bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychosocial impacts of the COVID-19 pandemic on young adult cancer survivors and parents of children with cancer.
Authors: Smith Stephanie M , Kumar Dhanya , Benedict Catherine , Heathcote Lauren C. , Aftandilian Catherine , Bondy Melissa , Schapira Lidia 
Published: June 2021

10050 Background: The COVID-19 pandemic has affected oncology practice in a variety of ways. We sought to evaluate the impact on pediatric oncology parent and young adult (YA) patient experiences, concerns, and perceived stress. Methods: We conducted a cross-sectional Internet-based survey of parents and YA patients in the pediatric oncology and survivorship clinics at Stanford between June-December 2020. Patients were recruited in person by clinic staff or through the electronic patient health portal. Surveys (available in English and Spanish) included the NIH Perceived Stress Scale (PSS-10) and investigator-developed questions evaluating clinical practice changes, concerns about health and cancer care, and pandemic-related challenges. Bivariate analyses evaluated associations between demographic, clinical, and pandemic-related factors and (a) concern about the pandemic affecting health and cancer care, and (b) perceived stress. Results: Among 81 participants (66 parents, mean age 41.6 ± SD 9.6; 15 YAs, mean age 21.9 ± 8.4 years), 37% self-identified as Hispanic/Latino, 36% non-Hispanic white, and 21% Asian. Twenty-eight percent were on treatment and 47% had completed treatment (79% < 5 years prior). Thirty percent reported cancer-related appointment changes, largely rescheduling (75%) and/or switching to telehealth (42%). Nearly half (45%) of parents and 27% of YAs reported feeling ‘very’ or ‘extremely’ concerned about the pandemic affecting their child’s/their health or cancer care. Race/ethnicity emerged as the only demographic feature that was significantly associated with high concern (p = 0.018), with 57% of Hispanic/Latino and only 21% of non-Hispanic white respondents reporting high levels of concern. Specific concerns included fear of severe infection, immunosuppression, and whether infection would change treatment and compromise effectiveness. Parents and YAs reported ‘a lot’ or ‘a great deal’ of challenges in their personal/family life (61%) and work/professional life (48%). Among these were having less support from friends/family (35%), reduced wages/work hours (31%), and job loss (20%) with 20% reporting ≥ 3 challenges. On the PSS-10, stress in the past month was high for parents (mean 30 ± 4) and YAs (mean 31 ± 5.1) on a scale of 0-40. Risk factors for higher stress included: male gender (p = 0.028), less support from family/friends (p = 0.002), and experiencing ≥ 3 pandemic-related challenges (p = 0.013). Conclusions: Our findings confirm the prevalent worry and stress that pediatric oncology patients and families are experiencing during the COVID-19 pandemic. Better communication about cancer care service changes may help to alleviate some concerns. Supportive care resources may also help patients and families cope with psychosocial stressors, particularly among at-risk groups.
Community-based lung cancer screening adherence to Lung-RADS recommendations.
Authors: Kim Roger , Rendle Katharine A. , Neslund-Dudas Christine , Greenlee Robert T. , Burnett-Hartman Andrea N. , Honda Stacey A. , Simoff Michael J. , Croswell Jennifer M. , Ritzwoller Debra P. , Vachani Anil 
Published: June 2021

10540 Background: In the NLST and NELSON trials, most low-dose CT (LDCT) screen-detected lung cancers were not diagnosed during the first round of screening, suggesting that longitudinal adherence to lung cancer screening (LCS) recommendations is key. Adherence was as high as 95% in clinical trials, but limited data exist regarding LCS adherence in clinical practice. We aimed to determine adherence to Lung-RADS recommendations among community-based patients undergoing LCS. Methods: We performed a multicenter retrospective cohort study of patients screened for lung cancer at healthcare systems within the Lung Population-based Research to Optimize the Screening Process (PROSPR) Consortium. We included 55-80 year-old current or former smokers who received a baseline (T0) LDCT with a Lung-RADS score between January 1, 2015 and September 30, 2017 and excluded patients who were diagnosed with lung cancer prior to the T0 scan. Over a 24-month period, we calculated the proportion of patients adherent to Lung-RADS