bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thyroid cancer incidence in India between 2006 and 2014 and impact of overdiagnosis.
Authors: Mathew Aju , Maso Luigino Dal , Panato Chiara , Serraino Diego , Franceschi Silvia , Basu Partha , Wang Kevin , Lei Feitong , Chen Quan , Huang Bin , Vaccarella Salvatore 
Published: May 2020

e18574 Background: Increases of thyroid cancer (TC) incidence emerged in the last decades in several countries. This study aimed to estimate time trends of TC incidence in India and the proportion of TC cases potentially attributable to overdiagnosis by sex, age, and area. Methods: TC cases aged 0-74 years reported to Indian cancer registries during 2006- 2014 were included. Age-standardized incidence rates (ASR) and TC overdiagnosis were estimated by sex, period, age, and area. Results: Between 2006-2008 and 2012-2014, the ASRs for TC in India increased from 2.5 to 3.5/100,000 women (+37%) and from 1.0 to 1.3/100.000 men (+27%). However, up to a 10-fold difference was found among regions in both sexes. Highest ASRs emerged in Thiruvananthapuram (14.6/100,000 women and 4.1/100,000 men in 2012- 2014), with 93% increase in women and 64% in men compared to 2006-2008. No evidence of overdiagnosis was found in Indian men. Conversely, overdiagnosis accounted for 51% of TC in Indian women: 74% in those aged < 35 years, 50% at ages 35-54 years, and 30% at ages 55-64 years. In particular, 80% of TC overdiagnosis in women emerged in Thiruvananthapuram, while none or limited evidence of overdiagnosis emerged in Kamrup, Dibrugarh, Bhopal, and Sikkim. Conclusions: Relatively high and increasing TC ASRs emerged in Indian regions where better access to healthcare was reported. In India, as elsewhere, new strategies are needed to discourage opportunistic screening practice, particularly in young women, and to avoid unnecessary and expensive treatments. Present results may serve as a warning also for other transitioning countries.
T-Cell receptor repertoire and genomic analysis of tracheal adenoid cystic carcinoma.
Authors: Wang Fei , Zhou Chengzhi , Xie Xiaohong , Liu Ming , Lin Xinqing , Qin Yinyin , Xie Zhanhong , Zhang Jiexia , Ouyang Ming , Song Mengmeng , Li Pansong , Guan Yan-Fang , Xia Xuefeng 
Published: May 2020

e18576 Background: Tracheal adenoid cystic carcinoma (TACC) is the second type of cancer in bronchial tumors, has a high rate of postoperative recurrence and poor prognosis for which therapeutic targets are unavailable. Currently, studies were mostly about ACC of salivary gland. Our study is aim to elucidate genomic landscape and predict clinical biomarker of TACC. Methods: We performed whole-exome sequencing (WES), T cell repertoire sequencing (TCR) and immunohistochemistry (IHC) on tumor tissue samples and matched peripheral blood (PB) samples from TACC patients. All patients were followed up for their disease-free survival. Results: 13 cases were enrolled from 2010 to 2019. Median age of 13 TACCs was 35 yrs. 7 patients were female. 12 patients were stage I. In 8 WES samples, TCEB3CL (62%, 5/8), LPAR3 (50%, 4/8), ALPI (38%, 3/8), ARID1A (38%, 3/8) and BCOR (38%, 3/8) mutated most frequently. The median TMB was 3.67 (1.37-6.77) mutations/Mb. 1 patient showed microsatellite instability high (MSI-H). 2 patients with the highest TMB both had POLE mutations. We compared frequency of most mutated genes in our 8 samples with three different ACC types, including 935 ACC of salivary gland cancer, 76 ACC of the lung, and 38 ACC of breast cancer. 7 mutated frequently genes were found both in TACC and other types of ACCs, including ARID1A, BCOR, ARID1B, KMT2C, KMT2D, CREBBP and FAT3. 6 of them were more frequent in TACC. 7 FFPE tumors and 13 PB samples from 13 TACCs were used to investigate immune microenvironment. In 13 PB samples, TCR diversity (shannon index) and clonality was negatively associated with age (Pearson, r = -0.53, p = 0.06; r = 0.53, p = 0.06, respectively). There was no significant association between the other clinical characteristics (gender and smoking history) and any TCR parameter (clonality, clonotype, shannon index). Patients with lower clonotype number had longer DFS than those with higher clonotype number (15.0 vs 9.5 months, p < 0.001, 95% CI, 0.23-675.66, HR, 12.46), while shannon index and clonality was not significantly associated with DFS. Conclusions: The genetic mutations associated with TACC are different from those implicated in non-small cell lung cancer. TCR analysis as a useful of indicator of disease development and prognosis in TACC may be utilized to direct further immunotherapy.
Has Medicaid expansion improved access to care among socioeconomically disadvantaged breast cancer patients? An NCDB analysis.
Authors: Elson Leah , Bilani Nadeem , Elimimian Elizabeth Blessing , Nahleh Zeina A. 
Published: May 2020

