bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract A85: Breast cancer pathology, receptor status, and patterns of metastasis in a rural Appalachian population
Authors: Vona-Davis Linda C. , Gadiyaram Vijaya , Ducatman Barbara , Kurian Sobha , Abraham Jame , Hazard Hannah , Hobbs Gerald 
Published: December 2010

Abstract
Background: Breast cancer patients in rural Appalachia have a high prevalence of obesity and poverty, together with excessive expression of the triple-negative phenotype.
Methods: Clinical records for 687 patients provided data which included tumor receptor status and time to distant metastasis. Breast cancers with the triple-negative phenotype were compared with other receptor combinations. Body mass index, tumor size, grade, nodal status, and receptor status, were related to metastatic patterns.
Results: Ninety-five of 687 patients, (13.8%) developed metastases to bone (n=42) or visceral sites (n=53). Metastases to viscera occurred within five years, a latent period which was shorter than that for bone (P = 0.042). Significantly more women with visceral metastasis presented with grade 3 tumors compared with the bone and non-metastatic groups (P = 0.0002). There were 135/574 women (23.5%) with triple-negative breast cancer, who presented with lymph node involvement and visceral metastases (68.2% versus 24.3%; P = 0.033). Triple-negative tumors that metastasized to visceral sites were significantly larger (P = 0.007). Although the probability of developing a visceral metastasis within 10 years was higher among women with triple-negative tumors, this relationship was not influenced by increasing body mass index.
Conclusions: For all breast cancer receptor subtypes, the probability of remaining distant metastasis-free was greater for brain and liver than for lung. The excess risk of metastatic spread to visceral organs in triple-negative breast cancers, even in the absence of positive nodes, was combined with the burden of larger and more advanced tumors.
Impact: The reduced survival of breast cancer patients in rural areas may be explained by a high prevalence of triple-negative tumors with a propensity for visceral metastasis.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A85.
Abstract A87: The epidemiology of breast and cervical cancer: Pre-and post-National Health Insurance Scheme in Ashanti region of Ghana
Authors: Dokurugu Yussif , Brown Perry , Dark Tyra , Awuah Baffour 
Published: December 2010

Abstract
Background: The relationship between breast and cervical cancer, inequality in income distribution and access to health care has attracted much attention during the last two decades. To reduce this problem of financial access to health care, Ghana's government is committed, and has introduced a convenient, affordable and sustainable health financing arrangement to protect the people, especially the poor, through the National Health Insurance Scheme (NHIS). Breast cancer and cervical cancer, once rare, is now becoming a major public health concern in Kumasi, Ghana. The introduction of the “cash and carry” system in 1992 compounded the problem of financial access to quality health care, and thus led to low utilization of health services especially, by the poor. This led to deteriorating health status for the people of Ghana. Though laudable, little is known about the efficacy of the health insurance in improving breast and cervical cancer care in Ghana. The purpose of this study was to examine the epidemiology of breast and cervical cancer both prior to and following the enactment of the NHIS. Time-Series data obtained from the Ghana Okonfo Anokye Teaching Hospital was utilized.
Methods: This project consisted of two phases. Medical records of inpatient and outpatient records for the period of 2001 through 2009 in the hospital were reviewed. Phase 1 consisted of pre-NHIS and post-NHIS data compilation and aggregation, variable construction and univariate and bivariate descriptive statistics provided an overview of the state of the health care system in Ghana. Phase 2 consisted of a time series analysis on 2001-2009 data. The SAS Proc ARIMA was utilized to determine if significant changes in the demographic characteristics of inpatients and outpatients occurred after the institution of the NHIS.
Results: Ghana recorded 0.54 outpatient visits per capita in 2005 (before national health insurance). The hospital admission rate was 36.5, per 1000 in 2005. Skilled obstetrical deliveries increased to 40.3% in 2005. It is against this background that trends in inpatient and outpatient medical visits were analyzed. Trends by gender, age, and diagnostic group were examined over an eight year period.
Conclusions: Prior to 2006 the country instituted a national health insurance plan. This plan provided free health coverage to all citizens. Prior to the NHIS the predominant mode of payment for healthcare services was cash and carry. Rates of outpatient services provided and inpatient admissions have changed by age group, gender and by diagnosis after national health insurance in Ghana.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A87.
Abstract A90: Nonmelanoma skin cancer epidemiology and DNA repair in Puerto Ricans
Authors: Bayona Manuel , Vidal Jose F. , Morales Luisa , Alvarez-Garriga Carolina , Sanchez Jorge , Villa Jaime , Ruiz Abigail , Matta Jaime L 
Published: December 2010

