bluuebunny/crossref_metadata_2025_split huggingface dataset:
Post mastectomy reconstruction choice: Do race and ethnicity play a role?
Authors: Chappuis Catherine , Bernik Stephanie , Mohabbatizadeh Borna , Huang Lillian , Chen Mu-Hsun , Billman Elle , Shah Reanna , Amenta Jacquelyn , Mazumdar Madhu , Port Elisa R. , Balija Tara 
Published: May 2024

1586 Background: The choice regarding reconstruction after mastectomy is based on multiple factors. We hypothesized that race and ethnicity are associated with decision making regarding reconstruction and choice for bilateral mastectomy among a diverse patient population with equal access to reconstructive options. Methods: A retrospective cohort study was performed of patients who underwent mastectomy with or without reconstruction for cancer or prophylaxis from 1/1/2019-12/31/2020 within a single health care system. Clinical and demographicfeatures were recorded. Study endpoints included reconstruction and contralateral prophylactic mastectomy (CPM) choice. Chi square and logistic regression analyses were performed with hypotheses tested at 5% significance level. Results: A total of 663 patients underwent mastectomy for cancer or prevention. Mean age was 54 (range: 24-93) and median BMI 25 (15-58). The majority of women included identified as Non-Hispanic White (NHW) (52%), with other women identifying as Hispanic, Asian, Non-Hispanic Black (NHB), or Other (Table). Of the total cohort, 647 (98%) patients had surgery for cancer, while 16 (2%) had surgery for prophylaxis. Among those with unilateral cancer (N=602, 91%), NHW women were more likely to get CPM (OR 2.12, p<.001), while NHB (OR 0.58, p=.02) and Asian women (OR 0.47, p=.01) were less likely to choose CPM. Asian women were less likely to undergo reconstruction compared to non-Asian women (OR=0.42, p=.01), while Hispanic women were almost twice as likely to undergo reconstruction compared to non-Hispanic women (OR 1.93, p=.016). Hispanic women were more likely to undergo a DIEP flap (OR 2.77, p <.001), while NHW women were more likely to choose implant reconstruction (OR 2.35, p<.001). Conclusions: In our hospital system, choice for reconstruction or CPM was found to differ based on race and ethnicity. NHW women were more likely to choose CPM and undergo implant-based reconstruction, Asian women were more likely to forgo reconstruction, and Hispanics were more likely to undergo DIEP flaps. Future analysis in this cohort will include other factors such as BMI, insurance status, religion, marital status, and employment status.[Table: see text]
Trends in location of death for individuals with pediatric cancer in the United States.
Authors: Jain Urvish , Mathew Angelin , Jain Bhav , Feliciano Erin Jay Garbes , Dee Edward Christopher Christopher , Wolden Suzanne L. 
Published: May 2024

1591 Background: Children and adolescents with cancer face unique symptomatic, psychosocial, and existential challenges at the end of life (EOL). Premature death alongside severe pain and complex symptoms is distressing for the patients and families. Location of death is an important clinical and psychosocial decision for many patients. Therefore, we explored differences in location of death amongst pediatric patients with cancer using a large, national US database. Methods: We performed multinomial logistic regressions and analyzed trends in place of death for children and adolescents (ages 0 to 19) diagnosed with cancer from 2003-2019 using the Centers for Disease Control and Prevention Wide-Range Online Data for Epidemiologic Research database (CDC WONDER). We studied associations in place of death with essential decedent characteristics (age, sex, and race) for ICD10 codes C00-C96 and D00-D49, which encompass the most common causes of cancer death in children and adolescents. Results: Of 1,910 pediatric oncology decedents, 910 died in a hospital, 794 died at home, 12 died in nursing facilities, 59 in hospice, and 135 in outpatient facilities. Over time, death at home decreased by 50%. Death in the hospital increased by 64% and death in hospice increased by 200%. Children 10-19 years-of-age were more likely to die in hospice than children younger than 4 and children between 5-9 years-of-age. Additionally, they were less likely to die in outpatient medical facilities and ED. 1,388 decedents were White, 411 were Black, 18 were American Indian, and 93 were Asian. Children of racial and ethnic minorities were significantly more likely to die in hospitals than White children with cancer (Black: 1.81 [1.44-2.28], Asian: 1.57 [1.03-2.41], and Hispanic: 1.60 [1.26-2.04]). Black children with cancer were also more likely (1.67 [1.11-2.53]) to die in outpatient facilities compared to White children. Asian children & Black children were less likely to die at home (0.48[0.38-0.61] and 0.55 [0.35-0.86] respectively). Conclusions: In contrast to the adult population that has demonstrated steady increases in deaths at home, for children with cancer, relative rates of death at home decreased while death in the hospital increased, with distinct differences among race/ethnic groups. Adequate education and support are needed to facilitate both autonomy and symptom palliation at EOL. Future work must explore underlying reasons for differences in place of death across time and demographic groups, so as to identify and alleviate any potential barriers, and to promote equitable access to a good death for each individual.
