjweh.3786] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives This study aimed to characterize the relationship between radiographic silicosis and exposure to respirable quartz and determine how exposure affects disease progression. Methods Surveillance chest radiographs from a cohort of 1902 workers were examined to identify 67 cases of radiographic silicosis and 167 matched controls. Exposures were estimated by linking work histories to a job exposure matrix (JEM) based on samples collected by the participating companies and historical estimates. Conditional logistic regression was used to examine exposure‒response relationships. Sequential radiographs from silicosis cases were used to assess associations between exposure and disease progression. Results Risk of silicosis increased with cumulative exposure [odds ratio (OR) 1.43 per 1 mg/m 3years, 95% confidence interval (CI) 1.23-1.66], average exposure concentration (OR 1.30 per 0.10 mg/m 3, 95% CI 1.11-1.51) and net exposure duration (OR 1.10 per year, 95% CI 1.05-1.16). Multivariate analyses indicated that the risk associated with cumulative exposure varied depending on exposure duration and concentration. Analysis of the time worked at differing exposure levels indicated that exposures ≤0.05 mg/m 3were not significantly associated with silicosis risk after adjustment for years worked at higher concentrations. Disease progression was related to subsequent exposure concentration, with a yearly increase in small opacity profusion of 0.052 subcategory per each 0.10 mg/m 3increase in concentration. Conclusions Workers with longer exposure at lower concentrations were at higher risk for silicosis than those with the same cumulative exposure who worked for a shorter time at higher concentrations. The rate of silicosis progression was related to subsequent exposure concentration.
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Affiliation(s)
- Pamela M Vacek
- Medical Biostatistics Unit, University of Vermont Larner College of Medicine, 105 Carrigan Dr., Burlington, VT 05405, USA.
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24
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Sprague BL, Vacek PM, Herschorn SD, James TA, Geller BM, Trentham-Dietz A, Stein JL, Weaver DL. Time-varying risks of second events following a DCIS diagnosis in the population-based Vermont DCIS cohort. Breast Cancer Res Treat 2018; 174:227-235. [PMID: 30448897 DOI: 10.1007/s10549-018-5048-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Long-term disease-free survival patterns following surgical, radiation, and endocrine therapy treatments for ductal carcinoma in situ (DCIS) are not well characterized in general US practice. METHODS We identified 1252 women diagnosed with DCIS in Vermont during 1994-2012 using data from the Vermont Breast Cancer Surveillance System, a statewide registry of breast imaging and pathology records. Poisson regression and Cox regression with time-varying hazards were used to evaluate disease-free survival among self-selected treatment groups. RESULTS With 7.8 years median follow-up, 192 cases experienced a second breast cancer diagnosis. For women treated with breast-conserving surgery (BCS) alone, the annual rate of second events decreased from 3.1% (95% CI 2.2-4.2%) during follow-up years 1-5 to 1.7% (95% CI 0.7-3.5%) after 10 years. In contrast, the annual rate of second events among women treated with BCS plus adjuvant radiation therapy increased from 1.8% (95% CI 1.1-2.6%) during years 1-5 to 2.8% (95% CI 1.6-4.7%) after 10 years (P < 0.05 for difference in trend compared to BCS alone). Annual rates of second events also increased over time among women treated with BCS plus adjuvant radiation and endocrine therapy (P = 0.01 for difference in trend compared to BCS alone). The rate of contralateral events increased after 10 years for all groups with adjuvant treatments. The rate of second events did not vary over time among women who underwent ipsilateral mastectomy (P = 0.62). CONCLUSIONS Long-term risk of a second event after DCIS varies over time in a manner dependent on initial treatment.
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Affiliation(s)
- Brian L Sprague
- Department of Surgery, University of Vermont, 1 S. Prospect St, UHC Room 4425, Burlington, VT, 05401, USA. .,Department of Radiology, University of Vermont, Burlington, VT, USA. .,University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA.
| | - Pamela M Vacek
- University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA.,Medical Biostatistics Unit, University of Vermont, Burlington, VT, USA
| | - Sally D Herschorn
- Department of Radiology, University of Vermont, Burlington, VT, USA.,University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA
| | - Ted A James
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Berta M Geller
- Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Amy Trentham-Dietz
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Janet L Stein
- University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA.,Department of Biochemistry, University of Vermont, Burlington, VT, USA
| | - Donald L Weaver
- University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA.,Department of Pathology, University of Vermont, Burlington, VT, USA
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Ehteshami Bejnordi B, Mullooly M, Pfeiffer RM, Fan S, Vacek PM, Weaver DL, Herschorn S, Brinton LA, van Ginneken B, Karssemeijer N, Beck AH, Gierach GL, van der Laak JAWM, Sherman ME. Using deep convolutional neural networks to identify and classify tumor-associated stroma in diagnostic breast biopsies. Mod Pathol 2018; 31:1502-1512. [PMID: 29899550 PMCID: PMC6752036 DOI: 10.1038/s41379-018-0073-z] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [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: 10/28/2017] [Revised: 04/04/2018] [Accepted: 04/08/2018] [Indexed: 12/21/2022]
Abstract
The breast stromal microenvironment is a pivotal factor in breast cancer development, growth and metastases. Although pathologists often detect morphologic changes in stroma by light microscopy, visual classification of such changes is subjective and non-quantitative, limiting its diagnostic utility. To gain insights into stromal changes associated with breast cancer, we applied automated machine learning techniques to digital images of 2387 hematoxylin and eosin stained tissue sections of benign and malignant image-guided breast biopsies performed to investigate mammographic abnormalities among 882 patients, ages 40-65 years, that were enrolled in the Breast Radiology Evaluation and Study of Tissues (BREAST) Stamp Project. Using deep convolutional neural networks, we trained an algorithm to discriminate between stroma surrounding invasive cancer and stroma from benign biopsies. In test sets (928 whole-slide images from 330 patients), this algorithm could distinguish biopsies diagnosed as invasive cancer from benign biopsies solely based on the stromal characteristics (area under the receiver operator characteristics curve = 0.962). Furthermore, without being trained specifically using ductal carcinoma in situ as an outcome, the algorithm detected tumor-associated stroma in greater amounts and at larger distances from grade 3 versus grade 1 ductal carcinoma in situ. Collectively, these results suggest that algorithms based on deep convolutional neural networks that evaluate only stroma may prove useful to classify breast biopsies and aid in understanding and evaluating the biology of breast lesions.
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Affiliation(s)
- Babak Ehteshami Bejnordi
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Maeve Mullooly
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Shaoqi Fan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Pamela M Vacek
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Donald L Weaver
- Department of Pathology, University of Vermont, Burlington, VT, USA
| | - Sally Herschorn
- University of Vermont Cancer Center, Burlington, VT, USA
- Department of Radiology, University of Vermont, Burlington, VT, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Bram van Ginneken
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nico Karssemeijer
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew H Beck
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- PathAI, Inc., Cambridge, MA, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jeroen A W M van der Laak
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
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Qian X, Aboushousha R, van de Wetering C, Chia SB, Amiel E, Schneider RW, van der Velden JLJ, Lahue KG, Hoagland DA, Casey DT, Daphtary N, Ather JL, Randall MJ, Aliyeva M, Black KE, Chapman DG, Lundblad LKA, McMillan DH, Dixon AE, Anathy V, Irvin CG, Poynter ME, Wouters EFM, Vacek PM, Henket M, Schleich F, Louis R, van der Vliet A, Janssen-Heininger YMW. IL-1/inhibitory κB kinase ε-induced glycolysis augment epithelial effector function and promote allergic airways disease. J Allergy Clin Immunol 2018; 142:435-450.e10. [PMID: 29108965 PMCID: PMC6278819 DOI: 10.1016/j.jaci.2017.08.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/30/2017] [Accepted: 08/23/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Emerging studies suggest that enhanced glycolysis accompanies inflammatory responses. Virtually nothing is known about the relevance of glycolysis in patients with allergic asthma. OBJECTIVES We sought to determine whether glycolysis is altered in patients with allergic asthma and to address its importance in the pathogenesis of allergic asthma. METHODS We examined alterations in glycolysis in sputum samples from asthmatic patients and primary human nasal cells and used murine models of allergic asthma, as well as primary mouse tracheal epithelial cells, to evaluate the relevance of glycolysis. RESULTS In a murine model of allergic asthma, glycolysis was induced in the lungs in an IL-1-dependent manner. Furthermore, administration of IL-1β into the airways stimulated lactate production and expression of glycolytic enzymes, with notable expression of lactate dehydrogenase A occurring in the airway epithelium. Indeed, exposure of mouse tracheal epithelial cells to IL-1β or IL-1α resulted in increased glycolytic flux, glucose use, expression of glycolysis genes, and lactate production. Enhanced glycolysis was required for IL-1β- or IL-1α-mediated proinflammatory responses and the stimulatory effects of IL-1β on house dust mite (HDM)-induced release of thymic stromal lymphopoietin and GM-CSF from tracheal epithelial cells. Inhibitor of κB kinase ε was downstream of HDM or IL-1β and required for HDM-induced glycolysis and pathogenesis of allergic airways disease. Small interfering RNA ablation of lactate dehydrogenase A attenuated HDM-induced increases in lactate levels and attenuated HDM-induced disease. Primary nasal epithelial cells from asthmatic patients intrinsically produced more lactate compared with cells from healthy subjects. Lactate content was significantly higher in sputum supernatants from asthmatic patients, notably those with greater than 61% neutrophils. A positive correlation was observed between sputum lactate and IL-1β levels, and lactate content correlated negatively with lung function. CONCLUSIONS Collectively, these findings demonstrate that IL-1β/inhibitory κB kinase ε signaling plays an important role in HDM-induced glycolysis and pathogenesis of allergic airways disease.
