bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation and outcomes of lung cancer screening in a community health care system.
Authors: McCabe Vita , Raleigh Ruth , Pichan Alice , Lavasseur Beth Irene , Swarup Rajeev , Fugenschuh David , Ferguson Eric , Stella Philip J. , Griggs Jennifer J. 
Published: September 2018

e13035 Background: Lung cancer screening using low dose computed tomography (LDCT) in patients meeting criteria is a covered preventative service under the Affordable Care Act and policies of CMS. The purpose of this study is to describe implementation and results of a lung cancer screening program in a community health care system. Methods: We prospectively collected data on all patients obtaining a baseline LDCT scan who enrolled beginning February 2015. Referring provider, smoking history, demographics, comorbidity, findings, and, in those found to have an abnormality, diagnosis were collected. The study was reviewed by the St Joseph Mercy Health System Institutional Review Board and was considered exempt. Results: Over the course of 18 months, 955 patients were referred for a baseline LDCT. 57% were current smokers, 53% were male, and 38% had no comorbid conditions. The mean number of pack-years was 50 (range 6 to 160). 76% of patients were referred by primary care providers. The number of new patients referred per month increased from 8 to 89, largely due to outreach and education directed at primary care physicians and office staff. Of the 955 patients screened, we identified cancer in 2% overall (small cell cancer in 0.2% patients and non-small cell lung cancer (NSCLC) in 1.6%). Among those with NSCLC, 60% had Stage I disease, 20% had Stage II, 13% had Stage III, and 7% had Stage IV disease. Compared to the stage distribution of lung cancer patients identified before the implementation of the screening program, there was significant down-staging in those with NSCLC. Barriers to implementation have included lack of clear smoking history documentation and billing code release delays which led to reimbursement difficulties. Conclusions: Successful implementation of a LDCT lung cancer screening program in a community setting. Improving patient/provider education and documentation of tobacco use in electronic medical records will streamline the referral process and increase screening among eligible patients. Outreach to practices that serve minority and other medically-underserved populations will require specific efforts to achieve health equity in the area of lung cancer screening.
Precision prostate cancer chemoprevention with gamma-tocotrienol.
Authors: Moore Christine Ann , Palau Victoria , Lightner Janet , Brannon Marianne , Stone William , Krishnan Koyamangalath 
Published: September 2018

e13043 Background:  A goal of precision chemoprevention is to prevent or delay cancer progression by using minimally toxic agents guided by knowledge of alterations in oncogenic molecular pathways and signaling cascades. Indolent prostate cancer can benefit from chemopreventive agents by delaying growth. Vitamin E is not a single compound and refers to four tocopherols and four tocotrienols. The use of all-racemic-alpha tocopheryl acetate in preventing cancer was studied in the SELECT clinical trial. This trial found it was not chemopreventive and could promote prostate cancer. We compared the abilities of RRR-alpha-tocopherol (AT), RRR-gamma-tocopherol (GT), and gamma-tocotrienol (GT3) in preventing growth of two prostate cancer cell lines (LNCaP and PC-3) and a control prostate cell line (RWPE-1) by quantifying their effects on two signaling pathways known to be pivotal in prostate carcinogenesis, AKT and MAP Kinase (pERK). Methods:  LNCaP, PC-3, and RWPE-1 cell lines were treated with increasing concentrations of AT, GT and GT3 in DMEM, and cytotoxicity determined by MTS cell culture experiments. We determined the effect of GT3 on signaling pathways by analyzing B-actin, P-AKT and p-ERK in combination with AKT and/or MEK inhibitors via Western immunoblot and PCR analysis. Results:  Initial experiments with LNCaP and PC-3 cells showed GT3 induced the expression of pERK and p-c-JUN, inhibited cell growth and promoted apoptotic cell death. Neither AT nor GT had these effects. AKT was not activated by AT, GT or GT3. Inhibition of AKT activation via MK-2206 did not block GT3 growth inhibition in LNCaP cells. No growth inhibition was found with RWPE-1 control cells in presence of AT, GT or GT3 yet GT3 induced pERK expression. AT did not interfere with cancer growth inhibition and did not block the anticancer effects of GT3. Conclusions: GT3 induces the activation of pERK but this effect is not sufficient to account for the in vitro chemopreventive effects of this form of vitamin E. The AKT pathway is not modulated by GT3 and does not appear to be relevant to GT3 killing of PC-3 or LNCaP. Of five signaling pathways implicated in prostate carcinogenesis, we explored AKT and pERK. Future research will explore B-catenin, mTOR and PI3K.
Identifying women at high-risk for breast cancer using data from the electronic health record compared to self-report.
Authors: Li Xinyi , McGuinness Julia E. , Vanegas Alejandro , Colbeth Hilary , Vargas Jennifer , Sandoval Rossy , Kukafka Rita , Crew Katherine D 
Published: September 2018

