The impact of race on high-risk types of uterine cancer is modified in non-Hispanic Black and non-Hispanic White women with multiple malignancies

ObjectivesAlthough outcomes for surgery versus radiotherapy (RT) for stage IB patients are similar, young women are often preferentially treated with surgery rather than RT. Adjuvant RT is indicated for high-risk patients after surgery. Our goal was to study the impact of race and partner status on patterns of care of young women with stage I cervical cancer.MethodsWe identified a cohort of 6586 women, aged 15 to 39 years, in the Surveillance, Epidemiology and End Results database diagnosed with stage I cervical cancer between 1988 and 2007.ResultsIn our cohort, 93% (n = 5080) of white women had surgery, and 86.5% (n = 985) of nonwhite women had surgery as primary treatment. On multivariate analysis, higher FIGO (International Federation of Gynecology and Obstetrics) stage (IA2 odds ratio [OR] 3.09 [P = 0.01]; IB OR, 21.41 [P < 0.001]), widowed/single (OR, 1.39; P = 0.02), squamous histology (OR, 1.69; P < 0.001), diagnosis during 1993-1997 time period (OR, 1.69; P < 0.001), and nonwhite race (OR, 1.95; P ≤ 0.001) were more likely to receive RT as primary treatment. Of the surgical patients, 15.45% of white women versus 20.4% in the nonwhite women (P < 0.001) had high-risk disease, and 66% of the white women versus 71% of the nonwhite women received adjuvant RT (P = 0.136). Race and marital status were not significant predictors of receiving adjuvant RT on multivariate analysis. Predictors of worse overall survival included RT as primary treatment (hazard ratio [HR], 1.89; P < 0.001) and nonwhite race (HR, 1.6; P = 0.001). Marital status was not a significant predictor of overall survival. Race was a significant predictor of survival for women who received surgery as primary treatment (nonwhite HR, 1.93; P < 0.001).ConclusionsNonwhites are more likely than whites to have RT as primary treatment. This suggests that nonwhite women may have social/cultural barriers impacting their treatment decision making or may have a higher likelihood of other comorbidities that limit their surgical options.

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Project CHAT: The Impact of a Brief Motivational Intervention for High-Risk Teens in Primary Care

PsycEXTRA Dataset ◽

10.1037/e679072007-001 ◽

2007 ◽

Author(s):

Elizabeth J. D'Amico ◽

Stefanie A. Stern ◽

Lisa S. Meredith ◽

Jeremy Miles

Keyword(s):

Primary Care ◽

High Risk ◽

Motivational Intervention ◽

Brief Motivational Intervention ◽

The Impact

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Epigenetics of TNBC in Overweight and Obese Hispanic & Non-Hispanic White Women

Case Medical Research ◽

10.31525/ct1-nct04291950 ◽

2020 ◽

Author(s):

Keyword(s):

White Women ◽

Hispanic White

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Welfare Reform and the Delivery of Welfare-to-Work Programs to AAPIs: What Works?

10.36650/nexus5.2_77-97_chun-chungchowetal ◽

2007 ◽

Vol 5 (2) ◽

pp. 77-97 ◽

Cited By ~ 1

Author(s):

Julian Chow ◽

Grace Yoo ◽

Catherine Vu

Keyword(s):

High Risk ◽

Welfare Reform ◽

Asian American ◽

Low Income ◽

Personal Responsibility ◽

Welfare To Work ◽

Work Program ◽

What Works ◽

One Stop ◽

The Impact

The passage of the Personal Responsibility and Work Opportunity Act (PRWORA) of 1996 has major implications for low-income Asian American and Pacific Islander (AAPI) populations. The purpose of this paper is to provide an overview of the research currently examining the impact of welfare reform on AAPI recipients and the welfare-to-work services available to this population. This article highlights AAPI participation and their timing-out rates in California’s CalWORKs program and their barriers to transitioning to work. Four welfare-to-work program models and recommendations are presented to illustrate strategies that can be used to address the unique needs of AAPI in order to alleviate their high risk for timing-out: one-stop-shops, transitional jobs programs, providing comprehensive and family focused services, and additional research and evaluation of programs specific to assisting the AAPI population on CalWORKs.