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Affiliation(s)
- Xi Qian
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Reem Aboushousha
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Cheryl van de Wetering
- Department of Pulmonology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Shi B Chia
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Eyal Amiel
- Department of Medical Laboratory and Radiation, University of Vermont College of Nursing and Health Sciences, Burlington, Vt
| | - Robert W Schneider
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Jos L J van der Velden
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Karolyn G Lahue
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Daisy A Hoagland
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Dylan T Casey
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Nirav Daphtary
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Jennifer L Ather
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Matthew J Randall
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Minara Aliyeva
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Kendall E Black
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - David G Chapman
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vt; Woolcock Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Lennart K A Lundblad
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - David H McMillan
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Anne E Dixon
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Vikas Anathy
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Charles G Irvin
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Matthew E Poynter
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vt
| | - Emiel F M Wouters
- Department of Pulmonology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pamela M Vacek
- Medical Biostatistics Unit, University of Vermont College of Medicine, Burlington, Vt
| | - Monique Henket
- Department of Respiratory Medicine, CHU Sart-TilmanB35, Liege, Belgium
| | - Florence Schleich
- Department of Respiratory Medicine, CHU Sart-TilmanB35, Liege, Belgium
| | - Renaud Louis
- Department of Respiratory Medicine, CHU Sart-TilmanB35, Liege, Belgium
| | - Albert van der Vliet
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vt
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Mullooly M, Puvanesarajah S, Fan S, Pfeiffer RM, Olsson L, Hada M, Kirk EL, Vacek PM, Weaver DL, Shepherd JA, Mahmoudzadeh AP, Wang J, Hewitt SM, Herschorn SD, Sherman ME, Troester MA, Gierach GL. Abstract 3260: Utilizing digital pathology to understand breast epithelial characteristics of benign breast disease among women undergoing diagnostic image-guided breast biopsy. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-3260] [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: Defining the histologic correlates of mammographic breast density (MD) may provide insights into why elevated MD is related to increased breast cancer risk. Studies suggest that reduced terminal ductal lobular (TDLU) involution is associated with elevated MD, and both are independent breast cancer risk factors among women who have undergone a biopsy for benign breast disease (BBD). Prior digital histologic analyses of normal breast tissues revealed epithelial nuclear density (END) and TDLU involution are correlated. Accordingly, we examined associations of END with TDLU involution and MD in clinical biopsies. Methods: We analyzed 262 image-guided breast biopsies diagnosed as BBD from 224 women. TDLU involution was visually assessed as TDLU count/mm2 and TDLU span (inversely related to level of involution) in background normal tissue, evaluated using digitized images. The Genie Classifier (Aperio) was applied to images to estimate nuclei count per unit epithelial area, (END). Single X-ray Absorptiometry of pre-biopsy craniocaudal digital mammograms was applied to measure global MD (percent fibroglandular volume (%FGV)). Analysis of covariance, adjusted for age and body mass index, examined mean END differences across tertiles of TDLU/MD measures. Analyses were conducted at the biopsy level using SAS PROC GENMOD to account for within-woman correlations. All tests were two-tailed. Results: Overall, 67% of BBD biopsies were proliferative. Higher END was observed among proliferative than non-proliferative BBD (median END: 10,187 vs. 9,953 respectively; p=0.04). Among all women, END significantly increased with increasing tertiles of TDLU measures (p-trends: TDLU count/100mm2=0.0001, TDLU span=0.046). Whereas TDLU metrics were positively associated with %FGV, no relationship was observed between END and %FGV. In analyses stratified by BBD severity, however, END and %FGV were positively associated among women with non-proliferative disease (p-trend=0.04), findings not observed with proliferative disease. Conclusions: Automated END and visually assessed TDLU involution metrics were positively associated with each other and with MD. However, associations were diluted for proliferative lesions, suggesting that applying automated digital pathology tools to unsegmented digital images of whole sections of BBD biopsies does not demonstrate the same associations with MD as visual assessment of TDLU involution.
Citation Format: Maeve Mullooly, Samantha Puvanesarajah, Shaoqi Fan, Ruth M. Pfeiffer, Linnea Olsson, Manila Hada, Erin L. Kirk, Pamela M. Vacek, Donald L. Weaver, John A. Shepherd, Amir P. Mahmoudzadeh, Jeff Wang, Stephen M. Hewitt, Sally D. Herschorn, Mark E. Sherman, Melissa A. Troester, Gretchen L. Gierach. Utilizing digital pathology to understand breast epithelial characteristics of benign breast disease among women undergoing diagnostic image-guided breast biopsy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3260.
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Affiliation(s)
| | | | - Shaoqi Fan
- 3National Cancer Institute, Bethesda, MD
| | | | | | | | - Erin L. Kirk
- 2University of North Carolina at Chapel Hill, NC
| | | | | | | | | | - Jeff Wang
- 6MD Anderson Cancer Center, Houston, TX
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Levins JG, Argentieri EC, Sturnick DR, Gardner-Morse M, Vacek PM, Tourville TW, Johnson RJ, Slauterbeck JR, Beynnon BD. Geometric Characteristics of the Knee Are Associated With a Noncontact ACL Injury to the Contralateral Knee After Unilateral ACL Injury in Young Female Athletes. Am J Sports Med 2017; 45:3223-3232. [PMID: 29028449 PMCID: PMC6533631 DOI: 10.1177/0363546517735091] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Contralateral anterior cruciate ligament (CACL) injury after recovery from a first-time ACL rupture occurs at a high rate in young females; however, little is known about the risk factors associated with bilateral ACL trauma. HYPOTHESIS The geometric characteristics of the contralateral knee at the time of the initial ACL injury are associated with risk of suffering a CACL injury in these female athletes. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Sixty-two female athletes who suffered their first noncontact ACL injury while participating in sports at the high school or college level were identified, and geometry of the femoral notch, ACL, tibial spines, tibial subchondral bone, articular cartilage surfaces, and menisci of the contralateral, uninjured, knee was characterized in 3 dimensions. We were unable to contact 7 subjects and followed the remaining 55 until either a CACL injury or an ACL graft injury occurred or, if they were not injured, until the date of last contact (mean, 34 months after their first ACL injury). Cox regression was used to identify risk factors for CACL injury. RESULTS Ten (18.2%) females suffered a CACL injury. Decreases of 1 SD in femoral intercondylar notch width (measured at its outlet and anterior attachment of the ACL) were associated with increases in the risk of suffering a CACL injury (hazard ratio = 1.88 and 2.05, respectively). Likewise, 1 SD decreases in medial-lateral width of the lateral tibial spine, height of the medial tibial spine, and thickness of the articular cartilage located at the posterior region of the medial tibial compartment were associated with 3.59-, 1.75-, and 2.15-fold increases in the risk of CACL injury, respectively. CONCLUSION After ACL injury, subsequent injury to the CACL is influenced by geometry of the structures that surround the ACL (the femoral notch and tibial spines). This information can be used to identify individuals at increased risk for CACL trauma, who might benefit from targeted risk-reduction interventions.
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Affiliation(s)
- James G. Levins
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Erin C. Argentieri
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Daniel R. Sturnick
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Mack Gardner-Morse
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Pamela M. Vacek
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Timothy W. Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Robert J. Johnson
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - James R. Slauterbeck
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Bruce D. Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA.,Address correspondence to Bruce D. Beynnon, PhD, McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, VT 05405, USA ()
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Slauterbeck JR, Reilly A, Vacek PM, Choquette R, Tourville TW, Mandelbaum B, Johnson RJ, Beynnon BD. Characterization of Prepractice Injury Prevention Exercises of High School Athletic Teams. Sports Health 2017; 9:511-517. [PMID: 28985697 PMCID: PMC5665116 DOI: 10.1177/1941738117733981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Static and dynamic exercises are performed before activity to decrease injury risk and increase performance. Although evidence supports using dynamic over static stretching and performing Fédération Internationale de Football Association (FIFA) 11+ as a dynamic prepractice routine, we do not know the frequency at which these exercises are utilized in high school populations. Hypothesis: We hypothesize that there is a wide variety of preparticipation exercises performed by high school athletes, and that few high school teams perform FIFA 11+ as an injury prevention program in its entirety. Study Design: Observational study. Level of Evidence: Level 4. Methods: High school prepractice routines were observed for 185 teams (football, soccer, basketball, and lacrosse) over 1 season. The percentages of team warm-up routines that included components of FIFA 11+ were calculated, and the chi-square test was used to compare sex, sport, and level of competition. Results: Of a total 644 warm-up observations, 450 (69.9%) included only non–FIFA 11+ exercises, 56 (8.7%) included at least 1 FIFA 11+ exercise, and 38 (5.9%) included only jogging; 69 (10.6%) consisted only of sport-specific activities. The type of warm-up differed significantly between males and females (P = 0.002), sports (P < 0.001), and level of competition (P < 0.001). Static stretching and athletes stretching on their own were observed in 14% and 15% of all observations. No team performed the FIFA 11+ injury prevention routine in its entirety. Conclusion: The type of warm-up differed by sex, sport, and level of competition. Static stretching was performed more frequently than anticipated, and an entire FIFA 11+ warm-up was never performed. Clinical Relevance: We need to identify the exercises that decrease injury and increase performance and better inform the athletic population about the risks and benefits of static and dynamic warm-up programs.
