Identifying opportunities to improve equity in breast cancer care for uninsured Hispanic patients in underserved communities.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 132-132
Author(s):  
Gehan Botrus ◽  
Natalie Ertz -Archambault ◽  
Heidi E. Kosiorek ◽  
Nellie Nafissi ◽  
Miguel Gonzales ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Mayo Clinic ◽  
Care Pathway ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Newly Diagnosed ◽  
Underserved Communities ◽  
Similar Treatment ◽  
Hispanic Ethnicity ◽  
Zip Code

132 Background: Enhancing equitable oncologic care is an increasingly emphasized priority. Our study aims to identify aspects of breast cancer (BC) care in which differences exist based on insurance coverage. Methods: We performed a retrospective, case control study, (from 2014-2020); 39 Hispanic ethnicity uninsured patients (UP) from underserved communities with newly diagnosed BC and 119 insured patients (IP) diagnosed at Mayo Clinic Arizona (MCA). Patients were matched 3:1 for age, stage, year of diagnosis, estrogen receptors and HER-2 status. Demographic information, clinical variables, and zip code level specific socioeconomic information were compared. Continuous variables were compared by Wilcoxon rank-sum test and categorical variables by chi-square test. All patients were treated at MCA. Results: Similar treatment patterns with radiotherapy, chemotherapy and surgery were observed between groups. Primary language was Spanish for 94% of UP and English for 97.5% of IP. The majority of UP were of Hispanic ethnicity (97.4%); IP were 83.2% non-Hispanic White, 9.2% Hispanic, 3.4% African American. Zip code level information reflected more unemployment with a median of 10.6% versus 6.9% p < 0.001, percent of high school or lower (53.0 % v 23.2 %, p < 0.001), and lower income for UP (33733.5 v 64728.0 p values < 0.001).BMI was significantly higher for UP (30.6 V 24.7, p = 0.005), with presence of more co-morbidities; diabetes (28.2% v 5.0%, p < 0.001), hypertension (35.9 % v 20.2%, p = 0.046), dyslipidemia (28.2% v 12.6%, p = 0.023), metabolic syndrome (p 23.7% v 8.5, p = 0.013), and tobacco use (17.9% v 2.5%, p < 0.001). Genetics consultation was performed for 62.2% IP versus 35.9% UP (p = 0.004), lower acceptance of nutrition consultation for UP (29.4% vs 7.4%, p = 0.024). Median time from mammogram to biopsy (25.5 days vs. 14 days, p = 0.056), and interval from diagnosis to treatment (62 days vs. 39 days) (p = 0.001) were less favorable for UP compared to IP. Conclusions: In comparing the status of UP and IP with newly diagnosed BC, we identified greater prevalence of co-morbidities and adverse social determinants of health in the former group. We identified access to genetic counseling, nutrition consultation, and timeliness of diagnostic biopsy and initiation of treatment as disparate features in the care pathway. These observations allowed development of tailored interventions to achieve greater equity in delivery of BC care at Mayo Clinic.

Comparison of care process for newly diagnosed breast cancer in insured versus uninsured populations: Opportunities for improving health equity.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18518-e18518
Author(s):  
Gehan Botrus ◽  
Natalie Ertz-Archambault ◽  
Nellie Nafissi ◽  
Miguel Gonzalez Velez ◽  
Heidi E. Kosiorek ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Treatment ◽  
Care Process ◽  
Categorical Variables ◽  
Newly Diagnosed ◽  
Similar Treatment ◽  
Hispanic Ethnicity ◽  
Abnormal Mammogram ◽  
Zip Code ◽  
Hispanic White