Abstract
Introduction: Nonmelanoma skin cancers (NMSC) including basal cell and squamous cell carcinomas are the most common human cancers. DNA damage can be caused by exposure to solar UV light and other types of radiation, dietary factors, and ageing. The relationship between DNA damage and oncogenesis suggests that diminished DNA repair capacity (DRC) is involved in tumorigenesis.
Purpose: The purpose of this study was to identify and assess selected exposures and DRC as predictors for NMSC in Puerto Rico.
Methods: An incident-cases case-control study was conducted. A total of 477 NMSC cases and 365 controls were compared regarding DRC levels and other selected factors. Participants with low and high DRC levels were also compared regarding the same factors as in NMSC. DRC was measured using a host-cell reactivation assay with a luciferase reporter gene irradiated with UV light and transfected into human peripheral lymphocytes from participant's blood samples. A standardized epidemiological questionnaire was used to collect data from the participants. The crude and multiple logistic regression adjusted odds ratio was used to assess the associations between NMSC or DRC levels with selected factors after adjusting for age, gender, skin, hair, and eye color, and other potential confounders simultaneously.
Results: Exposures increasing the odds for NMSC were being male, aging, light skin, presence of freckles, light hair, light eye color, increased sun exposure, severe insolations, family history of NMSC, and low DRC (p &lt; 0.05). Protective factors found in the study included using sun block, taking aspirin regularly, and multivitamin supplements intake (p &lt; 0.05). Factors associated with low DRC level were aging, light skin, sun exposure, severe insolations and not using sun block regularly.
Discussion: The present study identified major epidemiologic factors for NMSC in Puerto Rico that are consistent with similar investigations elsewhere. Low DRC was strongly associated with NMSC (Matta et al, 2003). New unpublished data include the finding of the protective effect of multivitamin supplementation. Light skin, increased sun exposure, severe insolations and not using sun block regularly were associated with low DRC.
Conclusions: The protective effect of multivitamins deserves further consideration to confirm our findings. Persons with light skin, increased sun exposure and not using sun block regularly had low DRC levels and increased odds for NMSC. DRC measurements might be used to monitor the potential preventive impact of multivitamins and sun block when used as preventive therapy.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A90.
Abstract A91: Epigenetic deregulation of IGF2 and cervical cancer precursors in HIV+ and HIV-patients
Authors: Hoyo Cathrine 
Published: December 2010

Abstract
Introduction: Early detection and aggressive treatment programs to prevent cervical carcinoma in situ (CIS) and invasive uterine cervical cancer (ICC) have been available for more than 30 years with more than 80% population coverage. Despite this, 11,000 cases of ICC and 40,000 cases of CIS continue to be diagnosed in the United States annually. Women of African descent are at &gt;2-fold higher risk of invasive cervical cancer death compared to other ethnic groups.
Objective: The overarching goal is to develop epigenetic biomarkers that can be used for early identification of aggressive cases likely to result in invasive cervical cancer and death.
Methods: We conducted a hospital-based, case-control study comprising 26 women with ICC, 18 with CIN2/3/HSIL, and 41 with normal cytology, at Kilimanjaro Christian Medical Center in Moshi, Tanzania. We analyzed methylation of three regions in the IGF2/H19 imprinted domain known to regulate the expression of imprinted IGF2. Aberrant methylation is associated with IGF2 deregulation, including changes in expression, loss of imprinting, and neoplasia.
Results: At the IGF2/H19 imprint center upstream of H19, methylation profiles for all women with no evidence of cervical abnormality or those with CIN2-CIN3 were within normal ranges (40%-60%), while 23% with invasive cancer had hypermethylation. In contrast, 25% of the CIN2/3 cases were abnormally hypomethylated at the IGF2 DMR in IGF2 intron 2, and the methylation profile worsened in the invasive cervical cancer cases with 64% having an abnormal methylation profile. A similar trend was found for the regulatory region in IGF2 intron 6. Stratifying these analyses by HIV status in ICC revealed that aberrant intragenic IGF2 hypomethylation was observed only among women without HIV. These associations persisted after adjusting for HPV genotype.
Conclusion: Our findings suggest that regulation of IGF2 is substantially altered in CIN2 or worse via epigenetic alterations. DNA methylation profiles of these regions may be markers of risk of progression especially in HIV-women. The findings support our hypothesis that epigenetic deregulation of this imprinted gene could be useful in discriminating women with dysplasia likely to progress.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A91.
Abstract A92: Preliminary report on the methylation status of CDKN2A and MLH1 genes in Puerto Rican patients with acute myeloid leukemia
Authors: Tirado-Gomez Maribel , Bernabe-Dones Raul D. , Lacourt Mercedes Y. , Castro-Munoz Cristina I. , Cotto-Santiago Maribel 
Published: December 2010

