bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-provider communication factors associated with mt-sDNA screening for colorectal cancer.
Authors: Alam Shama , Zhu Xuan , Madson Gabriel , Squiers Linda , Helmueller Leah , Southwell Brian , Gates Carlye , Kneedler Bonny , Limburg Paul J. , Finney Rutten Lila J. 
Published: June 2023

e22514 Background: Several colorectal cancer (CRC) screening tests, shown to reduce CRC incidence and mortality, are recommended for average-risk adults aged 45-75 years. CRC screening is underutilized in the US with access to facility-based options, such as colonoscopy, representing a barrier to screening. Stool-based tests are guideline-endorsed and offer patients a convenient and more accessible CRC screening option that can be completed at home. Provider recommendation is consistently identified as the primary factor driving patient adherence. Understanding how aspects of patient-provider communication influence CRC screening can inform interventions to improve adherence. We developed a survey, informed by behavioral theory, to identify communication factors associated with completion of mt-sDNA screening. Methods: Adults aged 45-75 years, with a US postal address, who received a valid order for mt-sDNA and whose kit was shipped between 5/21-9/21 were eligible for sampling. The survey was administered by RTI International between 3/22-6/22. Participants could complete electronic or paper surveys. We fit a multivariable logistic regression to identify patient-provider communication factors associated with mt-sDNA test completion. Results: 2,973 respondents completed the survey (response rate = 21.7%). The majority (77.3%) completed the mt-sDNA test and said they would be ‘very likely’ (76.8%) to complete Cologuard in the future. The proportion of respondents who had conversations with their healthcare provider about Cologuard, and the specific content of those conversations, was significantly different between completers and non-completers and between respondents who said they were ‘very likely’ to complete Cologuard in the future compared to respondents who were not. Results from a binary logistic regression suggested that discussions with a healthcare provider related to step-by-step instructions for completing Cologuard (OR = 1.62) and needing to have a colonoscopy follow-up (OR = 1.93), as well as feeling included ‘a great deal’ in the decision-process with respondents’ healthcare provider (compared to ‘somewhat’ or ‘not at all’) increase the odds of kit completion. Additionally, healthcare provider discussions relating to test cost (OR = 1.47) and performance (OR = 1.72), as well as feeling included ‘a great deal’ in the decision-process was positively associated with respondents indicating they were ‘very likely’ to use Cologuard in the future. Provider discussions about the cost of a follow-up colonoscopy was negatively associated with a ‘very likely’ future user (OR = 0.52). Conclusions: Healthcare providers play a key role in patient adherence to CRC screening and must be appropriately prepared and resourced to educate and to engage patients in shared decision-making about CRC screening.
Barriers to breast cancer screening in a developing middle eastern country: A nationwide survey.
Authors: Abdulelah Zaid A. , Abdulelah Ahmed A. , AlQirem Lina , AlSamhori Jehad , Al-Qirem Ahmad , AlSamhori Abdel Rahman 
Published: June 2023

e22517 Background: Breast cancer imposes a significant global health burden not only due to being constantly ranked as the leading malignancy in females, but also due to the immense resulting morbidity and mortality. Despite the presence of screening modalities, the uptake is relatively low due to unidentified barriers in many countries and regions. The Identification of these barriers towards screening is of paramount importance to tackle the health burden imposed by breast cancer, especially in countries like Jordan, a developing middle eastern country. Methods: A self-reporting survey consisting of comprehensive questions regarding the participant’s demographics, medical history, knowledge about breast cancer and the screening modalities was distributed to females aged 25 years and above with no prior history of breast cancer who are residing across the different regions of Jordan. The first consecutive 790 participants were enrolled, and data analysis was performed to identify the key barriers. Results: The mean age of the enrolled study population was 41 ± 9 years old with the majority being married (82.8%), have underwent a higher level of education (86.5%), are non-smokers (75.2%), and are medically insured (72.4%). 