Racial, ethnic, and regional influences on national patterns of mammographic screening for breast cancer.
Authors: Buchholz Thomas A. , Soriano Emily C. , Mesko Shane , Xavier Marin Feldman , Fortmann Adelaide L , Philis-Tsimikas Athena , Bagsic Samantha R. 
Published: May 2024

1600 Background: Racial, ethnic, and geographic factors can affect disparities in medical care. Mammographic screening has been demonstrated to reduce the risk of breast cancer death for appropriate subsets of women and accordingly is an accepted standard recommendation. Herein, we studied the utilization in screening mammography in patients who have access to primary care physicians according to race, ethnicity, and United States geographic region. Methods: We queried the Cosmos Epic national database to ascertain mammographic screening rates for women aged 50 to 65 who had 1 or more encounters with a primary care physician. Patients with a previous breast cancer and/or ductal carcinoma in situ history and those with missing race or ethnicity data were excluded. Results: The COSMOS database was queried for the period of 11/9/2020 – 11/8/2023. A total of 7,837,164 individuals met our study criteria. The overall rate of positive mammographic screening was 63.8%. Because of the large sample size, small differences in screening rates according to analyzed variables reached statistically significant differences. Accordingly, we defined a clinically relevant low rate of mammography screening for a specific variable as a utilization rate of less than 60%. Using this methodology, there were no differences noted according to race. Both Black/African American and Asian groups had a slightly higher screening rates than Whites. However, the data indicate that rates varied according to ethnicity. Mammographic screening was less frequent in Hispanic/Latino versus not Hispanic (58.9% vs. 64.3%). In addition, rates varied according to census US regions with the lowest rates in the West region (55.5%). Rates of mammographic screening for Blacks/African American and Whites were within 5% of one another in all four of the geographic regions. With respect to ethnicity, the South region had the only difference exceeding 5%, with respective rates of 61.8% for Not Hispanic/Latino versus 55.7% for Hispanic Latino. Conclusions: Many patients receiving health care in the United States do not undergo recommended mammogram screening. We found no clinically significant difference in screening rates according to race but identified a lower rate in Hispanic/Latino populations, particularly in the South. Targeted educational efforts and community outreach efforts in this region are warranted.
Colorectal cancer and the heart: Uncovering the beat of racial disparities in MACCE.
Authors: Uttam Chandani Kanishka , Agrawal Siddharth Pravin , Raval Maharshi , Siddiq Sajid , Nadeem Ahmed , Chintakuntlawar Ashish V. 