e13044 Background: One of the barriers to chemoprevention uptake among high-risk women is the lack of routine breast cancer risk assessment in the primary care setting. We calculated breast cancer risk using the Breast Cancer Surveillance Consortium (BCSC) model, which accounts for age, race/ethnicity, first-degree family history of breast cancer, benign breast disease, and mammographic density, using data collected from the electronic health record (EHR) compared to self-report. Methods: Among women undergoing screening mammography, we collected breast cancer risk information from the EHR and a self-administered survey. Eligibility criteria for calculating 5-year invasive breast cancer risk using the BCSC model included age 35-74, no prior history of breast cancer, mastectomy, or breast augmentation. We extracted data on demographics, structured first-degree family history, breast radiology and pathology reports from the EHR. We assessed agreement in breast cancer risk information between the EHR and self-report data. Results: Among 13,735 women with EHR data for BCSC risk calculation, 2708 women (20%) met high-risk criteria, based upon a 5-year breast cancer risk ≥1.67%. Among high-risk women, 2% were age 40-49, 23% age 50-59, 48% age 60-69, and 26% age 70-74. From the EHR, data was missing on 31% for race/ethnicity and 85% for family history. Among 2320 women with both EHR and self-report data, more complete information was available for race/ethnicity, family history, and breast biopsies in the surveys. More first-degree family history (14% vs. 3%) and prior breast biopsies (18% vs. 11%) were identified by self-report vs. EHR, respectively. However, more women with atypia and lobular carcinoma in situwere identified from the EHR. More high-risk women (20% vs. 16%) were identified with EHR vs. survey data, respectively, with correlation of 0.82. Conclusions: Among women undergoing screening mammography, we identified 20% who met high-risk criteria according to the BCSC model based upon EHR data, despite missing information on race/ethnicity, family history, and prior breast biopsies. This may serve as an initial screen for identifying women eligible for breast cancer chemoprevention.
National trends in cholangiocarcinoma in the United States (US): 2000-2014.
Authors: Lee Ru Min 
Published: September 2018

e13056 Background: Cholangiocarcinoma (CCA) arise from the epithelial cells of the intrahepatic and extrahepatic bile ducts. Although rare in the US, they are highly lethal because most are locally advanced at presentation. The incidence of CCA has increased over time. This study aims to estimate the characteristics, outcomes, and cost burden of patients hospitalized for CCA by using a large national database. Methods: The Nationwide Inpatient Sample (NIS) database was used to obtain data from 2000-2014. The NIS contains data from over 7 million hospital stays in the US per year generalizable to the American population. The NIS was queried for ICD-9 codes for primary diagnosis of CCA with 155.1 [Malignant Neoplasm of Intrahepatic Ducts (MNID)] and 156.1 [Malignant Neoplasm of Extrahepatic ducts (MNED)]. Information for total number of hospitalizations, mortality, and hospital charges was evaluated. Results: The number of hospitalizations for MNID increased from 2,599 in to 4,840 (p < 0.001) from 2000 to 2014. The number of hospitalizations for MNED decreased from 2,529 to 2,350 but was not statistically significant. Inpatient mortality of MNID decreased from 12.98% to 8.57% (p < 0.05%). Inpatient mortality of MNED decreased from 7.46% to 5.11% but was not statistically significant. Mean charges for MNID increased from $27,779 to $79,096 (p < 0.001). Mean charges for MNED increased from $34,212 to $89,852 (p < 0.001). Conclusions: This study demonstrates that the number of hospitalizations for MNID has increased by 86% from 2000 to 2014. This number continues to rise. However, inpatient mortality of MNID is decreasing. These findings show that the incidence of cholangiocarcinoma of the intrahepatic subtype is increasing and more study is required to investigate why this is so.
Epidemiology and outcomes of bloodstream infections in patients with solid tumors in a Latin American population at Mexico Hospital, San Jose, Costa Rica.
Authors: Calvo Jorge , Villalobos Juan , Ramos-Esquivel Allan , Landaverde Denis Ulises 
Published: September 2018