209 participants (26.5%) had reported a family history of breast cancer, while 83.4% of the participants reported awareness about breast cancer screening modalities with breast self-examination being the most commonly known modality of screening in 39.2% of the participants. Only 22.4% of the participants were aware of the 3 available screening methods. The majority of the participants (57.1%) did not undergo previous screening. When the participants who did not undergo previous breast cancer screening were compared with those who did, the participants without prior screening were more likely to report the lack of knowledge towards screening modalities (27.7% vs 8.0%) (p-value < 0.001), fear of the results (22.6% vs 13.9%) (p-value = 0.002), fear of pain during or after from the test (10.4% vs 5.9%) (p-value = 0.024), and feeling of embarrassment provoked by the screening test (15.7% vs 6.5%) (p-value < 0.001) as key barriers. On the contrary, there was no statistically significant difference between the two groups when assessing financial aspect of screening uptake as a potential barrier (p-value = 0.860). Conclusions: Despite the considerably high percentage of participants being aware of breast cancer screening modalities, an alarmingly low rate of screening uptake was witnessed due to several barriers. The collective identification of lack of knowledge towards screening modalities and the nature of the available tests, in addition to the fear of the results and pain following the test, and feeling of embarrassment undoubtedly mandates the formulation of comprehensive awareness campaigns that effectively tackle these barriers.
A case-control study of 10,757 individuals to assess potentially modifiable risk factors, including stress, for breast cancer among Chinese patients in Hong Kong.
Authors: Yeo Winnie , Yuen Lok-Wa , Tsoi Kelvin Kf , Chan Emily YY , Kwok Carol , Soong Sung Inda , Ng Ting Y. , Chiu Joanne , Chan Miranda , Chan Sharon Wing Wai , Wong Ting T. , Chan Yolanda HY , Li Lawrence PK , Yau Chun C , Hung Wai K. , Cheung Polly Suk-yee 
Published: June 2023

e22522 Background: Breast cancer is the most common cancer in women worldwide. Both intrinsic and environmental factors contribute to the disparities in breast cancer incidence across different regions. In Hong Kong, the incidence has been increasing in the past decades. With over 4700 women diagnosed in 2019, breast cancer is responsible for 27% of all female cancers in Hong Kong. Apart from intrinsic non-modifiable risk factors, some risk factors are modifiable and may reduce cancer risk. Methods: We conducted a case-control study that involved breast cancer patients from the Hong Kong Breast Cancer Registry with matched healthy controls from the community between 2014 and 2017. A standardized written questionnaire was used through face-to-face interviews of all study participants. The questionnaire collected information on participants’ demographics, general health, smoking history and other lifestyle factors including physical activity, self-assessed dietary habits (balanced, vegetarian, meat and dairy-rich diets), self-perceived stress levels (measured with a 4-point Likert scale, and high stress level was defined as having over 50% of the participant’s time with stress being scored 3 or above out of a Likert scale of 4), body mass index, family history, menstrual and reproductive history, and history on the use of oral contraceptives and hormone replacement therapy. Multiple logistic regression was fitted to compare all risk factors. Results: A total of 5,186 breast cancer patients and 5,571 controls were recruited. Modifiable risk factors that were shown to be associated with an increased risk of breast cancer included self-perceived high stress level (adjusted odd ratios [aOR] = 3.44; 95% CI = 3.13-3.78), meat-rich diet (aOR = 1.77; 95% CI = 1.54-2.04), dairy-rich diet (aOR = 3.33; 95% CI = 2.01-5.52), overweight/obese status (aOR = 1.21; 95% CI = 1.10-1.32), delayed child-bearing (aOR = 2.23; 95% CI = 1.79-2.79), nulliparity (aOR = 1.21; 95% CI = 1.08-1.35) and ever use of oral contraceptives (aOR = 1.34; 95% CI = 1.22-1.47), while exercise (OR = 0.62; 95% CI = 0.56-0.68) and breast-feeding (aOR = 0.76; 95% CI = 0.69-0.83) were associated with reduced risk. Conclusions: In Hong Kong, high stress level, meat- and dairy- rich diet, overweight/obese, reproductive history and use of oral contraceptives were identified to be modifiable risk factors for breast cancer. Adjusting these factors through lifestyle modification may curb the increasing trend of breast cancer incidences in the coming decades.
