bluuebunny/crossref_metadata_2025_split huggingface dataset:
S6-3: Influence of Hospital Factors, Physician Factors and Type of Health Insurance on Receipt of Immediate Postmastectomy Reconstruction in Young Women with Breast Cancer.
Authors: Hershman DL , Neugut AI , Richards CA , Kalinsky K , Charles AS , Wright JD 
Published: June 2012

Abstract
Objective
For women with breast cancer who choose mastectomy, breast reconstruction is known to offer a cosmetic and psychological advantage. Despite this, only a minority of patients undergo post mastectomy reconstruction. Little is known about factors that influence reconstruction in younger women who undergo mastectomy. We evaluated the association of demographic, hospital, physician and insurance factors with receipt of immediate breast reconstruction.
Methods
We used the Perspective database to identify women who underwent a mastectomy for breast cancer from 2000–2010. Perspective is a voluntary, fee-supported database that samples more than 500 acute-care hospitals throughout the United States that contribute data on inpatient hospital admissions. ICD-9 procedure codes were used to identify women who underwent reconstruction at the time of mastectomy. Differences in reconstruction rates over time were examined by age, race, and type of insurance (commercial, Medicaid, Medicare and self-pay). Logistic regression analysis was used to determine factors predictive of immediate breast reconstruction after mastectomy. Additional analyses were done on the population of younger women (&lt;50 years of age).
Results
We identified 106,988 women with breast cancer who underwent mastectomy, and of these, 24,150 (22.6%) underwent immediate reconstruction. From 2000 to 2010,, reconstruction rates increased from 15% to 33.3%, increasing the most for women with commercial insurance (25.3% to 54.6%) and women under the age of 50 (29% to 60%); for women under the age of 50 with commercial insurance the rate in 2010 was 67.5%. Multivariable analysis found that reconstruction was significantly less likely with increasing age, black race (OR=0.66), rural hospital location (OR=0.48), non-teaching hospital (OR=0.82) and &gt;2 co-morbid conditions (OR=0.72). Odds of reconstruction increased with commercial (OR=3.0) and public (OR=1.6) insurance (compared to self-pay), bilateral mastectomies (OR=2.5), being single (OR=1.09) and increased hospital volume (OR=1.94). No association was found with breast surgeon volume. Similar associations were seen in the subgroup of women &lt;50 years of age. Prolonged length of stay was greater for women undergoing reconstruction (29.2% vs. 18.5%, p&lt;0.0001); however, in-hospital complication rates were similar at 5.6% and 5.3%, respectively.
Conclusion
Despite its benefits, less than one-third of all women, and half of women under the age of 50, received post mastectomy reconstruction in 2010. Insurance status was one of the largest predictors of immediate reconstruction, and its influence has increased over time. Public policy should ensure that access to reconstructive surgery is available to all women, regardless of insurance type.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr S6-3.
SR1-1: Breast Cancer and the Environment: A Life Course Approach - Report Release from an IOM Committee.
Authors: Hertz-Picciotto I 
Published: June 2012

Abstract
In response to a request from Susan G. Komen for the Cure®, an Institute of Medicine (IOM) committee was convened to review and assess the strength of the science base regarding the relationship between breast cancer and the environment. As part of their charge, the committee members reviewed the evidentiary standards for identifying and measuring cancer risk factors and the methodological challenges involved in conducting research on breast cancer and the environment. They also considered the potential interaction between genetic and environmental risk factors. The committee's report notes evidence-based actions that women could take to reduce their risk of breast cancer and offers recommendations for future research on breast cancer and the environment. The results of this IOM committee's work will be presented.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr SR1-1.
SR2-5: The DNA Copy Number Landscapes and Genomic Architecture; Relevance for Progression and Outcome.
Authors: Børresen-Dale A-L 
Published: June 2012

