bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prospective study of reproductive factors, hormone use, and risk of lung cancer in postmenopausal women
Authors: Baik C. S. , Strauss G. M. , Feskanich D. 
Published: August 2020

1501 Background: There has been increased interest in understanding the role of hormonal factors in lung cancer (LC) in women with the observation that it exhibits different epidemiologic patterns and treatment response when compared to men. However, results of published studies have been inconsistent, possibly due to inadequate smoking adjustment. Methods: We prospectively examined the associations between reproductive factors, exogenous hormone use, and LC incidence in 106,574 postmenopausal women in the Nurses’ Health Study. Participants completed biennial questionnaires which included updated smoking history. We assessed age at menopause, age at menarche, type of menopause, parity, postmenopausal hormone (PMH), and oral contraceptive use. Cox proportional hazards modeling was used to estimate the relative risks (RR) of each exposure, adjusted for smoking status, number of cigarettes, time since quitting, age of initiating smoking, fruit/vegetable intake, body mass index, and environmental smoking exposure. Results: We identified 1,565 LC cases during follow up from 1984 to 2004. Parity was associated with decreased LC risk in never smokers (RR = 0.54, 95% CI 0.31–0.96) but increased risk in current smokers (RR = 1.44, 95% CI 1.03–2.02). No association was seen in former smokers. Also, younger age at menopause was associated with higher LC risk in women with natural menopause (p-trend = 0.016). PMH use was not associated with LC incidence. The RR for current PMH users was 1.01 (95% CI 0.87–1.17) and for past users was 0.95 (95% CI 0.82–1.1). No significant association was seen when assessed by duration of PMH use, time since last use, or type of PMH. However, past use of oral contraceptives for greater than 5 years was associated with increased LC risk (RR = 1.2, 95% CI 1.03–1.41). Conclusions: These results suggest that there may be an association between hormonal factors and LC development, and further suggest that the mechanism may differ in smokers versus lifelong never smokers. No significant financial relationships to disclose.
Occult ovarian cancers at the time of risk-reducing salpingo-oophorectomy in a prospective cohort of BRCA1/2 mutation carriers
Authors: Rebbeck T. R. , Friebel T. M. , Domchek S. M. 
Published: August 2020

1508 Background: Risk-reducing salpingo-oophorectomy (RRSO) is widely used for cancer risk reduction in women with BRCA1 or BRCA2 (BRCA1/2) mutations. Occult ovarian cancers (OOC) detected at the time of RRSO have been reported, but there is wide variability in reported prevalence rates. Methods: We evaluated a prospective cohort of 647 women from 18 centers who underwent RRSO between 2001 and 2007 after a positive genetic test for disease-associated BRCA1/2 mutations. We estimated the prevalence of OOC. Results: Mean follow-up from genetic testing to RRSO was 1.01 years. OOC was detected in 16 of 647 women (2%). The mean age of women in whom OOC was detected was 51.7 versus 46.6 in women undergoing RRSO in whom OOC was not detected (p = 0.017). Twelve of the 16 OOCs (75%) were diagnosed in women with a BRCA1 mutation. Two OOCs were detected on RRSO prior to age 40, both in BRCA1 mutation carriers. Thirty eight percent of women with OOC had stage I cancer, as opposed to 10% of women in the PROSE database diagnosed with ovarian cancer outside of screening (p = 0.006). Among the 283 women in whom pathology reports were available for central review, 71% of RRSO were performed at the respective PROSE sites (i.e. major genetic referral centers), while 29% of RRSO were performed at local sites (i.e. community hospitals). Ovarian and fallopian tube tissues removed at RRSO at major genetics referral centers were significantly more likely to have been examined in toto compared to specimens obtained at nonreferral centers (76% vs. 24%, p < 0.001). Conclusions: RRSO reduces cancer risk and mortality in BRCA1/2 mutation carriers. Our results confirm that OOC is present at RRSO in BRCA1/2 mutation carriers, and suggest that OOC are more frequent after age 40 and are of a more favorable stage than cancers found outside the context of RRSO. Despite the fact that we examined surgeries after 2001, an unacceptably high proportion of pathologic examinations did not adequately examine ovaries and fallopian tubes obtained at RRSO. Failure to perform adequate pathological examination may overlook OOC and have clinical consequences for women undergoing RRSO. No significant financial relationships to disclose.
Parent perceptions of offspring responses to parental communication of BRCA1/2 test results
Authors: Bradbury A. R. , Patrick-Miller L. , Egleston B. , Sands C. , Feigon M. , Pawlowski K. , Ibe C. , Daly M. , Olopade O. , Daugherty C. 
Published: August 2020