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Affiliation(s)
- James R Slauterbeck
- Department of Orthopaedics & Rehabilitation, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Autumn Reilly
- University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Pamela M Vacek
- Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - Rebecca Choquette
- Department of Orthopaedics & Rehabilitation, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Timothy W Tourville
- Department of Rehabilitation & Movement Science, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Bert Mandelbaum
- Santa Monica Orthopaedic and Sports Medicine Group and Sports Foundation, Santa Monica, California
| | - Robert J Johnson
- Department of Orthopaedics & Rehabilitation, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Bruce D Beynnon
- Department of Orthopaedics & Rehabilitation, University of Vermont Larner College of Medicine, Burlington, Vermont
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Khattab M, Walker DM, Albertini RJ, Nicklas JA, Lundblad LK, Vacek PM, Walker VE. Frequencies of micronucleated reticulocytes, a dosimeter of DNA double-strand breaks, in infants receiving computed tomography or cardiac catheterization. Mutation Research/Genetic Toxicology and Environmental Mutagenesis 2017; 820:8-18. [DOI: 10.1016/j.mrgentox.2017.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 12/18/2022]
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Mullooly M, Bejnordi BE, Palakal M, Vacek PM, Weaver DL, Shepherd JA, Fan B, Mahmoudzadeh AP, Wang J, Johnson JM, Herschorn SD, Sprague BL, Pfeiffer RM, Brinton LA, Sherman ME, Beck A, Gierach GL. Abstract 4235: Application of convolutional neural networks to breast biopsies to uncover tissue correlates of mammographic breast density. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4235] [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: High percent mammographic density (MD), which reflects the relative fibroglandular tissue content of the breast, is one of the strongest breast cancer risk factors; however, the pathologic mediators of this risk are unknown. We hypothesize that analysis of breast tissue sections using deep learning approaches may characterize histologic features that underpin risk associated with high MD.
Methods: Non-targeted H&E stained breast tissue sections of diagnostic image-guided breast biopsies were evaluated among 588 women enrolled following an abnormal mammogram in the Breast Radiology Evaluation and Study of Tissues (BREAST) Stamp Project (2007-2010). Overall volumetric percent MD for the biopsied breast and localized volumetric percent MD surrounding the biopsy site were determined for each participant. A deep convolutional neural network (CNN) model was trained to identify and quantitatively assess breast epithelial, stroma and fat tissue and their organizational and spatial arrangements. Least absolute shrinkage and selection operator (Lasso) regression was used to determine relationships between MD measures and pathological features. To ensure reliability of the model, a cross-validation strategy was employed to build and assess the performance of the fitted model. Finally, Spearman correlation coefficients were estimated to test the association between the predicted density values by each model (predicting overall or localized MD) and the actual MD measurements. We report the average and standard deviation (SD) of the correlation coefficients.
Results: In an independent validation set, the CNN model was 95.5% accurate in classifying epithelial, stromal and fat tissue. The mean (SD) correlations between the predicted model and the actual measurements for overall and localized MD were 0.70 (0.06) and 0.65 (0.06) respectively. The amount of stroma identified (normalized to tissue area) had the highest selection probability (P-value) by the Lasso model and thus the strongest positive relationship with MD (P-value >0.9 for each MD measurement). In contrast, the amount of normalized epithelial tissue was not related to MD (P-value=0.01 for each MD measurement). No association was observed for the total normalized fat area with MD (P-value <0.31 for each MD measurement). In addition, the number of distributed epithelial regions was positively associated, whereas the distance between epithelial regions was inversely associated with overall MD (P-value <0.87 and 0.62, respectively).
Conclusions: These results show that greater stromal tissue amount and spatial distribution patterns of epithelial regions, rather than total epithelial amounts, had the strongest relationships with elevated MD. Future work will determine the relationship of these MD features with biopsy diagnosis.
Citation Format: Maeve Mullooly, Babak Ehteshami Bejnordi, Maya Palakal, Pamela M. Vacek, Donald L. Weaver, John A. Shepherd, Bo Fan, Amir Pasha Mahmoudzadeh, Jeff Wang, Jason M. Johnson, Sally D. Herschorn, Brian L. Sprague, Ruth M. Pfeiffer, Louise A. Brinton, Mark E. Sherman, Andrew Beck, Gretchen L. Gierach. Application of convolutional neural networks to breast biopsies to uncover tissue correlates of mammographic breast density [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4235. doi:10.1158/1538-7445.AM2017-4235
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Affiliation(s)
| | | | | | | | | | | | - Bo Fan
- 4University of California, San Francisco, San Francisco, CA
| | | | - Jeff Wang
- 5Hokkaido University, Sapporo, Japan
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Carter JC, Sturnick DR, Vacek PM, DeSarno MJ, Argentieri EC, Slauterbeck JR, Johnson RJ, Beynnon BD. Relationship between geometry of the extensor mechanism of the knee and risk of anterior cruciate ligament injury. J Orthop Res 2017; 35:965-973. [PMID: 27882612 DOI: 10.1002/jor.23366] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/02/2016] [Indexed: 02/04/2023]
Abstract
The complex inter-segmental forces that are developed across an extended knee by body weight and contraction of the quadriceps muscle group transmits an anteriorly directed force on the tibia that strain the anterior cruciate ligament (ACL). We hypothesized that a relationship exists between geometry of the knees extensor mechanism and the risk of sustaining a non-contact ACL injury. Geometry of the extensor mechanism was characterized using MRI scans of the knees of 88 subjects that suffered their first non-contact ACL injury and 88 matched control subjects with normal knees that were on the same team. The orientation of the patellar tendon axis was measured relative to the femoral flexion-extension axis to determine the extensor moment arm (EMA), and relative to tibial long axis to measure coronal patellar tendon angle (CPTA) and sagittal patellar tendon angle (SPTA). Associations between these parameters and ACL injury risk were tested with and without adjustment for flexion and internal rotation position of the tibia relative to the femur during MRI data acquisition. After adjustment for internal rotation position of the tibia relative to the femur there were no associations between EMA, CPTA, and SPTA and risk of suffering an ACL injury. However, increased internal rotation position of the tibia relative to the femur was significantly associated with increased risk of ACL injury in female athletes both in univariate analysis (Odds Ratio = 1.16 per degree of internal rotation of the tibia, p = 0.002), as well as after adjustment for EMA, CPTA, and SPTA.: © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:965-973, 2017.
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Affiliation(s)
- Josh C Carter
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, College of Medicine, University of Vermont, Burlington, Vermont
| | - Daniel R Sturnick
- Hospital for Special Surgery, Department of Biomechanics, New York, New York
| | - Pamela M Vacek
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - Michael J DeSarno
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - Erin C Argentieri
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, College of Medicine, University of Vermont, Burlington, Vermont
| | - James R Slauterbeck
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, College of Medicine, University of Vermont, Burlington, Vermont
| | - Robert J Johnson
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, College of Medicine, University of Vermont, Burlington, Vermont
| | - Bruce D Beynnon
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, College of Medicine, University of Vermont, Burlington, Vermont
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Vacek PM, Callas PW. Lung-cancer mortality among Vermont granite workers: factors influencing exposure-response evaluation. Occup Environ Med 2016; 74:211-217. [PMID: 27821675 PMCID: PMC5520268 DOI: 10.1136/oemed-2015-103527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 09/27/2016] [Accepted: 10/12/2016] [Indexed: 11/28/2022]
Abstract
Objective To understand why 2 studies relating crystalline silica exposure to lung-cancer mortality in Vermont granite workers yielded conflicting results. Methods Data used in the 2 studies were linked to identify discrepancies. Mortality data and employment histories from the earlier study were revised based on data obtained in the later study. SMR were computed and Poisson regressions corresponding to those in the earlier study were performed using the original and revised data. Analyses were repeated with the addition of workers omitted from the earlier study. Results After correction of incomplete mortality and employment information in the original data, the overall SMR for the cohort in the earlier study increased from 1.17 (95% CI 1.03 to 1.36) to 1.39 (95% CI 1.22 to 1.59), and was similar to the SMR of 1.37 observed in the later study (95% CI 1.23 to 1.52). The exposure–response relationship was attenuated, particularly when person-years in all exposure categories were included in the analysis. Inclusion of additional workers had a smaller impact on the SMRs but further attenuated the exposure–response relationship. Conclusions Differing results from the 2 studies are partly attributable to incomplete vital status and work history information used in the earlier study, as well as differences in cohort inclusion criteria. However, differences in length of follow-up and other factors likely play a larger role.
