tbuckley/cabot-search huggingface dataset:
E-cigarette use and United States Preventive Services Task Force (USPSTF) lung cancer screening (LCS) eligibility.
Authors: Qian Wang, Changchuan Jiang, Hui Xie, Zhiting Tang, Yannan Li, Matthew M. Mirsky, Chi Wen, Melinda Laine Hsu, Debora S. Bruno, Yaning Zhang, Afshin Dowlati, Lauren Chiec, Giselle Dutcher, Paolo Boffetta, Chung Yin Kong
Journal: Journal of Clinical Oncology (2024)

10531 Background: Electronic cigarettes (E-cigarettes) have become frequently used as a smoking cessation tool. Emerging research has shown that e-cigarettes have similar carcinogenic effects as combustible cigarettes. While current lung cancer screening (LCS) guidelines primarily rely on individuals’ smoking history, it's becoming increasingly important to understand the prevalence of e-cigarette use among individuals, especially in the context of their LCS eligibility. Methods: Individuals aged 40-80 years were extracted from the 2022 Behavioral Risk Factor Surveillance System. Eligibility was defined using the 2021 USPSTF LCS criteria, i.e., aged 50-80 years who ever smoked, with at least a 20-pack-year smoking history, currently smoke or quit within the past 15 years. We compared the prevalence of current and ever e-cigarette use among LCS-eligible and non-eligible populations, overall and by smoking (combustible cigarettes) status using chi-square tests. All analyses were weighted. The significance level was set at a 2-sided p-value of &lt;0.05. Results: Among the 208,317 individuals included, 9.9% were eligible for LCS. Overall, 3.8% and 22.1% reported current and ever cigarette use, respectively. Fewer LCS-ineligible individuals reported currently using e-cigarettes than their LCS-eligible counterparts (Table). Among former combustible cigarette users, LCS-ineligible individuals were less likely to be current e-cigarette user than LCS-eligible individuals. However, among current combustible cigarette users, LCS-ineligible individuals were more likely to be current e-cigarettes users than LCS-eligible individuals. When examining the prevalence of ever e-cigarette use, similar findings were observed. Conclusions: Our study reveals a significant prevalence of e-cigarette usage among older adults (aged 40-80), with 1 in 5 individuals reporting ever having used e-cigarettes. Moreover, current cigarette users who were ineligible for LCS were more likely to use e-cigarette than their LCS-eligible counterparts. Future epidemiological studies are warranted to assess the risk of e-cigarette use (including intensity, duration and interactions with combustible cigarettes) and lung cancer risks. E-cigarette use may need to be considered in formulating future LCS guidelines. [Table: see text]
Implementation of video assisted point-of-care germline genetic education and testing for patients with peri-diagnostic pancreatic cancer.
Authors: Daniel King, Nathan Mitnick, Aman Mann, Noah D. Kauff
Journal: Journal of Clinical Oncology (2024)

e22530 Background: Germline genetic testing is universally recommended for patients with exocrine pancreatic cancer (PC). Pretest consultation with a genetics professional is recommended to ensure patients are informed about risks, benefits, and limitations of testing. This is a resource intensive process and is associated with a suboptimal testing rate (~30%). Prior work demonstrates that video-assisted pre-test education does not increase patient anxiety compared to traditional pre-test genetic counseling in peridiagnostic ovarian cancer patients. In this report, we assess the feasibility of using a similar video assisted, streamlined genetic education and testing approach in peridiagnostic PC patients. Methods: As part of a pilot quality improvement initiative, patients with a diagnosis of exocrine PC seen in a single academic practice were offered streamlined, video-assisted genetic education followed by germline testing. Patient eligibility for this pilot included: new diagnosis or radiographic suspicion of PC; English language proficiency; and no prior germline testing. After this approach was presented by the medical oncology team, eligible patients viewed a 9-minute educational video describing the goals, pros, and cons of germline genetic testing. After watching the video, patients were given the option to proceed with testing that day. Patients with pathogenic mutations were referred for formal post-test genetic counseling, and patients with variants of uncertain significance (VUSs) were referred on a case-by-case basis. Following IRB approval, we conducted a retrospective review of the experience of all patients presenting to this pilot site from April-Dec 2023. Results: During the study period, 56 new patients with exocrine PC presented to the pilot site. 50 patients were eligible for participating in the pilot program. All patients, except one who declined on the basis of transferring care, consented to testing (49/50; 98%). Median patient age was 71, 49% were female. Race distribution was: White (30), Asian (6), Black (4), Other (2), Declined (7). Median time from patient diagnosis to testing was 11 days. One patient had a germline ATM mutation, and this patient was seen for formal posttest counseling 18 days after testing was initiated. Seven patients had VUSs. Six new patients presenting during the study period were not eligible for this pilot, all due to limited English proficiency. All 6 of these patients underwent genetic testing after translation service assisted counseling by either the primary oncology or cancer genetics team. Conclusions: Video assisted point-of-care genetics education and testing led to nearly universal uptake of genetic testing in peridiagnostic PC patients. This workflow was feasible, timely, and optimized use of genetic counseling resources.