1511 Background: Many BRCA1/2 mutation carriers report sharing their genetic test results with their minor children. The impact of this communication on offspring remains unknown. Methods: 163 parents who had BRCA1/2 testing completed qualitative interviews regarding their experiences with communication of their genetic test results to offspring. Descriptive responses were coded and response proportions utilized to summarize results. We used multiple regressions fit by GEE to test associations with disclosure. We controlled for parent mutation status in each regression. Results: 163 parents (52 BRCA1/2 mutation carriers) reported on 323 offspring 5 to 25 years old at the time of parent genetic testing. 107 (66%) parents reported disclosing to at least one offspring. Child age (p < 0.001) and parent cancer history (p = 0.004) were positively associated with disclosure. Parents without a BRCA1/2 mutation were more likely to communicate test results than parents with a mutation (p = 0.007). Among parents who disclosed, few (14%) reported they perceived their offspring to have had an initial negative affective or behavioral response. Others (13%) reported offspring concern for self and family. Reports of initial negative responses and concern were more frequent among parents with a mutation or a variant of uncertain significance. Many parents reported that the communication had no significant impact (39%) or a positive impact (36%) on their offspring. Conclusions: Many parents report sharing BRCA1/2 test results with their offspring. Parent self-reports suggest that they do not perceive most offspring to experience adverse reactions to this communication. Self-reports suggest that offspring learning of a BRCA1/2 mutation or a variant of uncertain significance may be more susceptible to initial negative reactions. Further research is necessary to explore psychosocial and behavioral responses to learning of hereditary risk during childhood and adolescence, and to inform the development of interventions to optimize adaptive response. No significant financial relationships to disclose.
Characteristics of young women enrolled in a high-risk breast cancer screening program
Authors: Tierney S. , Delli Carpini J. C. , Gemignani M. L. 
Published: August 2020

1512 Background: Young women at higher risk for breast cancer may benefit from enrollment in a dedicated surveillance program to ensure that their unique needs for examination, imaging, and risk modification are met. Though these programs do exist, little information is known about their effectiveness. In this pilot study, we sought to characterize the patients enrolled in our high-risk screening program. Methods: The Special Surveillance Breast Program (SSBP) at the Memorial Sloan-Kettering Cancer Center (MSKCC) was initiated in 1992 and enrolls patients in four categories: known and probable genetic mutation carriers, atypia, LCIS, and positive family history. Data is collected prospectively in an IRB-approved database and reviewed retrospectively. Patients enrolled from 1992 to March 2008 were included. Inclusion criteria included age under 40 and at least one follow-up visit. Data was validated with the patients’ medical records. Results: Four hundred and thirteen patients met inclusion criteria. The median age at enrollment was 33. The median duration of enrollment was 41 months. Defining continued participation as having a follow up visit in 2008, 193 patients (48%) were retained. At enrollment, 247 patients (60%) had ever undergone screening breast imaging. Of these, 216 patients (52%) had undergone screening in the past 2 years. At the most recent visit, 394 patients (95%) had ever undergone screening breast imaging and 376 patients (91%) had undergone screening in the past 2 years. Of the patients who had not had any radiologic screening, 18 patients (78%) were under the age of 35 at the most recent visit. Two hundred and ninety one patients (70%) reported performing self-breast exams. Two patients were diagnosed with cancer during their participation. An additional six patients underwent prophylactic surgery at MSKCC. Conclusions: Enrollment in a high-risk screening program was associated in an increase in any utilization of radiologic screening from 60% to 95%. It is unknown how this would compare to similar high-risk populations not enrolled in any program. Considering their voluntary enrollment and return for follow-up, these women are likely highly motivated regarding their health care. Further prospectively collected survey data from patients, including those who did not return after their initial visit, is planned. No significant financial relationships to disclose.
Adherence to extracolonic cancer screening in Lynch syndrome kindreds
Authors: Stadler Z. K. , Stern R. , Devlin V. , Glogowski E. , Kauff N. , Offit K. , Hurley K. 
Published: August 2020