e19003 Background: For socioeconomically disadvantaged individuals without insurance, expenses related to diagnosis and management of chronic conditions, such as cancer, may be too costly to afford. This contributes to diagnoses made at later stages of disease, and inadequate treatment compliance. These factors are reported to lead to unfavorable clinical outcomes and higher mortality risk, historically making uninsured/Medicaid-ineligible patients an especially vulnerable group. With recent Affordable Care Act-related Medicaid expansion, state adoption allows new access to coverage for individuals with income <138% of the federal poverty limit. Therefore, we sought to understand how Medicaid expansion has affected demographic coverage and access to care among socioeconomically disadvantaged breast cancer patients. Methods: The data presented herein was extrapolated from a 2004-2016 NCDB breast cancer population. Sociodemographic and clinical data was evaluated for a sample of Medicaid-enrolled patients, diagnosed during pre- and post-expansion years. Results: In Medicaid-expanded states, there was a significantly increased utilization of Medicaid insurance (24.3% vs. 13.2%; p<0.001), and a significant trend towards an increased proportion of Hispanic enrollment in Medicaid (21.1% vs. 11.8%; p<0.001) than in non-expanded states. In non-expanded states, there was a larger proportion of black patients (p<0.001), and patients who live further from diagnostic centers (p<0.001), in more rural areas (p<0.001), with lower education levels (p<0.001). The total study population of Medicaid-enrolled patients was n=42,217; the total comparative uninsured population was n=13,133. Medicaid-enrolled patients were observed to have more timeliness to systemic treatment following diagnosis (85.6 vs. 87.6 days; p=0.021), and were 40% less likely to be diagnosed with late-stage disease (p<0.001) than uninsured patients. Conclusions: Medicaid expansion may be associated with a less diagnosis at late stages, more timeliness to treatment, and more Hispanic coverage, which may prove to be a positive paradigm shift in cancer outcomes for underserved and underinsured groups. Several socioeconomic factors already identified as being independently associated with poor outcomes are more prevalent in the non-expanded state populations compared to the expanded states. Therefore, while benefits have been noted in patients of expanded states, many breast cancer populations still remain vulnerable in the post-expansion era.
The influence of health disparities on risk factors in patients with colorectal cancer.
Authors: Hippalgaonkar Neha , Matin Khalid 
Published: May 2020

