bluuebunny/crossref_metadata_2025_split huggingface dataset:
Further insights on social determinants of health: Investigating racial disparities and estimated household income in relation to staging of newly diagnosed breast cancer.
Authors: Ghorpade Rina , Tissavirasingham Fiona , Loague Deanne , Escala Perez-Reyes Andrea , Victor Varun , Singla Shivam , Parekh Nitant , Malipeddi Yashaswi Ram , Trehan Shruti 
Published: June 2023

e22529 Background: The incidence of breast cancer in high-income countries has risen by over 20% in the past two decades, with higher incomes relating to higher incidence rates of breast cancer. Racial disparities relating to breast cancer have also been observed, with African American women being diagnosed with more aggressive and advanced-stage breast cancer. We aimed to study how racial disparities and household income relate to breast cancer staging at the time of diagnosis. Methods: A retrospective cohort study was conducted on 1000 breast cancer patients in Aultman hospital cancer center in Canton, Ohio. Patients with a diagnosis of breast cancer diagnosed between 2010-2020 were included in the study. Data including age, zip code, race, and tumor stage at the time of diagnosis was collected. Further, zip code information was used to estimate median household income by searching available US income statistics. For statistical analysis, the Pearson correlation and linear regression model were used, with p< 0.05 defining statistical significance. Results: Patients ranged from 25-95 years old. The percentage of patients with breast cancer staging of 0, I, II, III, and IV was 1.9%, 47.7%, 26.2%, 6.1%, and 18.1% respectively. When separated by income bracket, 86.6% of the study population was found to be within the $44,251-$88,450 income bracket. Regarding income and breast cancer stage, a correlation coefficient of -0.019 (p 0.557) was found. Further, the population of study was found to be 51.4% Caucasian, 2% African American, 0% Hispanic, 0.3% Asian, and 46.3% other races. Regarding race and breast cancer stage, a correlation coefficient of -0.174 (p < 0.01) was found. Conclusions: This study found no significant relationship between income and stage at the time of diagnosis. A limitation to our study was the use of estimated household income rather than exact patient reported income. However, a significant relationship was found between race and breast cancer staging, with earlier stage breast cancer detected among Caucasian women, and later stages among other races at the time of diagnosis. These findings emphasize the need to address racial disparities and access to care to improve upon breast cancer screening and early-stage detection.
Clinical implications of universal germline testing in breast cancer patients in an Arab population: The Jordanian Exploratory Cancer Genetics (Jo-ECAG) study.
Authors: Abdel-Razeq Hikmat , Nielsen Sarah M. , Sharaf Baha' , Bani Hani Hira , Russell Emily M , Heald Brandie , Alkyam Mais , Abujamous Lama , Mustafa Rawan Mohammed Mahmoud , Al-Azzam Khansa , Elemian Shatha , Abu-Fares Hala , Hamed Allah Majd , Zeidan Zeidan , Nussbaum Robert Luke , Esplin Edward D. 
Published: June 2023

