Abstract PR08: Tumor masking or tumor aggressiveness? A structural equations modeling approach to estimate the impact of breast density on breast cancer stage, overall and by race

OBJEKTIF: Kajian ini dilakukan untuk mengenalpasti kategori densiti payudara yang mempunyai kebarangkalian tinggi untuk menyebabkan kanser payudara tidak dikesan atau disalah diagnosis. METODOLOGI: Kelulusan etika menjalankan penyelidikan telah diperolehi daripada Jawatankuasa Etika Penyelidikan Universiti Kebangsaan Malaysia. Sebanyak 495 kes mamografi telah dipilih dari Jabatan Radiologi, Pusat Perubatan Universiti Kebangsaan Malaysia. Semua kes mamografi telah diasingkan kepada 4 kumpulan diagnosis iaitu negative benar, positif benar, positif palsu dan negatif palsu. Kemudian, setiap kes mamografi dibahagikan mengikut empat kategori densiti payudara BI-RADS (I, II, III, IV). Analisis kebarangkalian risiko (odd ratio) setiap kategori densiti payudara dengan keputusan positif palsu dan negatif palsu dilakukan dengan menggunakan ujian regresi logistik. HASIL KAJIAN: Kebarangkalian imej mamografi dalam kategori densiti BI-RAD IV didiagnosis sebagai positif palsu adalah emapt kali ganda berbanding imej mamografi dalam kategori densiti BI-RAD I (odd ratio [OR], 4.27; 95% CI,0.88- 20.67). Manakala, imej mamografi yang mempunyai densiti BI-RAD II dan BI-RAD III mempunyai hampir dua kali ganda kemungkinan didiagnosis sebagai negatif palsu berbanding wanita berdensiti BI-RAD I (odd ratio [OR], 1.59, 1.32; 95% CI, 0.29-8.77, 0.25-7.01). KESIMPULAN: Densiti payudara dalam mamografi mempengaruhi keputusan diagnosis pakar radiologi dalam pengesanan kanser payudara. Kes mamografi yang mempunyai densiti BI-RAD IV lebih cenderung disalah diagnosis. Manakala pengesanan kanser dalam payudara berdensiti BI-RAD II dan BI-RAD III lebih berisiko untuk tidak dikesan. Penelitian yang lebih perlu diberikan dalam mentafsir imej mamografi berdensiti BI-RAD II, III dan IV bagi mengelakkan kanser disalah diagnosis atau tidak dikesan di peringkat awal. Pengesanan awal kanser payudara dapat meningkatkan kemandirian pesakit kanser.

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Breast density in Brazilian women and its risk for breast cancer and tumor aggressiveness

The Breast Journal ◽

10.1111/tbj.14042 ◽

2020 ◽

Vol 26 (11) ◽

pp. 2314-2315

Author(s):

Marina Dessimoni ◽

Carla Pessoa ◽

Benedito Filho ◽

Heloisa Vespoli ◽

Eliana Nahas ◽

...

Keyword(s):

Breast Cancer ◽

Breast Density ◽

Tumor Aggressiveness

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Breast Cancer Stage at Presentation in Ohio: The Effect of Medicaid Expansion and the Affordable Care Act

The American Surgeon ◽

10.1177/000313482008600327 ◽

2020 ◽

Vol 86 (3) ◽

pp. 195-199

Author(s):

Dan Kirkpatrick ◽

Margaret Dunn ◽

Rebecca Tuttle

Keyword(s):

Breast Cancer ◽

Affordable Care Act ◽

Advanced Disease ◽

Disease Stage ◽

Cancer Stage ◽

Medicaid Expansion ◽

Cancer Data ◽

Before And After ◽

The Affordable Care Act ◽

The Impact

Patients presenting with localized breast cancer have a five-year survival of 99 per cent, whereas survival falls to 27 per cent in advanced disease. This obviates the importance of early diagnosis and treatment. Our study evaluates the impact of Ohio's Medicaid expansion and the passage of the Affordable Care Act (ACA) on the stage at which Ohioans were diagnosed with breast cancer. Data were collected for 3056 patients presenting with breast cancer between 2006 and 2016 in the Dayton area. Patients were divided into groups based on cancer stage. The percentage of patients presenting with advanced disease (stage 3 or 4) was compared both before and after ACA implementation and Ohio Medicaid expansion. These results were also compared with statewide data maintained by the Ohio Department of Health. Compared with pre-ACA, the number of uninsured patients post-ACA was noted to fall 83 per cent, the number of patients presenting with Medicaid increased by five times, and the proportion of patients younger than 65 years presenting with breast cancer increased by approximately 7 per cent. These changes notwithstanding, no difference was identified in the percentage of patients presenting with advanced breast cancer before and after ACA implementation or Ohio Medicaid expansion ( P = 0.56). Statewide data similarly demonstrated no change ( P = 0.88). Improved insurance access had a smaller-than-anticipated impact on the stage at which Ohioans presented with breast cancer. As significant morbidity and mortality can be avoided by earlier presentation, additional research is appropriate to identify factors affecting patients’ decision to seek breast cancer screening and care.