Published: May 2024

1611 Background: Due to its high prevalence, colorectal cancer (CRC) forms a considerable burden on the healthcare system. Advancements in treatment modalities like immunotherapy have led to significant improvement in the 5-year survival. This, along with the cardiotoxic therapy regimens results in a remarkable incidence of major cardiovascular and cerebrovascular events (MACCE). Thus, it becomes imperative to address the intricacies of factors including racial disparities in MACCE, as these aid with facilitating equitable management of all CRC patients. Methods: Using ICD-10 codes, patients with CRC were identified from National Inpatient Sample 2019 database. We included all-cause in-hospital mortality (ACIHM), acute myocardial infarction (AMI), atrial fibrillation (AF), cerebrovascular accident (CVA), and sudden cardiac death (SCD) as MACCE for the outcomes. Baseline characteristics including demographics, comorbidities; and MACCE outcomes were studied using chi-square for categorical or ANOVA for continuous data (statistical significance determined as p-value < 0.05) and results were stratified based on patient’s races. Results: A total sample patient population of 171,695 patients with a diagnosis of CRC were identified of which 70.71% (121,410) were White, 13.85% (23,790) were Black, 9.15% (15,720) were Hispanic, 3.23% (5,555) were Asian/Pacific Islander, 0.5% (840) were Native American, and 2.55% (4380) belonged to Other races. Substantial differences in the prevalence of comorbidities were noted with hypertension (46.32%) and renal failure (24.74%) being more common in Black patients, diabetes mellitus (37.5%) in Native American patients, and dyslipidemia (37.89%) in White patients. Upon comparison with White patients, the ACIHM was higher in Black patients with adjusted odds ratio (aOR) of 1.23 (95% CI 1.057-1.432, p = 0.007) and Asian/Pacific Islander patients with aOR of 1.359 (1.014-1.823, p = 0.04). While AMI was found to be lower in all races, as compared to White patients, AF was remarkably higher in all races. CVA was higher in Black patients as compared to White patients with aOR of 1.626 (95% CI 1.401-1.886, p < 0.001). SCD was substantially higher in Black patients with aOR 2.059 (95% CI 1.478-2.869, p < 0.001), and in Hispanic patients with aOR 1.743 (95% CI 1.1-2.761, p = 0.018), when compared to White patients. Conclusions: The study noted higher prevalence of MACCE across the board with poorer outcomes in non-White populations, which highlights the urgent need for resource allocation to improve outcomes. This has to be done in pre and post cancer treatment patients, especially in high risk populations. Additionally, the role of cardio-oncology service at every stage of management of CRC appears to be crucial.
Predicting therapeutic clinical trial enrollment for underrepresented patients in neuro-oncology using supervised machine learning.
Authors: Mehari Mulki , Warrier Gayathri , Dada Abraham , Kabir Aymen , Chukwueke Ugonma Nnenna , Porter Alyx B. , Hervey-Jumper Shawn L. 
Published: May 2024

1614 Background: Despite the unique ability of machine learning (ML) techniques to uncover complex interactive effects in datasets, studies exploring predictors of clinical trial enrollment have largely used standard statistical methods to discern associations. Furthermore, there have been limited applications of ML to close existing disparities in clinical trial enrollment of underrepresented patients in neuro-oncology. This study aims to use supervised machine learning to define and validate primary contributors of therapeutic clinical trial enrollment for a) all patients, b) women and c) NIH-designated minority patients with low- and high-grade glioma. Methods: Adult glioma patients who received care from the UCSF Brain Tumor Center between 1997- 2017 were identified in a prospective registry. Bootstrap forest (BF) and Recursive Partitioning (RP) models were created by randomly dividing patients in a 70/30 split into development (DEV) and validation (VAL) cohorts among all patients, women, and NIH-designated minority patients, separately. Model performance was assessed using the area under the curve (AUC) in the DEV and VAL cohorts. Results: Among 1042 patients, 350 patients (33.6%) enrolled in a therapeutic clinical trial. There were 445 women (42.7%), of which 144 (32.4%) enrolled, and 141 minority patients (13.5%), of which 39 (27.7%) enrolled. For all patients, in order of decreasing influence, the BF model selected median neighborhood household income, age, neighborhood poverty level, distance from hospital, tumor location, tumor volume, treatment with chemotherapy, occupation, KPS, insurance status, employment status, seizure at presentation, and volumetric extent of resection (EOR) to predict trial enrollment (DEV AUC: 0.984; VAL AUC: 0.746). For women, the BF model selected distance from hospital, age, household income, neighborhood poverty level, tumor location, treatment with chemotherapy, and KPS for trial prediction (DEV AUC: 0.972; VAL AUC: 0.746), whereas for minority patients, the BF model selected neighborhood poverty level, age, occupation, distance from hospital, tumor volume, insurance status, employment status, and EOR to predict trial enrollment (DEV AUC: 0.9830; VAL AUC: 0.769). The RP model for women designated those with non-White race as less likely to enroll (DEV AUC: 0.735; VAL AUC: 0.665) while the RP model for minority patients characterized those who preferred a non-English language or who were divorced or widowed as less likely to enroll (DEV AUC: 0.775; VAL AUC: 0.601). Conclusions: Supervised machine learning models achieved similar predictive performance among patient subgroups, while uncovering interactions between gender identity, minority status, and sociodemographic variables. These findings can guide targeted recruiting efforts to advance equitable trial enrollment for women and minorities.