Opinions and usage of cancer-associated thrombosis scoring systems among hematologists and oncologists: An international survey.
Authors: Agrawal Amulya , Bat Taha , Ibrahim Ibrahim , Choi Sung-Hee , Khan Adeel 
Published: June 2023

e22531 Background: Cancer-associated thrombosis (CAT) occurs in 20% of cancer patients and is currently their second leading cause of death. Several scoring systems (i.e., Khorana Risk Score, COMPASS-CAT, Vienna-CATS, etc) have been developed to allow clinicians to determine CAT risk and prescribe appropriate treatments. There is little data about how hematologists and oncologists use these risk assessment models in daily practice. We conducted a survey of hematologists and oncologists in different institutions about their usage and opinions of CAT scoring systems. Methods: We created a twelve-question survey querying hematologists and oncologists regarding their usage and perspectives on CAT and scoring systems. Survey participation was voluntary, non-incentivized, and anonymous. The survey was advertised on social media and email list groups from January to February 2023. Descriptive statistics were analyzed in R version 4.1.2. Results: Seventy hematologists/oncologists responded with 88.4% from the US and 11.6% international. The plurality of respondents (35.7%) identified as sub-specialty oncologists (e.g., GI oncology, thoracic oncology, etc), 18.6% identified as malignant hematologists, and 15.7% identified as non-malignant hematologists. Overall 71.4% of respondents worked in academic settings. The majority (57.1%) stated they do not use any CAT scoring system and 15.7% stated they do not have familiarity with any CAT scoring system. Zero respondents strongly agreed that they often use scoring systems. Of the CAT systems used, the Khorana score was by far the most common (80.0%). Respondents somewhat agreed (14.3), somewhat disagreed (10%), or were undecided (34.3%) that scoring systems make it easier to determine CAT risk in practice. The majority (54.3%) were also undecided that these systems’ predictions of CAT risk are accurate. There was general agreement in worry of bleeding in anticoagulating cancer patients prophylactically (strongly agree 12.9%, agree 32.9%, somewhat agree 22.9%). Respondents strongly agreed (34.3%) or agreed (40.0%) that decisions about anticoagulation are important part in cancer patients’ supportive care. Similarly, respondents strongly agreed (30.0%), agreed (38.6%), or somewhat agreed (22.9%) that counseling patients on CAT is important. Conclusions: To our knowledge, this is the first survey assessment of hematologists and oncologists regarding their opions on CAT and their usage patterns of scoring systems. Despite the widespread agreement that counseling regarding CAT is important and that decisions about anticoagulation are a vital part of a cancer patient's supportive care, most clinicians do not use CAT scoring systems in practice or are not familiar with them. Hematologists and oncologists worry about the risk of bleeding with anticoagulation and agree there is a need for new and improved CAT scoring systems.
Time trend on breast cancer mortality: How are we allocating physicians to deal with the disease in men and women in Brazil?