recommendations and evaluated associations with patient-level (age, sex, race, ethnicity, smoking status, body mass index, Elixhauser comorbidities, year of T0 scan, and Lung-RADS score) and census tract (median family income, level of education) data, using multivariable logistic regression with mixed effects to account for site variability. Results: Of the 6,723 patients in our cohort (median age 65 years [IQR 60-69]; 45.1% female; 73.0% white; 59.0% current smokers), 5,583 (83.0%) had Lung-RADS 1 or 2 T0 scans, 733 (10.9%) Lung-RADS 3, 274 (4.1%) Lung-RADS 4A, and 133 (2.0%) Lung-RADS 4B or 4X. Overall, 55.2% (3,709/6,723) of patients were adherent (Table). In the final multivariable model, Black patients had reduced adherence compared to white patients (adjusted odds ratio [aOR] 0.79, 95% CI 0.66-0.94), while greater adherence was observed in former smokers compared to current smokers (aOR 1.33, 95% 1.19-1.49). Compared to individuals with a negative T0 scan (Lung-RADS 1 or 2), those with Lung-RADS 3 (aOR 1.56, 95% CI 1.31-1.86), 4A (aOR 1.63, 95% CI 1.24-2.15), or 4B/4X (aOR 3.59, 95% CI 2.30-5.60) T0 scans had greater odds of adherence. Conclusions: In the largest study of real-world patients receiving LCS to date, adherence to Lung-RADS recommendations is lower than previously observed in clinical trials. Our results highlight the need for further study of system-level mechanisms to improve longitudinal LCS adherence rates.[Table: see text]
Global tissue stiffness on breast MR elastography: High-risk dense breast patients have higher stiffness compared to average-risk dense breast patients.
Authors: Patel Bhavika K. , Pepin Kay , Brandt Kathy R , Mazza Gina L. , Pockaj Barbara A. , Chen Jun , Zhou Yuxiang , Northfelt Donald W. , Anderson Karen , Ernst Brenda , Cronin Patricia , Ahmad Sarwat , Kling Juliana , Millstine Denise , Apsey Heidi , Vachon Celine M , Nelson Ilyse , Ehman Richard 
Published: June 2021

10541 Background: Biomechanical tissue properties may vary in the breasts of patients at elevated risk for breast cancer. We aim to quantify in vivo biomechanical tissue properties in various breast densities and in both normal risk and high risk women using Magnetic Resonance Imaging (MRI)/MRE and examine the association of biomechanical properties of the breast with cancer risk. Methods: In this IRB–approved prospective single-institution study, we recruited two groups of women differing by breast cancer risk to undergo a 3.0 T dynamic contrast enhanced MRI/MRE of the breast. Low-average risk women were defined as having no personal or significant family history of breast cancer, no prior high risk breast biopsies and a negative mammography within 12 months. High-risk breast cancer patients were recruited from those patients who underwent standard of care breast MR. Within each breast density group (non-dense versus dense), two-sample t-tests were used to compare breast stiffness, elasticity, and viscosity across risk groups (low-average vs high). Results: There were 50 low-average risk and 86 high-risk patients recruited to the study. The risk groups were similar on age (mean age = 55.6 and 53.6 years), density (68% vs. 64% dense breasts) and menopausal status (66.0% vs. 69.8%). Among patients with dense breasts, mean stiffness, elasticity, and viscosity were significantly higher in high risk patients ( N = 55) compared to low-average risk patients ( N = 34; all p < 0.001). In the multivariate logistic regression model, breast stiffness remained a significant predictor of risk status (OR=4.26, 95% CI [1.96, 9.25]) even after controlling for breast density, MRI BPE, age, and menopausal status. Similar results were seen for breast elasticity (OR=4.88, 95% CI [2.08, 11.43]) and viscosity (OR=11.49, 95% CI [1.15, 114.89]). Conclusions: Structurally-based, quantitative biomarker of tissue stiffness obtained from global 3D breast MRE is associated with differences in breast cancer risk in dense breasts. As such, tissue stiffness could provide a novel prognostic marker to help identify the subset of high-risk women with dense breasts who would benefit from increased surveillance.[Table: see text]
Understanding factors associated with uptake of lung cancer screening among individuals at higher risk.
Authors: Gudina Abdi , Cupertino Anapaula , Kamen Charles Stewart , Adler David , Belcher Elizabeth , Gilmore Nikesha , Kleckner Amber , Arana Evelyn , Kehoe Lee , Hardy Sara , Janelsins Michelle Christine , Morrow Gary R. 