Acceptability of stool-based DNA colorectal cancer (CRC) screening among Black/African American patients served by a Federally Qualified Health Center (FQHC).
Authors: Evan Keiser, A. Michelle Corbett, Onyema Chido-Amajuoyi, Allison Antoine, Carrie Stehman, Isabella Dorn, David Goines, Noelle K. LoConte
Journal: Journal of Clinical Oncology (2024)

10530 Background: CRC has an increased burden among Black/African American populations in the United States. Following the COVID-19 pandemic, home-based CRC screening options are being used more frequently. We conducted focus groups to understand the acceptability of stool-based DNA testing for CRC screening in this population. Methods: 10 Focus group sessions were conducted at 2 FQHCs in Milwaukee, WI from 06/22/2023-10/30/2023. Participants were paid $40 for participation. Groups were categorized by gender and age (younger [40-50] vs. older [over 50]). Participants were recruited by fliers and direct text from the FQHC. Eligibility was verified by FQHC staff. Each session was 90 minutes, held at the FQHC, and led by the same facilitator. Participants were given an overview of CRC screening tests and shown a video about stool DNA tests before beginning the focus groups. Thematic analysis was carried out using NVivo. Results: Across 10 groups, there were 79 participants, 32 younger (40.5%) and 47 older (59.5%), with 42 males (53.2%) and 37 (46.8%) females. In the overall study population, there was minimal knowledge of one’s risk for CRC, including the concept of average versus high-risk. Also, there was limited awareness of CRC screening options among younger patients and widespread lack of knowledge about stool-based DNA testing. None of the participants had personal experience with stool-based DNA screening. Most participants were open to the idea of stool-based DNA testing for screening. Examination of DNA was not a pervasive concern in the groups. Most preferred colonoscopy as their first-choice screening test. Reasons for colonoscopy preference included: definitive removal of polyps, direct visualization of the colon, increased confidence level in effectiveness, potential longer periods between screenings, and no need for confirmatory evaluation. Conclusions: Study findings reveal that stool-based DNA testing was acceptable among our study population, however, colonoscopy was identified as the preferred screening modality among this population of Black/African American patients served by an FQHC. Given the low awareness/knowledge of screening modalities identified in our study, educational interventions and shared decision making by primary care providers are needed to promote patient awareness of CRC screening options within the population.
Participant adherence in a lung cancer screening (LCS) program in a non-smoking population.