e18518 Background: Initiatives enhancing equitable oncologic care are an increasingly emphasized priority. Our study aims to identify aspects of breast cancer (BC) care in which differences exist based on insurance coverage status. Methods: We performed a retrospective, case control study consisting of 39 Hispanic ethnicity uninsured patients (UP) with newly diagnosed BC at federally qualified health centers and 119 insured patients (IP) diagnosed at Mayo Clinic Arizona (MCA). Patients were matched 3:1 for age, stage, year of diagnosis, ER and HER2 status. Demographic information, clinical variables, and zip code level specific socioeconomic information were compared. Continuous variables were compared by Wilcoxon rank-sum test and categorical variables by chi-square test. All patients ultimately received their cancer treatment at MCA. Results: Similar treatment patterns with chemotherapy, surgery, and radiation treatment were observed between groups. Primary language was Spanish for 94% of UP and English for 97.5% of IP. The majority of UP were of Hispanic ethnicity (97.4%); IP were 83.2% non-Hispanic White, 9.2% Hispanic, 3.4% African American. Zip code level information reflected more unemployment with a median of 10.6% versus 6.9% p ˂ 0.001, percent of high school or lower (53.0 % v 23.2 %, p ˂ 0.001), and lower income for UP (33733.5 v 64728.0 p values ˂ 0.001). UP BMI was significantly higher (30.6 V 24.7, p=0.005), with presence of more co-morbidities; diabetes (28.2% v 5.0%, p ˂ 0.001), hypertension (35.9 % v 20.2%, p= 0.046), dyslipidemia (28.2% v 12.6%, p = 0.023), metabolic syndrome (p 23.7% v 8.5, p= 0.013), and tobacco use (17.9% v 2.5%, p ˂ 0.001). IP had higher alcohol use (52.9% v 5.3%, p ˂ 0.001). Genetics consultation was performed for 62.2% IP versus 35.9% UP (p=0.004), lower acceptance of oncology nutrition consultation for UP (29.4% vs 7.4%, p= 0.024) Median time from abnormal mammogram to biopsy (25.5 days vs. 14 days, p=0.056), and interval from diagnosis to treatment (62 days vs. 39 days) (p=0.001) were less favorable for UP compared to IP. Conclusions: In comparing the status of UP (primarily Hispanic, Spanish-speaking) and IP (primarily non-Hispanic White, English-speaking) with newly diagnosed BC we identified greater prevalence of co-morbidities and adverse social determinants of health in the former group. We identified access to genetic counseling services, access to oncology nutrition consultation, and timeliness of diagnostic biopsy and initiation of treatment as disparate features in the care pathway. These observations can allow development of tailored interventions to achieve greater equity in delivery of BC care.

Radiation and cardiotoxicity: A retrospective analysis of a midwest population.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12616-e12616
Author(s):  
Nitin Tandan ◽  
Cameron Koester ◽  
Priyanka Parajuli ◽  
Odalys Estefania Lara Garcia ◽  
Manjari Rani Regmi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Large Scale ◽  
Categorical Variables ◽  
Rank Test ◽  
Continuous Variables ◽  
Breast Cancer Patients ◽  
Cardiac Events ◽  
Coronary Syndrome

e12616 Background: The most common female malignancy diagnosed in the US is breast cancer. Early breast cancer therapy is often treated with radiation therapy; one of the unfortunate side effects of radiotherapy in the past has been cardiotoxicity, especially coronary artery disease. Recent usage of dose reduction techniques have helped reduce these effects. Here, we present our analysis of breast cancer patients that received radiation therapy and the likelihood of cardiotoxicity. Methods: An IRB-approved retrospective study was performed utilizing ICD codes to analyze patients diagnosed with biopsy-confirmed breast cancer between January 1, 2014 and December 31, 2017. 478 of 1618 de-identified patients qualified for this study. Statistical analysis was performed with SAS v9.4. Descriptive statistics were computed for all study variables. Continuous variables were described with measures of central tendency (mean, median) and dispersion (range, standard deviation). Categorical variables were summarized as frequencies and percentages. Comparisons between categorical variables were compared with the Chi-Square test (or Fisher’s Exact) where appropriate. Survival curves were estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival were assessed with Cox proportional hazards regression analyses. All significance is assumed at the p < 0.05 level. Results: Of the 478 eligible patients, heart failure (HF), HF hospitalizations, acute coronary syndrome and overall cardiac events were compared among breast cancer patients. Patients who received radiation experienced HF 6.02% compared to 4.61% without radiation (p = 0.574). HF hospitalization was recorded as 2.27% in radiotherapy compared to 1.23% in non-radiotherapy patients (p = 0.686). Patients who radiation experienced ACS 2.27% of the time as compared to 1.21% in patients who were not treated with radiation. Of note, 9.25% receiving radiation experienced cardiac events compared to 4.24% in patients without radiation (p = 0.068). While results were not statistically significant, the trend of elevated cardiac events in breast cancer patients receiving radiation is noteworthy. Conclusions: Per our study, although statistically insignificant, radiation therapy may result in higher incidence of cardiac events in breast cancer patients. Further large-scale, prospective studies should be performed to confirm the aforementioned trends with respect to survival outcomes in urban and rural populations.