Abstract
Patterns of genomic aberrations have been defined that underlie specific expression subgroups of breast cancer (BC) that may infer paths of tumor progression and shed light on mechanisms involved. Classifications built on levels of genomic distortion have been shown to have prognostic value. We recently developed two platform-independent algorithms to explore genomic architectural distortion using aCGH data to measure whole-arm gains and losses [whole arm aberration index (WAAI)] and complex rearrangements [complex arm aberration index (CAAI)]. By applying CAAI and WAAI to data from 595 BC patients, we were able to separate the cases into eight subgroups with different distributions of genomic distortion. Within each subgroup data from expression analyses, sequencing and ploidy indicated that progression occurs along separate paths into more complex genotypes. Histological grade had prognostic impact only in the luminal-related groups, whereas the complexity identified by CAAI had an overall independent prognostic power. The results emphasized the relation among structural genomic alterations, molecular subtype, and clinical behavior and showed that objective score of genomic complexity (CAAI) is an independent prognostic marker. The CAAI algorithm calculates complexity scores per chromosome arm and is based on relatively large genomic stretches, in megabase order of magnitude. We have further developed this method to calculate probe-focused complexity scores per sample, a continuous complexity index (CCI), that increases the resolution significantly by calculating complexity scores for every genomic locus. CCI was calculated based on data derived from aCGH analyses of a set of 394 invasive ductal BCs. This approach enabled us to identify novel regions frequently subjected to high levels distortion and furthermore, to pinpoint regions with increased complexity which was associated with more aggressive disease. A total of 25 recurrent regions with high level complexity were identified. Regional complexities on chromosome arms 8p, 11q and 17q were each associated with clinical parameters associated with aggressive disease. Complexity patterns were different between tumors of different gene expression subtypes. Multivariate Cox analysis revealed that regional complexity on 17q21.32-q21.33 was significantly associated with shorter survival, independent of established clinical variables. The new algorithm developed represents a novel tool that can be utilized to identify smaller genomic regions of importance as well the genes therein that could be further explored.
References
Bergamaschi A. et al. Genes Chromosomes. Cancer 45, 1033–1040 (2006).
Hicks J. et al. Genome Res. 16(12):1465–79, (2006)
Kristensen VN and Vaske C et al. (2011) PNAS, spec BC issue (in press)
Russnes HG and Vollan HK et al. (2010) Sci. Transl. Med. 2, 38ra47
Stephens P et al. (2009) Nature. 462, 1005–1010
Aaroe J and Myhre S et al. under review
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr SR2-5.
Abstract A71: BRCA mutations and surgical decision making in a sample of young black women with invasive breast cancer
Authors: Fleming Patrice J. , Vadaparampil Susan T. , Bonner Devon , Monteiro Alvaro N. , Kessler Lisa , Royer Robert , Narod Steven , Pal Tuya 
Published: June 2012