Authors: Jaimie Bell, Wenyuan Li, Elaine Shum
Journal: Journal of Clinical Oncology (2024)

10556 Background: LCS guidelines in smoking populations includes an annual low-dose CT Chest (LDCT) scan. Historically, real-world adherence to repeat imaging following the baseline LDCT has been low at 22% (Silvestri et al. Chest 2023). Various reasons for non-adherence have been cited and can be amplified in populations where English is not the primary language, low health literacy, or logistical reasons that interfere with scheduling. We are conducting the Female Asian Nonsmoker Screening Study (FANSS), which is a pilot study for Asian women with no smoking history to provide LDCTs to this population. We describe the strategies utilized to address potential barriers to adherence and report the participant (pt) adherence observed to date for this population. Methods: FANSS is an IRB-approved trial that provides LDCTs annually for 3 years and has an interim follow-up phone call every 6 months. All aspects of the study other than the LDCT could be conducted virtually pending pt preference. All pt interactions were conducted in the pt’s requested language. LDCTs were interpreted according to Lung-RADS. Review of the LDCT results were available in-person or virtually by a nurse practitioner or the principal investigator. The timeline for the 2nd and 3rd LDCT after the baseline scan was determined as follows: pts with negative findings were recommended for a repeat LDCT in 1 year; pts with suspicious findings were reviewed at the NYU Multidisciplinary Nodule Board and recommended for a repeated LDCT in a 3 or 6 month interval. A bilingual (English and Chinese speaking) research coordinator and medical secretaries reached out to pts at their preferred contact (email, phone, or text) for scheduling the follow-up LDCT. Up to three attempts to reach pts to schedule their follow-up LDCT were made. Results: From 3/5/21 to 1/27/24, 634 subjects completed their baseline LDCTs. Language interpretation services were utilized in 30% of pts. As of 1/27/24, 215 pts were due for their 2nd LDCT: 195 (91%) completed (186) or scheduled (9) the LDCT, 5 pts withdrew their consent, and 15 did not complete the scan. The main reasons for not completing the scans were: living outside New York City, other health concerns, and lost to follow-up. As of 1/27/24, 95 pts were due for their 3rd LDCT: 87 (92%) completed (82) and scheduled (5) the LDCT, and 8 did not complete the scan due to being lost to follow-up. Conclusions: The FANSS population is a unique pt cohort comprised of all Asian women who do not qualify for current LCS guidelines. Interventions to address potential adherence issues were implemented. In our research-based setting, virtual conduct of most of the study procedures allowed pt flexibility. Pt outreach to ensure follow-up by contacting through various methods also ensured adherence of &gt;90%. These interventions can be considered for use in other LCS programs to improve adherence to LCS follow-up.
Universal germline testing for cancer susceptibility and actionable noncancer disorders among 19,842 patients: Initial findings from the City of Hope INSPIRE study.
Authors: Stacy W. Gray, Ilana Solomon, Heather Hampel, Michael Garcia, Lawrence Shaktah, Sandra Dreike, Gregory Idos, Lauren Gima, Sidney S. Lindsey, Marilan Luong, Kevin McDonnell, Bita Nehoray, Wai Park, Susan Shehayeb, Elise Sobotka, Yi Xiao, Elyssa Zukin, Joseph D. Bonner, Stanley R. Hamilton, Stephen B. Gruber
Journal: Journal of Clinical Oncology (2024)

10594 Background: Germline testing can be essential for risk stratification and therapeutic decision making. However, guideline-based testing misses ~50% of people with inherited cancer risk. To address this gap, we launched the INSPIRE study, offering universal germline testing (31 non-cancer and 154 cancer genes) to consented patients affected and unaffected with cancer. Methos: In 2020, we initiated a scalable in person/remote consent model without formal pre-test counseling. Consenting patients opted-in for one, both, or neither germline test. Research staff placed orders. Results were reviewed by a genetic counselor. Pathogenic/likely pathogenic (P/LP) and increased risk allele (IRA) results were disclosed by phone and scheduled for a genetic consult. Variant of uncertain significance (VUS)/negative results were disclosed by letter with a genetic consult available on request. Descriptive statistics and chi-squared tests evaluated a priori hypotheses regarding potential factors impacting genetic testing uptake and actionability. Results: We approached 26,920 patients: 22,115 (82%) enrolled, 1,830 (7%) declined, 2,975 (11%) deferred a decision. Consented patients opted for testing for germline cancer (21,871/ 99%), non-cancer (21,731/98%), or neither (160/0.7%). We have returned results to 19,842 patients: mean age 62, 69% female; 72% white, 14% Asian, 5% Black, 9% other; 24% Hispanic. Most patients (15,578) had cancer, 13% with multiple primaries. Among the 19,842 patients, 4,456 (23%) had at least one P/LP/IRA variant; 3,971 (20%) in a cancer risk gene and 589 (3%) in a non-cancer gene. Variant proportion by category was 1,466 (30%) high-penetrance, 847 (18%) moderate-penetrance, 1,127 (23%) low-penetrance, 1,282 (28%) recessive, and 34 (0.7%) preliminary evidence. Penetrance prevalence differed by sex: high penetrance variants were more common in females (33% vs. 27%; p=&lt;0.001) and moderate penetrance variants were more common in males (21% vs. 17%; p=0.003). 16,883 (85%) individuals carry at least one VUS. Conclusions: A scalable model to increase germline genetic testing among unselected cancer and unaffected patients across &gt;20 sites was highly feasible. A significant proportion of patients had actionable findings in cancer and non-cancer genes. Next steps include analyses to establish variant prevalence across groups, a longitudinal assessment of psychological outcomes and an evaluation of the impact of result disclosure on cost, patient care, and outcomes.