Association between obesity and the clinical stage of newly diagnosed breast cancer: Experience with 2212 patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12602-e12602
Author(s):  
Bader I Alshamsan ◽  
Kausar Suleman ◽  
Naela Agha ◽  
Marwa Ismail Abdelgawad ◽  
Mashari J Alzahrani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Confidence Interval ◽  
Cancer Patients ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Overweight And Obesity ◽  
Categorical Variables ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Time Of Presentation

e12602 Background: Excess weight is currently recognized as a risk factor for several cancer types, including breast cancer. The primary goal of this study was to evaluate the impact of overweight and obesity in newly diagnosed breast cancer patients at the time of presentation. Methods: A retrospective analysis of breast cancer from a prospective database of all newly diagnosed non-metastatic breast cancer patients seen at King Faisal Specialist Hospital and Research Center between 2002 and 2014 was performed. The clinical stages were divided into early stage breast cancer and locally advanced breast cancer. The body mass index (BMI) groups were underweight, normal, overweight, and obese based on the World Health Organization classifications of BMI. The patient characteristics are presented as medians with interquartile ranges (IQRs) and frequencies for continuous and categorical variables, respectively. The association between BMI groups and clinical stage at presentation was evaluated using the logistic regression model. Survival probabilities were calculated using the Kaplan-Meier estimator. Results: In total, 2212 patients were eligible for the study. The median age at diagnosis was 45 (IQR = 39-52) years; 62% patients were pre-menopausal, and 31% were post-menopausal. The median BMI was 30 (IQR = 26-34) kg/m2. In this population, 53% patients were obese; 31%, overweight; and 14.7%, in the normal range at diagnosis. Regression analysis revealed a significant association between clinical stage and BMI at the time of presentation (p = 0.006). Obese patients showed a 40% higher chance of having locally advanced presentation than the normal BMI group (OR = 1.41, 95% confidence interval = 1.06-1.86, p = 0.02). However, overweight had no significant association with clinical stage (OR = 1.03, 95% confidence interval = 0.76-1.8). The median follow-up duration was 39 (IQR = 22-66.6) months. Overall survival showed no significant association with different BMI groups and breast cancer subtypes. Conclusions: The prevalence of overweight and obesity was found to be high (85%) in newly diagnosed breast cancer patients in Saudi Arabia. Obesity is associated with a more advanced clinical stage at the time of diagnosis of breast cancer and may be a contributing factor for more locally advanced presentations in the region.

