Sleep Characteristics are Associated with Risk of Treated Diabetes Among Postmenopausal Women

OBJECTIVE

The purpose of this study was to determine whether sleep characteristics are associated with incidence of treated diabetes in postmenopausal individuals.

METHODS

Postmenopausal participants ages 50-79 years reported sleep duration, sleep-disordered breathing, or insomnia at baseline and again in a subsample 3 years later. The primary outcome was self-reported new diagnosis of diabetes treated with oral drugs or insulin at any time after baseline. Multivariable Cox proportional hazards models were used.

RESULTS

In 135,964 participants followed for 18.1 (± 6.3) years, there was a nonlinear association between sleep duration and risk of treated diabetes. Participants sleeping ≤5 hours at baseline had a 21% increased risk of diabetes compared with those sleeping 7 hours (adjusted hazard ratio [aHR] 1.21; 95% confidence interval [CI], 1.00-1.47). Those who slept for ≥9 hours had a nonsignificant 6% increased risk of diabetes compared with those sleeping 7 hours (aHR 1.06; 95% CI, 0.97-1.16). Participants whose sleep duration had decreased at 3 years had a 9% (aHR 1.09; 95% CI, 1.02-1.16) higher risk of diabetes than participants with unchanged sleep duration. Participants who reported increased sleep duration at 3 years had a risk of diabetes (HR 1.01; 95% CI, 0.95-1.08) similar to those with no sleep duration change. Participants at high risk of sleep-disordered breathing at baseline had a 31% higher risk of diabetes than those without (aHR 1.31; 95% CI, 1.26-1.37). No association was found between self-reported insomnia score and diabetes risk.

CONCLUSIONS

Sleep-disordered breathing and short or long sleep duration were associated with higher diabetes risk in a postmenopausal population.

Visceral Adiposity Is Associated With Shifts in the Gut Bacterial and Phage Microbiome in Postmenopausal Women

Objectives

More than 40% of U.S. adults are obese. Obesity, and in particular abdominal obesity, is associated with increased risk for developing a variety of chronic diseases. Obesity, aging, and menopause are each associated with differential shifts in the gut microbiome. We examined the association of visceral adiposity tissue (VAT) and the gut bacterial and phage microbiome.

Methods

We selected postmenopausal women (mean age 78 yrs) from the extremes of VAT (n = 25 per group; low VAT area (45.6 ± 12.5 cm²) and high VAT area (179.6 ± 30.4 cm²)) using data from dual x-ray absorptiometry (DXA) scans and performed shotgun metagenomic sequencing on fecal DNA collected at the time of DXA scan. Women with history of hypertension, diabetes, hormone therapy use, or antibiotic use within 90 days from sample collection were excluded. DNA libraries were prepared using the Illumina Nextera XT library preparation kit and libraries were sequenced on an Illumina HiSeq platform to generate 150-bp paired-ends reads. We examined the α-diversity (Shannon or Chao1), principal coordinate analysis β-diversity distances, and prevalence of microbiome taxa comparing the high vs. low VAT groups.

Results

There was no significant difference in α-diversity or β-diversity between VAT groups. At the phyla level, women with high VAT displayed elevated Bacteroidetes and Proteobacteria proportional abundance (p < 0.05). At the species level, women with low VAT displayed significantly elevated proportional abundance of Alistipes shahii, Anaerostipes hadrus, and Blautia wexlerae. Women with high VAT area displayed significantly elevated Parabacteroides distasonis, Bacteroides uniformis, and Roseburia intestinalis. Women with high VAT displayed elevated proportional abundance of Escherichia phage TL-2011b (p < 0.05).

Conclusions

Data suggest that postmenopausal women with high VAT display a differential bacterial microbiome and phage profile compared to postmenopausal women with low VAT, consistent with changes seen with age. Moreover, we identified an elevated proportional abundance of Alistipes shahii, Anaerostipes hadrus, and Blautia wexlerae in women with low VAT, suggesting potential for anti-obesity activity of these microbes in postmenopausal women.

Funding Sources

DOD BCRP Breakthrough Award to KLC. The WHI program is funded by the NHLBI/NIH. NIDCR/NIH R01 to JW-W.