e22535 Background: Germline genetic testing (GGT) for breast cancer (BC) has implications for surgical decision-making, treatment selection, clinical follow-up and cascade testing. As uptake of GGT increases globally, it is important to examine its impact on clinician decision-making, particularly in different ethnic groups. Methods: The Jo-ECAG Study consisted of unselected, newly diagnosed cancer patients (pts) from a single center in Jordan. Pts were classified as meeting (in criteria, IC) or not meeting (out of criteria, OOC) National Comprehensive Cancer Network (NCCN) v.1.2020 GGT criteria. Pts underwent a 84 gene test with clinician-reported outcomes collected >2 months post GGT. Analysis was limited to pts with BC. Pts with one PGV in a gene associated with autosomal recessive inheritance (“carriers”) were excluded from overall PGV count. Blank responses were considered uninformative. Descriptive statistics and Fisher’s exact test were employed. Results: 1648 (21 male) Arabic pts with BC, 36% metastatic, with a mean age at diagnosis of 50.5 were tested; 67% were IC. 212 PGVs were identified in 202 (12%) pts, with a significantly higher rate in IC vs. OOC pts (14% vs. 8%, p=0.0002). PGVs were most common in BRCA1/2 (4%), APC I1307K (4%), and other BC-associated genes such as ATM, CHEK2, PALB2 and TP53 (collectively, 3%). 2% of pts were carriers and 57% had uncertain results. Among pts with PGVs and informative responses (Table), 18% had changes to treatment (11% OOC) and 82% to surveillance/follow up (16% OOC) based on GGT results. Genetic counseling and/or GGT was recommended for relatives of >90% of PGV and carrier pts. No changes to treatment or follow-up were made for pts with negative or uncertain results. Conclusions: 1 in 8 Jordanian BC pts had a PGV identified, with a similar breakdown of PGVs observed in other ethnic cohorts, aside from a higher percentage of APC I1307K. Both treatment and surveillance/follow-up decisions were impacted by GGT results. Appropriately treatment or management was not escalated for pts with negative or uncertain results. [Table: see text]
Clinical synergy of universal paired tumor genomic and germline sequencing in an unselected, pan-cancer cohort of patients: Greater than the sum of the parts.
Authors: Heald Brandie , Nielsen Sarah M. , Ekpoh Idara , Alexander Dana , Pai Rish , Golafshar Michael A. , Kunze Katie , Uson Junior Pedro Luiz Serrano , Bekaii-Saab Tanios S. , Ahn Daniel H. , Wu Christina , Pineda Alvarez Daniel Esteban , Samadder N. Jewel , Esplin Edward D. 
Published: June 2023

e22537 Background: Germline and tumor next-generation sequencing (NGS) are complementary tests whose benefit in capturing patients (pts) potentially eligible for precision therapies is maximized when the tests are paired, as qualifying pathogenic variants (PVs) are missed if either test was done in isolation (Lincoln et al. 2020). Germline NGS has the additional benefit of informing prevention through surveillance and cascade testing. We highlight the benefits of a universal approach to concurrent testing in a subset of the previously reported cohort of pan-cancer pts who underwent universal germline NGS (Samadder et al. 2020). Methods: Unselected pts with solid tumors underwent an 80+ gene germline panel and 315+ gene tumor panel. Variants in genes unique to the germline or tumor panels, including microsatellite instability (MSI) and tumor mutation burden (TMB), were also evaluated. Results: 104 pts [81.7% White, non-Hispanic, 71.2% male] with 23 cancer types [28% colorectal, 13% lung, 11% prostate, 49% other] were included. Five (5%) pts had no actionable tumor alterations or germline variants identified (Table). 18 pts (17%) had 19 pathogenic germline variants (PGVs) identified, 11 (58%) of which were detected on tumor NGS (Table). 92 pts had >1 tumor alteration identified, of which 12% were confirmed as PGVs (Table). Notably, tumor NGS revealed 81 pts (78%) pts with biomarkers that would could not have been identified with germline testing alone, such as variants in genes not on germline panel (80) or MSI-high (4), or TMB-high (21) status of the tumor. Conclusions: Germline and tumor NGS are complementary tests that often detect different actionable alterations. There is value in confirming both the presence and absence of somatic variants in the germline in order to make appropriate clinical recommendations for the patient and their family members. [Table: see text]
Aligning NCCN criteria with testing workflows using a novel database application (Criterion).
Authors: Sharma Rekha , Vanzo Rena , St. Lewis Tawanna , Reeves Cheryl , Mukund Pranav , Tolley Morgan , Sharma Poonam , Sharma Jivesh 
Published: June 2023