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Affiliation(s)
- Pamela M Vacek
- Medical Biostatistics Unit and Department of Pathology, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Peter W Callas
- Department of Mathematics and Statistics, University of Vermont, Burlington, Vermont, USA
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Levins JG, Sturnick DR, Argentieri EC, Gardner-Morse M, Vacek PM, Desarno MJ, Tourville TW, Slauterbeck JR, Beynnon BD. Geometric Risk Factors Associated With Noncontact Anterior Cruciate Ligament Graft Rupture. Am J Sports Med 2016; 44:2537-2545. [PMID: 27514738 PMCID: PMC6604045 DOI: 10.1177/0363546516657525] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) graft rupture occurs at a high rate, especially in young athletes. The geometries of the tibial plateau and femoral intercondylar notch are risk factors for first-time ACL injury; however, little is known about the relationship between these geometries and risk of ACL graft rupture. HYPOTHESIS The geometric risk factors for noncontact graft rupture are similar to those previously identified for first-time noncontact ACL injury, and sex-specific differences exist. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Eleven subjects who suffered a noncontact ACL graft rupture and 44 subjects who underwent ACL reconstruction but did not experience graft rupture were included in the study. Using magnetic resonance imaging, the geometries of the tibial plateau subchondral bone, articular cartilage, meniscus, tibial spines, and femoral notch were measured. Risk factors associated with ACL graft rupture were identified using Cox regression. RESULTS The following were associated with increased risk of ACL graft injury in males: increased posterior-inferior-directed slope of the articular cartilage in the lateral tibial plateau measured at 2 locations (hazard ratio [HR] = 1.50, P = .029; HR = 1.39, P = .006), increased volume (HR = 1.45, P = .01) and anteroposterior length (HR = 1.34, P = .0023) of the medial tibial spine, and increased length (HR = 1.18, P = .0005) and mediolateral width (HR = 2.19, P = .0004) of the lateral tibial spine. In females, the following were associated with increased risk of injury: decreased volume (HR = 0.45, P = .02) and height (HR = 0.46, P = .02) of the medial tibial spine, decreased slope of the lateral tibial subchondral bone (HR = 0.72, P = .01), decreased height of the posterior horn of the medial meniscus (HR = 0.09, P = .001), and decreased intercondylar notch width at the anterior attachment of the ACL (HR = 0.72, P = .02). CONCLUSION The geometric risk factors for ACL graft rupture are different for males and females. For females, a decreased femoral intercondylar notch width and a decreased height of the posterior medial meniscus were risk factors for ACL graft rupture that have also been found to be risk factors for first-time injury. There were no risk factors in common between ACL graft injury and first-time ACL injury for males.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bruce D. Beynnon
- Address correspondence to Bruce D. Beynnon, PhD, McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, University of Vermont College of Medicine, Stafford Hall, Room 438, Burlington, VT, USA ()
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Klabunde CN, Zheng Y, Quinn VP, Beaber EF, Rutter CM, Halm EA, Chubak J, Doubeni CA, Haas JS, Kamineni A, Schapira MM, Vacek PM, Garcia MP, Corley DA. Influence of Age and Comorbidity on Colorectal Cancer Screening in the Elderly. Am J Prev Med 2016; 51:e67-75. [PMID: 27344108 PMCID: PMC4992638 DOI: 10.1016/j.amepre.2016.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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] [Received: 09/23/2015] [Revised: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Expert recommendations differ for colorectal cancer screening in the elderly. Recent studies suggest that healthy adults aged >75 years may benefit from screening. This study examined screening use and follow-up, and how they varied by health status within age strata, among a large cohort of elderly individuals in community settings. METHODS A population-based, longitudinal cohort study was conducted among health plan members aged 65-89 years enrolled during 2011-2012 in three integrated healthcare systems participating in the Population-Based Research Optimizing Screening through Personalized Regimens consortium. Comorbidity measurements used the Charlson index. Analyses, conducted in 2015, comprised descriptive statistics and multivariable modeling that estimated age by comorbidity-specific percentages of patients for two outcomes: colorectal cancer screening uptake and follow-up of abnormal fecal blood tests. RESULTS Among 846,267 patients, 72% were up-to-date with colorectal cancer screening. Of patients with a positive fecal blood test, 65% received follow-up colonoscopy within 3 months. Likelihood of being up-to-date and receiving timely follow-up was significantly lower for patients aged ≥76 years than their younger counterparts (p<0.001). Comorbidity was less influential than age and more strongly related to timely follow-up than being up-to-date. In all age groups, considerable numbers of patients with no/low comorbidity were not up-to-date or did not receive timely follow-up. CONCLUSIONS In three integrated healthcare systems, many older, relatively healthy patients were not screening up-to-date, and some relatively young, healthy patients did not receive timely follow-up. Findings suggest a need for re-evaluating age-based screening guidelines and improving screening completion among the elderly.
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Affiliation(s)
- Carrie N Klabunde
- Office of Disease Prevention, Office of the Director, NIH, Rockville, Maryland.
| | - Yingye Zheng
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Virginia P Quinn
- Kaiser Permanente Southern California, Research and Evaluation, Pasadena, California
| | - Elisabeth F Beaber
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Ethan A Halm
- Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Chyke A Doubeni
- Department of Family Medicine and Community Health and Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer S Haas
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Marilyn M Schapira
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania and the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
| | - Pamela M Vacek
- Medical Biostatistics Unit, University of Vermont College of Medicine, Burlington, Vermont
| | - Michael P Garcia
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Felix AS, Lenz P, Pfeiffer RM, Hewitt SM, Morris J, Patel DA, Geller B, Vacek PM, Weaver DL, Chicoine RE, Shepherd J, Mahmoudzadeh AP, Wang J, Fan B, Malkov S, Herschorn SD, Johnson JM, Cora RL, Brinton LA, Sherman ME, Gierach GL. Relationships between mammographic density, tissue microvessel density, and breast biopsy diagnosis. Breast Cancer Res 2016; 18:88. [PMID: 27552842 PMCID: PMC4995674 DOI: 10.1186/s13058-016-0746-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/28/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Women with high levels of mammographic density (MD) have a four- to six-fold increased risk of developing breast cancer; however, most neither have a prevalent tumor nor will they develop one. Magnetic resonance imaging (MRI) studies suggest that background parenchymal enhancement, an indicator of vascularity, is related to increased breast cancer risk. Correlations of microvessel density (MVD) in tissue, MD and biopsy diagnosis have not been defined, and we investigated these relationships among 218 women referred for biopsy. METHODS MVD was determined by counting CD31-positive vessels in whole sections of breast biopsies in three representative areas; average MVD was transformed to approximate normality. Using digital mammograms, we quantified MD volume with single X-ray absorptiometry. We used linear regression to evaluate associations between MVD and MD adjusted for age and body mass index (BMI) overall, and stratified by biopsy diagnosis: cases (in situ or invasive cancer, n = 44) versus non-cases (non-proliferative or proliferative benign breast disease, n = 174). Logistic regression adjusted for age, BMI, and MD was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs) for associations between MVD and biopsy diagnosis. We also assessed whether the MVD-breast cancer association varied by MD. RESULTS MVD and MD were not consistently associated. Higher MVD was significantly associated with higher odds of in situ/invasive disease (ORAdjusted = 1.69, 95 % CI = 1.17-2.44). MVD-breast cancer associations were strongest among women with greater non-dense volume. CONCLUSIONS Increased MVD in tissues is associated with breast cancer, independently of MD, consistent with MRI findings suggestive of its possible value as a radiological cancer biomarker.
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Affiliation(s)
- Ashley S. Felix
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
- Present address: Division of Epidemiology, The Ohio State University College of Public Health, 1841 Neil Avenue, 300C Cunz Hall, Columbus, OH 43210 USA
| | - Petra Lenz
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD USA
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Stephen M. Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Jennifer Morris
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Deesha A. Patel
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Berta Geller
- Department of Family Medicine, University of Vermont, Burlington, VT USA
| | - Pamela M. Vacek
- Department of Pathology, University of Vermont, Burlington, VT USA
| | - Donald L. Weaver
- Department of Pathology, University of Vermont, Burlington, VT USA
| | - Rachael E. Chicoine
- Office of Health Promotion Research, University of Vermont, Burlington, VT USA
| | | | | | - Jeff Wang
- University of California, San Francisco, CA USA
- Present address: Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Bo Fan
- University of California, San Francisco, CA USA
| | | | | | - Jason M. Johnson
- Department of Diagnostic Radiology, Neuroradiology Section, MD Anderson Cancer Center, Houston, TX USA
| | - Renata L. Cora
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Louise A. Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Mark E. Sherman
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Gretchen L. Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
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Rohan KJ, Rough JN, Evans M, Ho SY, Meyerhoff J, Roberts LM, Vacek PM. A protocol for the Hamilton Rating Scale for Depression: Item scoring rules, Rater training, and outcome accuracy with data on its application in a clinical trial. J Affect Disord 2016; 200:111-8. [PMID: 27130960 PMCID: PMC4894486 DOI: 10.1016/j.jad.2016.01.051] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/14/2015] [Accepted: 01/24/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND We present a fully articulated protocol for the Hamilton Rating Scale for Depression (HAM-D), including item scoring rules, rater training procedures, and a data management algorithm to increase accuracy of scores prior to outcome analyses. The latter involves identifying potentially inaccurate scores as interviews with discrepancies between two independent raters on the basis of either scores >=5-point difference) or meeting threshold for depression recurrence status, a long-term treatment outcome with public health significance. Discrepancies are resolved by assigning two new raters, identifying items with disagreement per an algorithm, and reaching consensus on the most accurate scores for those items. METHODS These methods were applied in a clinical trial where the primary outcome was the Structured Interview Guide for the Hamilton Rating Scale for Depression-Seasonal Affective Disorder version (SIGH-SAD), which includes the 21-item HAM-D and 8 items assessing atypical symptoms. 177 seasonally depressed adult patients were enrolled and interviewed at 10 time points across treatment and the 2-year followup interval for a total of 1589 completed interviews with 1535 (96.6%) archived. RESULTS Inter-rater reliability ranged from ICCs of .923-.967. Only 86 (5.6%) interviews met criteria for a between-rater discrepancy. HAM-D items "Depressed Mood", "Work and Activities", "Middle Insomnia", and "Hypochondriasis" and Atypical items "Fatigability" and "Hypersomnia" contributed most to discrepancies. LIMITATIONS Generalizability beyond well-trained, experienced raters in a clinical trial is unknown. CONCLUSIONS Researchers might want to consider adopting this protocol in part or full. Clinicians might want to tailor it to their needs.