Clinical, sociodemographic, and pathological characteristics of breast cancer in the United States: A cross-sectional analysis from the National Cancer Database (NCDB).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13623-e13623
Author(s):  
Zeina A. Nahleh ◽  
Nadeem Bilani ◽  
Leah Elson ◽  
Elizabeth Blessing Elimimian ◽  
Emily Craig Zabor
Keyword(s):  
Breast Cancer ◽  
Academic Research ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Integrated Network ◽  
Hormone Receptor Positive ◽  
Kaplan Meier ◽  
Facility Type

e13623 Background: Breast cancer (BC) remains the most commonly-diagnosed malignancy in women. BC encompasses great heterogeneity in patient pathologic and clinical characteristics, as well as treatment approaches and outcome by stage and subtype. This study aims to explore recent differences in characteristics and overall survival (OS) of BC across different facility types. Methods: We conducted a retrospective analysis of patients with BC, diagnosed between 2004-2016, based on the NCDB. Categorical variables were summarized using frequencies/percentages, whereas continuous variables were summarized using the median/interquartile range (IQR). OS was explored using the Kaplan-Meier method. Results: A total of 2,671,549 patients with BC were captured in this dataset. The median age at diagnosis was 61 (range 18-90 years). The majority n = 1,986,450 (75%) were non-Hispanic (NH) white; 286,176 (11%) were NH-black; 124,877 (4.7%) were Hispanic-white; 2,977 (0.1%) were Hispanic-black and 90,484 (6.1%) were Asian. The most common BC subtype was hormone receptor-positive (HR+)/HER2- (58%), followed by HR+/HER2+ (26%), HR-/HER2-negative (10%) and HR-/HER2+ (6.4%). 73% of cases were ductal; 15% lobular; the remaining histological subtypes included 0.9% epithelial-myoepithelial, 0.1% fibroepithelial, 0.4% metaplastic, < 0.1% mesenchymal, 1.6% rare breast carcinomas and 7% other carcinomas. The majority of patients received therapy at comprehensive community cancer programs (CPs) (45%), followed by academic/research CPs (30%), integrated network CPs (15%) and community CPs (9.5%). OS was best at academic (72% 10-year OS), followed by integrated network (69% 10-year OS), comprehensive community (68% 10-year OS) and community (63% 10-year OS) CPs. Significant differences in OS according to facility type remained when stratified by stage of disease (all p < 0.0001). OS was also significantly better for white (69% 10-year OS) versus black (63% 10-year OS) patients. Conclusions: This large database from the NCDB provides a comprehensive, recent overview of BC over the last 12 years. Facility type appears to be significantly associated with OS, such that academically designated centers have superior OS across all stages.

Breast cancer incidence and behavior in younger patients: A study from the surveillance, epidemiology, and end results (SEER) database.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13581-e13581
Author(s):  
Zuha Nasim ◽  
Christine Girtain ◽  
Ishan Patel ◽  
Varsha Gupta ◽  
Mohammad Hossain
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Breast Cancer Incidence ◽  
Categorical Variables ◽  
High Grade ◽  
Continuous Variables ◽  
Younger Women ◽  
Increased Risk ◽  
And Behavior ◽  
End Results

e13581 Background: Breast cancer screening for women less than 40 years old is practically nonexistent. Since screening can detect cancer at an early stage, not having a surveillance guideline for breast cancer in younger women can result in detection of the cancer at advanced stage. The purpose of this study was to investigate the incidence and behavior of breast cancer in younger women. Methods: The Surveillance Epidemiology, and End Results (SEER) registry data from 2004-2014 was accessed for the study. All women diagnosed with breast cancer and with complete information were included in the study. The data was further divided into two groups based on the age of the patient at the time of diagnosis. The younger group consisted of women < 40 years old (group 1) and the older group consisted of women ≥40 years old (group 2). Both groups were compared on demography and characteristics of the cancer. The continuous variables were tested using student t-tests and categorical variables were compared using Chi-squared or Fisher exact tests. Multivariate analysis was done to find the association of high-grade cancer using a logistic regression model. All p-values are two sided and values < 0.05 were considered statistically significant. Results: Of 599,782 patients who satisfied the inclusion criteria, 28, 243 (4.71%) diagnosed with breast cancer were younger women age < 40 years old. A higher proportion of these younger women presented with larger tumor sizes (between 5.1-10.0 cm), poorly differentiated cancer cells (55.88% vs. 32.85%, P < 0.001) and triple negative receptors (6.83% vs. 3.81%, P < 0.001) than older women respectively. Younger age was significantly associated with high-grade tumor at presentation when controlling for race and marital status. There was roughly 3% increased risk of a high-grade tumor with each decrease of 1 year (odds ratio 0.97, 95% confidence interval [CI] [0.96, 0.99], P = 0.001). Conclusions: This study found that the incidence of breast cancer in younger women was just below 5%, however, when the cancer was diagnosed, these group presented in advanced stages and more aggressive cancer types.