e13057 Background: Bloodstream infections (BSI) are an important cause of mortality in patients with solid tumors. We decided to conduct a retrospective study to evaluate the epidemiological profile and mortality of BSI in admitted patients with solid tumors at Mexico Hospital, being the first study in Costa Rica and also Central America describing our current epidemiological situation. Methods: We analyzed the infectious disease database for BSI in patients with solid tumors admitted in our Institution from January 2012 to December 2014. Epidemiology and mortality was obtained according to microorganism, antibiotic sensitivity, tumor type and presence of central venous catheter (CVC). Descriptive statistics were used. Results: A total of 164 BSI were recorded, the median age was 58 years, 103 cases (63%) were males, 128 cases (78%) were due to gram-negative bacilli (GNB), K. pneumoniae (21%), E. coli (21%) and P. aeruginosa (15%) were the most common microorganisms isolated. Gram-positive cocci (GPC) were found in 36 cases, being the most frequent S. aureus (10%) and S. epidermidis (6%). In respect to tumor type, BSI were more frequent in the gastrointestinal tract, as follow: gastric 43 (27%), colorectal 23 (14%), pancreatic 9 (6%), but also 7 cases (4%) in breast cancer and lung cancer 6 (4%). In terms of antibiotic sensitivity only 17% (GNB) expressed extended spectrum beta-lactamase (ESBL) and 12% (GPC) had methicillin-resistance. Patients with CVC inserted (59 cases) were colonized by GNB (78%). In overall the mortality rate at 30 days was 30%. Conclusions: GNB are the most frequent cause of BSI in solid tumors, and in patients with CVC inserted. Gastrointestinal cancers reported more BSI than other sites. Mortality as well as antibiotic sensitivity remain stable and acceptable during the observational time, in this Latin American population.
A ten-year epidemiology of cancers managed at the hematology and oncology unit of a Haitian tertiary hospital from 2006 to 2015.
Authors: Jacques Flawendjee Djaweelentz , Bernard Joseph , Chalumeau Elsie Metellus 
Published: September 2018

e13061 Background: The recent epidemiology of cancers in Haiti is poorly known, since there is no national cancer registry. The data from GLOBOCAN 2012 are estimations that do not reflect the real cancer epidemiology in countries such as Haiti. The aim of this study was to determine the ten-year epidemiology of cancer cases managed at a Haitian tertiary hospital. Methods: A retrospective study based on the chart review of cancer cases aged 18 years old or more with histologic diagnosis was conducted at the Hematology and Oncology Unit of the State University Hospital of Haiti (HUEH) from 2006 to 2015. Variables such as age, gender, year of diagnosis and cancer type were collected. Results: Eight hundred seventy-five cancer cases out of 1191 (73.47%) were selected for this study. The mean age of the study population is 51 years-old [18 – 91] and there were 13.6% males and 86.4% females. Breast cancer is the most common type (70.74% [95% CI, 67.58% - 73.71%]) followed by gastrointestinal cancers (5.6% [95% CI, 4.21% - 7.39%]), leukemias/multiple myeloma (4.69% [95% CI, 3.43% - 6.36%]), skin cancers (4.57% [95% CI, 3.32% - 6.23%]), gynecological cancers (4% [95% CI, 2.84% - 5.58%]), lymphomas (3.77% [95% CI, 2.65% - 5.31%]), sarcomas (3.31% [95% CI, 2.27% - 4.78%]) and ear, nose and throat (ENT) cancers (1.14% [95% CI, 0.58% - 2.16%]). Breast cancer is the most common type among women (80.6%) and the gastrointestinal cancers the most diagnosed among men (21.9%). Conclusions: Breast cancer is by far the most prevalent cancer in this retrospective cohort. Gynecological and lung cancers are underestimated and urology cancers not represented in this sample possibly because they are not systematically referred to the unit.This study can hopefully lead to more advocacy for all patients to be evaluated at the Hematology and Oncology Unit for a better management.
Sociodemographic factors associated with developing head and neck and esophageal cancers following breast cancer.
Authors: Tyker Albina , Dollar Krista , Simpson Matthew , Adjei Boakye Eric , Varvares Mark A , Osazuwa-Peters Nosayaba 
Published: September 2018