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Affiliation(s)
- Kelly J. Rohan
- Department of Psychological Science, University of Vermont,
Burlington, VT,Department of Psychological Science, University
of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134.
Phone: (802) 656-0798, FAX: (802) 656-8783,
| | - Jennifer N. Rough
- Department of Psychological Science, University of Vermont,
Burlington, VT
| | - Maggie Evans
- Department of Psychological Science, University of Vermont,
Burlington, VT
| | - Sheau-Yan Ho
- Department of Psychological Science, University of Vermont,
Burlington, VT
| | - Jonah Meyerhoff
- Department of Psychological Science, University of Vermont,
Burlington, VT
| | - Lorinda M. Roberts
- Department of Psychological Science, University of Vermont,
Burlington, VT
| | - Pamela M. Vacek
- Department of Medical Biostatistics, University of Vermont
College of Medicine, Burlington, VT
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Oh H, Bodelon C, Palakal M, Chatterjee N, Sherman ME, Linville L, Geller BM, Vacek PM, Weaver DL, Chicoine RE, Papathomas D, Patel DA, Xiang J, Clare SE, Visscher DW, Mies C, Hewitt SM, Brinton LA, Storniolo AMV, He C, Garcia-Closas M, Chanock SJ, Gierach GL, Figueroa JD. Ages at menarche- and menopause-related genetic variants in relation to terminal duct lobular unit involution in normal breast tissue. Breast Cancer Res Treat 2016; 158:341-50. [PMID: 27342457 DOI: 10.1007/s10549-016-3859-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 04/06/2016] [Accepted: 06/07/2016] [Indexed: 12/21/2022]
Abstract
Reduced levels of terminal duct lobular unit (TDLU) involution, as reflected by higher numbers of TDLUs and acini per TDLU, have been associated with higher breast cancer risk. Younger age at menarche and older age at menopause have been previously related to lower levels of TDLU involution. To determine a possible genetic link, we examined whether single-nucleotide polymorphisms (SNPs) previously established in genome-wide association studies (GWAS) for ages at menarche and menopause are associated with TDLU involution. We conducted a pooled analysis of 862 women from two studies. H&E tissue sections were assessed for numbers of TDLUs and acini/TDLU. Poisson regression models were used to estimate associations of 36 menarche- and 21 menopause-SNPs with TDLU counts, acini counts/TDLU, and the product of these two measures, adjusting for age and study site. Fourteen percent of evaluated SNPs (eight SNPs) were associated with TDLU counts at p < 0.05, suggesting an enrichment of associations with TDLU counts. However, only menopause-SNPs had >50 % that were either significantly or nonsignificantly associated with TDLU measures in the directions consistent with their relationships shown in GWAS. Among ten SNPs that were statistically significantly associated with at least one TDLU involution measure (p < 0.05), seven SNPs (rs466639: RXRG; rs2243803: SLC14A2; rs2292573: GAB2; rs6438424: 3q13.32; rs7606918: METAP1D; rs11668344: TMEM150B; rs1635501: EXO1) were associated in the consistent directions. Our data suggest that the loci associated with ages at menarche and menopause may influence TDLU involution, suggesting some shared genetic mechanisms. However, larger studies are needed to confirm the results.
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Affiliation(s)
- Hannah Oh
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA.
| | - Clara Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Maya Palakal
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Nilanjan Chatterjee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA.,Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Laura Linville
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | | | | | | | | | - Daphne Papathomas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Deesha A Patel
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Jackie Xiang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Susan E Clare
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel W Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Carolyn Mies
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Genomic Health, Inc., Redwood City, CA, USA
| | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Anna Maria V Storniolo
- Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Chunyan He
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.,Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA.,Usher Institute of Population Health Sciences and Informatics, Institute of Genomics and Molecular Medicine, Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
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Vacek PM, Slauterbeck JR, Tourville TW, Sturnick DR, Holterman LA, Smith HC, Shultz SJ, Johnson RJ, Tourville KJ, Beynnon BD. Multivariate Analysis of the Risk Factors for First-Time Noncontact ACL Injury in High School and College Athletes: A Prospective Cohort Study With a Nested, Matched Case-Control Analysis. Am J Sports Med 2016; 44:1492-501. [PMID: 27217522 PMCID: PMC6533630 DOI: 10.1177/0363546516634682] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Multivariate analysis that identifies the combination of risk factors associated with anterior cruciate ligament (ACL) trauma is important because it provides insight into whether a variable has a direct causal effect on risk or an indirect effect that is mediated by other variables. It can also reveal risk factors that might not be evident in univariate analyses; if a variable's effect is moderated by other variables, its association with risk may be apparent only after adjustment for the other variables. Most important, multivariate analyses can identify combinations of risk factors that are more predictive of risk than individual risk factors. HYPOTHESIS A diverse combination of risk factors predispose athletes to first-time noncontact ACL injury, and these relationships are different for male and female athletes. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Athletes competing in organized sports at the high school and college levels participated in this study. Data from injured subjects (109 suffering an ACL injury) and matched controls (227 subjects) from the same athletic team were analyzed with multivariate conditional logistic regression to examine the effects of combinations of variables (demographic characteristics, joint laxity, lower extremity alignment, strength, and personality traits) on the risk of suffering their first ACL injury and to construct risk models. RESULTS For male athletes, increases in anterior-posterior displacement of the tibia relative to the femur (knee laxity), posterior knee stiffness, navicular drop, and a decrease in standing quadriceps angle were jointly predictive of suffering an ACL injury. For female athletes the combined effects of having a parent who had suffered an ACL injury and increases in anterior-posterior knee laxity and body mass index were predictive of ACL injury. CONCLUSION Multivariate models provided more information about ACL injury risk than individual risk factors. Both male and female risk models included increased anterior-posterior knee laxity as a predictor of ACL injury but were otherwise dissimilar.
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Affiliation(s)
- Pamela M Vacek
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - James R Slauterbeck
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Timothy W Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Daniel R Sturnick
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Leigh-Ann Holterman
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Helen C Smith
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Robert J Johnson
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Kelly J Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Bruce D Beynnon
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
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Rohan KJ, Meyerhoff J, Ho SY, Evans M, Postolache TT, Vacek PM. Outcomes One and Two Winters Following Cognitive-Behavioral Therapy or Light Therapy for Seasonal Affective Disorder. Am J Psychiatry 2016; 173:244-51. [PMID: 26539881 PMCID: PMC4939843 DOI: 10.1176/appi.ajp.2015.15060773] [Citation(s) in RCA: 33] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The central public health challenge for winter seasonal affective disorder (SAD) is recurrence prevention. Preliminary studies suggest better long-term outcomes following cognitive-behavioral therapy tailored for SAD (CBT-SAD) than light therapy. The present study is a large, randomized head-to-head comparison of these treatments on outcomes one and two winters after acute treatment. METHOD Community adults with major depression, recurrent with seasonal pattern (N=177) were followed one and two winters after a randomized trial of 6 weeks of CBT-SAD (N=88) or light therapy (N=89). Prospective follow-up visits occurred in January or February of each year, and major depression status was assessed by telephone in October and December of the first year. The primary outcome was winter depression recurrence status on the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder Version (SIGH-SAD). Other outcomes were depression severity on the SIGH-SAD and the Beck Depression Inventory-Second Edition (BDI-II), remission status based on severity cutoff scores, and major depression status from tracking calls. RESULTS The treatments did not differ on any outcome during the first year of follow-up. At the second winter, CBT-SAD was associated with a smaller proportion of SIGH-SAD recurrences (27.3% compared with 45.6%), less severe symptoms on both measures, and a larger proportion of remissions defined as a BDI-II score ≤8 (68.3% compared with 44.5%) compared with light therapy. Nonrecurrence at the next winter was more highly associated with nonrecurrence at the second winter among CBT-SAD participants (relative risk=5.12) compared with light therapy participants (relative risk=1.92). CONCLUSIONS CBT-SAD was superior to light therapy two winters following acute treatment, suggesting greater durability for CBT-SAD.