Effect of low-dose tamoxifen on IGF-I/IGFBP-3 and estradiol/SHBG ratio and their prognostic/predictive effect in DCIS/LCIS/ADH.
Authors: Andrea De Censi, Harriet Johansson, Matteo Puntoni, Debora Macis, Aliana Guerrieri-Gonzaga, Valentina Aristarco, Irene Maria Briata, Martino Oliva, Luca Boni, Matteo Lazzeroni, Davide Serrano, Livia Giordano, Maria Digennaro, Laura Cortesi, Francesco Millo, Katia Cagossi, Giuseppe Aprile, Fabio Falcini, Elisa Gallerani, Bernardo Bonanni
Journal: Journal of Clinical Oncology (2024)

10510 Background: Babytam (BT), 5 mg/day for 3 years (y) is a popular choice for preventive therapy after breast DCIS/LCIS/ADH given its 10-y efficacy to prevent recurrence without adverse events (1). Here we investigated the effect of BT on serum biomarkers and their role as prognostic and predictive factors. Methods: In a phase-III trial of BT or placebo (P), 406 out of 500 women consented to blood sampling at baseline, 1 and 3 y. Serum estradiol (E2), SHBG, IGF-I, IGFBP-3 and their molar ratios were measured by CLIA. Biomarker changes were estimated with mixed-effects models for repeated measures and Incidence Rate Ratios (IRR) of the primary endpoint (invasive breast cancer or DCIS) were calculated after 5 and 10 y of follow-up with Poisson regression. Subgroup analyses were performed by interaction test. Results: There were no differences in event rates between women with blood samples and those w/out. Compared with P at 1 y, IGF-I/IGFBP-3 decreased by 0.039 (95%CI, 0.027-0.052), relative difference (rd), 22% (15-29) (p&lt;0.001), whereas E2/SHBG increased by 2.967 (1.767-4.166), rd, 79% (47-111) in pre- and decreased by 0.121 (-1.117-0.874), rd, -9% (-84-66), in postmenopausal women on BT (p-interaction=0.001). The mean annual rate of events (x1000 PY) after 5 and 10 y follow-up according to baseline level of IGF-I/IGFBP-3 (all women) and E2/SHBG (postmenopausal). Conclusions: BT significantly lowers IGF-I/IGFBP-3 ratio, increases E2/SHBG in premenopause to a lesser extent than 20 mg/d and is effective in most subgroups regardless of baseline biomarker levels. While lower baseline IGF-I/IGFBP-3 levels were predictive of BT efficacy at 5 and 10 y, higher levels at 10 y were associated with a lower benefit of BT. E2/SHBG had a tendency to be prognostic and predictive of BT efficacy at 5 y, but softened down at 10 y. These biomarkers may help differentiate which women benefit most from BT. The role of IGF-I change as surrogate biomarker of BT effect requires further studies. 1. Lazzeroni et al: JCO 41:3116, 2023. Clinical trial information: NCT01357772 . [Table: see text]
Information and prevention needs among germline <i>TP53</i>(g<i>TP53</i>m)pathogenic variants carriers.