e13063 Background: Breast cancer survivors may develop other primary malignancies due to several factors. However, sociodemographic factors associated with the development of head and neck (HN) and esophageal second primary malignancies (SPMs) following management of primary breast cancer (BC) have not been well studied. This study examined the association between BC patients’ sociodemographic characteristics and the development of an esophageal or HN SPM. Methods: Patients ( n= 505,641) diagnosed with breast cancer between 1973 and 2013 in the Surveillance, Epidemiology, and End Results (SEER) 9 program were used for this analysis. HN SPMs included oral cavity, pharynx, larynx, and sinuses. Cox proportional hazards regression was used to evaluate estimators of survival based on age at diagnosis, race, marital status, treatment type, and year of diagnosis. Results: A total of 284 BC patients developed an esophageal SPM, and 969 developed HN SPM. In the adjusted model, increased age at BC diagnosis was a significant predictor for developing both HN and esophageal SPMs. For every 1-year increase in age at diagnosis, the hazard of developing an esophageal SPM increased (HR: 1.05; 95% CI: 1.04-1.06) and HN SPM increased (HR: 1.02; 95% CI: 1.02 -1.03). Hispanic women had a decreased hazard (HR: 0.63; 95% CI: 0.47-0.85) of developing HN SPM compared to non-Hispanic White women, however there was no significant difference for esophageal SPM. Women that were married had a decreased hazard (HR: 0.70; 95% CI: 0.55-0.90) of developing esophageal SPM compared to unmarried women. Conclusions: Sociodemographic factors may be important in the development of SPMs after treatment for breast cancer. While older women with BC were more likely to develop SPMs of the HN and esophagus, Hispanic breast cancer survivors and married women were less likely to develop SPMs of the HN and esophagus. To optimize survival benefits in the breast cancer population, there is need to further explore these sociodemographic factors associated with developing SPMs.
Exploring the association between renal cell carcinoma (RCC) and myeloid malignancies.
Authors: Shenoy Niraj Konchady , Mudireddy Mythri , Leung Nelson , Costello Brian Addis , Leibovich Bradley C. , Thompson Robert Houston , Pagliaro Lance C. , Witzig Thomas E. , Ou Fang-Shu , Ordog Tamas , Patnaik Mrinal Mahesh , Tefferi Ayalew , Begna Kebede 
Published: September 2018

e13073 Background: We observed several patients with a personal history of both RCC and myeloid malignancy, and aimed to explore a possible association, especially given the similarity in their epigenetic landscape, with both being characterized by widespread aberrant hypermethylation (Hu C et al, CCR 2014; Jiang Y et al, Blood 2009). Methods: Mayo Clinic’s ‘Advanced Cohort Explorer’ database was used to identify patients with a history of both RCC and a myeloid malignancy - Acute Myelogenous Leukemia (AML), Myeloproliferative Neoplasms (MPN), Myelodysplastic syndromes (MDS) - and to determine the clinical characteristics. The incidence of MDS in patients ≥65 years with a history of RCC was compared to that in the general population ≥65 years (SEER- Medicare database) as well as the general patient population at Mayo Clinic, using one sample test of proportions. Results: A total of 59 patients were identified, with both biopsy proven RCC and a myeloid malignancy during their life time (12 AML, 9 MPN, 9 low risk MDS and 29 intermediate- high risk MDS). The cohort was characterized by marked male predominance (4.4: 1). Median age at RCC diagnosis was 64 years (range 37-87) and myeloid malignancy was 75 years (range 44-90). 46/59 patients had the RCC antecedent, 10/59 concurrent and 3/59 subsequent to the myeloid malignancy with a median time of myeloid malignancy diagnosis after RCC diagnosis of 7.7 years. For patients ≥65 years, the risk of developing MDS with a history of stage I/II RCC and nephrectomy was 5.26 times that of the general population based on the SEER-Medicare database (Cogle, Blood 2011)(395/100,000 vs 75/100,000; p value < 0.001), and 3.07 times that of the general population at Mayo Clinic (395/100,000 vs 128.4/100,000; p value < 0. 001). Conclusions: We observed an association between RCC and myeloid malignancies, particularly MDS; with a history of RCC conferring a substantially increased risk of developing MDS. We hypothesize that the perturbation of epigenetic landscape in the form of widespread hypermethylation may explain, in part, the association between the two malignancies; and aim to explore the potential aberrancy of epigenetic regulators in our patient cohort with a genomic, epigenomic and transcriptomic analysis.
Prevalence of EGFR mutations in the Peruvian population: Study in a large cohort of patients with NSCLC.
Authors: Mas Luis , Piscocha Christian , Landa Jose , Roe Carlos , Roe Eduardo , Barletta Claudia , Velarde Raul E. , Larrabure Luis , Jauregui Sandra , Flores Christina , Gomez de la Torre Juan C 
Published: September 2018