Diagnostic test use and time to cancer diagnosis in Medicare recipients.
Authors: Chung Karen , Epstein Andrew J. , Kim Michelle K. , Karlitz Jordan J. 
Published: May 2024

1622 Background: In the Medicare-aged population, liver, ovarian and pancreatic cancers have an incidence of 34–73/100,000, are associated with high mortality, can often be associated with no or vague symptoms, and rely on multiple tests for diagnosis (dx). Our objective is to quantitate dx testing and time to a cancer dx in Medicare recipients. Methods: Pts with newly dx’d liver, ovarian or pancreatic cancers were identified in 100% fee-for-service (FFS) Medicare enrollment and claims data from 1 Oct 2017 - 31 Dec 2022. Dx test use was tracked for up to 24 months prior to dx; pts had to have ≥1 dx test within 60 days before the cancer dx date. Inclusion criteria also included ≥24 months of continuous enrollment in FFS Medicare prior to dx and qualification based on age ≥65. Exclusion criteria included prior cancer dx and Medicare Advantage enrollment. The start of dx workup was identified by looking back in time at the sequence of dx tests occurring before the cancer dx date and were separated by ≤60 days between consecutive tests. The earliest test in the sequence was deemed the first dx test. Index date was defined as the latest office visit date before the first dx test or date of the first dx test if no office visit met criteria. Dx tests (ie, biopsies, endoscopies, imaging, lab tests) were identified by billing/CPT codes. Dx workup duration from index to dx date and dx test types received were tracked. Results: Among 59,490 Medicare beneficiaries analyzed, mean age was 77.0 (SD 7.3), 60% were female, and 80% were non-Hispanic White. Median (25th, 75th percentile) days from index date to cancer dx was 56 (24, 109) for liver, 47 (20, 91) for ovary, and 43 (16, 89) for pancreas. Dx testing modalities utilized for each cancer type (Table) demonstrate high variability. The percentage of pts who underwent both CT and MRI to help establish a liver, ovarian and pancreatic cancer dx was 38.6%, 14.1% and 32.3%, respectively. While overall imaging use prior to dx was high, PET and PET-CT use was low (<1% PET; 1.7%–2.2% PET-CT). Conclusions: Multiple tests are utilized to establish a cancer dx in Medicare beneficiaries, including use of multiple imaging modalities in the same patient. 25% of pts required more than 89-109 days, depending on cancer type, to establish a dx. There may be opportunities to increase diagnostic efficiency and shorten time to cancer diagnosis in older individuals. [Table: see text]
Analyzing correlates for cervical cancer awareness in Mauritania, Madagascar, and Benin from the Demographic Health Survey (DHS): 2017-2022.
Authors: Olivieri Daniel J , Eastment McKenna , Mugisha Noleb Mugume , Pinder Leeya Fatima , Menon Manoj 
Published: May 2024

1626 Background: Cervical cancer is the leading cause of cancer-related mortality in low- and middle-income countries (LMICs). Prior studies associate high cervical cancer awareness with reductions in cervical cancer incidence. Herein we utilize nationally representative Demographic and Health Surveys Program (DHS) to analyze correlates of cervical cancer awareness and inform global outreach strategies. Methods: All DHS surveys conducted between 2017-2022 were queried for questions on cervical cancer awareness. Socio-demographic (e.g., age, marital status), socioeconomic (e.g., education, wealth, literacy) and variables pertaining to healthcare decision making, intimate partner violence (IPV), and female genital mutilation/circumcision (FGC/M)) were extracted. Sample weights were applied, and bivariate logistic regressions were performed. Variables with p<0.20 were included in multivariate analysis. Results: Of the DHS surveys, we analyzed data from 25,239 women aged 15-49 years old living in Mauritania, Madagascar, and Benin - the only three countries which met search criteria. Cervical cancer awareness varied from 41% in Mauritania (3,283/7,290), 32% in Madagascar (3,071/9597), and 10% in Benin (783/7,712). After multivariate adjustment, age (OR=1.03 [1.02-1.04]; OR=1.04 [1.03-1.05]; OR=1.03 [1.01-1.05]), education (OR=1.21 [1.06-1.38]; OR=1.68 [1.48-1.91]; OR=1.83 [1.51-2.23]), and wealth index (OR=1.18 [1.07-1.30]; OR=1.24 [1.16-1.32]; OR=1.18 [1.07-1.30]) were associated with increased