Abstract
In acute myeloid leukemias, aberrant DNA methylation of promoter-associated CpG islands represents an important mechanism in leukemogenesis. Hypermethylation of promoters blocks transcriptional activity of genes associated with tumor suppression and cell cycle control. In this study, we evaluate the promoter methylation status of genes CDKN2A and MLH1 in a small sample of Puertorrican patients with acute myeloid leukemia.
Methods: Peripheral blood was obtained from 6 patients with acute myeloid leukemia at the time of their diagnosis. Mononuclear cells were isolated by density gradient technique. DNA was isolated and further modified with sodium bisulfite. Methylation-specific polymerase (MSP) chain reaction was performed to detect the aberrant promoter methylation of CDKN2A and MLH1 genes in 6 patients with acute myeloid leukemia.
Results: A total of 6 samples were analyzed. The mean age was 44 years (24-66) and most of the patients were female (5/6,83%). Four of the patients had diploid cytogenetics, one patient had t(8;21) and one had-7q cytogenetics. WBC counts at presentation were 5.35/uL (0.8-13.8). Hypermethylation of CDKN2A and MLH1 was not detected in any of the samples.
Conclusions: Hypermethylation of CDKN2Aand MLH1 was not seen in the first six samples analyzed in this cohort of Puertorrican patients. Collection of more patient's samples and correlation with clinical data is ongoing.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A92.
Abstract B108: “GET SCREENED”: A randomized trial of reminders, recall, and outreach (RRO) to improve cancer screening in safety-net primary care practices
Authors: Fiscella Kevin , Hendren Samantha , Humiston Sharon , Ford Patricia , Winters Paul , Specht Ray , Loader Starlene , Yosha Amy , Marcus Steve , Pope Shirley , Idris Amna 
Published: December 2010

Abstract
Background: Members of racial and ethnic groups and persons with low socioeconomic status (SES) tend to be diagnosed at later stages of cancer and experience higher cancer related mortality. Overall rates of cancer screening have improved, but there has been only modest improvement in disparities in screening. A practice-based intervention using a combination of repeated reminders, recall and outreach (RRO) has been shown to significantly improve child and adult immunizations within safety net practices and reduce community wide disparities. We hypothesized that a similar approach could improve cancer screening in primary care practices that service predominantly minority and low SES patients.
Objective: To measure the efficacy of RRO on cancer screening rates within a large practice serving low income minority patients.
Methods: A patient-level randomized controlled trial was conducted within a family practice serving large numbers of minority and low SES patients. Eligibility criteria included (1) being a registered patient at the practice; (2) having at least 1 visit in the last 2 years; (3) age 40-75 for Breast Cancer (BC) screening and 50-75 for Colorectal Cancer (CRC) screening; (4) being past due for BC screening, CRC screening or both. Patients were assigned based on their medical record number to either intervention or usual care. The intervention included reminders (repeated point of care prompts to patients and their providers), recall (personalized letters to patients) and outreach (follow-up phone calls and mailed fecal occult blood testing kits). Relevant patient information was abstracted from the electronic medical record and imported into a customized patient tracking registry created in MicrsoftAccess™.
Results: Of 3,528 appropriately-aged patients in the practice, 2,389 were overdue for screening and met the eligibility criteria (1730 female; 686 male). At the end of the study period, the BC screening rate was 17% among controls vs 41% in the intervention group (p&lt;0.0001); the CRC screening rates were 10% vs 30% (control vs intervention, p&lt;0.0001).
Conclusion: Practice-based RRO significantly improves cancer screening among largely low income and minority patient population.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B108.
Abstract B111: Disparities in colorectal cancer: Who receives screening?
Authors: Oliver JoAnn S. , Allen Rebecca S. , DeCoster Jamie , Worley Courtney , Palardy Leslie , Kim Giyeon 
Published: December 2010