A cross-sectional analysis of muscle density and physical function in head and neck cancer patients

e18597

Background: Head and neck cancer (HNC) is a debilitating disease that affects tens of thousands each year and both the disease and its treatment can cause long-term morbidity. HNC patients with greater physical function at baseline may better withstand both disease and treatment, therefore we hypothesized that baseline physical function is associated with baseline skeletal muscle density (SMD). Methods: A cross-sectional study of existing medical records was conducted. SMD was classified using pre-treatment PET-CT scans and interpreted using Sliceomatic software, and pre-treatment physical function assessed in three ways: hand grip strength, timed up and go, and short physical performance battery. Linear regression models were utilized to assess the association between SMD and each measure of physical function, with adjustment for muscle mass, sex and cancer stage in the hand grip strength model and adjustment for muscle mass and age in both the timed up and go, and short physical performance battery models. Results: The sample of 90 HNC patients, was mostly white, male, former smokers with an average BMI of 28 kg/m2. In adjusted models that included men only, we observed that for every Hounsfield unit increase in SMD there was a 0.08 increase in SPPB score (p=0.005), a 0.31 kg increase in hand grip strength (p=0.04), and a 0.13 second decrease in timed up and go (p=0.0007). In adjusted models that included women only, we observed that for every Hounsfield unit increase in SMD there was a 0.03 decrease in SPPB score (p=0.75), a 0.12 kg increase in hand grip strength (p=0.65), and a 0.01 second increase in timed up and go (p=0.84). Conclusions: Baseline physical function is associated with higher baseline physical SMD. Larger studies involving a more women are needed to replicate these findings and to further examine the potential role of effect modification by both sex and muscle mass.

Discovery and fine-mapping of height loci via high-density imputation of GWASs in individuals of African ancestry

Although many loci have been associated with height in European ancestry populations, very few have been identified in African ancestry individuals. Furthermore, many of the known loci have yet to be generalized to and fine-mapped within a large-scale African ancestry sample. We performed sex-combined and sex-stratified meta-analyses in up to 52,764 individuals with height and genome-wide genotyping data from the African Ancestry Anthropometry Genetics Consortium (AAAGC). We additionally combined our African ancestry meta-analysis results with published European genome-wide association study (GWAS) data. In the African ancestry analyses, we identified three novel loci (SLC4A3, NCOA2, ECD/FAM149B1) in sex-combined results and two loci (CRB1, KLF6) in women only. In the African plus European sex-combined GWAS, we identified an additional three novel loci (RCCD1, G6PC3, CEP95) which were equally driven by AAAGC and European results. Among 39 genome-wide significant signals at known loci, conditioning index SNPs from European studies identified 20 secondary signals. Two of the 20 new secondary signals and none of the 8 novel loci had minor allele frequencies (MAF) < 5%. Of 802 known European height signals, 643 displayed directionally consistent associations with height, of which 205 were nominally significant (p < 0.05) in the African ancestry sex-combined sample. Furthermore, 148 of 241 loci contained ≤20 variants in the credible sets that jointly account for 99% of the posterior probability of driving the associations. In summary, trans-ethnic meta-analyses revealed novel signals and further improved fine-mapping of putative causal variants in loci shared between African and European ancestry populations.

Prevalence of Pathogenic Variants in Cancer Susceptibility Genes Among Women With Postmenopausal Breast Cancer

This study uses Women’s Health Initiative data to compare the prevalence of pathogenic variants (PVs) in breast cancer susceptibility genes in postmenopausal women with vs without breast cancer to guide decisions about who should undergo PV testing.