Abstract
Background: On average, Black women develop breast cancer ten years earlier than White women and are more likely to die from the disease. Early onset breast cancer is a hallmark feature of the BRCA1 and BRCA2 (BRCA) gene mutations and may contribute to a portion of breast cancers in Black women. Widespread availability of genetic testing for hereditary breast cancer has resulted in an increasing number of women considering their BRCA test results prior to surgical treatment decisions for their breast cancer surgery (e.g., consideration of a risk-reducing bilateral mastectomy, contralateral prophylactic mastectomy). However, little is known about use of BRCA testing prior to definitive surgery specifically among Black women. The purpose of this abstract is to describe baseline utilization of BRCA testing in Black breast cancer patients prior to surgery and to document the prevalence of BRCA mutations in a cohort of Black women with early onset breast cancer.
Methods: Black women diagnosed with invasive breast cancer ≤ age 50 between the years of 2005 and 2006 were recruited through the Florida Cancer Registry utilizing state-mandated recruitment methods. Participants completed genetic counseling and a comprehensive risk factor questionnaire including 7 items specific to referral and uptake of genetics clinical services. Biological specimens (either blood or saliva) were collected, and BRCA testing was performed.
Results: Of the 209 eligible cases, 48 women consented to study participation. Of the 46 women with usable biological specimens: the average age of diagnosis was 42.8 ±6.14 and 50% (n=23) reported a positive family history of breast cancer (i.e., ≥ 1 first and/or second-degree relative with breast cancer). A previous BRCA test was reported by 30.4% (n=14) of those completing the study with only 2 participants (4.3%) receiving a genetic test result prior to making a breast surgery decision. Seven women (15.2 %) chose a bilateral mastectomy, 4 of which were risk reducing. No association was observed between family history and the type of breast surgery elected. Mutations in the BRCA genes were identified in three participants (including 1 in BRCA1 and 2 in BRCA2). In 16 additional participants, there were a total of 28 variants of uncertain significance (VUS) identified.
Conclusions: Our results suggest that few Black women utilized genetic test results and/or family history to make surgical decisions for their breast cancer treatment despite data documenting similar BRCA prevalence rates in Black women with early onset breast cancers as those previously reported in White women. These findings highlight an important health disparity in access to and utilization of genetics services among Black women with breast cancer.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A71.
Abstract A72: Occupational sunlight exposure, race, and risk of renal cancer
Authors: Karami Sara , Purdue Mark P. , Colt Joanne S. , Schwartz Kendra , Moore Lee E. , Stewart Patricia A. , Davis Faith G. , Ruterbusch Julie J. , Chow Wong-Ho , Wacholder Sholom , Graubard Barry I. 
Published: June 2012

Abstract
Introduction: Vitamin D, obtained primarily from ultraviolet (UV) exposure, is hydroxylated to its biologically active form within the kidneys. Epidemiological evidence supporting a relationship between vitamin D and kidney cancer risk has been inconsistent despite experimental data indicating that vitamin D and its metabolites may inhibit carcinogenesis. Previously we reported an inverse association between renal cell carcinoma (RCC) risk and occupational UV exposure among men in Europe. In the current study, we examined the association between occupational UV exposure and RCC risk among U.S. residents and investigated whether this association varies by race and sex.
Methods: Lifetime occupational data for 1,217 RCC cases and 1,235 controls in a large population-based case-control study were blindly assessed by an industrial hygiene expert to create a job exposure matrix that categorized frequency, duration, confidence, and intensity of occupational UV exposure. Categorical exposure metrics used to evaluate exposure-response relationships with occupational exposure were based on tertiles of exposure levels among controls. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between RCC risk and UV exposure by sex and race.
Results: Across all exposure-response matrices, women in the highest tertile of occupational UV exposure had a 40% reduction in RCC risk compared to those in the lowest tertile; risk decreased significantly as occupational UV exposure increased (p-trend=0.01 to 0.004). A marginally significant, non-linear inverse association was observed among men. Further stratification by race revealed similar findings for black and white women. Significantly decreased associations between RCC risk and occupational UV exposure were observed among black men (p-trend=0.05), but not among white men, although results for blacks were based on small numbers.
Our findings suggest that occupational UV exposure may protect against RCC. We caution any inferences made using race, given power limitations for stratified analyses, until additional well-powered studies can replicate and extend these findings.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A72.
Abstract A84: Race, neighborhood socioeconomic characteristics, and Helicobacter pylori seroprevalence
Authors: Epplein Meira , Cohen Sarah , Sonderman Jennifer , Zheng Wei , Cai Qiuyin , Williams Scott , Blot William J. , Signorello Lisa B. 
Published: June 2012

