Breast conserving surgery versus mastectomy: the influence of comorbidities on choice of surgical operation in the Department of Defense health care system

BACKGROUND

Studies on the effect of comorbidities on breast cancer operation have been limited and inconsistent. This study investigated whether pre-existing comorbidities influenced breast cancer surgical operation in an equal access health care system.

METHODS

This study was based on linked Department of Defense cancer registry and medical claims data. The study subjects were patients diagnosed with stage I to III breast cancer during 2001 to 2007. Logistic regression was used to determine if comorbidity was associated with operation type and time between diagnosis and operation.

RESULTS

Breast cancer patients with comorbidities were more likely to receive mastectomy (odds ratio [OR] = 1.27; 95% confidence interval [CI], 1.14 to 1.42) than breast conserving surgery plus radiation. Patients with comorbidities were also more likely to delay having operation than those without comorbidities (OR = 1.27; 95% CI, 1.14 to 1.41).

CONCLUSIONS

In an equal access health care system, comorbidity was associated with having a mastectomy and with a delay in undergoing operation.

Abstract B99: Colon cancer treatment: Are there racial disparities in an equal-access healthcare system?

Purpose: Accessibility to medical care may be the most important factor influencing differences in colon cancer treatment among whites and blacks. This study assessed whether racial disparities in colon cancer surgery and chemotherapy existed in an equal access healthcare system. Additionally, we sought to examine whether racial differences varied by tumor stage.

Methods: Patients included 2,570 non-Hispanic whites and non-Hispanic blacks with colon cancer diagnosed from 1998 to 2007. Logistic regression was used to assess the associations between race and the receipt of colon cancer surgery or chemotherapy, while controlling for available potential confounders, both overall and stratified by tumor stage.

Results: Univariate analysis revealed that there were no racial differences in surgery but that non-Hispanic blacks were more likely to receive chemotherapy than non-Hispanic whites. However, after multivariate adjustment, the odds of receiving colon cancer surgery and chemotherapy were similar between the two racial groups and did not vary by tumor stage.

Conclusion: When access to medical care is equal, racial disparities in the receipt of colon cancer surgery and chemotherapy were not apparent. Thus, it is possible that equal access to care is the driving force behind racial disparities in cancer treatment in the general population.

Citation Format: Abegail Andaya, Lindsey Enewold, Shelia H. Zahm, Craig D. Shriver, Joan Warren, Alexander Stojadinovic, Katherine McGlynn, Kangmin Zhu. Colon cancer treatment: Are there racial disparities in an equal-access healthcare system? [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B99.

Coffee intake and breast cancer risk in the NIH-AARP diet and health study cohort

There are several biologic mechanisms whereby coffee might reduce breast cancer risk. Caffeine and caffeic acid, major coffee constituents, have been shown to suppress mammary tumor formation in animal models and to inhibit DNA methylation in human breast cancer cells, respectively. Coffee may also reduce risk through decreasing inflammation and influencing estrogen metabolism. However, epidemiologic studies have been inconsistent and few studies have examined the association by estrogen and progesterone receptor (ER/PR) status. We evaluated coffee intake for its effect on incident breast cancer in the National Institutes of Health-AARP Diet and Health Study cohort, which included 198,404 women aged 50-71 with no history of cancer, who in 1995-1996 completed a questionnaire capturing usual coffee intake over the past year. State cancer registry and mortality index linkage identified 9,915 primary incident breast carcinomas through December 2006; available information on hormone receptor (HR) status identified 2,051 ER+/PR+ and 453 ER-/PR- cancers. In multivariable proportional hazards models, coffee intake was not associated with breast cancer risk (p-value for trend = 0.38; relative risk = 0.98, 95% confidence interval: 0.91-1.07, for four or more cups per day as compared to women who never drank coffee), and results did not vary by body mass index or history of benign breast biopsy (p-value for interaction > 0.10). We found no evidence of a relationship with either caffeinated or decaffeinated coffee. Null findings persisted for risk of both HR-positive and -negative breast cancers. These findings from a large prospective cohort do not support a role of coffee intake in breast carcinogenesis.