Who Controls the Message?

2019 ◽  
pp. 319-329
Author(s):  
Deanna J. Attai ◽  
Johanna Pas ◽  
Kwanele Asante-Shongwe ◽  
Liz O'Riordan ◽  
Carol Benn ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Survivors ◽  
Shared Decision Making ◽  
Breast Cancer Survivors ◽  
Patient Involvement ◽  
Care Pathway ◽  
Shared Decision ◽  
Newly Diagnosed ◽  
Patient Surveys

Abstract: The increasing numbers of breast cancer survivors from newly diagnosed to metastatic requires more personalised management by the medical breast cancer community. The increasing numbers of breast cancer survivors from newly diagnosed to metastatic requires more personalised management by the medical breast cancer community. Whereas oncology specialists provide useful information, patients may not hear it. An equal partnership between patients and their doctors is proposed. Patient involvement is more than patient surveys. Patients need appropriate information which they can understand and trust and is tailored to their specific needs at each step of the care pathway. Patients are facing difficulties navigating all the information and available options. Physicians need to understand that patients receive information from multiple sites. Many tools are available to help in shared decision-making.

Understanding barriers to receiving genetic testing after referral.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e13108-e13108
Author(s):  
Drew Murray ◽  
Mounika Mandadi
Keyword(s):  
Breast Cancer ◽  
Genetic Testing ◽  
Cancer Patients ◽  
Statistical Significance ◽  
Private Insurance ◽  
Categorical Variables ◽  
Insurance Status ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Nccn Guidelines

e13108 Background: About 5-10% of breast cancers are hereditary. Identifying women with hereditary breast and ovarian cancer syndromes helps implement screening strategies, chemoprevention regimens, preventative surgeries and identify family members at risk. Little is known about reasons for non-compliance with genetic testing after referral by an oncologist. To gain insight we investigated these barriers in a population of patients in Louisville, Kentucky. Methods: The study design was a IRB approved single institution retrospective analysis of all newly diagnosed breast cancer patients in the year 2014. Data on age, gender, race, education, insurance status, family history, referral orders and genetic testing results were analyzed for 204 patients. Characteristics of patients who received genetic testing after referral was made were compared to patients who did not receive genetic testing, despite referral. The categorical variables were compared using the Pearson Chi-square test for contingency tables while the t-test was used for continuous variables. Significance level was set at p≤0.05. All calculations are performed with SAS statistical software (SAS Institute Inc., Cary, NC). Results: Of 204 newly diagnosed breast cancer patients seen in 2014, 109 met NCCN guidelines for genetic testing. 89 total patients were referred for genetic testing. 67 patients received genetic testing after referral, while 22 patients did not receive the testing despite being referred. 29 patients met criteria for testing but were never referred. Statistical significance existed (P = 0.019) for the insurance status variable, those with private insurance being more likely to receive testing after being referred, and those without insurance being less likely to show up for genetic testing after being referred. There was no statistical significance for age(P = 0.787), race(P = 0.555), or education (P = 0.322). Conclusions: Being covered by private insurance was associated with increased completion of genetic testing after being referred by an oncologist. Age, race, and education did not impact the likelihood of receiving testing if referred. Further investigations will be made into reasons for non-referral in patients who met NCCN guidelines for testing.