e22541 Background: As cost decreases and benefits become more well known, more individuals are seeking genetic testing. Physicians, genetic counselors, and other healthcare professionals play a critical role in explaining the benefits and limitations of genetic testing for hereditary cancer syndromes. Here we discuss our experience creating a web-based application, utilized by a variety of stakeholders, to determine whether patients are likely to meet clinical testing criteria set forth by the National Comprehensive Cancer Network (NCCN). Methods: To address the challenge of efficiently and accurately determining medical necessity for hereditary cancer genetic testing, we developed a pilot study to assess the utility of Criterion beta, a web-based pilot application. A questionnaire was sent to laboratory staff, genetic counselor assistants, genetic counselors, and physicians to assess the accuracy and usability of Criterion beta. 14 respondents each evaluated three mock patient profiles. They were initially asked to determine if the patients met current NCCN criteria for hereditary cancer genetic testing without using any alternative references or resources. Respondents with no prior training using Criterion were then asked to answer the exact same questions using Criterion beta. Results: Results of this pilot study indicate that implementation of Criterion beta leads to more accurate decision-making. Preliminary survey data shows that response accuracy for NCCN criteria determinations improved by 72% with the use of Criterion beta (see Figure 1). In addition, 85% of respondents reported that the application would allow them to routinely make more accurate decisions regarding who meets NCCN criteria for hereditary cancer genetic testing. Conclusions: As the demand for genetic testing increases, accessibility of professional guidelines like NCCN is important for multiple entities involved in the testing process, especially those unfamiliar with the concept of medical necessity. Clinically-based tools like Criteron beta are critical in this process because guidelines can be complex to navigate. In addition, through its ease of use, Criteron beta can better align implementation of genetic testing among high-risk populations. It may also place indirect pressure on industry stakeholders to align their eligibility requirements with clinical standards like NCCN, ultimately serving the best interests of patients in need of preventative care.
Modifiable risk factors and risk of colorectal and endometrial cancer in Lynch syndrome: A systematic review and meta-analysis.
Authors: Power Robert , Doherty Damien , Parker Imelda , Lowery Maeve Aine , Cadoo Karen Anne 
Published: June 2023

e22544 Background: Lynch syndrome is the most common hereditary cause of colorectal and endometrial cancer. Non-genetic risk factors, including obesity, physical activity, alcohol intake, and smoking are well-established in sporadic cancers but are less studied in Lynch syndrome. A better understanding of these risk factors could directly contribute to cancer prevention. Methods: Searches were conducted on MEDLINE, Embase and Web of Science for retrospective or prospective cohort studies that investigated the association between modifiable risk factors and the risk of colorectal or endometrial cancer in people with Lynch syndrome. Screening, data extraction and quality assessment were completed by 2 reviewers independently. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for colorectal and endometrial cancer were pooled using a random effects model. The protocol was prospectively registered on PROSPERO (CRD 42022378462) and the meta-analysis conducted in accordance with PRISMA and MOOSE reporting guidelines. Results: A total of 770 citations were reviewed. Twelve cohort studies involving 12685 patients with Lynch syndrome investigated risk of colorectal cancer, while 3 studies including 1865 patients assessed risk factors for endometrial cancer. Eight colorectal cancer studies were eligible for meta-analysis. Obesity (HR 2.38, 95% CI 1.52-3.73) and alcohol intake (HR 1.43, 95% CI 1.05-1.94) increased colorectal cancer risk, physical activity was protective (HR 0.66, 95% CI 0.52-0.83), and smoking had no effect (HR 1.02 95% CI 0.83-1.27). Type 2 diabetes mellitus and low dietary intake of calcium and multivitamins might increase risk of colorectal cancer, although more studies are needed. There is a paucity of data pertaining to endometrial cancer. In a qualitative synthesis of 3 endometrial cancer cohort studies, female hormonal risk factors and type 2 diabetes mellitus may affect the risk of endometrial cancer, but obesity was not associated with an increased risk. Conclusions: Lifestyle recommendations related to weight, physical activity, and alcohol may also be relevant to cancer prevention for individuals with Lynch syndrome and may provide a meaningful adjunct to standard interventions for risk modification. There are very poor data examining modifiable risk factors in endometrial cancer. Further high-quality prospective cohort studies, in particular including endometrial cancer as an endpoint, are needed to inform evidence-based cancer prevention strategies in this high-risk population.
Trends of female representation in ASCO leadership and abstracts authorship: A detailed review.
Authors: Aljaras Razan , Karkash Ahmad , Dandu Vidya Sree , Alhader Ahmad Abdelfattah 
Published: June 2023