Abstract
Background: Recently, very high Helicobacter pylori sero-prevalence rates were found among African Americans, especially those of higher percentage of African ancestry, residing in the southeastern US. We sought to determine if neighborhood-level socio-economic characteristics, above and beyond individual-level socio-economic characteristics, are associated with Helicobacter pylori prevalence, and, if so, if this helps to explain the strong association with African ancestry.
Methods: Antibodies to Helicobacter pylori proteins were assessed in the serum of 665 African American and white participants from the Southern Community Cohort Study. African and European admixture was estimated using a panel of 276 ancestry genetic markers. Prevalence odds ratios for CagA-specific Helicobacter pylori status associated with10 block-level measures of socio-economic status, obtained from linkage to the US Census, were calculated using polytomous logistic regression.
Results: After adjusting for individual-level socio-economic characteristics, three neighborhood-level characteristics were significantly inversely related to CagA+ Helicobacter pylori sero-positivity: percent adults completed high school; median value of owner-occupied houses; and percent employed (comparing highest tertile to lowest tertile, OR=0.47, 95%CI: 0.26–0.85; OR=0.56, 95% CI: 0.32–0.99; and OR=0.59, 95% CI: 0.34–1.03, respectively). However, inclusion of these neighborhood-level measures did not attenuate the association of African ancestry and CagA+ Helicobacter pylori sero-prevalence, with African Americans of low, medium, and high African ancestry maintaining 2-, 7-, and 9-fold increased odds compared to whites.
Neighborhood levels of education, house values, and employment are associated with sero-prevalence to CagA+Helicobacter pylori, highlighting high-risk areas for prevention and screening efforts, but the strong relationship between African ancestry level and CagA+ Helicobacter pylori sero-prevalence persisted after adjustment for individual and neighborhood-level socio-economic characteristics, suggesting a biological basis for this association.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A84.
Abstract A96: Breast cancer screening resources and early-stage diagnosis in Appalachia: A geospatial perspective
Authors: Yao Nengliang (Aaron) , Hillemeier Marianne , Anderson Roger 
Published: June 2012

Abstract
Background: National Cancer Institute has designated Appalachia as a priority area characterized by significant disparities in cancer outcomes. However, little research focuses on the availability of cancer care resources in this region and how resource availability may relate to cancer outcomes. This paper will describe the distribution of breast cancer screening resources in Appalachia and examine the relationship between screening resources and breast cancer stage at diagnosis at the population level.
Method: Early stage breast cancer as a percent of all breast cancer cases are computed based on the county-level registry data from the four Appalachian states during 2000–2008. Availability of breast cancer screening providers and facilities are estimated for these Appalachian states. Descriptive analysis, exploratory spatial data analysis, and spatial regression are conducted.
Results: Appalachian counties have significantly fewer primary physicians, OB/GYN specialists, and diagnostic radiologists per capita than non-Appalachian counties. Spatial analysis demonstrates moderate clustering of scarce breast cancer screening resources and low percentages of early stage breast cancer in West Virginia and Appalachian Kentucky. Those diagnosed at early stages were 67.92% of all Appalachian cases vs. 68.34% of non-Appalachian breast cancer patients. The number of diagnostic radiologists per capita is significantly associated with the percentage of early stage breast cancer incidence when controlling for covariates such as county level poverty rates, uninsurance rate, percentage of adults with college degree, and primary care resources.
Conclusions: Fewer diagnostic radiologists per capita in West Virginia and Appalachia Kentucky is associated with lower percentage of early stage breast cancer incidence in the Central Appalachia region. Public health interventions should include policies and regulations to improve breast cancer screening resources in this region.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A96.
Abstract A98: Physician social networks and variation in prostate cancer treatment in three cities
Authors: Pollack Craig Evan , Weissman Gary , Bekelman Justin , Liao K.J. , Armstrong Katrina 
Published: June 2012