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Impact of primary care providers on patient screening mammography and initial presentation in an underserved clinical setting.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.28_suppl.8 ◽

2015 ◽

Vol 33 (28_suppl) ◽

pp. 8-8

Author(s):

Ajaratu Keshinro ◽

Ioannis Hatzaras ◽

Shubhada Dhage ◽

Kenneth Rifkind ◽

Kathie-Ann P. Joseph

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Primary Care Providers ◽

Screening Mammography ◽

Stage I ◽

Cancer Stage ◽

Care Providers ◽

Palpable Mass ◽

Stage Iv Breast Cancer ◽

The Impact

8 Background: Screening mammography (SM) is a routinely used modality for earlier detection of breast cancer and is effective in reducing breast cancer-related morbidity and mortality. A better understanding of the impact of access to primary care physician (PCP), on the screening protocols and stage presentation, is needed to address the issue of breast cancer stage disparity amongst underserved women. Methods: A retrospective chart review of the electronic medical record, for breast cancer patients newly diagnosed from 2012-2013, was performed using the tumor registry at Bellevue Hospital Center, the largest public hospital in New York City. Patients with recurrent breast cancer, stage IV breast cancer, and those that weren’t managed surgically at our institution, were excluded from the study. Data including patient demographics, established relationship with PCP, and screening mammogram and palpable mass at presentation, were obtained and analyzed using SPSS Statistics Software. Results: 173 patients were included in the study of which 5 presented with bilateral breast cancer (n = 178). The majority of the patients seen at our institution were from minority groups, primarily Hispanic (34%) and Chinese (23%). 129 patients (72%) had a PCP at the time of diagnosis versus 49 patients (28%) without a PCP. Patients without a PCP were more likely to have a palpable breast mass at presentation, compared to patients with a PCP (73% vs. 42% respectively, p < 0.05). Furthermore, only 32 % of patients without a PCP had a SM at time of presentation, compared to 61% of patients with a PCP (p = 0.003). Overall, in the group of patients with a PCP, the majority presented with stage I breast cancer (43%), followed by 29% with stage 0. In comparison, the majority of patient without a PCP presented with stage II (41%), followed by 29% with stage I (p = 0.019). Conclusions: There is a benefit for patients with access to a PCP, as it leads to a higher likelihood of breast cancer detection via SM, as opposed to a symptomatic presentation, such as a palpable mass. Therefore, these patients are more likely to be diagnosed with an earlier stage of breast cancer, which improves their mortality.

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The influence of dietary patterns and stressful life events on psychological problems in a large sample of Iranian industrial employees: Structural equations modeling approach

Journal of Affective Disorders ◽

10.1016/j.jad.2018.04.120 ◽

2018 ◽

Vol 236 ◽

pp. 140-148 ◽

Cited By ~ 5

Author(s):

Maryam Yazdi ◽

Hamidreza Roohafza ◽

Awat Feizi ◽

Katayoon Rabiei ◽

Nizal Sarafzadegan

Keyword(s):

Life Events ◽

Dietary Patterns ◽

Stressful Life Events ◽

Structural Equations ◽

Psychological Problems ◽

Stressful Life ◽

Structural Equations Modeling ◽

Large Sample ◽

Modeling Approach

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Incidence of Venous Thromboembolism and the Impact on Survival in Breast Cancer Patients

Journal of Clinical Oncology ◽

10.1200/jco.2006.07.4393 ◽

2007 ◽

Vol 26 (1) ◽

pp. 70-76 ◽

Cited By ~ 156

Author(s):

Helen K. Chew ◽

Theodore Wun ◽

Danielle J. Harvey ◽

Hong Zhou ◽

Richard H. White

Keyword(s):

Breast Cancer ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Metastatic Disease ◽

Cancer Stage ◽

Breast Cancer Patients ◽

Data Set ◽

Discharge Data ◽

Risk Of Death ◽

The Impact

Purpose The incidence of venous thromboembolism (VTE) and the risk factors associated with development of VTE have not been reported in a large population-based study of breast cancer patients. Patients and Methods The California Cancer Registry was merged with the Patient Discharge Data Set, and the number of VTE events determined among patients diagnosed between 1993 and 1999. Results Among 108,255 patients with breast cancer, the 2-year cumulative VTE incidence was 1.2%, with a rate of 1.2 and 0.6 events/100 patient-years during the first and second half-year, respectively. The 1-year incidence of VTE was significantly increased compared with the general population (standardized incidence ratio of VTE, 4.2; 95% CI, 3.9 to 4.4). In a multivariate model, significant predictors of developing VTE within 2 years were: age (hazard ratio [HR], 2.0 if > 75 years v < 45; 95% CI, 1.6 to 2.6), the number of chronic medical comorbidities (HR, 2.9 if 3 v 0; 95% CI, 2.4 to 3.5), and advancing cancer stage (HR, 6.3; 95% CI, 5.3 to 7.5 for metastatic v local disease). In multivariate models, VTE was a significant predictor of decreased 2-year survival (HR, 2.3; 95% CI, 2.1 to 2.6) and when stratified by initial cancer stage, the effect was highest in patients with localized (HR, 5.1; 95% CI, 3.6 to 7.1) or regional stage (HR, 3.5; 95% CI, 2.5 to 4.8) cancer compared with patients with metastatic disease (HR, 1.9; 95% CI, 1.5 to 2.4). Conclusion Approximately 1% of breast cancer patients developed VTE within 2 years, with the highest incidence in the first 6 months after diagnosis. Metastatic disease and comorbidities were the strongest predictors. The diagnosis of VTE was associated with a higher risk of death within 2 years.

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