Prevalence and penetrance of breast cancer-associated mutations identified by multiple-gene sequencing in the Women’s Health Initiative

1513

Background: Next-generation sequencing enables rapid analysis of many inherited cancer susceptibility genes. Little is known about the prevalence and penetrance of pathogenic variants (PVs) in such genes among post-menopausal women with breast cancer, who comprise the majority of all breast cancer patients. Methods: The Women’s Health Initiative enrolled post-menopausal women from 1993-1998. We conducted a nested case-control study using banked DNA samples of 2,195 women who subsequently developed invasive breast cancer (cases) and 2,322 cancer-free controls. Sequenced genes were APC, ATM, BARD1, BMPR1A, BRCA1, BRCA2, BRIP1, CDH1, CDK4, CDKN2A (p16INK4a and p14ARF) , CHEK2, EPCAM, GREM1, MLH1, MSH2, MSH6, MUTYH, NBN, PALB2, PMS2, POLD1, POLE, PTEN, RAD51C, RAD51D, SMAD4, STK11, and TP53. PV were defined using American College of Medical Genetics criteria. PV prevalence is reported as proportions and penetrance as the odds ratio (OR) and 95% confidence interval (CI) of PV versus none among cases versus controls. Results: Among cases, the median age at diagnosis was 73 years; 66% were White, 18% Black, 6% Hispanic, 6% Asian and 4% other. The prevalence of PVs in any gene was significantly higher in cases (6.61%, 95% CI 5.57-7.65%) versus controls (4.09%, 95% CI 3.29-4.90%). The prevalence of BRCA1/2 PVs was 1.2% in cases and 0.22% in controls. Among cases, the prevalence of PVs in other breast cancer-risk genes was 2.3% ( ATM, CDH1, BARD1, BRIP1, CHEK2, NBN, and PALB2 collectively), two-fold higher than PVs in BRCA1/2. Prevalence of BRCA1/2 PVs decreased with age among cases, while prevalence of ATM, CHEK2 and PALB2 PVs did not. Statistically significant ORs for breast cancer penetrance were observed for BRCA1 (5.43, 95% CI 1.19-51.52), BRCA2 (4.71, 95% CI 1.84-15.08), BARD1 (9.78, 95% CI 1.04-1295.87) and PALB2 (6.30, 95% CI 1.93-31.94). Conclusions: Approximately 7% of women diagnosed with post-menopausal breast cancer carry a PV in a cancer susceptibility gene. In contrast to studies of younger breast cancer patients, PVs in other breast cancer-related genes were two times more common than in BRCA1/2. Results may guide genetic testing of women with post-menopausal breast cancer.

Characteristics of Self-Reported Sleep and the Risk of Falls and Fractures: The Women's Health Initiative (WHI)

Sleep disturbances are common and may influence falls and fracture directly by influencing bone turnover and muscle strength or indirectly through high comorbidity or poor physical function. To investigate the association between self-reported sleep and falls and fractures, we prospectively studied 157,306 women in the Women's Health Initiative (WHI) using information on sleep quality, sleep duration, and insomnia from questionnaires. Annual self-report of falling two or more times (ie, "recurrent falling") during each year of follow-up was modeled with repeated measures logistic regression models fit by generalized estimating equations. Cox proportional hazards models were used to investigate sleep disturbance and time to first fracture. We examined the risks of recurrent falls and fracture by sleep duration with 7 hours as referent. We examined the risks across categories of sleep disturbance, insomnia status, and sleep quality. The average follow-up time was 7.6 years for falls and 12.0 years for fractures. In multivariable adjusted models, including adjustment for comorbidity, medications, and physical function, women who were short (≤5 hours) and long (≥10 hours) sleepers had increased odds of recurrent falls (odds ratio [OR] 1.28; 95% confidence interval [CI], 1.23 to 1.34 and OR 1.25; 95% CI, 1.09 to 1.43, respectively). Poor sleep quality, insomnia, and more sleep disturbances were also associated with an increased odds of recurrent falls. Short sleep was associated with an increased risk of all fractures, and upper limb, lower limb, and central body fractures, but not hip fractures, with hazard ratios ranging from 1.10 to 1.13 (p < 0.05). There was little association between other sleep characteristics and fracture. In conclusion, short and long sleep duration and poor sleep quality were independently associated with increased odds of recurrent falls. Short sleep was associated with modest increase in fractures. Future long-term trials of sleep interventions should include falls and fractures as endpoints. © 2018 American Society for Bone and Mineral Research.