Abstract
Background: Racial differences in cancer treatment may result, in part, from distinct physician practice styles in the setting of regional healthcare environments. Emerging methodological tools allow for physician social networks to be constructed and analyzed using claims data.
Objective: To examine whether physician social networks are associated with variation and racial differences in treatment for men with localized prostate cancer.
Research design: We performed a retrospective cohort study using 2004–2005 SEER-Medicare data from three cities. Algorithms were generated to identify a patient's primary care physicians, urologists, and radiation oncologists. Within each city, a network of these physicians was constructed, with physicians as the nodes and shared patients as the links (edges) between nodes. From the overall network structure, distinct subgroups of physicians were identified using the Girvan-Newman algorithm. Subgroups were defined as those physicians who were highly clustered with one another and with relatively sparse connections to physicians in other subgroups. Patients were assigned to the subgroup of their diagnosing urologist. Network measures were then incorporated in logistic regression analyses with robust standard errors to examine the predictors of treatment, adjusting for patient-level factors.
Results: Patients who were seen by different subgroups of physician varied widely in their unadjusted rates of prostatectomy and the racial/ethnic and socioeconomic composition. In city A, for example, rates of prostatectomy varied from 8.6% to 25.3% for patients who saw different subgroups of doctors. Similarly, in city A, the proportion of minority patients ranged from 15.9% in one subgroup to 64.8% in another. After adjustment for patient-level covariates, patients who were diagnosed by a urologist in one of four subgroups had significantly lower odds of prostatectomy compared to those patients who saw urologists in the subgroup with the highest rates of prostatectomy. Similarly, in cities B and C, patients who saw specific subgroups had significantly lower odds of prostatectomy compared to the subgroup with the highest rates of prostatectomy. Contrary to our expectations, accounting for subgroups, did not appear to mediate racial/ethnic differences in rates of active treatment.
Conclusions: Using claims data to map physician networks may provide insight into the observed variation in treatment patterns for men with prostate cancer. Physician networks may be used to identify densely connected physicians who disproportionately care for minority patients.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A98.
Abstract B101: Cost comparison of high-risk targeted breast MRI vs. mammography in screening underserved women
Authors: Banks Lamisha , Ford Anne C. , Seewaldt Victoria L. 
Published: June 2012

Abstract
Background: Our current recommendations for mammographic and MRI screening are based on studies in European, European-Canadian and European-American women. To our knowledge, there has been no large-scale analysis of the effectiveness of mammographic screening in African-American and Latino women. We have little information on the relative benefits of general mammography screening versus high-risk targeted breast Magnetic Resonance Imaging (MRI) screening in underserved women. Mammography has the advantage of being relatively inexpensive and well accepted. In contrast, MRI is expensive and has the potential to increase the number of benign biopsy.
Methods: We compared the ability of mammography screening in a general risk underserved population (standard-of-care) with targeted breast MRI screening in high-risk underserved women to a) detect breast cancer, b) cost of screening/breast diagnosis, c) number of benign biopsies, and d) compliance. From 6/15/2004 to 5/7/2011, 1) 299 general risk women underserved women were underwent digital mammographic screening and 2) 299 high-risk women underwent combined mammogram and breast MRI screening. Women were recruited by our Breast Navigation team from sites throughout central North Carolina and underwent screening accompanied by a member of our Navigation team. Women found to have an abnormal mammogram were evaluated by ultrasound, ultrasound guided biopsy, and/or stereotactic biopsy. Women with an abnormal breast MRI were evaluated with ultrasound, ultrasound guided biopsy, and/or MRI guided biopsy. All follow-up services were provided for free.
Results: The average age of women was 50 years for women undergoing mammographic screening and 47 years for women undergoing MRI. The racial composition of general-risk women undergoing mammographic screening was 40% African American, 25% Caucasian, 25% Hispanic, and 1% other vs. 33% African American, 62% Caucasian, 3% Hispanic, and 2% other for high-risk women undergoing breast MRI. Mammographic screening detected 1 breast cancer vs. 9 for MRI. The cost per diagnosis was $37,375.00 vs. $21,561.22.
The number of benign breast biopsies/total biopsies was 7/8 (88%) for mammographic screening vs. 31/40 (78%) for MRI. Compliance with follow-up studies was 75% for mammographic screening vs. 90% for MRI.
Conclusions: Breast MRI screening in high-risk underserved women is highly feasible and with Navigation, there is a high rate of compliance with follow up studies. The cost per breast cancer diagnosis is significantly lower for targeted breast MRI screening of high-risk women than for mammographic screening of general risk women.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B101.