1513 Introduction: In addition to colorectal cancer (CRC), Lynch syndrome (LS) patients are at increased risk of extracolonic malignancies including endometrial (EC), ovarian (OC), upper gastrointestinal and urothelial tract cancers. Although the efficacy of extracolonic cancer screening in LS has not been clearly demonstrated, multi-organ screening is routinely recommended for LS patients (Lindor et al., JAMA 2006). Anecdotal evidence suggests that adherence to such screening may be inferior to CRC screening. Methods: 35 adults, identified in the context of genetic counseling and testing (GCT) as being from LS kindreds, were given recommendations for multi-organ screening and enrolled on a prospective follow-up study. For participants with relevant organs at risk, these included colonoscopy, urine cytology, transvaginal ultrasound (TVUS), CA-125 level and endometrial sampling all to be performed at least annually. Adherence with screening, perceived risk of cancer subtype and future intentions regarding screening were evaluated at least 12 months after GCT. Results: Median age at time of GCT was 44, 66% were female and 69% were diagnosed with a LS- related cancer prior to GCT (15 CRC; 9 EC). At time of follow-up, 89% of patients without CRC had a colonoscopy within the year. Among women at-risk for OC, 25% had TVUS and 38% had CA-125 level within the year. Among women at risk for EC, 22% had TVUS and 22% had endometrial sampling within the year. Of all participants, 40% had urine cytology within the year. Of participants with relevant organs at-risk, 72%, 33%, 75% and 12% reported their risk of developing CRC, EC, OC, and urothelial tract cancer, respectively, as “moderately”, “very” or “extremely” high. Of patients with previous colonoscopy, 93% had definitive intentions to continue on schedule screening. However, only 68%, 50%, 60% and 50% of patients who underwent previous urine cytology, TVUS, CA-125 or endometrial sampling, respectively, had definitive intentions of continuing on schedule screening. Conclusions: Adherence with extracolonic cancer screening in LS kindreds is poor and patients persistently underestimate their extracolonic risk despite GCT. Possible interventions should be aimed at better educating patients about extracolonic cancer risk and importance of on-going surveillance. No significant financial relationships to disclose.
Feasibility of thermal infrared imaging screening for breast cancer in rural communities of Southern Mexico: The experience of the Centro de Estudios y Prevencion del Cancer (CEPREC)
Authors: Gutierrez-Delgado F. , Vazquez-Luna J. , Venegas-Hernandez L. , Terrazas-Espitia S. , Marcial-Toledo S. , Guzman-Patraca C. , Perez-Romero J. , Saldana-Tellez M. 
Published: August 2020