e23010 Background: Gender inequalities in medicine are ongoing challenges facing health care providers in different fields. Gender bias in medicine is gaining more attention, raising the awareness of this important topic. Per ASCO 2022 snapshot, females represent 35.8% of total oncologists in the United States. This study aims to spot the light on female representation in ASCO abstracts authors and presidents, adding to the continuous efforts aiming to achieve gender equity in the oncology practice. Methods: Data from the ASCO database and conference materials was gathered for analysis in the different categories. These categories included presidents of ASCO since it was founded in 1964 through 2022, and first authors in abstracts accepted over the past 5 years (2018-2022). Statistical analyses on first authors data were conducted, and a P-value of < 0.001 was deemed to be statistically significant. Results: In the 58-year period (1964-2022), ASCO had 49 men (85%) and 9 women (15%) serve as presidents. 7 out of 9 total female presidents were elected in the last 20 years. In the 5 year period (2018-2022), there was a significant increase in the percentage of abstracts accepted for a female author. 37.1% of the presenters in 2018 were females, compared to 41.4% in 2022, with statistically significant results (P value < 0.001), detailed percentages are shown in tables. Conclusions: Gender gap in the field of oncology goes beyond pay differences to include leadership positions and research authorship. But as shown by our analysis, there has been an increase in representation of females in ASCO abstracts authorship and leadership over the past years. Nonetheless, further work is needed to identify factors contributing to lower representation of women in oncology, and suggested solutions. [Table: see text][Table: see text]
Gastric gastrointestinal stromal tumors and overall survival in elderly patients.
Authors: Spitzer Asha , Kwak Hyunjee V. , Chang Amber , Peng Peter D , Kazantsev George , Chang CK 
Published: June 2023

e23516 Background: The purpose of this study is to analyze the overall survival (OS) of various age groups of patients diagnosed with gastric gastrointestinal stromal tumors (GIST). Methods: We compared 4 different age groups ( < 50 years old, 50-64 years old, 65-79 years old, and 80 or greater) comprising 230 patients in terms of various clinicopathological parameters and OS from January 2010 to December 2020 within Kaiser Permanente Northern California (KPNC), using Kaplan-Meier curves, and Cox proportional hazard regression model. Results: Univariate analysis showed that mitosis greater 10 HPF was a statistically significant predictor of decreased OS from gastric GIST (p = .032). Although necrosis alone was not significant (p = .271), the combination with higher mitotic rate was significant (p = .025). Octogenarians with gastric GIST were more likely to present with bleeding, with a 5.3% ninety-day surgical mortality rate. Multivariate Cox regression showed that patients 80 years of age or greater had decreased OS when compared to the other age groups ( p= .002). Conclusions: Gastric GIST mitotic rate is significant in term of overall survival across all age groups and the combination with necrosis portends decreased overall survival. Patients over 80 have a decreased overall survival and require additional vigilance in the early peri-operative period.
Preliminary survival outcomes and toxicities in patients with retroperitoneal sarcoma treated with radiotherapy.
Authors: Cheng Hao-shen , Liu Yi-Chun 
Published: June 2023