Depressive factors associated with breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13091-e13091
Author(s):  
Alexandre Alberto Mendes Tostes ◽  
Carla Simone Moreira de Freitas ◽  
Aleida Nazareth Soares
Keyword(s):  
Breast Cancer ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Parametric Test ◽  
Cancer Hospital ◽  
Treatment Type ◽  
Health Council ◽  
Significant Difference ◽  
Group B

e13091 Background: In Brazil, the estimated cancer for the 2019 was approximately 420 thousand new cases. In Minas Gerais, the estimate was 5,360 new cases. Objective is to relate comorbid humor disorders with breast cancer in patients treated at a cancer hospital. Methods: Cross-sectional and descriptive study with a sample of 100 patients with Breast Cancer (BC), chosen at random. Data were collected at a Muriaé cancer hospital in, from January to June 2019. Semi-structured sociodemographic and clinical suervey and the Beck Depression Inventory (BDI-II) to check for signs and symptoms of depression. Data analysis was performed using the statistical packages SPSS. To check if there was a difference between groups in continuous variables, Shapiro-Wilk test; the data considered normal the Student's t test (parametric test) and the data considered non-normal the Mann Whitney test (non-parametric test). For categorical variables, the chi-square test, Fisher's exact test or Monte Carlo simulation. As for the interpretation of Beck's inventory, the scores were analyzed and demonstrated according to the standardized by the inventory, that is, the result obtained was the sum of the individual items, reaching a maximum score of 63 points. The classification of the levels of depression varies between minimum, mild, moderate and severe, thus indicating the intensity of the depression. The study was developed according to Resol. 466/12, of the National Health Council. Results: Average age of women with BC in both groups was 55 years, with low education (43%), married (48%), and, 50% of them have one or more children and, 70% do not work. Regarding the use of drugs and/or medication and smoking, it was higher in group B (with depression) (64.6%). In the other variables (family relationship, self-preservation of health, affected daily life, family/social isolation, living with other women with BC, perspective of life after treatment, type of follow-up), the proportion was always higher in group B compared to group A (without depression). The time of diagnosis, staging, type of surgery and edema in the upper limb did not show significant difference between the two groups analyzed. Regarding the type of treatment, there was a significant difference, mainly showing that proportionally the Surgery + Chemotherapy treatment is higher in the group without depression while the and Surgery + Chemotherapy + Radiotherapy + Hormone therapy are proportionally higher in the group with depression. Conclusions: Women with BC have depressive symptoms frequently and should be investigated and treated so that the negative impacts can be minimized.

Aromatase inhibitors and the risk of contralateral breast cancer in BRCA mutation carriers.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 3-3 ◽  
Author(s):  
Maryam Nemati Shafaee ◽  
Angelica M. Gutierrez-Barrera ◽  
Heather Y. Lin ◽  
Banu Arun
Keyword(s):  
Breast Cancer ◽  
Contralateral Breast Cancer ◽  
Multivariate Analyses ◽  
Brca Mutation ◽  
Contralateral Breast ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Estrogen Receptor Positive