e19006 Background: There are convincing data that suggest that lifestyle factors play a strong role in colorectal cancer. Obesity in particular is associated with higher incidence of colorectal cancer (CRC) and increased mortality. Racial and ethnic minorities are more likely to develop colorectal cancer when compared to the general population in the US, and the population in Richmond is made up of 47% of African Americans (AA), with 24% of the total persons in poverty and a median household income of $45,117, allowing us to uncover important factors that may affect the development of CRC. Purpose: We aim to uncover trends in the AA population as compared to the Caucasian population to determine the effect of health disparities in obesity-related risk factors in patients with CRC. Methods: We used the Virginia Commonwealth University (VCU) network within TriNetX, a global federated health research network that provides access to statistics in electronic medical records of diagnoses, laboratory values and vitals. We compared Caucasian and AA patients with a diagnosis of CRC from 14 different health networks in the US from 2010-2019. Results: In the TriNetX network, we found that the African American population exhibited higher rates of obesity (33% vs. 26%), irritable bowel disease (38% vs. 33%) and hypertension (71% vs. 33%) as compared to AA patients in the other 14 networks. Increased rates of diabetes (33% vs. 22%), hyperlipidemia (33% vs. 28%) and hypertension (71% vs. 56%) were found in the African American population compared to the Caucasian population in the VCU Network. Notably, we also observed increased rates of homelessness & unemployment (5% vs. 3%) in the AA population. Conclusions: These data suggest that important comorbidities are more prevalent in AA populations population than in the Caucasian populations. Our findings demonstrate the fundamental importance of considering racial and socioeconomic factors when designing screening, treatment and management plans in an effort to reduce the mortality of CRC in an underserved community.
Pancreatic cancer: Do disparities in mortality rates exist with respect to socioeconomic status?
Authors: Sheppard Richard Stephen , Adekunle Adewumi , Beale Stefani , Joseph Janet , Fletcher Gerald , Ahluwalia Meena 
Published: May 2020

e19007 Background: Pancreatic cancer continues to have one of the highest mortality rates among major cancer diagnoses with rates greater than 90 percent for all stages and with five year survival rates below 10 percent. With access to treatment modalities such as chemo-radiation, staged surgical interventions and targeted therapies, survival times have increased but due to the costs of these procedures, they may not be accessible to all members of society. Recent studies have shown that lower socioeconomic status is associated with higher mortality rates and lower survival times. With this study we aim to investigate if disparities exist among socioeconomic classes, based on zip code location, in a major multi-ethnic metropolitan city using census data. Methods: Malignant neoplasm mortality data at the ZIP code level was gathered from the New York City Department of Health Vital Statistics Mortality Data from years 2009-2011. NYC population data was gathered from the U.S. Census Bureau 2010 decennial census. We used ordinary least squares regression to assess the independent association between neighborhood median income and neighborhood mortality from malignant neoplasms arising from the pancreas. Results: In 2009-2011, 2,527 deaths from malignant neoplasms arising from the pancreas were recorded across NYC. There is no statistically significant correlation between neighborhood median income and age-adjusted mortality from malignant neoplasms arising from the pancreas for males and for females. For males, there was an R-squared of 0.001721 ( P-value > 0.05). For females, there was an adjusted adjusted R-squared of 9.818e-05 ( P-value > 0.05). Conclusions: Neighborhood median income is not associated with an increase in mortality rate with respect to neoplasms arising from the pancreas.
ER, PR, and HER2 expression in Ugandan breast cancer patients: An evaluation of in-country RT-PCR compared to IHC.
Authors: Menon Manoj , Orem Jackson , Adams Scott , Bakenga Alex , Basemera Diana , Kasozi David , Konnick Eric Quentin , Mubiru Kelvin , Mulumba Yusuf , Muwonge Catherine , Okoche Lazarus , Pierce Robert , Gralow Julie , Niyonzima Nixon 
Published: May 2020