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Decision Aids for Generating Analytical Review Alternatives: The Impact of Goal Framing and Audit-Risk Level

Behavioral Research in Accounting ◽

10.2308/bria.2002.14.1.157 ◽

2002 ◽

Vol 14 (1) ◽

pp. 157-177 ◽

Cited By ~ 20

Author(s):

Jennifer M. Mueller ◽

John C. Anderson

Keyword(s):

High Risk ◽

Cognitive Load ◽

Information Search ◽

Decision Aid ◽

Decision Aids ◽

Risk Level ◽

Audit Risk ◽

Goal Framing ◽

Analytical Review ◽

The Impact

An auditor generating potential explanations for an unusual variance in analytical review may utilize a decision aid, which provides many explanations. However, circumstances of budgetary constraints and limited cognitive load deter an auditor from using a lengthy list of explanations in an information search. A two-way between-subjects design was created to investigate the effects of two complementary approaches to trimming down the lengthy list on the number of remaining explanations carried forward into an information search. These two approaches, which represent the same goal (reducing the list) but framed differently, are found to result in a significantly different number of remaining explanations, in both low- and high-risk audit environments. The results of the study suggest that the extent to which an auditor narrows the lengthy list of explanations is important to the implementation of decision aids in analytical review.

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Cisplatin +/− rucaparib after preoperative chemotherapy in patients with triple-negative or BRCA mutated breast cancer

npj Breast Cancer ◽

10.1038/s41523-021-00240-w ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Maitri Kalra ◽

Yan Tong ◽

David R. Jones ◽

Tom Walsh ◽

Michael A. Danso ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Neoadjuvant Therapy ◽

Triple Negative ◽

Residual Disease ◽

Disease Free Survival ◽

Parp Inhibition ◽

High Risk Population ◽

Risk Population ◽

The Impact

AbstractPatients with triple-negative breast cancer (TNBC) who have residual disease after neoadjuvant therapy have a high risk of recurrence. We tested the impact of DNA-damaging chemotherapy alone or with PARP inhibition in this high-risk population. Patients with TNBC or deleterious BRCA mutation (TNBC/BRCAmut) who had >2 cm of invasive disease in the breast or persistent lymph node (LN) involvement after neoadjuvant therapy were assigned 1:1 to cisplatin alone or with rucaparib. Germline mutations were identified with BROCA analysis. The primary endpoint was 2-year disease-free survival (DFS) with 80% power to detect an HR 0.5. From Feb 2010 to May 2013, 128 patients were enrolled. Median tumor size at surgery was 1.9 cm (0–11.5 cm) with 1 (0–38) involved LN; median Residual Cancer Burden (RCB) score was 2.6. Six patients had known deleterious BRCA1 or BRCA2 mutations at study entry, but BROCA identified deleterious mutations in 22% of patients with available samples. Toxicity was similar in both arms. Despite frequent dose reductions (21% of patients) and delays (43.8% of patients), 73% of patients completed planned cisplatin. Rucaparib exposure was limited with median concentration 275 (82–4694) ng/mL post-infusion on day 3. The addition of rucaparib to cisplatin did not increase 2-year DFS (54.2% cisplatin vs. 64.1% cisplatin + rucaparib; P = 0.29). In the high-risk post preoperative TNBC/BRCAmut setting, the addition of low-dose rucaparib did not improve 2-year DFS or increase the toxicity of cisplatin. Genetic testing was underutilized in this high-risk population.

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Polygenic burden has broader impact on health, cognition, and socioeconomic outcomes than most rare and high-risk copy number variants

Molecular Psychiatry ◽

10.1038/s41380-021-01026-z ◽

2021 ◽

Author(s):

Elmo Christian Saarentaus ◽

Aki Samuli Havulinna ◽

Nina Mars ◽

Ari Ahola-Olli ◽

Tuomo Tapio Johannes Kiiskinen ◽

...

Keyword(s):

High Risk ◽

Educational Attainment ◽

Household Income ◽

Copy Number ◽

Copy Number Variants ◽

Well Being ◽

Subjective Health ◽

Polygenic Risk Score ◽

The Impact ◽

Health Cognition

AbstractCopy number variants (CNVs) are associated with syndromic and severe neurological and psychiatric disorders (SNPDs), such as intellectual disability, epilepsy, schizophrenia, and bipolar disorder. Although considered high-impact, CNVs are also observed in the general population. This presents a diagnostic challenge in evaluating their clinical significance. To estimate the phenotypic differences between CNV carriers and non-carriers regarding general health and well-being, we compared the impact of SNPD-associated CNVs on health, cognition, and socioeconomic phenotypes to the impact of three genome-wide polygenic risk score (PRS) in two Finnish cohorts (FINRISK, n = 23,053 and NFBC1966, n = 4895). The focus was on CNV carriers and PRS extremes who do not have an SNPD diagnosis. We identified high-risk CNVs (DECIPHER CNVs, risk gene deletions, or large [>1 Mb] CNVs) in 744 study participants (2.66%), 36 (4.8%) of whom had a diagnosed SNPD. In the remaining 708 unaffected carriers, we observed lower educational attainment (EA; OR = 0.77 [95% CI 0.66–0.89]) and lower household income (OR = 0.77 [0.66–0.89]). Income-associated CNVs also lowered household income (OR = 0.50 [0.38–0.66]), and CNVs with medical consequences lowered subjective health (OR = 0.48 [0.32–0.72]). The impact of PRSs was broader. At the lowest extreme of PRS for EA, we observed lower EA (OR = 0.31 [0.26–0.37]), lower-income (OR = 0.66 [0.57–0.77]), lower subjective health (OR = 0.72 [0.61–0.83]), and increased mortality (Cox’s HR = 1.55 [1.21–1.98]). PRS for intelligence had a similar impact, whereas PRS for schizophrenia did not affect these traits. We conclude that the majority of working-age individuals carrying high-risk CNVs without SNPD diagnosis have a modest impact on morbidity and mortality, as well as the limited impact on income and educational attainment, compared to individuals at the extreme end of common genetic variation. Our findings highlight that the contribution of traditional high-risk variants such as CNVs should be analyzed in a broader genetic context, rather than evaluated in isolation.