Abstract C54: Parity and breastfeeding associations with familial estrogen receptor-negative breast cancer

Background. Disparities exist in the incidence of aggressive breast cancer characteristics by race. In order to characterize potential contributors to breast cancer disparities, we studied breastfeeding and parity characteristics in a sample of African American families with breast cancer. Based on evidence suggesting that lack of breastfeeding may influence the development of aggressive tumors, we performed both case/non-case comparisons and case-only comparisons according to receptor status. We hypothesized that African American women who developed estrogen receptor (ER)-negative and triple negative breast cancer are less likely to have ever breastfed, a shorter breastfeeding history, and more children than their sisters who did not develop breast cancer.

Methods. In a sample of 281 African American women (197 breast cancer cases and 84 unaffected sisters of cases) from 106 families, we examined differences in reproductive risk factor profiles (including parity a breastfeeding histories) between women diagnosed with breast cancer and their unaffected sisters using t-tests and chi-square tests. In cases only, we characterized breastfeeding duration and parity according to breast cancer subtypes using t-tests.

Results. African American women who developed breast cancer had an earlier age at menarche than their unaffected sisters (12.3 versus 13.1 years; p=0.01). Breast cancer cases also were more likely to have had a hysterectomy (49% versus 32%; p=0.02) and less likely to have used hormone therapy (19% versus 33%; p=0.01) compared to their sisters. Approximately 40% of cases reported ever breastfeeding compared to 50% of their non-case relatives; however this was not statistically significant (p=0.17). In case-only analyses, we observed a statistically significant shorter duration of breastfeeding in women with ER-negative compared to ER-positive tumors (11.3 versus 36.7 weeks; p=0.01), and in women with triple negative tumors compared to non-triple negative tumors (8.7 versus 35.1 weeks; p=0.00001). In terms of parity, women with ER-negative tumors had fewer births compared to ER-positive (1.54 versus 2.07 births; p=0.04). Similarly, women with triple negative tumors had significantly fewer births than cases who did not have triple negative tumors (1.39 versus 3.19 births; p=0.01).

Conclusion. In a sample of African Americans with a notable family history of breast cancer, short duration of breastfeeding may represent an additional and modifiable risk factor for aggressive breast cancer. These findings support literature on the association of breastfeeding and ER-negative tumors, providing additional insight into the possible prevention of familial breast cancer. Studies including African Americans to further replicate these findings and shed light on potential biologic mechanisms are needed.

Citation Format: Mattie Dibbell, Deborah Erwin, Detric Johnson, Lina Jandorf, Veronica Meadows Ray, Heather Ochs-Balcom. Parity and breastfeeding associations with familial estrogen receptor-negative breast cancer. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C54.

Validation of the Behavioral Risk Factor Surveillance System Sleep Questions

STUDY OBJECTIVES

leep problems may constitute a risk for health problems, including cardiovascular disease, depression, diabetes, poor work performance, and motor vehicle accidents. The primary purpose of this study was to assess the validity of the current Behavioral Risk Factor Surveillance System (BRFSS) sleep questions by establishing the sensitivity and specificity for detection of sleep/ wake disturbance.

METHODS

Repeated cross-sectional assessment of 300 community dwelling adults over the age of 18 who did not wear CPAP or oxygen during sleep. Reliability and validity testing of the BRFSS sleep questions was performed comparing to BFRSS responses to data from home sleep study, actigraphy for 14 days, Insomnia Severity Index, Epworth Sleepiness Scale, and PROMIS-57.

RESULTS

Only two of the five BRFSS sleep questions were found valid and reliable in determining total sleep time and excessive daytime sleepiness.

CONCLUSIONS

Refinement of the BRFSS questions is recommended.

Pre-diagnostic Sleep Duration and Sleep Quality in Relation to Subsequent Cancer Survival

STUDY OBJECTIVES

Poor sleep quality and short sleep duration have been associated with elevated risk for several cancer types; however, the relationship between sleep and cancer outcomes has not been well characterized. We assessed the association between pre-diagnostic sleep attributes and subsequent cancer survival within the Women's Health Initiative (WHI).

METHODS

We identified WHI participants in whom a first primary invasive cancer had been diagnosed during follow-up (n = 21,230). Participants provided information on sleep characteristics at enrollment. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between these pre-diagnostic sleep characteristics and cancer-specific survival for all cancers combined and separately for common cancers. Analyses were adjusted for age, study arm, cancer site, marital status, income, smoking, physical activity, and time to diagnosis.