e19009 Background: Breast cancer, the most common cancer in sub-Saharan Africa (SSA), is characterized by poor survival. An accurate assessment of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 receptor (HER2) status, typically via immunohistochemistry (IHC), is considered essential to provide prognostic data and guide therapeutic decision-making. However, due to inaccessible IHC services, these data are often unavailable in many parts of SSA; alternate methods need to be explored. Given the lab infrastructure developed in response to the HIV pandemic, RT-PCR testing is more readily accessible and feasible in SSA. Here we assess the potential of RT-PCR in evaluating the receptor status of women with breast cancer in Uganda. Methods: We enrolled women with a new diagnosis of invasive breast cancer at the Uganda Cancer Institute. Demographic and clinical data were obtained. A formalin-fixed paraffin embedded (FFPE) specimen was utilized for quantitative RT-PCR, using a validated assay for the detection of the ER, PR and HER2. Receptor expression levels were expressed as relative quantity (RQ) compared to housekeeping genes (CALM2). HER2 IHC results were categorized as negative (score 0 or 1+) or positive (3+); 2+ results (n=6) were excluded as FISH testing was not performed. Unstained slides were sent to the Fred Hutchinson Cancer Research Center for IHC. Receiver operating characteristic (ROC) analysis was applied to compare RT-PCR to IHC (gold standard). Results: We analyzed interim data (anticipated N=100 of an ongoing study) from 32 women aged 35 to 56 years. The majority of women (25, 78%) presented with advanced stage disease. Of the 32 cancers, 18 were ER+ (56%), 10 were PR+ (31%), 9 were HER2+ (28%) and 8 were triple negative (25%) by IHC. From ROC analysis, the AUC were 0.94, 0.95, and 0.81 for ER, PR, and HER2 respectively with high sensitivity and specificity (Table). Conclusions: Despite the tremendous need, the ability to detect the ER, PR, and HER2 via IHC in SSA is limited. Here we demonstrate the favorable test characteristics of RT-PCR when compared to IHC. Given the relatively wide accessibility of RT-PCR and endocrine therapy for breast cancer, as well as the recent inclusion of trastuzumab in the WHO’s Essential Medicines List, the results of this study have both direct diagnostic and therapeutic implications. Clinical trial information: NCT03518242 . [Table: see text]
Feasibility of an electronic risk score questionnaire in rural practice.
Authors: Bulbul Ajaz , Campbell Sara 
Published: May 2020

e19014 Background: Genetic testing (GT) has significant implications for cancer management. Its implementation is difficult in small rural practices (RP). We examined an electronic risk Score questionnaire (ERSQ) that blends genetic risk factors with clinical and cancer family history to determine its feasibility. Methods: Clinic encounters between Oct 18 - Jan 20 were evaluated. Prior to Oct 19 patients were screening based on physician recommendation (PRBS) without an established screening questionnaire. Between Oct 19 - Jan 20 an ERSQ on a tablet identified patients meeting either USPSTF (US preventative Task force), NCCN (National comprehensive cancer center) or ASBS (American Society of Breast Surgeons) guidelines for GT. Statistical analysis was performed using paired t-test. Out of pocket costs (OOP$), prevalence, patient care impact, High risk negative (HRN) requiring change in screening recommendation (CSR) were evaluated. Genetic telephonic genetic counselling was offered to patients. Results: Pre-ESRQ cohort covering 12 months included 3520 patient encounters; with 1024 encounters post-ESRQ lasting 90 days. Forty three GT’s were performed over 16 months. Pre-ESRQ, seventy three patients were offered PRBS. Sixteen were tested (22% compliance), 13 reported out with two positive results (15% prevalence) and one HRN requiring CSR in 23% (3/13). Post ESRQ, 257 patients were offered GT; 68/131 (51% compliance) (p < 0.0001) screened with the ESRQ met at least one criteria for GT with one positive GT (1/18; 5% prevalence) and 4 HRN; CSR 5/18 (28% CSR)(p < 0.0003). In the Post ESRQ cohort GT was cancelled due to cost burden to patients in 6/27 (22%) and in 2/18 (11%) of the pre ESRQ group (p < 0.0001). Out of 26 patients with OOP$ information 23/26 (88%) incurred a zero OOP$. ESRQ took a median of 8 minutes in the office. Conclusions: An effective tablet based ESRQ may be feasible to adapt in a busy RP and help address disparity in access to genetic screening. There may be a beneficial effect on compliance with limited cost burden to patients that needs further study. ESRQ can improve CSR. A larger prospective cohort may help confirm these findings.
African Access Initiative: A holistic, multi-sector approach to mitigating Africa’s cancer crisis.
Authors: Dent Jennifer , Graef Katy , Hargan-Calvopina Joseph , LeJeune Analise , Seymour Daniel , Weber Callie 
Published: May 2020