e13076 Background: The evaluation of EGFR mutational status of the EGFR in non-small cell lung cancer (NSCLC) is crucial to select the adequate targeted therapy and to know the outcome of patients. Previous studies in relative small sample sizes have described a higher prevalence of EGFR mutations in Peruvian population than other Latin American countries. Our aim in this study was to determine the prevalence of activating and resistance mutations of EGFR in a large cohort of Peruvian patients. Methods: We profiled metastatic tumor samples from 847 NSCLC patients for known EGFR mutations associated to sensitivity or resistance EGFR inhibitors, including exon 18 (G719X), exon 19 (deletions), exon 20 (T790M, S768I and insertions) and exon 21 (L858R). All samples were centrally tested in reference laboratory (Roe laboratory, Lima-Peru). Results: A total of 847 samples were profiled for EGFR mutational status. EGFR mutations were present in 32.9% of cases (n = 279). In regard to distribution of mutations in cases EGFR mutated, G719X (in exon 18) was present in 2.5% (n = 7); deletions in exon 19 had a frequency of 58.4% (n = 163). Mutations in exon 20 were present in 9.7% (n = 27). In patients with exon 20 mutated, 14 cases had insertions, 9 cases had the mutation T790M and 4 cases had the mutation S768I. Mutation L858R (exon 21) was present in 34.1% (n = 95) of cases. Coexistence of two mutations were present in exon 18/exon 20 (n = 1), exon 19/exon 20 (n = 7) and exon 20/ exon 21 (n = 5). In tumors with EGFR mutated. The sensible profile for EGFR tyrosine kinase inhibitors (TKI´s) was present in 96.8% of cases (n = 138). Conclusions: We have a high prevalence of EGFR mutations compared than Caucasian or other Hispanic cohorts. It has relevance in the Peruvian public health because more efforts should be done to screen NSCLC patients for EGFR mutations.
Emerging trends in pancreatic cancer and diabetes.
Authors: Niphadkar Seema , Nathan Rachel , Perimbeti Stuthi , Liang Ya Yu , Marconcini Luiz Antonio Liarte , Lee William May , Nandi Neilanjan , Jain Maneesh Rajiv , Ward Kristine Marie , Styler Michael 
Published: September 2018

e13077 Background: Risk factors for cancer and diabetes mellitus (DM) include aging, obesity, smoking, and physical inactivity. Present studies conflict on the role of DM in cancer pathogenesis; however, the link between DM and pancreatic cancer (PC) is well studied. We assessed the prevalence of DM in PC, exploring trends in demographics, length of stay (LOS), cost and inpatient mortality in teaching vs non-teaching hospitals. Methods: The Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (1999 – 2014) was queried for patients > 18 with primary diagnosis of PC (excluding Whipple procedure) and secondary DM using ICD9 codes. We studied prevalence of DM and PC and compared cost of admission, LOS, mortality, and demographics between teaching and non-teaching hospitals. Chi-square test analyzed categorical variables. Results: Of 113,677 admissions for PC, 35,496 (31%) had DM. PC associated DM prevalence was higher in whites compared to blacks 57.9 % vs 12.7%, patients aged 65-79 47.7%, and southern US 37% with p < 0.0001. Income disparities have decreased between 25th percentile and > 75thpercentiles from 1999 (7.3 and 32.5%) to 2014 (23.6 and 26.1%). The adjusted cost per hospitalization increased from 1999 to 2014 ($34,950 to $78,469) while LOS decreased (9.26 to 7.50 days). In teaching vs non-teaching hospitals, average cost of hospitalization ($60,465 vs $44,955) and LOS (8.8 vs 7.8 days) were higher (p < 0.0001). In-hospital mortality for diabetic PC trended down from 13.09 to 6.81% and average mortality was higher in non-teaching vs teaching 11.25% vs 7.59% (all p < 0.0001). Conclusions: The link between diabetes and PC has been suggested although the complete mechanism is not well understood. Our analysis showed 31% of PC cases had DM. In-hospital mortality and LOS have decreased possibly due to advances in diagnosis and treatment of both conditions. Income disparities in admissions have converged perhaps due to improved access to care for low income and outpatient management for higher income brackets. Mortality is lower in teaching hospitals but is linked with a higher cost and LOS possibly due to utilization of testing and sub-specialty access. The findings of increased white and southern prevalence are unexplained and warrant further investigation.