Published: June 2021

10559 Background: Lung cancer is the leading cause of cancer death in the U.S, accounting for about 25% of all cancer mortality. The U.S Preventive Services Task Force has recommended annual screening for lung cancer using low-dose computed tomography (LDCT) scanning for individuals at higher risk (aged 55-80 years with a >30 pack-year smoking history). Early detection using LDCT scanning reduces lung cancer specific mortality by 20%. Despite its efficacy, the uptake of annual lung cancer screening among high-risk individuals remains low ( < 18%). The purpose of this study was to identify factors associated with the uptake of lung cancer screening in high-risk individuals in the U.S population. Methods: Data for this study were obtained from the 2017-2019 Behavioral Risk Factor Surveillance System (BRFSS), a population-based survey conducted annually by the Centers for Disease Control and Prevention (CDC) in collaboration with health departments in all 50 states, Washington, DC, and the U.S territories. We restricted our sample to high-risk individuals aged 55-80 years with a >30 pack-year smoking history. Only subjects with complete data on all predictor variables (age, gender, race/ethnicity, marital status, education, income, insurance, COPD, current smoking status, primary care provider) and the outcome variable (uptake of lung cancer screening) (n = 11, 714) were included in the final analysis. Chi-square tests were used to compare the uptake of lung cancer screening by demographic and socioeconomic factors. Multivariable logistic regression models were used to model the association between the predictors and the outcome variable. Results: Individuals with no health insurance (OR: 0.64; 95%CI: 0.46-0.90), no primary healthcare provider (OR: 0.40; 95%CI: 0.31-0.52), no chronic obstructive pulmonary disease (COPD) (OR: 0.35; 95%CI: 0.31-0.0.40) and who were females (OR: 0.86; 95%CI: 0.76-0.96) were less likely to participate in annual lung cancer screening. Individuals aged 65–69 years (OR: 1.65; 95%CI: 1.38-1.97), 70–74 years (OR: 1.77; 95%CI: 1.46-2.14) or 75–80 years (OR: 1.42; 95%CI: 1.16-1.76) were more likely to receive annual lung cancer screening compared with those aged 55-59 years. Race/ethnicity, level of education, level of income, marital status, and current smoking status had no significant association with the uptake of annual lung cancer screening. Conclusions: Our study identifies factors associated with lower uptake of annual lung cancer screening (no health insurance coverage, no primary healthcare provider, no COPD, and female gender). The findings from this study have important implications for the design of more effective interventions to target specific subgroups for the uptake of annual lung cancer screening.
Trends in breast cancer incidence among young women aged 20 to 49 years in the United States.
Authors: Xu Shuai , Han Yunan , Wan Fei , Toriola Adetunji T. 
Published: June 2021

10573 Background: Breast cancer in young women is diagnosed at more advanced stages and has a less favorable prognosis. We investigated trends in breast cancer incidence by race/ethnicity, hormone receptor status, and tumor stage in women aged 20-49 years over the past 25 years, as well as the impact of period and cohort effects on these trends. Methods: We used data from Surveillance, Epidemiology, and End Results (SEER) 13 registries for 1993-2002 and SEER 18 registries for 2003-2017. We calculated age-standardized incidence rates and annual percent change (APC), and stratified by race/ethnicity, hormone receptor status (estrogen receptor [ER] and progesterone receptor [PR]), and tumor stage (I-IV) for 222,424 women aged 20-49 years with a primary invasive breast cancer. We performed age-period-cohort analysis (presented as incidence rate ratios [IRR]) to investigate the effects of age, period, and cohort on incidence trends using the 1948 cohort and 1993-1997 period as the reference groups, respectively. Results: Between 2010-2017, invasive breast cancer incidence increased (APC = 0.67%, 95%CI: 0.32 to 1.03) among women aged 20-49 years, after being stable from 1993-2010. There were differences by race over the 25-year period (1993-2017). We observed significant increases in incidence among non-Hispanic White (NHW) (APC = 0.25%, 95%CI: 0.16 to 0.34), non-Hispanic Asia/Pacific Islander (NHAPI) (APC = 0.58%, 95%CI: 0.34 to 