Abstract
Background: Colorectal cancer is a leading cause of cancer morbidity and mortality in the United States. It is estimated that approximately 142,570 new cases of colorectal cancer will be diagnosed and over 51,000 will die in 2010. Further, African Americans are diagnosed at later stages and suffer disproportionately higher mortality rates from colon cancer. Despite the increased attention to the importance of colorectal cancer screening, the American Cancer Society reports half of the US population has not been tested. The purpose of this study was to examine the characteristics of individuals who receive three common screening methods for colorectal cancer: Fecal occult blood test (FOBT), sigmoidoscopy and colonoscopy
Methods: Data were drawn from the 2007 Health Information National Trends Survey (HINTS). Following the American College of Gastroenterology Guidelines, a total of 4,464 participants aged from 45 to 75 years were selected for secondary data analysis. The selected sample included both men and women participants whose mean age was 58.89 (±8.41) with approximately 59.7% female, 74.1% Caucasian and 9.3% African American. Logistic regressions were performed to determine significant predictors of having fecal occult testing, colonoscopy, and sigmoidoscopy.
Results: Odds of having FOBT, colonoscopy or sigmoidoscopy was increased among older individuals with higher education. FOBT was higher among females and those with insurance compared to those without (both p&lt;.05). Colonoscopy was higher among those with insurance and higher income (p&lt;.001). Having a sigmoidoscopy was more likely among those with higher income, but differed among subgroups. There were significant interaction effects of gender by age and race by gender in having a sigmoidoscopy. Both males and females had higher log odds of having a sigmoidoscopy among older individuals, compared to younger individuals, but the age difference was more pronounced among females. The odds of having a sigmoidoscopy were much lower among African American men than other groups.
Conclusion: Those who were older and more educated are more likely to participate in colorectal screening. Higher income was associated with both colonoscopy and sigmoidoscopy screening procedures with insurance also being significant for colonoscopy. African American men, who are at greater risk for colorectal morbidity and mortality, are significantly less likely to have participated in screening using a sigmoidoscopy. Socioeconomic dividers which often parallel health disparities e.g. income, education and insurance are similarly associated with colorectal cancer screening participation. Understanding the characteristics of individuals who choose to participate in colorectal cancer preventive screenings could contribute to the development of interventions and or policies geared toward those who do not.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B111.
Abstract B22: Demographic and psychosocial predictors of low-income mothers’ decision to vaccinate their daughters against HPV
Authors: Floyd Tiffany 
Published: December 2010

Abstract
Human papillomavirus (HPV) is the leading cause of cervical cancer, which disproportionately affects women of low-income. The availability of a safe and efficacious vaccine against HPV offers a novel approach to cancer prevention and control, as well as an important opportunity to eliminate income-based disparities in cervical cancer. Realization of this potential, however, will depend in part on low-income mothers’ decisions to either vaccinate or not vaccinate their daughters against HPV. In the present study, N=68 low-income mothers participated in a pediatric waiting-room assessment of theory-driven factors associated with medical decision-making. Daughters’ vaccination status was assessed 8-months post-baseline via medical chart review. At eight months, 63% of mothers had not initiated the vaccine series for their daughter. Older age of daughter was the strongest predictor of initiating the vaccine series (p &lt; .01). Results of chi-square analyses indicated that, compared to mothers who pursued vaccination, those who did not had less knowledge of HPV as a condition affecting both males and females, were more likely to agree that giving their daughter a new vaccine is like performing an experiment on her, and were more likely to believe that their daughter should have no role in the decision-making process. Findings provide insight into factors influencing uptake of childhood HPV vaccination within low-income populations, among whom there is an excess burden of cervical cancer.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B22.
Abstract B34: Discrimination, stress and risk factors for cancer among Latinos
Authors: Ornelas India , Mariscal Norma , Martinez Javiera , Ceballos Rachel , Thompson Beti 
Published: December 2010

Abstract
Racial/ethnic discrimination is associated disparate health outcomes among racial/ethnic minorities. Theory and empirical evidence suggest that stress associated with experiencing discrimination can lead to the adoption of unhealthy behaviors such as poor diet, tobacco and alcohol use. Our study sought to explore the relationship between discrimination, stress and health behaviors among Latinos in both rural and urban settings in Washington state. Latinos were recruited for the study through community based organizations serving Latinos in both Seattle (urban) and the lower Yakima valley (rural). The sample of 40 participants included both men and women, United States and foreign-born, and a broad age range (20 – 70). Qualitative in-depth interviews were conducted in participants’ preferred language (Spanish or English). Interviews were transcribed, entered into Atlas. ti and coded for analysis. Analysis allowed for deductive codes based on theory and previous literature, as well as deductive codes that emerged from the data. Transcripts were also analyzed to identify differences by urban/rural setting, language use and immigrant status. The analysis revealed several key themes related to types of discrimination, health effects of discrimination and stress, and coping strategies. The majority of the participants had experienced discrimination in their lifetime, most often related to their race/ethnicity or language use. Settings in which discrimination occurred included work, school, and when seeking services. Common reactions to discrimination were to avoid it, ignore it, talk with someone about it, or pray about it. Respondents also reported that discrimination and other stressors influenced their sleeping habits, diet, physical activity, smoking and alcohol use. The findings reveal important relationships between discrimination, stress and behavioral risk factors for cancer. The results can inform future research on the health impact of discrimination among Latinos, including the measurement of discrimination and stress.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B34.