Authors: Schoueri Jean Henri , Werneck De Carvalho Luis Eduardo , Sette Claudia Vaz De Melo , de Abreu Luiz Carlos , Fonseca Fernando Luiz Affonso , da Silva Paiva Laercio , Adami Fernando 
Published: June 2023

e22532 Background: Female breast cancer (FBC) is a well-known public health issue worldwide. However, male breast cancer (MBC) is a rare condition, which might be overlooked by public health authorities and clinicians alike. Methods: Ecological study conducted with secondary data from 2008-2020 to examine the relationship between the amount of doctors per inhabitant on FBC and MBC mortality in Brazil and its federative regions. All data were gathered from Brazil’s public health system. For each cancer, mortality was analyzed by age and standardized by the World Health Organization’s population. The number of physicians was obtained from the Unified Health System and was calculated as the rate per 100,000 inhabitants. Linear regression was performed using stepwise selection/backward elimination. Results: Despite not reaching statistical significance, the total amount of physicians that work in the Unified Health System (UHS) was positively associated with MBC mortality (β 0.00003, IC95% -5,77 x 10-6; 0.00007, p = 0.097), whereas there was a clear trend on FBC mortality reduction over the years (β -0.157, IC95% -0.2355;, p < 0.001) and with higher number of gynecologists (β -0.0400, IC95% -0.577; -0.2236, p < 0.001). Also, FBC mortality rates were positively associated with higher availability of physicians in general (β 0.0088, IC95% 0.0079; 0.0098, p < 0.001) in the UHS. Conclusions: Trends on FBC and MBC mortality rates differ in Brazil. Whereas higher mortality was associated with a greater amount of doctors per inhabitant, perhaps due to more diagnosis, trends on lower mortality rates were found only for FBC – in those cases, it was associated with more gynecologists available. For both neoplasms, there was no association between mortality rates and the amount of clinical oncologists nor primary care physicians available in the country. [Table: see text]
Measuring real-world concordance with evidence-based guidelines for genetic testing in patients with breast cancer: A retrospective quality review.
Authors: Ezratty Charlotte , Kessler Alaina J. , Klein Paula 
Published: June 2023

e22542 Background: Genetic testing plays an important role in the detection and management of breast cancer. Patients with high-risk mutations may undergo more frequent screening and possible risk reduction with medical and surgical management. Genetic testing also guides treatment decisions, including the recent approval of adjuvant olaparib for patients with high-risk BRCA1/2-mutated early-stage breast cancer. The most recent NCCN guidelines expand the age recommendation for genetic testing for patients with a personal history of breast cancer from age ≤ 45 years to ≤ 50 years though in clinical practice, it is likely patients age 46-50 were undergoing genetic testing prior to this recommendation. The goal of this quality review was to assess real-world concordance with genetic testing as per NCCN guidelines and evaluate practice patterns of genetic testing in patients age 46-50 at two large academic centers with a diverse patient population. Methods: We conducted a retrospective quality review of patients age ≤ 50 years diagnosed with early-stage breast cancer at two academic centers from 2019 to 2021. Imaging, pathology, and genetic testing were abstracted from medical records. Baseline characteristics included age, gender, race, ethnicity, stage at diagnosis, receptor status, and genetic testing data. We used descriptive statistics to describe the population and genetic testing results. Results: There were a total of 376 patients with an average age of 44 years. Of these patients, 374 (99%) were female, 158 (42%) white, 76 (20%) African American, 60 (16%) Asian, and 77 (20%) identified as Hispanic. There were 255 patients (68%) diagnosed with stage I cancer, 82 (22%) with stage II, and 39 (10%) with stage III. There were 261 patients (69%) with hormone-receptor positive, HER2-negative cancer and 45 patients (12%) with triple-negative breast cancer (TNBC). Of the 230 patients age ≤ 45, 225 (98%) completed genetic testing. Of the patients who did not undergo genetic testing, 2 were offered and declined. Genetic mutations were found in 25 patients including 13 patients with BRCA1 and 4 patients with BRCA2. Of the 146 patients age 46-50, 134 (92%) completed genetic testing. Excluding patients with TNBC as genetic testing is recommended at any age for patients with TNBC, 115 patients (91%) underwent genetic testing. Mutations were identified in 8 patients including 3 patients with BRCA1 and 2 patients with BRCA2. Conclusions: Genetic testing is a key component of the pre-treatment diagnostic evaluation for patients with breast cancer given implications for management. Our study demonstrated nearly all patients age ≤ 45 with early-stage breast cancer underwent genetic testing, reflecting concordance with evidence-based guidelines. Furthermore, most patients age 46-50 at our institution had undergone genetic testing prior to the expanded NCCN guidelines.
BRCA mutations in triple negative breast cancer patients in Guatemala: A descriptive study.