RESULTS

No individual pre-diagnostic sleep characteristics were found to be significantly associated with cancer survival in analyses of all cancer sites combined; however, women who reported short sleep duration (≤ 6 h sleep/night) combined with frequent snoring (≥ 5 nights/w experienced significantly poorer cancer-specific survival than those who reported 7-8 h of sleep/night and no snoring (HR = 1.32, 95% CI: 1.14-1.54). Short sleep duration (HR = 1.46, 95% CI: 1.07-1.99) and frequent snoring (HR = 1.34, 95% CI: 0.98-1.85) were each associated with poorer breast cancer survival; those reporting short sleep combined with frequent snoring combined had substantially poorer breast cancer survival than those reporting neither (HR = 2.14, 95% CI: 1.47-3.13).

CONCLUSIONS

Short sleep duration combined with frequent snoring reported prior to cancer diagnosis may influence subsequent cancer survival, particularly breast cancer survival.

Abstract B12: Recruitment of African American breast cancer pedigrees for The Jewels in Our Genes Study: Recruitment outcomes and sample characteristics

Background. Few studies have investigated the contribution of inherited genetic variation to breast cancer disparities and fewer have examined whether risk alleles shared in families may contribute to higher risk of aggressive tumors. One barrier is the challenge of effectively recruiting African American families for research.

Methods. Using a community-based participatory research (CBPR) orientation, we utilized multi-level methods in an iterative fashion to recruit for a breast cancer genetic linkage study. We recruited affected relative pairs as well as discordant sibling pairs where possible. We analyzed our recruitment yield by method and calculated descriptive statistics for several demographic and clinical characteristics of families selected for genotyping, which includes 281 individuals from 106 pedigrees (197 affecteds, 84 unaffecteds).

Results. We recruited 341 African American women (247 with breast cancer and 94 unaffecteds) from 127 families. The top three yields were obtained via collaboration with the Love Army of Women (34% of sample), The National Witness Project (NWP, 29% of sample), and previous epidemiologic studies (24% of sample). Within the set of 106 pedigrees selected for genotyping, 27 pedigrees have one affected relative, 68 pedigrees have 2 affecteds, 10 pedigrees have 3 affecteds, and one pedigree has 6 affecteds. Where adjudicated (n=141, 72%), the mean and median age at diagnosis was 51.6 years (SD 12.0) and 51.6 years, respectively. Affected women were younger at menarche (p=0.002) and more likely to be hysterectomized (p=0.018) compared to unaffected women. According to tumor receptor status, approximately 26% of cases are ER negative, 40% are PR negative, 49% are HER2 negative, and overall 16% are ER/PR/HER2 negative.

Conclusions. Approaching recruitment of African American pedigrees with use of a multi-pronged approach that includes collaboration from the community can greatly facilitate success. While our sample has a slightly younger age of onset compared to African American cases in the general population (SEER median age for African Americans is 58 yrs), the sample approximates the US proportion of all invasive breast cancers in the US with regard to triple negative status (∼15%).

Citation Format: Youjin Wang, Deborah O. Erwin, Lina Jandorf, Detric Johnson, Veronica Meadows-Ray, Mattye Willis, Heather Ochs-Balcom. Recruitment of African American breast cancer pedigrees for The Jewels in Our Genes Study: Recruitment outcomes and sample characteristics. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B12. doi:10.1158/1538-7755.DISP13-B12

Abstract B50: Effects of automated tobacco assessment and cessation on survival for thoracic cancer patients

Purpose: Most tobacco cessation studies in cancer patients rely upon retrospective reviews in a small subsample of cancer patients presenting for treatment. The purpose of this study is to describe the tobacco use and cessation patterns for all patients (100% sampling) presenting to a thoracic oncology clinic at a NCI Designated Comprehensive Cancer Center using a standardized assessment and automatic tobacco cessation referral program.