3 Background: Contralateral breast cancer (CBC) risk in BRCA1 & 2 mutations is up to 64%. Patients (pts) with estrogen receptor positive (ER+) breast cancer (BC) are offered tamoxifen (TAM) or Aromase inhibitors (AI) adjuvantly. Reports suggest that TAM may reduce the risk of CBC in BRCA mutation; however there is no such data on the effect of AIs. Here, we evaluate the effect of TAM and AI as potential CBC risk reducers in a cohort of women with known BRCA status. Methods: 1043 BC pts receiving genetic counseling and BRCA testing were included. 13 had metastasis, 168 had a variant BRCA, and 50 had synchronous BC, and were excluded. Of the 812 remaining pts, 153 had a deleterious BRCA 1 or 2 mutations. Pts were followed from the diagnosis of BC until CBC, death, or last follow-up. The study had IRB approval. Univariate analyses were performed to test the significance of each variable in relation to BRCA status using chi-square tests for categorical variables and t tests for continuous variables. Results: The median age at diagnosis of BC was 42.3 years (range: 21-84). Median follow up was 8.6 years. 86% (700) had ER+ tumors, 80% were diagnosed with T1-2, and 81% had N0-N1. 76% (622) received TAM, and 37% (304) received AI. A total of 68 (8.7%) CBCs occurred of which 14% (21/153) occurred in BRCA carriers vs 7% (47/659) in BRCA non-carriers. Multivariate analyses indicated that BRCA status and AI use were significantly associated with CBC. Specifically, compared with BRCA negative, pts with BRCA1+ or BRCA2+ had larger hazard of developing CBC, Hazard Ratio (HR) (95% confidence interval (CI)) = 2.49 (1.21, 5.10), p = 0.013 for BRCA1+ vs Negative. HR (95%CI) = 1.97 (1.05, 3.73), p = 0.036 for BRCA2+ vs Negative. Compared to pts who did not receive AI, those who received AI had smaller hazard of developing CBC, HR (95%CI) = 0.42 (0.22, 0.81), p = 0.01. The interaction between AI and BRCA status was not significant (p = 0.4), hence all pts benefited from AI use in terms of CBC risk reduction. TAM use did not show significant effect on the risk of CBC in univariate and multivariate analyses (p > 0.13). Conclusions: This is the first report showing that AIs can reduce risk of CBC in women with BC who have a BRCA mutation. This finding should be validated in larger independent cohorts.

Improving risk assessment of obesity-associated breast cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1544-1544
Author(s):  
Neil M. Iyengar ◽  
Ayca Gucalp ◽  
Xi K. Zhou ◽  
Hanhan Wang ◽  
Dilip D. Giri ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Physical Activity ◽  
Body Fat ◽  
Menopausal Status ◽  
Postmenopausal Breast Cancer ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Exact Test ◽  
Increased Risk ◽  
Adipocyte Hypertrophy

1544 Background: Elevated body mass index (BMI) is associated with increased risk of estrogen receptor (ER)-positive postmenopausal breast cancer. The risk is also elevated in women with a normal BMI but excess body fat. These risks may be driven by breast white adipose tissue inflammation (WATi), which is associated with elevated aromatase levels and systemic metabolic dysfunction (e.g. hyperinsulinemia). We hypothesized that body fat assessment is superior to BMI for detecting the pathophysiology that promotes obesity-related breast cancer, particularly among normal BMI women. Methods: Non-tumorous breast tissue was collected from women undergoing mastectomy for breast cancer treatment or prevention. Breast WATi was detected by the presence of crown-like structures in the breast, which are composed of a dead/dying adipocyte surrounded by CD68+ macrophages. Body composition was measured prior to mastectomy via dual energy X-ray absorptiometry. Exercise behavior was also assessed prior to surgery using the Godin Leisure Time Exercise Questionnaire. Associations among categorical variables were examined using Χ2 or Fisher’s exact test. Relationships between continuous variables were examined using the Spearman correlation. Results: From April 5, 2016 to August 31, 2018, 100 patients were enrolled; median age 49 (range 29 to 82) years. Breast WATi was present in 56/100 (56%) women and was associated with elevated BMI and body fat levels, breast adipocyte hypertrophy, postmenopausal status, metabolic syndrome and decreased physical activity (P < 0.05). Among 39 women with normal BMI, breast WATi was present in 14 (36%) and was associated with elevated body fat levels, breast adipocyte hypertrophy, dyslipidemia, and decreased physical activity (P < 0.05). There was no statistically significant association between BMI and breast WATi in the normal BMI group. Menopausal status and total fat mass had greater sensitivity and specificity for the detection of breast WATi compared to a BMI-based model (AUC 0.843 vs. 0.779, respectively). Conclusions: Measurement of body fat is superior to BMI for predicting breast inflammation, which has been shown to promote obesity-related breast cancer.

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