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Understanding low chemoprevention uptake by women at high risk of breast cancer: findings from a qualitative inductive study of women’s risk-reduction experiences

BMC Women s Health ◽

10.1186/s12905-021-01279-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tasleem J. Padamsee ◽

Megan Hils ◽

Anna Muraveva

Keyword(s):

Breast Cancer ◽

African American ◽

High Risk ◽

Risk Reduction ◽

White Women ◽

Future Research ◽

Structured Interviews ◽

Critical Gap ◽

High Risk Women ◽

Parent Project

Abstract Background Chemoprevention is one of several methods that have been developed to help high-risk women reduce their risk of breast cancer. Reasons for the low uptake of chemoprevention are poorly understood. This paper seeks a deeper understanding of this phenomenon by drawing on women’s own narratives about their awareness of chemoprevention and their risk-related experiences. Methods This research is based on a parent project that included fifty in-depth, semi-structured interviews with a purposive sample of African American and White women at elevated risk of breast cancer. This specific study draws on the forty-seven interviews conducted with women at high or severe risk of breast cancer, all of whom are eligible to use chemoprevention for breast cancer risk-reduction. Interviews were analyzed using grounded theory methods. Results Forty-five percent of participants, and only 21% of African American participants, were aware of chemoprevention options. Women who had seen specialists were more likely to be aware, particularly if they had ongoing specialist access. Aware and unaware women relied on different types of sources for prevention-related information. Those whose main source of information was a healthcare provider were more likely to know about chemoprevention. Aware women used more nuanced information gathering strategies and worried more about cancer. Women simultaneously considered all risk-reduction options they knew about. Those who knew about chemoprevention but were reluctant to use it felt this way for multiple reasons, having to do with potential side effects, perceived extreme-ness of the intervention, similarity to chemotherapy, unknown information about chemoprevention, and reluctance to take medications in general. Conclusions Lack of chemoprevention awareness is a critical gap in women’s ability to make health-protective choices. Future research in this field must consider complexities in both women’s perspectives on chemoprevention and the reasons they are reluctant to use it.

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Effectiveness of Yoga Lifestyle on Lipid Metabolism in a Vulnerable Population—A Community Based Multicenter Randomized Controlled Trial

Medicines ◽

10.3390/medicines8070037 ◽

2021 ◽

Vol 8 (7) ◽

pp. 37

Author(s):

Raghuram Nagarathna ◽

Saurabh Kumar ◽

Akshay Anand ◽

Ishwara N. Acharya ◽

Amit Kumar Singh ◽

...

Keyword(s):

Randomized Controlled Trial ◽

High Risk ◽

Controlled Trial ◽

Density Lipoprotein ◽

Lipid Profiles ◽

Community Based ◽

Randomized Controlled ◽

Rural And Urban ◽

Yoga Group ◽

The Impact

Background: Dyslipidemia poses a high risk for cardiovascular disease and stroke in Type 2 diabetes (T2DM). There are no studies on the impact of a validated integrated yoga lifestyle protocol on lipid profiles in a high-risk diabetes population. Methods: Here, we report the results of lipid profile values of 11,254 (yoga 5932 and control 5322) adults (20–70 years) of both genders with high risk (≥60 on Indian diabetes risk score) for diabetes from a nationwide rural and urban community-based two group (yoga and conventional management) cluster randomized controlled trial. The yoga group practiced a validated integrated yoga lifestyle protocol (DYP) in nine day camps followed by daily one-hour practice. Biochemical profiling included glycated hemoglobin and lipid profiles before and after three months. Results: There was a significant difference between groups (p < 0.001 ANCOVA) with improved serum total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein in the yoga group compared to the control group. Further, the regulatory effect of yoga was noted with a significant decrease or increase in those with high or low values of lipids, respectively, with marginal or no change in those within the normal range. Conclusion: Yoga lifestyle improves and regulates (lowered if high, increased if low) the blood lipid levels in both genders of prediabetic and diabetic individuals in both rural and urban Indian communities.

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