e23524 Background: To investigate the survival outcomes, the treatment toxicities, and the recurrence pattern of nineteen patients with retroperitoneal sarcoma treated with radiotherapy. Methods: The inclusion criteria for this retrospective study were previously untreated retroperitoneal sarcoma who had received radiotherapy. From March 2016 to June 2022, the chart records and images of 22 eligible patients were reviewed. There were ten males and twelve females, and their ages ranged from 34 to 80 years old (median 55). Sixteen patients (72.7%) had a liposarcoma, four patients (18.3%) had a leiomyosarcoma, one patient (4.5%) had a spindle cell sarcoma, and one patient (4.5%) had a malignant peripheral nerve sheath tumor with heterologous rhabdomyosarcomatous and liposarcomatous differentiation. At diagnosis, four patients (18.1%) had a stage I-II disease, eighteen patients (77.4%) had a stage III disease, and only one patient (4.5%) had a stage IV disease. Twenty one patients (95.5%) received operation, and nineteen of them had a positive or close ( < 1mm) surgical margin. Nineteen patients (86.4%) received adjuvant radiotherapy (median dose 5400cGy, ranging 5000 to 6300cGy), one patient (5.3%) received neoadjuvant radiotherapy (5000cGy), one patient received definitive chemoradiotherapy (7000cGy), and one patient received palliative radiotherapy (3000cGy) to bone metastasis. Results: The medial follow-up was 32 months, and the two-year overall survival rate was 79.8%. Acute toxicities of radiotherapy included gastrointestinal toxicities (grade 1-2: 9 patients), nausea (grade 1-2: 7 patients, grade 3-4: 3 patients), vomiting (grade 1-2: 3 patients, grade 3-4: 2 patients), neutropenia (grade 1-2: 2 patients, grade 3-4: 1 patients), and fatigue (grade 1-2: 5 patients). In patients without metastatic disease at diagnosis, two-year overall survival rate was 84.0%, and two-year disease-free survival rate was 62.9%. There were 8 recurrences (1 local alone, 2 distant metastasis alone, 1 local plus regional, 3 local plus distant metastasis, and 1 local plus regional plus distant metastasis), and 5 deaths. Recurrent metastatic locations included lung (n = 1), liver (n = 1), bone (n = 2), peritoneum (n = 1), distant lymph nodes (n = 1), and soft tissue of thigh (n = 1). One patient with metastatic disease at diagnosis expired due to disease progression with 8 months survival. Conclusions: Radiotherapy in retroperitoneal sarcoma provided an acceptable two-year survival rate with tolerable toxicities, but recurrence rate was still high. About 75.0% of recurrent events consisted of local recurrence, so close follow up of primary tumor area is necessary.
Efficacy and safety of pazopanib in the treatment of pediatric sarcoma: Retrospective cohort study.
Authors: Unal Emel Cabi , Incesoy Ozdemir Sonay , Tacyildiz Nurdan , Dincaslan Handan , Dogrul Caglar , Guven Ezgi , Yaman Ortakoylu Melek , Bozer Asli , Yavuz Gulsan 
Published: June 2023

e23526 Background: The presence of frequent genetic alterations activating the tyrosine kinase (TKI) signaling pathway has recently led to a more targeted therapeutic approach. We describe our institutional experience using pazopanib for pediatric sarcomas. Methods: We performed a retrospective, IRB approved, chart review of all patients with sarcoma treated with pazopanib off-study at Ankara University Pediatric Oncology Clinic between 2019–2021. Results: Twenty-five patients were identified. Median age at commencement of pazopanib treatment was 13 years old (range 4 to18 years; 15 male: 10 female). Median duration on treatment with pazopanib was 16 months (range, 2 to 33). The median duration between the diagnosis of sarcoma and the beginning of pazopanib was 17.0 months (range, 1 to 80 months). Twelve of 25 patients due to metastatic disease at diagnosis, pazopanib was started with first-line chemotherapy and/or continued as maintenance therapy (Group 1). In the remaining 13 of 25 patients, received a second-line chemotherapy with pazopanib was administrated due to relapsed disease (Group 2). Nine patients (36.0%) ( 2 patients in group 1 and 7 patients in group 2) had died from progressive disease ranging between 13 and 70 months (median 33 months) after the diagnosis. OS rate was 64,0% in the entire cohort; group 1 and group 2 were 83,3%, and 46,2%, respectively. The overall median OS was 69.4 months. No new pazopanib-related adverse effects were identified. Conclusions: Pazopanib appears to be an effective treatment for pediatric sarcoma. Treatment with pazopanib is well-tolerated and could have a role to maintain response in patients with pediatric sarcoma. Further studies are needed to better define the use of this regimen in the upfront management of those patients.