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Affiliation(s)
- Kelly J. Rohan
- Department of Psychological Science, University of Vermont
| | | | - Sheau-Yan Ho
- Department of Psychological Science, University of Vermont
| | - Maggie Evans
- Department of Psychological Science, University of Vermont
| | | | - Pamela M. Vacek
- Department of Medical Biostatistics, University of Vermont College of Medicine
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Horne HN, Sherman ME, Pfeiffer RM, Figueroa JD, Khodr ZG, Falk RT, Pollak M, Patel DA, Palakal MM, Linville L, Papathomas D, Geller B, Vacek PM, Weaver DL, Chicoine R, Shepherd J, Mahmoudzadeh AP, Wang J, Fan B, Malkov S, Herschorn S, Hewitt SM, Brinton LA, Gierach GL. Circulating insulin-like growth factor-I, insulin-like growth factor binding protein-3 and terminal duct lobular unit involution of the breast: a cross-sectional study of women with benign breast disease. Breast Cancer Res 2016; 18:24. [PMID: 26893016 PMCID: PMC4758090 DOI: 10.1186/s13058-016-0678-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/29/2016] [Indexed: 12/19/2022] Open
Abstract
Background Terminal duct lobular units (TDLUs) are the primary structures from which breast cancers and their precursors arise. Decreased age-related TDLU involution and elevated mammographic density are both correlated and independently associated with increased breast cancer risk, suggesting that these characteristics of breast parenchyma might be linked to a common factor. Given data suggesting that increased circulating levels of insulin-like growth factors (IGFs) factors are related to reduced TDLU involution and increased mammographic density, we assessed these relationships using validated quantitative methods in a cross-sectional study of women with benign breast disease. Methods Serum IGF-I, IGFBP-3 and IGF-I:IGFBP-3 molar ratios were measured in 228 women, ages 40-64, who underwent diagnostic breast biopsies yielding benign diagnoses at University of Vermont affiliated centers. Biopsies were assessed for three separate measures inversely related to TDLU involution: numbers of TDLUs per unit of tissue area (“TDLU count”), median TDLU diameter (“TDLU span”), and number of acini per TDLU (“acini count”). Regression models, stratified by menopausal status and adjusted for potential confounders, were used to assess the associations of TDLU count, median TDLU span and median acini count per TDLU with tertiles of circulating IGFs. Given that mammographic density is associated with both IGF levels and breast cancer risk, we also stratified these associations by mammographic density. Results Higher IGF-I levels among postmenopausal women and an elevated IGF-I:IGFBP-3 ratio among all women were associated with higher TDLU counts, a marker of decreased lobular involution (P-trend = 0.009 and <0.0001, respectively); these associations were strongest among women with elevated mammographic density (P-interaction <0.01). Circulating IGF levels were not significantly associated with TDLU span or acini count per TDLU. Conclusions These results suggest that elevated IGF levels may define a sub-group of women with high mammographic density and limited TDLU involution, two markers that have been related to increased breast cancer risk. If confirmed in prospective studies with cancer endpoints, these data may suggest that evaluation of IGF signaling and its downstream effects may have value for risk prediction and suggest strategies for breast cancer chemoprevention through inhibition of the IGF system. Electronic supplementary material The online version of this article (doi:10.1186/s13058-016-0678-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hisani N Horne
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA. .,Present Affiliation: Food and Drug Administration, Silver Spring, MD, USA.
| | - Mark E Sherman
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Jonine D Figueroa
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland.
| | - Zeina G Khodr
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA.
| | - Roni T Falk
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA.
| | | | - Deesha A Patel
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA. .,Present Affiliation: Northwestern University Medical School, Chicago, IL, USA.
| | - Maya M Palakal
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA.
| | - Laura Linville
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA.
| | - Daphne Papathomas
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA.
| | | | | | | | | | - John Shepherd
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Amir Pasha Mahmoudzadeh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Jeff Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA. .,Present Affiliation: Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
| | - Bo Fan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Serghei Malkov
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Sally Herschorn
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Louise A Brinton
- Office of the Director, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Gretchen L Gierach
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD, 20892-9774, USA.
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Tourville TW, Shultz SJ, Vacek PM, Knudsen EJ, Bernstein IM, Tourville KJ, Hardy DM, Johnson RJ, Slauterbeck JR, Beynnon BD. Evaluation of an Algorithm to Predict Menstrual-Cycle Phase at the Time of Injury. J Athl Train 2016; 51:47-56. [PMID: 26807868 DOI: 10.4085/1062-6050-51.3.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Women are 2 to 8 times more likely to sustain an anterior cruciate ligament (ACL) injury than men, and previous studies indicated an increased risk for injury during the preovulatory phase of the menstrual cycle (MC). However, investigations of risk rely on retrospective classification of MC phase, and no tools for this have been validated. OBJECTIVE To evaluate the accuracy of an algorithm for retrospectively classifying MC phase at the time of a mock injury based on MC history and salivary progesterone (P4) concentration. DESIGN Descriptive laboratory study. SETTING Research laboratory. PARTICIPANTS Thirty-one healthy female collegiate athletes (age range, 18-24 years) provided serum or saliva (or both) samples at 8 visits over 1 complete MC. MAIN OUTCOME MEASURE(S) Self-reported MC information was obtained on a randomized date (1-45 days) after mock injury, which is the typical timeframe in which researchers have access to ACL-injured study participants. The MC phase was classified using the algorithm as applied in a stand-alone computational fashion and also by 4 clinical experts using the algorithm and additional subjective hormonal history information to help inform their decision. To assess algorithm accuracy, phase classifications were compared with the actual MC phase at the time of mock injury (ascertained using urinary luteinizing hormone tests and serial serum P4 samples). Clinical expert and computed classifications were compared using κ statistics. RESULTS Fourteen participants (45%) experienced anovulatory cycles. The algorithm correctly classified MC phase for 23 participants (74%): 22 (76%) of 29 who were preovulatory/anovulatory and 1 (50%) of 2 who were postovulatory. Agreement between expert and algorithm classifications ranged from 80.6% (κ = 0.50) to 93% (κ = 0.83). Classifications based on same-day saliva sample and optimal P4 threshold were the same as those based on MC history alone (87.1% correct). Algorithm accuracy varied during the MC but at no time were both sensitivity and specificity levels acceptable. CONCLUSIONS These findings raise concerns about the accuracy of previous retrospective MC-phase classification systems, particularly in a population with a high occurrence of anovulatory cycles.
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Affiliation(s)
- Timothy W Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington
| | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Pamela M Vacek
- Medical Biostatistics Unit, University of Vermont, Burlington
| | | | - Ira M Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington
| | - Kelly J Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington
| | - Daniel M Hardy
- Department of Cell Biology and Biochemistry, Texas Tech University, Lubbock
| | - Robert J Johnson
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington
| | - James R Slauterbeck
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington
| | - Bruce D Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington
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Gierach GL, Patel DA, Pfeiffer RM, Figueroa JD, Linville L, Papathomas D, Johnson JM, Chicoine RE, Herschorn SD, Shepherd JA, Wang J, Malkov S, Vacek PM, Weaver DL, Fan B, Mahmoudzadeh AP, Palakal M, Xiang J, Oh H, Horne HN, Sprague BL, Hewitt SM, Brinton LA, Sherman ME. Relationship of Terminal Duct Lobular Unit Involution of the Breast with Area and Volume Mammographic Densities. Cancer Prev Res (Phila) 2015; 9:149-58. [PMID: 26645278 DOI: 10.1158/1940-6207.capr-15-0282] [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: 07/15/2015] [Accepted: 11/17/2015] [Indexed: 01/05/2023]
Abstract
Elevated mammographic density (MD) is an established breast cancer risk factor. Reduced involution of terminal duct lobular units (TDLU), the histologic source of most breast cancers, has been associated with higher MD and breast cancer risk. We investigated relationships of TDLU involution with area and volumetric MD, measured throughout the breast and surrounding biopsy targets (perilesional). Three measures inversely related to TDLU involution (TDLU count/mm(2), median TDLU span, median acini count/TDLU) assessed in benign diagnostic biopsies from 348 women, ages 40-65, were related to MD area (quantified with thresholding software) and volume (assessed with a density phantom) by analysis of covariance, stratified by menopausal status and adjusted for confounders. Among premenopausal women, TDLU count was directly associated with percent perilesional MD (P trend = 0.03), but not with absolute dense area/volume. Greater TDLU span was associated with elevated percent dense area/volume (P trend<0.05) and absolute perilesional MD (P = 0.003). Acini count was directly associated with absolute perilesional MD (P = 0.02). Greater TDLU involution (all metrics) was associated with increased nondense area/volume (P trend ≤ 0.04). Among postmenopausal women, TDLU measures were not significantly associated with MD. Among premenopausal women, reduced TDLU involution was associated with higher area and volumetric MD, particularly in perilesional parenchyma. Data indicating that TDLU involution and MD are correlated markers of breast cancer risk suggest that associations of MD with breast cancer may partly reflect amounts of at-risk epithelium. If confirmed, these results could suggest a prevention paradigm based on enhancing TDLU involution and monitoring efficacy by assessing MD reduction.