awareness across Mauritania, Madagascar, and Benin, respectively. Mobile telephone ownership was associated with increased awareness in Mauritania (OR=1.87 [1.48-2.36]) and Benin (OR=1.66 [1.27-2.19]), and internet usage was associated with increased awareness in Madagascar (OR=1.75 [1.46-2.10]) and Benin (OR=1.71 [1.33-2.31]). Women who underwent FCG/M (OR=0.81 [0.67-0.98]) were associated with decreased awareness in Mauritania. Women who experienced IPV were associated with increased awareness (OR=1.39 [1.11-1.73]) in Mauritania. Women who independently make healthcare decisions were associated with decreased awareness in Mauritania (OR=0.88 [0.83-0.95]) but increased awareness in Madagascar (OR=1.07 [1-1.15]). Rurality was associated with decreased awareness in Madagascar (OR=0.71 [0.59-0.84]). Last, less than 1% (200/25,239) of all women were screened for cervical cancer. Conclusions: Age, education, and wealth were associated with increasing awareness, while rurality and FGM/C were associated with decreased awareness in various settings. Given the known association between awareness and screening, targeted efforts to increase awareness among women with lower socioeconomic status has the potential to reduce global cervical cancer disparities.
Evaluating the utility of routine survivorship exams in breast cancer: Modality of detection of recurrence in a prospective cohort study.
Authors: Duffens Ali , Laurent Cecile , Roh Janise M. , Kushi Lawrence H. , Liu Raymond 
Published: May 2024

1629 Background: National Comprehensive Cancer Network surveillance guidelines for invasive breast cancer recommend a history and physical exam every 3-12 months for the first 5 years, followed by annually, and mammography every 12 months. However, frequent in-office visits create time toxicity for breast cancer survivors, may have low utility in recurrence detection, and can create false reassurance. This study evaluates the modality of breast cancer recurrence in an integrated health system with access to primary and specialty care. Methods: We investigated mode of detection of recurrent breast cancer in the Pathways Study, a prospective cohort study of adult women diagnosed with and treated for invasive breast cancer in Kaiser Permanente Northern California, with enrollment from 2006 to 2013, and follow-up through December 2021. In this analysis, we included 4,431 women diagnosed at Stages I-III. Cohort members were followed for recurrences, deaths, and other outcomes. Of primary interest was modality of detection of recurrence, categorized as patient-driven symptoms, surveillance mammogram, diagnostic testing (i.e., other surveillance imaging for recurrence such as PET CT or MRI), routine clinical breast exam, or incidental finding. Results: A total of 617 (13.9%) women were identified as having breast cancer recurrence. Patients with recurrence shared similar demographic characteristics to those without recurrence. The recurrence population had median age of 59.2 years, BMI of 28.2 kg/m2, and racial/ethnic composition of 63% white,13% Hispanic,12% Asian, and 10% black. The median time from diagnosis to recurrence was 4 years. Seventy percent of recurrences were found to have distant metastatic disease, of which only 6.7% had concurrent local nodal and/or breast involvement. For those without metastases, 17.7% had recurrence localized in the ipsilateral breast, 2.8% in both the breast and locoregional nodes, and 9.3% only in locoregional nodes. Most recurrences were detected by patient driven symptoms (69.4%). Among the total cases, 8.1% of patients were diagnosed by routine mammogram, 10.9% with diagnostic testing and 4.5% by incidental finding. Recurrences in 6.8% of patients were detected by routine physician exam. Overall survival for those with recurrence was 31.1% and most deaths were attributed to breast cancer (89%). Conclusions: Our study, the largest investigation of breast cancer recurrence modality of detection in a US community oncology setting with comprehensive care, revealed the majority of recurrences were identified through patient self-detection with only 6.8% detected by physician exam. Most recurrences were distant, underscoring the need for alternative screening modalities to detect metastatic recurrences earlier, especially in the context of emerging treatments and improved survival rates for oligometastatic disease.