Reproductive and hormonal factors and lung cancer risk in the NIH-AARP Diet and Health Study cohort

BACKGROUND

Lung cancer exhibits unique patterns among women including high adenocarcinoma rates among nonsmokers. Inconsistent findings about hormonal factors on risk may reflect incomplete control for confounding, misclassification of exposures, or insufficient attention to variation by histology.

METHODS

Among 185,017 women, ages 50 to 71 years, recruited during 1995 and 1996 for the NIH-AARP (American Association of Retired Persons) Diet and Health Study, we identified 3,512 incident lung cancers (including 276 in never smokers) in follow-up through December 2006. Multivariable Cox proportional hazards models estimated relative risks (RR) and 95% CIs for self-reported hormonally related risk factors.

RESULTS

After adjustment for smoking and other confounders, subjects with late menarche were at reduced risk, with the association specific for adenocarcinomas (RR = 0.72 for menarche 15+ vs. <11, P(trend) < 0.01). Subjects with early ages at ovarian cessation (either from natural menopause or bilateral oophorectomy) were at an increased risk for adenocarcinomas and squamous cell tumors, but the associations were strongest for smokers, suggesting either residual confounding or an enhanced effect of menopausally related factors among subjects with decreased endogenous estrogens. In contrast, we saw no relationships of risk with either parity, age at first birth, or exogenous hormone use.

CONCLUSIONS

Elevated levels of hormones may adversely affect lung function early in life while assisting with cellular and immunologic responses later in life. Additional attention toward the role of hormonal factors may further our understanding of lung carcinogenesis.

IMPACT

Our findings provide some support for a role of hormonal factors in the etiology of lung cancer, although the mechanisms appear complicated.

Prolactin serum levels and breast cancer: relationships with risk factors and tumour characteristics among pre- and postmenopausal women in a population-based case-control study from Poland

Background:

Previous prospective studies have found an association between prolactin (PRL) levels and increased risk of breast cancer. Using data from a population-based breast cancer case–control study conducted in two cities in Poland (2000–2003), we examined the association of PRL levels with breast cancer risk factors among controls and with tumour characteristics among the cases.

Methods:

We analysed PRL serum levels among 773 controls without breast cancer matched on age and residence to 776 invasive breast cancer cases with available pretreatment serum. Tumours were centrally reviewed and prepared as tissue microarrays for immunohistochemical analysis. Breast cancer risk factors, assessed by interview, were related to serum PRL levels among controls using analysis of variance. Mean serum PRL levels by tumour characteristics are reported. These associations also were evaluated using polytomous logistic regression.

Results:

Prolactin levels were associated with nulliparity in premenopausal (P=0.05) but not in postmenopausal women. Associations in postmenopausal women included an inverse association with increasing body mass index (P=0.0008) and direct association with use of recent/current hormone therapy (P=0.0006). In case-only analyses, higher PRL levels were more strongly associated with lobular compared with ductal carcinoma among postmenopausal women (P=0.02). Levels were not different by tumour size, grade, node involvement or oestrogen receptor, progesterone receptor, or human epidermal growth factor receptor 2 status.

Conclusions:

Our analysis demonstrates that PRL levels are higher among premenopausal nulliparous as compared with parous women. Among postmenopausal women, levels were higher among hormone users and lower among obese women. These results may have value in understanding the mechanisms underlying several breast cancer risk factor associations.

Abstract 861: Relationships of prolactin serum levels to breast cancer risk and tumor characteristics in a population-based case-control study from Poland

Background: Prolactin is a peptide hormone that is important in growth and development of the human breast. Prolactin also induces migration, proliferation, and survival of cancer cells in vitro and mammary gland tumorigenesis in animal models. Recent studies suggest that elevated serum prolactin levels are related to increased breast cancer risk, but confirmation and extension of these results are needed. Accordingly, we analyzed associations of serum prolactin levels with breast cancer risk using data from a population-based breast cancer case-control study conducted in Poland.