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Affiliation(s)
- Gretchen L Gierach
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Deesha A Patel
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jonine D Figueroa
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Laura Linville
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Daphne Papathomas
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jason M Johnson
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - John A Shepherd
- University of California, San Francisco, San Francisco, California
| | - Jeff Wang
- University of California, San Francisco, San Francisco, California
| | - Serghei Malkov
- University of California, San Francisco, San Francisco, California
| | | | | | - Bo Fan
- University of California, San Francisco, San Francisco, California
| | | | - Maya Palakal
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jackie Xiang
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Hannah Oh
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Hisani N Horne
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark E Sherman
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Bodelon C, Heaphy CM, Meeker AK, Geller B, Vacek PM, Weaver DL, Chicoine RE, Shepherd JA, Mahmoudzadeh AP, Patel DA, Brinton LA, Sherman ME, Gierach GL. Leukocyte telomere length and its association with mammographic density and proliferative diagnosis among women undergoing diagnostic image-guided breast biopsy. BMC Cancer 2015; 15:823. [PMID: 26519084 PMCID: PMC4628256 DOI: 10.1186/s12885-015-1860-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Elevated mammographic density (MD) is a strong breast cancer risk factor but the mechanisms underlying the association are poorly understood. High MD and breast cancer risk may reflect cumulative exposures to factors that promote epithelial cell division. One marker of cellular replicative history is telomere length, but its association with MD is unknown. We investigated the relation of telomere length, a marker of cellular replicative history, with MD and biopsy diagnosis. Methods One hundred and ninety-five women, ages 40–65, were clinically referred for image-guided breast biopsies at an academic facility in Vermont. Relative peripheral blood leukocyte telomere length (LTL) was measured using quantitative polymerase chain reaction. MD volume was quantified in cranio-caudal views of the breast contralateral to the primary diagnosis in digital mammograms using a breast density phantom, while MD area (cm2) was measured using thresholding software. Associations between log-transformed LTL and continuous MD measurements (volume and area) were evaluated using linear regression models adjusted for age and body mass index. Analyses were stratified by biopsy diagnosis: proliferative (hyperplasia, in-situ or invasive carcinoma) or non-proliferative (benign or other non-proliferative benign diagnoses). Results Mean relative LTL in women with proliferative disease (n = 141) was 1.6 (SD = 0.9) vs. 1.2 (SD = 0.6) in those with non-proliferative diagnoses (n = 54) (P = 0.002). Mean percent MD volume did not differ by diagnosis (P = 0.69). LTL was not associated with MD in women with proliferative (P = 0.89) or non-proliferative (P = 0.48) diagnoses. However, LTL was associated with a significant increased risk of proliferative diagnosis (adjusted OR = 2.46, 95 % CI: 1.47, 4.42). Conclusions Our analysis of LTL did not find an association with MD. However, our findings suggest that LTL may be a marker of risk for proliferative pathology among women referred for biopsy based on breast imaging.
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Affiliation(s)
- Clara Bodelon
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA. .,Division of Cancer Epidemiology and Genetics, 9609 Medical Center Dr., Rm 7-E236, Bethesda, MD, 20892, USA.
| | - Christopher M Heaphy
- Department of Pathology, John Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Alan K Meeker
- Departments of Pathology, Oncology and Urology, John Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Berta Geller
- Department of Health Promotion Research, University of Vermont College of Medicine and Vermont Cancer Center, Burlington, VT, USA.
| | - Pamela M Vacek
- Department of Biostatistics, University of Vermont College of Medicine and Vermont Cancer Center, Burlington, VT, USA
| | - Donald L Weaver
- Department of Pathology, University of Vermont College of Medicine and Vermont Cancer Center, Burlington, VT, USA.
| | - Rachael E Chicoine
- Office of Health Promotion Research, University of Vermont College of Medicine and Vermont Cancer Center, Burlington, VT, USA.
| | - John A Shepherd
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Amir Pasha Mahmoudzadeh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Deesha A Patel
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | - Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | - Mark E Sherman
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA.
| | - Gretchen L Gierach
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
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45
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Beynnon BD, Sturnick DR, Argentieri EC, Slauterbeck JR, Tourville TW, Shultz SJ, Vacek PM. A Sex-Stratified Multivariate Risk Factor Model for Anterior Cruciate Ligament Injury. J Athl Train 2015; 50:1094-6. [PMID: 26340614 DOI: 10.4085/1062-6050-50.10.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bruce D Beynnon
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, and
| | - Daniel R Sturnick
- Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Erin C Argentieri
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, and
| | - James R Slauterbeck
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, and
| | - Timothy W Tourville
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, and
| | - Sandra J Shultz
- Biostatistics Unit, University of Vermont College of Medicine, Burlington
| | - Pamela M Vacek
- Department of Kinesiology, University of North Carolina at Greensboro
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Rohan KJ, Mahon JN, Evans M, Ho SY, Meyerhoff J, Postolache TT, Vacek PM. Randomized Trial of Cognitive-Behavioral Therapy Versus Light Therapy for Seasonal Affective Disorder: Acute Outcomes. Am J Psychiatry 2015; 172:862-9. [PMID: 25859764 PMCID: PMC7962797 DOI: 10.1176/appi.ajp.2015.14101293] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Whereas considerable evidence supports light therapy for winter seasonal affective disorder (SAD), data on cognitive-behavioral therapy for SAD (CBT-SAD) are promising but preliminary. This study estimated the difference between CBT-SAD and light therapy outcomes in a large, more definitive test. METHOD The participants were 177 adults with a current episode of major depression that was recurrent with a seasonal pattern. The randomized clinical trial compared 6 weeks of CBT-SAD (N=88) and light therapy (N=89). Light therapy consisted of 10,000-lux cool-white florescent light, initiated at 30 minutes each morning and adjusted according to a treatment algorithm based on response and side effects. CBT-SAD comprised 12 sessions of the authors' SAD-tailored protocol in a group format and was administered by Ph.D. psychologists in two 90-minute sessions per week. Outcomes were continuous scores on the Structured Interview Guide for the Hamilton Rating Scale for Depression-SAD Version (SIGH-SAD, administered weekly) and Beck Depression Inventory-Second Edition (BDI-II, administered before treatment, at week 3, and after treatment) and posttreatment remission status based on cut points. RESULTS Depression severity measured with the SIGH-SAD and BDI-II improved significantly and comparably with CBT-SAD and light therapy. Having a baseline comorbid diagnosis was associated with higher depression scores across all time points in both treatments. CBT-SAD and light therapy did not differ in remission rates based on the SIGH-SAD (47.6% and 47.2%, respectively) or the BDI-II (56.0% and 63.6%). CONCLUSIONS CBT-SAD and light therapy are comparably effective for SAD during an acute episode, and both may be considered as treatment options.
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Affiliation(s)
- Kelly J. Rohan
- Department of Psychological Science, University of Vermont
| | | | - Maggie Evans
- Department of Psychological Science, University of Vermont
| | - Sheau-Yan Ho
- Department of Psychological Science, University of Vermont
| | | | | | - Pamela M. Vacek
- Department of Medical Biostatistics, University of Vermont College of Medicine
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47
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Felix AS, Lenz P, Pfeiffer RM, Hewitt SM, Morris J, Patel D, Geller B, Vacek PM, Weaver DL, Chicoine RE, Shepherd J, Mahmoudzadeh AP, Wang J, Fan B, Herschorn S, Johnson J, Brinton LA, Sherman ME, Gierach GL. Abstract 2768: Relationships between mammographic density, microvessel density, and breast biopsy diagnosis. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-2768] [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: Mammographic density (MD) is a strong breast cancer risk factor; however, the majority of women with high MD have neither a prevalent tumor nor will they develop one in immediate follow-up. Magnetic resonance imaging (MRI) studies suggest that background parenchymal enhancement, an indicator of vascularity, is another strong breast cancer risk predictor. However, it is uncertain how correlated microvessel density (MVD), a histological marker of vascularity, is with MD and if it adds information for disease detection. We therefore investigated relationships between MVD, area and volume measures of MD, and biopsy diagnosis among 218 women referred for image-guided vacuum-assisted breast biopsies.
Methods: MVD was determined by counting CD31 (endothelial marker) positive vessels in whole sections of breast biopsies in three areas containing five 40X high power fields. Average MVD per area was calculated and then transformed based on a Box-Cox analysis to approximate a normal distribution. MD volume was quantified using single X-ray absorptiometry (SXA) in digital mammograms and MD area was quantified on the same image using thresholding methods. We used linear regression to evaluate associations between MVD (as the outcome) and MD measures (area and volume) adjusted for age and body mass index (BMI) in the overall population and stratified by biopsy diagnosis: cases (in situ or invasive carcinoma, n = 44) vs. non-cases (non-proliferative or proliferative benign breast disease, n = 174). Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between MVD and biopsy diagnosis (cases vs. non-cases) in models adjusted for age, BMI, and MD measures.