Methods: Patients presenting to the thoracic oncology clinic at Roswell Park Cancer Institute (RPCI) were screened with a standardized tobacco assessment and all patients who used tobacco within the past 30 days were automatically referred to a dedicated tobacco cessation program. Demographic and health information were obtained from the electronic medical record, as well as the RPCI tumor registry, for all thoracic patients referred to the cessation program between October 2010 and October 2012. Tobacco information was collected by the cessation specialist. Descriptive and multivariate analyses were used to identify significant associations between demographics and disease characteristics with participation rates and self-reported quit rates.

Results: Among the 978 patients referred to the cessation program, 531 (54.2%) had information in the tumor registry. 476 (89.6%) patients had a form of lung cancer and 55 (5.6%) had another thoracic cancer, such as esophageal, bronchial, thymus, mediastinum or pleura cancer. 226 out of the 531 (42.6%) patients with tumor registry information were deceased, of whom the majority died from the primary thoracic cancer or complication from that cancer (N=151/226; 66.8%). Among those who were deceased, those who self-reported former tobacco use status (not currently using) at the first visit had a significantly longer survival time (n=53; mean=20.40 months, SD=30.91) compared to current users at first visit (n=157; mean=13.75 months, SD=15.41; p=0.042). Change in quit status from diagnosis to the first contact was not statistically associated with survival outcomes after controlling for age, packyears, sex and clinical stage of disease. Compared to being a current tobacco user at diagnosis and first contact, a significant difference in survival was not observed among those who quit between diagnosis and the first contact by the cessation service (HR=1.16, 95%CI: 0.63-2.13), those who relapsed between diagnosis and the first contact (HR=0.80, 95% CI: 0.36-1.79), and those who self-reported being quit at diagnosis and the first contact (HR=0.61, 95% CI: 0.28-1.34). However, age (HR=1.03; 95% CI: 1.01-1.05); being male compared to female (HR=1.64; 95% CI: 1.07-2.51) and clinical stage of disease (clinical stage compared to stage 1: HRstage2=2.20; 95% CI: 0.84-5.78; HRstage3=3.48; 95% CI: 1.67-7.24; HRstage4=8.49; 95% CI: 4.35-16.58) were significantly associated with survival. Although the association of quitting after diagnosis and survival was not statistically significant, the number of those who quit was small, limiting statistical power.

Conclusions: Patients who participated in an automated institutional cessation program and who quit smoking may have a reduced risk of death.

Citation Format: Katharine Dobson Amato, Mary Reid, Robert Reed, Patricia Hysert, Robert Hysert, Stephanie Segal, Gary Giovino, Maansi Travers, Heather Ochs-Balcom, Michael Zevon, Kenneth Michael Cummings, Chukwumere Nwogu, James Marshall, Martin Mahoney, Andrew Hyland, Graham Warren. Effects of automated tobacco assessment and cessation on survival for thoracic cancer patients. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B50.

Evaluation of a dedicated institutional tobacco cessation service for thoracic clinic cancer patients

1603

Background: Tobacco use by cancer patients is associated with poor therapeutic outcomes including increased toxicity, decreased quality of life, and decreased survival. Though recommendations provide for tobacco assessment and cessation for cancer patients, few oncologists provide cessation support. Presented are data from universal tobacco assessment and cessation program for patients presenting at a thoracic oncology clinic in a NCI Designated Comprehensive Cancer Center. Methods: A standard set of evidence based tobacco assessment questions were incorporated into an automated electronic medical record based system delivered by nursing at initial consult and at follow-up. Patients eligible for tobacco cessation support (i.e. patients self-reporting tobacco use within 30 days) were automatically referred to a dedicated tobacco cessation service. All referred patients are sent a standardized packet of cessation materials with telephone-based follow-up by trained cessation counselors. Results: A total of 980 new thoracic clinic patients were referred to the cessation service from January 2011 and October 2012. Two-thirds of the patients referred (n=728) referred into the system were current smokers and the remainder had quit in the 30 days prior to assessment. Among the 788 patients with contact attempts by the cessation service, 81.2% (n=640) were successfully contacted and only 2.5% (n=20) refused the offer of cessation support. At first contact, 75.6% (n=484) of patients reported continued current tobacco use. Follow-up calls were placed for 53.1% (n=340) of those who participated in the first contact an average of 39 days after the first successful contact. The follow-up had a 93.2% (n=317) participation rate which revealed that 33.3% (n=106) reported not smoking, an 8.9% increase since the first cessation service telephone call. Conclusions: Data demonstrate that an automated tobacco assessment and cessation service for thoracic oncology patients can effectively generate a large mandatory referral base with high patient interest in cessation, and that cessation support can be implemented and maintained in high risk cancer patients.