1521 Background: Breast cancer is the second cause of death from cancer among Mexican women but the incidence continues to rise mainly in rural communities. However, among women older than 50 years, only 7% of them report having had a mammogram because of insufficient number of mammography equipment and trained health care professionals. Mammography has limitation in sensitivity and specificity greater than 70 % and greater than 80 %, respectively. Breast thermography is a noncontact, noninvasive technique and easy to use outside hospitals. We propose to evaluate the feasibility of thermal infrared imaging as screening tool for early detection of breast cancer. Methods: Between November 2006 and December 2008, women were offered clinical breast examination (CBE) followed by breast thermography and mammography, and biopsy if indicated. Thermal infrared imaging was obtained by using an infrared camera (DL-700; 320*240 UFPA, Zhejiang Dali Technology Co., Ltd.). Infrared imaging was performed in a controlled environment with temperature and humidity maintained between 18 ºC and 23 ºC. Breast thermography diagnosis was established according to Hobbins criteria where TH1 to TH5 are equivalent to BI-RADS I to V (Intermer J of Rad 1987;12:337). CBE and breast thermography were correlated with mammography and histologic diagnosis. Results: Nine hundred and eleven (100%) women (median age 44 years, range 15–83) were evaluated. Five hundred and three (55%) of them were older than 40 years, 137 (15%) were between 35 and 39 years. Cancer was diagnosed in 14 (3%) and 2 (1.4%) women, respectively. Overall cancer was diagnosed in 16 (2.5 %) out of 640 women older 35 years. Among 116 (13%) women between 30 and 34 years, cancer was found in 1 (0.8 %) patient. Cancer was not found among 155 (17%) women between 15 and 29 years. Conclusions: In this study cancer was diagnosed in 1.8 % of women by using breast thermography. Thermal infrared imaging allows to select patients who could require further work-up. Breast thermography emerges as a potential screening tool for early detection of breast cancer. No significant financial relationships to disclose.
Evaluation of the effect of screening on the detection of good and poor prognosis breast cancers
Authors: van 't Veer L. J. , Esserman L. J. , Linn S. , Rutgers E. , Knauer M. , Retel V. , Davis S. E. , Lin C. 
Published: August 2020

1525 Background: Since the advent of screening, breast cancer incidence has significantly increased in the United States as well as other countries. SEER data from the US shows that the increase is largely in localized disease without a concomitant or significant decrease in regionalized disease. In addition, the increase has occurred essentially in women over 50. We asked whether molecular characterization of tumors would shed light on the types of tumors detected in screening and in locally advanced breast cancers (LABC). Methods: We identified two groups of patients from European studies before and after the introduction of population based screened (in 1995) where the 70-gene prognosis test (MammaPrint) results were available. The first source is the European Validation Study (EVS) (Buyse et al, J Natl Cancer Inst. 2006). The second was a prospective implementation trial of MammaPrint in the Netherlands (RASTER study) (Bueno de Mesquita et al, Lancet Oncol. 2007). The source of LABC patients comes from the multicenter I-SPY TRIAL (CALGB 150007/150012) who underwent routine screening (prior mammogram within 2 years of diagnosis). Results: In women age 50–60, the fraction of cancers that were MammaPrint good prognosis were 40% and 60% prior to and after the introduction of screening, respectively. For women 50–60 who were actually undergoing screening, the fraction of tumors that were MammaPrint good prognosis was 67%. For patients aged 30–40 with stage I and II lymph node-negative disease, who did not undergo screening in either period, the fraction of MammaPrint good prognosis tumors did not change (29% and 31%, for EVS and Raster, respectively). For patients with LABC, from the I-SPY TRIAL, the fraction of tumors that are MammaPrint good prognosis is 7% and 29% for women aged 30–40 and 50–60, respectively. Of the LABC patients undergoing screening, 80% presented clinically during the interval between routine mammograms. Conclusions: Current screening programs are increasing the burden of low-risk cancers. Screening programs should consider including molecular profiles at the time of diagnosis to reduce overtreatment. The majority of LABCs have high-risk molecular profiles and do not present as screen detected cancers. New strategies are needed for early detection of LABC. [Table: see text]
Delays in presentation and treatment of breast cancer in Nigeria
Authors: Ezeome R. E. 
Published: August 2020