Results: MVD was inversely associated with absolute dense area and absolute dense volume in the overall sample (area p = 0.01, volume p = 0.11) and among non-cases (area p = 0.009, volume p = 0.007). In age-, BMI-, and dense area- or dense volume- adjusted logistic regression models, MVD was significantly associated with risk of in situ/invasive disease independent of absolute dense area (OR = 1.16, 95% CI = 1.04, 1.28) and independent of absolute dense volume (OR = 1.16, 95% CI = 1.05-1.29).
Conclusion: Our histopathologic analysis suggests that tissue vascularity, as reflected by MVD, may predict breast cancer risk independently of MD, thus providing theoretical support for the potential utility in breast cancer detection of imaging methods that reflect vascularity, such as contrast-enhanced MRI.
Citation Format: Ashley S. Felix, Petra Lenz, Ruth M. Pfeiffer, Stephen M. Hewitt, Jennifer Morris, Deesha Patel, Berta Geller, Pamela M. Vacek, Donald L. Weaver, Rachael E. Chicoine, John Shepherd, Amir P. Mahmoudzadeh, Jeff Wang, Bo Fan, Sally Herschorn, Jason Johnson, Louise A. Brinton, Mark E. Sherman, Gretchen L. Gierach. Relationships between mammographic density, microvessel density, and breast biopsy diagnosis. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2768. doi:10.1158/1538-7445.AM2015-2768
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Affiliation(s)
| | - Petra Lenz
- 2Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | | | | | | | | | | | | | | | - John Shepherd
- 4Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA
| | - Amir P. Mahmoudzadeh
- 4Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA
| | - Jeff Wang
- 5Hokkaido University, Sapporo, Japan
| | - Bo Fan
- 4Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA
| | | | - Jason Johnson
- 6Department of Diagnostic Radiology, Neuroradiology Section, Houston, TX
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48
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Albertini RJ, Vacek PM, Carter EW, Nicklas JA, Squibb KS, Gucer PW, Engelhardt SM, McDiarmid MA. Mutagenicity monitoring following battlefield exposures: Longitudinal study of HPRT mutations in Gulf War I veterans exposed to depleted uranium. Environ Mol Mutagen 2015; 56:581-593. [PMID: 25914368 DOI: 10.1002/em.21955] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/08/2015] [Indexed: 06/04/2023]
Abstract
A total of 70 military Veterans have been monitored for HPRT T-cell mutations in five separate studies at 2-year intervals over an 8-year period. Systemic depleted uranium (DU) levels were measured at the time of each study by determining urinary uranium (uU) excretion. Each HPRT study included 30-40 Veterans, several with retained DU-containing shrapnel. Forty-nine Veterans were evaluated in multiple studies, including 14 who were in all five studies. This permitted a characterization of the HPRT mutation assay over time to assess the effects of age, smoking and non-selected cloning efficiencies, as well as the inter- and intra-individual variability across time points. Molecular analyses identified the HPRT mutation and T-cell receptor (TCR) gene rearrangement in 1,377 mutant isolates. An unexpected finding was that in vivo clones of HPRT mutant T-cells were present in some Veterans, and could persist over several years of the study. The calculated HPRT mutant frequencies (MFs) were repeatedly elevated in replicate studies in three outlier Veterans with elevated urinary uranium excretion levels. However, these three outlier Veterans also harbored large and persistent in vivo HPRT mutant T-cell clones, each of which was represented by a single founder mutation. Correction for in vivo clonality allowed calculation of HPRT T-cell mutation frequencies (MutFs). Despite earlier reports of DU associated increases in HPRT MFs in some Veterans, the results presented here demonstrate that HPRT mutations are not increased by systemic DU exposure. Additional battlefield exposures were also evaluated for associations with HPRT mutations and none were found.
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Affiliation(s)
- Richard J Albertini
- Department of Pathology, University of Vermont College of Medicine, Burlington, Vermont
| | - Pamela M Vacek
- Medical Biostatistics Unit, University of Vermont College of Medicine, Burlington, Vermont
| | - Elizabeth W Carter
- Center for Clinical and Translational Science-Biomedical Informatics Unit, University of Vermont, Burlington, Vermont
| | - Janice A Nicklas
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont
| | - Katherine S Squibb
- Occupational Health Program, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Patricia W Gucer
- Occupational Health Program, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Melissa A McDiarmid
- Occupational Health Program, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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49
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Nicklas JA, Albertini RJ, Vacek PM, Ardell SK, Carter EW, McDiarmid MA, Engelhardt SM, Gucer PW, Squibb KS. Mutagenicity monitoring following battlefield exposures: Molecular analysis of HPRT mutations in Gulf War I veterans exposed to depleted uranium. Environ Mol Mutagen 2015; 56:594-608. [PMID: 25914382 DOI: 10.1002/em.21956] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/06/2015] [Accepted: 04/08/2015] [Indexed: 06/04/2023]
Abstract
Molecular studies that involved cDNA and genomic DNA sequencing as well as multiplex PCR of the HPRT gene were performed to determine the molecular mutational spectrum for 1,377 HPRT mutant isolates obtained from 61 Veterans of the 1991 Gulf War, most of whom were exposed to depleted uranium (DU). Mutant colonies were isolated from one to four times from each Veteran (in 2003, 2005, 2007, and/or 2009). The relative frequencies of the various types of mutations (point mutations, deletions, insertions, etc.) were compared between high versus low DU exposed groups, (based on their urine U concentration levels), with HPRT mutant frequency (as determined in the companion paper) and with a database of historic controls. The mutational spectrum includes all classes of gene mutations with no significant differences observed in Veterans related to their DU exposures.
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Affiliation(s)
- Janice A Nicklas
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont
| | - Richard J Albertini
- Department of Pathology, University of Vermont College of Medicine, Burlington, Vermont
- Biostatistics Unit, University of Vermont College of Medicine, Burlington, Vermont
| | - Pamela M Vacek
- Center for Clinical and Translational Science - Biomedical Informatics Unit, University of Vermont, Burlington, Vermont
| | - Stephanie K Ardell
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Elizabeth W Carter
- Center for Clinical and Translational Science - Biomedical Informatics Unit, University of Vermont, Burlington, Vermont
| | - Melissa A McDiarmid
- Occupational Health Program, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Patricia W Gucer
- Occupational Health Program, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Katherine S Squibb
- Occupational Health Program, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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50
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Gierach GL, Patel DA, Falk RT, Pfeiffer RM, Geller BM, Vacek PM, Weaver DL, Chicoine RE, Shepherd JA, Mahmoudzadeh AP, Wang J, Fan B, Herschorn SD, Xu X, Veenstra T, Fuhrman B, Sherman ME, Brinton LA. Relationship of serum estrogens and metabolites with area and volume mammographic densities. Horm Cancer 2015; 6:107-19. [PMID: 25757805 PMCID: PMC4558904 DOI: 10.1007/s12672-015-0216-3] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/29/2015] [Indexed: 12/12/2022]
Abstract
Elevated mammographic density is a breast cancer risk factor, which has a suggestive, but unproven, relationship with increased exposure to sex steroid hormones. We examined associations of serum estrogens and estrogen metabolites with area and novel volume mammographic density measures among 187 women, ages 40-65, undergoing diagnostic breast biopsies at an academic facility in Vermont. Serum parent estrogens, estrone and estradiol, and their 2-, 4-, and 16-hydroxylated metabolites were measured using liquid chromatography-tandem mass spectrometry. Area mammographic density was measured in the breast contralateral to the biopsy using thresholding software; volume mammographic density was quantified using a density phantom. Linear regression was used to estimate associations of estrogens with mammographic densities, adjusted for age and body mass index, and stratified by menopausal status and menstrual cycle phase. Weak, positive associations between estrogens, estrogen metabolites, and mammographic density were observed, primarily among postmenopausal women. Among premenopausal luteal phase women, the 16-pathway metabolite estriol was associated with percent area (p = 0.04) and volume (p = 0.05) mammographic densities and absolute area (p = 0.02) and volume (p = 0.05) densities. Among postmenopausal women, levels of total estrogens, the sum of parent estrogens, and 2-, 4- and 16-hydroxylation pathway metabolites were positively associated with area density measures (percent: p = 0.03, p = 0.04, p = 0.01, p = 0.02, p = 0.07; absolute: p = 0.02, p = 0.02, p = 0.01, p = 0.02, p = 0.03, respectively) but not volume density measures. Our data suggest that serum estrogen profiles are weak determinants of mammographic density and that analysis of different density metrics may provide complementary information about relationships of estrogen exposure to breast tissue composition.
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Affiliation(s)
- Gretchen L. Gierach
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
- 9609 Medical Center Drive, Rm. 7-E108, Bethesda, MD 20892-9774 USA
| | - Deesha A. Patel
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Roni T. Falk
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Ruth M. Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | | | | | | | | | | | | | - Jeff Wang
- University of California, San Francisco, San Francisco, CA USA
- Present Address: Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Bo Fan
- University of California, San Francisco, San Francisco, CA USA
| | | | - Xia Xu
- Laboratory of Proteomics and Analytical Technologies, Cancer Research Technology Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD USA
| | - Timothy Veenstra
- Laboratory of Proteomics and Analytical Technologies, Cancer Research Technology Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD USA
- Present Address: CN Diagnostics, 4041 Forest Park Avenue, Saint Louis, MO USA
| | - Barbara Fuhrman
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Mark E. Sherman
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Louise A. Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
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