Gastroesophageal reflux symptoms in patients with adenocarcinoma of the esophagus or cardia

BACKGROUND

The efficacy of endoscopic screening for chronic gastroesophageal reflux symptoms of heartburn and regurgitation in adult subjects depends on the sensitivity of this strategy for detecting Barrett esophagus in subjects before the development of adenocarcinoma of the esophagus or cardia. The aim of the current study was to determine what proportion of patients with cancer of the esophagus or cardia would have been candidates for a screening endoscopy before their cancer diagnosis based on the presence and duration of preceding reflux symptoms.

METHODS

All patients with adenocarcinoma of the esophagus, adenocarcinoma of the cardia, or long-segment Barrett esophagus presenting for endoscopy at 4 tertiary care and 2 Veterans Affairs (VA) hospitals were given a previously validated questionnaire to determine their recall of common gastroesophageal reflux symptoms.

RESULTS

The study population of 375 subjects consisted primarily of 294 (78%) white men. Only 67 of 110 patients (61%) with adenocarcinoma of the esophagus and 8 of 21 patients (38%) with adenocarcinoma of the cardia recalled symptoms of heartburn or regurgitation being present for >5 years before their diagnosis of cancer. Only 40 of 110 patients (36%) with adenocarcinoma of the esophagus and 5 of 21 patients (24%) with adenocarcinoma of the cardia recalled weekly symptoms being present for >5 years before their cancer diagnosis. Of the 244 patients with Barrett esophagus, 170 (70%) recalled heartburn or regurgitation for >5 years and 89 patients (37%) recalled weekly symptoms for >5 years.

CONCLUSIONS

Current practice, which uses a screening strategy of performing endoscopy in patients with >5 years of heartburn or regurgitation, can detect Barrett epithelium in only a limited proportion of those patients at risk for developing adenocarcinoma of the esophagus or adenocarcinoma of the cardia.

Familiality in Barrett's esophagus, adenocarcinoma of the esophagus, and adenocarcinoma of the gastroesophageal junction

BACKGROUND AND AIM

The familial aggregation of Barrett's esophagus, adenocarcinoma of the esophagus, and adenocarcinoma of the gastroesophageal junction, jointly termed familial Barrett's esophagus, may represent a complex genetic trait. The aim of this study was to determine the proportion of patients with these diseases who have familial Barrett's esophagus.

METHODS

Information on gastroesophageal reflux symptoms, known risk factors for Barrett's esophagus, and family history of Barrett's esophagus and cancers, was collected at six hospitals using a structured questionnaire from probands with either long-segment Barrett's esophagus, adenocarcinoma of the esophagus, or adenocarcinoma of the gastroesophageal junction. Family history of Barrett's esophagus or esophageal cancer in a first- or second-degree relative was determined by reviewing medical records of all relatives reported to be affected.

RESULTS

Seventy one of 411 (17.3%) probands reported an affected first- and/or second-degree relative. Upon review of medical records of the reportedly affected relatives, familial Barrett's esophagus was definitively determined in the case of 30 (7.3%) probands comprising 17 of 276 (6.2%) with Barrett's esophagus, 11 of 116 (9.5%) with adenocarcinoma of the esophagus, and 2 of 21 (9.5%) with adenocarcinoma of the gastroesophageal junction. The diagnosis in the relative reported by the proband to be affected was found not to be Barrett's esophagus or adenocarcinoma in 15 (3.6%) cases. The diagnosis could not be determined in 26 (6.3%) cases in which the proband reported an affected relative. There were no significant differences in age of disease onset, gender, race, or gastroesophageal reflux symptoms between definitive familial Barrett's esophagus probands and nonfamilial probands.

CONCLUSION

Familial Barrett's esophagus can be confirmed in 7.3% of persons presenting with Barrett's esophagus, adenocarcinoma of the esophagus, or adenocarcinoma of the gastroesophageal junction.