Authors: Tarek Ben Ahmed, Pauline Vidican, Nadège Corradini, Christine Lasset, Veronica Goldbarg, Léa Guerrini-Rousseau, Beatrivr Claret, Béatrice Fervers, Pauline Rochefort, Suzette Delaloge, Olivier Caron
Journal: Journal of Clinical Oncology (2024)

10551 Background: Li-Fraumeni syndrome (LFS) and more generally g TP53m situations increase the risk of many malignancies. A modifier role of several attributable factors has been recently suggested on LFS-carcinogenesis, including reproductive and lifestyle factors, obesity, physical activity (PA) and diet. However, among g TP53m carriers, prevention approaches have yet primarily focused on intensive cancer screening, with very little emphasis put on primary prevention measures. Methods: As part of the construction of a multicenter, national, multidisciplinary intervention delivering multimodal cancer prevention to g TP53m carriers, we designed a specific patient survey that aimed to analyze potential participants’ needs and wishes. The online questionnaire was sent to g TP53m adult carriers already followed in two national reference centers (n=120). Participants were asked to rate their personal perception of importance and need for each item from 0 to 100 (0=not interested, 100=very interested). The questionnaire contained no identifying data and was approved by the local ethics and data protection committee. Results: The response rate was 61%. 18% were aged &lt; 30, 71% between 30 and 60. g TP53m had been diagnosed in the past 10 years in 29% of patients, and 11% for &lt; 2 years. 58% had a personal history of cancer, and 18% were still receiving a treatment. The median perceived risk of new cancer was 79% for all, and 65% for those w/o a previous history of cancer. 19% did not feel comfortable to participate in information workshops with people they do not know. The median score of the main question on devoting a day to cancer risk information and primary and secondary prevention measures was 88 (95%CI 78 -96). The main desired topics (median score 69-92) were information on research programs, personal cancer risk, well-being measures, psychological aspects, and other cancer risk factors (diet, PA, etc). Wished supports were individual consultation for nutrition (score 81.5 (95%CI 59 -87.5), group workshop for risk factors (score 76 (95%CI 64 -86) and individual coaching for PA (score 76 (95%CI 71 -88.5). Demand for addictologist was low. Conclusions: This study could identify major unmet needs and very strong information-seeking behaviors among g TP53m carriers. It enables us to co-construct a coordinated multi-professional intervention focused on proactive shared cancer prevention. In a second phase, we will assess the effectiveness and feasibility of this new personalized cancer prevention intervention.
Clinical and economic benefit of genomic testing strategies to guide the treatment of patients with HR+/HER2- breast cancer in the US.
Authors: Mark Gouldson, Vlad Berdunov, Quang Anh Le, Steve Millen, Jennifer M. Racz, Bradley A. Arrick, Deborah Hartzfeld, Snehal Govind Thakkar, Brandie Heald, Christy A Russell, Sebastien Eymere, Camille Moyon, Harriet Simmons, Gebra Cuyun Carter
Journal: Journal of Clinical Oncology (2024)

10584 Background: Multiple testing technologies are available to inform treatment decisions for hormone receptor positive (HR+) and human epidermal growth factor receptor 2 negative (HER2-) early-stage breast cancer, including tumor profiling and germline genetic testing (GGT). The 21-gene assay provides an estimate of distant recurrence risk and potential clinical benefit of chemotherapy. GGT identifies pathogenic variants which inform lifetime cancer risk as well may inform therapy options. This study explored the potential synergy of utilizing both tests by assessing the cost-effectiveness of this strategy compared to no testing from a societal perspective. Methods: A health economic model was developed using best practices to assess a patient cohort with HR+/HER2-, node-negative (N0) or node-positive (N1) breast cancer that was guided to surgical and adjuvant treatment by GGT ( ATM, BRCA1/2, CDH1, CHEK2, PALB2, PTEN,and TP53) and the 21-gene assay. Treatment effectiveness was informed by clinical trials (TAILORx and RxPONDER); costs for treatment, monitoring, and health utilities were sourced from literature. Clinical expert opinion and guidelines informed current US clinical practice. The base case analysis evaluated lifetime total costs, life-years, and quality-adjusted life years (QALYs) versus no testing. Scenario and sensitivity analyses were performed to evaluate model robustness. Results: The testing strategy was dominant (lower cost and higher QALYs gained) compared to no testing leading to a QALY improvement of 0.286 and cost savings of $16,463 in the N0 population (Table) and a 0.099 QALY improvement and $299 cost savings in the N1 population. Scenario analyses indicated that while the 21-gene assay was the primary driver of results, there were synergistic effects when tests were combined. Sensitivity analysis supported cost-effectiveness at most willingness-to-pay thresholds and identified the probability of chemotherapy and rate of distant recurrence as the most impactful model inputs. Conclusions: Using a testing strategy including both the 21-gene assay and GGT enables optimization of treatment decisions in early HR+/HER2- breast cancer, improving patient outcomes at reduced costs. [Table: see text]