1527 Background: Programs on breast cancer prevention inresource poor countries often emphasize cost effective interventions to increase the uptake of screening, breast awareness, and the use of breast self examination. The success of such programs depends on the response of women and health professionals to the presence of symptoms of breast cancer. Understanding the factors at play in these responses is a prerequisite for strategies to shorten delays and improve stage at diagnosis. This study was designed to assess the delays and define the causes of delays in getting medical treatment by patients with breast cancer at University of Nigeria Teaching Hospital Enugu, (UNTH-E), Nigeria. Methods: A cross-sectional survey of consecutively presenting patients with breast cancer at the Surgical Oncology unit of the UNTH-E, Nigeria, was carried out between June 1999 and May 2005. A structured questionnaire was used to explore delays and the factors that influence delays in presentation and treatment of breast cancer. Results: One hundred and sixty four patients with breast cancer were interviewed. Most of them were married (71.2%), literate (84.7%), low (58.8%) or middle socioeconomic class (40%), and had access to hospitals within their area of residence. Most (81.6%) reported first for treatment at a modern health facility while 17.5% used alternative practitioners first. Twenty-six percent (42) presented within a month of noticing the symptoms while 45.3% (72) delayed for 3 months or more. In contrast, 17% (18) were seen at the site of definitive treatment within 1 month of seeking help at the initial hospital while 73.4% had a delay of more than 3 months after the initial hospital contact. Institutional or physician related delays were present in 44.5% of the cases while patient-related delays were present in 76.7% of cases. Only use of alternative practitioners as the first treatment point was significantly related to delays of more than 3 months before presentation (p = 0.029). Conclusions: For breast cancer prevention programs in Nigeria to succeed, they must, in addition to breast awareness and screening programs, address the institutional bottlenecks, the dearth of knowledge among primary care physicians, and improved referrals from alternative practitioners. No significant financial relationships to disclose.
Influence of the dramatic fall of hormone replacement therapy (HRT) prescription on postmenopausal breast cancer incidence: The Austrian data
Authors: Pfeiler G. , Glatz C. , Königsberg R. , Vutuc C. , Kubista E. , Singer C. 
Published: August 2020

1529 Background: The Women's Health Initiative trial showed a significant increase in breast cancer risk among women using HRT. This publication led to a dramatic fall in HRT prescription worldwide. Several studies argued that the ensuing decline in breast cancer incidence among postmenopausal women was due to the reduced HRT prescriptions. We have investigated whether the strong decline in HRT prescription in Austrian women from 2002 onward was associated with a decrease in postmenopausal breast cancer incidence in Austria. Methods: Breast cancer incidence data were obtained from the National Austrian Cancer Registry. HRT prescription data were calculated using Pharmaceutical Benefits Scheme data. Hormone receptor expression data were taken from the pathology report of all patients with breast cancer, who were operated on at the Division of Special Gynecology, as well as the Department of Surgery, Medical University of Vienna (MUW), from 1998 to 2000, and 2005 to 2007, respectively. Chi-Square test was used to identify significant differences. Results: HRT prescription slightly increased from 1998 to 2000, but dramatically decreased by 70% after 2003, reaching a significantly lower level. When comparing breast cancer incidence data from 1999 and 2004, a nonsignificant trend toward a decreased incidence in 50- to 54-year-old women could be observed. Comparing predicted breast cancer incidence for 2004 with the actual incidence for 2004 in this group, a significant decrease could be demonstrated. Ten percent to 12% of all new breast cancers in Austria are treated at the MUW every year. Regarding histopathologic breast cancer parameters of patients treated at the MUW from 1998 to 2000 and 2005 to 2007, respectively, a nonsignificant decline of hormone receptor positive tumors in 50- to 54-year-old patients with breast cancer could be observed. Conclusions: The decline of HRT use in Austria is associated with a reduction in breast cancer incidence in postmenopausal women. Our data underline the association between HRT and breast cancer. No significant financial relationships to disclose.