0.82), and Hispanic women (APC = 0.59%, 95%CI: 0.34 to 0.83), but not among non-Hispanic black (NHB) women (APC = 0.14%, 95%CI: -0.06 to 0.34). Incidence increased for ER+ tumors but decreased for ER- tumors: ER+/PR+ (APC = 2.39%, 95%CI: 2.20 to 2.58), ER+/PR- (APC = 1.46%, 95%CI: 1.05 to 1.87), ER-/PR+ (APC = -6.33%, 95%CI: -7.31 to -5.33), and ER-/PR- (APC = -0.70%, 95%CI: -1.09 to -0.32). The decrease in ER-/PR- tumors appeared largely driven by decreases among HNW women. Incidence for stages I (APC = 0.31, 95%CI: 0.07 to 0.55), II (APC = 0.99, 95%CI: 0.82 to 1.16), and IV (APC = 2.88, 95%CI: 2.37 to 3.39) tumors increased while that for stage III tumors decreased (APC = 0.81%, 95%CI: -1.04 to -0.59). Both the cohort and period effects impacted incidence, with the cohort effect almost 10 times larger than the period effect. Age-specific relative risk by birth cohort initially decreased between 1948 and 1958 but steadily increased from 1958 to 1993. Breast cancer incidence was higher among women born in the 1988 (IRR = 1.17, 95%CI: 1.07 to 1.28) and 1993 (IRR = 1.22, 95%CI: 0.99 to 1.51) cohorts than for those born in 1948 cohort. Conclusions: Breast cancer incidence is increasing among young women, mainly driven by increases in ER+ tumors. Prevention efforts need to focus on how we can address factors driving the increase in ER+ tumors and also learn from what has worked for decreasing ER- tumors.
Hereditary cancer testing in an ethnically diverse U.S. population.
Authors: Basiliere Michele , Woods Stephanie , Owen Heidi , Dohany Lindsay , McDaniel Lisa , Wisniewski Nicholas 
Published: June 2021

10579 Background: The clinical utility of hereditary cancer multigene testing is well-established. Most testing has been performed in the White European population, with a relative shortage of data in other ethnic groups. Evaluation of hereditary cancer variants within diverse ethnic populations is important to drive accurate variant interpretation. This study aims to review the outcomes of hereditary cancer testing in an ethnically diverse U.S. population. Methods: We conducted a retrospective analysis of 8,888 test results from a 31-gene hereditary cancer test using next-generation sequencing with copy number variant analysis. Results were separated into seven categories based on the ethnicity selected on the test requisition: African American (AA), Asian (A), Ashkenazi Jewish (AJ), Hispanic (H), White (W), Other (O), and Unknown (U). O was used for any handwritten ethnicity or if multiple ethnicities were selected and U if no ethnicity was chosen. We quantified the number of negative, positive (pathogenic or likely pathogenic (P/LP) variant) and variant of uncertain significant (VUS) results for each ethnic group. We tallied the gene and variant for each result with a positive, negative or VUS. We used a Fisher's Exact test and Bonferroni-adjusted p-values to account for multiple hypothesis testing. Results: Of the 8,888 orders reviewed, 45% were non-White ethnic groups. The P/LP variant rate was lower for AA (4%, p=2e-04) compared to W (9%). The VUS rate was higher for O, AA and A (48%, 56%, and 57%; p=0.0045, 3.1e-17 and 4.8e-06, respectively), compared to 38% in W. Lower negative rates were found in A and AA (37% and 40%; p=0.00024 and 9.4e-10, respectively), and trending lower in O (46%, p=0.0097), compared to 58% for W. The VUS rate for H is 41% (p value = 0.095). Conclusions: Our results suggest that non-Whites may be at a disadvantage when it comes to hereditary cancer multigene testing due to the higher rate of VUS results. The inverse correlation between the overall rates of VUS and negative results when comparing these populations suggests there may be limited variant information for the non-White population in medical literature and available databases. This underrepresentation may make it more difficult to accurately characterize a variant. Despite the small sample size, these findings are consistent with previous publications; however, gene specific outcomes could not be evaluated. This finding suggests that providers could give these patients uninformative results more often, which has potential to impact screening protocols for these families. More research is needed to understand the impact of variant classification across ethnicities to decrease health disparities.
Variant reclassification and its impact on clinical care in an Asian cancer center.