e19015 Background: In a dramatic reversal of trends, cancer now kills more Africans each year than malaria. Should trends continue, Africa’s cancer burden is projected to double to over 2 million new cases and over 1.4 million deaths annually by 2040. Africa’s burgeoning cancer crisis is attributable to many factors, including insufficient preventive, diagnostic, and treatment services; inadequate clinical infrastructure; and shortages of trained healthcare personnel. Methods: BVGH launched the African Access Initiative (AAI) in 2017 to address Africa’s cancer crisis. Utilizing a holistic approach that establishes sustainable access to cancer medicines, strengthens healthcare infrastructure, and builds clinical oncology capacity, BVGH is eliminating or minimizing many of the challenges African clinicians face when diagnosing and treating cancer patients. Complementing its innovative approach, BVGH engages experts across sectors to build capacity and execute programs. African ministries of health and cancer leaders are engaged to ensure AAI activities are driven by their priorities and needs. AAI is not a donation-based program. Pharmaceutical companies are engaged to ensure access to quality, lifesaving cancer drugs in a sustainable and patient-focused manner. International cancer experts are enlisted in capacity building programs that directly align with their expertise and meet their global oncology goals. Results: BVGH is applying its multi-faceted, multi-sector model in Cameroon, Côte d'Ivoire, Kenya, Nigeria, Rwanda, and Senegal. In partnership with Nigeria’s Ministry of Health, BVGH held a cancer stakeholder meeting to define the country’s priority cancers, drugs, and treatment regimens. Following the meeting, BVGH launched an RFP to pharmaceutical companies and subsequently developed reports that forecast full treatment costs based on the companies’ offerings of deeply-discounted drug prices. While simultaneously coordinating drug access, BVGH began planning training refreshers to ensure recipient Nigerian hospitals were ready to use the prioritized cancer drugs successfully. Beyond Nigeria, BVGH has improved Rwanda’s ability to diagnose cancer efficiently; improved Côte d'Ivoire’s multidisciplinary approach to diagnosing and treating cancer patients; and helped Kenya refine its cancer patient sample referral mechanisms. Conclusions: This presentation will describe BVGH’s holistic, multi-sector approach to addressing Africa’s cancer crisis, including partners, activities, lessons learned, and best practices.
Role of patient navigation in improving access to radiotherapy treatment in a limited resource setting.
Authors: Vieira Carolina Martins , Krush Lindsay , Goss Paul E. , Rodrigues Angelica Nogueira 
Published: May 2020

e19019 Background: Approximately 60% of cancer patients in low- and middle-income countries (LMICs) require radiotherapy (RT), with RT contributing 40% of curative treatment for cancers. Timely RT impacts prognosis. There are several difficulties in accessing RT in the Brazilian public health system: deficit of devices, obsolete machines, heterogeneous distribution of services, lack of investment in human resources and socioeconomic obstacles. Thus, it becomes necessary to optimize available resources. Although there are examples of successful patient navigation (PN) programs in vulnerable populations in high-income countries (HICs), data is scarce for LMICs. Considering the high incidence of cancer, complex difficulties in accessing treatment, and the positive results of PN in HICs, it was decided to evaluate this tool to improve RT access in the public system in Brazil. Methods: This pilot study was carried out in in a public school hospital in Belo Horizonte, Brazil, in partnership with the Global Cancer Institute, with a historical cohort as the control arm. The primary objective was to evaluate the changes in the time from definitive diagnosis to the start of treatment with the implementation of PN. Secondary objectives included: evaluating changes in the time between the beginning and end of RT, identification of the obstacles to access care, and quality of life data. Candidates for the program would be those considered for neoadjuvant or definitive RT, without previous cancer treatment. Results: 124 patients were included in the retrospective arm (12 excluded) and 73 in the navigation arm (1 excluded). Most had loco-regionally advanced disease, the most prevalent sites being esophagus, head, neck, and rectum. PN decreased the median time from biopsy result to the beginning of RT from 108 to 74 days (p < 0.001). PN also decreased the time between biopsy results and referral to RT (53 to 40.5 days, p = 0.011); between the referral and the first consultation in the RT (25 to 13 days, p < 0.001) and between the referral and the end of the RT (98 to 78 days, p < 0.003). There was an increase in the proportion of patients who started RT within 60 days (maximum period established by law to start cancer treatment), from 20.5% in the retrospective arm to 38.5% in the prospective arm (p = 0.026). PN in this context showed no impeditive costs ( < $140 USD per patient) with a satisfaction rate greater than 90% from patients. Conclusions: In an oncological context of socioeconomic vulnerability, PN is a financially viable and efficient tool to optimize access to timely radiotherapy.