Methods: The Polish study included 2,386 consenting cases with pathologically confirmed breast cancer and 2,502 age and residency matched controls living in Warsaw and Lodz, Poland recruited during the years 2000 to 2003. Participation rates were 79% for cases and 69% for controls. This analysis included 773 cases and 776 controls with available serum and twofold representation of tumor in tissue microarrays. 70% of this study population was postmenopausal. Serum prolactin was measured by immunoassay at Quest Diagnostics. The overall CV for the prolactin serum assay was 99%. Detailed medical history and breast cancer risk factor information were obtained by interview. Tumor pathology data were collected via surgical pathology reports and independently reviewed in the U.S. Among controls, we assessed associations of prolactin levels with breast cancer risk factors using analysis of variance; case-control associations between breast cancer risk and prolactin levels (quartiles) were assessed by logistic regression.

Results: Among premenopausal controls, nulliparity was inversely associated with prolactin levels (p=0.05), whereas among postmenopausal women, current/recent use of combined hormone replacement therapy (p&lt;0.0001) and lower body mass index (BMI, p&lt;0.0001) were associated with higher prolactin levels. After adjustment for these and other known breast cancer risk factors, as well as for matching factors, elevated prolactin levels were significantly associated with postmenopausal breast cancer risk (OR=1.95; 95% CI 1.37-2.78, p&lt;0.0001), when comparing the highest quartile of prolactin levels to the lowest. Among premenopausal women, risk also was elevated for all levels of prolactin, but risks were not significant and did not increase in a monotonic pattern.

Conclusions: Prolactin levels are significantly associated with breast cancer risk factors and risk for postmenopausal breast cancer. Our results confirm and extend prior studies focused on circulating prolactin levels and human breast cancer risk. Analyses examining associations between prolactin and tumor subclassifications based on immunological staining using tumor tissue microarrays are ongoing.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 861.

CD4 T cell control primary measles virus infection of the CNS: regulation is dependent on combined activity with either CD8 T cells or with B cells: CD4, CD8 or B cells alone are ineffective

Measles virus (MV), one of the most infectious of human pathogens, still infects over 30 million humans and causes over 500,000 deaths each year [Griffin, D., 2001. Measles virus. In: Fields, B., Knipe, D., Howley, P. (Eds.), Fields Virology. Lippincott-Raven, Philadelphia, pp. 1401-1442; ]. Death is primarily due to secondary microbial infections associated with the immunosuppression caused by MV. Studies of humans with genetic or acquired deficiencies of either the humoral or cellular arm of the immune system, and rodent models have implicated T cells in the control of the ongoing MV infection but the precise role and activities of the specific T cell subset or the molecules they produce is not clear. Using a transgenic mouse model in conjunction with depletion and reconstitution of individual B and T cell subsets alone or in combination, we show that neither CD4, CD8 nor B cells per se control acute MV infection. However, combinations of either CD4 T cells and B cells, or of CD4 and CD8 T cells are essential but CD8 T with B cells are ineffective. Interferon-gamma and neutralizing antibodies, but neither perforin nor TNF-alpha alone are associated with clearance of MV infection. TNF-alpha combined with interferon-gamma is more effective in protection than interferon alone. Further, the lack of an interferon-gamma response leads to persistence of MV.

Preliminary evaluation of prostate cancer metastatic risk biomarkers

Prostate cancer patients at high risk of metastasis need to be identified as early as possible since metastasis is invariably fatal. Treatment could be tailored to risk. Recent array comparative genomic hybridization (aCGH) studies of primary and metastatic prostate tumors identified 39 BAC clones capable of detecting genomic signatures of metastasis. We termed these loci the genomic evaluators of metastatic CaP (GEMCaP). Risk assessments were made on a set of men who were managed with radical prostatectomy. We compared the utility of GEMCaP loci and the Kattan nomogram, a common risk assessment tool, in relation to biochemical outcome. This preliminary evaluation experiment suggests we can use aCGH to detect genomic signatures of metastasis in primary tumors with an accuracy of 78%. The classification accuracy for the Kattan nomogram was 75%. Therefore, validation of GEMCaP is warranted in a larger, appropriately designed cohort.