Authors: Kihn-Alarcón Alba , Marroquin Flores Diana Beatriz , de Falla Vicky , Siliézar Mauricio , Silva Carlos , Velarde Angel 
Published: June 2023

e22543 Background: In Guatemala, breast cancer is the most common malignancy among women, the habitants in the country are characterized by being of different ethnic groups and little is understood about the prevalence of germline mutations and their influence in the prognosis and diagnosis of triple negative breast cancer patients, reason why the aim of our study is to determine the prevalence of BRCA1 and BRCA2 germline mutations among this population. Methods: Forty-five patients with confirmed biopsy of triple negative breast cancer by immunohistochemistry treated at Liga Nacional Contra el Cáncer-INCAN Guatemala in 2022 were enrolled in the study. Triple negativity was defined as < 1% estrogen, progesterone and HER2 staining by immunohistochemistry or not amplified by fluorescence in situ hybridization in those with HER2 borderline result. After consent, patients had next generation sequencing and multiplex ligation-dependent probe amplification for BRCA1 and BRCA2 genes. From medical records, we obtained: demographic, clinico-pathological and treatment data. Median was calculated for age, while frequencies and percentages were computed for the categorical variables. Results: The study identified 19 patients with a BRCA1 or BRCA2 germline mutations (42.22%). The median age at cancer diagnosis was 39 vs. 49 years old compared to patients with lack of mutations of the genes analyzed. The majority harboring a mutation (36.84%) were from the countryside, especially the regions IV and V (southeast and central). Among all groups, (66.67%) were diagnosed with locally advanced disease and initially treated with neoadjuvant chemotherapy. According to our findings, the most prevalent mutations were located in the BRCA1 gene (47.37%), with BRCA1 c.212+1G > A and BRCA2 c.2806_2809del being the most frequent variants (36.84%). Conclusions: Triple negative breast cancer patients in Guatemala have higher prevalence of BRCA1 and BRCA2 mutations than reported among other populations, longer follow up of this study is expected to confirm the results and further understand how the presence of mutations could affect the response to treatment of the patients, their prognosis and the impact in their families. [Table: see text]
Breast cancer in patients with Lynch syndrome: A single institution retrospective analysis.
Authors: Miano Salvatora tindara , Petrioli Roberto , Martellucci Ignazio , Montagnani Francesco , Civitelli Serenella , Francini Guido , Giuffrida Dario , Mencarelli Maria Antonietta , Renieri Alessandra , Prestifilippo Angela , Francini Edoardo 
Published: June 2023

e22549 Background: Lynch syndrome (LS) is associated with an increased risk of several malignancies including gastrointestinal, genitourinary, gynecologic, skin, and brain cancers. However, whether patients with LS have higher risk of developing breast cancer (BC) or not is still controversial and a relevant clinical question. Methods: From the Santa Maria alle Scotte Hospital registry, we retrospectively identified consecutive patients with LS diagnosed by detecting a germline heterozygous pathogenic or likely-pathogenic variant in MLH1, MSH2, MSH6 or PMS2 on molecular genetic testing within April 2016-January 2022. We compared our sample size to Surveillance, Epidemiology, and End Results Program (SEER) of 2017 National Cancer Institute database. Results: Overall, 43 patients with LS were identified. Of those, 11 (25.6%; 95% CI 1.58-26.72%; p < 0.0001) had histologically confirmed BC, 10 (91%) of whom were hormone receptor positive tumors and BC is the only diagnosis of cancer to date. In this 11 patients median age at diagnosis was 54.5 years. 45% of 11 BC LS patients has germinal MSH2 mutation , 45% of 11% are MSH6 mutaded and has a more aggressive breast cancer. Median follow-up was 3 years and 8 months. All patients are still alive and under treatment. Conclusions: Within the limitations of a small sample size and retrospective design, our analysis suggests a significant association between patients with LS and the diagnosis of primary BC. Validation of such findings through prospective clinical studies with larger samples is warranted and would lead to fundamental modifications to LS screening and follow-up international recommendations.