Authors: Chiang Jianbang , Chia Tze Hao , Chan Sock Hoai , Ngeow Joanne YY 
Published: June 2021

10583 Background: Genetic testing has demonstrated clinical utility in the identification and subsequent surveillance of patients with cancer predisposition syndromes. However, the increased likelihood of encountering a variant of uncertain significance (VUS) in individuals of non-European descent such as Asians may be challenging to both clinicians and patients in interpretation and management. VUS can be reclassified as more data becomes available. VUS reclassification is important, as it may have implications for surveillance and treatment. This study aims to evaluate the prevalence and patterns of variant reclassification in an Asian country and its impact on patient management. Methods: A prospective cohort of patients seen at the Cancer Genetics Service at the National Cancer Center Singapore between February 2014 to March 2020 was evaluated. The frequency, direction and time to variant reclassification was assessed by comparing the reclassified report against the original report. Results: A total of 1412 VUS were reported in 49.9% (845/1695) of patients. Over six-years, 6.7% (94/1412) of variants were reclassified. Most VUS (94.1%; 80/85) were downgraded to benign/likely benign variant, with a smaller proportion of VUS (5.9%; 5/85) upgraded to pathogenic/likely pathogenic variant. Actionable VUS upgrades and pathogenic/likely pathogenic variant downgrades, that resulted in management changes, happened in 31.0% (39/126) of patients. The median and mean time taken for reclassification were 1 and 1.62 year(s) respectively. Conclusions: Clinicians need to put in place a system for review of variants, as variant reclassification can lead to changes in management in nearly 1/3 of patients. Management should be based on the patient’s personal history, family history and variant interpretation. We propose a clinical guideline to standardize management of patients with VUS. For clinically relevant or suspicious VUS, follow-up is recommended every two years, as actionable reclassifications may happen during this period.
Evaluation of cohort diversity in development and validation studies of hereditary cancer genetic risk assessment models.
Authors: Gammon Amanda , Khan Ambreen , Jeter Joanne M. 
Published: June 2021

10600 Background: Multiple models estimate a person’s chance of harboring a pathogenic variant increasing cancer risk. Some pathogenic variants are more common in individuals from specific ancestries, such as the BRCA1 and BRCA2 founder variants in Ashkenazi Jews. Yet data remains limited on the larger variant spectrum seen among people of different ancestral backgrounds and whether or not the pathogenic variant frequency differs in many populations. Due to this, it is important that genetic risk assessment models be validated in a diverse cohort including Black, Indigenous, People of Color (BIPOC). Methods: A literature search was conducted to identify published development and validation studies for the following genetic risk assessment models: BRCAPRO, MMRPRO, CanRisk/BOADICEA, Tyrer-Cuzick, and PREMM. Validation studies that only evaluated the cancer risk prediction capabilities of the models (and not the genetic variant risk prediction) were excluded. The following participant information was abstracted from each study: total number of participants, gender, race, and ethnicity. Authors were contacted to obtain missing information (if available). Results: 12 development and 12 validation studies of the genetic risk assessment models BRCAPRO, MMRPRO, CanRisk/BOADICEA, Tyrer-Cuzick, and PREMM were abstracted. Of the validation studies, five were internal validation studies conducted by the model developers, and seven were external validation studies. Four external validation studies compared multiple models. 75% (18/24) of papers did not include reporting of participant race or ethnicity information in their published reports. External validation studies (4/7, 57%) more often reported participant race/ethnicity than development (0/12, 0%) or internal validation (2/5, 40%) studies. The external validation studies for BRCAPRO reporting race/ethnicity information involved cohorts that ranged from 50-51% non-Ashkenazi Jewish white, 28% African American, 1% Asian, 2-49% Hispanic, and 19-42% Ashkenazi Jewish. The external validation studies for MMRPRO and PREMM reporting race/ethnicity information involved cohort that ranged from 0-82% white, 4-100% Asian, 7% Black, and 7% Hispanic. Conclusions: Increased reporting of participant ancestry and ethnicity is needed in the development and validation studies of genetic risk assessment models. BRCAPRO’s validation cohorts have included a higher percentage of Hispanic and Black/African American participants, while MMRPRO and PREMM have been validated in a higher percentage of Asian participants. As debate continues about the utility of currently used racial categories in genetics research, it will be important to determine how best to report on participant diversity. These findings highlight the continued need for genetics researchers to engage BIPOC and identify ways to diversify their participant cohorts.